Upper abdominal symptoms after side-to-side choledochoduodenostomy (CDDY) may be attributed to st... more Upper abdominal symptoms after side-to-side choledochoduodenostomy (CDDY) may be attributed to stagnant bik. food and calculi pooling in the distal bile duct 'sump' with resultant biliary or pancnatic duct obstruction and sepsis. Endoscopic sphinctemtomy (ES) provides a means of draining this sump. The aim of this study was to assess outcome following endoscopic retrograde choledochopancreatography (ERCP) and ES in patients with post-CDDY symptoms. Eight such patients (M: F = I :7) underwent ERCP between September 1981 and March 1987. Their median age was 60 years (range: 37-72 years) and the median periud since CDDY was I I years (range: 1-28 years). The median follow-up after ERCP was 18 months (range: 14-94 months). Presenting symptoms comprised postprandial (one) or intermittent (seven) abdominal pain. cholangitis (three), pancreatitis (one) and jaundice (one). ERCP revealed bik duct abnormalities in four. consisting of tilling defects alone (two). anastomic narrowing with filling defects (one) and sclerosing cholangitis. ES was performed in seven. of whom three (all with filling defects at ERCP) remain asymptomatic and three arc significantly improved. One had recurrent pancreatitis for which a sphincteroplasty and pancreatic duct septectomy was performed. ES was not performed in one because of technical difficulties (there being no subsequent improvement). It is concluded that, in patients with post-CDDY biliary symptoms. endoscopic sphinctemtomy relieves the symptoms by either producing drainage of the sump at the distal bile duct, or dividing a dysfunctioning sphincter of Mi. Key w e common Wt dwt* mdoscopy, extrahcpotk Mk duct obstrortion, pllstoms* F l r s t i U S , -rgwy.
The aim of this study was to define the P1 purinergic receptors that regulate spontaneous or aden... more The aim of this study was to define the P1 purinergic receptors that regulate spontaneous or adenosine-induced duodenal motor activity. 2 Spontaneous contractile activity was recorded isometrically from possum longitudinal duodenal muscle strips. Adenosine (0.5 mm-1 mm) was administered noncumulatively and repeated after pretreatment with a P1 antagonist or tetrodotoxin (TTX, 1 mm), (n ¼ 4-7). Antagonists used were: A 1 , 8-cyclopentyl-1,3-dipropylxanthine (DPCPX, 10 nm); A 2A , 8-(3-chlorostyryl)caffeine (CSC, 10 mm); A 2B , 3-isobutyl-8-pyrrolidinoxanthine (IPDX, 10 mm); A 3 , 9-chloro-2-(2-furanyl)-5-[(phenylacetyl) amino][1,2,4]-triazolo(1,5-c)quinazoline (MRS1220, 10 mm). Changes in activity are expressed as percentage of baseline. Statistical analysis utilised nonparametric tests. 3 Adenosine (n ¼ 34) induced a long-lasting, concentration-dependent decrease in activity by 55.673.2% area under curve (AUC), 47.374.0% contraction amplitude, 31.673.6% basal tension and 10.471.7% contraction frequency (all Po0.001). The adenosine-induced decrease in contraction amplitude was blocked by CSC (Po0.01) or inhibited by MRS1220 (Po0.03) pretreatment, but not modified by TTX, DPCPX or IPDX pretreatment. 4 Adenosine antagonists modified spontaneous contractile activity. Pretreatment with DPCPX or CSC increased basal tension, whereas IPDX or MRS1220 pretreatment decreased contractile activity. 5 In conclusion, exogenous adenosine reduced duodenal longitudinal motor activity via A 2A and A 3 receptors. Our findings suggest that endogenous purines may modulate spontaneous duodenal motor activity.
In 150 patients with undefined biliary pain after cholecystectomy, responses to morphine were com... more In 150 patients with undefined biliary pain after cholecystectomy, responses to morphine were compared with responses to morphine combined with neostigmine. The relationship between rises in plasma levels of aspartate aminotransferase (AST) after morphine or morphine-neostigmine and sphincter of Oddi motility as assessed by endoscopic manometry was also examined. When compared with morphine-neostigmine, patients given morphine alone showed a similar frequency (30% versus 33%) of increases in plasma levels of AST (greater than twice the upper limit of the reference range) but had less abdominal pain and a lower frequency of similar increases in plasma levels of amylase (4% versus 25%). Of 92 patients who consented to endoscopic manometry of the sphincter of Oddi, satisfactory manometric records were obtained in 84, 31 with and 53 without increases in AST after morphine or morphine-neostigmine. Those showing rises in AST had a higher frequency of abnormal manometric records (81% versus 57%, P = 0.025), higher basal pressures in the sphincter of Oddi (P = 0.0001) and higher pressures within ducts (P = 0.02). There was a significant correlation between sphincter basal pressures and intraduct pressures (r = 0.51, P less than 0.001). Rises in plasma AST after morphine are similar to those after morphine-neostigmine and are influenced by, or linked to, factors which determine sphincter basal pressures and intraduct pressures.
American Journal of Physiology-Gastrointestinal and Liver Physiology, 1988
The topography of human pyloric pressure is ill defined, and previous studies of pyloric motility... more The topography of human pyloric pressure is ill defined, and previous studies of pyloric motility in humans have given conflicting results. A detailed profile of pyloric pressure has been recorded in seven healthy volunteers using a manometric assembly with 13 side holes spaced at 3-mm intervals on reverse aspect of a 3.5-cm long sleeve sensor. After a fasting control period of 40 min, recordings were made for 40 min during intraduodenal infusion of a lipid emulsion. Two major patterns of pressure waves were seen during the fasting control period, namely pressure waves confined to a narrow pyloric zone (isolated pyloric pressure waves) and pressure waves that were less localized and involved the antrum and/or duodenum. During lipid infusion the motility pattern was dominated by isolated pyloric pressure waves and localized pyloric tone. Ninety-two percent of the isolated pyloric pressure waves recorded by the sleeve were recorded by only one or two side holes, consistent with a phas...
The neural distribution and action of gastrin-releasing peptide in the extrahepatic biliary tree ... more The neural distribution and action of gastrin-releasing peptide in the extrahepatic biliary tree of the Australian brush-tailed possum was investigated. Immunohistochemical staining of fixed specimens demonstrated gastrin-releasing peptide-containing nerves throughout the neural plexuses of the gallbladder, sphincter of Oddi, and mucosa of the common bile duct. Gastrin-releasing peptide (5-2000 ng/kg) increased gallbladder tone to a level equivalent to that produced by cholecystokinin octapeptide (160 ng/kg). This action was tetrodotoxin-insensitive. Sphincter of Oddi motility and transsphincteric flow were not altered. Possible mediation of the gallbladder response by gastrin was examined. Gastrin (50-2500 ng/kg) stimulated gastric acid secretion, elevated gallbladder motility to 64% of that produced by gastrin-releasing peptide, and did not alter sphincter of Oddi motility. In conclusion, gastrin-releasing peptide-containing nerves are found in the neural plexus of the possum extr...
A 45-minute infusion of an octapeptide of cholecystokinin (Kinevac; Squibb Diagnostics, New Bruns... more A 45-minute infusion of an octapeptide of cholecystokinin (Kinevac; Squibb Diagnostics, New Brunswick, NJ) was used to measure the gallbladder ejection fraction during cholescintigraphy in 40 normal volunteers. Cholecystokinin cholescintigraphy was shown to be a reproducible test. The maximum mean gallbladder ejection fraction occurred 15 minutes after cholecystokinin infusion and was 74.5% +/- 1.9% (mean +/- SEM). A gallbladder ejection fraction greater than 40% (mean -3SD) was arbitrarily defined to be normal. The gallbladder ejection fraction test was then used to identify patients with acalculous biliary symptoms who may respond to cholecystectomy. A total of 103 patients was tested; 21 had abnormal gallbladder ejection fractions and were randomized into two groups, cholecystectomy or no operation. These patients were followed up symptomatically at 3-month intervals for 13-54 months (mean, 34 months). Of the 11 patients who underwent cholecystectomy, 10 (91%) lost their symptoms...
Pancreatic exocrine insufficiency (PEI) occurs when the amounts of enzymes secreted into the duod... more Pancreatic exocrine insufficiency (PEI) occurs when the amounts of enzymes secreted into the duodenum in response to a meal are insufficient to maintain normal digestive processes. The main clinical consequence of PEI is fat maldigestion and malabsorption, resulting in steatorrhoea. Pancreatic exocrine function is commonly assessed by conducting a 3-day faecal fat test and by measuring levels of faecal elastase-1 and serum trypsinogen. Pancreatic enzyme replacement therapy is the mainstay of treatment for PEI. In adults, the initial recommended dose of pancreatic enzymes is 25,000 units of lipase per meal, titrating up to a maximum of 80,000 units of lipase per meal. In infants and children, the initial recommended dose of pancreatic enzymes is 500 units of lipase per gram of dietary fat; the maximum daily dose should not exceed 10,000 units of lipase per kilogram of bodyweight. Oral pancreatic enzymes should be taken with meals to ensure adequate mixing with the chyme. Adjunct ther...
Canadian journal of gastroenterology = Journal canadien de gastroenterologie, 2000
The sphincter of Oddi (SO) is situated at the junction of the bile and pancreatic ducts where the... more The sphincter of Oddi (SO) is situated at the junction of the bile and pancreatic ducts where they enter the duodenum, and it serves to regulate the flow of bile and pancreatic juices as well as to prevent the reflux of duodenal contents into the pancreatobiliary system. SO dysfunction relates to either the biliary or pancreatic portions of the sphincter. Distinct clinical syndromes relating to either sphincter segment are recognized. The mechanism of dysfunction remains uncertain, but disruption of neural pathways involved in sphincter function seems likely. SO dysfunction is best diagnosed by manometry, which is able to correctly stratify patient groups and determine therapy. Biliary scintigraphy, which is noninvasive, has shown promise as a screening tool for patients with suspected SO dysfunction. Division of the sphincter is an effective treatment for patients with manometrically proven SO stenosis for either the biliary or pancreatic form of the disorder. Other forms of SO dys...
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1998
high, and proper management continues to be a challenge. Appropriate systemic antibiotics and fun... more high, and proper management continues to be a challenge. Appropriate systemic antibiotics and fungal agents as well as adequate surgical, percutaneous, or biliary drainage are required for the best results. Objective: The authors document changes in the etiology, diagnosis, bacteriology, treatment, and outcome of patients with pyogenic hepatic abscesses over the past 4 decades.
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1997
Long term complications of laparoscopic cholecystectomy are uncommon. However, as experience with... more Long term complications of laparoscopic cholecystectomy are uncommon. However, as experience with this procedure accumulates, sporadic reports of non-biliary complication have been published. We report a case of abdominal wall sinus formation secondary to gallbladder perforation and stone spillage occurring during laparoscopic cholecystectomy.
Journal of the autonomic nervous system, Jan 19, 1997
The aims of this study were to determine if neural pathways between the duodenum and sphincter of... more The aims of this study were to determine if neural pathways between the duodenum and sphincter of Oddi are intramural, activated by duodenal electrical field stimulation (EFS) in vitro, and contain capsaicin-sensitive primary afferents. The possible involvement of cholinergic (muscarinic and/or nicotinic) and adrenergic receptors in these pathways were also investigated. Duodenal EFS (5-60 Hz, 70 V, 0.5 ms duration, 10 s train) at sites 2 cm oral and 2 cm anal to the sphincter of Oddi-duodenal junction produced frequency-dependent excitatory responses in the sphincter of Oddi, measured by manometry (n = 3). Excitatory responses from duodenal circular muscle were also evident. Tetrodotoxin (1 microM; n = 7) pretreatment abolished both sphincter of Oddi and duodenal responses to duodenal EFS. Crushing the duodenum between the site of stimulation and the sphincter of Oddi-duodenal junction also abolished sphincter of Oddi response. The sphincter of Oddi responses to duodenal EFS at the...
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1993
The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Tricho... more The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Trichosurus vulpecula, was examined. The gross morphology of the gallbladder, hepatic and cystic ducts, and the course of the common bile duct, conforms to those of other species. The sphincter of Oddi has an extraduodenal segment that extends 15mm from the duodenal wall; within this segment the pancreatic and common bile ducts are ensheathed together by sphincter muscle. Their lumens unite to form a common channel within the terminal intraduodenal segment. Nerve cell bodies of the gallbladder were found in an inter-connecting network of ganglia that were located in the serosa, muscularis and mucosa. Nerve fibres innervated the muscle, arterioles and the mucosa. Few ganglia were found along the supra sphincteric portion of the common bile duct. Nerve trunks followed the duct and a dense nerve fibre plexus was found in the mucosa. In the sphincter most ganglia were located in two plexuses, the ...
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1994
Duodenal malformations are the third commonest cause of intestinal obstruction in infants. A spec... more Duodenal malformations are the third commonest cause of intestinal obstruction in infants. A spectrum of intrinsic obstructive lesions within the duodenum ranges from atresia to congenital bands. Rarely, duodenal malformations may first present in adulthood. Less than 70 cases of duodenal web presenting in an adult have been reported in the literature. In 10 patients the presentation was associated with pancreatitis. We report a case of congenital duodenal web associated with pancreas divisum which first presented in an adult with the clinical characteristics of recurrent acute pancreatitis.
Nitric oxide has been shown to play an important role in neurally mediated relaxations of gastroi... more Nitric oxide has been shown to play an important role in neurally mediated relaxations of gastrointestinal smooth muscle. The aim of this study was to determine whether NO may be the inhibitory transmitter to circular smooth muscle from the sphincter of Oddi of the Australian brush-tailed possum (Trichosurus vulpecula). The effects of drugs on relaxations evoked by electrical-field stimulation of circular muscle strips precontracted with either erythromycin or carbachol were studied. Preparations were also processed histochemically to determine the presence of nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase reactivity in the tissue. NG-nitro-L-arginine methyl ester reduced the amplitude of relaxations; this effect could be partially reversed by millimolar concentrations of L-arginine but not by D-arginine. Oxyhemoglobin also reduced the amplitude of the relaxations, and sodium nitroprusside mimicked the relaxations in precontracted strips. Histochemical processing rev...
In this study, we evaluated the effect of histamine on phasic contractile activity in the opossum... more In this study, we evaluated the effect of histamine on phasic contractile activity in the opossum sphincter of Oddi (SO). SO manometry was done in 35 animals, using an infused catheter system with minimal compliance. In anesthetized animals, phasic SO contractions occurred at a frequency of 7.3 +/- 0.3 (SE) contractions/min with an amplitude of 83 +/- 4 mmHg. Intravenous histamine (5-80 micrograms/kg) invariably inhibited the frequency and amplitude of SO phasic contractions. At larger doses, the SO contractions were abolished for several minutes. The SO inhibitory effect of histamine was duplicated by the selective H1-agonist, 2-pyridylethylamine, and abolished by H1-blockade with pyrilamine or neural blockade with tetrodotoxin. After tetrodotoxin, histamine and 2-pyridylethylamine caused an increased frequency and amplitude of SO contractions. This excitatory effect was blocked by pyrilamine. The histamine effects on SO phasic contractions were not altered by metiamide, atropine, ...
Upper abdominal symptoms after side-to-side choledochoduodenostomy (CDDY) may be attributed to st... more Upper abdominal symptoms after side-to-side choledochoduodenostomy (CDDY) may be attributed to stagnant bik. food and calculi pooling in the distal bile duct 'sump' with resultant biliary or pancnatic duct obstruction and sepsis. Endoscopic sphinctemtomy (ES) provides a means of draining this sump. The aim of this study was to assess outcome following endoscopic retrograde choledochopancreatography (ERCP) and ES in patients with post-CDDY symptoms. Eight such patients (M: F = I :7) underwent ERCP between September 1981 and March 1987. Their median age was 60 years (range: 37-72 years) and the median periud since CDDY was I I years (range: 1-28 years). The median follow-up after ERCP was 18 months (range: 14-94 months). Presenting symptoms comprised postprandial (one) or intermittent (seven) abdominal pain. cholangitis (three), pancreatitis (one) and jaundice (one). ERCP revealed bik duct abnormalities in four. consisting of tilling defects alone (two). anastomic narrowing with filling defects (one) and sclerosing cholangitis. ES was performed in seven. of whom three (all with filling defects at ERCP) remain asymptomatic and three arc significantly improved. One had recurrent pancreatitis for which a sphincteroplasty and pancreatic duct septectomy was performed. ES was not performed in one because of technical difficulties (there being no subsequent improvement). It is concluded that, in patients with post-CDDY biliary symptoms. endoscopic sphinctemtomy relieves the symptoms by either producing drainage of the sump at the distal bile duct, or dividing a dysfunctioning sphincter of Mi. Key w e common Wt dwt* mdoscopy, extrahcpotk Mk duct obstrortion, pllstoms* F l r s t i U S , -rgwy.
The aim of this study was to define the P1 purinergic receptors that regulate spontaneous or aden... more The aim of this study was to define the P1 purinergic receptors that regulate spontaneous or adenosine-induced duodenal motor activity. 2 Spontaneous contractile activity was recorded isometrically from possum longitudinal duodenal muscle strips. Adenosine (0.5 mm-1 mm) was administered noncumulatively and repeated after pretreatment with a P1 antagonist or tetrodotoxin (TTX, 1 mm), (n ¼ 4-7). Antagonists used were: A 1 , 8-cyclopentyl-1,3-dipropylxanthine (DPCPX, 10 nm); A 2A , 8-(3-chlorostyryl)caffeine (CSC, 10 mm); A 2B , 3-isobutyl-8-pyrrolidinoxanthine (IPDX, 10 mm); A 3 , 9-chloro-2-(2-furanyl)-5-[(phenylacetyl) amino][1,2,4]-triazolo(1,5-c)quinazoline (MRS1220, 10 mm). Changes in activity are expressed as percentage of baseline. Statistical analysis utilised nonparametric tests. 3 Adenosine (n ¼ 34) induced a long-lasting, concentration-dependent decrease in activity by 55.673.2% area under curve (AUC), 47.374.0% contraction amplitude, 31.673.6% basal tension and 10.471.7% contraction frequency (all Po0.001). The adenosine-induced decrease in contraction amplitude was blocked by CSC (Po0.01) or inhibited by MRS1220 (Po0.03) pretreatment, but not modified by TTX, DPCPX or IPDX pretreatment. 4 Adenosine antagonists modified spontaneous contractile activity. Pretreatment with DPCPX or CSC increased basal tension, whereas IPDX or MRS1220 pretreatment decreased contractile activity. 5 In conclusion, exogenous adenosine reduced duodenal longitudinal motor activity via A 2A and A 3 receptors. Our findings suggest that endogenous purines may modulate spontaneous duodenal motor activity.
In 150 patients with undefined biliary pain after cholecystectomy, responses to morphine were com... more In 150 patients with undefined biliary pain after cholecystectomy, responses to morphine were compared with responses to morphine combined with neostigmine. The relationship between rises in plasma levels of aspartate aminotransferase (AST) after morphine or morphine-neostigmine and sphincter of Oddi motility as assessed by endoscopic manometry was also examined. When compared with morphine-neostigmine, patients given morphine alone showed a similar frequency (30% versus 33%) of increases in plasma levels of AST (greater than twice the upper limit of the reference range) but had less abdominal pain and a lower frequency of similar increases in plasma levels of amylase (4% versus 25%). Of 92 patients who consented to endoscopic manometry of the sphincter of Oddi, satisfactory manometric records were obtained in 84, 31 with and 53 without increases in AST after morphine or morphine-neostigmine. Those showing rises in AST had a higher frequency of abnormal manometric records (81% versus 57%, P = 0.025), higher basal pressures in the sphincter of Oddi (P = 0.0001) and higher pressures within ducts (P = 0.02). There was a significant correlation between sphincter basal pressures and intraduct pressures (r = 0.51, P less than 0.001). Rises in plasma AST after morphine are similar to those after morphine-neostigmine and are influenced by, or linked to, factors which determine sphincter basal pressures and intraduct pressures.
American Journal of Physiology-Gastrointestinal and Liver Physiology, 1988
The topography of human pyloric pressure is ill defined, and previous studies of pyloric motility... more The topography of human pyloric pressure is ill defined, and previous studies of pyloric motility in humans have given conflicting results. A detailed profile of pyloric pressure has been recorded in seven healthy volunteers using a manometric assembly with 13 side holes spaced at 3-mm intervals on reverse aspect of a 3.5-cm long sleeve sensor. After a fasting control period of 40 min, recordings were made for 40 min during intraduodenal infusion of a lipid emulsion. Two major patterns of pressure waves were seen during the fasting control period, namely pressure waves confined to a narrow pyloric zone (isolated pyloric pressure waves) and pressure waves that were less localized and involved the antrum and/or duodenum. During lipid infusion the motility pattern was dominated by isolated pyloric pressure waves and localized pyloric tone. Ninety-two percent of the isolated pyloric pressure waves recorded by the sleeve were recorded by only one or two side holes, consistent with a phas...
The neural distribution and action of gastrin-releasing peptide in the extrahepatic biliary tree ... more The neural distribution and action of gastrin-releasing peptide in the extrahepatic biliary tree of the Australian brush-tailed possum was investigated. Immunohistochemical staining of fixed specimens demonstrated gastrin-releasing peptide-containing nerves throughout the neural plexuses of the gallbladder, sphincter of Oddi, and mucosa of the common bile duct. Gastrin-releasing peptide (5-2000 ng/kg) increased gallbladder tone to a level equivalent to that produced by cholecystokinin octapeptide (160 ng/kg). This action was tetrodotoxin-insensitive. Sphincter of Oddi motility and transsphincteric flow were not altered. Possible mediation of the gallbladder response by gastrin was examined. Gastrin (50-2500 ng/kg) stimulated gastric acid secretion, elevated gallbladder motility to 64% of that produced by gastrin-releasing peptide, and did not alter sphincter of Oddi motility. In conclusion, gastrin-releasing peptide-containing nerves are found in the neural plexus of the possum extr...
A 45-minute infusion of an octapeptide of cholecystokinin (Kinevac; Squibb Diagnostics, New Bruns... more A 45-minute infusion of an octapeptide of cholecystokinin (Kinevac; Squibb Diagnostics, New Brunswick, NJ) was used to measure the gallbladder ejection fraction during cholescintigraphy in 40 normal volunteers. Cholecystokinin cholescintigraphy was shown to be a reproducible test. The maximum mean gallbladder ejection fraction occurred 15 minutes after cholecystokinin infusion and was 74.5% +/- 1.9% (mean +/- SEM). A gallbladder ejection fraction greater than 40% (mean -3SD) was arbitrarily defined to be normal. The gallbladder ejection fraction test was then used to identify patients with acalculous biliary symptoms who may respond to cholecystectomy. A total of 103 patients was tested; 21 had abnormal gallbladder ejection fractions and were randomized into two groups, cholecystectomy or no operation. These patients were followed up symptomatically at 3-month intervals for 13-54 months (mean, 34 months). Of the 11 patients who underwent cholecystectomy, 10 (91%) lost their symptoms...
Pancreatic exocrine insufficiency (PEI) occurs when the amounts of enzymes secreted into the duod... more Pancreatic exocrine insufficiency (PEI) occurs when the amounts of enzymes secreted into the duodenum in response to a meal are insufficient to maintain normal digestive processes. The main clinical consequence of PEI is fat maldigestion and malabsorption, resulting in steatorrhoea. Pancreatic exocrine function is commonly assessed by conducting a 3-day faecal fat test and by measuring levels of faecal elastase-1 and serum trypsinogen. Pancreatic enzyme replacement therapy is the mainstay of treatment for PEI. In adults, the initial recommended dose of pancreatic enzymes is 25,000 units of lipase per meal, titrating up to a maximum of 80,000 units of lipase per meal. In infants and children, the initial recommended dose of pancreatic enzymes is 500 units of lipase per gram of dietary fat; the maximum daily dose should not exceed 10,000 units of lipase per kilogram of bodyweight. Oral pancreatic enzymes should be taken with meals to ensure adequate mixing with the chyme. Adjunct ther...
Canadian journal of gastroenterology = Journal canadien de gastroenterologie, 2000
The sphincter of Oddi (SO) is situated at the junction of the bile and pancreatic ducts where the... more The sphincter of Oddi (SO) is situated at the junction of the bile and pancreatic ducts where they enter the duodenum, and it serves to regulate the flow of bile and pancreatic juices as well as to prevent the reflux of duodenal contents into the pancreatobiliary system. SO dysfunction relates to either the biliary or pancreatic portions of the sphincter. Distinct clinical syndromes relating to either sphincter segment are recognized. The mechanism of dysfunction remains uncertain, but disruption of neural pathways involved in sphincter function seems likely. SO dysfunction is best diagnosed by manometry, which is able to correctly stratify patient groups and determine therapy. Biliary scintigraphy, which is noninvasive, has shown promise as a screening tool for patients with suspected SO dysfunction. Division of the sphincter is an effective treatment for patients with manometrically proven SO stenosis for either the biliary or pancreatic form of the disorder. Other forms of SO dys...
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1998
high, and proper management continues to be a challenge. Appropriate systemic antibiotics and fun... more high, and proper management continues to be a challenge. Appropriate systemic antibiotics and fungal agents as well as adequate surgical, percutaneous, or biliary drainage are required for the best results. Objective: The authors document changes in the etiology, diagnosis, bacteriology, treatment, and outcome of patients with pyogenic hepatic abscesses over the past 4 decades.
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1997
Long term complications of laparoscopic cholecystectomy are uncommon. However, as experience with... more Long term complications of laparoscopic cholecystectomy are uncommon. However, as experience with this procedure accumulates, sporadic reports of non-biliary complication have been published. We report a case of abdominal wall sinus formation secondary to gallbladder perforation and stone spillage occurring during laparoscopic cholecystectomy.
Journal of the autonomic nervous system, Jan 19, 1997
The aims of this study were to determine if neural pathways between the duodenum and sphincter of... more The aims of this study were to determine if neural pathways between the duodenum and sphincter of Oddi are intramural, activated by duodenal electrical field stimulation (EFS) in vitro, and contain capsaicin-sensitive primary afferents. The possible involvement of cholinergic (muscarinic and/or nicotinic) and adrenergic receptors in these pathways were also investigated. Duodenal EFS (5-60 Hz, 70 V, 0.5 ms duration, 10 s train) at sites 2 cm oral and 2 cm anal to the sphincter of Oddi-duodenal junction produced frequency-dependent excitatory responses in the sphincter of Oddi, measured by manometry (n = 3). Excitatory responses from duodenal circular muscle were also evident. Tetrodotoxin (1 microM; n = 7) pretreatment abolished both sphincter of Oddi and duodenal responses to duodenal EFS. Crushing the duodenum between the site of stimulation and the sphincter of Oddi-duodenal junction also abolished sphincter of Oddi response. The sphincter of Oddi responses to duodenal EFS at the...
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1993
The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Tricho... more The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Trichosurus vulpecula, was examined. The gross morphology of the gallbladder, hepatic and cystic ducts, and the course of the common bile duct, conforms to those of other species. The sphincter of Oddi has an extraduodenal segment that extends 15mm from the duodenal wall; within this segment the pancreatic and common bile ducts are ensheathed together by sphincter muscle. Their lumens unite to form a common channel within the terminal intraduodenal segment. Nerve cell bodies of the gallbladder were found in an inter-connecting network of ganglia that were located in the serosa, muscularis and mucosa. Nerve fibres innervated the muscle, arterioles and the mucosa. Few ganglia were found along the supra sphincteric portion of the common bile duct. Nerve trunks followed the duct and a dense nerve fibre plexus was found in the mucosa. In the sphincter most ganglia were located in two plexuses, the ...
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1994
Duodenal malformations are the third commonest cause of intestinal obstruction in infants. A spec... more Duodenal malformations are the third commonest cause of intestinal obstruction in infants. A spectrum of intrinsic obstructive lesions within the duodenum ranges from atresia to congenital bands. Rarely, duodenal malformations may first present in adulthood. Less than 70 cases of duodenal web presenting in an adult have been reported in the literature. In 10 patients the presentation was associated with pancreatitis. We report a case of congenital duodenal web associated with pancreas divisum which first presented in an adult with the clinical characteristics of recurrent acute pancreatitis.
Nitric oxide has been shown to play an important role in neurally mediated relaxations of gastroi... more Nitric oxide has been shown to play an important role in neurally mediated relaxations of gastrointestinal smooth muscle. The aim of this study was to determine whether NO may be the inhibitory transmitter to circular smooth muscle from the sphincter of Oddi of the Australian brush-tailed possum (Trichosurus vulpecula). The effects of drugs on relaxations evoked by electrical-field stimulation of circular muscle strips precontracted with either erythromycin or carbachol were studied. Preparations were also processed histochemically to determine the presence of nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase reactivity in the tissue. NG-nitro-L-arginine methyl ester reduced the amplitude of relaxations; this effect could be partially reversed by millimolar concentrations of L-arginine but not by D-arginine. Oxyhemoglobin also reduced the amplitude of the relaxations, and sodium nitroprusside mimicked the relaxations in precontracted strips. Histochemical processing rev...
In this study, we evaluated the effect of histamine on phasic contractile activity in the opossum... more In this study, we evaluated the effect of histamine on phasic contractile activity in the opossum sphincter of Oddi (SO). SO manometry was done in 35 animals, using an infused catheter system with minimal compliance. In anesthetized animals, phasic SO contractions occurred at a frequency of 7.3 +/- 0.3 (SE) contractions/min with an amplitude of 83 +/- 4 mmHg. Intravenous histamine (5-80 micrograms/kg) invariably inhibited the frequency and amplitude of SO phasic contractions. At larger doses, the SO contractions were abolished for several minutes. The SO inhibitory effect of histamine was duplicated by the selective H1-agonist, 2-pyridylethylamine, and abolished by H1-blockade with pyrilamine or neural blockade with tetrodotoxin. After tetrodotoxin, histamine and 2-pyridylethylamine caused an increased frequency and amplitude of SO contractions. This excitatory effect was blocked by pyrilamine. The histamine effects on SO phasic contractions were not altered by metiamide, atropine, ...
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