Search

Acute pancreatitis is a protean disease capable of wide clinical variation, ranging from mild discomfort to apocalyptic prostration. Moreover, the inflammatory process may remain localized in the pancreas, spread to regional tissues, or even involve remote organ systems. This variability in presentation and clinical course has plagued the study and management of acute pancreatitis since its original clinical description. In the absence of accepted definitions for acute pancreatitis and its complications, it has not been possible to devise a clinical classification system useful for case management. Following 3 days of group meetings and open discussions, unanimous consensus on a series of definitions and a clinically based classification system for acute pancreatitis was achieved by a diverse group of 40 international authorities from six medical disciplines and 15 countries. The proposed classification system will be of value to practicing clinicians in the care of individual patients and to academicians seeking to compare interinstitutional data.

The incidence of anemia after total gastrectomy has not received sufficient clinical emphasis. During a follow-up period averaging 32 months, postresectional anemia developed in seven of ten patients without evidence of malignant neoplasm; all but one of these patients had received parenterally administered cyanocobalamin. Despite low levels of circulating erythrocytes and proportionately increased erythropoietin levels, reticulocytosis was not evident. This observation suggests an uncharacterized failure of marrow erythyroid precursors. Multiple deficits in intake of constituents necessary for the production of erythrocytes were demonstrated. With the possible exception of iron, malabsorption of these constituents is not an important factor in the production of anemia. Postresectional anemia is multicausal, but is primarily nutritional. As total gastrectomy becomes more commonly employed in the treatment of nonmalignant conditions, recognition of the frequency and causes of postresectional anemia should assist both diagnostic anticipation and therapy.

Knowing that hypoglycemia and inappropriate plasma insulin levels and insulin-glucose ratios can occur after gastric surgery may prevent unwarranted exploration for insulinoma in patients with alimentary tract hypoglycemia (ATH). Absolute differentiation may be achieved by comparing the insulin-glucose ratios obtained during a 72-hour fast with those obtained during an oral glucose tolerance test. The treatment of ATH is primarily medical, surgery being reserved for those patients in whom diet and drug therapy fails. For such medically intractable patients , reversal of a 10-cm segment of jejunum at the gastroenteric stoma is highly effective in controlling the symptoms of hypoglycemia.

Increasing attention is being focused on the relationship between gastrointestinal hormones and calcium metabolism. While it is apparent that some relationship does exist, the exact nature and significance is as yet undefined. Information regarding the effect of secretin on serum calcium has been both sparse and contradictory. Boot's secretin, 3 units/kg, was given to a group of 44 patients consisting of normal controls and patients with duodenal, gastric, and marginal ulcers; primary hyperparathyroidism; and pernicious anemia. Six serial serum specimens were obtained from each patient at ten-minute intervals for calcium determination by atomic absorption spectrophotometry. Using two-way analysis of variance, no significant changes in postsecretin serum calcium values were observed. It is unlikely that physiologic levels of secretin exert any effect on serum calcium.

Appendiceal abscess developed in 2% of 2,621 patients with acute appendicitis seen between 1962 and 1976. While representing a commendable decline in frequency from earlier studies, in view of the demonstrated prolonged delay in seeking medical care, further decreases in incidence could be affected by increased patient education. Sixty-one of 68 patients underwent surgical drainage of the abscess, with a 28% complication rate. Interval appendectomy was performed in 42 cases, with a 19% complication rate. Two patients (3%) died. These rates do no differ appreciably from those reported during the preantibiotic era. Recurrent appendicitis developed in only one of 13 patients not undergoing interval appendectomy during a follow-up period averaging five years. Interval appendectomy should be withheld only in those poor-risk patients in whom the 10% to 20% incidence of recurrent appendicitis seems the smaller risk.