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1.  Evaluation of a novel endoluminal brush method for in situ diagnosis of catheter related sepsis. 
Journal of Clinical Pathology  1997;50(4):278-282.
AIMS: To determine the accuracy of a novel endoluminal brush method for the diagnosis of catheter related sepsis (CRS), which is performed in situ and hence does not require line sacrifice. METHODS: 230 central venous catheters in 216 patients were examined prospectively for evidence of CRS or colonisation using an endoluminal brush method in conjunction with peripheral blood cultures. The results were compared with those obtained using methods that require line sacrifice: extraluminal sampling (Maki roll) or endoluminal sampling (modified Cleri flush) of microorganisms. RESULTS: Only 16% of 128 patients suspected clinically of having line associated infection were confirmed as having CRS. In addition, 2 of 102 patients not suspected of having line associated infection had CRS. Line colonisation was apparent in approximately twice as many catheters using the Maki roll criteria (92%) compared with either the endoluminal brush (43%) or Cleri flush (43%). Furthermore, colonised catheters sampled using the Maki roll technique yielded mixed growth twice as often as when examined by endoluminal methods (17 and 8 cases, respectively). It was rare to detect either only endoluminal (4 of 22 episodes) or extraluminal (1 of 22 episodes) microorganisms in cases of CRS. In contrast, catheters defined as being colonised most frequently (59% of episodes) yielded only significant extraluminal growth. Only one case of CRS (5%) would have been "missed" if lines yielding a negative result from endoluminal brush sampling had been left in situ. Conversely, four episodes of CRS (18%) would not have been diagnosed by relying on extraluminal sampling alone. CONCLUSIONS: Diagnosis of CRS by the endoluminal brush method can be achieved without line sacrifice and is more sensitive (95%) and specific (84%) than extraluminal sampling of the catheter tip by the Maki roll technique (82% and 66%, respectively).
PMCID: PMC499875  PMID: 9215141
2.  Highly selective vagotomy plus dilatation of the stenosis compared with truncal vagotomy and drainage in the treatment of pyloric stenosis secondary to duodenal ulceration. 
Gut  1976;17(6):471-476.
Twenty-three consecutive patients with duodenal ulceration complicated by pyloric stenosis who came under the care of one surgeon were treated by highly selective vagotomy (HSV) combined with digital dilatation of the stenosis through a gastrotomy. No form of drainage procedure was used. Thus the antral "mill" and the pyloric sphineter were left intact. Since the stenosis is usually distal to the pylorus rather than truly pyloric such dilatation does not damage the pyloric ring, although it may on occasion lead to perforation of the first part of the duodenum. The subsequent progress of these patients was compared with that of a similar, consecutive series of 23 patients with pyloric stenosis who were treated by truncal vagotomy with a drainage procedure by other surgeons on the same surgical unit. Patients were followed up for between four months and five years. The clinical assessment was carried out in "blind" fashion at a special gastric follow-up clinic. No evidence of recurrent ulceration was found in either group of patients. Two patients from each group subsequently came to reoperation for the relief of gastric stasis. Twenty-two of the 23 patients (96%) who had undergone HSV plus dilatation eventually achieved a good-to-excellent clinical result (Visick grades 1+2), wheras only 17 of the 23 patients (74%) who had undergone truncal vagotomy with drainage achieved such a result. The main clinical difference between the two groups was that side effects such as diarrhoea and abdominal pain or discomfort were more common after vagotomy with drainage than after HSV. These results bear witness to the remarkable propulsive powers of the gastric antrum after HSV, which were evidently sufficient to overcome any tendency to re-stenosis in more than 90% of patients. The 9% incidence of failure due to re-stenosis could perhaps be avoided if a small duodenoplasty were performed instead of simple digital dilatation. The results support the hypothesis that damage to the antral mill and pyloric sphincter can be avoided in the course of operations for "pyloric" stenosis secondary to duodenal ulceration. Avoidance of the drainage procedure is of benefit to the patient, just as it is in patients who have duodenal ulceration without stenosis.
PMCID: PMC1411117  PMID: 955505
3.  Cardiac tamponade and central venous catheters. 
British Medical Journal  1975;2(5971):595-597.
An analysis of the reports on 16 patients who developed cardiac tamponade, complicating the use of central venous catheters, showed that 14 died. The two survivors were treated by removal of the catheter and needle aspiration of the pericardial fluid. Some patients complained of warning symptoms such as nausea, pain, and dyspnoea, and the combination of tachycardia, hypotension, and raised venous pressure was common. We suggest that awareness of the hazard, radiographic visualization of the catheter tip, and expeditious treatment would reduce the mortality.
PMCID: PMC1673526  PMID: 1131628
5.  Factors Affecting Perceptual Threshold in Argus II Retinal Prosthesis Subjects 
Purpose
The Argus II epiretinal prosthesis has been developed to provide partial restoration of vision to subjects blinded from outer retinal degenerative disease. Participants were surgically implanted with the system in the United States and Europe in a single arm, prospective, multicenter clinical trial. The purpose of this investigation was to determine which factors affect electrical thresholds in order to inform surgical placement of the device.
Methods
Electrode–retina and electrode–fovea distances were determined using SD-OCT and fundus photography, respectively. Perceptual threshold to electrical stimulation of electrodes was measured using custom developed software, in which current amplitude was varied until the threshold was found. Full field stimulus light threshold was measured using the Espion D-FST test. Relationships between electrical threshold and these three explanatory variables (electrode–retina distance, electrode–fovea distance, and monocular light threshold) were quantified using regression.
Results
Regression analysis showed a significant correlation between electrical threshold and electrode–retina distance (R2 = 0.50, P = 0.0002; n = 703 electrodes). 90.3% of electrodes in contact with the macula (n = 207) elicited percepts at charge densities less than 1 mC/cm2/phase. These threshold data also correlated well with ganglion cell density profile (P = 0.03). A weaker, but still significant, inverse correlation was found between light threshold and electrical threshold (R2 < 0.52, P = 0.01). Multivariate modeling indicated that electrode–retina distance and light threshold are highly predictive of electrode threshold (R2 = 0.87; P < 0.0005).
Conclusions
Taken together, these results suggest that while light threshold should be used to inform patient selection, macular contact of the array is paramount.
Translational Relevance
Reported Argus II clinical study results are in good agreement with prior in vitro and in vivo studies, and support the development of higher-density systems that employ smaller diameter electrodes. (clinicaltrials.gov identifier: NCT00407602)
doi:10.1167/tvst.2.4.1
PMCID: PMC3763895  PMID: 24049718
retinal prosthesis; retinal degeneration; retinitis pigmentosa
6.  Blind subjects implanted with the Argus II retinal prosthesis are able to improve performance in a spatial-motor task 
Background/aims
To determine to what extent subjects implanted with the Argus II retinal prosthesis can improve performance compared with residual native vision in a spatial-motor task.
Methods
High-contrast square stimuli (5.85 cm sides) were displayed in random locations on a 19″ (48.3 cm) touch screen monitor located 12″ (30.5 cm) in front of the subject. Subjects were instructed to locate and touch the square centre with the system on and then off (40 trials each). The coordinates of the square centre and location touched were recorded.
Results
Ninety-six percent (26/27) of subjects showed a significant improvement in accuracy and 93% (25/27) show a significant improvement in repeatability with the system on compared with off (p<0.05, Student t test). A group of five subjects that had both accuracy and repeatability values <250 pixels (7.4 cm) with the system off (ie, using only their residual vision) was significantly more accurate and repeatable than the remainder of the cohort (p<0.01). Of this group, four subjects showed a significant improvement in both accuracy and repeatability with the system on.
Conclusion
In a study on the largest cohort of visual prosthesis recipients to date, we found that artificial vision augments information from existing vision in a spatial-motor task.
Clinical trials registry no
NCT00407602.
doi:10.1136/bjo.2010.179622
PMCID: PMC3345188  PMID: 20881025
7.  An unusual cystic lesion of liver 
Gut  2006;55(5):742.
doi:10.1136/gut.2005.066498
PMCID: PMC1856144  PMID: 16609137
cystic lesion; liver
10.  Bronchiectasis and rheumatoid arthritis: a clinical study. 
Annals of the Rheumatic Diseases  1993;52(11):776-779.
OBJECTIVES--To examine the relation between rheumatoid arthritis (RA) and bronchiectasis (BR). METHODS--Disease activity, outcome, extra-articular manifestations, and laboratory features were compared in 32 patients with BR and RA (RA-BR group), 32 matched patients with RA without BR (RA group), and 31 patients with BR but without arthritis (BR group). RESULTS--In 30 of the 32 (94%) patients with RA-BR, BR preceded RA. There was no functional or radiological difference between the RA-BR and RA groups, and except for xerophthalmia, which was more common in patients with RA-BR than patients with RA, there was no difference in extra-articular or laboratory features. CONCLUSIONS--Bronchiectasis does not lead to a more aggressive disease course in RA and, despite the recognised association, BR is not an extra-articular manifestation of rheumatoid disease.
PMCID: PMC1005187  PMID: 8250608
11.  Prevention of catheter related bloodstream infection by silver iontophoretic central venous catheters: a randomised controlled trial 
Journal of Clinical Pathology  2003;56(10):731-735.
Aim: To evaluate the efficacy of silver iontophoretic central venous catheters in preventing catheter related colonisation and bloodstream infection among high risk patients in a tertiary hospital.
Methods: Patients requiring central venous access for a period greater than seven days were stratified into two groups according to systemic inflammatory response syndrome criteria before being randomly assigned to receive either silver iontophoretic or control catheters. The incidence of catheter colonisation and catheter related bloodstream infection (CRBSI) was recorded.
Results: Three hundred and four single lumen study catheters were inserted into 268 patients. Total duration of catheterisation was 5449 days (median, 12 days/catheter). Complete data could be evaluated in 270 catheters: 128 silver iontophoretic catheters and 140 untreated catheters. Forty seven silver iontophoretic catheters (36.7%) were colonised compared with 48 control catheters (33.8%). Seven cases (5.5%) of CRBSI occurred in patients who received silver iontophoretic catheters, compared with 11 cases (7.7%) in patients receiving control catheters. There was no significant difference in the incidence of catheter colonisation or CRBSI between silver iontophoretic and control catheters. When the duration of catheter placement was taken into consideration, Kaplan-Meier analysis showed no significant difference in the risk of CRBSI between the silver iontophoretic catheters and the untreated catheters (p = 0.77).
Conclusion: There was no significant difference in the incidence of catheter colonisation or CRBSI among high risk patients between silver iontophoretic catheters and control catheters. Future prospective, randomised studies with a larger number of catheters are encouraged to confirm or refute these results.
PMCID: PMC1770068  PMID: 14514774
antiseptics; catheter related bloodstream infection; central venous catheter; iontophoresis; silver ions
12.  Influence of fine-bore catheter length on infusion thrombophlebitis in peripheral intravenous nutrition: a randomised controlled trial. 
Previous studies indicated that the risk of thrombophlebitis associated with continuous infusion of intravenous nutrition (IVN) via peripheral veins was reduced when fine-bore catheters, inserted to 15 cm, were used in place of standard intravenous cannulas. An explanation has not been identified, but may be owing to the greater length of the catheters. A randomised controlled study was performed in which a standard nutritional solution was infused via 22G polyurethane catheters inserted to a length of either 5 cm or 15 cm. Catheters were reviewed twice each day and removed when complications occurred, or when IVN was no longer required. There was no significant difference in median time to thrombophlebitis or extravasation, or in daily risk of thrombophlebitis, between insertion lengths. Survival proportions were similar for each length at all times. Catheters inserted into cephalic veins were more prone to thrombophlebitis or extravasation (nine episodes, 14 catheters) than catheters inserted into basilic veins (five episodes, 24 catheters, P = 0.009). The survival proportion was at all times greater when catheter tips lay in basilic veins. Thus, the risk of thrombophlebitis or extravasation was not influenced by the length of catheter within the vein. However, the vein in which the catheter tip lay appeared to influence the development of morbidity.
PMCID: PMC2502878  PMID: 9196346
13.  Increased nitric oxide excretion in patients with severe acute pancreatitis: evidence of an endotoxin mediated inflammatory response? 
Gut  2003;52(2):270-274.
Background and aims: Nitric oxide represents a potential key mediator of the local and systemic manifestations of acute pancreatitis (AP) in experimental models but its role in human disease is uncertain. We therefore sought to assess if systemic nitric oxide (NO) production is elevated in severe AP and determine whether this is a reflection of biochemical severity or endotoxin exposure.
Patients and methods: Patients were recruited within 72 hours of pain onset. NO derived nitrite excretion determined from a 24 hour sterile urine collection was correlated with intestinal macromolecular permeability (polyethylene glycol excretion ratio), markers of systemic endotoxin exposure (IgG:IgM endotoxin core antibody (EndoCAb) ratio), disease severity, and the magnitude of systemic inflammation (peak C reactive protein (CRP) and Acute Physiology and Chronic Health Evaluation score II (APACHE-II)).
Results: In patients with a severe attack (n=20), nitrite excretion was increased significantly compared with patients with a mild attack (n=45, 20.6 μg v 15.65 μg; p<0.00) and the latter with healthy controls (n=20, p=0.004). Nitrite excretion correlated strongly with both intestinal permeability (r=0.7, p=0.006) and EndoCAb ratio (r=0.7, p<0.01) but not with CRP or APACHE-II scores (p>0.1).
Conclusions: Total urinary nitrite excretion is increased in patients with severe AP, and may not be simply a reflection of systemic inflammation, but potentially a consequence of endotoxin mediated upregulation of inducible NO synthase activity.
PMCID: PMC1774972  PMID: 12524412
nitric oxide; intestinal permeability; acute pancreatitis; bacterial translocation; urinary nitrite excretion
14.  Morphological Changes of Benign Prostatic Hyperplasia in Culture 
British Journal of Cancer  1973;27(4):323-335.
A technique is described for the culture of slices of benign prostatic hyperplasia (BPH) for periods of a week in organ culture. Under these conditions tissue repair took place, resulting in a covering layer of transitional epithelium which formed around the explant and spread out laterally as a monolayer. Autoradiography and studies with [3H]thymidine uptake suggested that the repair activity, which reached a peak at Day 3 in culture, was the centre of biochemical activity, overshadowing that of the rest of the explant. Necrosis of the explant base tended to develop abruptly during the first day of culture but thereafter remained stable. The epithelium was well preserved morphologically, but explant acid phosphatase activity fell progressively.
No morphological response to testosterone (10-5 mol/l) or stilboestrol diphosphate (10-5 mol/l) was seen.
Attention is drawn to a possible source of misinterpretation of results offered by the uptake of [3H]thymidine into DNA in organ culture.
Images
PMCID: PMC2008784  PMID: 4121823
15.  DNA fingerprinting analysis of coagulase negative staphylococci implicated in catheter related bloodstream infections 
Journal of Clinical Pathology  2002;55(11):824-828.
Aims: The epidemiological assessment of cases of coagulase negative staphylococcal catheter related bloodstream infection.
Methods: Two hundred and thirty patients with suspected catheter related bloodstream infection were evaluated over a two year period. Central venous catheters were cultured both endoluminally and extraluminally. Peripheral blood, catheter hubs, skin entry, and skin control sites were also cultured. Pulsed field gel electrophoresis (PFGE) was used to DNA fingerprint coagulase negative staphylococci isolated from patients with presumptive catheter related bloodstream infection.
Results: Sixty cases of catheter related bloodstream infection were identified, 21 of which were attributed to coagulase negative staphylococci. Two hundred and ninety four separate isolates of coagulase negative staphylococci from the 21 cases of catheter related bloodstream infection were subjected to PFGE (mean of 14 for each case). Catheter related bloodstream infection was only confirmed by PFGE analysis in 16 of the 21 cases because in the remaining five cases peripheral blood and central venous catheter coagulase negative staphylococci isolates were different. Skin entry, control skin, and central venous catheter hub isolates matched peripheral blood isolates in six, four, and seven cases, respectively. Coagulase negative staphylococci isolates could not be cultured from the patients’ own skin in seven cases of catheter related bloodstream infection. Central venous catheter lumens were colonised in all cases of catheter related bloodstream infection compared with 44–81% of cases that had positive external surface catheter tip cultures, depending on the threshold used to define significant growth.
Conclusions: Catheter related bloodstream infection as a result of coagulase negative staphylococci may be over stated in about a quarter of cases, unless a discriminatory technique is used to fingerprint isolates. No single, simplistic route of bacterial contamination of central venous catheters was identified, but endoluminal catheter colonisation is invariably present in cases of catheter related bloodstream infection.
PMCID: PMC1769792  PMID: 12401819
catheter; infection; intravascular; staphylococcal
16.  Detection of c-Ki-ras mutations in bile samples from patients with pancreatic and biliary cancers 
Clinical Molecular Pathology  1995;48(6):M316-M318.
Aim—To determine whether c-Ki-ras mutations can be detected in bile from patients with biliary strictures caused by pancreatic cancer and other biliary tumours, with a view to developing bile c-Ki-ras mutations as a non-invasive diagnostic marker of pancreatic cancer.
Methods—Bile was collected from 89 subjects (47 controls (including patients with bile duct stones or benign stricture), 20 patients with pancreatic cancer, 11 with cholangiocarcinoma, five with ampullary cancer, and six with metastatic biliary obstruction) referred for endoscopic retrograde cholangiopancreatography. DNA was extracted from bile and c-Ki-ras codon 12 mutations were detected using PCR and a restriction enzyme digestion method.
Results—c-Ki-ras mutations were detected in 10 (50%) of 20 patients with pancreatic cancer, in one (9%) of 11 with cholangiocarcinoma, and in two (33%) of six patients with metastatic biliary obstruction (primary tumours: colon and prostate). C-Ki-ras mutations were not detected in the controls and patients with ampullary cancer.
Conclusions—The sensitivity of this test is too low at 50% to recommend its use clinically, but with refinement has potential as a diagnostic marker for pancreatic cancer.
Images
PMCID: PMC407997  PMID: 16696030
Bile; c-Ki-ras; pancreatic cancer; biliary cancer
17.  Preservation of the spleen improves survival after radical surgery for gastric cancer. 
Gut  1995;36(5):684-690.
One hundred and ninety five consecutive, potentially curative resections for adenocarcinoma of the stomach were performed in one surgical department between 1970 and 1989: 76 patients underwent gastrectomy with splenectomy and 119 gastrectomy without splenectomy. Operative mortality was 12% after gastrectomy with splenectomy, but only 2.5% after gastrectomy without splenectomy (p < 0.05). Postoperative complications were also significantly more common when splenectomy was combined with gastrectomy (41% v 14%, p < 0.01). Cumulative five year survival was 45% after gastrectomy with splenectomy, compared with 71% after gastrectomy alone (p < 0.01). When the results of the two groups of patients were compared, stage for pathological stage, no evidence was found that splenectomy improved survival. Application of Cox's proportional hazards model, which makes allowance for other variables such as the T and N stages, showed that splenectomy had an adverse influence on patients' survival. Splenectomy does not benefit the patient and its routine use in the course of radical resections for carcinoma of the stomach should be abandoned.
PMCID: PMC1382670  PMID: 7797117
18.  An audit of the treatment of cancer of the oesophagus. 
Gut  1994;35(7):941-945.
The treatment of cancer of the oesophagus in The General Infirmary at Leeds between the years 1975 and 1988 was reviewed. All cases with histologically proved cancer of the oesophagus were included, data being obtained from case notes, theatre operation books, endoscopy records, pathology records, and the Yorkshire Cancer Registry. Three hundred and sixteen patients were identified. Demographic details, mode of presentation, preoperative investigations, surgical management, methods of palliation, and survival data were entered into a database. The male to female ratio was 3:2 and the median age at presentation was 69 years (range 35-96). Surgical exploration was carried out in 134 of 316 patients (42%). Resection of the tumour, whether curative or palliative, was possible in 106 of 134 patients (79%). Operative (30 day) mortality was 27%. In 22 of 134 patients (16%), only intubation of the tumour was possible, while six patients (5%) had a thoracotomy or laparotomy alone. Median survival of the 106 patients after surgical resection was 292 days (range 0-14.2 years) and seven of them (7%) were still alive five years later. Of the remaining 182 patients (58%) who were not operated upon, 36 patients (11%) had a radical course of radiotherapy with a median survival of 175 days (range 80-453) and 146 patients (46%) either had endoscopic intubation (n = 64) or received no specific treatment (n = 82) with a median survival of 106 days (1-725) and 91 days (1-358) respectively. None of the 182 patients who did not have surgical treatment was alive at five years.
PMCID: PMC1374841  PMID: 7794305
19.  Gastric cancer: a curable disease in Britain. 
BMJ : British Medical Journal  1993;307(6904):591-596.
OBJECTIVE--To determine whether more vigorous efforts aimed at earlier diagnosis allied to radical surgical resection lead to improved survival of patients with gastric cancer. DESIGN--Prospective audit of all cases of gastric cancer treated during 1970-89. SETTING--Department of surgery, general hospital. SUBJECTS--493 consecutive patients with gastric adenocarcinoma. MAIN OUTCOME MEASURES--Operative mortality, postoperative morbidity, and five year survival after radical potentially curative resection. RESULTS--207 (42%) patients underwent potentially curative resection. The proportion of all patients in whom this was possible increased significantly (p < 0.01) from 31% in the first five year period to 53% in the last five year period. The proportion of patients who had early gastric cancer rose from 1% to 15% (p < 0.01) and stage I disease rose from 4% to 26% (p < 0.001). After potentially curative resection, mortality 30 days after operation was 6%. Operative mortality decreased from 9% in the 1970s to 5% in the 1980s. Likewise, the incidence of serious postoperative complications decreased from 33% in the 1970s to 17% in the 1980s (p < 0.01). Five year survival was 60% in patients who underwent curative resection, 98% in patients with early gastric cancer, and 93%, 69%, and 28% in stage I, II, and III disease respectively. By the late 1980s five year survival after operation was about 70%. CONCLUSIONS--These findings suggest that an increasing proportion of patients with gastric cancer could be diagnosed at a relatively early pathological stage when about two thirds are curable by means of radical surgery.
PMCID: PMC1678908  PMID: 8401015
20.  Early gastric cancer: 46 cases treated in one surgical department. 
Gut  1992;33(10):1318-1322.
Forty six consecutive patients with early gastric cancer were treated between 1970 and 1990. The proportion of cases of early gastric cancer increased significantly (p < 0.01) from 1% of all cases in the first five year period to 15% in the last five year period, because of greater awareness of the condition and more widespread use of endoscopy. There were 33 men and 13 women, of median age 69 years (range 38-86). Most patients (91%) presented with symptoms indistinguishable from those of peptic ulceration. The median duration of symptoms was four months (range 0.1-36 months). All 46 patients were treated surgically. Three patients (6.5%) died after operation and a further 10 (22%) suffered postoperative complications. None of the surviving patients has been lost to follow up and 25 have been followed up for a minimum period of five years. Five year survival by life table analysis was 98%. These findings suggest that in Britain in the 1990s, as in Japan, it may be possible to diagnose an increasing proportion of patients with gastric cancer at a relatively early pathological stage, when most patients can be cured by radical surgical resection with lymphadenectomy.
PMCID: PMC1379596  PMID: 1446852
21.  Alpha 2 macroglobulin state in acute pancreatitis. Raised values of alpha 2 macroglobulin-protease complexes in severe and mild attacks. 
Gut  1991;32(4):430-434.
Plasma values of C reactive protein, alpha 1 proteinase inhibitor, alpha 2 macroglobulin, and complexed alpha 2 macroglobulin have been determined in serial samples from 27 patients with acute pancreatitis. Complexed alpha 2 macroglobulin was measured by a novel enzyme linked immunosorbent assay with a monoclonal antibody specific for the complexed form. Patients with severe illness had lower concentrations of total alpha 2 macroglobulin and higher concentrations of complexed alpha 2 macroglobulin than those with mild illness, and in the majority of severe attacks the abnormal amounts of complexed alpha 2 macroglobulin were present throughout the eight days of the study. The proportion of total alpha 2 macroglobulin in the uncomplexed form, however, was generally greater than 90%, and in 26% of the mild cases completely normal concentrations of uncomplexed alpha 2 macroglobulin (greater than 99% of total) were found throughout the eight days of the study. This suggests that exhaustion of alpha 2 macroglobulin in plasma is unlikely to be a major factor in the pathogenesis of acute pancreatitis.
PMCID: PMC1379085  PMID: 1709131
23.  Enzyme transfer from pancreas to plasma during acute pancreatitis. The contribution of ascitic fluid and lymphatic drainage of the pancreas. 
Gut  1985;26(9):876-881.
Acute pancreatitis was induced in anaesthetised dogs in order to investigate the relative contribution of peritoneal ascitic fluid and thoracic duct lymph as routes of transfer of pancreatic enzymes from the inflamed gland to the blood. In eight animals the exudate from the gland was collected in a plastic bag and continuously drained away, and in a further eight it was allowed to accumulate within the peritoneal cavity. The thoracic duct was cannulated and in four of the animals of each group the lymph which drained was discarded; in the other four it was returned via a venous cannula. The initial rise of plasma amylase and lipase was probably because of the direct transfer of enzyme into veins draining the pancreas or peri-pancreatic tissues. Thereafter transfer of enzyme via the thoracic duct significantly influenced plasma concentrations of amylase and lipase. The majority of enzyme released from the gland accumulated within the peritoneal ascitic fluid, but this intraperitoneal accumulation did not appear to have a significant influence upon lymph or plasma concentrations of amylase or lipase.
PMCID: PMC1432861  PMID: 2411638

Results 1-25 (39)