Living "anyway:" stories of access.

Elana Dykewomon's 1974 novel, Riverfinger Women, was among the first lesbian books with a "happy ending." Her seven books of fiction and poetry include the Lambda Award winner Beyond the Pale (now an audio and e-book) and Lambda nominee, Risk. She was an editor of the lesbian-feminist journal, Sinister Wisdom, for eight years. Her literary work foregrounds the lesbian heroic as integral to women's communities. As a social justice activist, she has organized and participated in anti-war, anti-racist, anti-classist, fat and disability rights work since the 1970s. She is now working with Old Lesbians Organizing for Change. She is happy to live embedded in dyke community as a lesbian radical committed to a loving justice. While she suffered psychiatric abuse at 13 (and acknowledges long-term adaptive behavior on that account), she has not experienced disabling mental illness since. Her primary disabilities are mobility impairment through severe, progressive arthritis and constant low-to-powerful pain, sometimes diagnosed as fibromyalgia. Her acute illnesses include pancreatitis and a rare-in-adults kidney disease currently in remission.

A historic perspective on the contributions of surgeons to the understanding of acute pancreatitis.

BACKGROUND: Acute pancreatitis is a disease with a broad spectrum of presentation, severity, and treatment. Current management involves a multidisplinary team of surgeons, gastroenterologists, and interventional radiologists whose varied clinical skills contribute to the evolving diagnostic and therapeutic strategies for this disease. However, critical aspects of therapy have remained the responsibility of the general surgeon. The purpose of this review is to examine the many contributions of surgeons in acute pancreatitis. DATA SOURCES: A review of the literature taken from PubMed on seminal articles published by surgeons on the subject of acute pancreatitis. CONCLUSIONS: Surgeons have made significant contributions to the understanding of the pathophysiology and evolution of therapy of acute pancreatitis. The specialty should continue to take a leadership role to improve outcomes.

Enteral nutrition in HPB surgery: past and future.

Perioperative nutrition has, during the past century, been transformed from a tool to provide calorie and nitrogen support to a tool to boost the immune system and increase resistance to complications. Despite all the progress in medicine and surgery, perioperative morbidity, the rate of infections, thrombosis, and the development of serosal adhesions has remained the same as long as can be judged, or at least during the past 80 years. Most prone to develop complications are persons above the age of 65 and persons with depressed immunity. About 80% of the immune system is localized in the gastrointestinal tract, which offers great opportunities for modulation through enteral nutrition. As the stomach has a tendency to develop postoperative paralysis, tube feeding is often necessary. In 1918, Andresen demonstrated the advantages of enteral nutrition, which already started on the operating table. Mulholland and colleagues and Rhoads and co-workers demonstrated, during the 1940s, certain advantages of enteral tube feeding. Also, the works by Alexander, Fischer, and Ryan, and their co-workers supported the value of early enteral feeding, and suggested enteral feeding as an effective tool to boost the immune system. It was, however, works published in the early 1990s, by Moore and colleagues and by Kudsk and colleagues, which made surgeons more aware of the advantages of early enteral nutrition. Surgery in the hepatobiliary pancreatic field is known to have a high rate of complications. Uninterrupted perioperative nutrition, i.e., nutrition during the night before, during surgery, and immediately after, offers a strong tool to prevent complications. It is essential that the nutrition also provides food for the colon, e.g., fiber and healthy bacteria (probiotics) to ferment the fiber and boost the immune system.

Surgery of chronic pancreatitis: chronicle of confusion and despair.

The evolution of surgery for pancreatitic disease has been arduous owing to the technical difficulties of addressing the organ and the lack of understanding the mechanisms of the disease processes involving it. In particular, the tardy advance of surgery in the management of chronic pancreatitis exemplifies these problems. Because no specific target has been identified, mechanical intervention has for the most part reflected intuitive or creative attempts to address perceived pathologic issues such as sphincter disease, calculi, and fibrotic masses. The past and present remain a confusion of etiologies and diagnoses. Treatment remains for the most part a dramatically disappointing scenario, and both patients and their physicians are frustrated. Although the remarkable technologic progress exhibited by the odyssey of operative strategy from simple drainage, to ductal drainage, to the complex refinements of extensive resection is a testimonial to surgical skill and determination, it has been nullified to a large extent by the inability to address the initiating factors of the disease or alter those that engender progress of the pathology. It is not unreasonable to recognize that we are facing an enigmatic disease process generically classified as "chronic pancreatitis" for want of any more specific terminology. In the light of our current knowledge and experience, intervention should probably be modest in the extreme and limited to centers and individuals with expertise or who are involved in specific studies to determine the precise criteria and techniques necessary for optimum intervention. It is important that when charting such a course future surgeons involved in the management of chronic pancreatitis have an understanding of the historical evolution of the subject. As Theodor Billroth, the greatest of the surgical innovators remarked: "An awareness of the past is necessary to comprehend the present, and without it no consideration of the future is possible."

Historia de las manifestaciones gastrointestinales del lupus eritematoso sistemico / History of the gastrointestinal manifestations in systemic lupus erythematosus

En este articulo revisamos la historia de las manifestaciones gastrointestinales en el Lupus Eritematoso Sistemico desde el siglo XIX hasta nuestros dias, recorriendo cada uno de los organos involucrados en este sistema y haciendo especial mencion de la gastropatia, enteritis, ileitis, sindrome de malabsorcion, vasculitis y vasculopatia intestinal, trombosis mesenterica, pancreatitis, ascitis, peritonitis, hepatitis autoinmune, entre otros

Hereditary pancreatitis. Historical perspectives.

Clinically, hereditary pancreatitis was not distinguishable from any other cause of pancreatitis. But astute clinical observations demonstrated an evolution toward chronic pancreatitis that could develop into carcinoma in some patients. A chromosomal abnormality was identified on chromosome 7q35, and then three separate genetic abnormalities were identified. It is now understood that a defect in trypsinogen is at the basis of the anomaly, and further developments should help identify new therapeutic approaches.

Chronic pancreatitis: a historical and clinical sketch of the pancreas and pancreatitis.

Chronic pancreatitis (CP), a disease described only in 1946 by Comfort and colleagues is currently a global disease. Chronic alcoholism, albeit is the most frequent etiologic factor for the disease in most of the affluent nations, a form of CP of undetermined etiology, tropical calculous pancreatitis (nutritional pancreatitis, Afro-Asian pancreatitis, or tropical calculous pancreatopathy) has been recognized to be prevalent in many developing nations. Hereditary pancreatitis inherited as an autosomal dominant disease is reported from all parts of the world. A landmark is the recent discovery of a gene that transmits the disease. Nearly 10% of cases of CP are truly "idiopathic" with no identifiable cause. Recent studies indicate that the idiopathic variety of CP has two subsets--a juvenile form and a senile or late onset form, with distinct clinical features. It is extremely rare to see CP secondary to hyperlipidemia or hypercalcemia. These etiologic associations appear to be overemphasized. Epidemiological studies indicate that alcoholism is growing in incidence all over the world along with an increase in all alcohol-associated disorders such as cirrhosis of the liver or pancreatitis. A genetic predisposition to alcoholic pancreatitis is suspected based on population studies, but not proven. The influence of cigarette smoking in enhancing alcohol-induced injury to the pancreas underscores the health hazard associated with alcoholism and cigarette smoking--two habits that often coexist in many individuals. The recent finding that all forms of CP are premalignant further emphasizes the need to enforce preventive measures. The hope is that CP is a preventable disease. The despair is that alcoholism is increasing and spreads across geographic and religious boundaries.

Pancreatitis en la infancia: descripción clínico-histopatológica / Childhood pancreatitis: a clinical and histopathologic description

Introducción.La pancreatitis en la infancia es considerada una enfermedad poco frecuente.Se estudiaron retrospectivamente 47 necropsias con diagnóstico histopatológico de pancreatitis con el fin de analizar las características clínicas y anatomopatológicos de esta enfermedad poco frecuente.Se estudiaron retrospectivamente 47 necropsias con diagnóstico histopatológico de pancreatitis con el fin de analizar las características clínicas y anatomopatológicas de esta enfermedad.material y métodos.Las observaciones se agruparon de acuerdo a la etiología de la pamcreatitisinfecciosa en 29 pacientes,secundaria a drogas o tóxicos en 4,post-quirúrgica o secundaria a la obstrucción del flujo biliar en 3 de casa uno y 8 necropsias con causas diversas.Se analizaron las historias clínicas y se encontró que existían síntomas sugerentes de pancreatitis en 10(21 por ciento) pacientes del total,sin que se observara ninguna relación con las etiologías.Resultados.No hubo correlación entre etiología y tipo histológico,se observaron 19 pancreatitis agudas hemorrágicas,17 agudas intersticiales,7 crónicas y 4 granulomatosas.Se consideró luego del análisis de cada necropsia que la pancreatitis contribuyó a la muerte en 35 niños(74 por ciento).Conclusiones.En esta muestra la pancreatitis frecuentemente fue la etiología infecciosa,tuvo cuadro histopatológico no específico,produjo escasos síntomasy,por la severidad del daño estuvo,probablemente relacionada con la muerte

[Study of the pancreas and its inflammatory diseases from the 16th-19th century]. / Die Erforschung des Pankreas und seiner entzündlichen Krankheiten vom 16.-19. Jahrhundert.

The author describes the development of medical research since the 16th century based on a literary review of the study of the anatomy, physiology and pathology of the pancreas. The anatomical basis was first created in the 17th century when the pancreatic duct was discovered (J.C. Wirsung 1642) and the duodenal papilla was described (J.K. Brunner 1683, C.B. Holdefreund 1713 and A. Vater 1750). The physiological function of the pancreas as a secretary gland was first experimentally investigated by R. Graaf (1671). A few decades later the enzymatic breakdown of nutrients by pancreatic juice was demonstrated in animal experiments (G. Valentin 1844, Cl. Bernard 1849). The earliest case reports of patients dying of suppurative inflammation or tumours of the pancreas were presented by S. Alberti (1578), J. Schenck (1600), and N. Tulp (1641). The presence of fatty necrosis in acute pancreatitis was first indicated by W. Balser (1882), and the autodigestive genesis was suspected by H. Chiari (1896). The discovery in the 19th century that diabetes mellitus occurs in dogs following total pancreatectomy (J. von Mering and O. Minkowski 1890) and the first operation on a pancreatic cyst by "marsupialisation" (C. Gussenbauer 1883) as well as the emergence of the connection between cholelithiasis and acute pancreatitis (E.L. Opie and W. St. Halsted 1901) laid the foundation for 20th century research.

Acute pancreatitis at its centenary. The contribution of Reginald Fitz.

1989 represents the 100th anniversary of Reginald Fitz's initial characterization of acute pancreatitis. Our current understanding of this disease has advanced little beyond Fitz's early description. While survival from pancreatitis has improved largely through advancements in critical care techniques, no medical or surgical therapy exists that can limit pancreatic autodigestion and inflammation. Recent investigations have suggested that pancreatitis may result from a disruption of normal stimulus-secretion coupling within the acinar cell. Future research based on these observations may ultimately result in successful therapy for this disease.

Surgical management of chronic relapsing pancreatitis.

Chronic relapsing pancreatitis is a syndrome usually associated with chronic alcohol abuse, and is characterized by pain in the upper abdomen and back, weight loss, and disturbances in function of the endocrine and exocrine pancreas. A surgical attack on this disorder can be traced to the turn of the century, when experimental work suggested the feasibility of operations of the pancreas. In 1911 Link performed pancreatostomy for this disease and achieved an excellent long-term result. Later, partial or total pancreatectomy was introduced in the management of this condition. With pathologic evidence of pancreatic duct dilatation, attempts at retrograde drainage of the duct into the gastrointestinal tract were introduced in the 1950s, with encouraging results. The recent advent of diagnostic modalities capable of more precise definition of ductal anatomy allows more discriminate application of the two major surgical approaches of resection and internal drainage. In this review, the literature concerning this interesting subject is surveyed and the favored diagnostic and surgical methods are assessed.