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Biomedical subjects

D G Hutson

Publications and source records attributed to D G Hutson.

At least 19 recordsLinked to original sources
PubMed2001

Dilatation of biliary strictures through the afferent limb of a Roux-en-Y choledochojejunostomy in patients with sclerosing cholangitis.

Repeated dilatation of biliary strictures in patients with sclerosing cholangitis through a subcutaneously placed afferent limb of a choledochojejunostomy is technically feasible and safe. This study is a prospective 15-year evaluation of 36 patients treated by repeat dilatation through this jejunal limb. There was one operative death and one major complication of dilatation. The 5-year survival of all patients was 74%. If patients with cirrhosis or unproven cholangiocarcinoma at the time of operation are not included, the 5-year survival is 86%. The 15-year survival of all patients was 30%; it was 64% if those with cirrhosis and unproven cholangiocarcinoma at the time of operation are not included. Six patients are presently alive with an average survival of 159 months. The study suggests that a combination of repeated dilatations combined with transplantation is the approach of choice in selected patients.

Adolescent↗
PubMed2000

A subcutaneous or subfascial jejunostomy is beneficial in the surgical management of extrahepatic bile duct cancers.

BACKGROUND: Extrahepatic bile duct cancers are rare tumors with a dismal prognosis. Even after a resection, obstructive cholestasis and other biliary complications are the rule. To facilitate retrograde access to the biliary tree for treatment of such biliary complications, a modified Roux-en-Y hepaticojejunostomy is constructed such that the afferent limb is brought up as a subcutaneous or subfascial jejunostomy (SJ). The safety and utility of construction of an SJ was evaluated in patients with extrahepatic cholangiocarcinoma. METHODS: From 1985 to 1997, 24 patients with extrahepatic bile duct cancers received an SJ as part of their management. Demographic data, operative data, tumor characteristics, and postoperative courses were retrospectively reviewed. All but 3 patients were followed to the time of death. RESULTS: The average age of the patients was 62 +/- 9 years. The tumor was resected in 17 patients. Major complications occurred in 5 patients (21%). There was 1 operative death (4%). None of the complications could be attributed to construction of the SJ, although 1 patient had a soft tissue infection at the site of the percutaneous access of the SJ. Frequent dilatations of biliary strictures were required in 5 patients, and 1 patient eventually required insertion of an internal biliary stent. These procedures could all be accomplished through the SJ. CONCLUSIONS: The SJ is a technically simple and safe addition to the management of resectable and unresectable extrahepatic bile duct cancers, particularly proximal lesions. The procedure facilitates brachytherapy if indicated, and it allows convenient management of postoperative biliary complications, including recurrent strictures.

Aged↗
PubMed1998

Percutaneous dilatation of biliary strictures through the afferent limb of a modified Roux-en-Y choledochojejunostomy or hepaticojejunostomy.

BACKGROUND: This report is a 13-year prospective evaluation of percutaneous balloon dilatation of benign biliary strictures through the subcutaneous or subfascially positioned afferent limb of a choledocho or hepaticojejunostomy in 30 patients. DATA SOURCE: Twenty-seven strictures developed after a common duct injury sustained at the time of cholecystectomy, two after hepatectomy reconstruction for trauma and one following a gastrectomy. Twelve injuries (40%) were recognized at operation. Of the 18 patients where the injury was unrecognized at the time of operation, 8 had not been reoperated at the time of referral, 7 had late repairs by the referring physician, and 3 had late repairs at our institution. The follow-up is 1 to 13 years. RESULTS: There has been 1 late death and 6 patients are lost alive. The jejunal-limb was accessed 50 times with two minor and no major complications. There have been two parajejunal hernia repairs, but there have not been any reoperations for recurrent biliary strictures. CONCLUSIONS: Benign biliary strictures can be effectively managed by repeat balloon dilatations thru the afferent limb of a choledocho or hepaticojejunostomy, thus eliminating the need for repeat surgical interventions.

Adult↗
PubMed1997

A technique for prolonged arterial infusions of fibrinolytic agents in the immediate postoperative period through a cutaneous venostomy.

Prolonged use of fibrinolytic agents post thrombectomy is limited by present techniques that require arterial puncture and indwelling arterial catheters. This limitation can be avoided by attaching a short segment of saphenous vein to the arteriotomy used for the thrombectomy and bringing this out to the skin as a "venostomy"; thus providing ready access to the vascular tree for arteriography, prolonged infusion of thrombolytic agents, or selective catheter placement. In delayed thrombectomies (Categories 2 & 3 as described by the Ad Hoc Committee on Reporting Standards, J Vasc Surg 1986;4:80-94), extending the use of these agents may represent the only hope for limb salvage.

Adult↗
PubMed1997

Trends in resident experience in open and laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) as the most common operation for gallbladder disease. Our goal was to determine the effect of this phenomenon on resident training in biliary surgery. The numbers of all cholecystectomies (ACs), OCs, LCs, and advanced procedures (common bile duct exploration and choledochoscopy, (CBDE) performed by residents during academic years 1989 to 1994 were examined. Trends for the residency as a whole and for each cohort of residents completing the program were studied. The number of LCs performed by the residency as a whole per academic year over the 1989 to 1994 period has increased, whereas the number of OCs decreased. The net effect of these trends was an increase in the number of ACs. Although the percentage of LCs performed by postgraduate year 1, 2, and 3 residents (juniors) increased over the study period, the proportion of OCs and ACs performed by this group decreased. For each cohort of residents completing training in the years 1989 through 1994, the number of ACs and LCs performed increased, whereas the number of OCs decreased. Experience in CBDE for the residency as a whole and for the cohort was stable. In conclusion, experience in ACs and LCs has increased, and experience in OCs has decreased. Also, experience in biliary surgery has shifted to the senior level.

Cholecystectomy↗
PubMed1995

Balloon dilatation through the subcutaneously placed afferent limb of a hepaticojejunostomy in patients with resected Klatskin tumors.

It is generally conceded that palliation for proximal bile duct tumors (Klatskin) is exceptional if obstruction and the resultant infections can be prevented. Our experience with balloon dilatations thru the subcutaneously placed afferent limb of a choledocho or hepatico jejunostomy in patients with benign strictures suggests that this approach will be effective in patients with malignancies and thus provide long-term control of the obstruction without the need for external tubes. This is a report on one patient who, following a resected Klatskin tumor with positive margins, was treated with transhepatic internal external stents and was converted to a subcutaneous limb following numerous bouts of cholangitis. A schedule for repeat dilatations thru the jejunal limb was established. The patient has remained afebrile with a normal bilirubin and a moderately elevated alkaline phosphatase. Recurrent tumors or postirradiation strictures in patients with resected Klatskin tumors can be effectively controlled by repeated balloon dilatation without the need for external stents.

Aged↗
PubMed1993

The action of ammonia on astrocyte glycogen and glycogenolysis.

Most of the brain glycogen, a major energy reserve that can be mobilized in response to increased neuronal activity, resides in the astrocyte, the site of the neuropathological abnormality found in hepatic encephalopathy (HE). Ammonia, a neurotoxin implicated in the pathogenesis of HE, has been reported to cause a depletion of glycogen in primary astrocyte cultures. To further investigate the action of ammonia on glycogen levels, cultured astrocytes were exposed to ammonium chloride (1-5 mM) for various times up to 7 d. Treatment with ammonia for 24 h did not alter deoxyglucose uptake, but significantly lowered peak glycogen values (found at 1.5 h following feeding with medium containing 5.5 mM glucose) in a concentration-dependent manner. This inhibitory effect was not observed after longer exposure times to ammonia. Three day treatment of cells did, however, significantly reduce norepinephrine-stimulated glycogenolysis, an effect not seen after 1 d of ammonia treatment. Part of the neurotoxic action of long term ammonia exposure in humans and experimental animals may be to inhibit the breakdown of glycogen. The effect of ammonia on astrocyte glycogen synthesis and/or breakdown may disrupt glial neuronal signaling and thus play a role in the pathogenesis of HE.

Ammonia↗
PubMed1993

Pulseless (Takayasu) disease with ophthalmic manifestations.

Pulseless disease (PD) is a rare disorder in which inflammation of the aorta and its major branches leads to stenosis or occlusion of these arteries. It mainly affects young Oriental women, who suffer chronic ischemic injury to tissues of the brain, orbits, upper limbs, myocardium, and kidneys. The ophthalmologic features of pulseless disease tend to be late manifestations, and can include ischemia of the retina, choroid, and anterior segment. The inflammatory process may be reversed in early stages with systemic corticosteroids, but, more frequently, significant arterial stenosis necessitates arterial bypass surgery. A 59-year-old Caucasian woman with stenosis of all four major cervical arteries presented with recurrent blurred vision, syncope, mental obtundation, and a remarkable funduscopic appearance due to bilateral orbital hypoperfusion. Her acute symptoms improved slightly on high-dose systemic corticosteroids, and then resolved completely following arterial bypass surgery.

Arterial Occlusive Diseases↗
PubMed1990

[Hepaticojejunostomy with a subcutaneous blind jejunum segment. An alternative in the treatment of stenosing bile duct diseases].

The choledochojejunostomy and hepaticojejunostomy with a blind subcutaneous segment of the jejunum offer a safe, simple and nearly linear access for repeated retrograde balloon dilatations of the biliary tract. 81 patients, both with malignant as well as benign stenoses of the biliary system have been treated with this method during the last 8 years. Operative technique and preliminary results of this new procedure, which we believe to be the method of choice in recurrent or multiple iatrogenic or posttraumatic biliary strictures, are presented in this paper.

Aged↗
PubMed1988

Combined surgical and radiologic approach to recurrent cholangitis and intrahepatic pigment stones.

A 37-yr-old white woman from Australia presented with ascending cholangitis and jaundice and was found to have multiple brown, "earthy" pigment stones in the biliary tree, including the segmental ducts. Removal of these stones was accomplished via a subcutaneously placed afferent jejunal limb of a choledochojejunostomy using balloon dilators. The jejunal conduit also served as an access for periodic removal of newly formed stones. This combined surgical and radiologic approach is an effective way of removing recurring pigment stones. The afferent jejunal limb can also be used to perfuse dissolution agents, if necessary, via catheters placed in the biliary tree.

Adult↗
PubMed1988

Portal hypertension. A fifteen year perspective.

Two hundred six consecutive patients were followed from 5 to 15 years after a distal splenorenal shunt operation. Nonalcoholic patients demonstrated nearly twice the survival rate when compared with alcoholic patients. The mean duration of life for the surviving nonalcoholics was 10 years and for the alcoholics, 9 years. We predict that approximately a third of the nonalcoholics will enjoy long-term survival. The operative mortality rate was similar in both groups, being about 4 percent. The risk of liver cancer was highest in the male alcoholics, and long-term survival was greater for women in both the alcoholic and nonalcoholic groups.

Alcoholism↗
PubMed1987

Postoperative jaundice as a clue to unrecognized biliary tract obstruction.

Postoperative jaundice is often a complex clinical problem of multifactorial origin. If underlying liver disease is present preoperatively, there is a greater likelihood of jaundice after surgery. We describe two patients: one with intrabiliary hepatocellular carcinoma and the other with primary sclerosing cholangitis. The underlying processes were unmasked after the development of jaundice in the postoperative period. These cases point out the importance of considering previously undiagnosed biliary tract obstruction in the differential diagnosis of postoperative jaundice.

Aged↗
PubMed1986

Acute peripheral arterial occlusion associated with surgery for gynecologic cancer.

Four cases are described of acute peripheral arterial occlusion associated with surgery for gynecologic cancer during the 5 years 1979 to 1983 at the University of Miami, Jackson Memorial Hospital Center. No such cases were recorded during the preceding 5 years. The probable underlying etiologic factors are discussed and recommendations made regarding the evaluation and management of such patients.

Adenocarcinoma↗
PubMed1986

Percutaneous transjejunal biliary dilatation: alternate management for benign strictures.

Since 1980, 23 patients with diffuse benign biliary strictures underwent percutaneous retrograde biliary dilatation through a surgically created jejunal access route. Bile ducts of 15 patients with sclerosing cholangitis, five with traumatic strictures, and three with strictures of diverse etiology were dilated with 25-atm balloons during 88 separate sessions. Individual dilatation intervals ranged between 2 and 36 months. Three patients with sclerosing cholangitis died. One uncomplicated bile duct rupture occurred in the trauma group because of balloon oversizing. Our 5-year experience indicates that bile duct patency can be safely maintained by repeated retrograde dilatations without the need for biliary catheters or stents.

Adolescent↗
PubMed1985

Lowering of plasma free tryptophan in normal and portacaval shunt dogs.

The purpose of this study was to develop a method which would produce immediate and sustained lowering of plasma free tryptophan. Glucose, insulin, and mixtures of the two in different concentrations were infused into dogs over a period of 6 hr. Blood was sampled during the course of the infusion for assay of plasma free and total tryptophan, free fatty acids, glucose, and insulin. The infusate found to produce the most significant and sustained reduction in plasma free tryptophan in normal dogs was a mixture of 25% glucose and insulin. The lowering ranged from 26 to 47% during the course of the infusion. When the same infusion mixture was administered to dogs with established portacaval shunts, and elevated plasma free tryptophan concentrations (3.3 +/- 0.3 micrograms/ml compared to normal dogs which had 1.9 +/- 0.1 micrograms/ml), there was a 35% reduction to normal levels (2.0-2.2 micrograms/ml). A glucose-insulin mixture has, therefore, been found which, upon infusion into dogs, significantly lowers plasma free tryptophan levels. The effect of such an infusion on the plasma levels of free tryptophan, and the clinical course of patients with hepatic encephalopathy remains to be determined.

Animals↗
PubMed1985

Transgastric drainage of pancreatic fluid collections.

Eight pancreatic fluid collections in seven patients were successfully drained percutaneously through a transgastric approach. The drainage catheters were left in place for 3-6 weeks to promote the formation of a fistulous tract between the stomach and the pancreatic collection. Computed tomography (CT) was used for diagnosis and for planning of the access route. Combined sonography and fluoroscopy were used for guidance. Radiologic follow-up examinations (CT and sinograms) have shown no recurrences (3-12 months). No complications were encountered.

Drainage↗