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Biomedical subjects

D R Hunt

Publications and source records attributed to D R Hunt.

At least 37 records · Page 2Linked to original sources
PubMed1995

Is laparoscopy associated with a lower rate of postoperative adhesions than laparotomy? A comparative study in the rabbit.

This trial set out to test the hypothesis that there is no difference in the incidence of intra-abdominal adhesions after a stereotyped intraperitoneal injury created via laparoscopy or laparotomy. Twenty New Zealand White rabbits had a 2 x 2 cm area of peritoneum stripped off their caecum and adjacent parietal peritoneum, either by laparotomy or laparoscopy. Outcome was assessed by the incidence of adhesions to the test site and the wound. There was no difference in the rate of adhesions at the test site in the two groups. The rate of adhesions to the wound was different in the two groups (70% laparotomy, 0% laparoscopy; P = 0.003). In a rabbit model, comparing laparoscopy and laparotomy in a strictly controlled operative environment, a stereotyped intraperitoneal injury results in similar rates of postoperative adhesions. Laparoscopy is, however, associated with a much lower incidence of wound adhesion. The potential for postoperative adhesions is real after laparoscopic surgery.

Animals↗
PubMed1995

A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy.

The aims of this study were to see if laparoscopic cholecystectomy is associated with a similar postoperative pain pattern to gynaecological laparoscopy and to see whether the use of a suprahepatic suction drain makes recovery from laparoscopic cholecystectomy more comfortable. After routine laparoscopic cholecystectomy and insertion of a suprahepatic suction drain, patients were randomized to suction or no suction on the drain. The time course of the severity of wound, abdominal and shoulder tip pain was assessed by visual analogue scales administered in the morning and afternoon of the first 3 postoperative days. The control group had a high incidence of shoulder tip pain similar to that after gynaecological laparoscopy. Patients in the treatment group reported significantly less shoulder tip pain than the control group (O.R. 0.16, 95% CI, 0.06-0.40). There was a tendency for the treatment group to report reduced abdominal and, to a lesser extent, wound pain. The authors recommend suprahepatic suction as a simple and more effective way to improve patient comfort after laparoscopic cholecystectomy.

Abdominal Pain↗
PubMed1995

The measure and mismeasure of the tibia: implications for stature estimation.

Trotter and Gleser's stature estimation formulae, based on skeletons of the Terry collection and on WWII casualties, have been widely used in forensic work. Our work with the Terry and WWII data yielded tibia lengths too short compared to other data sets. Using Trotter's original measurements, we discovered that she consistently mismeasured the tibia. Contrary to standard practice and her own definitions, she omitted the malleolus from the measurement. Trotter's measurements of the tibia are 10 to 12 mm shorter than they should have been, resulting in stature estimations averaging 2.5 to 3.0 cm too great when the formulae are used with properly measured tibia. We also examined tibia lengths of Korean War casualties, which were measured by technicians rather than by Trotter. Korean tibia measurements are also too short, but by a smaller amount than Terry and WWII. Since the Korean tibia are unavailable for restudy, it is unclear how they were measured. Estimation of stature from Trotter and Gleser's tibia formulae is to be avoided if possible. If necessary, the 1952 formulae could be used with tibia measured in the same manner that Trotter measured, excluding the malleolus.

Asian People↗
PubMed1994

Bacteremia associated with operative decompression of a small bowel obstruction.

BACKGROUND: Intraoperative decompression of the small bowel has been advocated as a method of aiding recovery of both the patient and the intestine. However, the methods proposed (retrograde stripping or enterotomy) require vigorous handling of bacteria-laden small bowel, possibly giving rise to a bacteremia. STUDY DESIGN: A small bowel obstruction was created in 31 rats by means of a ligature. Twenty-four hours later, the obstruction was relieved, and the rats were divided into three groups: relief of obstruction alone, relief with retrograde stripping, and relief with enterotomy plus suction. Blood cultures were taken before and after manipulation of the bowel. RESULTS: In blood cultures taken before and after manipulation there was a significant increase of Escherichia coli bacteremia in the two manipulation groups compared with the relief of obstruction only group. CONCLUSIONS: Bacteremia may be an effect of operative decompression of obstructed bowel, which at times outweighs its supposed benefits.

Animals↗
PubMed1994

Lower limb venous hemodynamics during laparoscopy: an animal study.

To assess the impact of raised intra-abdominal pressure associated with laparoscopy on venous return, we have used an animal model (pig) to study the effect of progressive increases in insufflation pressure on femoral venous blood outflow. As a second variable, the effect on flow of the reverse Trendelenburg position was also assessed. Evidence of any adaptation in venous blood flow to the increased intra-abdominal pressure was assessed during a prolonged surgical procedure. These studies have shown that femoral venous blood outflow in the pig is markedly depressed at insufflation pressures of 10 to 20 mm Hg. The reverse Trendelenburg position accentuates this reduction in flow, and there was no sign of adaptation to this depressed flow during a laparoscopic Nissen fundoplication. These findings have clear implications for the potential of deep venous thrombosis/pulmonary embolism (DVT/PE) following prolonged therapeutic laparoscopy.

Abdomen↗
PubMed1994

Venous stasis during laparoscopic cholecystectomy.

The objectives of this research were (a) to determine the effect of insufflation at laparoscopic cholecystectomy to 12 mm Hg on femoral venous blood flow; and (b) to assess the function of intermittent pneumatic compressors (IPC) and intermittent electric calf stimulators (IECS) in the presence of a pneumoperitoneum. Measures of baseline venous blood flow velocity, femoral vein diameter, and maximum blood flow velocity achieved by IPC or IECS were made in the presence or absence of a pneumoperitoneum of 12 mm Hg. The ICP and IECS were randomly allocated to either leg. All measures were made by an experienced sonologist. Insufflation to 12 mm Hg caused a statically significant decrease in femoral blood flow velocity and was accompanied by a significant increase in femoral vein diameter. The IPC and IECS were able to achieve pulsatile venous blood flow despite the presence of a pneumoperitoneum, but they had no effect on the depressed baseline blood flow velocity. We concluded that insufflation to 12 mm Hg causes significant venous stasis in the lower limb and that IPC and IECS cannot completely eliminate this stasis. Further research needs to be done to clarify the optimal methods of prophylaxis in view of the implications for deep venous thrombosis.

Adult↗
PubMed1993

Endoscopic drainage of esophageal suture line leaks.

Suture line leaks after esophageal or gastric surgery are associated with high morbidity and mortality rates. We report a new approach to the management of this problem, which has been used successfully in the treatment of nine patients with such leaks who were treated at or referred to our unit. The suture line defect is first visualized by endoscopy, after which a sump nasogastric tube is advanced down the esophagus and out through the defect into the abscess cavity. The tubes are irrigated intermittently to achieve patency and maintained with continuous suction. Separate pleural or subphrenic collections are drained by conventional techniques. After the injection of contrast down the tube, serial radiologic studies are used to monitor progress and to guide the slow withdrawal of the tube as the cavity collapses.

Abscess↗
PubMed1993

Laparoscopic cholecystectomy. A prospective analysis of the potential causes of failure.

Most experienced laparoscopic units suggest a rate of conversion to open cholecystectomy of about 5%. Some failures are predictable preoperatively. We have reviewed the prospective data collected on our first 285 laparoscopic cholecystectomies to provide a basis for advising patients about the likelihood of conversion (failure) if laparoscopic cholecystectomy is attempted. Risk factor analysis was performed to assess the effect on the conversion rate of clinical presentation, preoperative ultrasound features, previous abdominal surgery, and morbid obesity. The overall conversion rate was 4.9%. We identified three preoperative clinical parameters associated with a high risk of failure at laparoscopic cholecystectomy: a contracted gallbladder on ultrasound, gallstone pancreatitis, and a previous history of upper abdominal surgery. Factors that did not predict failure were: an ultrasound report of a thick gallbladder wall, morbid obesity, or acute cholecystitis. It is concluded that laparoscopic cholecystectomy is technically feasible in most patients, but those having the above-mentioned risk factors should be warned of a higher than usual chance of conversion to open cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed1992

Variation among North Amerindians: analysis of Boas's anthropometric data.

In the late nineteenth century Franz Boas was responsible for assembling anthropometric data from North Amerindians. Approximately 15,000 subjects were measured, but the data have never been systematically analyzed. Here we describe our efforts to develop a computerized database from Boas's data and present the first systematic analysis of these data. In addition to a general analysis of North Amerindian anthropometric variation, we also present a more detailed analysis of anthropometric variation among tribes located in the American Northwest. In the general analysis we find that anthropometric variation is strongly patterned along geographic lines. We examine geographic and language patterning by grouping tribes by culture area and language phylum. Both have high explanatory power, culture area being the higher. The Northwest analysis shows that both language and geographic location are important in explaining anthropometric variation.

Anthropology, Physical↗
PubMed1990

Endoscopic diagnosis of small flat carcinoma of the colon. Report of three cases.

Most small carcinomas arise from polyps. Small lesions with cellular features of malignancy and early invasion, but with no histologic evidence of residual adenoma, are rare. Diagnosed by endoscopy, three such lesions are described. They were recognized as mucosal plaques, measuring between 6 and 8 mm in diameter. In each case, there was either synchronous or metachronous carcinoma elsewhere in the colon, as well as benign adenomatous polyps. Colonoscopic identification of such lesions allows inclusion of that bowel segment in any planned resection.

Adenocarcinoma↗
PubMed1990

Bile duct emptying in response to fat: a validation study.

Fatty meal sonography has been suggested to assess patients with biliary pain after cholecystectomy, but the effects of gallbladder removal on biliary dynamics has not been studied prospectively. Before elective cholecystectomy, 25 patients had their common hepatic ducts' diameter measured by ultrasonography before and after a fat stimulus. In 23, tests were repeated 1 month, 1 year, and 5 years after surgery. In preoperative studies, 5 patients showed dilatation after fat and 2 of these had stones in the common bile duct. However, another 4 patients with stones or sludge in the duct did not show dilatation, so that the response to fat was a poor indicator of patients requiring common bile duct exploration. No patient had major symptoms after surgery. At 1 month and 12 months, the response to fat was variable with more than half of those tested showing no decrease in duct size. A more consistent pattern emerged at 5 years, when 14 of 18 patients tested showed a decrease in common hepatic duct after fat; 3 were unchanged and 1 increased by 1 mm. The response to fat was less consistent and more difficult to measure in the common bile duct, even 5 years after operation. It was concluded that not all patients with indications for exploration of the common bile duct on operative cholangiography show a dilatation response to fat on preoperative testing. Also, fatty meal sonography should be used with caution because the response to fat in asymptomatic patients soon after operation is unpredictable, with occasional patients showing dilation without apparent obstruction. Measurement of common hepatic duct is preferred to common bile duct and increases in diameter of 1 mm are probably not significant.

Bile Duct Diseases↗
PubMed1990

Costs of magnetic resonance imaging services in public hospitals.

Audited cost data from two public hospital installations participating in a trial of the utilisation and efficacy of magnetic resonance imaging are presented. The data cover the period July 1987 to June 1988 when both installations had attained stable patterns of operation. One hospital operated a superconductive system and the other a resistive magnetic resonance imaging unit. Depreciation and salaries represented the major components of cost.

Australia↗
PubMed1990

Pre-operative ultrasound measurement of bile duct diameter: basis for selective cholangiography.

In this prospective study, prior to cholecystectomy, the diameter of the common hepatic duct was measured; duct size was then compared with probability of finding stones at operation. Of 115 patients entering the study, 36 had stones removed from the common duct at the time of cholecystectomy but only three (8%) were demonstrated by ultrasonography. No stones were found in ducts less than or equal to 3 mm in size (31% patients). Only two of 26 patients with ducts measuring 4 mm had stones. As duct size increased, so did the probability of stones and all patients with ducts greater than or equal to 9 mm in diameter had stones. It is concluded that pre-operative ultrasound provides a reliable basis for a policy of selective cholangiography.

Cholangiography↗
PubMed1990

Sex determination in the subadult ilia: an indirect test of Weaver's nonmetric sexing method.

The sexing of subadult remains has been an ongoing problem in physical anthropology for many years. This is due in part to the scarcity of subadult collections of known age and sex which are large enough to be used to develop and test analytical methods. Several methods have been devised but few have produced reliable results. In 1980, Weaver presented a method for sexing subadult ilia using a nonmetric trait (the raised versus nonraised auricular surface), which has an accuracy of 75% in fetal females and 92% in fetal males. His method has not been tested for reliability on a different subadult sample. An indirect test of Weaver's method was made on a sample of subadult South Dakota Arikara Indian ilia by comparing the ratio of raised to nonraised auricular surfaces with an expected 1:1 sex distribution. Bimodal sex distributions in the Arikara formed unrealistic sex ratios, following an age-related shift from a 6:1 raised/nonraised ratio in newborns to a 1:4 ratio in young adolescence. Significant age correlations were found both in the present study and in Weaver's published results. The age-to-sex correlations indicated no confounding in the present study. The results of this test suggest that auricular surface morphology is not sex specific in subadult ilia, but may be related to aspects of shape and morphology in pelvic growth.

Adolescent↗
PubMed1989

Pylorus-preserving pancreatectomy: functional results.

The pylorus-preserving technique is reported as improving the functional results of pancreatectomy but it is complicated in the early postoperative period by delayed recovery of gastric function in a proportion of patients. We have examined early and late gastrointestinal function in a prospective study of 16 patients having this procedure. The late results appear better than reported results for conventional Whipple resection and the delay in early recovery does not appear to have any late sequelae, provided that it does not require gastric bypass for relief.

Adult↗