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Biomedical subjects

D R Hunt

Publications and source records attributed to D R Hunt.

At least 55 records · Page 3Linked to original sources
PubMed1989

Changes in bile duct diameter after cholecystectomy: a 5-year prospective study.

In this prospective study, we have measured with ultrasound the diameter of the common hepatic duct and the common bile duct in a series of 24 patients having elective cholecystectomy. Preoperative measurements by ultrasound were compared with measurements taken directly from operative cholangiograms and excellent correlation was observed (r = 0.938). Studies were repeated 1 mo, 12 mo, and 5 yr after operation. Of 21 patients returning for study at 5 yr, there were 4 patients with 1-mm ducts before surgery who showed an increase in the size of the common hepatic duct but in none was the final measurement greater than 4 mm. Mean common hepatic duct diameter (n = 21) increased from 3.95 mm before to 4.48 mm 5 yr after surgery (p = 0.24, paired t-test). Common bile duct was more easily seen after cholecystectomy and of 13 ducts satisfactorily measured 1 and 5 yr after surgery, 7 showed an increase in size (mean common hepatic duct 1 yr = 4.77 mm, 5 yr = 5.92 mm, p = 0.059, paired t-test). Significant dilatation of the common hepatic duct was seen in only 2 of 21 patients, but a strong trend to minor dilatation was observed in the common bile duct after cholecystectomy.

Cholecystectomy↗
PubMed1989

Recurrent hepatic hydatid disease or prior omentoplasty: diagnostic dilemma.

Endocystectomy combined with omentoplasty has become an accepted technique in the treatment of hydatid disease of the liver. Its attractiveness lies in its simplicity, its low frequency of postoperative biliary fistula, and the lack of specific complications related to the omentoplasty itself. However, radiological appearances after this procedure may be confusing. Two patients with upper abdominal pain are described in whom the radiological appearances of a previous omentoplasty could not be distinguished from a recurrent hydatid cyst.

Adult↗
PubMed1989

Angiomyolipoma of the liver.

Hepatic angiomyolipoma is a rare tumour of the liver. Its behaviour is benign and this paper reports the first case described in Australia. A review of the literature suggests that the use of ultrasonography, computerized tomography and angiography should enable pre-operative diagnosis to be made with relative certainty, yet the difficulties with histological diagnosis, particularly on needle biopsy, may necessitate resection.

Female↗
PubMed1987

Abdominal wound drainage--a prospective, randomized trial.

Prophylactic drainage of abdominal wounds with a closed suction system has been carried out in a prospective, randomized trial. There was no significant difference in the incidence of haematomas or infection rates in the groups with or without drainage. We conclude that wound drainage should be reserved for selected cases and that routine prophylactic drainage should not be practiced.

Abdominal Muscles↗
PubMed1987

Suprapubic catheters: a comparison of suprapubic versus urethral catheters in the treatment of acute urinary retention.

Sixty patients presenting with acute urinary retention were randomly allocated to treatment with either suprapubic or urethral catheters. An initial specimen of urine was obtained for bacteriological culture and organism count. Subsequently, repeat specimens of urine were obtained at intervals of 2 days until the catheter was removed. The results of these cultures showed that suprapubic catheters caused less urinary tract infection (P less than 0.05). In addition, suprapubic catheters were more comfortable for the patients, easier to manage and more cost-effective. In patients with suprapubic catheters, their ability to void could be assessed prior to removal of the catheter, thus avoiding the need for recatheterization. It was concluded that patients presenting with acute urinary retention should be routinely treated by drainage using suprapubic catheters.

Acute Disease↗
PubMed1986

Surgical aspects of pancreatic abscess.

In a retrospective study of all patients admitted with acute pancreatitis to a single hospital over the 10 year period 1975-1984, 22 patients operated upon for pancreatic abscess complicating acute pancreatitis were identified. The accuracy of the assessment by the surgeon of the extent of the abscess and the results of treatment by either local or wide drainage have been reviewed. The surgeon underestimated the extent of the abscess in 5 of the 22 patients. Four of these five patients were assessed as having a localized abscess presenting in the lesser sac and, in the other, the abscess was thought to be confined to the tail of the pancreas. Local exploration and drainage were performed in 13 patients and resulted in a high morbidity and mortality (54 per cent). Wide exploration was performed in nine patients with only two deaths, despite the greater extent of abscess formation. Improvement in outcome seen in the second 5 year period appears to be due to a more aggressive approach to exploration and drainage. The surgeon must be aware that abscesses in the lesser sac often signify more widespread abscess formation. Without wide exploration of the pancreas, assessment at laparotomy is likely to be unreliable. There appears to be additional benefit from wide drainage, even where abscess formation appears localized.

Abscess↗
PubMed1986

Long term biliary access by modified hepaticojejunostomy for high bile duct stricture.

Patients with recurrent high bile duct strictures pose special problems for management. Relief of obstruction by hepaticojejunostomy is usually possible but the standard technique does not permit long term access. Six patients with benign strictures involving hepatic ducts have been treated by a simple modification of hepaticojejunostomy retaining access for either balloon dilatation of intrahepatic strictures or investigation and treatment at a later stage if problems recur. Employing a longer than usual Roux-en-Y loop, the sutured anastomosis of right and left hepatic ducts is performed 10-15 cm from the free end of jejunum. Silastic tubes are placed into each hepatic duct crossing the anastomosis to exit from the free end of the jejunum which is closed around the tubes. The closed end of jejunum is buried in the peritoneum deep to linea alba and the tubes emerge in the epigastrium. Safe access is retained via the tubes. If the tubes are removed, a 'mini-lap' will expose the Roux loop for endoscopic or radiological access.

Adolescent↗
PubMed1986

Shigella dysenteriae type 1 enterocolitis.

Shigella dysenteriae type 1 is much more virulent than Shigella flexneri and sonnei which are endemic in Australia. This report describes a 22 year old woman who acquired Shigella dysenteriae type 1 whilst travelling in India. During the course of her illness, she developed severe enterocolitis for which a subtotal colectomy was performed. The illness resembled fulminant ulcerative colitis and its infectious nature was difficult to establish because several fecal cultures failed to grow the pathogen. Her infection was complicated by shigella bacteremia, disseminated intravascular coagulation, and renal cortical necrosis which requires continued hemodialysis.

Adult↗
PubMed1985

Bile duct obstruction by villous papilloma of duodenum.

Two cases of peri-ampullary villous adenomas involving the common bile duct are reported. The pathology of benign duodenal tumours is discussed, and the possibility of common bile duct involvement, albeit uncommon, is stressed. Obtaining an endoscopic histologic diagnosis is important in planning appropriate operative treatment. Although benign, these tumours should be removed; they are a cause of serious symptoms and have proven premalignant potential. Endoscopic removal is usually not possible. Endoscopy for dyspepsia should include examination of the second part of duodenum, to avoid overlooking duodenal tumours.

Aged↗
PubMed1985

A simple nutrition screening procedure for hospital patients.

Nutrition screening is the process of identifying hospital patients with a high risk for nutrition problems who may require comprehensive nutrition assessment. Dietitians at a 700-bed teaching hospital recently implemented a nutrition screening program remarkable for efficient use of existing personnel resources. The three-step procedure includes a nutrition questionnaire completed by the patient in the hospital admissions office, measurement of each patient's height and weight by an admissions nurse, and addition of the patient's serum albumin concentration plus summary and recommendations for nutrition intervention by a registered dietitian. The procedure reduces the time needed for individual evaluation from 25 to 5 minutes and results in 1 1/2-hour time saving per day per clinical dietitian. Patients designated as "high risk" by this method appear to be more seriously ill, as shown by significantly longer hospitalization. The nutrition screening procedure described is simple, efficient, and applicable to a wide variety of institutional settings.

Admitting Department, Hospital↗
PubMed1982

Endotoxemia, disturbance of coagulation, and obstructive jaundice.

A prospective study of coagulation disturbances and endotoxemia in 42 patients having major pancreatic or biliary surgery was performed. Endotoxin, soluble fibrin, and fibrin degradation products were measured before and after operation in 28 patients with obstructive jaundice and in 14 nonjaundiced controls. In the control group there was one death and no unexplained fever or postoperative hemorrhage. The jaundiced group had more complications: seven deaths, nine episodes of fever, and six episodes of hemorrhage. Soluble fibrin was detected only in patients with obstructive jaundice, in whom it occurred in 38 percent before operation. Positive endotoxin assay was as common in control patients as in the jaundiced group, but in the latter endotoxin was associated (p less than 0.05) with increased FDP and soluble fibrin. Patients with endotoxin or increased FDP levels before operation for jaundice carry a poor prognosis (7 of 11 died). Preoperative bowel preparation in 16 of the jaundiced patients did not affect the outcome.

Adult↗
PubMed1982

Preoperative differentiation between carcinoma of the pancreas and chronic pancreatitis: the contribution of cytology.

In a prospective study of 54 consecutive patients where carcinoma of the pancreas was suspected, a simple protocol was employed. Each patient had duodenoscopy and pancreatic juice cytology. Those patients with jaundice had cholangiography by percutaneous or endoscopic retrograde technique. Patients who were not jaundiced had endoscopic retrograde cholangiopancreatography. Malignancy, confirmed by histology, was diagnosed in 25 patients. Patients diagnosed to have benign disease have been followed for two years and in none has the diagnosis changed to malignancy. Twenty-one of those with carcinoma were correctly diagnosed on the basis of cholangiograms or pancreatograms but there were three false-positive diagnoses of malignancy. Cytology identified 15 of the 25 with carcinoma; there were no false positive diagnoses. Pancreatic cytology is highly specific for the diagnosis of carcinoma and should be used early. In patients with negative cytology, an acceptable level of accuracy can be achieved by a combination of endoscopy and radiology.

Carcinoma↗