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Biomedical subjects

D R Hunt

Publications and source records attributed to D R Hunt.

At least 73 records · Page 4Linked to original sources
PubMed1980

Iatrogenic choledochoduodenal fistula: an unsuspected cause of post-cholecystectomy symptoms.

In the investigation of 90 patients referred with severe post-cholecystectomy problems, 8 patients were found at ERCP to have choledochoduodenal fistula. The clinical features associated with the fistula included pain with fever, jaundice or hyperamylasaemia. Reviewing the details of the original surgery and the endoscopic findings, it is suggested that most, if not all, of these fistulas are iatrogenic. Treatment by biliary bypass is recommended.

Adult↗
PubMed1980

The identification of risk factors and their application to the management of obstructive jaundice.

In the presence of obstructive jaundice, surgical procedures are associated with high rates of mortality and morbidity. In an endeavour to identify risk factors associated with a poor outcome, a detailed prospective study of 28 jaundiced patients has been performed. Factors associated with a fatal outcome of operation were serum bilirubin level > 300 mumol/1, glomerular filtration rate < 50 ml/min, the presence of an abnormal level of fibrin degradation products (FDP) in serum, and the presence of endotoxaemia. Postoperative deep venous thrombosis was associated with low serum albumin, normal liver enzymes and rapid kaolin clotting time. Postoperative haemorrhage occurred in patients with FDP or endotoxaemia. Patients with normal renal function or elevated levels of liver enzymes were protected from sepsis. Based on the identification of these risk factors and of those patients with inoperable disease, a plan for management is proposed.

Bilirubin↗
PubMed1979

The role of grey scale ultrasonography in the investigation of jaundice.

Sixty-seven patients were prospectively studied using grey scale ultrasound (GSU) to assess its possible role as part of a jaundice investigation programme. All scans were performed by one radiologist, without clinical information. When intrahepatic ductal dilatation was found an attempt was made to establish the level and cause of obstruction. The calibre of the intrahepatic bile ducts was correctly reported in 66 patients (98 per cent). Forty-three proved to have extrahepatic cholestasis, 24 had intrahepatic cholestasis. No patient with intrahepatic cholestasis had dilated ducts seen on ultrasound. In 43 patients with obstructive jaundice, GSU accurately detected the level of obstruction in 28. This accuracy varied with the cause of obstruction. A direct indication of diagnosis was possible in 45 of the 67 patients. In a unit specializing in the management of complicated hepatobiliary problems, GSU has been shown to be accurate in differentiating extra- from intrahepatic jaundice. Being non-invasive, it appears ideally suited for use as a screening procedure, permitting selection of appropriate invasive investigations to provide complete preoperative imaging of the biliary tree. In patients with jaundice due to gallstones, GSU may be the only imaging technique required before surgery provided good operative cholangiography is available.

Bile Ducts, Intrahepatic↗
PubMed1979

Changes in liver blood flow with development of biliary obstruction in the rat.

As well as causing retention of biliary secretory products, bile duct obstruction is associated with other hepatic and systemic effects which are poorly understood. These latter changes contribute to the increased morbidity and mortality associated with surgery for biliary obstruction. This study examines the changes in liver blood flow occurring after common bile duct (CBD) ligation in the belief that relative hepatic ischaemia may contribute to dysfunction. A new method for measuring liver blood flow (LBF) based on the clearance of 133Xe from the liver following injection into the portal vein is described. With this new development, serial measurements of LBF can be performed in the conscious, unfasted rat. With the development of jaundice, a highly significant reduction in LBF is seen which is first evident 36 hours after CBD ligation. By the third day after ligation, LBF is only 54% of the control value. No fall in LBF is seen in rats subjected to sham ligation. The mechanism for the reduction in LBF is uncertain, but the delayed onset makes any relfex autonomic reaction unlikely.

Animals↗
PubMed1978

Illustrated multiple choice examinations.

Interpretation of visual data is an essential component of clinical competence. Illustrated multiple choice items have been used to measure interpretation, but the effects of introducing visual material into multiple choice items has not been critically assessed. A series of problem-sequenced multiple choice items containing, in the stem, a description of visual data such as a radiologist's report, was selected and matched with identical items where the description was replaced by reproductions of the original data. These two series of items were arranged into two parallel examinations which were taken by groups of final year medical students. From a comparison of the performance of the students in these two examinations it is concluded that substitution of actual visual data for the written description increases the difficulty of items, but is without consistent effect on discrimination. The illustrated format was commended by students for its clinical relevance but certain problems with the reproduction of radiographs and the selection of data have been revealed.

Australia↗
PubMed1976

Release of gastrin by vagal stimulation in the acid secretory response to food.

Gastric pouches were constructed in 8 dogs; in 4 they were of denervated type and in 4 the innervation was intact. An oesophageal fistula was then prepared in each dog. The acid secretory response to oral, tube and sham feeding was determined before and after denervation of the pyloric antrum. The results support the view that vagal release of gastrin makes a relatively small contribution to the total acid secretory response to food.

Animals↗
PubMed1976

The inhibitory influence of the pyloric antrum on gastric secretion in dogs.

The effect of the pyloric antrum and of subsequent vagotomy on the secretory responses of an innervated or a denervated gastric pouch in the dog to histamine and pentagastrin was determined. The increased sensitivity of the gastric pouch to stimulation after these procedures is in keeping with the concept that an inhibitory reflex is concerned with the control of acid gastric secretion.

Animals↗
PubMed1975

Etiology of strictures of the colon associated with pancreatitis.

Colonic strictures are an uncommon complication of pancreatitis. Three new cases are described and in each case the histological features strongly resemble those seen in strictures of ischemic origin. It is postulated that ischemia and not encircling pericolic inflammation, is the cause of strictures associated with pancreatitis.

Adult↗
PubMed1975

Effect of denervation of pyloric antrum on the gastric secretory response to food.

The effect of selective denervation of the pyloric antrum on secretory response to three types of food was determined in 3 dogs with innervated and 4 with denervated stomach pouches. With the antrum in situ this procedure has surprisingly little effect on the total meal responses in innervated pouches, on the variation in response induced by altered buffering capacity of the meals, or on the effect of subsequent vagotomy. However, the antrum appears less sensitive to local stimuli after denervation, as evidenced by the reduced meal response from the denervated indicator pouch after denervation of the antrum.

Animals↗