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Biomedical subjects

G A Kune

Publications and source records attributed to G A Kune.

At least 73 records · Page 4Linked to original sources
PubMed1983

Postoperative wound infections: a study of bacteriology and pathogenesis.

Of 200 patients, 6.5% were skin carriers of Staphylococcus aureus and 3.5% became skin carriers after admission. Development of skin carrier state was associated with a long preoperative hospital stay. A second study of 275 cases showed that skin carriers of S. aureus had a significantly higher subsequent staph wound infection rate than non-carriers, but nose and/or throat carriers of S. aureus did not. Peroperative wound contamination was a significant factor in the subsequent development of wound infection. In clean surgery the infection rate was 5.9%. Both wound contamination and infection was due to gram positive organisms, usually S. aureus. When the gastrointestinal or biliary tract had been opened, the infection rate was 28%, the usual contaminating and infecting organisms were enteric and only occasionally S. aureus. There is a need for improved methods of minimizing peroperative wound contamination.

Bacteriological Techniques↗
PubMed1983

Wound infection rates after gastric surgery in a Melbourne hospital.

In four groups of 25 patients in whom perioperative prophylactic antibiotics were not used, the wound infection rates after partial gastrectomy were 40% in gastric cancer, 44% in chronic gastric ulcer, 24% in chronic duodenal ulcer and after trunkal vagotomy and pyloroplasty, the wound infection rate was 12%. In gastric cancer and chronic gastric ulcer, most wound infections were caused by enterobacteria, while in chronic duodenal ulcer almost all infections were caused by Staphylococcus aureus. Appropriate short-term perioperative prophylactic antibiotic use is likely to decrease wound sepsis rate in patients who have a gastric resection in the presence of gastric cancer or gastric ulcer.

Adult↗
PubMed1983

A suction cone to prevent spillage during hydatid surgery.

A safe and reliable suction cone is described which has an important place in the surgical treatment of hydatid cysts and has been successfully used in 42 cases. This device may also have a role in the surgical treatment of huge malignant ovarian cysts.

Echinococcosis↗
PubMed1982

Carcinoma of the papilla of Vater.

Carcinoma of the papilla of Vater was diagnosed in 18 patients during the period 1970 to 1980. In ten patients, surgical treatment was facilitated by a preoperative diagnosis based on duodenal endoscopy, biopsy, cytology and retrograde cholangiopancreatography. Of 16 patients with apparently localised disease at laparotomy, nine had pancreatoduodenectomy (Whipple's operation), three had local resection and four had biliary bypass. Six of nine patients treated by pancreatoduodenectomy are surviving for periods ranging from one to ten years, mean four years, whereas the four patients treated by biliary bypass survived for 0 to 18 months. Tumour recurred in the region of the papilla in two of three patients treated by local resection. Carcinoma of the papilla of Vater is usually localised at the time of diagnosis and prolonged survival can be achieved by pancreatoduodenectomy.

Adenocarcinoma↗
PubMed1981

Cancer of the pancreas. Factors affecting survival.

Mean survival after diagnosis in 73 patients with cancer of the pancreas was 7.2 months. Mean survival was 8.7 months for patients who presented with obstructive jaundice, and 4.5 months for those who presented without jaundice, 8.2 months for patients with a head of pancreas tumour, 6.3 months for patients with the head and body tumour, and 5.0 months for those with the tumor in the body and tail of pancreas. Mean survival was 13.3 months for patients with a mobile, non-metastatic growth and 4.7 months when the cancer was fixed, or metastatic. Appropriate biliary and gastrointestinal bypass can prolong survival, as can radiotherapy combined with chemotherapy, while it is uncertain whether radical surgery prolongs survival. Uniform clinical and operative staging of pancreas cancer is desirable to learn about its natural history, and about the effects on survival of the various treatment modalities.

Aged↗
PubMed1980

Natural history of acute pancreatitis. A long-term study.

Detailed clinical and laboratory follow-up was made of 113 patients, two to 12 years after their first attack of acute pancreatitis, to assess complete recovery versus the development either of acute relapsing pancreatitis, or of chronic pancreatitis. Mortality was low in patients with recurrent attacks of acute pancreatitis. Complete recovery decreased wih increasing periods of follow-up. In the group of alcoholic patients, complete recovery decreased continuously with a corresponding increase in chronic pancreatitis. In the group of patients with gallstones, chronic pancreatitis developed up to about three years after the acute attack, after which the recovery rate remained steady. Chronic pancreatitis in the patients with gallstones was usually painless. In patients with idiopathic pancreatitis, a high incidence of acute relapsing pancreatitis was seen, but this rarely persisted after three years. Pancreas function rarely recovered completely after an attack of severe acute pancreatitis. Alcohol withdrawal decreased the pain syndrome, but not the development of chronic pancreatitis. Early removal of gallstones minimized the development of chronic pancreatitis. Complete recovery did occur after one attack of acute pancreatitis, but probably only when the aetiological antecedent (alcohol or gallstones) had not been operating for a long time, as it is the antecedent rather than the acute attack which determines the eventual outcome.

Alcoholism↗
PubMed1980

Juxtapapillary duodenal diverticula. Association with gallstones and pancreatitis.

Juxtapapillary duodenal diverticula were identified at duodenal endoscopy in 42 (9%) of 470 consecutive patients undergoing endoscopic retrograde cholangiopancreatography. Patients with duodenal diverticula had a higher frequency of gallstones disease (52% versus 35%) and of relapsing or chronic pancreatitis (26% versus 14%) and a higher frequency of recurrent bile duct calculi after biliary surgery (12% versus 2%). The association between gallstone disease and duodenal diverticula was corroborated by a second study showing a significantly higher frequency of gallstones in 350 patients who had a duodenal diverticulum on barium-meal X-ray examination.

Adult↗
PubMed1980

The objectives of palliative surgery in pancreas cancer: a retrospective study of 73 cases.

In 73 cases of pancreas cancer, histological diagnosis was not obtained in 43 (59%). Relief of obstructive jaundice was not satisfactorilly achieved in 14 of 39 patients at risk (36%), while gastric outflow obstruction developed subsequent to surgery in eight of 31 patients at risk (26%). Fine needle aspiration cytology is advocated to improve the rate of positive peroperative tissue diagnosis. To relieve bile duct obstruction, cholecystojejunostomy is advocated only in patients with pancreas cancer who have a very short life expectancy, and only when the cystic duct is patent. Choledochojejunostomy and gastrojejunostomy "double bypass" is advocated for cancers which are macroscopically localized to the pancreatic area. The selective use of this double bypass will improve surgical palliation and minimize reoperations in cancer of the pancreas.

Cholestasis↗
PubMed1979

Solitary liver abscess: a continuing medicosurgical problem.

The management problems of 22 patients with solitary liver abscess are reviewed. To achieve earlier diagnosis, and reduce the high mortality rate of this condition (32% in this series), clinicians need to change their data base of the clinical presentation and also to incorporate liver imaging as part of the routine investigation of a patient with pyrexia of uncertain origin. The problems associated with operative diagnosis, and with methods of surgical drainage are discussed. The need for careful bacteriological cultures is emphasized, and the use of the most appropriate antibiotics is described. While in many cases the cause of the liver abscess remains unknown, in Australia the possibility of the abscess being amoebic or an infected hydatid cyst should be kept in mind.

Adolescent↗
PubMed1979

Bile duct injury during cholecystectomy: causes, prevention and surgical repair in 1979.

Bile duct injury during cholecystectomy is almost always a high injury of the proximal common hepatic duct, because the surgeon mistakes this duct for the cystic duct and a segment of it is removed with the gallbladder. Most of these injuries are preventable by following certain principles of careful surgical dissection of the ductal system during surgery. Surgical reconstruction is always difficult, and restricturing of the anastomosis remains the most important problem. Recent advances in surgical technique have minimized the risk of recurrent stricture formation. At present the most suitable reconstruction for the typical high common hepatic duct lesion is a hepaticojejunostomy Roux-en-Y, using transhepatic intubation and a "mucosal graft" type of procedure. Biliary reconstruction was performed on 32 patients referred to the writer during the past 13 years resulting in six recurrent strictures needing a second reconstruction. At the end of 1978, 10 patients are too early to evaluate, two are dead and 20 have obtained a good final result.

Bile Ducts↗
PubMed1978

Cancer of the pancreas in young adults.

Two young women with cancer of the pancreas are described. The rising incidence and epidemiology of this cancer is discussed. The need for tissue diagnosis and some new aspects of treatment of pancreatic cancer relevant to these cases are presented.

Adenocarcinoma↗
PubMed1978

Accuracy in diagnosis of acute pancreatitis.

During an eight-year period, 113 cases of acute pancreatitis were studied to determine the accuracy and modes of diagnosis in the first attack. In 65% of cases, a confident diagnosis was made on a combination of the clinical picture and a marked elevation of the serum amylase level. Diagnosis on laparotomy was made in 30% of cases, and autopsy diagnosis in the remaining 5%. Cullen's and Grey Turner's signs, radiology test results, and the presence of hyperglycaemia were of little or no diagnostic value. Recently developed laboratory tests may increase the diagnostic yield in the future. The precise indications for laparotomy diagnosis in the first attack are discussed. Laparotomy for diagnosis did not increase the mortality rate in this series.

Acute Disease↗
PubMed1978

External pancreatic fistula: a recent advance in management.

The management of six consecutive recent cases of external pancreatic fistula is reported in which the use of total parenteral nutrition resulted in rapid closure of the fistula. The fistulae closed from 11 to 28 days after the commencement of total parenteral nutrition, with an average of 19 days. Surgical intervention to close the fistula was not required in any of the cases.

Adult↗
PubMed1978

Life-threatening surgical infection: its development and prediction.

A number of clinical, investigational, immunological, and peroperative host factors are identified which will predispose the patient to a serious postoperative infection that may endanger his life. The degree of the risk and the severity of the infection can be predicted, but only fairly crudely at present. The future holds a more precise identification of these risk factors and thus greater accuracy in predicting operative risk. The methods of preventing life-threatening postoperative infections, both those currently used and those projected for the future, are discussed.

Abscess↗