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Biomedical subjects

J B Hanks

Publications and source records attributed to J B Hanks.

54 records · Page 3Linked to original sources
PubMed1984

Hepatic resection for metastatic cancer.

One-year survival is infrequent in patients with metastatic cancer to the liver. This report includes 21 patients who underwent hepatic resection between 1974 and 1981. Operative procedures included one trisegmentectomy, 12 right hepatic lobectomies, two left hepatic lobectomies, two left lateral segmentectomies, and four wedge resections. Operative morbidity and mortality rates were 43% and 5%, respectively. Life-table analysis revealed an overall 7-year survival rate of 34%. The subset of patients (16) with colorectal adenocarcinoma had a 7-year survival rate of 29% after hepatic resection. In three patients with colorectal adenocarcinoma, frequent CEA determinations were made after surgery in order to calculate the serum half-life of CEA. The data fitted a biexponential function yielding two half-lives for CEA disappearance, 0.8 +/- 0.5 days and 25.9 +/- 10.3 days. We conclude that hepatic resection for isolated hepatic metastases can be performed with acceptable morbidity, low mortality, and prolongation of patient survival.

Adenocarcinoma↗
PubMed1984

Postoperative recurrence in Crohn's disease. The effect of the initial length of bowel resection and operative procedure.

We reviewed the surgical experience of 61 patients with Crohn's disease who have received surgical treatment over a 32-year period. Sex, age at onset of symptoms, associated systemic abnormalities, presenting symptoms, indication for previous surgery, and site of disease were not significant predictors of postoperative recurrence. Certain extensive resections of the small bowel are associated with a decreased probability of rehospitalization and reoperation. Resection of more than 25 cm of the small bowel and more than 50 cm of the "total" (small plus large) bowel was associated with a decreased likelihood of recurrence. Interestingly, analysis of larger resections (50, 75, 100 cm) failed to document a decreased likelihood of recurrence. The amount of large bowel resected did not predict postoperative recurrence. Bypass and diversion procedures offer a significantly enhanced risk for recurrent disease, whereas procedures employing resection are associated with lower probabilities of recurrent disease. We conclude that technically adequate resections of 25 to 50 cm of the small bowel or the combined small and large bowel are associated with a decreased probability of reoperation or rehospitalization after the initial surgery for Crohn's disease.

Adolescent↗
PubMed1984

The hepatic extraction of gastric inhibitory polypeptide and insulin.

The hepatic extractions of gastric inhibitory polypeptide (GIP) and insulin were determined using in vitro and in vivo methods to assess the role of the liver in GIP metabolism and the possible effect of GIP on the hepatic extraction of insulin. During in vitro studies using the isolated perfused rat liver, infusion of GIP (2000 pg/ml) alone and in combination with porcine insulin (200 microU/ml) resulted in negligible hepatic extraction of immunoreactive GIP (IR-GIP) in both fed and fasted animals during either physiologically euglycemic or hyperglycemic perfusions. Hepatic extraction of insulin, however, ranged from 26-36% in fasted animals and from 7-25% in fed animals. Hepatic extraction of insulin and net hepatic glucose appearance were minimally affected by GIP. In vivo studies in awake dogs were then performed, in which simultaneous portal and peripheral venous levels of IR-GIP, immunoreactive insulin (IRI), and glucose were assessed after intraduodenal glucose administration. The portal to peripheral (PORT/PERI) venous ratio of endogenous IRI and IR-GIP reflected the findings of the in vitro studies; the PORT/PERI ratio of IRI levels rose from a basal value of 1.9 +/- 0.3 to a peak of 3.7 +/- 0.9, while the PORT/PERI ratio of IR-GIP levels rose from a basal value of 1.0 +/- 0.1 to a peak of 1.4 +/- 0.2, then rapidly returned to 1.0. The in vivo data are consistent with a continuous hepatic extraction of 40-50% of the insulin entering the liver and a negligible hepatic extraction of IR-GIP. We conclude that hepatic extraction of GIP in vitro or in vivo is minimal. In addition, while the fed state of the animal before infusion can result in changes in the in vitro hepatic extraction of insulin, GIP does not mediate these changes.

Animals↗
PubMed1984

Hormonal contributions to biliary secretion.

Gastrointestinal hormones appear to be important modulators of bile flow and composition. Insulin and glucagon induce choleresis at physiologic levels and may alter lipid output and concentration as well. The effects of many hormones such as insulin, glucagon, secretin, and pancreatic polypeptide are at least partially independent of their effects on neurovascular factors. Furthermore, recently studied hormones such as somatostatin, vasoactive intestinal polypeptide, and pancreatic polypeptide have also been shown not only to alter bile flow but to affect bile composition. Understanding the role of gastrointestinal hormones in hepatic physiology may elucidate the causes of gallstone formation, disorders of biliary excretion, and hypercholesteremic states.

Animals↗
PubMed1983

Somatostatin suppression of canine fasting bile secretion.

Somatostatin, a peptide present in hypothalamus, gastric mucosa, and pancreas, suppresses several gastrointestinal functions. We evaluated the effect of graded doses of intravenous somatostatin on taurocholate-stimulated bile flow awake fasting dogs. Somatostatin doses of 1.5-200 ng . kg-1 . min-1 significantly suppressed fasting biliary flow. Biliary lipid concentration showed progressive elevations approaching 200% with 200 ng . kg-1 . min-1 somatostatin, while lipid outputs were not altered. The data suggest that somatostatin inhibited bile salt-independent canalicular or ductular secretion, because bile flow, chloride, and bicarbonate output, and the biliary clearance of erythritol were significantly reduced, while bile salt output remained unchanged. In addition, suppression of basal insulin concentration occurred at somatostatin infusion of 200 ng . kg-1 . min-1. Additional studies in anesthetized dogs demonstrated that somatostatin could suppress bile secretion without altering hepatic blood flow.

Animals↗
PubMed1982

Marginal ulcer. A difficult surgical problem.

One hundred sixty-six patients with documented recurrent or marginal ulcers following previous ulcer operations were seen at Duke Medical Center and the Durham VA Hospital from 1950 through 1980. Patients with the diagnosis of gastrinoma were excluded from the series. Evaluation of initial operation for recurrent ulcer showed that the highest recurrence rate occurred following non-acid-reducing operations. Analysis of the symptom-free interval following initial ulcer operation showed a significantly longer interval prior to recurrent ulcer development following gastroenterostomy than other procedures, while resection and Billroth I reanastomosis showed a significantly shorter symptom-free interval than did other procedures. Endoscopy proved 85% sensitive in making the diagnosis of marginal ulcer, while upper GI series was 71% sensitive. Surgical treatment of 132 patients resulted in a 20.4% recurrence rate of second marginal ulcer, with a 2.3% mortality rate and a 10.6% morbidity rate. Second operation for recurrent ulcer in 24 patients yielded no deaths, a 12.5% morbidity rate, and a 29.2% recurrence rate. Average follow-up for the series was 12.3 years, and ultimate outcome of treatment showed, of patients not lost to follow-up, a 58.2% satisfactory to excellent rating, while 42.8% of patients had an unsatisfactory result of treatment.

Adult↗
PubMed1982

Gastrointestinal complications after cardiopulmonary bypass.

Gastrointestinal (GI) complications after surgery requiring cardiopulmonary bypass (CPB) can be serious, often lethal events. In our study, from 1970 through 1981 there were 43 such complications after 5080 CPB cases (0.85%). We noted on annual persistent occurrence of approximately 1%. The overall mortality rate was 63%. The most frequent complication was hemorrhage (usually gastroduodenal). Other complications encountered were pancreatitis, cholecystitis, hyperbilirubinemia, bowel perforations or infarcts, and gastroduodenal alterations. We concluded that GI complications after CPB are associated with a high mortality rate and often occur with other complications. Careful judgment is needed for appropriate diagnosis and therapy.

Cardiopulmonary Bypass↗
PubMed1981

Chronic primary intestinal pseudo-obstruction.

Chronic primary intestinal pseudo-obstruction (CPIP) has received attention despite of its unclear etiology and infrequent occurrence. Recently a patient with this disorder had evidence of a primary visceral neuropathy. Reviewing the literature, we found 30 case reports of CPIP and evaluated their clinicopathologic findings. Presenting symptoms and radiologic findings were nonspecific. Esophageal motility was abnormal in 12 of 14 reports. Intestinal histopathology revealed normal muscle wall, mucosa, and ganglion cells in over 50% of reports. Only 48% of cases demonstrated clinical improvement. Thirty percent (8 of 30) ultimately died. We conclude that CPIP is a perplexing, often fatal entity that can mimic mechanical obstruction in the absence of definite etiology. Primary neurologic or muscular disease may be a possible explanation, but, as yet, definite documentation does not exist.

Adolescent↗
PubMed1980

Surgical resection for benign and malignant liver disease.

The indications for major hepatic resections in 32 patients and the results are presented. Twelve right lobectomies, eight partial left lobectomies, five left lobectomies, four extended right lobectomies and three partial right lobectomies were performed with a 46% complication rate and an operative mortality rate of 12.5%. Ten primary liver cancers, 12 metastatic lesions, four hemangiomas and six "benign" lesions were removed. Of seven patients with hepatomas, four are alive at an average of 24 months postresection and three have no evidence of recurrence. Of 11 adult patients with metastatic lesions, six are alive at an average of 27 months postresection and three patients have no evidence of recurrence. All four patients with hemangioma are alive at an average of seven years. As in other series, our experience has increased with seven resections prior to 1970 and 25 since. Operative mortality has decreased in that period of time (42% to 4%); however, our complication rate in survivors has remained elevated (25% to 50%). Our experience agrees with others that cautious selection of patients for resection of malignant tumors of the liver can extend survival.

Adolescent↗
PubMed1980

Postoperative function of "free" jejunal transplants for replacement of the cervical esophagus.

The postoperative function of "free" jejunal autotransplants for replacement of the pharyngoesophagus after palliative resection was evaluated in nine patients using clinical assessment, cinefluoroscopy, manometry, and electrical studies. After an initial period of adjustment, all patients swallowed solids and liquids with minimal difficulty, gained weight appropriately and were satisfied with their operations. Cinefluoroscopy and esophageal manometry demonstrated normal function of the intact distal esophagus, which correlated with the absence of reflux symptoms. The grafts were capable of contraction in response to local distension and maintained an intrinsic myoelectrical activity. These results indicate that jejunal autotransplantation may provide excellent palliation with restoration of a near normal swallowing mechanism for patients with large resectable lesions of the pharyngoesophagus. An additional observation was that the instillation of food directly into the gastric antrum caused a change in the motor activity in the transplantd jejunum, indicating physiological hormonal control of intestinal motility.

Aged↗
PubMed1980

Selective biliary secretion of basal and glucagon-inhibited neutral sterol after triparanol administration.

Biliary cholesterol secretion was studied in dogs with chronic bile fistulas, using glucagon, an inhibitor of biliary cholesterol secretion, and triparanol, an inhibitor of cholesterol synthesis. Glucagon inhibited neutral sterol secretion before and after triparanol administration. Triparanol caused a significant accumulation in bile of the cholesterol precursor desmosterol which comprised a significant portion of the neutral sterol in bile but not in blood. Glucagon inhibited both biliary desmosterol and cholesterol secretions to a similar degree. These findings suggest that biliary cholesterol is derived from newly synthesized hepatic sterol as well as from equilibrated sources. Furthermore, glucagon suppressed biliary secretion of both equilibrated as well as newly synthesized neutral sterol, suggesting that glucagon inhibits the movement of neutral sterol to or through the canalicular membrane.

Animals↗
PubMed1979

Inhibition of basal and meal-stimulated choleresis by somatostatin.

The effect of somatostatin, an inhibitor of release of a number of gastrointestinal and other hormones, on choleresis was investigated in chronic, bile fistula dogs with taurocholate-stabilized bile flow. Somatostatin inhibited both fasting and meal-stimulated choleresis, and bile flows during somatostatin inhibition of both fasting and fed dogs were similar, suggesting a complete suppression of factors causing feeding choleresis. Although a transient decrease in bile salt output was observed, bile salt output was unaffected during most of the period of bile flow inhibition. Hormone suppression by somatostatin, indicated by measurement of serum insulin, occurred over a similar time course as inhibition of choleresis. These observations provide further evidence for physiological humoral regulation of choleresis.

Animals↗
PubMed1972

Salmonellae as an index of pollution of surface waters.

Screening enrichments of surface water specimens by means of a polyvalent fluorescent antibody reagent for the salmonellae yielded approximately 60% more positive specimens than was obtained by cultural procedures. It is not known what fraction of the excess of fluorescent antibody-positive over culturally positive specimens represents staining of non-salmonellae or non-arizonae as opposed to the staining of non-cultivatable organisms of these two genera. Cotton gauze and rayon-polypropylene fiber swabs were equally sensitive for collecting salmonellae from the streams examined. Tetrathionate enrichment incubated at 41.5 C appeared to be superior to selenite-cystine for isolation of salmonellae from surface waters. Twenty-eight serotypes of Salmonella and two serotypes of Arizona were identified in the 121 positive specimens. In water rated moderately polluted, 65% of all specimens tested were positive; in minimally polluted waters, 38% were positive; and in unpolluted streams, 44% were positive.

Bacteriological Techniques↗
PubMedDate not supplied

A comparison of the haemostatic effect of Vivostat patient-derived fibrin sealant with oxidised cellulose (Surgicel) in multiple surgical procedures.

AIM: To evaluate the haemostatic properties of Vivostat patient-derived fibrin sealant in a broad range of surgical procedures. METHOD: In a prospective, randomised, multicentre, clinical study, typical surgical wounds of 69 patients (cardiothoracic, general, obstetric and gynaecologic, and vascular), requiring intervention to control bleeding, were treated with either Vivostat-derived sealant (n = 35) or Surgicel (n = 34) as required and the time taken to arrest bleeding was assessed. RESULTS: Compared with Surgicel, the mean time to haemostasis of Vivostat-derived sealant was significantly shorter (1.6 vs. 3.3 min, p < 0.0001) and more patients were successfully treated (i.e. no additional haemostatic measures required; 94 vs. 65%, p = 0.003). CONCLUSION: Vivostat-derived sealant is a more reliable and rapidly effective surgical haemostat than Surgicel.

Adult↗
PubMedDate not supplied

Effect of total laryngectomy on esophageal motility.

Total laryngectomy for cancer can result in dysphagia and altered esophageal motility. Manometric changes in the upper esophageal sphincter (UES), and in proximal and distal esophageal function have been reported. However, most studies have failed to take into account radiation therapy and appropriate controls. We selected ten male patients (54.3 +/- 1.9 yr) for longitudinal manometric evaluation prior to laryngectomy then at two weeks and again six months later. No patient received preoperative radiation therapy, had a previous history of esophageal surgery, or developed a postoperative wound infection or fistula. Seven of ten patients had positive nodes and received 6,000-6,600 rads postoperative radiation therapy. Preoperatively 4 of 10 patients complained of dysphagia which did not significantly change following surgery and radiation. Two of three patients who did not complain of dysphagia preoperatively and received radiation postoperatively developed dysphagia. No patient without dysphagia preoperatively who received no radiation therapy developed symptoms. Our studies show that laryngectomy causes alterations in the UES resting and peak pressures but not in the proximal or distal esophagus, or the lower esophageal sphincter. These data also imply radiation therapy may be associated with progressive alterations in motility and symptomatology. Further study regarding the effects of radiation on esophageal motility and function are urged.

Deglutition Disorders↗