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Biomedical subjects

J M Ham

Publications and source records attributed to J M Ham.

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

The hepatic artery in liver transplantation.

Hepatic artery complications after liver transplantation are uncommon, but represent an important cause of morbidity and mortality. In addition, these complications tax an already limited supply of donor organs because of the frequent need for retransplantation in this group of patients. In this study, we examined the incidence of hepatic arterial anomalies in donors and recipients of orthotopic liver transplants, focusing on the techniques that are available for hepatic arterial reconstruction and on the occurrence of hepatic arterial complications. A total of 77 liver transplants were carried out in 68 patients. Standard recipient anatomy was present in 60 of 68 patients (88%). Anomalous vessels were identified in eight patients (12%), including six cases of replaced right hepatic artery (9%) and two cases of replaced left hepatic artery (3%). Donor liver arterial anatomy was standard in 62 cases (80%). Anomalous arterial supply was identified in 15 of 77 donor livers (20%), including replaced left hepatic artery in nine (12%) and replaced right hepatic artery in six (8%). A variety of methods were used to manage the anomalous vessels. There was one hepatic artery pseudoaneurysm, three cases of hepatic artery thrombosis (4%), and one patient developed a dissection of the native celiac axis. In primary transplants, utilization of the recipient's proper hepatic artery was associated with a significantly higher risk of hepatic artery thrombosis (P less than 0.04) when compared with the common hepatic artery or the branch patch technique. Use of a Carrel patch on the donor artery was associated with a significantly reduced incidence of hepatic artery thrombosis (P less than 0.0003). For retransplantation, it is recommended that a more proximal recipient anastomotic site be chosen. An innovative method is described that provides increased length of the donor arterial supply without the use of an arterial graft.

Hepatic Artery↗
PubMed1989

Liver transplantation at the University of Michigan.

Liver transplantation is a highly successful therapy for liver diseases that were previously debilitating and often fatal within a few months. One-year actuarial patient survival for our first 162 patients is 74.7%. Our results have improved since the inception of the program despite the fact that the indications have been extended to higher risk patients such as those with fulminating hepatitis or thrombosed portal veins. The prognosis following transplantation for each specific indication needs to be defined, especially for hepatitis, alcoholic cirrhosis and individual cancers. We believe that a more conservative approach to immunosuppression, close attention to intravenous and enteral nutrition, and aggressive treatment of complications (including prompt reoperation when indicated) have been important improvements in our management practices.

Adolescent↗
PubMed1987

Model of TPN-associated hepatobiliary dysfunction in the young pig.

Gallbladder 'sludge' and cholestasis are two common complications associated with total parenteral nutrition (TPN), but the aetiology of each is uncertain. An animal model has been developed in the young pig which demonstrates these two complications. Five female piglets, of Landrace Large White Cross variety weighing 4.5-5.9 kg, received nutritional support for 2 weeks with a continuous infusion of TPN solution at a dose of 150 kcal kg-1 day-1. The solution was 35 per cent dextrose, 5 per cent L-amino acids with conventional electrolyte, mineral and vitamin additives. No lipid was used in the solution. Five weight-matched animals were used as controls. All animals in the TPN group developed 'sludge' in their gallbladders, decreased basal bile flow, decreased bile salt excretion and a diminished response to bile salt stimulated bile flow, as compared with controls. There was no abnormality in routine liver function tests or liver histology. It is concluded that TPN therapy in this animal model is associated with the appearance of gallbladder 'sludge', and cholestasis as demonstrated by direct bile flow studies. It is suggested that this bile flow abnormality is due to a decrease in bile salt dependent and bile salt independent fractions of canalicular bile flow. The model provides the opportunity to investigate TPN related hepatobiliary dysfunction in an animal that has similar liver function to man and comparable nutritional requirements.

Animals↗
PubMed1986

Effect of haemorrhage on hepatic glutathione concentration: an experimental study in the pig.

Depletion in the hepatic concentration of reduced glutathione (GSH) may potentiate liver injury resulting from toxic metabolites. Patients who have had severe haemorrhage frequently develop hepatic dysfunction and we have shown that the hepatic GSH level is decreased in these patients. The present study has examined the time-course effect of a 30% haemorrhage on the hepatic GSH level by sequential biopsies of the liver. Acute and chronic experiments were performed and, in both, the hepatic concentration of GSH fell during the first 6 h after haemorrhage; this fall was followed by a significant rebound elevation at 24 h. In the chronic haemorrhage experiment the hepatic GSH level was normal at 1 week after haemorrhage. Thus, the susceptibility of the liver to toxic metabolite injury after haemorrhage persists for less than 24 h in this experimental model and haemorrhage appears to have no long term effect on the hepatic GSH concentration.

Animals↗
PubMed1985

Splenectomy for massive splenomegaly.

The technique, and short and long term results, of splenectomy for massive splenomegaly are presented. The latter was defined as a spleen weighing in excess of 1.5 kg. Thirty-five of the 38 patients had a serious haematological disorder as the indication for the operation, usually non-Hodgkin's lymphoma or myelofibrosis. All operations were carried out through abdominal incisions. Accessible splenic attachments were divided, and the splenic artery was ligated in continuity, prior to posterior mobilization. Two patients (5.3%) died as a result of the operation, both deaths being due to sepsis. Septic and thrombo-embolic complications were common, and occurred both early and late after the operation. Overall, eight of the 12 deaths during the first postoperative year were due to the primary disease, whereas all of the five deaths after that time were due to causes other than the primary disease. Twenty-four patients lived at least 1 year, and 10 patients are alive for more than 5 years.

Hodgkin Disease↗
PubMed1984

Pancreatic abscesses.

This paper presents the clinical features and problems in the management of 34 patients with pancreatic abscesses. In the majority of patients the abscesses developed following an attack of pancreatitis due to alcohol or gallstones. The abscesses were usually multilocular, and often had spread widely in the retroperitoneal space. Invasion into surrounding viscera or the peritoneal cavity occurred in 12 instances, and eight patients developed major bleeding into the abscess cavity. Obstructive complications (affecting bowel, common bile duct and large veins) occurred in eight patients. Twelve of the 34 patients (35 per cent) died, most deaths being due to failure to control sepsis (seven patients) or to massive bleeding from the abscess cavity (three patients). The mortality of this condition is likely to remain high, but may be reduced by better drainage techniques at the initial exploration. The importance of the infra-mesocolic approach for drainage is emphasized.

Abscess↗
PubMed1984

Cholescintigraphy in acute cholecystitis: use of intravenous morphine.

Conventional cholescintigraphy (60 patients) and a modified protocol (59 patients) were compared in 74 females and 45 males with acute cholecystitis. In the modified protocol, intravenous morphine (0.04 mg/kg) was administered whenever the gallbladder was not seen 40 minutes after injection of Tc-99m-pyridoxylideneglutamate (36/59). Accuracy was 98% with morphine, compared with 88% for the conventional protocol; specificity improved from 83% to 100% with no loss of sensitivity (96% in both groups). Low doses of morphine are well tolerated and can result in a highly accurate diagnosis of acute cholecystitis without the need for delayed imaging.

Acute Disease↗
PubMed1982

Factors influencing hepatic glutathione concentrations: a study in surgical patients.

1. Hepatic total glutathione (reduced plus oxidized) and oxidized glutathione levels were measured in operative wedge liver biopsy specimens obtained from 70 patients. 2. The effects on hepatic reduced glutathione (GSH) level of four potential risk factors (abnormal liver histology, abnormal preoperative tests fo liver function, drug ingestion and protein malnutrition) were examined. 3. Each of the four risk factors was associated with a significant reduction in hepatic GSH. Multivariate analysis indicated that only three of these risk factors (abnormal liver histology, drug ingestion and protein malnutrition) had independent effects in reducing hepatic GSH. 4. Twenty-five of the 70 patients studied did not have any of the four risk factors. The mean hepatic GSH level in these patients was 3.92 mumol/g of liver wet weight (SD 0.62), giving a 95% reference range of 2.71-5.14 mumol/g of liver net weight.

Adolescent↗
PubMed1981

Possible association of angiosarcoma with oral contraceptive agents.

Angiosarcoma of the liver has been reported to be associated with the long-term use of androgenic-anabolic and oestrogenic steroids. It has been suggested that this tumour might develop in women after long-term exposure to oral contraceptive steroids, although this association has not yet been reported. We present here the clinical and pathological findings in a 42-year-old woman who died of hepatic angiosarcoma after taking oral contraceptive steroids for 10 years.

Adult↗
PubMed1981

The ordering of blood for elective general surgical operations.

The current practice in ordering blood for common elective general surgical operations in the Prince of Wales Hospital has been studied. The numbers of patients having serum grouped and held and those having cross-matched were determined, together with the number of units cross-matched. The percentage of patients transfused and the number of units of blood given were then assessed for each procedure. The results demonstrated that blood was often ordered for patients who were most unlikely to require it. In addition, the amounts of blood ordered were frequently excessive, so that the cross-match-to-transfusion ratio (C/T ratio) for some procedures was high. We suggest that relatively simple changes in the current practice of ordering blood for operations should result in savings in costs, and most importantly, in a reduction in the wastage of blood.

Blood Transfusion↗
PubMed1980

Hemangioendothelial sarcoma of the liver associated with long-term estrogen therapy in a man.

An elderly male patient developed a hemangioendothelial sarcoma of the liver after 9 years of stilbestrol therapy. The latter had been commenced as treatment for presumed carcinoma of the prostate. However, the latter diagnosis was never established, even at a subsequent autopsy, and presumably this was the reason he survived and had such a long course of treatment. It is suggested that there was a causal relationship between the estrogen therapy and the development of the sarcoma. This suggestion is supported by the fact that one similar case has been reported, and by recent evidence that hemangioendothelial sarcoma may be associated with the long-term use of androgenic-anabolic steroids.

Aged↗
PubMed1980

Benign biliary strictures associated with chronic pancreatitis and gallstones.

A series of twenty-seven patients with benign non-traumatic biliary strictures is presented. Fifteen strictures were associated with chronic pancreatitis, and were typically long, tapered strictures of the intrapancreatic portion of the common bile duct. Twelve were associated with choledocholithiasis; these were usually short-segment and occurred both above and below stones in the duct. These strictures are important surgically, since they may produce pain, cholestasis and cholangitis, stone formation, and biliary cirrhosis. They may be difficult to distinguish from bile duct or pancreatic carcinomas. In the patients with chronic pancreatitis, treatment by biliary bypass was effective in the presence of cholestasis, but was ineffective for chronic pain. Treatment by biliary bypass or sphincteroplasty was highly effective in those patients with choledocholithiasis.

Adult↗