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Biomedical subjects

J M Little

Publications and source records attributed to J M Little.

At least 127 records · Page 7Linked to original sources
PubMed1987

Duodenal trauma.

Fifteen cases of duodenal trauma that presented to Westmead Hospital between 1979 and July 1986 are reviewed. There were 12 blunt injuries, nine caused by motor vehicle accidents. Three patients sustained penetrating injuries, two due to stab wounds. Repair for blunt laceration or incised wound was by primary closure or serosal patch repair, most often with decompressive t-tube duodenostomy. No leak from the duodenal repair occurred in any patient. Two patients died. This was not due to complications of the duodenal injury. Pyloric exclusion, duodenal diverticulization or pancreaticoduodenectomy was not considered necessary in any patient. Morbidity of duodenal haematoma in the form of continuing abdominal pain may be avoided by intra-operative drainage.

Accidents, Traffic↗
PubMed1987

Malignant jaundice.

Fifty-five consecutive patients presenting to a Surgical Unit for management of malignant obstructive jaundice are reported in this paper. An increasing incidence of bile-duct carcinoma has been noted since the end of 1983. The hospital mortality for all cases was 15%, a figure which did not differ significantly from the 11% mortality associated with the surgical management of benign obstructive jaundice. The median survival of patients with malignant obstructive jaundice was 6 months and the 2 year survival 10%. The only long-term survivors were those in whom pancreaticoduodenectomy was employed. Until radical improvements in treatment are achieved, effective palliation must remain the goal for the surgeon. This means that there is a need for rapid diagnosis, rapid decision making and early intervention to restore bile flow to the intestine. The best palliative procedure has yet to be defined and the status of stent insertion, of surgical bypass procedures and of palliative resection of some tumours remain unclear. Similarly, the place of adjuvant chemotherapy and radiotherapy have not been clearly established. There is a real need for a trial of various methods of treatment which employs an evaluation that takes into account both duration and quality of life.

Australia↗
PubMed1987

The changing pattern of vascular surgery: the effect of percutaneous transluminal angioplasty.

The pattern of vascular surgery at Westmead Hospital from 1979 to 1985 has been reviewed. There has been an upward trend in the number of patients having repair of abdominal aortic aneurysm and carotid endarterectomy. However, the number of operations for peripheral vascular disease has not increased. This may be due to the increasing use of percutaneous transluminal angioplasty (PTA), but it may also be associated with the increasing difficulty in obtaining hospital admission for patients with conditions not immediately life or limb threatening.

Aged↗
PubMed1987

Hepatic resection for colorectal metastases--selection of cases and determinants of success.

Twenty-six patients undergoing hepatic resection for colorectal metastases have been followed for periods varying from 1 month to 8 years. The actuarial 5 year survival rate was just over 50% for all patients. Patients surviving for more than 2 years have been considered separately, and an attempt was made to determine what clinical factors determine whether a patient is likely to benefit from surgery or not. A stage I hepatic lesion, involvement of one rather than both lobes, the presence of less than four metastases and pathological proof that resection margins were free of tumour combined to define a group of patients with a 75% 5 year survival rate. The stage of the disease and the presence of unilobar metastases were the most important determinants of benefit. Patients demonstrating one or more unfavourable factors did not appear to benefit from hepatic resection.

Adult↗
PubMed1987

A method of calculating the value of palliative care of cancer patients.

There are no entirely satisfactory methods for measuring the value of palliative treatment of advanced cancer. A useful instrument of measurement should take into account both length and quality of survival. A method is proposed for determining the area under the time-quality of life curve, using Simpson's discrete approximation, an algorithm which can be programmed simply into a small computer or programmable calculator. The Karnofsky index has been used as an indicator of the quality of life, but the method is adaptable to other quality of life scales. Efficiency of palliation can be estimated by comparison with the area produced by theoretically perfect palliation. The ability to quantitate palliation in these ways might help to resolve uncertainties that surround the alternative methods of management of incurable cancer.

Humans↗
PubMed1987

Isolated tuberculous hepatic abscess.

Tuberculous hepatic abscess occurs rarely, most of these being associated with tuberculosis at other sites. Only 11 reports of isolated tuberculous hepatic abscess have been made in the English literature. A further case of isolated tuberculous hepatic abscess is reported with particular emphasis on the difficulty that may be encountered in reaching the correct diagnosis.

Adult↗
PubMed1987

Electrical stimulation in the treatment of chronic venous ulceration.

A clinical study was conducted over a 2 year period to assess the effect of four different treatments on the healing of venous leg ulcers. The treatments consisted of standard local applications of povidone-iodine or normal saline, with and without electrode therapy. At weekly intervals, ulcer areas were measured using a newly developed technique. This allowed time-to-heal data to be analysed. A comparison of the four treatments revealed a highly significant retarding effect on ulcer healing by the povidone-iodine plus electrode treatment. There were no statistical differences for comparisons made between povidone-iodine alone and normal saline alone or for normal saline with and without electrode. Covariates were considered in the analyses. Patient sex and initial ulcer area were identified as significant factors in ulcer's time-to-heal (P less than 0.05), while patient's smoking habits, age and ulcer's initial total organism count had no influence.

Aged↗
PubMed1987

Hyodeoxycholate-6-O-glucuronide cannot be quantitated with 3 alpha-hydroxysteroid dehydrogenase.

The reaction of the 6-hydroxylated bile acid, hyodeoxycholic acid, and its 6-O-glucuronide conjugate with 3 alpha-hydroxysteroid dehydrogenase was examined. A standard end-point assay and determination of the initial rates of reaction showed only minimal activity of the enzyme toward hyodeoxycholate-6-glucuronide in spite of the presence of a free 3 alpha-hydroxyl group. It was established that 6-hydroxylation itself did not significantly affect the enzyme reaction. It is concluded that the 6-glucuronide either blocks or hinders enzyme access to the 3-hydroxyl group.

3-Hydroxysteroid Dehydrogenases↗
PubMed1987

A prospective evaluation of computerized estimates of risk in the management of obstructive jaundice.

This article reports on a prospective study of 46 patients who had undergone treatment for obstructive jaundice. Previously described computer estimates of risk were calculated, as were the K value and the mortality index. The computer was no more accurate than an experienced clinician in the prediction of morbidity. In the prediction of mortality, however, the computer was far more accurate than the clinician. Clinical prediction of mortality was associated with a risk ratio of 3.2, a critically elevated K value with a risk ratio of 21.7, and an elevated mortality index with a risk ratio of at least 70. In conclusion, both measures have some use in providing objective measures of stratification among patients with jaundice. The mortality index is also useful in the determination of a program for clinical management and, in particular, the timing of any surgical intervention.

Adult↗
PubMed1987

Alcohol abuse and chronic pancreatitis.

The relationship between alcohol abuse and pancreatitis is now better defined than it once was. However, the effects of abstinence on the outcome of treatment are less clear, although it is generally assumed that abstinence is associated with a better outcome. The present study of 28 alcoholics confirms the importance of abstinence and demonstrates an important relationship between narcotic abuse and continued drinking. This suggests a profound psychosocial disturbance in a patient unlikely to benefit from surgery. These findings justify recommending other approaches to the management of patients with chronic pancreatitis who are likely to continue to drink, particularly when there is a history of significant narcotic abuse.

Adolescent↗
PubMed1986

Serum bilirubin after surgery for obstructive jaundice.

A method of analysis of bilirubin clearance is suggested, which allows the calculation of a decay constant (k) and half-life (t0.5). These parameters allow ready comparison of the bilirubin clearance between patient groups. The value of k could be predicted with reasonable accuracy by a regression equation employing as determinants a score for cholangitis, pre-operative serum ALT and bilirubin, and the patient's sex. Bilirubin clearance is known to correlate strongly with antipyrine clearance, and antipyrine clearance with prognosis after biliary drainage. A similar prognostic index may be derived from simple clinical and biochemical parameters which will predict the decay constant and half-life of endogenous bilirubin.

Adult↗
PubMed1986

The relationship of nutritional parameters to mortality and septic complications.

The relationship of a number of nutritional parameters to mortality and sepsis was assessed in a group of 82 patients requiring total parenteral nutrition (TPN). Duration of TPN ranged from 9 to 105 days with a mean of 32.3 days. Parameters assessed were serum albumin, transferrin, absolute lymphocyte count (ALC), delayed hypersensitivity skin test reaction, mid-arm muscle circumference, triceps skin-fold thickness and weight. Combinations of parameters were found to be more useful than single parameters. The only single parameter of significance was ALC. The best overall predictor of death and/or sepsis was a combination of reduced serum albumin, transferrin, ALC and anergy, which was found to be related to a significantly higher mortality (P = 0.002) and incidence of septic complications (P = 0.003). This combination of parameters also had the best specificity (90%), accuracy (79%) and positive predictive value (65%) for prediction of death and/or sepsis. Increasing age was also found to be associated with a higher mortality (P less than 0.001) and increased incidence of septic complications (P = 0.01).

Adolescent↗
PubMed1986

Home parenteral nutrition: Westmead Hospital experience.

Home parenteral nutrition (HPN) has been used in 13 patients over a 7 year period for intervals ranging from 14 to 608 days with a mean of 255 days. This represents a total experience of 3315 patient days or 9.1 patient years. The commonest causes for intestinal failure requiring HPN were short bowel syndrome following massive small bowel resection for mesenteric ischaemia (four patients), and radiation enteritis (three patients). Four patients died, including three of four who had presented with mesenteric ischaemia and one from disseminated malignancy. One of the deaths was from massive pulmonary embolus and may have been catheter-related. Seven patients were able to cease HPN after a mean of 200.7 days because of treatment and/or improvement in the underlying cause of their intestinal failure. Central venous thrombosis was the commonest complication and occurred in six patients, including the four who died.

Adolescent↗
PubMed1986

A new means of assessing healing in chronic venous ulceration.

A new method of assessing venous ulceration has been developed using a camera, slide projector, viewing box and planimeter. This method is accurate and reproducible. Thirteen patients with chronic venous ulcers were studied. The method enabled a healing curve to be constructed for each ulcer. The healing rate for the group was determined by construction of a linear regression line of best fit through the averaged data points. This method allows accurate comparisons to be made between treatment regimes.

Chronic Disease↗
PubMed1986

Anergy and the severely ill surgical patient.

Delayed hypersensitivity skin test reaction was evaluated using Multitest CMI, an implement which provides seven standardized antigens in a single application. Eighty-two patients requiring Total Parenteral Nutrition for a variety of conditions were studied. The incidence of anergy was 65%. Seven anergic patients died, but there were no deaths in the reactive group, this difference being significant (P = 0.04). There was a significant association of anergy with carcinoma (P = 0.007) and anergic patients with carcinoma had a significantly greater risk of dying than reactive patients without carcinoma (P = 0.038). Anergic patients also had significantly lower nutritional parameters of serum albumin (P = 0.04), transferrin (P less than 0.001), absolute lymphocyte count (P = 0.009) and mid-arm muscle circumference (P = 0.02) compared to the reactive group.

Adolescent↗
PubMed1986

Percutaneous transluminal angioplasty for severe lower extremity ischaemia.

Percutaneous transluminal angioplasty (PTA) was attempted on 70 occasions in 63 consecutive patients presenting with advanced ischaemia. The procedure was technically successful in 64 (91%) with haemodynamic improvement in 39 (56%) and clinical improvement maintained at 6 months in 51 (73%). Follow-up ranged from 6 months to 4 years and life-table analysis showed 60% success at 1 year and 58% success at 2 years. Overall limb salvage was 76%. Complications occurred in 6 (9%) and in one case this lead to amputation. The relationship of a number of associated factors to outcome was assessed. The presence of cardiac disease requiring treatment for failure or angina was a highly significant adverse factor (P less than 0.001). Decreasing age and greater extent of disease were also significant adverse factors (P less than 0.05). Therefore, because of its low morbidity and cost, PTA can be seen as a useful procedure in patients presenting with advanced peripheral vascular disease.

Adult↗
PubMed1986

High calorie and protein clear fluid regime for pre-operative bowel preparation.

The effect of a high calorie and protein clear fluid regime for pre-operative bowel preparation was assessed in 16 patients requiring aortic grafting for aneurysm or occlusive disease. Patients were randomized to receive either standard clear fluids or a special high calorie and protein clear fluid regime for 48 h pre-operatively. Nitrogen balance was calculated for the first 5 postoperative days. The group receiving the special high calorie and protein clear fluid regime had a consistent reduction in negative nitrogen balance on each day of the study with a mean daily negative nitrogen balance of 9.00 g compared to 12.33 g, this difference being highly significant (P = 0.004).

Aged↗