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Biomedical subjects

J M Little

Publications and source records attributed to J M Little.

At least 145 records · Page 8Linked to original sources
PubMed1986

Percutaneous transhepatic dilatation in the management of bile duct strictures.

Despite improvements in surgical techniques, some complex bile duct strictures continue to present difficult management problems. Strictures recurring after previous biliary-enteric bypass, those associated with established biliary cirrhosis or coexistent malignancy, and those that follow hepatic resection may pose almost insuperable technical and physiological problems. Percutaneous transhepatic balloon dilatation will not solve all problems, but can help in some instances. Six patients are presented in whom this technique has been used in attempts to overcome particular problems. The strengths and weaknesses of the method are discussed.

Adult↗
PubMed1986

Liver trauma.

A series of 97 patients has been studied who were treated for liver injury at Westmead Hospital between January 1979 and January 1985. Patients were noted to be younger than those reported in previous series from Sydney, and to have suffered more frequent, significant, head injuries. Paramedical roadside intervention probably allowed more patients to reach hospital alive than was the case before the advent of the Intensive Care Ambulance system. Improved organ imaging has allowed more confident non-operative management of 13% of patients. Hepatic resection has been used infrequently (10%). Packing has been used in six patients as part of the definitive treatment of severe injuries and coagulopathy, and to allow the transfer of a further seven patients from peripheral hospitals. Ten of these 13 patients survived. Head injury continues to be a major cause of death in these patients. Death from the liver injury itself is usually associated with high grade damage to the liver and the associated hepatic veins and vena cava. It is speculated that improvement in the management of these lethal injuries will come about only from the early identification of patients likely to have suffered such trauma, and the pre-operative control of bleeding. Balloon catheter placement under radiological control, to tamponade the inferior vena cava and abdominal aorta, is suggested as one means by which this goal might be achieved.

Adolescent↗
PubMed1986

Trauma triage--a comparison of the trauma score and the vital signs score.

A pilot study of the Trauma Score (TS) was performed from July to September 1983. The Vital Signs Score (VSS) used by the ambulance paramedics, was compared with TS. Of 266 patients suitable for study, TS data was collected for 110. Other exclusions resulted in a detailed analysis of data from 65 patients among whom there were eight deaths. There was a significant correlation between TS and VSS, however, TS more accurately defined the population at risk of death. A score greater than 12 correlated with a mortality of zero for the TS, but for the VSS it correlated with a mortality of 4.4%. A score less than or equal to 12 correlated with a mortality of 61.5% for the TS but only 30% for the VSS. Stepwise regression analysis of the TS, VSS and combinations of their components was performed to determine their capacities to predict death. A combination of three components of the TS, corresponding to the Triage Index of Champion, was a better predictor than the total TS. Neither the VSS nor any combinations of its components had the predictive capacity of the total TS. If the TS and the VSS were used to select high risk patients for a particular rescue or resuscitation protocol, and scores were selected which gave 100% sensitivity with the highest possible specificity, the positive predictive values of the TS and VSS would be respectively 61.5% and 26.7%. The protocol would be administered unnecessarily to 73.3% of patients selected by the VSS, but only to 38.5% of patients selected by the TS. The TS is proposed as an aid to triage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Intrahepatic biliary-intestinal bypass in malignant jaundice.

There is still dispute as to the best treatment for obstructive jaundice of malignant origin when the bile ducts are blocked high in the porta hepatis. Intrahepatic duct-to-jejunal anastomoses provide a surgical solution which frees the patient from the need to wear external appliances. A series of eight patients having such anastomoses have been studied to determine the adequacy of bilirubin clearance, the durability of relief from jaundice, the length of hospital stay, the operative mortality and survival from the time of surgery. Intrahepatic bypasses were shown to allow bilirubin clearance in the lower range of normal. Freedom from jaundice persisted until death at a median time of 5 months from operation. Cholangitis was not a problem in any patient postoperatively. There was only one operative death. The major disadvantage of the technique arose from the hospital stay, a median of 30 days. It is suggested that all these factors should be considered in studies to compare surgical bypass with endoscopic or percutaneous methods for the relief of malignant jaundice.

Aged↗
PubMed1986

A comparison of parenteral nutrition and early postoperative enteral feeding on the nitrogen balance after major surgery.

The nitrogen balance in 28 patients undergoing aortic grafting for aneurysm or occlusive disease was studied. Patients were randomized to receive after surgery either standard intravenous fluids (group 1), parenteral nutrition (group 2), or early postoperative enteral feeding (group 3). The mean daily negative nitrogen balance was 11.22 gm in group 1, 4.20 gm in group 2, and 4.14 gm in group 3. The difference between group 1 and groups 2 and 3 was highly significant (p less than 0.001), but there was no significant difference between groups 2 and 3. It is concluded that early postoperative enteral feeding can be as effective as parenteral nutrition in reducing the negative nitrogen balance induced by major surgery.

Adult↗
PubMed1985

Variceal bleeding.

Explore the source record for details and available documents.

Esophageal and Gastric Varices↗
PubMed1985

Obstructive jaundice in a referral unit: surgical practice and risk factors.

A series of 46 consecutive patients with obstructive jaundice have been referred to a surgical unit with a special interest in hepatobiliary surgery. The cases were evenly divided between benign and malignant causes. The hospital mortality was 13% (six cases), and the mortality was also evenly divided between the two subgroups. A scoring system has been devised to rate 12 easily measured clinical and pathological parameters, and a regression analysis used to measure the contribution made by each parameter to hospital morbidity and mortality and to later mortality over a 5 year period. Previous bile duct trauma and liver damage were the major determinants of hospital morbidity, while bile duct trauma, liver disease, acute pancreatitis and increasing age were the significant determinants of hospital mortality. Malignancy and cirrhosis determined late mortality. A plea is made for the early referral of high risk patients to specialized units, particularly when bile duct trauma is involved.

Australia↗
PubMed1985

Hepatic haemobilia: non-operative management in eight cases.

Eight cases of major haemobilia have been seen by the Surgical Hepatobiliary service at Westmead Hospital between 1979 and 1984. Two occurred following blunt abdominal trauma, three after percutaneous biliary drainage or liver biopsy, two in association with postoperative haemorrhagic pancreatitis and one because of an abscess complicating hepatic hydatid disease. Coeliac and superior mesenteric angiography were carried out in all patients, and false aneurysms were demonstrated in seven of the eight. A marked coagulopathy was present in the remaining patient, in whom bleeding stopped without intervention when the coagulopathy was reversed. Those with false aneurysms were treated by radiologically controlled transarterial embolization with gelfoam, acrylate or Gianturco coils, and bleeding was controlled in all. There was one death from overwhelming sepsis in the patient with the hepatic abscess. It is concluded that percutaneous radiologically controlled embolization is the treatment of choice for most cases of haemobilia, except when there is major hepatic sepsis.

Acute Disease↗
PubMed1985

Long term central venous access catheters: review of 134 catheters inserted in 100 patients.

The first 100 patients at Westmead Centre who received long term central venous access catheters were reviewed. The indication for insertion in 77% of the patients was administration of chemotherapy, 15% had insertion for parenteral nutrition and 8% for blood product administration or anti-microbial therapy. Catheter manipulations were carried out under strict aseptic conditions by a limited group of nursing staff. Of the catheters, 73.1% functioned satisfactorily and were removed electively or were functioning at death or time of review. The main reason for removal was suspected infection, but this was proven in only 4.5% although strongly suspected in another 5.2%. The infection rate was 13 episodes per 13 987 catheter days. The duration of function of catheters was analysed by the life table method, demonstrating a 50% catheter survival rate of 300 days.

Adolescent↗
PubMed1985

Use of a microcomputer in the assessment of diagnosis and risk in obstructive jaundice.

A series of multivariate analyses have been carried out in 49 patients with obstructive jaundice and three indices have been derived which help in the assessment of risk and the planning of investigation and management. The k-value, a measure of endogenous bilirubin clearance, is affected by cholangitis, alanine aminotransferase, pre-intervention bilirubin levels and the patient's sex. It has similar strength to the antipyrine clearance test in predicting morbidity and mortality. The mortality discriminant index is obtained from creatinine level, serum albumin and a score for cholangitis, and has an overall accuracy of 95%. The malignancy discriminant index depends on age, cholangitis score, creatinine level and gamma glutamyl transferase, and has an accuracy of 84%. All three indices have been programmed into a commercially available spreadsheet on a small microcomputer, and are automatically and rapidly available as soon as standard biochemical and clinical measurements have been entered.

Adult↗
PubMed1985

Pellet-gun eye injuries.

Twelve male patients with pellet-gun eye injuries are presented. Most were young teenagers. Six patients had a significant loss of vision due to retinal injury, and in one of these cases the eye was enucleated. The injuries ranged in severity from contusion with a small hyphema to rupture of the globe with uveal prolapse, retinal hemorrhage and detachment, optic nerve contusion, glaucoma and intracranial penetration.

Adolescent↗
PubMed1985

Excretion of cholate glucuronide.

[3-3H]Cholic acid glucuronide [7 alpha,12 alpha-dihydroxy-3 alpha-O-(beta-D-glucopyranosyluronate)-5 beta- cholan-24-oate] was synthesized and administered to rats prepared with either an external biliary fistula or a ligated bile duct. When bile fistula animals were given either microgram or milligram amounts of the glucuronide, biliary secretion of label was rapid and efficient: greater than 90% of the administered label was secreted within 60 min and total recovery of label in bile was 98.6 +/- 1.2%. Studies in which [14C]taurocholate was included in the dose indicated that this bile acid was secreted into bile significantly more rapidly than was the glucuronide. In animals with ligated bile ducts, urinary excretion was the major route of elimination: after 20 hr, 83.4 +/- 9.3% of the administered dose had been excreted in urine. Urinary excretion of cholate glucuronide was significantly more rapid than that of taurocholate. Gas-liquid chromatographic analysis of the methyl ester acetate derivatives of labeled compounds isolated from bile and urine by chromatography established that the bulk (greater than 70%) of the administered material was secreted in bile or excreted in urine as the intact cholate glucuronide. From these results, we conclude that the glucuronidation of cholic acid produces a derivative which is rapidly and effectively cleared from the circulation and excreted.

Animals↗
PubMed1985

Celiac axis compression syndrome: factors predicting a favorable outcome.

There is still considerable doubt about the existence of the celiac axis compression syndrome. Asymptomatic compression or narrowing of the celiac artery is common, and it is difficult to understand why some patients have significant symptoms while others have none. One major problem emerges from a study of the literature, in that there is no precise definition of the clinical features of a syndrome. Patients with all kinds of abdominal symptoms and varying psychiatric and medical backgrounds have been included in previous studies. It is not surprising, then, that there is no agreement on whether surgery is ever justified. We reported a small series of 11 patients whose clinical features have been carefully documented. Regression analysis of results suggests that good surgical results can be achieved in selected patients by decompression of the artery and restoration of the normal arterial lumen. Patients likely to benefit are those with epigastric pain related to food or hunger who do not have a galaxy of other unrelated symptoms. It is suggested that these factors be included in subsequent definitions of the celiac axis compression syndrome, so that some uniformity be introduced into the writing and thinking about this confusing problem.

Abdomen↗
PubMed1984

Trilateral retinoblastoma. Report of two cases.

Two children had bilateral retinoblastoma and a morphologically similar intracranial neoplasm localized to the region of the pineal gland as shown on computed tomography and at postmortem examination. The first child's intracranial malignant neoplasm produced symptoms that indicated its probable presence when the ocular tumors were first diagnosed. With the second child, there was a latent period of more than three years between the diagnosis and initial management of the ocular neoplasms and the onset of symptoms from the pineal tumor. We diagnosed both cases as trilateral retinoblastoma, which in our experience is a relatively frequent cause of mortality in patients with heritable retinoblastoma.

Brain Neoplasms↗