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Biomedical subjects

J R Hiatt

Publications and source records attributed to J R Hiatt.

107 records · Page 6Linked to original sources
PubMed1986

Biliary disease in pregnancy: strategy for surgical management.

Acute biliary tract disease complicated intrauterine pregnancy in 26 patients seen during a 5 year period. Biliary symptoms were distinct and occurred during the first trimester in 7 patients, the second trimester in 5 patients, the third trimester in 12 patients, and in two early postpartum patients. Nine patients had marked hyperamylasemia which resolved with medical management, and no severe cases of pancreatitis occurred. Ultrasonography was used to confirm the presence of gallstones in 18 patients and demonstrated dilated intrahepatic ducts in one of two patients with surgically proved choledocholithiasis. Nineteen patients had cholecystectomy and cholangiography, and 4 had common bile duct explorations. Only two of seven patients who presented in the first trimester had term pregnancy. Diagnosis of cholelithiasis in pregnancy by ultrasonography is accurate and reliable. The risk to the fetus of radionuclide scanning and conventional radiography is not justified. Secondary hyperamylasemia is common but responds to conservative therapy. Operation may be delayed until delivery in most patients, with urgent exploration reserved for uncertainty in diagnosis, choledocholithiasis, or acute cholecystitis that does not resolve with medical measures.

Acute Disease↗
PubMed1986

Liver transplantation at UCLA. Program development, organization, initiation, and early results.

The development of a liver transplantation program requires a multidisciplinary approach which can only be provided in a large tertiary referral medical center. Preparation for the clinical program involves training of all team members, both in the animal laboratory and at an established liver transplant center. A special commitment from the medical center to the program is essential and involves medical, nursing, and administrative divisions, blood bank, social service, and operating room personnel, and intensive care unit facilities. With careful planning, a successful liver transplant program can be realized from the onset. In the first 2 years of UCLA's liver transplant program, 62 transplants in 50 patients were performed. The overall survival rate was 72 percent with no operative deaths. Thirty-four of 36 surviving patients have returned to useful, productive lives after orthotopic liver transplantation.

Actuarial Analysis↗
PubMed1986

Surgical preparation of the trauma victim.

Successful management of the victim of multisystem trauma depends on an orderly scheme of resuscitation and diagnostic evaluation. This management is directed by the general surgeon heading the trauma service. Based on his or her knowledge of the mechanisms of injury and the initial physical examination, the surgeon establishes priorities of treatment for the most life-threatening injuries. He directs the preoperative preparation, including communication with the operating room and anesthesia staffs, assembly of a basic laboratory profile, and placement of lines and tubes. The trauma surgeon identifies need for consultation in the medical or surgical specialties and formulates a strategy for surgical management with the consultants. Finally, based on his or her impression of the injuries and their relative severity, the surgeon selects the diagnostic tests, particularly peritoneal lavage, CT scan of the head and body, and arteriography, all of which will be needed to complete the surgical preparation.

Diagnosis, Differential↗
PubMed1986

A method for atraumatic surgical access to the pancreatic duct.

A method for atraumatic surgical access to the pancreatic duct which uses a soft, flexible polyethylene catheter to intubate the duct, followed by progressive dilation with a vein catheter introducer, a blunt silver probe, and a grooved director is described herein. Sphincteroplasty of the pancreatic duct can then be easily accomplished.

Catheterization↗
PubMed1986

Perineal gangrene in the patient with granulocytopenia: the importance of early diverting colostomy.

Perirectal and perineal infections represent a life-threatening complication of hematologic diseases associated with granulocytopenia. Early and aggressive surgical management is essential. This should include hemodynamic support and monitoring, broad-spectrum antibiotics, wide surgical debridement, and a totally diverting colostomy. The prognosis of these infections parallels that of the underlying hematologic disease. Three patients seen on a university surgical service whose clinical management and course underscore these principles are presented.

Adolescent↗
PubMed1985

Cancer of the distal esophagus and cardia: preoperative irradiation prolongs survival.

Ninety-five patients with carcinoma of the esophagus and gastric cardia seen between 1979 and 1984 were managed in one of four ways: radiotherapy alone (6,000 rads), esophagogastrectomy alone, preoperative radiotherapy (4,000 rads over 4 weeks) followed by esophagogastrectomy, or no definitive treatment for patients with advanced disease. Patients who receive radiotherapy alone or no definitive therapy were considered unfit for operation; however, those patients who had operation only were equivalent with regard to histologic stage and risk to patients who received preoperative radiotherapy and surgery. Patients who received no definitive therapy died within 1 year, with a mean survival of 3.7 months. The mean survival for patients who received radiotherapy only was 8.3 months; for those who had surgery alone, 13 months; and for those who had preoperative radiotherapy, 24 months. Patients who received preoperative radiotherapy had significantly longer survival times when followed 12, 15, and 18 months postoperatively. Preoperative radiotherapy did not improve overall resectability, and postoperative mortality was similar in the two surgical groups. In comparable patients treated by esophagogastrectomy, preoperative irradiation prolonged the disease-free survival time and is advocated for all surgical candidates.

Adenocarcinoma↗
PubMed1984

Management of adenocarcinoma extending to the middle and upper part of the esophagus.

Of 30 patients with adenocarcinoma of the gastroesophageal junction treated between 1977 and 1982, 11 had tumor spread to the middle or upper thirds of the esophagus. Ten were treated with esophagogastrectomy by the Lewis approach, with two operative deaths. All of the tumors had spread to the periesophageal tissues. The eight surviving patients had relief of dysphagia. Five died with recurrent tumor after a mean survival time of 11 months; three are alive at five and 16 months (without evidence of disease) and 13 months (with recurrence). Adjuvant preoperative radiation therapy was used in four patients, three of whom received concomitant total parenteral nutrition. Despite the poor prognosis of this particularly unfavorable subset of patients with tumors of the gastroesophageal junction, operative resection provides acceptable palliation. Further study of adjuvant modalities is needed.

Adenocarcinoma↗
PubMed1984

Impact of routine arteriography on management of penetrating neck injuries.

We evaluated the impact of routine arteriography on the management of 105 patients with penetrating injuries to the neck and upper chest. Of 72 patients with bullet wounds and 33 with knife wounds, surgical exploration on an emergency basis was performed in three patients because of shock; the remaining 102 underwent aortic arch or selective arteriography. Surgical exploration was performed in 18 patients because of abnormal arteriograms and in 13 (10 with normal arteriograms) because of shock or suspected hemorrhage. Operative findings confirmed the angiographic interpretation in 26 of the 31 patients who were explored. The angiogram underestimated the arterial injury in two patients and failed to identify an associated venous injury in three. Seventy-two patients with negative arteriograms received expectant treatment without subsequent complications. Routine arteriography is integral to expeditious triage and accurate diagnosis of patients with brachiocephalic trauma. A negative study in almost 80% of patients permits safe nonoperative management, whereas a positive study allows the surgeon to plan his operative approach more judiciously. Endoscopic procedures are important adjuncts in selected patients.

Adolescent↗
PubMed1983

Amebic liver abscess. The surgeon's role in management.

Hepatic amebic abscess presented as an acute abdominal illness in 71 patients seen at the Harbor-UCLA Medical Center during the past 10 years. Most of the patients were young, Mexican and male, and half had coexistent medical diseases. The correct diagnosis was made by ultrasonography in 27 patients, laparotomy in 6, and radionuclide scan in 38. More than half (38 patients) were diagnosed accurately within 24 hours of admission. Sixty-seven abscesses were located in the right or both lobes; only 4 were limited to the left lobe, all of which had caused perforation. Operative findings in 20 patients were ruptured abscess in 12 and unruptured abscess in 2; abscesses were missed during exploration in 6 patients, one of whom had acute cholecystitis and another, a small bowel infarction. Other complications were intrathoracic rupture in four and intrapericardial rupture in one. Metronidazole was successful as initial drug therapy in 64 patients. Ultrasonographically-guided percutaneous drainage was used as a diagnostic and therapeutic adjunct to management in 15 patients. In a metropolitan population, the surgeon must consider amebic abscess in the evaluation of a febrile patient with right upper quadrant illness. With ultrasonography or radionuclide scanning, he can establish a reliable diagnosis in 24 hours. Although medical therapy is effective, surgery is required in 20 percent of patients for drainage of the ruptured abscess or treatment of a coexistent surgical condition. An unruptured abscess should be sought in an apparently negative exploration. A solitary abscess of the left lobe is rare but has a particular propensity to cause perforation.

Adolescent↗
PubMed1983

A method for vascular access in small children.

A new method is described to achieve vascular access for either hemodialysis or plasmapheresis in small children. This technique provides reliable arterial inflow and venous outflow with minimal complications.

Age Factors↗
PubMed1983

Surgical management of unilateral groin infection after aortofemoral bypass.

The most common site for infection in reconstructive peripheral vascular operations is the inguinal area. Treatment is controversial, with recommendations ranging from antiseptic irrigation techniques to total graft excision. We present a plan for the surgical management of unilateral groin infection after aortofemoral bypass that was used in five patients. After assuring the viability of the extremity independent of the prosthesis, by compression of the graft limb with a concurrent Doppler ankle to wrist ratio index exceeding 0.3, vascular repair was performed as a two-stage procedure combining clean retroperitoneal detachment of the infected graft limb and inguinal excision of the involved graft limb followed by delayed vascular reconstruction by extra-anatomic cross femoral bypass. This has shown to be a reliable surgical method for salvaging the aortofemoral bypass with unilateral groin infection.

Aged↗
PubMed1982

The value of open lung biopsy in the immunosuppressed patient.

To evaluate the impact of the open lung biopsy on diagnosis and therapy in the immunosuppressed patient, 68 such patients managed at UCLA from 1975 to 1980 were reviewed. Most had hematologic malignancies, and all were severely immunosuppressed. The rates of surgical mortality (1 operative death) and morbidity were minimal. There were 10 diagnostic differences apparent when biopsy results were compared with autopsy findings in 28 autopsied patients. Therapy was initiated or modified in 19 patients on the basis of open lung biopsy. Forty-four patients lived 1 year or less, 14 for more than 1 year, and 10 were lost to follow-up. Of 42 patients with an untreatable disease on the basis of lung biopsy, 67% died and 33% lived to leave the hospital. Of 25 patients with a treatable disease, 56% died and 44% left the hospital. Of 28 autopsied patients, only 12 were receiving appropriate medication at time of death despite biopsy. The patient whose disease is generally characterized by brief survival like acute leukemia, and whose situation is most desperate, unfortunately benefits least from open lung biopsy. We conclude that this procedure has only a modest impact in the management of these critically ill patients and should be used conservatively.

Adolescent↗
PubMedDate not supplied

A randomized, prospective study of perioperative antimicrobial prophylaxis for vascular access surgery.

A blinded, randomized, prospective study of 38 chronic renal failure patients was done to evaluate perioperative antibiotics in the prevention of postoperative infection of vascular access prostheses. Expanded polytetrafluoroethylene (PTFE) hemodialysis grafts were placed either in radiocephalic (19) or femorosaphenous (19) position. Cefamandole or placebo was given intravenously 30 minutes prior to operation and six to 12 hours postoperatively. The overall infection rate for the group was 26.3 percent with two of 19 antibiotic-treated and eight of 19 placebo-treated patients developing an infection (p less than 0.04). Grafts placed in the thigh have a greater risk of intraoperative contamination and infection. Postoperative infection associated with implantation of hemodialysis prostheses was significantly reduced by perioperative antimicrobials.

Adult↗