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Biomedical subjects

M J Hart

Publications and source records attributed to M J Hart.

51 records · Page 3Linked to original sources
PubMed1987

Potentially curable masses in the pancreas.

Twenty patients with intraabdominal non-Hodgkin's lymphoma localized to the peripancreatic area were reviewed. Appropriate diagnosis and staging required exploratory laparotomy and biopsy. With appropriate chemotherapy and radiotherapy, 40 percent of these patients were alive 3 years after diagnosis without evidence of disease. It is for this reason that we have adopted an aggressive approach in obtaining histologic diagnoses for all pancreatic masses.

Adenocarcinoma↗
PubMed1987

Primary sclerosing cholangitis.

Primary sclerosing cholangitis was seen in only 7 of 6,494 biliary operations performed between 1948 and 1979. Fifteen more cases were seen in 1,467 biliary operations performed over a recent 5 year period. Surgery was directed primarily towards the differential diagnosis between cholangiocarcinoma and primary sclerosing cholangitis of the upper bile duct and the need for decompression (nine patients), accompanying gallstones (4 patients), and focal distal bile duct stricture with a question of cholangiocarcinoma (two patients). Invasive radiologic dilatation of the bile ducts was not possible in most instances. Two patients have had successful liver transplants and two more were pending at last follow-up.

Adult↗
PubMed1985

Selected positions of acyl chains are affected differently by antibody binding which results in decreased membrane fluidity.

We have studied the interaction between monoclonal anti-trinitrophenyl antibodies (IgGl and IgG2a) and haptenated phospholipid vesicles using stopped-flow fluorometry. Conformational changes of the antibodies were induced very rapidly (within 0.1 s) after binding to lipid haptens (TNP-Cap-DPPE) on the membrane surfaces. Conversely, after that, the bound antibody molecules decreased the degree of molecular motion at different depths in the bilayer, ranging from the polar head group to the terminal methyl groups of the fatty acyl chains. Such an effect reaches all places of the bilayer within 40 s at 25 degrees C.

Acylation↗
PubMed1985

Cholangiography and small duct injury.

Eighteen instances of bile duct injury over the past 25 years have been reported. Manipulation of a minute cystic duct where the common bile duct was 3 mm in diameter or less was responsible for the division of the duct in eight cases. Most of the commercial catheters are sharp, about 2 mm in diameter, and can easily divide the bile duct if pushed too far. Since manipulation of the duct with a mosquito or tonsil clamp to insert other smaller catheters can also divide a small bile duct, we have decided to discontinue obtaining cholangiograms under these circumstances. Longitudinal splitting of two additional 3 mm ducts with a 3 mm dilator was another major source of injury. Overclipping of the cystic artery to involve the hepatic duct and overmobilization of the bile duct were other sources of injury. We have ceased attempting to obtain cholangiograms in patients with small cystic ducts because of the availability of endoscopic sphincterotomy, the low yield of the films under these circumstances, and fear of damaging the ducts. We use hepaticojejunostomy with Silastic tube stenting for repair of bile duct injuries.

Bile Ducts↗
PubMed1983

Pancreaticojejunostomy. Report of a 25 year experience.

Surgical therapy for 88 patients operated on between 1958 and 1982 has been reviewed. Ninety-three operative procedures were performed including pancreaticojejunostomy in 56, pancreaticocystojejunostomy in 12, pancreaticojejunostomy with resection of less than 10 percent of the pancreas in 16, and pancreaticojejunostomy with resection of more than 50 percent of the pancreas in 9. Operative mortality was 7.5 percent and operative morbidity was 25 percent. Overall, 63 percent of the patients had an excellent or good result in the postoperative follow-up period which averaged 4 years. In the nonalcohol-induced pancreatitis group, ductal diameter was a good predictor of postoperative success, whereas in the alcoholic patient population, abstinence from further alcohol intake was a more accurate predictor of the success of pancreatic drainage.

Adult↗
PubMed1981

Choledochal cysts presenting in late childhood and adulthood.

Primary excision is well accepted in children. Although the length of follow-up is inadequate, our review of the literature and experience with five patients suggests primary excision as the procedure of choice in older children and adults. Although the number of cases is too small and the follow-up too sporadic to draw statistically valid conclusions, excision has a lower morbidity, mortality and reoperation rate than internal cyst drainage, and definitive removal of tissue at risk for malignant degeneration seems intuitively more appealing.

Adult↗
PubMed1981

Ampullary disconnection during the course of biliary and duodenal surgery.

Ampullary disconnection is fortunately rare. As this experience indicates, the long-term salvage rate is good but demands immediate recognition, precise repair and frequently reoperation to obtain a satisfactory result. One should be aware that the ampulla may be located very proximally in patients with long-standing peptic ulceration. The common duct should be catheterized while reoperation is required in this area in cases of obscured anatomy of the distal bile and pancreatic ducts.

Adult↗
PubMed1981

Spontaneous and drug induced concanavalin A capping of neutrophils from human infants and their mothers.

We investigated concanavalin A capping that occurred either spontaneously (neutrophils incubated only with buffer) or was drug induced (neutrophils with colchicine or diamide) using neutrophils obtained from the blood of newborn infants and their mothers. A greater proportion of infant and maternal neutrophils than controls formed caps spontaneously (P less than 0.01). The percent of capped neutrophils (mean +/- S.E.) for 24 infants and their mothers was 23 +/- 3 and 39 +/- 4, respectively, versus 13 +/- 2 for 26 controls. Spontaneous capping was significantly decreased when neutrophils were incubated with catalase and superoxide dismutase to suggest that it was related, at least in part, to oxidation. Drug-induced capping of infant and maternal neutrophils was decreased when compared to controls (P less than 0.05). Colchicine increased capping of control neutrophils 11.76-fold above the spontaneous value, whereas capping of infant and maternal cells was increased only 2.35- and 1.65-fold. Corresponding values for diamide were 11.94-, 2.27, and 2.49-fold for control, infant, and maternal neutrophils, respectively. Many cellular processes are involved in capping, and the mechanisms responsible for aberrant capping of infant neutrophils remain undefined. However, this is another property that distinguishes infant neutrophils from those of older individuals.

Adult↗
PubMed1980

Central hepatic resection and anastomosis for stricture or carcinoma at the hepatic bifurcation.

Ten cases of central hepatic resection for benign and malignant strictures are reported. Reconstruction was by hepaticojejunostomy with placement of a transhepatic silastic stent across the anastomosis. Four patients had carcinomas at the hepatic bifurcation. Four had high biliary stricture and two had intrahepatic stones and strictures. Follow-up ranged from six to 30 months. Two patients died in the postoperative period at two months and 18 months, both with widely patent hepaticojejunostomies. Satisfactory results have been obtained in seven of the eight remaining patients. These seven are symptom-free and without jaundice.

Adult↗