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Biomedical subjects

R H Hawes

Publications and source records attributed to R H Hawes.

At least 109 records · Page 6Linked to original sources
PubMed1996

Effects of meperidine on the pancreatic and biliary sphincter.

BACKGROUND: Opioids are traditionally avoided during sphincter of Oddi manometry because of indirect evidence suggesting that these agents cause sphincter of Oddi spasm. This study was undertaken to determine the direct effects of meperidine on the biliary and pancreatic sphincter. METHODS: Forty-seven patients were prospectively evaluated by sphincter of Oddi manometry in the conventional retrograde fashion. Manometry was initially performed with intravenous diazepam sedation alone. The manometry was repeated 3 to 5 minutes after meperidine was administered. RESULTS: The basal sphincter pressure of the biliary sphincter, pancreatic sphincter, and the combined sphincter group were not significantly altered by meperidine. Concordance (normal versus abnormal) between the basal sphincter pressure before and after meperidine was seen in 44 of 47 patients (94%). Meperidine produced a significant increase in the pancreatic, biliary, and combined sphincter phasic frequency and a significant decrease in the phasic duration. The pancreatic and combined sphincter phasic pressures were significantly reduced following meperidine administration. Seventeen manometry tracings (36%) were believed to be qualitatively better after meperidine, while only four (8.5%; p < .001) were qualitatively better with diazepam alone. CONCLUSION: Meperidine can be used for additional analgesia during sphincter of Oddi manometry if the basal sphincter pressure is the parameter used to determine therapy.

Humans↗
PubMed1996

Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy.

BACKGROUND: Polyethylene stents placed in the main pancreatic duct induce morphologic alterations that may resemble chronic pancreatitis. METHODS: We reviewed the sequential pancreatograms of stented patients who had long-term follow-up after stent removal. RESULTS: Forty patients (66%) had a normal baseline pancreatogram, whereas 21 (34%) showed changes of chronic pancreatitis. In 49 of 61 patients (80.3%), one or more had new morphologic changes immediately after stent withdrawal graded as mild (69%), moderate (29%), or severe (2%). Changes included ductal irregularity (49%), narrowing (35.5%), and side branch change (15.5%). Sixteen of the 21 patients (76.1%) with an abnormal baseline pancreatogram had worsening of the baseline abnormality or additional changes while stented, whereas 33 of 40 (82.5%) with a normal baseline developed new morphologic changes. Correlation of stent-induced changes with stent size, length, patency at removal, and duration of stenting failed to show an association. Twenty-five patients with stent-induced changes had a follow-up pancreatogram at a mean of 192 days (10 to 740) after stent removal. There was complete resolution of the changes in 64%, partial resolution in 32%, and no improvement in 5%. CONCLUSION: Morphologic changes induced by polyethylene pancreatic duct stents occurred in 80% of patients. More than one third of these changes did not resolve during the follow-up period. Because of concern over stent-induced fibrosis, the use of pancreatic stents should remain largely experimental.

Follow-Up Studies↗
PubMed1996

Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP.

BACKGROUND: Polyethylene pancreatic duct stents induce morphologic changes of the pancreatic duct in the majority of patients. This study was undertaken to determine if parenchymal abnormalities are present in patients undergoing short-term pancreatic duct stenting and to correlate these findings with the pancreatogram obtained at stent removal. METHODS: Twenty-five patients underwent pancreatic duct stenting and had an endoscopic ultrasound evaluation of the pancreas at stent removal. The pancreatograms were evaluated at stent removal for ductal irregularity, narrowing, and side branch changes. Endoscopic ultrasound was used to assess for differences in the echo characteristics of the pancreatic parenchyma around the stent compared with the rest of the gland. RESULTS: Of the 16 patients evaluated by ERCP at stent removal, 9 (56%) had 1 or more new ductographic changes. Endoscopic ultrasound identified parenchymal changes in the stented region in 17 of 25 patients (68%). Four patients who had parenchymal changes in the stented region on endoscopic ultrasound at stent removal had a follow-up study at a mean time of 16 months. Two patients had (new) changes suggestive of focal chronic pancreatitis in the stented region. CONCLUSION: Short-term pancreatic duct stenting induced both ductal and parenchymal changes in more than 50% of patients. Chronic pancreatitis may be a consequence of pancreatic duct stenting.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1996

Detection of embryologic ventral pancreatic parenchyma with endoscopic ultrasound.

BACKGROUND: The prevalence of detecting the embryologic ventral pancreas (ventral anlage) with endoscopic ultrasound (EUS) is unknown. PURPOSE: To determine the frequency of, and factors associated with, EUS findings consistent with the ventral anlage. METHODS: One hundred patients undergoing upper gastrointestinal EUS for any indication were prospectively evaluated for the presence of a focal, hypoechoic area in the pancreatic head using a radial scanning echoendoscope. Multiple clinical and EUS variables were tested against the ability to detect the ventral anlage. RESULTS: The overall detection rate of the ventral anlage was 59%. The ventral anlage was detected in 75% of patients undergoing EUS for nonpancreatic indications, compared to 40% of patients undergoing EUS to evaluate suspected pancreatic disease (p< 0.001). EUS detected the ventral anlage in 72% of patients with a normal EUS-appearing pancreatic head, compared to 29% of patients who had abnormal pancreatic head parenchyma (mass or chronic pancreatitis) on EUS (p < 0.001). Multivariate analysis revealed the only variable associated with detecting the ventral anlage was abnormal pancreatic head parenchyma on EUS. CONCLUSION: The ventral anlage is frequently detected during pancreatic EUS, with a significantly lower rate of detection in patients with EUS findings of a pancreatic head mass or diffuse chronic pancreatitis.

Analysis of Variance↗
PubMed1996

Delayed presentation of a penetrating biliary tract injury in a child.

An 8-year-old child presented with obstruction of the common hepatic duct from a 9-mm bullet that had entered her liver 22 months earlier. Evaluation revealed migration of the bullet with complete obstruction of the common hepatic duct. Surgical removal and reconstruction with hepaticojejunostomy has provided long-term drainage.

Child↗
PubMed1996

Percutaneous choledochoscopy.

This article reviews the technique and results of the percutaneous application of flexible endoscopy to the biliary tree. Included are some speculations by the authors on future applications.

Bile Duct Diseases↗
PubMed1995

Dysphagia due to mediastinal granulomas: diagnosis with endoscopic ultrasonography.

BACKGROUND & AIMS: Mediastinal granulomas due to histoplasmosis can cause dysphagia and can be difficult to diagnose. The aim of this study was to describe the endoscopic ultrasonography (EUS) findings of suspected mediastinal granulomas. METHODS: Eleven patients with dysphagia were referred for EUS because endoscopy showed a midesophageal submucosal mass or stricture. RESULTS: All patients had similar EUS findings of a large mass of matted, posterior mediastinal lymph nodes that were adherent to a focally thickened esophageal wall. The cause of the mediastinal granulomas was believed to be histoplasmosis because 3 of the patients had positive complement fixation titers of 1:32, 1 of whom had a surgical resection showing a caseating granuloma. The diagnosis of histoplasmosis mediastinal granulomas was also supported by the findings of lymph node calcification on EUS in 7 patients, the presence or development of midesophageal traction diverticula in 5 patients, and clinical improvement after oral antifungal drug therapy in 7 patients. No patient developed evidence of malignancy during a mean follow-up period of 20.5 months. CONCLUSIONS: Based on characteristic EUS findings, mediastinal granulomas are believed to occur in patients with dysphagia who have a midesophageal submucosal mass or stricture on endoscopy and who live in a highly endemic area for histoplasmosis.

Adolescent↗
PubMed1995

Classification and treatment of local septic complications in acute pancreatitis.

BACKGROUND: An international symposium on acute pancreatitis recently developed a clinical classification system for severe acute pancreatitis that classifies all local septic complications into three groups: infected necrosis (IN), sterile necrosis (SN), and pancreatic abscess (PA). Despite the appeal of having three distinct, well-defined labels for this complex process, the clinical utility of this schema has yet to be determined. The purpose of this study was to investigate the prognostic and therapeutic utility of applying this clinical classification system to a large group of surgical patients with local septic complication from acute pancreatitis. PATIENTS AND METHODS: We reviewed the cases of 62 patients with complicated pancreatitis, classifying them into IN (n = 20), SN (n = 14), or PA (n = 28) groups. Ranson's score, APACHE II score, and computed tomography grading were calculated within the first 48 hours of admission. Information on patient demographics, etiology of pancreatitis, operative procedures, timing of intervention, bacteriology, blood loss, intensive care unit days, ventilator days, and morbidity and mortality were also accrued and analyzed. RESULTS: Despite similar demographics and etiology of pancreatitis, patients with necrosis, both IN and SN, were more critically ill than were patients with PA (APACHE II score > 15, 21% versus 0%, respectively), required earlier operative intervention (mean 14 days versus 29 days, P = 0.02), required necrosectomy with drainage (65% versus 4%, P < 0.001) rather than simple drainage (3% versus 86%, P < 0.001), more reoperations (2.3 versus 1.1, P < 0.05), and had a significantly higher mortality rate (35% versus 4%, P < 0.05). In addition, patients with IN required significantly more hospital days, ventilator days, and blood transfusions than either patients with SN or PA (P < 0.05). CONCLUSIONS: We conclude that this classification system allows for the stratification of patients into three distinct groups--infected necrosis, sterile necrosis, and pancreatic abscess--and has both therapeutic and prognostic usefulness.

Abscess↗
PubMed1995

Success and yield of second attempt ERCP.

Endoscopic retrograde cholangiopancreatography (ERCP) has been shown to be an accurate and reliable method to evaluate biliary and pancreatic disorders. When an attempt to perform ERCP fails, the managing physician must decide whether to repeat the procedure or rely on other alternatives. We tallied the data from 113 patients referred to our institution for repeat ERCP after a failed attempt at another hospital. This group represented approximately 5% of the total population studied during that period of time. All of the patients had undergone one or more unsuccessful ERCP(s) and were referred to our center for another attempt at ERCP. Using a variety of techniques, we were successful in cannulating the desired duct in 96% of attempts. Pathologic findings were present in 64% of cases, of which 22% were sphincter of Oddi dysfunction. Thus, second attempt ERCP is generally worthwhile if clinically indicated and ERCP expertise is geographically available.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): a multicenter retrospective cohort study.

BACKGROUND: Endosonography is a significant advance in the preoperative staging (TNM classification) of esophageal cancer. Its accuracy for evaluating depth of tumor invasion is over 80%. METHODS: A multicenter retrospective cohort study of patients with esophageal carcinomas defined to be invasive (T4) by endosonography was performed to compare the survival of surgically and nonsurgically treated patients. Median survival time, overall mortality, and Kaplan-Meier survival curves were compared by treatment group. Univariate and Cox regression analysis were used to evaluate the effects of various prognostic factors and treatment on the risk of death. RESULTS: A total of 79 patients were studied. The surgical group (Group I, n = 42) was significantly younger and had more distal tumors (adenocarcinomas) than the nonsurgical group (Group II, n = 37). Endosonography was significantly more accurate than CT scanning in identifying tumor invasion (87.5% versus 43.8%, respectively, p = .0002). Overall mortality rate was not significantly different between treatment groups; 59.5% of the surgical group and 64.9% of the nonsurgical group were dead at follow-up (p = 0.65). Similarly, the median survival times of Group I and Group II patients were similar (5.2 and 7.0 months, respectively, p = 0.50). Survival curves for the two groups were almost overlapping (log rank test, p = 0.84). Even after adjusting for age, histologic diagnosis, tumor location, and regional lymph node status, surgical treatment did not significantly influence survival (p = 0.24). CONCLUSIONS: Endosonography accurately identifies patients with invasive T4 tumors who have a poor prognosis. This prognosis is independent of mode of therapy.

Adenocarcinoma↗
PubMed1995

Does routine intravenous glucagon administration facilitate colonoscopy? A randomized trial.

BACKGROUND: Previous studies on the routine use of glucagon in colonoscopy have produced conflicting results. METHODS: Two separate studies were performed. In one study (Study 1), 80 consecutive patients were randomized after cecal intubation to receive 1 mg glucagon (n = 41) or placebo (n = 39), intravenously, in double-blind fashion. In a second study (Study 2) 90 sedated patients undergoing colonoscopy were randomized to receive 1 mg glucagon (n = 46) or placebo (n = 44), intravenously, just before colonoscope insertion. In each study, colonoscope insertion and withdrawal time, therapeutic intervention time, the presence and severity of colonic spasm, colonoscopy yield, and side effects were recorded. RESULTS: Mean withdrawal time in Study 1 was similar in those receiving glucagon (6.85 min) and in those receiving placebo (6.92 min). Mean insertion time in Study 2 (5.07 min) was identical between groups. Spasm scores and colonoscopy yield did not differ between glucagon and placebo in either study. There was a trend toward more side effects (nausea and vomiting) with glucagon in Study 1. Glucagon did not facilitate insertion or withdrawal in the subset of patients with diverticulosis. CONCLUSIONS: Routine use of intravenous glucagon in a dosage of 1 mg does not facilitate colonoscopy by experienced examiners.

Adult↗
PubMed1995

Endoscopic management of recurrent and chronic pancreatitis.

Endoscopic therapy is now being utilized in the setting of recurrent acute and chronic pancreatitis. This review analyzes the current state of the art of these new applications of endoscopy. Selection of appropriate candidates for the various treatment modalities appears important for optimal results of therapy. Patients with gallstone pancreatitis, pancreas divisum, obstructing main pancreatic duct stones, and bulging pseudocysts appear to be the best candidates for endoscopic therapy.

Cholangiopancreatography, Endoscopic Retrograde↗