Search PubMed⌕ Search

Biomedical subjects

R J Hall

Publications and source records attributed to R J Hall.

At least 91 records · Page 5Linked to original sources
PubMed1989

The surgery of biliary atresia.

One hundred thirty-one consecutive infants with biliary atresia were operated on during the 15-year period between 1973 and 1988. Six patients did not have biliary reconstruction because of advanced cirrhosis or transplant preference. The other 125 infants had excision of all nonpatent extrahepatic bile ducts; biliary drainage was provided by a gallbladder-common bile duct conduit in 14 patients and by a Roux-en-Y portoenterostomy in 111 infants (including the seven patients with correctable biliary atresia). The bilioenteric conduit was temporarily exteriorized and, for the past 2 years, a conduit intussusception valve was incorporated. Immediate postsurgical bile drainage was achieved in 103 infants (82%). Reoperation during the first 6 postoperative weeks restored bile flow in 14 of 18 infants who had shut down. Seventy-two patients (57%) had sustained (more than 1 year) relief of biliary obstruction. Postoperative morbidity was substantial. The six children not having corrective surgery died within 19 months. Three patients were lost to follow-up. Sixty-eight patients having Kasai's operation died, 55 from complications of liver disease, 1 from a coexisting malformation, and 12 after liver transplantation. Fifty-seven patients are alive, 13 by virtue of liver replacement, 9 with mild-to-moderate hepatic sequelae, and 35 (28%) with normal to near-normal liver function. Although none is considered "cured," the 35 children are anicteric, have normal growth and development, and participate in full school activities (including contact sports). Average follow-up is 85.8 months (range 1 to 15 years).

Anastomosis, Roux-en-Y↗
PubMed1989

Exercise testing soon after myocardial infarction: its relation to course and outcome at one year in patients aged less than 55 years.

A consecutive series of 184 patients aged less than 55 years who had an acute myocardial infarction were enrolled in a study to examine outcome at one year. One hundred of these patients underwent a maximal exercise test six weeks after infarction to evaluate its ability to predict cardiac events. The in-hospital mortality for the series was 7.6% (14 deaths) and the one year mortality for the 170 survivors was 3.8% (seven deaths). During the exercise test 31 patients had angina and 21 had ST depression. During the one year follow up period 39 of 100 patients had angina on exertion, 15 patients underwent coronary artery surgery, three patients had a reinfarction, and one patient died. Angina during the exercise test but not ST segment depression during the exercise test predicted angina on exertion and the need for coronary artery surgery. In the year of follow up angina occurred during everyday exertion in 25 (81%) (95% confidence interval 62 to 92%) of the 31 patients who developed angina during the exercise test and in only 14 (20%) (95% confidence interval 12 to 32%) of 69 patients who did not, and coronary artery surgery was performed in 11 (35%) (95% confidence interval 19 to 54%) of the 31 patients with angina during the exercise test and only four (6%) (95% confidence interval 2 to 15%) of 69 patients without angina. The outcome after myocardial infarction in patients aged less than 55 years was good and the occurrence of angina, but not ST segment depression, during a maximal exercise test six weeks after infarction was an indication for further investigation.

Age Factors↗
PubMed1989

Cold intolerance in patients with angina pectoris: effect of nifedipine and propranolol.

Fifteen patients with chronic stable angina pectoris and a history of reduced exercise tolerance in cold weather (cold intolerance) underwent symptom limited treadmill exercise tests at 20 degrees C and 0 degrees C in a specially constructed cold chamber while taking no antianginal medication. Their mean time to onset of angina (5.8 v 4.2 min), to 1 mm ST depression (5.1 v 3.8 min), and to peak exercise (7.4 v 5.7 min) was significantly shorter on exercise at 0 degrees C than at 20 degrees C. The double product of heart rate and systolic blood pressure at each of these end points was the same in both exercise tests. Eight of these patients were treated with nifedipine 10 mg three times a day for two weeks and then with propranolol 40 mg three times a day for another two weeks. Repeat exercise testing was performed at the end of each two week treatment period. The mean time (SD) to peak exercise at the end of the nifedipine treatment period was 9.1 (2.0) min at 20 degrees C and 8.5 (2.3) min at 0 degrees C. The double product at peak exercise was the same for both exercise tests. At the end of the propranolol treatment period the mean time to peak exercise was significantly less at 0 degrees C (7.8 (2.6) min) than at 20 degrees C (8.9 (2.4) min). The double product at peak exercise was the same for both exercise tests but was significantly less than that on nifedipine. Cold intolerance was shown in patients with a positive history by symptom limited treadmill exercise testing at 0 degrees C. It persisted when they were treated with propranolol, albeit to a lesser extent, but not when they were treated with nifedipine.

Adult↗
PubMed1988

Endoscopic esophageal varix ligation: technique and preliminary results in children.

A technique for treating esophageal variceal hemorrhage in children using endoscopically placed rubber ligatures was evaluated in six children. The method offers a major advantage over chemical obliteration of varices by sclerosants in the absence of systemic, local, or distant organ reactions and, perhaps, in the avoidance of esophageal motor dysfunction.

Adolescent↗
PubMed1988

Immunologic outcome of enteric administration of ovalbumin to neonatal rats is anatomic-site specific.

An important immunologic response to the oral ingestion of a protein antigen is systemic tolerance to subsequent parenteral encounter with the same antigen. In the newborn intestine, ileal epithelial cells nonspecifically take up macromolecules and degrade them in lysosomal enzyme-containing vacuoles. We speculated that processing of protein antigens by the ileal cells helps mediate systemic immunologic tolerance to the antigens. Therefore, we developed a neonatal rat model in which ovalbumin (OVA) was administered either by gastric gavage or by infusion into surgically constructed loops of jejunum or ileum. We also administered OVA to other groups of animals by injection into the intact jejunum or ileum. Two and 4 weeks later, animals were challenged with OVA measured. Whereas animals that received OVA by gastric gavage were made tolerant to the protein (produced no detectable serum IgG anti-OVA antibodies after parenteral challenge), the animals given OVA into the jejunum or ileum did not show tolerance; indeed, some of those given OVA into the ileum were immunized by the enteric exposure. From these data we postulate that the development of systemic immunologic tolerance to a protein antigen in the newborn requires "upstream" processing of the antigen by gastric or pancreatic secretions and that exposure of the distal intestine to intact protein antigens can result in systemic sensitization to the antigens. The latter response might be causally linked to food allergies or autoimmune diseases.

Animals↗
PubMed1988

Manometric and pH consequences of esophageal endosclerosis in children.

Twenty-seven manometric and 22 18-hour pH monitoring studies were done in 17 consecutive patients undergoing esophageal endosclerosis. Prior to endosclerosis, esophageal manometry was normal in eight of nine patients. Peristaltic dysfunction was observed in all 13 postendosclerosis patients and consisted of (1) decreased mean peristaltic amplitude pressures. Pressures were 61.4 and 74.7 mmHg at 0 to 2 cm and 3 to 4 cm above the lower esophageal sphincter (LES), respectively, prior to treatment. After endosclerosis, values fell to 30.2 and 43.3 mmHg; (2) a drop in mean resting LES pressure from 22.3 mmHg before endosclerosis to 17.1 mmHg afterward and (3) an increase in the rate of peristaltic propagation failure from 12% to 26% after endosclerosis. Esophageal pH monitoring demonstrated gastroesophageal reflux (GER) in three of seven patients before endosclerosis and in five of 11 patients afterward. Because of the major incidence of GER before endosclerosis, the procedure could not be causally incriminated. However, GER was roughly correlated with the severity of the manometric dysfunction. There was no correlation of GER or manometric abnormality with the number of endosclerosis treatment nor the interval between endosclerosis and pH and manometric studies. The remote sequelae of the abnormalities are conjectural.

Child↗
PubMed1988

Liver transplantation and the Kasai operation in biliary atresia.

To assess the respective morbidity of the Kasai operation and liver transplantation in treating biliary atresia from the perspective of the referring institution, we analyzed the clinical course of 43 consecutive patients hospitalized at our institution from October 1980 to December 1985. Morbidity was arbitrarily defined as complications that required hospitalization, cholangitis, rejection, and was calculated by dividing the actual days hospitalized by the days "at risk." Morbidity assigned to transplantation also included pretransplant hospitalizations necessitated for life-sustaining treatment after referral. The morbidity in 40 patients who were treated by the Kasai procedure was 16.1%, which could be broken down to 50.6% in those who died after operation, 17.4% in those patients subsequently referred for transplantation, and 10.2% in the 16 patients successfully treated. Thirteen of the latter have perfect or near perfect liver function and are in excellent health. The morbidity of the 17 patients who were referred for liver transplantation, including two referred immediately after initial exploration, was 16.0%, which could be broken down to 10.4% before transplantation and 49.8% afterwards. Seven patients died awaiting transplantation, all but one of whom were referred during the first year of life. The average time spent on the waiting list was 203 days. Biliary atresia remains a disease of high morbidity regardless of treatment. Continued hospitalizations are necessary for ongoing Kasai management and life-sustaining treatment following transplant referral. The time spent on transplant waiting lists is protracted, and many patients die before obtaining a new liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Biliary Atresia↗
PubMed1988

Lack of correlation between infection with reovirus 3 and extrahepatic biliary atresia or neonatal hepatitis.

Infection with reovirus 3 (Reo-3) has been suggested as the cause of extrahepatic biliary atresia and idiopathic neonatal hepatitis, but confirmation has been lacking. Therefore we have searched for a specific anti-Reo-3 antibody response in the sera of patients with biliary atresia or neonatal hepatitis and for Reo-3 antigens in their hepatobiliary tissues. Sera from 23 infants with extrahepatic biliary atresia, 12 with neonatal hepatitis, 30 age-matched control patients with other liver diseases, and 55 control patients without liver disease were tested by an enzyme-linked immunosorbent assay for total (IgA, IgG, and IgM) anti-Reo-3 antibodies; sera of infants younger than 6 months of age were tested also for IgM anti-Reo-3 antibodies alone. There was no difference between either total or IgM anti-Reo-3 antibody levels in infants with extrahepatic biliary atresia or neonatal hepatitis and levels in control infants. Reo-3 antigens were not detected in the hepatobiliary tissues of 19 infants (18 with biliary atresia, one with neonatal hepatitis) by an immunoperoxidase method that readily demonstrated Reo-3 in control infected HEp-G2 cells. Our data do not support a relationship between neonatal liver diseases and infection with Reo-3.

Antigens, Viral↗
PubMed1988

Thromboembolic disease.

(1) Thromboembolic disease is a rare condition in physically fit subjects and is, therefore, likely to occur only rarely in aircrew. (2) The clinical diagnosis of both pulmonary embolism and deep venous thrombosis is unreliable. As the occurrence of these conditions has serious implications so far as the future licensing of airmen is concerned, it is of paramount importance to establish the diagnosis beyond doubt. (3) The chance of recurrence after an acute pulmonary embolus is low, particularly in those subjects in whom a definite acute and transient predisposing factor such as recent surgery or trauma can be identified. (4) When there is no definite predisposing factor to an acute pulmonary embolism, careful assessment is needed. The possibility that the embolus was the first sign of some serious sytemic illness, such as malignancy, should be considered and the possibility of rare clotting abnormalities sought. (5) Patients with subacute pulmonary embolism should be regarded as for those with acute pulmonary embolism and no obvious risk factor. A large proportion of these patients will have no predisposing factor and will require long-term oral anticoagulants as part of their routine therapy. Fortunately this condition is very rare. (6) Patients with repeated deep venous thrombosis, usually associated with chronic damage to the venous system of the leg, also may require long-term oral anticoagulants and their condition is likely to be exacerbated by long periods of inactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerospace Medicine↗
PubMed1988

A controlled trial of GL enzyme in the treatment of acute myocardial infarction.

GL enzyme (hyaglosidase) is a highly purified component enzyme of hyaluronidase. A therapeutic trial was carried out in the treatment of suspected myocardial infarction among 1,488 patients presenting within 6 h of the onset of symptoms. No significant reduction in mortality at 6 months was observed in the GL group (15.7%) compared with the placebo group (16.4%). Mortality at 2 weeks was also unaffected by treatment (GL 10.3%; placebo 10.9%).

Clinical Trials as Topic↗
PubMed1988

An unusual complication of left ventricular pseudoaneurysm: hemoptysis.

Left ventricular aneurysm is a common sequela of anterior myocardial infarction. At the time of coronary artery bypass grafting, resection of this aneurysm is frequently undertaken to alleviate symptoms of heart failure and/or refractory ventricular tachycardia. Complications related to aneurysmectomy are uncommon. We describe an unusual patient who presented with hemoptysis related to the formation of a pseudoaneurysm which communicated with the lung parenchyma. The etiology of the pseudoaneurysm formation was an indolent, slow-growing infection.

Aged↗
PubMed1988

Coronary artery anomalies: a review of more than 10,000 patients from the Clayton Cardiovascular Laboratories.

We reviewed the records of 10,661 patients who had undergone coronary angiography at the Clayton Foundation Cardiovascular Laboratories between 1 June 1974 and 15 March 1986, and identified major coronary artery anomalies in 83 adults. In addition, we included in our review 9 adults and 2 adolescents who had been referred for evaluation of anomalies documented elsewhere. Here we present the clinical and angiographic data for all 94 patients (76 men and 18 women). Most patients were men who presented with chest pain. The most common anomaly, found in 38 patients, was origin of left circumflex coronary artery from right coronary artery or right aortic sinus. In contrast to other studies, which have not shown increased incidence of coronary atherosclerosis in the anomalous circumflex artery, 71% of our patients with this anomaly had significant coronary atherosclerosis in the proximal portion of the anomalous vessel. The posterior course of the anomalous circumflex coronary artery may predispose this vessel to atherosclerosis in patients with coronary disease. The overall incidence of atherosclerotic disease in coronary arteries was 68% (64 of 94 patients) in the present study.

Journal Article↗
PubMed1988

Surface electrocardiographic recognition of dual atrioventricular nodal pathways during sinus rhythm.

Atrioventricular nodal reentry is the most common mechanism of paroxysmal supraventricular tachycardia. Electrocardiograms obtained during sinus rhythm rarely serve to identify the mechanism of paroxysmal supraventricular tachycardia. We report two cases of dual atrioventricular nodal reentry in which electrocardiograms recorded during sinus rhythm disclosed two separate PR intervals that suggested dual atrioventricular nodal pathways.

Journal Article↗