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Biomedical subjects

T B Hugh

Publications and source records attributed to T B Hugh.

At least 55 records · Page 3Linked to original sources
PubMed1991

Endoscopic management of gallstone pancreatitis.

The use of minimally invasive techniques of removing gallstones, and the gall-bladder, is an attractive option for patients who may be severely ill with pancreatitis. We describe here a patient with gallstone pancreatitis who was managed completely by endoscopic techniques consisting of endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy.

Adult↗
PubMed1991

Physics and function of operating room suction.

A study was done to evaluate the performance of suction apparatus in the operating room. The investigation was prompted by perceived poor suction performance in a suite of new operating rooms built in accordance with Standards Australia (SA) specifications. SA performance tests were conducted on each of four suction outlets in nine operating rooms. All 36 outlets complied with SA standards for flow-rate (minimum 40 L/min) and occluded negative pressure (ONP; minimum -60 kPa). However, 24 collection units failed to comply with standards (ONP) of -40 kPa achieved in less than 4 s when a 4 L disposable suction apparatus was connected (mean time to ONP: 6.1 s, 95% confidence interval: 4.9, 7.3). When smaller capacity suction jars were substituted, more units met SA standards. The standards therefore need revision to include specification of the capacity of the collecting apparatus. Other factors that were found to degrade suction performance significantly were air leakage and defective shut-off valves. The physical principles involved in operating room suction are described. Surgeons and anaesthetists should understand these principles, and it is recommended that a simple pre-operative check of the suction apparatus should be carried out, as follows: (1) Turn the wall control knob fully on, and disconnect the suction apparatus. The gauge should register zero. (2) Connect the suction jars. If the indicated gauge pressure is in excess of -15 kPa, investigate the equipment for excessive resistance, particularly in the shut-off valve, which should be replaced with a new unit if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed1988

Combined gastrointestinal and abdominal aortic aneurysm operations.

Experience with gastrointestinal surgical conditions in 154 consecutive aneurysm operations at St Vincent's Hospital, Sydney, over 5 years (1982-86) is reported. Seventeen patients (11%) had coincidental gallstones, and six patients had other gastrointestinal conditions. Postoperative gastrointestinal complications occurred in eight patients. The overall in-hospital mortality rate was 7.8%. Four of the 12 deaths were associated with gastrointestinal problems, but these complications first developed after aneurysm surgery in three patients and could not have been avoided by a concurrent operation. The management of gastrointestinal pathology in association with the treatment of abdominal aneurysm is reviewed. The coincidence of these disorders is not sufficiently frequent to allow valid comment on the probability of successful outcomes, but the risks posed by surgically untreated gastrointestinal conditions are low, so that secondary gastrointestinal procedures should be avoided in most aneurysm operations.

Aorta, Abdominal↗
PubMed1988

Primary adrenal tumours--a ten-year experience.

The experience of 31 patients with primary adrenal tumours seen in one teaching hospital over a 10-year period is reviewed. There were 10 patients who had benign cortical adenomas; 11 had adrenal cortical carcinomas, and 10 had phaeochromocytomas, one of which was malignant. During the review period, a primary adrenal mass was discovered in 5% of 2951 autopsies performed in the study institution. The diagnosis and management of these uncommon tumours is reviewed.

Adenoma↗
PubMed1987

Methyl tertiary butyl ether cholelitholysis of calculi in the gallbladder and bile ducts.

Recent use of the cholelitholytic agent, methyl tertiary butyl ether (MTBE) has demonstrated its efficacy in the dissolution of cholesterol calculi. In three patients with retained stones in the bile duct, MTBE was instilled and aspirated through a T tube to effect dissolution. Stones dissolved completely in two patients, while in the third, partial dissolution permitted instrumental extraction through the T tube tract. In this third patient, dissolution of gallbladder stones in vitro was relatively slow. Patients tolerated the procedure well and there were no major complications. There was no evidence of duodenal inflammation in two patients who underwent duodenoscopy and biopsy before and after treatment. Four patients with cholesterol cholelithiasis underwent direct gallbladder perfusion with MTBE. The mean size of the gallstones was 0.8 cm (range 0.25-1.75 cm) and the mean number of stones per patient was four (range 1-13 stones). MTBE was instilled via a percutaneous gallbladder catheter inserted under local anesthesia with X-ray control. In three patients, the stone dissolution appeared to be complete after three to six hours of treatment. In the fourth patient, catheter displacement led to termination of dissolution therapy. Follow-up ultrasonograms in two patients demonstrated residual debris not visualised on the immediate post-dissolution films. Complications occurred in two patients and included catheter dislodgement and bile leakage after catheter withdrawal. Biliary perfusion with MTBE is a therapeutic option in patients with retained stones in whom instrumental retrieval has failed. It may also have a role in selected patients with symptomatic stones in the gallbladder.

Adult↗
PubMed1986

Persistent postoperative enterocutaneous fistula: pathophysiology and treatment.

The cause of an enterocutaneous fistula following an abdominal operation, in the absence of inflammatory bowel disease or irradiation damage, is often obscure. In this study, it is postulated that distal obstruction, associated with peritoneal adhesions or abscess, is the critical determinant of fistula persistence. The 'venting' effect of the fistula, and the presence of obstruction which is frequently partial, makes recognition of the obstructive element difficult. It is suggested that operations to cure postoperative fistula should be based on the assumption that distal obstruction is always present, and should include a complete lysis of adhesions involving the small and large bowel. A postoperative fistula was cured in 21 out of 23 patients treated on this basis.

Abscess↗
PubMed1986

Splenic protection in left upper quadrant operations.

Splenectomy produces significant immediate and long-term risks for the patient, and there is general agreement that it should be reserved for clear-cut unavoidable indications. However, accidental injury to the spleen in the course of another operation (incidental splenectomy,) accounts for almost 40% of splenectomies in some series. Incidental splenectomy is most likely to occur in left upper quadrant operations such as proximal gastric vagotomy, or in colonic operations involving mobilization of the splenic flexure. Incidental splenectomy rates of between 2% and 9% have been reported in association with these procedures. The results of an operative strategy of specific protection of the spleen as the first step in a left upper quadrant operation ('defusing' the spleen) are reported. It was not necessary to remove the spleen because of accidental injury in 417 consecutive operations over a 5 year period after implementation of this policy. There were several minor splenic capsular tears which were controlled by intraoperative haemostatic measures. There were no cases of postoperative splenic bleeding. 'Defusing' the spleen is an effective step in preventing splenic injury in left upper quadrant operations.

Abdomen↗
PubMed1984

Epidemiology of peptic ulcer in Australia. A study based on government statistics in four states.

A study of Pharmaceutical Benefits Scheme cimetidine prescriptions, hospital admissions, and deaths due to peptic ulcer in 13 million Australians in 1981 indicated that the annual ulcer incidence per 1000 population was 3.8 for duodenal ulcer and 0.7 for gastric ulcer. Approximately 70 000 Australians appear to receive initial treatment for a peptic ulcer each year. Two-thirds of patients were managed outside hospital. Patients with gastric ulcers were more likely to be admitted to hospital or to die from their ulcer than were patients with duodenal ulcers. Significant regional differences in ulcer frequency were found; in particular, the risk of gastric ulcer in NSW was four times that in Victoria. Gastric and duodenal ulcers were more common in New South Wales than in Victoria, Queensland or Western Australia. These differences, and other regional variations, indicate appropriate localities for further studies of the aetiology of peptic ulcer.

Adolescent↗