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A Hatfield

Publications and source records attributed to A Hatfield.

At least 19 recordsLinked to original sources
PubMed1999

Portable ultrasonic scanning of the anterior neck before percutaneous dilatational tracheostomy.

We used portable ultrasound scans to identify relevant anatomical structures in the necks of 30 patients before percutaneous tracheostomy. We identified the tracheal midline, thyroid isthmus and blood vessels and located a safe level for needle insertion. Anterior jugular veins were seen in 15 patients; eight were near the midline and were considered vulnerable. Three veins were more than 4 mm in diameter and these larger vessels were electively ligated. Four patients had arteries which were considered vulnerable to damage. All patients underwent successful percutaneous tracheostomy. Portable ultrasound provides a simple method of screening for vulnerable blood vessels in the neck and for locating the midline before percutaneous tracheostomy. This method is particularly suitable for patients with landmarks that are difficult to visualise or palpate. Based on the ultrasonic findings we can make an informed decision about referral for surgical tracheostomy.

Adolescent↗
PubMed1999

Portable ultrasound for difficult central venous access.

Central venous catheterization can be difficult and can cause serious complications. Ultrasound-guided venous access is increasingly used but reports concern only routine cases. We performed a prospective observational study in 'difficult' or 'failed' procedures to assess the usefulness of ultrasound guidance. We used the technique in 33 patients; 23 had previous failed attempts or had suffered complications from such attempts. Ultrasound provided an anatomical reason for failure in 16 patients. Ten other patients were expected to be difficult before catheterization. Ultrasound identified a suitable site for catheterization in all 33 patients. Real-time ultrasound was used to successfully catheterize 22 patients. In nine patients, a surface landmark technique was used, which failed in three patients. In these three patients, ultrasound guidance allowed successful cannulation. Ultrasound guidance is a useful technique to aid central venous access when difficulties or complications have been encountered or anticipated.

Adolescent↗
PubMed1997

Hepatic artery aneurysms: evaluation using three-dimensional spiral CT angiography.

Hepatic artery aneurysms are rare and frequently difficult to diagnose. Computed tomography (CT) and ultrasound rarely make the definitive diagnosis and angiography is usually required. We present three cases of hepatic artery aneurysms in which the definitive diagnosis was made on three-dimensional (3-D) spiral CT angiography-to our knowledge, this has not previously been described. Our experience shows that in many cases of hepatic artery aneurysm, conventional angiography need only be performed as a prelude to embolization.

Adult↗
PubMed1996

[Mini-probe ultrasound of the upper gastrointestinal tract--1995 state of the art and perspectives. Workshop on Mini-Probe Ultrasound in Gastroenterology, Münster, 28 October 1995].

Endoscopic ultrasound (EUS) allows for intraluminal sonographic imaging of the oesophagus, stomach, pancreatobiliary duct system, the papilla of Vater, as well as the colon and rectum. EUS has proved valuable for diagnosis and staging of tumours of the upper intestinal tract. EUS can also provide valuable additional information concerning lesions that cannot be immediately classified. As doing this involves, first, removal of the conventional endoscope and, second, insertion of the echo endoscope, EUS is not suitable for routine examinations. Therefore EUS has remained an independent endoscopic diagnostic modality. Moreover, due to their diameter conventional echoendoscopes cannot be inserted into the pancreatobiliary duct system. Fine calibre high frequency ultrasound probes promise a resolution of less than 2 mm in diameter. The following report is a summary of a one-day workshop which took place in Muenster, Germany on Oct. 28, 1995. Its goal was to define the current state of the art of miniaturised endoscopic ultrasound probes in the field of gastroenterology. During this workshop, possible clinical applications for diagnosis, therapy, as well as follow-up were described and discussed. The potential of miniaturised endoscopic ultrasound probes was explored in terms of possible future technical developments.

Endoscopy, Gastrointestinal↗
PubMed1985

Aziridinylbenzoquinone in recurrent, progressive glioma of the central nervous system. A Phase II study by the Illinois Cancer Council.

Aziridinylbenzoquinone (AZQ) was studied in a Phase II protocol for persons with glioma of the central nervous system (CNS) recurrent or progressive after surgery and radiotherapy. Patients received AZQ, 30 mg/m2 intravenously every 3 weeks if previously untreated or 27.5 mg/m2 if previously exposed to cytotoxic drugs. Partial response was defined as a reduction of at least 50% reduction in the product of the two longest perpendicular diameters of the indicator lesion persisting for a minimum of 28 days. Twenty-eight patients are evaluable for response at this time. Objective response (OR) occurred in four (14.3%): two complete and two partial. Stabilization of disease (SD) was seen in 7 (25.0%). Median survival, in weeks, was greater than 46.0 for responders, 41.7 for SD, and 19.3 for those with progressive disease. The survival experiences are significantly different (P = 0.030 [Breslow]). The OR rate was 21.1% in 19 without prior chemotherapy and 0% in 9 previously treated patients. There were two AZQ-related deaths in patients with prior exposure to nitrosoureas (1 CNS hemorrhage; 1 aspiration pneumonia). One patient had an anaphylactic reaction. Three patients whose tumor initially increased in size subsequently had marked tumor shrinkage. AZQ is an active agent that must be used with added caution in patients who have received nitrosoureas. Initial tumor enlargement may precede response. Although response appears to prolong survival, the correlation between stabilization of disease and survival is not well-defined.

Adolescent↗
PubMed1983

Cooperative groups and community hospitals. Measurement of impact in the community hospitals.

The Eastern Cooperative Oncology Group, composed of major cancer treatment centers, has an outreach program which involves community hospitals in ongoing cancer clinical trials. A prevalence survey was carried out in February 1981 among 104 community hospitals and 21 member institutions to determine the characteristics of patients being treated, their staffing, and reasons why patients were not on protocol studies. The survey sampled 25 (50) consecutive patients from community hospitals (member institutions). The purpose of the study was to assess the impact of a community cancer control program. The results of the study demonstrated that 16% of patients surveyed in the affiliated community hospitals were being treated on a research protocol. In addition, a further 35% had their treatment plan influenced by a protocol. Consequently protocols have impacted directly or indirectly on 51% of the patients. The corresponding figures in member institutions were 23% and 38% for a total of 61%. In studying protocol availability, it was found that 66% of all patients were ineligible for any protocol. Of patients eligible for a protocol but not registered on one, 52% were not registered because of physician preference for a specific treatment. The affiliates surveyed were shown to be on average half as large as member institutions in terms of number of beds and staff size. Also, staff/patient ratios are generally smaller in the community hospitals. The median age of patients was considerably lower than SEER incidence data. Also, elderly patients were slightly more prevalent in community hospitals than in member institutions. A clear relationship between disease stage and age in breast cancer patients was noted with the representation of early-stage disease much higher in young women.

Adult↗
PubMed1983

Primary sclerosing cholangitis associated with inflammatory bowel disease in Cape Town, 1975 - 1981.

Patients with inflammatory bowel disease and serum alkaline phosphatase persistently raised to more than twice the normal level were investigated to assess the frequency of primary sclerosing cholangitis (PSC) in the Gastro-intestinal Clinic from 1975 to 1981. Twelve patients had a persistently raised alkaline phosphatase level of hepatic origin, 9 out of 250 with ulcerative colitis and 3 out of 164 with Crohn's disease. PSC was demonstrated in 8(3%) of the patients with ulcerative colitis, and carcinoma of the pancreas in the remaining 1. Three of the patients with PSC also had gallstones. The colitis antedated the biliary symptoms and signs in all but 1 patient. There was no correlation between the duration, extent and activity of the colitis and the development and outcome of the liver involvement. Investigations in the 3 patients with Crohn's disease revealed the presence of PSC in 2 (1,2%) and chronic active hepatitis in the 3rd. Of the 2 with PSC, one had cholelithiasis and has had recurrent episodes of cholangitis. The other has had only mild symptoms.

Adult↗
PubMed1982

Ranitidine heals duodenal ulcers.

A double-blind placebo-controlled study of ranitidine 150 mg given twice daily for 4 weeks was carried out in 80 ambulant patients with endoscopically proven duodenal ulceration. Fifteen patients were withdrawn because of poor compliance or default. Of the remaining 65 patients, endoscopic healing (with or without residual erosion) was noted in 28 of the 34 ranitidine-treated patients (82%) and in 14 of the 31 placebo-treated patients (45%) (P less than 0.005). Twenty-three patients whose ulcers were unhealed after 4 weeks of ranitidine therapy or placebo were then given ranitidine for a further 4-week period. Four of these patients were withdrawn, but ulcer healing was achieved in 16 of the remaining 19 patients (4 out of 5 (80%) initially treated with ranitidine and 12 of 14 (86%) initially treated with placebo). No significant clinical, biochemical or haematological adverse reactions were noted in either treatment group. It is concluded that ranitidine is a safe and effective therapy in patients with duodenal ulceration and that initial unsuccessful treatment with placebo does not appear to influence the subsequent response to ranitidine.

Adult↗