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Biomedical subjects

A R Dennison

Publications and source records attributed to A R Dennison.

At least 73 records · Page 4Linked to original sources
PubMed1992

Enucleation of giant hemangiomas of the liver. Technical and pathologic aspects of a neglected procedure.

Cavernous hemangiomas are the most common benign tumors of the liver. Giant cavernous hemangiomas, defined as those larger than 4 cm in diameter, can reach enormous proportions. Newer imaging modalities, although often demonstrating characteristic features that strongly suggest the diagnosis, should not be augmented by biopsy because of the risk of hemorrhage. Elective surgical resection may be indicated for symptomatic giant lesions and for those with an atypical appearance where the diagnosis is in doubt. Between October 1986 and May 1991, we treated 10 patients with giant hemangiomas by enucleation or enucleation plus resection. Median operative blood loss was 800 mL (range, 200 to 3000 mL). One patient required reoperation for control of postoperative hemorrhage. Detailed pathologic examination has demonstrated an interface between hemangiomas and the normal liver tissue that allows enucleation. Enucleation is an underused procedure that if carefully performed allows resection of giant hemangiomas with a reduced blood loss and the preservation of virtually all normal hepatic parenchyma.

Adult↗
PubMed1992

Central European surgical training.

The opportunity and need for surgical training overseas changes with time. In the past, young surgeons in Australia and England completed their training with periods spent in the UK or USA respectively. Recent times have however seen a dramatic reduction in the numbers going abroad. This is in part due to concern about the ability to return to the domestic system in either Australia or the UK and in part due to a lack of knowledge about opportunities that exist not only in the English speaking medical community but also those on mainland Europe. We have been fortunate in having been able to work as members of the Department of Surgery in Rennes with Professor B. Launois (G. M.) and in Paris with Professor H. Bismuth (A. D.) and together in Berne Switzerland with Professor L. H. Blumgart. This experience has furthered our training in hepato-biliary surgery in non-English speaking environments. Supervisors and surgeons in training may wish to consider the possibility of additional experience in Europe rather than the UK or USA.

Consultants↗
PubMed1992

Fatal ascaris pancreatitis: an uncommon problem in the west.

Gastrointestinal parasites, although an uncommon cause of biliary and pancreatic problems in western medicine, can produce fatal complications. A Swiss patient presented with acute pancreatitis, with no evidence of gall stones or history of alcohol abuse. He died after a short fulminant illness. At necropsy, an Ascaris lumbracoides was found impacted within the ampulla of Vater and serves as a reminder that non-indigenous causes of biliary tract obstruction should not be overlooked.

Aged↗
PubMed1992

Current management of hilar cholangiocarcinoma.

The goal in the treatment of hilar cholangiocarcinoma is the relief of biliary obstruction with the quality survival. The choice of therapy for an individual patient requires complete preoperative staging to determine the resectability. This is best accomplished in a multidisciplinary setting with radiologists, gastroenterologists and surgeons participating in the diagnostic and therapeutic strategies. Operative removal of the tumor can be performed with low mortality and, when possible, provides the longest palliation and offers potential for cure. For tumors found at operation to be unresectable, biliary enteric bypass provides a durable method of palliation. The relative merits of the newer methods of radiologic stenting are encouraging, but further study will require prospective trials in comparison to operative biliary enteric bypass.

Adenoma, Bile Duct↗
PubMed1992

Primary carcinoma of the gallbladder: a 10-year experience.

New developments in the management of gallstone disease, and particularly percutaneous and extracorporeal treatments that leave the mucosa intact, have renewed interest in the relationship between cholelithiasis and carcinoma. These treatments are both available in our hospital and to examine this question we studied the patients presenting between 1980 and 1990 with gallbladder cancer. The study comprised 21 patients with histologically proven carcinoma. The M:F ratio was 1:4 with a mean age of 76 years. Gallstones were present in 18 patients (85.7%). Ten patients remain alive today and in the 11 who died the median survival was 4 months. A preoperative diagnosis was made by ultrasound in only two patients. The lack of a preoperative diagnosis in the majority of patients is clearly a cause for concern and while our figures, like other series, do not establish a causal relationship with gallbladder carcinoma, it is vital to be diligent in the follow-up of high-risk patients (stones greater than 3 cm) with intact gallbladder mucosa after the treatment of stone disease.

Aged↗
PubMed1991

Detection of colorectal liver metastases using intraoperative ultrasonography.

Intraoperative ultrasonography of the liver has been carried out in 99 patients undergoing surgery for colorectal cancer. Palpation of the liver, preoperative abdominal ultrasonography and computed tomography scanning were also performed in all patients. Metastases were identified in 26 of the 99 patients (26 per cent). Intraoperative ultrasonography diagnosed more metastases than palpation, abdominal ultrasonography or CT scanning, identifying metastases in 24 of the 26 patients, including six patients in whom the metastases were not detected by any other technique. Identification and localization of impalpable liver metastases is therefore possible using intraoperative ultrasonography.

Colorectal Neoplasms↗
PubMed1991

Primary leiomyosarcoma of the liver.

A case of primary leiomyosarcoma of the liver is described and the problems in diagnosis and management are discussed together with a review of the available literature. These tumours have a favourable prognosis when diagnosed preoperatively and the value of electron microscopic findings in this situation are highlighted.

Angiography↗
PubMed1991

Primary carcinoma of the gallbladder.

Carcinoma of the gallbladder is a relatively rare malignancy which is difficult to diagnose. The advent of improved imaging methods and the expansion of interventional radiology however, combined with advances in surgical technique, has produced a change in attitude towards this tumour. The available world literature since 1960 has been reviewed and is presented in this article. However, whilst the outlook for diagnosis and treatment is improving, clearly the association with cholelithiasis (between 45% and 100%), is a cause for concern particularly with the advent of treatments (lithotripsy, percutaneous gallstone extraction) which leave gall bladder mucosa and residual fragments of stone in situ.

Aged↗
PubMed1991

The changing pattern of thoracic surgery in the United Kingdom 1963-1982.

During the period 1963-1982 a total of 11,459 patients with general surgical and thoracic conditions were admitted to the Churchill and John Radcliffe Hospitals in Oxford under the care of a single thoracic surgeon. 55.1% of the admissions were for general surgical conditions whereas 44.9% were for a thoracic disorder. The total period has been studied by dividing it into three subgroups of 7, 6 and 7 years (1963-1969, 1970-1975, 1976-1982). The percentage of thoracic patients treated during the three periods was found to be 48.86%, 41.73% and 50.11% respectively. The three periods studied have been subdivided into major disease groups and the changes in these groups have been studied in detail. During this 20-year period there has been a dramatic change in the makeup of a typical thoracic surgical practice. This is in part due to the changing pattern and prevalence of many of the diseases treated by thoracic surgeons, but is also due to a change in referral patterns, the distribution of patients between thoracic and general surgeons and also the dichotomy emerging between thoracic and cardiac surgeons.

Cardiac Surgical Procedures↗
PubMed1989

Parasitic causes of obstructive jaundice.

Short case reports are presented of two patients seen in the U.K. with 'parasitic' obstructive jaundice. In one case the parasite involved was Clonorchis, and in the other it was Echinococcus. Both these parasites are uncommon in this country.

Animals↗
PubMed1989

The natural history of peptic oesophageal strictures treated by dilatation and antireflux therapy alone.

A total of 195 patients with benign peptic oesophageal strictures treated by endoscopic dilatation and antireflux medication between July 1977 and July 1986 were studied prospectively to determine the effect of such treatment on the subsequent course of this disease. Of the patients, 58% were female and they were significantly older than the males at the time of initial presentation (75 years vs 68 years, P less than 0.0001). 46% of both sexes required only one dilatation but the men required more dilatations over a longer period: 31% males vs 19% females required more than 3 dilatations (P less than 0.05) and 40% males vs 27% females were being dilated 2 years or more after the initial dilatation (P less than 0.05). Dilatation combined with antireflux medication is clearly an effective method of management for most patients with peptic oesophageal strictures. The value of antireflux surgery requires evaluation for that subset of patients, predominantly males, who require long-term and repeated dilatation.

Adult↗
PubMed1988

Hemorrhoids. Nonoperative management.

It is remarkable that the pathogenesis of a condition with as long a history and as much morbidity as hemorrhoids is incompletely understood, but various theories still contend for acceptance. The classification, presentation, symptoms, and complications of hemorrhoids are discussed, and various treatment options--injection sclerotherapy, rubber band ligation, manual anal dilatation, sphincterotomy, cryotherapy, infrared photocoagulation, bipolar diathermy, and the galvanic generator and probe--are reviewed.

Diathermy↗