PubMed Health⌕ Search

Biomedical subjects

D G Hutson

Publications and source records attributed to D G Hutson.

At least 19 recordsLinked to original sources
PubMed1995

Balloon dilatation through the subcutaneously placed afferent limb of a hepaticojejunostomy in patients with resected Klatskin tumors.

It is generally conceded that palliation for proximal bile duct tumors (Klatskin) is exceptional if obstruction and the resultant infections can be prevented. Our experience with balloon dilatations thru the subcutaneously placed afferent limb of a choledocho or hepatico jejunostomy in patients with benign strictures suggests that this approach will be effective in patients with malignancies and thus provide long-term control of the obstruction without the need for external tubes. This is a report on one patient who, following a resected Klatskin tumor with positive margins, was treated with transhepatic internal external stents and was converted to a subcutaneous limb following numerous bouts of cholangitis. A schedule for repeat dilatations thru the jejunal limb was established. The patient has remained afebrile with a normal bilirubin and a moderately elevated alkaline phosphatase. Recurrent tumors or postirradiation strictures in patients with resected Klatskin tumors can be effectively controlled by repeated balloon dilatation without the need for external stents.

Aged↗
PubMed1993

The action of ammonia on astrocyte glycogen and glycogenolysis.

Most of the brain glycogen, a major energy reserve that can be mobilized in response to increased neuronal activity, resides in the astrocyte, the site of the neuropathological abnormality found in hepatic encephalopathy (HE). Ammonia, a neurotoxin implicated in the pathogenesis of HE, has been reported to cause a depletion of glycogen in primary astrocyte cultures. To further investigate the action of ammonia on glycogen levels, cultured astrocytes were exposed to ammonium chloride (1-5 mM) for various times up to 7 d. Treatment with ammonia for 24 h did not alter deoxyglucose uptake, but significantly lowered peak glycogen values (found at 1.5 h following feeding with medium containing 5.5 mM glucose) in a concentration-dependent manner. This inhibitory effect was not observed after longer exposure times to ammonia. Three day treatment of cells did, however, significantly reduce norepinephrine-stimulated glycogenolysis, an effect not seen after 1 d of ammonia treatment. Part of the neurotoxic action of long term ammonia exposure in humans and experimental animals may be to inhibit the breakdown of glycogen. The effect of ammonia on astrocyte glycogen synthesis and/or breakdown may disrupt glial neuronal signaling and thus play a role in the pathogenesis of HE.

Ammonia↗
PubMed1993

Pulseless (Takayasu) disease with ophthalmic manifestations.

Pulseless disease (PD) is a rare disorder in which inflammation of the aorta and its major branches leads to stenosis or occlusion of these arteries. It mainly affects young Oriental women, who suffer chronic ischemic injury to tissues of the brain, orbits, upper limbs, myocardium, and kidneys. The ophthalmologic features of pulseless disease tend to be late manifestations, and can include ischemia of the retina, choroid, and anterior segment. The inflammatory process may be reversed in early stages with systemic corticosteroids, but, more frequently, significant arterial stenosis necessitates arterial bypass surgery. A 59-year-old Caucasian woman with stenosis of all four major cervical arteries presented with recurrent blurred vision, syncope, mental obtundation, and a remarkable funduscopic appearance due to bilateral orbital hypoperfusion. Her acute symptoms improved slightly on high-dose systemic corticosteroids, and then resolved completely following arterial bypass surgery.

Arterial Occlusive Diseases↗
PubMed1990

[Hepaticojejunostomy with a subcutaneous blind jejunum segment. An alternative in the treatment of stenosing bile duct diseases].

The choledochojejunostomy and hepaticojejunostomy with a blind subcutaneous segment of the jejunum offer a safe, simple and nearly linear access for repeated retrograde balloon dilatations of the biliary tract. 81 patients, both with malignant as well as benign stenoses of the biliary system have been treated with this method during the last 8 years. Operative technique and preliminary results of this new procedure, which we believe to be the method of choice in recurrent or multiple iatrogenic or posttraumatic biliary strictures, are presented in this paper.

Aged↗
PubMed1988

Combined surgical and radiologic approach to recurrent cholangitis and intrahepatic pigment stones.

A 37-yr-old white woman from Australia presented with ascending cholangitis and jaundice and was found to have multiple brown, "earthy" pigment stones in the biliary tree, including the segmental ducts. Removal of these stones was accomplished via a subcutaneously placed afferent jejunal limb of a choledochojejunostomy using balloon dilators. The jejunal conduit also served as an access for periodic removal of newly formed stones. This combined surgical and radiologic approach is an effective way of removing recurring pigment stones. The afferent jejunal limb can also be used to perfuse dissolution agents, if necessary, via catheters placed in the biliary tree.

Adult↗
PubMed1988

Portal hypertension. A fifteen year perspective.

Two hundred six consecutive patients were followed from 5 to 15 years after a distal splenorenal shunt operation. Nonalcoholic patients demonstrated nearly twice the survival rate when compared with alcoholic patients. The mean duration of life for the surviving nonalcoholics was 10 years and for the alcoholics, 9 years. We predict that approximately a third of the nonalcoholics will enjoy long-term survival. The operative mortality rate was similar in both groups, being about 4 percent. The risk of liver cancer was highest in the male alcoholics, and long-term survival was greater for women in both the alcoholic and nonalcoholic groups.

Alcoholism↗
PubMed1987

Postoperative jaundice as a clue to unrecognized biliary tract obstruction.

Postoperative jaundice is often a complex clinical problem of multifactorial origin. If underlying liver disease is present preoperatively, there is a greater likelihood of jaundice after surgery. We describe two patients: one with intrabiliary hepatocellular carcinoma and the other with primary sclerosing cholangitis. The underlying processes were unmasked after the development of jaundice in the postoperative period. These cases point out the importance of considering previously undiagnosed biliary tract obstruction in the differential diagnosis of postoperative jaundice.

Aged↗
PubMed1986

Acute peripheral arterial occlusion associated with surgery for gynecologic cancer.

Four cases are described of acute peripheral arterial occlusion associated with surgery for gynecologic cancer during the 5 years 1979 to 1983 at the University of Miami, Jackson Memorial Hospital Center. No such cases were recorded during the preceding 5 years. The probable underlying etiologic factors are discussed and recommendations made regarding the evaluation and management of such patients.

Adenocarcinoma↗
PubMed1986

Percutaneous transjejunal biliary dilatation: alternate management for benign strictures.

Since 1980, 23 patients with diffuse benign biliary strictures underwent percutaneous retrograde biliary dilatation through a surgically created jejunal access route. Bile ducts of 15 patients with sclerosing cholangitis, five with traumatic strictures, and three with strictures of diverse etiology were dilated with 25-atm balloons during 88 separate sessions. Individual dilatation intervals ranged between 2 and 36 months. Three patients with sclerosing cholangitis died. One uncomplicated bile duct rupture occurred in the trauma group because of balloon oversizing. Our 5-year experience indicates that bile duct patency can be safely maintained by repeated retrograde dilatations without the need for biliary catheters or stents.

Adolescent↗
PubMed1985

Lowering of plasma free tryptophan in normal and portacaval shunt dogs.

The purpose of this study was to develop a method which would produce immediate and sustained lowering of plasma free tryptophan. Glucose, insulin, and mixtures of the two in different concentrations were infused into dogs over a period of 6 hr. Blood was sampled during the course of the infusion for assay of plasma free and total tryptophan, free fatty acids, glucose, and insulin. The infusate found to produce the most significant and sustained reduction in plasma free tryptophan in normal dogs was a mixture of 25% glucose and insulin. The lowering ranged from 26 to 47% during the course of the infusion. When the same infusion mixture was administered to dogs with established portacaval shunts, and elevated plasma free tryptophan concentrations (3.3 +/- 0.3 micrograms/ml compared to normal dogs which had 1.9 +/- 0.1 micrograms/ml), there was a 35% reduction to normal levels (2.0-2.2 micrograms/ml). A glucose-insulin mixture has, therefore, been found which, upon infusion into dogs, significantly lowers plasma free tryptophan levels. The effect of such an infusion on the plasma levels of free tryptophan, and the clinical course of patients with hepatic encephalopathy remains to be determined.

Animals↗
PubMed1985

Transgastric drainage of pancreatic fluid collections.

Eight pancreatic fluid collections in seven patients were successfully drained percutaneously through a transgastric approach. The drainage catheters were left in place for 3-6 weeks to promote the formation of a fistulous tract between the stomach and the pancreatic collection. Computed tomography (CT) was used for diagnosis and for planning of the access route. Combined sonography and fluoroscopy were used for guidance. Radiologic follow-up examinations (CT and sinograms) have shown no recurrences (3-12 months). No complications were encountered.

Drainage↗
PubMed1984

Insulin degradation in hepatic cirrhosis.

Hepatic insulinase activity was studied in cirrhosis in an attempt to explain the hyperinsulinemia known to occur in this disease. Liver tissue was obtained during laparotomy in seven patients with cirrhosis of the liver and five patients without liver disease. Insulin degradation was significantly decreased in the cirrhotic liver at each time interval measured (p less than 0.05). Insulinase inhibitor activity was measured in the plasma of 12 patients with cirrhosis of the liver and six controls. There was no significant difference between the two groups. Decreased insulinase activity in cirrhosis may account, in part, for the hyperinsulinemia seen in this disease.

Animals↗
PubMed1984

Balloon dilatation of biliary strictures through a choledochojejuno-cutaneous fistula.

The problem of recurrent strictures following repair for bile duct injuries or in patients with sclerosing cholangitis is well recognized. For the most part, the recurrent problems have required repeated operations. The possibility of controlling the recurrent strictures by dilatation has been postulated, but repeated dilatations obviously require simple access to the entire biliary tree. We have found that stomatization of the afferent limb of a choledochojejunostomy or hepaticojejunostomy provides ready access to the biliary tree through which strictures can be readily traversed and dilated. Our early results with this procedure suggest that long-term patency can be expected following dilatation of these strictures.

Adult↗
PubMed1984

Ampicillin versus cefamandole in biliary tract surgery. A prospective, randomized clinical and bacteriological study.

A prospective, randomized study was conducted on 219 surgical patients with biliary tract disease. There were 100 patients undergoing elective biliary surgery, and 119 others with suspected biliary sepsis who were assigned to Prophylactic or Therapeutic clinical categories, then randomized into ampicillin or cefamandole treatment groups. Organisms resistant to the antibiotics given were found less often among patients in the cefamandole groups than among those in the ampicillin groups. No postoperative wound or intra-abdominal sepsis (IAS) occurred in the Prophylactic category. In the Therapeutic category there were two cases (3.2%) of wound and IAS in the ampicillin group and one case (1.8%) of wound infection in the cefamandole group. Overall, cefamandole showed superior coverage in vitro against the biliary flora, but both drugs were equally effective in maintaining a low incidence of postoperative sepsis as well as a minimal number of febrile or total hospital days. The authors suggest that the choice of antimicrobials may not be as critical as effective surgical management in the prevention of septic complications following biliary tract surgery.

Adult↗
PubMed1982

A possible hepatic factor in the control of plasma free fatty acid levels.

Insulin acts as a regulator of lipid metabolism by inhibiting the rate of lipolysis. Hyperinsulinemia, produced by the peripheral infusion of glucose, therefore, causes a lowering of plasma free fatty acids (FFA) by decreasing the mobilization of fats from peripheral deposits. Based on previous studies, it was postulated that a lowering of plasma FFA could be produced, in the absence of hyperinsulinemia, by the infusion of glucose directly into the liver. This study was undertaken to investigate the existence of endogenous factors other than insulin, which inhibit lipolysis. It was determined that glucose at a dosage of 0.125 gm/kg/hr could be infused into the portal vein of dogs without increasing plasma insulin levels. This dosage significantly lowered plasma FFA levels when injected into the portal vein but had no effect on plasma FFA when infused peripherally. There were significant decreases in FFA turnover following portal glucose administration, with no changes in fractional turnover. This indicated that the lowered plasma FFA concentrations found following portal infusions of glucose, were due to reduced lipid mobilization from adipose tissue, rather than increased tissue uptake of FFA. These results suggested the existence of an hepatic factor, stimulated by portal glucose infusion, which lowered FFA mobilization from adipose tissue.

Animals↗