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Biomedical subjects

D J Hehir

Publications and source records attributed to D J Hehir.

At least 19 recordsLinked to original sources
PubMed1996

Influence of teaching on the triage of multiple injury patients.

Attempts to improve the standard of early trauma management through the training and instruction of medical personnel have had variable results. Knowledge of trauma care is inadequate among all grades of medical and paramedical staff, and not much improvement has been made by the availability of instruction courses in trauma management. Staff most likely to attend such courses are seemingly already more proficient than staff who choose not to. To achieve maximum benefit from future courses, therefore, we believe attendance should be compulsory for all personnel involved in acute trauma care.

Case-Control Studies↗
PubMed1994

Riedel's thyroiditis--case report and literature review.

A fifty two year old female underwent attempted thyroidectomy for a progressively enlarging cervical swelling. At operation the thyroid gland was extensively fibrosed and not resectable, frozen section showed fibrous replacement. The patient was given a short course of postoperative corticosteroid therapy and was maintained on thyroid replacement therapy. Thirty months later the patient remains asymptomatic.

Combined Modality Therapy↗
PubMed1994

Improved limb salvage and mobility following peroneal artery bypass.

During the 10-year period August 1981 to 1991, 92 consecutive patients underwent revascularisation to the peroneal artery (40 to the upper third, 30 to the mid and 22 to the distal third). The male/female ratio was 1.6:1 and the mean age was 72 years. Thirteen patients had independent mobility preoperatively while 58 had limited mobility and the remaining 18 were bed/housebound. Following surgery the patients were prospectively evaluated and mean follow-up was 25 months. The 1 and 3 year patency rates were 67 and 59% respectively and cumulative limb salvage rates were 75 and 71%. Forty-four patients returned to independent mobility while 36 had limited mobility and 11 remained housebound. Reconstruction to the peroneal artery is a valuable adjuvant for limb salvage providing satisfactory cumulative patency and facilitating improved mobility.

Aged↗
PubMed1993

c-myc oncogene expression: a marker for females at risk of breast carcinoma.

In an attempt to identify patients at risk of breast cancer, 9E 10 c-myc monoclonal antibody was used to detect the oncogene products in 64 breast tissue biopsies. There were 44 specimens of benign breast disorders: 21 from patients who developed subsequent breast cancer, and 23 from patients who did not. The remainder were malignant tumor biopsies from those who developed breast cancer. C-myc over-expression was identified in 12 (60%) of the breast carcinomas; it was also noted in 13 (62%) of the benign biopsies from patients who developed subsequent breast carcinoma. Expression was observed in only 3 (13%) controls--patients who did not develop cancer. A prospective study is now warranted to determine the clinical usefulness of our findings.

Antibodies, Monoclonal↗
PubMed1993

Long-term results of limited thoracic sympathectomy for palmar hyperhidrosis.

Eighteen children (15 females, 3 males) aged 7 to 15 years underwent resection of the thoracic sympathetic chain for severe palmar hyperhidrosis. A localized section of chain immediately below the first thoracic ganglion and including the second thoracic sympathetic ganglion was removed. Patients were followed for 24 to 136 months. All patients had immediate and permanent abolition of palmar hyperhidrosis. There was no mortality, one patient developed intermittent ptosis and myosis, three patients reported compensatory hyperhidrosis and one girl was unhappy with the cosmetic results. We conclude that thoracic sympathectomy is a safe and permanent treatment for severe palmar hyperhidrosis in children. In addition, limited sympathetic resection is associated with a lower incidence of compensatory hyperhidrosis than conventional more radical sympathectomy.

Adolescent↗
PubMed1992

Foreign body complications of central venous catheterisation in critically ill patients.

In three critically ill patients, central venous catheter--associated foreign bodies were identified while the patients were in the intensive care unit. Two patients had fragments of retained catheter; in the third patient a guide-wire was lost within the vascular tree. The catheter fragments were associated with clinical symptoms while side effects were not observed with loss of the guide-wire. All three foreign bodies were removed without complications.

Catheterization, Central Venous↗
PubMed1992

Argyrophylic nucleolar organiser regions (AgNOR's) as a prognostic indicator in breast carcinoma.

Silver staining nucleolar organiser regions (AgNOR's) were determined in archival histological specimens of breast carcinoma. Representative samples from forty-eight female patients were counted manually for AgNOR's--median 3.85 (range 1.1-10.2 AgNOR's per cell). Taking the median value of 3.85 as a cutoff, the patients were divided into two groups: A = Those with AgNOR counts > 3.85; B = Patients with AgNOR counts < or = 3.85. The 5 year survival was 21% in group A and 85% in group B (p < 0.001). There was no significant correlation between AgNOR's and tumour size, lymph node status, tumour grade, menopausal status and oestrogen receptors. We conclude that nucleolar organiser regions may be useful as a prognostic indicator in breast carcinoma especially in patients in whom other prognostic information is unavailable.

Adult↗
PubMed1992

Intravenous nutritional support and the surgeon: where next?

Over the past twenty five years the development of total parenteral nutrition has in many ways revolutionised the practice of surgery. It has enhanced survival in otherwise high mortality operations such as oesophageal surgery, especially with anastomotic complications. It has changed significantly the management of fistulae, either post operative or associated with diseases such as Crohn's enteritis. Here a basic general principle is applied--that a fistula will close if there is no distal obstruction and the throughput can be diminished. This can be achieved by withholding oral feeding and using the parenteral route. It has allowed survival in the short gut syndrome from whatever cause and it is interesting to see the degree of "intestinal adaptation" that occurs once the first critical year is survived with the help of intravenous nutrition. The assessment of nutritional status is difficult and while the level of serum albumin may be taken as a clinical standard, it is obvious that many patients survive extensive surgery with low albumin levels and also that there appears to be a lag period to the restoration of albumin levels, even with otherwise successful nutritional support and with other parameters being satisfactory. Even complex formulae using a combination of laboratory and antropometric parameters is not fully satisfactory as an absolute assessment of nutritional status. It is now interesting to see that nutrition can affect both immune competence and even carcinogenesis. The lipid element in intravenous nutrition may cause dysfunction of immunity and vitamin status, gastric and platelet function with impaired oxygen diffusion leading to increased wedge pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1992

Nutrition in the critically ill.

When indicated, artificial feeding in critically ill patients should be instituted as early and as simply as possible. If feasible, enteral feeding is preferable but a period of intravenous nutrition is usually necessary in the critically ill. A compounded feed, administered via a sterile single lumen subclavian catheter is recommended. The volume and electrolyte composition are centrally important. High nitrogen and relatively low caloric intake are more likely requirements in stressed patients. The most important supplements are water soluble vitamins (including folate) and the trace element zinc. Safe practice requires a system of monitoring and awareness of potential complications.

Critical Illness↗
PubMed1992

Primary breast carcinoma in patients with malignant melanoma.

Malignant melanoma and primary breast cancer are tumours which have an association based on genetic and hormonal factors. It is not generally appreciated that there is an increased incidence of melanoma in patients with breast cancer and vice versa. We present two cases of patients who developed breast carcinoma following previous treatment for melanoma. We review previous reports of this association and examine the theoretical reasons why this should be so. Medical practitioners should be aware of this association in order to alter their index of suspicion appropriately.

Breast Neoplasms↗
PubMed1986

Improved protein kinetics and albumin synthesis by branched chain amino acid-enriched total parenteral nutrition in cancer cachexia. A prospective randomized crossover trial.

A prospective randomized crossover trial was conducted to determine the effect of a branched chain amino acid (BCAA)-enriched solution on whole body leucine kinetics and fractional rates of albumin synthesis in patients with intra-abdominal metastatic adenocarcinoma. Ten malnourished cancer patients were provided isonitrogenous amounts of both a conventional total parenteral nutrition (TPN) formula containing 19% BCAA and a BCAA-enriched TPN formula containing 50% of the amino acids as BCAA in a random order. Whole body protein turnover was determined by a 10 hour continuous infusion of leucine 14C. Increased whole body leucine flux (68 +/- 5 mumols/kg BW/hr versus 145 +/- 11; mean +/- SEM; P less than 0.001) and oxidation (13 +/- 2 mumols/kg BW/hr to 46 +/- 5; P less than 0.001) were determined on the BCAA-enriched TPN. Increased whole body protein synthesis (2.2 +/- 0.2 g protein/kg BW/day versus 3.9 +/- 0.3; P less than 0.005) and leucine balance (2.5 +/- 0.4 g leucine/d versus 6.5 +/- 0.6; P less than 0.001) were also observed in patients receiving the BCAA-enriched TPN solution. Leucine release from protein breakdown was not statistically elevated (1.65 +/- 0.18 g protein/kg BW/d versus 2.48 +/- 0.40; P greater than 0.05) but, incorporation of leucine 14C into plasma albumin was significantly elevated (2.37 +/- 0.23 mumols/g/hr to 4.21 +/- 0.33; P less than 0.001) when the patients received BCAA-enriched TPN. Despite the better leucine balance, the improvement in the 24-hour urinary nitrogen balance was not statistically significant (6.6 +/- 3.9 g protein/d versus 11.4 +/- 2.9; control versus BCAA-enriched; P = 0.15). BCAA-enriched formulas improve whole body leucine kinetics, fractional rates of albumin synthesis, and leucine balance, and thus may favorably influence protein metabolism in cancer cachexia.

Abdominal Neoplasms↗
PubMed1985

Abnormal phenylalanine hydroxylation and tyrosine oxidation in a patient with acute fulminant liver disease with correction by liver transplantation.

Phenylalanine hydroxylation, tyrosine oxidation, and plasma appearance of phenylalanine and tyrosine were evaluated in a 49-yr-old woman with fulminant non-A, non-B hepatitis and encephalopathy using a continuous intravenous infusion of L-[ring-D5]phenylalanine and L-[U-14C]tyrosine. Despite marked elevations in plasma phenylalanine and tyrosine appearance and normal apparent albumin synthetic rates, phenylalanine clearance and hydroxylation to tyrosine were only 12% and 60%, respectively, of values observed in individuals with normal liver function. Three days after orthotopic liver transplantation, plasma phenylalanine and tyrosine appearances were not markedly changed. Phenylalanine clearance and conversion to tyrosine, however, were restored to normal. In addition, tyrosine oxidation and apparent albumin synthesis were increased. This case report represents the first in vivo demonstration of a selective diminution of enzyme function in an individual with fulminant liver disease. Liver replacement restored aromatic amino acid degradative capacity and increased albumin synthesis.

Female↗
PubMedDate not supplied

Open common bile duct exploration--end of an epoch?

With the advent of laparoscopic cholecystectomy and the impending replacement of open common bile duct exploration, we have reviewed our ten year experience of conventional common bile duct exploration. Open cholecystectomy was performed in 1681 patients and the common bile duct was explored in 325 (19%). Following initial duct exploration, rigid choledo identified residual choledocholithiasis in 58 and periampullary neoplasia in 2 patients. Unexpected retained stones were identified in 3 patients (0.9%). In a further 4 patients, stones which could not be dislodged from the hepatic ducts were confirmed on 10 day T-tube cholangiogram--transduodenal sphincteroplasty had been performed at the time of original surgery in all four. The mortality was 1.9% overall and 1% during the last 5 years. Endoscopic exploration must compare favourably with these data for safe transition to less invasive techniques.

Adult↗
PubMedDate not supplied

Deliberate ingestion of foreign bodies by institutionalised psychiatric hospital patients and prison inmates.

Deliberate and recurrent foreign body ingestion is a common problem among institutionalised patients. We review our experience with 36 cases of deliberate foreign body ingestion by prisoners or psychiatric patients, thirty of whom were institutionalised at the time of ingestion. Symptoms were frequently severe in the prison inmate group but, in contrast, psychiatric patients presented with few, if any, symptoms. A majority of objects pass spontaneously or remain in situ without complication. Twenty-four patients were discharged following initial evaluation and without specific treatment. Eight of these were reviewed electively and discharged within one week. Twelve patients were admitted for observation, seven of whom were discharged within 48 hrs. Upper gastrointestinal endoscopy was performed in four patients and an intragastric foreign body identified in two cases. Laparotomy was performed in two cases for unresolving mechanical intestinal obstruction. Management should be conservative when possible, with surgery indicated only for complications.

Adolescent↗