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Biomedical subjects

D R Hunt

Publications and source records attributed to D R Hunt.

At least 19 recordsLinked to original sources
PubMed1992

Variation among North Amerindians: analysis of Boas's anthropometric data.

In the late nineteenth century Franz Boas was responsible for assembling anthropometric data from North Amerindians. Approximately 15,000 subjects were measured, but the data have never been systematically analyzed. Here we describe our efforts to develop a computerized database from Boas's data and present the first systematic analysis of these data. In addition to a general analysis of North Amerindian anthropometric variation, we also present a more detailed analysis of anthropometric variation among tribes located in the American Northwest. In the general analysis we find that anthropometric variation is strongly patterned along geographic lines. We examine geographic and language patterning by grouping tribes by culture area and language phylum. Both have high explanatory power, culture area being the higher. The Northwest analysis shows that both language and geographic location are important in explaining anthropometric variation.

Anthropology, Physical↗
PubMed1990

Endoscopic diagnosis of small flat carcinoma of the colon. Report of three cases.

Most small carcinomas arise from polyps. Small lesions with cellular features of malignancy and early invasion, but with no histologic evidence of residual adenoma, are rare. Diagnosed by endoscopy, three such lesions are described. They were recognized as mucosal plaques, measuring between 6 and 8 mm in diameter. In each case, there was either synchronous or metachronous carcinoma elsewhere in the colon, as well as benign adenomatous polyps. Colonoscopic identification of such lesions allows inclusion of that bowel segment in any planned resection.

Adenocarcinoma↗
PubMed1990

Bile duct emptying in response to fat: a validation study.

Fatty meal sonography has been suggested to assess patients with biliary pain after cholecystectomy, but the effects of gallbladder removal on biliary dynamics has not been studied prospectively. Before elective cholecystectomy, 25 patients had their common hepatic ducts' diameter measured by ultrasonography before and after a fat stimulus. In 23, tests were repeated 1 month, 1 year, and 5 years after surgery. In preoperative studies, 5 patients showed dilatation after fat and 2 of these had stones in the common bile duct. However, another 4 patients with stones or sludge in the duct did not show dilatation, so that the response to fat was a poor indicator of patients requiring common bile duct exploration. No patient had major symptoms after surgery. At 1 month and 12 months, the response to fat was variable with more than half of those tested showing no decrease in duct size. A more consistent pattern emerged at 5 years, when 14 of 18 patients tested showed a decrease in common hepatic duct after fat; 3 were unchanged and 1 increased by 1 mm. The response to fat was less consistent and more difficult to measure in the common bile duct, even 5 years after operation. It was concluded that not all patients with indications for exploration of the common bile duct on operative cholangiography show a dilatation response to fat on preoperative testing. Also, fatty meal sonography should be used with caution because the response to fat in asymptomatic patients soon after operation is unpredictable, with occasional patients showing dilation without apparent obstruction. Measurement of common hepatic duct is preferred to common bile duct and increases in diameter of 1 mm are probably not significant.

Bile Duct Diseases↗
PubMed1990

Costs of magnetic resonance imaging services in public hospitals.

Audited cost data from two public hospital installations participating in a trial of the utilisation and efficacy of magnetic resonance imaging are presented. The data cover the period July 1987 to June 1988 when both installations had attained stable patterns of operation. One hospital operated a superconductive system and the other a resistive magnetic resonance imaging unit. Depreciation and salaries represented the major components of cost.

Australia↗
PubMed1990

Pre-operative ultrasound measurement of bile duct diameter: basis for selective cholangiography.

In this prospective study, prior to cholecystectomy, the diameter of the common hepatic duct was measured; duct size was then compared with probability of finding stones at operation. Of 115 patients entering the study, 36 had stones removed from the common duct at the time of cholecystectomy but only three (8%) were demonstrated by ultrasonography. No stones were found in ducts less than or equal to 3 mm in size (31% patients). Only two of 26 patients with ducts measuring 4 mm had stones. As duct size increased, so did the probability of stones and all patients with ducts greater than or equal to 9 mm in diameter had stones. It is concluded that pre-operative ultrasound provides a reliable basis for a policy of selective cholangiography.

Cholangiography↗
PubMed1990

Sex determination in the subadult ilia: an indirect test of Weaver's nonmetric sexing method.

The sexing of subadult remains has been an ongoing problem in physical anthropology for many years. This is due in part to the scarcity of subadult collections of known age and sex which are large enough to be used to develop and test analytical methods. Several methods have been devised but few have produced reliable results. In 1980, Weaver presented a method for sexing subadult ilia using a nonmetric trait (the raised versus nonraised auricular surface), which has an accuracy of 75% in fetal females and 92% in fetal males. His method has not been tested for reliability on a different subadult sample. An indirect test of Weaver's method was made on a sample of subadult South Dakota Arikara Indian ilia by comparing the ratio of raised to nonraised auricular surfaces with an expected 1:1 sex distribution. Bimodal sex distributions in the Arikara formed unrealistic sex ratios, following an age-related shift from a 6:1 raised/nonraised ratio in newborns to a 1:4 ratio in young adolescence. Significant age correlations were found both in the present study and in Weaver's published results. The age-to-sex correlations indicated no confounding in the present study. The results of this test suggest that auricular surface morphology is not sex specific in subadult ilia, but may be related to aspects of shape and morphology in pelvic growth.

Adolescent↗
PubMed1989

Pylorus-preserving pancreatectomy: functional results.

The pylorus-preserving technique is reported as improving the functional results of pancreatectomy but it is complicated in the early postoperative period by delayed recovery of gastric function in a proportion of patients. We have examined early and late gastrointestinal function in a prospective study of 16 patients having this procedure. The late results appear better than reported results for conventional Whipple resection and the delay in early recovery does not appear to have any late sequelae, provided that it does not require gastric bypass for relief.

Adult↗
PubMed1989

Changes in bile duct diameter after cholecystectomy: a 5-year prospective study.

In this prospective study, we have measured with ultrasound the diameter of the common hepatic duct and the common bile duct in a series of 24 patients having elective cholecystectomy. Preoperative measurements by ultrasound were compared with measurements taken directly from operative cholangiograms and excellent correlation was observed (r = 0.938). Studies were repeated 1 mo, 12 mo, and 5 yr after operation. Of 21 patients returning for study at 5 yr, there were 4 patients with 1-mm ducts before surgery who showed an increase in the size of the common hepatic duct but in none was the final measurement greater than 4 mm. Mean common hepatic duct diameter (n = 21) increased from 3.95 mm before to 4.48 mm 5 yr after surgery (p = 0.24, paired t-test). Common bile duct was more easily seen after cholecystectomy and of 13 ducts satisfactorily measured 1 and 5 yr after surgery, 7 showed an increase in size (mean common hepatic duct 1 yr = 4.77 mm, 5 yr = 5.92 mm, p = 0.059, paired t-test). Significant dilatation of the common hepatic duct was seen in only 2 of 21 patients, but a strong trend to minor dilatation was observed in the common bile duct after cholecystectomy.

Cholecystectomy↗
PubMed1989

Recurrent hepatic hydatid disease or prior omentoplasty: diagnostic dilemma.

Endocystectomy combined with omentoplasty has become an accepted technique in the treatment of hydatid disease of the liver. Its attractiveness lies in its simplicity, its low frequency of postoperative biliary fistula, and the lack of specific complications related to the omentoplasty itself. However, radiological appearances after this procedure may be confusing. Two patients with upper abdominal pain are described in whom the radiological appearances of a previous omentoplasty could not be distinguished from a recurrent hydatid cyst.

Adult↗
PubMed1989

Angiomyolipoma of the liver.

Hepatic angiomyolipoma is a rare tumour of the liver. Its behaviour is benign and this paper reports the first case described in Australia. A review of the literature suggests that the use of ultrasonography, computerized tomography and angiography should enable pre-operative diagnosis to be made with relative certainty, yet the difficulties with histological diagnosis, particularly on needle biopsy, may necessitate resection.

Female↗
PubMed1987

Abdominal wound drainage--a prospective, randomized trial.

Prophylactic drainage of abdominal wounds with a closed suction system has been carried out in a prospective, randomized trial. There was no significant difference in the incidence of haematomas or infection rates in the groups with or without drainage. We conclude that wound drainage should be reserved for selected cases and that routine prophylactic drainage should not be practiced.

Abdominal Muscles↗
PubMed1987

Suprapubic catheters: a comparison of suprapubic versus urethral catheters in the treatment of acute urinary retention.

Sixty patients presenting with acute urinary retention were randomly allocated to treatment with either suprapubic or urethral catheters. An initial specimen of urine was obtained for bacteriological culture and organism count. Subsequently, repeat specimens of urine were obtained at intervals of 2 days until the catheter was removed. The results of these cultures showed that suprapubic catheters caused less urinary tract infection (P less than 0.05). In addition, suprapubic catheters were more comfortable for the patients, easier to manage and more cost-effective. In patients with suprapubic catheters, their ability to void could be assessed prior to removal of the catheter, thus avoiding the need for recatheterization. It was concluded that patients presenting with acute urinary retention should be routinely treated by drainage using suprapubic catheters.

Acute Disease↗
PubMed1986

Surgical aspects of pancreatic abscess.

In a retrospective study of all patients admitted with acute pancreatitis to a single hospital over the 10 year period 1975-1984, 22 patients operated upon for pancreatic abscess complicating acute pancreatitis were identified. The accuracy of the assessment by the surgeon of the extent of the abscess and the results of treatment by either local or wide drainage have been reviewed. The surgeon underestimated the extent of the abscess in 5 of the 22 patients. Four of these five patients were assessed as having a localized abscess presenting in the lesser sac and, in the other, the abscess was thought to be confined to the tail of the pancreas. Local exploration and drainage were performed in 13 patients and resulted in a high morbidity and mortality (54 per cent). Wide exploration was performed in nine patients with only two deaths, despite the greater extent of abscess formation. Improvement in outcome seen in the second 5 year period appears to be due to a more aggressive approach to exploration and drainage. The surgeon must be aware that abscesses in the lesser sac often signify more widespread abscess formation. Without wide exploration of the pancreas, assessment at laparotomy is likely to be unreliable. There appears to be additional benefit from wide drainage, even where abscess formation appears localized.

Abscess↗
PubMed1986

Long term biliary access by modified hepaticojejunostomy for high bile duct stricture.

Patients with recurrent high bile duct strictures pose special problems for management. Relief of obstruction by hepaticojejunostomy is usually possible but the standard technique does not permit long term access. Six patients with benign strictures involving hepatic ducts have been treated by a simple modification of hepaticojejunostomy retaining access for either balloon dilatation of intrahepatic strictures or investigation and treatment at a later stage if problems recur. Employing a longer than usual Roux-en-Y loop, the sutured anastomosis of right and left hepatic ducts is performed 10-15 cm from the free end of jejunum. Silastic tubes are placed into each hepatic duct crossing the anastomosis to exit from the free end of the jejunum which is closed around the tubes. The closed end of jejunum is buried in the peritoneum deep to linea alba and the tubes emerge in the epigastrium. Safe access is retained via the tubes. If the tubes are removed, a 'mini-lap' will expose the Roux loop for endoscopic or radiological access.

Adolescent↗
PubMed1986

Shigella dysenteriae type 1 enterocolitis.

Shigella dysenteriae type 1 is much more virulent than Shigella flexneri and sonnei which are endemic in Australia. This report describes a 22 year old woman who acquired Shigella dysenteriae type 1 whilst travelling in India. During the course of her illness, she developed severe enterocolitis for which a subtotal colectomy was performed. The illness resembled fulminant ulcerative colitis and its infectious nature was difficult to establish because several fecal cultures failed to grow the pathogen. Her infection was complicated by shigella bacteremia, disseminated intravascular coagulation, and renal cortical necrosis which requires continued hemodialysis.

Adult↗