PubMed Health⌕ Search

Biomedical subjects

J G Hunter

Publications and source records attributed to J G Hunter.

At least 91 records · Page 5Linked to original sources
PubMed1993

Familial subungual keratoacanthoma in association with ectodermal dysplasia.

Described is the first report of familial SUKA, occurring in two of three sisters with ectodermal dysplasia, a rare, hereditary disorder involving ectodermally derived organ systems. Although rare, SUKA should be considered when assessing rapidly growing nailbed lesions. Differentiation from subungual squamous cell carcinoma is essential. Tumor excision and curettage and close postoperative follow-up are recommended, with conservative amputation reserved for tumor recurrences. If the diagnosis of SUKA is confirmed in a female, an association with ectodermal dysplasia should be sought.

Adult↗
PubMed1993

Advantages of laser application in endoscopic surgery.

This article discusses the various kinds of laser therapy used in endoscopic surgery and their respective indications. Following a brief introduction into the basics of laser-tissue-interaction it is shown how less expensive treatment modalities have narrowed the range of laser applications to very specific purposes. In upper gastrointestinal bleeding argon and KTP lasers are mainly used for treatment of pigmented gut lesions. In malignant disease the combined use of balloon dilatation and laser irradiation has proved efficient in restoring patency to the gastrointestinal tract. Argon and CO2 lasers are used by gynaecologists for ablation of endometrioma. In an assessment of future prospects it is concluded that the lasting value of the laser lies in its ability to selectively destroy pigmented pathologic tissues.

Endoscopes, Gastrointestinal↗
PubMed1992

Laparoscopic transcystic common bile duct exploration.

This study reviews the results of transcystic common bile duct exploration (CBDE) for unsuspected stones found during laparoscopic cholecystectomy by a single surgeon in 150 consecutive patients. Fluoroscopic cholangiography was attempted in all but four patients. If the cholangiogram appeared to show common bile duct (CBD) stones, a 5 Fr, 8-mm ureteral stone basket was passed through the cystic duct into the duodenum, opened, and trolled through the CBD. Routine cholangiography was successful in 131 of 144 attempts (90%). An indication for CBDE was found by cholangiogram in seven patients (5%). Two cholangiograms were falsely positive. Stones were removed in five patients. Completion cholangiograms were normal in all patients. One patient developed mild pancreatitis but was discharged 2 days after laparoscopic cholecystectomy. The remainder were discharged on postoperative day 1. One patient was readmitted on postoperative day 2, possibly having passed a retained stone. Fluoroscopic CBDE was successful in clearing the CBD in all patients in this small series and deserves further evaluation.

Cholangiography↗
PubMed1992

Pediatric maxillofacial trauma.

The accurate diagnosis and timely, appropriate treatment of soft-tissue and bony maxillofacial injuries in children are of critical importance due to the potential adverse impact of maxillofacial trauma on subsequent facial growth and development. Guidelines are provided to assist the pediatrician in the evaluation and treatment of minor and major facial injuries.

Adolescent↗
PubMed1992

Laser use in laparoscopic surgery.

Gynecologists have found the argon and CO2 lasers very valuable for performance of pelviscopic surgery. Their interest was born from the complications initially seen with electrosurgical pelviscopic procedures and from the unique features of the laser for treatment of endometriosis. Laser technology was applied to laparoscopic cholecystectomy from its inception. This article reviews the arguments for laser and electrosurgical use in the many laparoscopic procedures--established and in evolution.

Cholecystectomy↗
PubMed1992

Laparoscopic management of bile duct stones.

Although it may seem that laparoscopic cholecystectomy has revolutionized the way we approach the patient with stones in the gallbladder and bile ducts, only a few rules have really changed. Fluoroscopic cholangiography, a requirement for radiologists and gastroenterologists performing percutaneous transhepatic cholangiography and ERCP, is slowly finding its way into the operating room. No longer is a "palpable stone" a common indication for common bile duct exploration. Most importantly, it is not necessary to make an incision into the bile duct to remove the majority of bile duct stones. The transcystic approach will clear the duct in 85% to 90% of all patients, sparing them extra hospitalization, a T-tube, and the risk of creating a bile duct stricture during sutured closure of the choledochotomy.

Cholangiography↗
PubMed1992

Suturing and knot tying in laparoscopy.

Laparoscopic surgery is evolving, and its applications are growing to include most abdominal operations. Tissue approximation by means other than mechanical clips or staples will be increasingly important. Laparoscopic surgeons must learn and apply basic suturing and knot-tying skills in this remote, two-dimensional operating theater. The authors advocate practice of these skills using inanimate and animate training models prior to application in the clinical setting.

General Surgery↗
PubMed1992

Primary cutaneous cryptococcosis as the presenting manifestation of AIDS.

Presented is a case of primary cutaneous cryptococcosis, presenting as a papular facial lesion with subsequent ulceration, as the initial manifestation of AIDS. This unusual condition must be considered in the workup of unexplained or therapeutically unresponsive skin lesions. If it is diagnosed in an ostensibly "healthy" individual, evaluation for evidence of immunosuppression, and its underlying cause, must be undertaken.

AIDS-Related Opportunistic Infections↗
PubMed1991

Routine fluoroscopic cholangiography during laparoscopic cholecystectomy: an argument.

We evaluated the impact of routine fluoroscopic cholangiography on our first 100 laparoscopic cholecystectomies. Catheterization of the cystic duct was successfully performed in 89 of 99 attempts. The cholangiogram altered the course of the procedure in 9 (10%) of these cases. In three subjects, the information obtained revealed unsuspected choledocholithiasis. In the remaining six patients, unusual and potentially hazardous anatomic relationships were discovered that were not visible via laparoscopic exposure alone. Arguments for the selective use of cholangiography during open cholecystectomy are based only on the identification of unsuspected stones. The strongest argument for routine cholangiography during laparoscopic cholecystectomy is the additional anatomic information obtained. Based on our experience, we advocate that routine cholangiography be a part of all laparoscopic cholecystectomies.

Adult↗
PubMed1991

Results of laparoscopic cholecystectomy in a university hospital.

This study analyzed the first 100 laparoscopic cholecystectomies performed at a university teaching hospital by a single surgeon. Patients presented with chronic cholecystitis (92), acute cholecystitis (5), acalculus cholecystitis (2), and asymptomatic cholelithiasis (1). The operative time ranged from 59 minutes to 185 minutes (mean: 110 minutes). Cholangiography was performed in 88 patients, and common bile duct stones were discovered in 3. Choledocholithiasis was managed successfully through the cystic duct in all cases. Two procedures were converted to open cholecystectomy. Operative complications included ductal injury in one patient, bile leak in two, wound cellulitis in four, and atelectasis in one. Ninety-seven patients were released within 24 hours after surgery. Mean hospital charges for laparoscopic cholecystectomy were $828 less than the cost incurred for open cholecystectomy. These early results support the view that laparoscopic cholecystectomy is a safe, cost-effective method for performing cholecystectomy with a remarkable improvement in patient recovery time.

Acute Disease↗
PubMed1991

Avoidance of bile duct injury during laparoscopic cholecystectomy.

Common bile duct (CBD) injury during laparoscopic cholecystectomy appears to have a higher incidence than during open cholecystectomy. This may be a function of inadequate instruction, inadequate caution, or inexperience, or may represent an inherent flaw in laparoscopic exposure. The aim of this study was to identify several steps in laparoscopic exposure of the gallbladder, cystic duct, and Calot's triangle to minimize the risk of surgical disorientation and CBD injury. A review of the first 180 laparoscopic cholecystectomies from the author's series was performed. Maneuvers that provided optimal exposure of the critical anatomy were culled from the video record. These maneuvers were (1) routine use of a 30 degree forward oblique viewing telescope, (2) firm cephalic traction on the fundus of the gallbladder to reduce redundancy in the infundibulum of the gallbladder and best expose the cystic duct, (3) lateral traction on the infundibulum of the gallbladder to place the cystic duct perpendicular to the CBD, (4) dissection of the cystic duct at the infundibulum of the gallbladder, and (5) routine fluoroscopic cholangiography. If these steps do not provide the surgeon with comfortable anatomic orientation, the procedure should be converted to open cholecystectomy.

Cholangiography↗
PubMed1991

Laser or electrocautery for laparoscopic cholecystectomy?

There are few concerns related to laparoscopic cholecystectomy that evoke as much emotion as the question of which is the superior energy source, laser or electrocautery. Monopolar radio frequency electricity (electrosurgery) and collimated coherent light (laser) injure tissue by the generation of heat, and in this regard are remarkably similar. The greatest differences between these sources of heat are related to predictability of injury, selective absorption of free beam laser energy, ability to coagulate, and cost. Although there are no prospective data yet available to answer the question of superiority, it appears that electrosurgical dissection may be faster and is generally less costly. Laser dissection may be more precise. In difficult cases, hemostasis appears to be superior with electrosurgery.

Cholecystectomy↗
PubMed1991

The argon beam coagulator provides rapid hemostasis of experimental hepatic and splenic hemorrhage in anticoagulated dogs.

The argon beam coagulator (ABC) delivers radiofrequency electrical energy to tissue across a jet of argon gas, providing noncontact, monopolar, electrothermal hemostasis. This study compared the efficacy of the ABC with conventional techniques for control of traumatic hepatic and splenic hemorrhage. Standardized lacerations were made to the liver and spleen of 6 heparinized dogs. Control of bleeding was attempted with the ABC (150 W), the Nd:YAG laser (90 W, noncontact), horizontal mattress suture, microcrystalline collagen, and regenerated cellulose. If bleeding had not been controlled within 3 minutes, coagulation was attempted with the ABC in order to prevent exsanguination. Tissue from both the liver and spleen was assessed histologically for damage induced by the ABC. Delayed injury and early healing after ABC coagulation was studied in six additional dogs killed 1 and 3 weeks postoperatively. The ABC stopped bleeding from 25/25 hepatic lacerations in 48 +/- 8 seconds (mean +/- SEM) and from 18/18 splenic lacerations in 28 +/- 3 seconds. The Nd:YAG laser, mattress sutures, and topical hemostatic agents failed to control bleeding in 14 of 15 applications after 3 minutes. The ABC successfully salvaged all failures in less than 1 minute. The depth of splenic and hepatic thermal injury with the ABC ranged from 2 to 7 mm and was proportional to the duration of application. Postoperatively wound healing progressed normally without bleeding or infection at the coagulation site. The ABC appears to be a excellent instrument for achieving hemostasis in solid organ injury, and may be especially valuable in managing patients with coagulation deficits.

Animals↗
PubMed1991

Percutaneous rotational contact biliary lithotripsy: initial clinical results with the Kensey Nash lithotrite.

The percutaneous rotary lithotrite introduces a new concept to fragmentation and percutaneous removal of gallstones. A fluid vortex is generated, pulling calculi into a high-speed blade that fragments stones to predominantly under 500 microns. The results of treating the first 10 patients with this instrument reveal that large stone burdens as well as small stones (2-3 mm) of any composition can be removed if the gallbladder is of sufficient size to accommodate the six-pronged basket. Rotation times of 7-39 minutes were required. Nine of 10 procedures were completed; access was lost in one case. One major complication occurred. At repeat oral cholecystography, the gallbladder was visualized after 3-6 weeks in eight of the nine patients. Ursodeoxycholic acid was administered from 3 to 12 months to five patients with either residual stones or aggregates. The hospital stay ranged from 48 to 72 hours. All patients (except the patient who underwent surgery) resumed light activity in 3-4 days and strenuous activity and full diet within 3 weeks.

Cholelithiasis↗
PubMed1991

Intraoperative cholangiography: use of portable fluoroscopy and transmitted images.

Intraoperative cholangiograms were obtained with portable fluoroscopy in 53 patients during laparoscopic cholecystectomy, and the images were transmitted to the radiology department. Each image was assessed for diagnostic quality and bile duct abnormalities (eg, retained stones and duct aberrancies). The aberrancy rate was 5.7% with the aberrant duct in the region of surgical dissection. The fluoroscopic technique provided diagnostic images with the advantage of real-time visualization, immediate communication with the surgeon, and the potential to decrease the risk of bile duct injury.

Cholangiography↗
PubMed1991

Laparoscopic cholecystectomy is less expensive than open cholecystectomy.

Laparoscopic cholecystectomy (LC) is emerging as the most attractive alternative to open cholecystectomy (OC) ever offered to patients. It combines a rapid recovery time with definitive therapy for their affliction. In addition to its greater acceptance by patients, LC has the potential to be more economical than OC because of the markedly shorter hospital stay required by most patients who have undergone LC. In this article we compare the hospital charges for patients undergoing LC with a matched group of patients undergoing OC. The hospital charge was $4,070 +/- 297 (mean +/- SEM) for patients undergoing LC and $5,017 +/- 497 for patients undergoing OC. This difference arises from the mean cost of in-patient care, which was $353 +/- 40 for LC patients and $1,335 +/- 138 for OC patients. LC appeared to be a bargain, both economically and physiologically.

Adult↗