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Biomedical subjects

L H Blumgart

Publications and source records attributed to L H Blumgart.

At least 19 recordsLinked to original sources
PubMed1992

Staging of hilar cholangiocarcinoma by ultrasound and duplex sonography: a comparison with angiography and operative findings.

The pre-operative radiological assessment of proximal bile duct tumours is clinically important as resection may be limited by tumour extension along the bile ducts, into hepatic parenchyma or the adjacent vascular structures. Demonstration of the extent of biliary and vascular involvement can direct additional investigations and definitive treatment. 22 patients with hilar cholangiocarcinoma were studied pre-operatively by conventional ultrasound (US) and duplex sonography (DS). The extent of tumour infiltration and vascular involvement was compared with arteriography and operative findings. Bile duct dilatation and the level of obstruction was documented by US in 22 (100%), and the tumour was shown by US in 19 (86%). In these 19 patients, the extent of extraductal extension compared with operative findings was correct in 13, underestimated in two, and in four infiltration was massed. Vascular patency or involvement was correctly determined by DS in 19 (86%), and by arteriography in 18 (82%). In two of the three incorrect DS interpretations, lobar atrophy and contralateral hypertrophy distorted the hilar anatomy. US with DS is valuable in the pre-operative staging of proximal bile duct tumours in predicting ductal and vascular involvement.

Adenoma, Bile Duct↗
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↗
PubMed1979

Serum enzymes in colorectal cancer.

A study of the value of serum enzymes in 184 patients with colorectal cancer has been performed. The enzymes studied were gamma glutamyltransferase (gammaGT), alkaline phosphatase (AP), lactate dehydrogenase (LDH), 5'-nucleotidase (5'-NT), glutathione reductase (GR), alanine and aspartate transaminases. In patients without liver metastases, elevated enzyme levels were found in 11-55% preoperatively. 5'-NT showed the least number of elevated activities, while gammaGT activities were increased in 29% and LDH in 55%. The percentage of elevated enzyme levels rose significantly in the early postoperative period. Patients with liver metastases showed increased enzyme activities in 40-60% preoperatively: gammaGT was the most sensitive indicator. Increased enzyme activity was related to the degree of liver involvement with secondary tumor. With extensive liver metastases, gammaGT levels were increased in 82%. It is concluded that serum enzymes are of limited value in the preoperative detection of liver metastases, and particularly when tumor involvement of the liver is small.

Alanine Transaminase↗
PubMed1979

The role of grey scale ultrasonography in the investigation of jaundice.

Sixty-seven patients were prospectively studied using grey scale ultrasound (GSU) to assess its possible role as part of a jaundice investigation programme. All scans were performed by one radiologist, without clinical information. When intrahepatic ductal dilatation was found an attempt was made to establish the level and cause of obstruction. The calibre of the intrahepatic bile ducts was correctly reported in 66 patients (98 per cent). Forty-three proved to have extrahepatic cholestasis, 24 had intrahepatic cholestasis. No patient with intrahepatic cholestasis had dilated ducts seen on ultrasound. In 43 patients with obstructive jaundice, GSU accurately detected the level of obstruction in 28. This accuracy varied with the cause of obstruction. A direct indication of diagnosis was possible in 45 of the 67 patients. In a unit specializing in the management of complicated hepatobiliary problems, GSU has been shown to be accurate in differentiating extra- from intrahepatic jaundice. Being non-invasive, it appears ideally suited for use as a screening procedure, permitting selection of appropriate invasive investigations to provide complete preoperative imaging of the biliary tree. In patients with jaundice due to gallstones, GSU may be the only imaging technique required before surgery provided good operative cholangiography is available.

Bile Ducts, Intrahepatic↗
PubMed1979

Renal function and other factors in obstructive jaundice.

Renal function and other factors that possibly affect the outcome of operation were measured in 24 patients with obstructive jaundice and in 15 non-jaundiced controls. The preoperative features that were associated with a poor postoperative recovery from obstructive jaundice were a raised serum fibrinogen/fibrin degradation product concentration, infection, hypoalbuminaemia and a low glomerular filtration rate. Preoperative serum fibrinogen/fibrin degradation product concentrations were raised in 4 of the 6 jaundiced patients who died after surgery but in none of the controls, in whom there was no mortality. In the jaundiced patients there was a greater incidence of postoperative renal impairment than in the controls. All patients were given mannitol during operation. Further mannitol was required after surgery in 13 of the 24 jaundiced patients in order to maintain urine flow rate despite adequate intravenous fluids being given. In contrast, only 1 of the 15 control patients required post operative mannitol. It is emphasized that repeated doses of mannitol can lead to a profound natriuresis and adequate intravenous saline should be given.

Cholestasis↗
PubMed1979

Hepatic resection for trauma, tumour and biliary obstruction.

Hepatic resection was performed in 37 patients. Fifteen emergency procedures were undertaken for blunt trauma and 16 patients had elective resection for hepatic tumour. A further 6 resections were performed for benign biliary tract obstruction. The importance of preoperative assessment and the indications for resection are discussed particularly in relation to resection for biliary obstruction. Operative procedures are outlined and the technique of extended left lobectomy is described in detail.

Adolescent↗
PubMed1979

In vitro dissolution of human gallstones: the efficacy of heparinized solutions.

The use of heparinized solutions to dissolve or fragment stones retained in the biliary tree after surgery is still controversial. In this in vitro study heparin in concentrations of up to 100,000 mu/l did not dissolve or fragment the stones examined, nor did it enhance the dissolution properties of the bile salt, sodium cholate.

Cholelithiasis↗
PubMed1979

A simple technique of measuring liver blood flow--intrasplenic injection of 133Xenon.

Intrasplenic injection of 133Xe was studied as an inert gas clearance technique for measuring liver blood flow in 13 dogs. This was done by comparing technique with intraportal injection of 133Xe (n = 41), and with electromagnetic flowmeter measurements of total liver blood flow. Very good correlation was obtained against the two latter techniques, the correlation coefficients being 0.99 and 0.90 respectively. The comparisons were made over a range of liver blood flow rates from 37 to 297 ml 100 g-1 min-1. The technique is potentially suitable for preoperative measurements, and may be particularly convenient when performed in conjunction with splenoportovenography.

Animals↗
PubMed1979

Rupture strength of skin wounds in jaundiced rats.

The rupture strength of 7-day-old wounds in normal rats, in rats in which there had been a previous skin incision, and in sham bile-duct-ligated and bile-duct-ligated jaundiced groups of rats was studied. It was found that wounds in jaundiced rats were significantly weaker than the wounds in the normal group of rats. Skin wounds in normal animals were significantly stronger than wounds in animals with sham bile-duct ligation. No difference was seen between sham bile-duct-ligated and bile-duct-ligated jaundiced rats.

Animals↗
PubMed1979

Activated charcoal haemoperfusion via an extracorporeal circuit in the unrestrained and unanaesthetized rat.

Repeated haemoperfusion over activated charcoal was performed in unanaesthetized and unrestrained rats, using a specially designed system. This allowed the effects of haemoperfusion on body weight, organ weight and various biochemical and haematological parameters to be studied, without the possible influence of repeated stress and exposure to anaesthetic agents. The procedure was well tolerated, even after 4 consecutive haemoperfusions. Changes in body weight occurred, but no significant difference was noticed between animals subjected to 4 consecutive haemoperfusions and those perfused through empty columns. Organ weight of liver and spleen were comparable to control values, but kidney weight increased after haemoperfusion over activated charcoal, but not in control animals. A progressive rise in leucocyte count was found after successive haemoperfusions, but levels returned to normal 21 days after their initial operative procedure. Platelet counts fell after charcoal haemoperfusion, but returned to within normal levels before the next perfusion.

Animals↗
PubMed1978

The early use of fine-needle percutaneous transhepatic cholangiography in an approach to the diagnosis of jaundice in a surgical unit.

Fine-needle percutaneous transhepatic cholangiography (PTC) was performed in a series of 46 patients with jaundice or suspected biliary tract disease. The ductal system was successfully outlined in each of 20 patients with dilated intrahepatic ducts and in 19 of 26 patients with intrahepatic ducts of normal calibre. There were two episodes of septicaemia after PTC, one of them fatal. Valuable accurate diagnostic information was obtained in all cases with biliary tract obstruction. A programmed approach to diagnosis of suspected obstructive jaundice is outlined. Fine-needle PTC is an acceptably safe procedure and need not be followed by immediate laparotomy.

Adult↗