Biomedical subjects
Publications and source records attributed to T B Hugh.
A technic of intraoperative contact cholangiography is described in which a sterile wrapped film is placed behind the mobilized duodenum and common bile duct. In series of 120 cholecystectomies this technic, in conjunction with conventional cholangiography, allowed a low rate of exploration of the common bile duct (15 per cent) and has detected otherwise unsuspected stones in two patients.
The efficacy of antifibrinolytic therapy in the management of acute upper gastrointestinal haemorrhage has been investigated in a double-blind clinical trial. Two-hundred patients were studied using tranexamic acid, a potent antifibrinolytic agent. Of these, 103 were in the treatment group and 97 in the control group. Patients were analysed to determine severity of initial blood loss, transfusion requirements, together with the incidence of recurrent bleeding, surgical intervention, and death. Final diagnosis as to the site of bleeding was arrived at using endoscopy, barium studies, and the findings at operation and necropsy. The groups were well matched as regards severity of initial haemorrhage, age, sex, aetiological diagnosis, and precipitating factors. A significant difference was observed in the requirement for surgical intervention to control continuing or recurrent haemorrhage. Twenty-three of 97 in the control group and seven of 103 in the treatment group required surgery. There appeared to be a reduction in the transfusion rate after the first three days of hospitalization in the treatment group. There were no significant differences in mortality or in side-effects between the two groups.
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Starch peritonitis, a granulomatous reacton to surgical glove powder, is reported in four patients. The condition presents as a well defined clinical syndrome, and should perferably be diagnosed clinically to avoid reoperation and the risk of introduction of more starch. Studies show that a mean of 107 mg of starch per pair is present on the outside of Austrailn-made surgical gloves. It is suggested that gloves be rinsed and dried before operation and it is recommended that a warning to this effect be printed on glove packets.
Traditional indications for exploration of the common bile duct have been made anachronistic by developments in operative cholangiography. A new technique of contact cholangiography, described in this paper, improves the precision of operative cholangiography and allows the traditional indications for exploration to be modified. A new set of guidelines for exploration of the common duct, based on high-quality operative cholangiography, is outlined, and the place of the supraduodenal and transduodenal routes for exploration is discussed. The results of the application of these policies in a series of 120 cholecystectomies are presented.
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A case is reported of a patient with a 9-cm stricture of the esophagus caused by ingestion of sodium hydroxide, who was treated by gastric antral patch esophagoplasty. In this procedure, a full-thickness pedicled patch of gastric antrum, based on the left gastroepiploic artery, was used to enlarge the esophageal lumen, thus allowing preservation of esophageal continuity and utilization of a functioning lower esophageal sphincter. The patient ate normally after the operation, and radiological, manometric, and esophageal pH monitoring studies indicated satisfactory esophageal function. Gastric antral patch esophagoplasty avoids the complications associated with esophageal bypass or resection. Previous long-term results of this procedure in patients with reflux-induced esophageal stricture have been good, and the technique merits consideration in the treatment of severe corrosive strictures.
This study describes a prospective randomized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds. Consecutive patients undergoing abdominal operation--elective and emergency surgery--through a midline abdominal wound were randomized to have the peritoneal layer closed with continuous catgut, or to have this step omitted. The linea alba was closed with interrupted stainless steel sutures, and the skin approximated with staples. Patients were evaluated for wound sepsis, wound dehiscence, and subsequent incisional hernia development. Postoperative pain was assessed by a self-administered visual analogue score, and by measuring narcotic requirements. There was no significant difference in narcotic requirements, pain scores, or wound complications between the 2 groups. Single-layer closure of the abdominal wall is quicker, less costly, and theoretically safer than layered closure, and it is recommended that separate suture of the peritoneum be abandoned.
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