1
|
Maille JM, Hanna SS, Shah DN. Addition of clobazam successfully treating drug resistant seizures in Heidenhain variant Creutzfeldt Jakob disease: A case report. Epilepsy Behav Rep 2023; 21:100585. [PMID: 36698381 PMCID: PMC9867951 DOI: 10.1016/j.ebr.2023.100585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Creutzfeldt Jakob Disease (CJD) is a rapidly progressive and fatal neurodegenerative disease that is uncommonly accompanied with seizures. In this case report, we describe a 63-year-old male patient who presented with a 3-week history of visual disturbances and clonic movement of his left arm. Additionally, the patient was reported to have developed erratic behaviors along with insomnia during this period. An EEG showed 4 electrographic seizures of bilateral temporo-occipital onset characterized by 1.5 Hz periodic discharges, lasting 2-13 min. Levetiracetam was started and titrated to the maximal dose however seizures continued so lacosamide and clonazepam were initiated. Despite these aggressive treatments, seizures continued, and oral clobazam 5 mg BID replaced clonazepam. Continued electrographic seizures warranted an increase in clobazam to 10 mg BID after which the seizures stopped; of note, lateralized periodic discharges (LPDs) remained. The patient's symptoms were consistent with the Heidenhain variant, along with probable CJD due to positive RT-QuIC assay, positive 14-3-3 protein, MRI FLAIR hyperintensities, and EEG findings. Although the patient passed away 3 weeks following admission as a result of CJD, we propose that there may be clinical benefit in the use of clobazam in suspected CJD patients presenting with seizures, and its use merits further investigation.
Collapse
Affiliation(s)
- Jason M. Maille
- Texas A&M University College of Pharmacy, 59 Reynolds Medical Building, College Station, TX 77843, USA,Corresponding author at: PO Box 962, Kotzebue, AK 99752, USA.
| | - Sebastian S. Hanna
- University of Vermont Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Darshan N. Shah
- Seton Brain and Spine Institute Neurology, 1601 Trinity St #804, Austin, TX 78701, USA
| |
Collapse
|
2
|
Hanna SS, Jewell R, Anker CJ, DeWitt JC, Tranmer B, Thomas AA. Clinical Reasoning: A 67-Year-Old Woman With Abdominal Pain, Constipation, and Urinary Retention. Neurology 2022; 99:117-122. [PMID: 35523586 DOI: 10.1212/wnl.0000000000200748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
Meningeal melanocytomas are extremely rare, pigmented tumors of the CNS. They generally carry a favorable prognosis, although recurrence and transformation into the more aggressive malignant melanoma have been reported. We present a case of a patient who reported constipation and abdominal pain around the umbilicus, which progressed into cord compression with lower extremity weakness and gait instability. Spinal MRI revealed a tumor at the level of T11, and she underwent gross total resection of the mass. Pathology demonstrated a meningeal melanocytoma with intermediate features. She received postoperative radiation therapy and had stable disease for 3 years, at which time she developed new weakness and drop metastases. This case represents a rare presentation of a rare disease, in which a spinal cord tumor presented with constipation and abdominal distress. Intradural extramedullary tumors of the thoracic spine are most commonly nerve sheath tumors or meningiomas, but rare entities such as melanocytomas can present in this location; even more rarely, these tumors can have an aggressive course with delayed recurrence.
Collapse
Affiliation(s)
- Sebastian S Hanna
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.).
| | - Ryan Jewell
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
| | - Christopher J Anker
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
| | - John C DeWitt
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
| | - Bruce Tranmer
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
| | - Alissa A Thomas
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
| |
Collapse
|
3
|
|
4
|
Martoff CJ, Hanna SS, Pocanic D, Wang K, Cummings WJ, Byrd RC, Foster CC. Reaction 13C(n,p)13B at 118 MeV. Phys Rev C Nucl Phys 1996; 54:2767-2770. [PMID: 9971632 DOI: 10.1103/physrevc.54.2767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
5
|
Kirkpatrick AW, Hanna SS, Skinner BA. Surgical treatment of pancreatic cholera: a case report. Can J Surg 1996; 39:155-8. [PMID: 8769928 PMCID: PMC3949856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
After surgical resection for rectosigmoid carcinoma a 63-year-old man had secretory diarrhea causing severe metabolic acidosis, hypokalemia, hypercalcemia and dehydration. Subsequent investigations revealed a mass measuring 4 x 5 cm in the uncinate process of the pancreas and an elevated vasoactive intestinal polypeptide concentration. The diarrhea responded to treatment with the somatostatin analogue. Sandostatin, and remained under control during a prolonged preoperative period. The patient underwent a Whipple procedure with immediate lessening of his diarrhea. This report illustrates a classic case of vipoma and demonstrates the need to consider this condition in the differential diagnosis of secretory diarrhea, even in the presence of other gastrointestinal lesions. The effectiveness of somatostatin analogues in stabilizing the diarrhea preoperatively is also well illustrated.
Collapse
Affiliation(s)
- A W Kirkpatrick
- Division of General Surgery, Sunnybrook Health Science Centre, Toronto, Ont
| | | | | |
Collapse
|
6
|
Wang K, Martoff CJ, Pocanic D, Hanna SS, Brady FP, Romero JL, Castaneda CM, Drummond JR, McEachern B, Sorenson DS. Reaction 13C(n,p)13B at 65 MeV. Phys Rev C Nucl Phys 1996; 53:1718-1724. [PMID: 9971122 DOI: 10.1103/physrevc.53.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
7
|
Law CH, Brenneman FD, Rizoli SB, Boulanger BR, Hanna SS. Post-traumatic small-bowel stricture: a case report. Can J Surg 1996; 39:57-8. [PMID: 8599794 PMCID: PMC3895128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The use of lap seat belts has recently been recognized as a mechanism of blunt injury to the small bowel. Patients usually present immediately after injury and require urgent laparotomy. An unusual case of delayed small-bowel stricture after conservative management of an injury resulting from blunt trauma is reported. A 37-year-old woman involved in a high-speed motor vehicle accident was managed in hospital by observation. She had abdominal distension and pain, which gradually decreased and allowed slow introduction of a liquid diet. She was discharged from hospital but returned 6 weeks after injury with pain, abdominal distension, vomiting and obstipation. Stricture of an 8-cm segment of distal jejunum was found. Resection of the involved segment with primary anastomosis was curative.
Collapse
Affiliation(s)
- C H Law
- Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont
| | | | | | | | | |
Collapse
|
8
|
Abstract
Ultrasonic dissection (USD) and intraoperative ultrasonography (IOUS) have shown encouraging results in a retrospective analysis of 109 patients with benign or malignant liver disease. Of 109 patients assessed between 1980 and 1993, 84 were resected: 27 by finger fracture technique (FFT) and 57 by USD. Hospital mortality was 4.8% (4/84) and 30-day mortality was 6.0% (5/84). Overall morbidity was 48.8% (41/84) and liver related morbidity (hepatic bleeding, sepsis, and bile leak) was 34.5% (29/84); of the 29 patients, 5 required re-operation. Liver complications occurred in 12/27 (44.4%) in the FFT group as opposed to 17/57 (29.8%) in the USD group. The incidence of postoperative hepatic bleeding was significantly less by USD than by FFT (p = 0.03). As well, intraoperative blood loss (p = 0.01) number of intraoperative blood units used (p = 0.002), and postoperative length of stay (p = 0.009) have been significantly reduced by USD. IOUS was used on 64 patients. Not only has it improved the sensitivity (99%) and specificity (98%) for detection of hepatic neoplasms, it has also helped increase the precision and accuracy of anatomical tumour localization. As a result, 11/64 patients (17.2%) had their preoperative plans changed: 8 were abandoned and 3 were revised. In summary, USD has significantly reduced intraoperative blood loss and hence reduced the number of intraoperative transfusions, incidence of postoperative complications and postoperative length of stay. IOUS should be routinely employed in patients undergoing liver resection since it provides critical information that could obviate oncologically useless resections.
Collapse
Affiliation(s)
- S S Hanna
- Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada
| | | | | |
Collapse
|
9
|
Abstract
The classification of liver injuries is important for clinical practice, clinical research and quality assurance activities. The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of Trauma proposed the OIS for liver trauma in 1989. The purpose of the present study was to apply this scale to a cohort of liver trauma patients managed at a single Canadian trauma centre from January 1987 to June 1992. 170 study patients were identified and reviewed. The mean age was 30, with 69% male and a mean ISS of 33. 90% had a blunt mechanism of injury. The 170 patients were categorized into the 6 OIS grades of liver injury. The number of units of blood transfused, the magnitude of the operative treatment required, the liver-related complications and the liver-related mortality correlated well with the OIS grade. The OIS grade was unable to predict the need for laparotomy or the length of stay in hospital. We conclude that the OIS is a useful, practical and important tool for the categorization of liver injuries, and it may prove to be the universally accepted classification scheme in liver trauma.
Collapse
Affiliation(s)
- S B Rizoli
- Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
10
|
Dowdell TR, Leonhardt CM, Arenson AM, Hanna SS. Peripancreatic retroperitoneal gas mimicking necrotizing pancreatitis after laparoscopic cholecystectomy. Can J Surg 1995; 38:547-9. [PMID: 7497373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The computed tomographic image of gas in the pancreas and peripancreatic retroperitoneum is strongly suggestive of necrotizing pancreatitis. The authors describe an 81-year-old woman who, 7 days after laparoscopic cholecystectomy, presented with retroperitoneal gas but did not have the clinical or biochemical features of necrotizing pancreatitis. Resolution of her low-grade fever and of the radiologic findings with conservative treatment and the absence of other causes for pneumoretroperitoneum suggest that the gas observed was related to the laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- T R Dowdell
- Department of Radiology, Sunnybrook Health Science Centre, North York, Ont
| | | | | | | |
Collapse
|
11
|
Haider MA, Leonhardt C, Hanna SS, Tennenhouse J. The role of intraoperative ultrasonography in planning the resection of hepatic neoplasms. Can Assoc Radiol J 1995; 46:98-104. [PMID: 7704684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Both intraoperative ultrasonography (US) and computed tomography with arterial portography (CTAP) may be used in planning segment-oriented liver resection in patients with primary or secondary hepatic neoplasms. This study was conducted to determine if intraoperative US findings substantially alter surgical plans based on CTAP findings alone. PATIENTS AND METHODS Patients with potentially resectable hepatic lesions were considered for the study; judgement as to whether a lesion was resectable was based on a clinical evaluation and CTAP. Over the period Apr. 4, 1991, to Oct. 1, 1993, 24 consecutive patients with hepatic lesions were examined; of these, 22 (13 men and 9 women with a mean age of 60.1 years) underwent US during resection, 1 did not undergo surgery and 1 was found at surgery to have carcinomatosis. The true nature of the lesions was verified pathologically or by follow-up imaging and assays for carcinoembryonic antigen. RESULTS The surgical plan based on CTAP findings alone was altered by the intraoperative US findings in 9 (41%) of the 22 patients. A total of 60 intrahepatic abnormalities were evaluated: 49 malignant lesions and 11 artifacts. The specificity (100%) and negative predictive value (73.3%) for intraoperative US were significantly greater than for CTAP (specificity of 9.1% and negative predictive value of 14.1%). CONCLUSION In a substantial proportion of patients undergoing hepatic resection, intraoperative US alters the surgical plan based on CTAP and provides additional specificity in the evaluation of liver lesions. This method of imaging is therefore justified for patients undergoing liver resection.
Collapse
Affiliation(s)
- M A Haider
- Department of Radiological Sciences, Sunnybrook Health Science Centre, North York, Ont
| | | | | | | |
Collapse
|
12
|
Kuhn SE, Cummings WJ, Dodge GE, Hanna SS, King BH, Shin YM, Congleton JG, Helmer R, Schubank RB, Stevenson NR, Wienands U, Lee YK, Mason GR, King BE, Chung KS, Lee JM, Rosenzweig DP. Multinucleon effects in muon capture on 3He at high energy transfer. Phys Rev C Nucl Phys 1994; 50:1771-1786. [PMID: 9969852 DOI: 10.1103/physrevc.50.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
13
|
Affiliation(s)
- F D Brenneman
- Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
14
|
Knudson JN, Bowman JD, Penttilä SI, Comfort JR, Tinsley J, Ritchie BG, Görgen J, Mathis D, Hanna SS, King B, Pocanic D, Loveman RA, Fritz LS, Dixon NS. Neutron deformation in 165Ho. Phys Rev C Nucl Phys 1994; 50:909-917. [PMID: 9969734 DOI: 10.1103/physrevc.50.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
15
|
Pocanic D, Frlez E, Assamagan KA, Chen JP, Keeter KJ, Marshall RM, Minehart RC, Smith LC, Dodge GE, Hanna SS, King BH, Knudson JN. Reaction pi +p--> pi + pi 0p near threshold and chiral symmetry breaking. Phys Rev Lett 1994; 72:1156-1159. [PMID: 10056637 DOI: 10.1103/physrevlett.72.1156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
16
|
Salonen DC, Leonhardt CM, Hemphill D, Hanna SS, Pappas SC. Radiographic features of hepatocellular carcinoma and their relation to prognosis in Canada. Can Assoc Radiol J 1994; 45:35-9. [PMID: 7509715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
To determine the radiographic features of hepatocellular carcinoma (HCC) as seen in Canada and their relation to prognosis, multiple imaging studies for 40 patients with histologically proven HCC were reviewed. The patients, 34 men and 6 women ranging in age from 43 to 86 years, were selected from a larger database on the basis of the availability of ultrasound (US) images and at least one other imaging study. The patients had been examined between 1981 and 1991 at a tertiary-care hospital. In 35 of the 40 cases (88%) HCC had been detected by US assessment, the criterion for complete analysis, but in one of those cases the lesion was not observed in the initial scans. HCC was detected by computed tomography (CT) in the 27 cases in which that technique had been used. Cirrhosis was present in 27 of the 35 patients (77%) for which a complete analysis was performed. Median survival after diagnosis for all 40 patients was 14.1 weeks. Seven radiographic features were analysed for prognostic value by univariate and multivariate (Cox) regression analysis. However, the regression analysis indicated no relation between survival and tumour size, the nature of the tumour (diffuse and infiltrative or discrete), vascular involvement, encapsulation, extrahepatic spread, tumour location or echogenicity. No radiographic feature, including tumour size, correlated with the serum level of alpha-fetoprotein, which was elevated in 23 of the 32 cases (72%) in which it had been determined. These results confirm the variable radiographic appearance of HCC but differ in other respects from those reported previously, particularly those for studies performed outside North America.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- D C Salonen
- Department of Diagnostic Imaging, University of Toronto, North York, Ont
| | | | | | | | | |
Collapse
|
17
|
Hanna SS, Withers C, Arenson AM, Hamilton P, Leonhardt C, Towers M. Role of intraoperative ultrasonography in hepatic surgery: a preliminary report. Can J Surg 1992; 35:151-3. [PMID: 1562923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Twenty-four patients who underwent ultrasonography during hepatic surgery in the 22 months from October 1989 to July 1991 were studied prospectively to determine the value, if any, of intraoperative ultrasonography. For 6 (25%) of the 24 patients the operative plan was altered because of the ultrasonographic findings. In one of them resection was extended from a left lateral segmentectomy or sectorectomy to a left hemihepatectomy. In the other five patients the planned liver procedure was abandoned. Two of these five patients were cirrhotic--in one of them an additional metastasis was seen, and in the other there was tumour invasion of the portal vein. Of the three noncirrhotic patients, one had tumour invasion of the right hepatic vein, and the other two patients had additional metastases in the caudate lobe (Couinaud segment 1). Ultrasonography was found to be useful in 25% of patients who underwent this investigation during hepatic surgery--it avoided liver resections that would have failed because of advanced malignant disease.
Collapse
Affiliation(s)
- S S Hanna
- Department of Surgery, Sunnybrook Health Science Centre, Toronto, Ont
| | | | | | | | | | | |
Collapse
|
18
|
Ali J, Qi W, Hanna SS, Huang SN. Clinical presentations of gastrointestinal inflammatory fibroid polyps. Can J Surg 1992; 35:194-8. [PMID: 1562933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Two cases of inflammatory fibroid polyps are described. They involved the uncommon sites of the terminal ileum and ileocecal region respectively. Both lesions, although benign, presented as possible malignant tumours. One was associated with anemia and the other with obstructive symptoms. From a review of the literature and the two case reports the authors believe that the diagnosis of such inflammatory fibroid polyps, on clinical and gross appearance, can be difficult, and they emphasize the importance of awaiting histologic assessment before proceeding with extensive definitive surgery.
Collapse
Affiliation(s)
- J Ali
- Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ont
| | | | | | | |
Collapse
|
19
|
Cummings WJ, Dodge GE, Hanna SS, King BH, Kuhn SE, Shin YM, Helmer R, Schubank RB, Stevenson NR, Wienands U, Lee YK, Mason GR, King BE, Chung KS, Lee JM, Rosenzweig DP. Energetic protons and deuterons emitted following micro- capture by 3He nuclei. Phys Rev Lett 1992; 68:293-296. [PMID: 10045855 DOI: 10.1103/physrevlett.68.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
20
|
Martoff CJ, Cummings WJ, Poanic D, Hanna SS, Ullrich H, Furic M, Petkovic T, Kozlowski T, Perroud JP. Nucleon pairing in micro- capture by 40Ca. Phys Rev C Nucl Phys 1991; 43:1106-1110. [PMID: 9967153 DOI: 10.1103/physrevc.43.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
21
|
Knudson JN, Bowman JD, Penttilä SI, Comfort JR, Ritchie BG, Goergen J, Mathis D, Tinsley J, Hanna SS, King B, Pocanic D, Loveman RA, Fritz LS, Dixon NS. Neutron deformation in 165Ho. Phys Rev Lett 1991; 66:1026-1029. [PMID: 10043977 DOI: 10.1103/physrevlett.66.1026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
22
|
Abstract
Between June 1, 1976 and June 30, 1989 The Regional Trauma Unit at Sunnybrook Medical Centre in Toronto, Ontario, Canada received 3730 patients. Of these 335 (9%) sustained a liver injury, 95% being due to blunt trauma. Open peritoneal lavage was performed on 80% of liver trauma patients (267/335), 99% being true positive. A laparotomy was performed on 97% of patients (324/335). Major surgical treatment was required in 132 patients (41%) and minor treatment in 192 patients (59%). The remaining 11 patients were treated conservatively (n = 3) or died during resuscitation (n = 8). Morbidity directly related to the liver injury was seen in 29 of 249 surviving patients (11%) although overall morbidity was 27% (67/249). Reoperation was required in 6% (14/249) with abscess or hematoma accounting for 11 of 14 operations. The overall mortality rate was 26% (86/335). Eighty two percent of patients (n = 276) had a grade I, II or III liver trauma according to Moore's classification with a mortality of 12% (n = 32). The remaining 18% of patients (n = 59) had a grade IV or V liver trauma with a mortality of 44% (n = 26). Of the 86 deaths, head injury accounted for 48 (56% of deaths); liver hemorrhage for 17 (20%), liver sepsis for 1 (1%) and other causes for 20 deaths (23%). Thus death due to the liver injury itself (hemorrhage and sepsis) occurred in 18 out of 335 patients (5% overall). Head injury accounted for the death of 48 out of 335 patients (14% overall). Over the past 13 years a trend has occurred at our institution whereby we are seeing less liver trauma in our population of multiply injured patients from 12% (1976-1983) down to 7% (1985-1989); with a gradual decline in overall mortality from 32% (1976-1983) to 19% (1985-1989), whereas the percentage of deaths due to head injuries and liver injury have increased.
Collapse
Affiliation(s)
- S S Hanna
- Department of Surgery, Sunnybrook Medical Centre, University of Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
23
|
Wu CY, Satteson M, Wang K, Cline D, Gove HE, Hanna SS, Hass M, Ibbotson R, Ramayya AV. Isomers in iodine nuclei. Phys Rev C Nucl Phys 1990; 41:1600-1605. [PMID: 9966506 DOI: 10.1103/physrevc.41.1600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
24
|
Wu CY, Boyle J, Cline D, Dafni E, Gove HE, Satteson M, Wang K, Hanna SS, Ramayya AV. Successive decays of isomers in 81Sr. Phys Rev C Nucl Phys 1989; 39:250-252. [PMID: 9955184 DOI: 10.1103/physrevc.39.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
25
|
Wang K, Martoff CJ, Poanic D, Cummings WJ, Hanna SS, Byrd RC, Foster CC. Reaction 6Li. Phys Rev C Nucl Phys 1988; 38:2478-2481. [PMID: 9955087 DOI: 10.1103/physrevc.38.2478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
26
|
Hanna SS, Pagliarello G, Ing A. Liver blood flow after major hepatic resection. Can J Surg 1988; 31:363-7. [PMID: 3046733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The factors involved in liver regeneration are poorly understood, but it has been suggested that blood flow plays a role. This paper documents the changes in liver blood flow (LBF) that occur after major hepatic resection. Eight patients, ranging in age from 37 to 76 years, underwent liver resection. Liver blood flow was measured preoperatively and on days 1, 4 and 7 postoperatively by low-dose galactose clearance. There was a significant (p less than 0.01) fall in LBF on day 1 compared with the baseline value, followed by a significant (p less than 0.01) rise from the baseline value by day 4. By day 7, LBF had returned to baseline levels and was significantly (p less than 0.01) lower than on day 4. These changes in LBF may be related to the stimulus for liver regeneration and increased functional demands during the early regenerative phase.
Collapse
Affiliation(s)
- S S Hanna
- Department of Surgery, Sunnybrook Medical Centre, University of Toronto, Ont
| | | | | |
Collapse
|
27
|
Kurjan PM, Calarco JR, Fisher GA, Hanna SS. Giant E1 resonances in 20Ne observed with the 19F(p. Phys Rev C Nucl Phys 1988; 37:2281-2288. [PMID: 9954708 DOI: 10.1103/physrevc.37.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
28
|
Wissink SW, Hanna SS, Mavis DG, Wang TR. Electric quadrupole strength in 16O from the 15N(p. Phys Rev C Nucl Phys 1988; 37:2289-2300. [PMID: 9954709 DOI: 10.1103/physrevc.37.2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
29
|
Dunham JS, Westervelt RT, Avida R, Hanna SS. Magnetic moments of the first excited 2+ states of the even-even Te isotopes. Phys Rev C Nucl Phys 1988; 37:2881-2884. [PMID: 9954762 DOI: 10.1103/physrevc.37.2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
30
|
Wang TR, Haeberli W, Wissink SW, Hanna SS. Electric quadrupole strength in 20Ne from the 19F(p. Phys Rev C Nucl Phys 1988; 37:2301-2311. [PMID: 9954710 DOI: 10.1103/physrevc.37.2301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
31
|
Abstract
A patient receiving intraperitoneal chemotherapy with cisplatin and cytosine arabinoside developed an abdominal skin rash similar in appearance to Cullen's sign. She subsequently received intraperitoneal mitoxantrone, which became visible in the skin close to the peritoneal catheter tract in the region of the skin rash within 24 hours of drug administration. There was no evidence for drug extravasation from the entry portal of the peritoneal catheter or visible fluid leakage. Although the clinical picture was dramatic there was no significant clinical sequela to the extravasation of these drugs. The potential significance of this event is discussed.
Collapse
Affiliation(s)
- I G Kerr
- Toronto-Bayview Regional Cancer Centre, Sunnybrook Medical Centre, Ontario, Canada
| | | | | | | |
Collapse
|
32
|
Vickers RM, Yu VL, Hanna SS, Muraca P, Diven W, Carmen N, Taylor FB. Determinants of Legionella pneumophila contamination of water distribution systems: 15-hospital prospective study. Infect Control 1987; 8:357-63. [PMID: 3654130 DOI: 10.1017/s0195941700067412] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We conducted a prospective environmental study for Legionella pneumophila in 15 hospitals in Pennsylvania. Hot water tanks, cold water sites, faucets, and showerheads were surveyed four times over a one-year period. Sixty percent (9/15) of hospitals surveyed were contaminated with L pneumophila. Although contamination could not be linked to a specific municipal water supplier, most of the contaminated supplies came from rivers. Parameters found to be significantly associated with contamination included elevated hot water temperature, vertical configuration of the hot water tank, older tanks, and elevated calcium and magnesium concentrations of the water (P less than 0.05). This study suggests that L pneumophila contamination could be predicted based on design of the distribution system, as well as physicochemical characteristics of the water.
Collapse
Affiliation(s)
- R M Vickers
- Hospital Council of Western Pennsylvania, University of Pittsburgh
| | | | | | | | | | | | | |
Collapse
|
33
|
Kerr IG, Hanna SS. Use of the Huber-point needle in the Port-A-Cath system. Can J Surg 1987; 30:317. [PMID: 3664381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
|
34
|
Abstract
Between 1 June 1976 and 30 June 1985 Sunnybrook Medical Centre Regional Trauma Unit admitted 2,016 patients of whom 220 (11%) sustained liver injury. Of these 220 patients, 211 (96%) sustained blunt liver trauma; 175 of 176 patients who underwent open peritoneal lavage had a true positive lavage. Resuscitation was successful in 212 patients, of whom 209 underwent laparotomy and three were treated nonoperatively: 129 of 209 patients (62%) required only minor surgical treatment; the remaining 80 patients (38%) required major surgical procedures. The overall mortality was 29% (64/220). Eight patients died during resuscitation, one of them of liver hemorrhage. Of the 56 patients who died after admission, the cause of death was head injury in 31, liver hemorrhage in 11 (five intraoperatively) and 14 died of other causes. Overall, liver hemorrhage was the cause of death in 12 of 64 deaths (19%). In other words, 12 of the total of 220 patients (6%) died from liver-related mortality.
Collapse
Affiliation(s)
- S S Hanna
- Department of Surgery, Sunnybrook Medical Centre, University of Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
35
|
Knudson JN, Comfort JR, Gianelli RA, Ritchie BG, Rothenberger D, Poanic D, Hanna SS, Bowman JD, Baer HW, Bergmann AG, Heusi PA, Irom F, Seftor CJ, Hoibräten S, Loveman RA, Rokni SH, Crannell H, Sober DI, Fickinger WJ, Marshak H. Excitation of the isobaric analog state of 165Ho by pion single-charge exchange. Phys Rev C Nucl Phys 1987; 35:1382-1387. [PMID: 9953910 DOI: 10.1103/physrevc.35.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
36
|
Neyer BT, Clark DL, Dunham JS, Seale WA, Thornton JL, Westervelt RT, Hanna SS, Brown BA, Wildenthal BH. Lifetime of the lowest 0(+), T=1 state of 22Na. Phys Rev C Nucl Phys 1987; 35:890-893. [PMID: 9953847 DOI: 10.1103/physrevc.35.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
37
|
Pagliarello G, Hanna SS, Gregory WD, McKee JD, Harrison AW, Taylor GA, Miller HA, Maggisano R. Abdominopelvic computerized tomography and open peritoneal lavage in patients with blunt abdominal trauma: a prospective study. Can J Surg 1987; 30:10-3. [PMID: 3815173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This prospective trial compares abdominopelvic computerized tomography and open peritoneal lavage in the diagnosis of blunt abdominal trauma. Fifteen patients (group 1) were evaluated by both methods. Another 15 patients (group 2) had only computerized tomography. Criteria for a "positive" scan were hemoperitoneum and evidence of solid organ injury. Criteria for "positive" lavage were a grossly bloody return, erythrocyte count greater than 20.0 X 10(9)/L and leukocyte count greater than 0.5 X 10(9)/L. At laparotomy, only injuries requiring repair or excision were considered "true positive". Patients who did not have laparotomy and had an uncomplicated clinical course were considered "true negative". With tomographic criteria alone for diagnosis there would have been one false-positive and three false-negative results, compared with three false positive and no false negatives for open peritoneal lavage alone. None of the three patients who had negative findings on laparotomy suffered any morbidity or died. Results of computerized tomography and open peritoneal lavage agreed in 8 of 15 patients (kappa value = 0.52), indicating a low level of agreement between the two. The authors believe that open peritoneal lavage remains the diagnostic procedure of choice in blunt abdominal trauma.
Collapse
|
38
|
Abstract
The purpose of this study was to demonstrate that galactose clearance (GC) can measure acute changes in liver blood flow (LBF) in normal and cirrhotic dogs. Ten dogs were studied. GC was measured preop. At laparotomy, GC, hepatic artery (HA) flow, portal vein (PV) flow, and cardiac output (CO) were measured at baseline, 50% portal vein occlusion (PVO), and portal vein release. HA and PV flows were measured using a flow probe (FP). Common bile duct ligation was then performed to cause cirrhosis and all measurements were repeated in 7 weeks. Statistical analyses showed that on PVO in both normal dogs (n = 10) and cirrhotic dogs (n = 5) the GC, HA flow, and CO were significantly different from their baseline values. In both groups PVO caused HA flow to increase, thus keeping FP-LBF unchanged while GC-LBF was significantly reduced compared to baseline. The possible explanations for this are discussed in the text. PVO also caused a significant reduction in CO due to splanchnic pooling in both normal and cirrhotic dogs. In both groups PVO results in an increased percentage of CO going to FP-LBF, while the percentage of CO going to GC-LBF remains unchanged. We conclude that GC can measure acute changes in LBF caused by a 50% PVO in both normal and cirrhotic dogs.
Collapse
|
39
|
Hanna SS, Maheshwari Y, Harrison AW, Taylor GA, Miller HA, Maggisano R. Blunt liver trauma at the Sunnybrook Regional Trauma Unit. Can J Surg 1985; 28:220-3. [PMID: 3995419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Between June 1, 1976 and Mar. 31, 1983, the Sunnybrook Medical Centre Regional Trauma Unit in Toronto, Ont., admitted 145 patients with liver trauma; of these, 141 (97%) had sustained blunt liver trauma. Of 113 patients who underwent open peritoneal lavage, 112 had a true-positive lavage. Resuscitation was successful in 137 patients and 134 of these underwent laparotomy. Seventy-nine (59%) of the 134 patients required only minor surgical treatment; the other 55 (41%) required major surgical procedures. The overall mortality was 32% (47 of 145). Eight patients died during resuscitation but only one of them died of liver hemorrhage. Of the 39 patients who died after admission, the cause of death was head injury in 22, while 6 died of liver hemorrhage and 11 of other causes. Overall, liver hemorrhage was the cause of death in 15% of cases (7 of 47).
Collapse
|
40
|
McLellan BA, Hanna SS, Montoya DR, Harrison AW, Taylor GA, Miller HA, Maggisano R, McMurtry RY. Analysis of peritoneal lavage parameters in blunt abdominal trauma. J Trauma 1985; 25:393-9. [PMID: 2582143 DOI: 10.1097/00005373-198505000-00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Peritoneal lavage is the most valuable diagnostic modality presently available for the evaluation of patients with blunt abdominal trauma. A retrospective review of 523 patients who underwent open peritoneal lavage for blunt abdominal trauma over a 3 1/2-year period revealed serious intra-abdominal pathology in 83% of patients undergoing laparotomy with RBC lavage counts in the range of 20,000 to 100,000 cells/mm3, a level considered by many authors to be negative or indeterminate. Two patients with isolated small bowel perforations had an elevated amylase level as the only measured abnormality. The data indicate that the standard guidelines for RBC positivity (positive count greater than 100,000 cells/mm3 and indeterminate count 50,000 to 100,000 cells/mm3) result in missed intraperitoneal injuries in a large percentage of patients and therefore require reevaluation. Lavage amylase determinations, previously stated to be costly and of insignificant yield, should be performed on patients whose lavage would otherwise be considered negative by RBC and WBC counts.
Collapse
|
41
|
Mustard RA, Hanna SS, Blair G, Harrison AW, Taylor GA, Miller HA, Maggisano R. Blunt splenic trauma: diagnosis and management. Can J Surg 1984; 27:330-3. [PMID: 6378346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To examine the morbidity and mortality associated with blunt splenic injuries, the authors reviewed the results in 106 such patients treated in the Sunnybrook Regional Trauma Unit between June 1, 1976 and June 30, 1983. Initial assessment included peritoneal lavage in 86 patients. No patient with known or suspected splenic injury was treated nonoperatively nor were any patients found to have had splenic injuries missed at the initial assessment. Seventy-one splenectomies and 35 splenorrhaphies were performed. The overall mortality was 25% and 10 surviving patients had serious complications. The splenic injury itself was never the cause of death. Only one patient who initially underwent splenorrhaphy later required splenectomy. It is concluded that blunt splenic injury is rarely the cause of death or serious morbidity when a policy of immediate diagnosis and operative treatment is carried out. Furthermore, in selected patients, splenorrhaphy is a safe and effective treatment.
Collapse
|
42
|
Hanna SS. Measurement of liver blood flow by galactose clearance. Can J Surg 1984; 27:218-20. [PMID: 6722669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Low-dose galactose clearance is a new method for measuring functional (nutrient) liver blood flow. In 22 healthy beagle dogs, the mean (+/- SD) blood galactose clearance rate of 311 +/- 93 mL/min was not significantly different from the mean measurement obtained using electromagnetic flow probes (322 +/- 37 mL/min). This shows that galactose clearance can be used to measure liver blood flow in healthy dogs. The 22 dogs were divided into two groups of 11. The first group underwent portacaval shunting and weekly galactose clearance rates were measured until death an average of 6 weeks later. The anticipated fall in liver blood flow was successfully detected by the second week after shunting. This suggests that long-term (week-to-week) changes in liver blood flow can be detected by this method. In the second group, ligation of the common bile duct was used to induce secondary biliary cirrhosis. Galactose clearance was measured weekly for 6 weeks and showed a significant decrease by 6 weeks. At 7 weeks, laparotomy was performed in order to take flow-probe measurements; the galactose clearance rate was also measured. Whereas the two methods were similar at the time of the original operation, 7 weeks after ligation there was a significant difference (p = 0.02) with the rate of liver blood flow as measured by galactose clearance being much lower than the flow rate measured by the electromagnetic flow probes. These findings suggest that in cirrhotic dogs, galactose clearance measures functional or effective (nutrient) liver blood flow whereas the electromagnetic flow probe measures anatomic flow. The effective flow gives a more accurate reflection of perfusion of the hepatocyte by blood.
Collapse
|
43
|
Henderson JM, Hanna SS. Effective liver blood flow: determination by galactose clearance. Can J Surg 1983; 26:129-32. [PMID: 6824999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Effective liver blood flow is the portion of total flow that perfuses functional sinusoids and is available for metabolic exchange. Clearance of galactose from blood at concentrations below 10 mg/dl (0.555 mmol/l) measures this index and is calculated during continuous infusion of 5% D-galactose at a rate of 50 mg/min. The low galactose concentrations are measured accurately by a new fluorometric assay, which gives a precision +/- 0.2 mg/dl (0.011 mmol/l). In healthy people, plasma galactose clearance was 1366 +/- 172 ml/min, and hepatic extraction was 95%. Clearance in cirrhotics depends on the stage of their disease: in a stable group of patients with advanced cirrhosis, clearance was 835 +/- 87 ml/min with hepatic extraction ranging from 60% to 95%. The day-to-day coefficient of variation was 4.5%. Direct comparison with flow-probe liver blood flow measured in 11 normal dogs showed that galactose clearance was not significantly different. These findings support the hypothesis that galactose clearance correlates with effective liver blood flow.
Collapse
|
44
|
|
45
|
Hanna SS, Warren WD, Galambos JT, Millikan WJ. Bleeding varices: 1. Emergency management. Can Med Assoc J 1981; 124:29-41. [PMID: 7006779 PMCID: PMC1705097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of the emergency management of bleeding varices is to stop the hemorrhage nonoperatively if possible, avoiding emergency shunt surgery, an operation that has a higher mortality than elective shunt surgery. Patients with an upper gastrointestinal hemorrhage should undergo endoscopy immediately to verify the diagnosis of bleeding varices. They can then be categorized according to whether they stop bleeding spontaneously (group 1), continue to bleed slowly (group 2) or continue to bleed rapidly (group 3). Group 1 patients are discussed in the second part of this two-part series. Group 2 patients are initially treated with vasopressin given intravenously; those who fail to respond should undergo emergency angiography and receive vasopressin intra-arterially. If this fails, patients at low surgical risk should undergo urgent shunt surgery; those at high risk do better with endoscopic sclerotherapy. Group 3 patients are also given an intravenous infusion of vasopressin. Patients at low surgical risk who continue to bleed then receive tamponade with a Sengstaken--Blakemore tube. If this fails, they undergo emergency creation of an H-shaped mesocaval shunt. Patients at high surgical risk who fail to respond to vasopressin given intravenously are next treated intra-arterially. If this fails they are given either endoscopic or transhepatic sclerotherapy.
Collapse
|
46
|
Hanna SS, Warren WD, Galambos JT, Millikan WJ. Bleeding varices: 2. Elective management. Can Med Assoc J 1981; 124:42-7. [PMID: 7006780 PMCID: PMC1705090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients who have previously bled from esophageal varices should have their hepatic function, neurologic status and nutritional status evaluated and should be examined for ascites before elective variceal decompression is done to prevent recurrent variceal hemorrhage. The two most important procedures used for this evaluation are liver biopsy and visceral angiography. If the liver biopsy reveals little or no necroinflammatory activity, shunt surgery is indicated. For patients with moderate or severe necroinflammatory activity, surgery is delayed until the inflammation subsides. The central aim of visceral angiography is to determine whether the patient has hepatopetal or hepatofugal portal venous flow. Patients with hepatopetal flow are treated with a selective distal splenorenal shunt. Those with hepatofugal flow are managed with a total shunt, such as an interposition H-graft portacaval or mesocaval shunt.
Collapse
|
47
|
Hanna SS, Jirsch DW. Management of colonic and rectal injuries. Can Med Assoc J 1979; 120:1387-91. [PMID: 455185 PMCID: PMC1819361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In managing a colonic or rectal injury the surgeon must decide whether it is acceptable to have feces passing over a suture line or anastomosis. If it is, resection and anastomosis or simple oversewing of the bowel can be done. If it is not, there are four choices: (a) closure of the wound, drainage and proximal diversion; (b) primary closure or resection and anastomosis of the wound with exteriorization; (c) formation of a double-barrelled colostomy; and (d) resection of the injured colon with formation of an end-colostomy and a mucosal fistula or a Hartmann procedure. The surgeon's choice should be dictated by the severity of the injury, the degree of fecal contamination and the general condition of the patient.
Collapse
|
48
|
Fleischer-Djoleto O, Hanna SS, Jirsch DW. Surgical management of subphrenic abscess. Can J Surg 1979; 22:85-7. [PMID: 109176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
49
|
Black K, Hanna SS, Langer B, Jirsch DW, Rider WD. Management of carcinoma of the extrahepatic bile ducts. Can J Surg 1978; 21:542-5. [PMID: 83901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The records of 80 cases of carcinoma of the extrahepatic bile ducts were studied. The median duration of survival, in months, of patients who were treated by curative surgery, palliative surgery and radiation, palliative surgery alone and biopsy alone was 21.7, 9.3, 5.5 and 1, respectively. The best results were obtained by excision of the tumour, but only 10% of tumours were considered resectable. A more aggressive surgical approach to tumours still confined to the bile ducts might be expected to increase the resectability rate and improve survival. The use of a U tube is recommended because it ensures greater comfort even though survival is no longer than when a T tube is used. The roles of adjuvant radiotherapy and chemotherapy need further study. Because of some encouraging responses with the use of radiotherapy and the infusion of 5-fluorouracil the authors are currently evaluating these two methods of treatment.
Collapse
|
50
|
Hanna SS, Jirsch DW. Management of hepatic injury. Can Med Assoc J 1977; 117:352-3. [PMID: 890631 PMCID: PMC1879764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Liver injuries may be due to either blunt or penetrating trauma to the thorax or abdomen. Specific treatment depends on the site and extent of hepatic injury. Following resuscitation with intravenous fluids and blood as needed, surgical therapy is directed to provide hemostasis, remove necrotic liver tissue and promote adequate external drainage in the postoperative period. While local measures are usually sufficient, complex hepatic wounds may require extensive resection and vascular ligature or repair.
Collapse
|