Kevin Hanel - Academia.edu (original) (raw)

Papers by Kevin Hanel

The Medical journal of Australia, Jan 26, 1986

Two patients with Hickman catheters that were used for long-term venous access developed major ve... more Two patients with Hickman catheters that were used for long-term venous access developed major venous thrombosis, one with superior vena caval and the other with subclavian vein thrombosis. This represented an incidence of 9% of all Hickman catheters that were inserted over two years in The St George Hospital. Staphylococcus epidermidis was cultured from blood that was sampled through the Hickman catheter in both patients; the organism was also cultured from the tip of the removed catheter in one patient. Transverse thoracic computerized tomographic scanning diagnosed the presence and the site of thrombosis as well as excluding the presence of a mediastinal tumour that was causing extrinsic compression. The catheter had to be removed in one patient; in the other patient, heparinization without removal resulted in the resolution of symptoms.

Annals of The Royal …, 1997

International Journal of Vascular Medicine, 2015

Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign ute... more Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign uterine leiomyoma. Incomplete resection has a recurrence rate of over 30%. Different hormonal treatments have been described following incomplete resection; however no standard therapy currently exists. We review the literature for medical treatments options following incomplete resection of IVL with CE. Methods. Electronic databases were searched for all studies reporting IVL with CE. These studies were then searched for reports of patients with inoperable or incomplete resection and any further medical treatments. Our database was searched for patients with medical therapy following incomplete resection of IVL with CE and their results were included. Results. All studies were either case reports or case series. Five literature reviews confirm that surgery is the only treatment to achieve cure. The uses of progesterone, estrogen modulation, gonadotropin-releasing hormone antagonism, and aromatase inhibition have been described following incomplete resection. Currently no studies have reviewed the outcomes of these treatments. Conclusions. Complete surgical resection is the only means of cure for IVL with CE, while multiple hormonal therapies have been used with varying results following incomplete resection. Aromatase inhibitors are the only reported treatment to prevent tumor progression or recurrence in patients with incompletely resected IVL with CE.

Surgical Laparoscopy Endoscopy & Percutaneous Techniques

ABSTRACT

A consensus exists that aneurysm size is most appropriately assessed by measurement of maximal tr... more A consensus exists that aneurysm size is most appropriately assessed by measurement of maximal transverse aneurysmal diameter in either the anteroposterior or lateral dimensions. We have examined the hypothesis that these dimensions are interchangeable in patients with aneurysm disease. We have followed 56 patients with infrarenal aortic aneurysm disease using ultrasound scanning. These patients have undergone 149 ultrasound assessments of aortic aneurysms. In these patients the corresponding anteroposterior diameter was a mean of 3.71 cm (3.59–3.84, 95% confidence interval [CI]) versus a lateral diameter of mean 4.0 cm (3.88–4.11 cm, 95% CI), p = 0.0001.We believe that aneurysm dimensions are best reflected by transverse anteroposterior diameter, although this may not always be the largest aneurysm diameter.

The New Zealand medical journal, Jan 8, 1994

A review of 5 years' experience with central venous access catheters (CVAC) to examine the re... more A review of 5 years' experience with central venous access catheters (CVAC) to examine the results of catheter placement technique (open or percutaneous) on subsequent CVAC performance. In addition the catheter function and utilisation of both Hickman type and Access Port type of CVAC were reviewed to assess the indications and the types of access devices chosen in selected patients. A retrospective review of CVAC between 1987 and 1991 was undertaken. During this time 113 CVAC were placed by the open (n = 76) or percutaneous (n = 37) method. The type of catheter used was Hickman (n = 79) or Access Port (n = 34). Indications for CVAC placement were haematological malignancy 74.2%, other malignancy 14.1%, and the rest were accounted for by TPN, HIV infection, osteomyelitis, anaemia and haemochromatosis. There was no difference between duration of function for CVAC placed by the open (5.1 months 95% CI, 3.8-6.4) and percutaneous methods (3 months, 95% CI 2.2-3.8). Nor was there a d...

Cardiovascular Surgery, 1995

The clinical course of 76 patients with aortic aneurysmal disease undergoing 107 coincidental sur... more The clinical course of 76 patients with aortic aneurysmal disease undergoing 107 coincidental surgical procedures was analysed in order to examine the relationship between aortic aneurysmal rupture and coincidental treatment. Additionally the incidence of aneurysmal rupture was assessed following 82 endoscopic procedures in 42 patients with aortic aneurysms. Two patients ruptured an aortic aneurysm after operation, one after colonoscopy (maximal transverse diameter 7cm) and one after coronary artery bypass grafting (maximal transverse diameter 5.6cm). The mean maximal transverse diameter of aneurysms in 76 patients was 5.08 cm (95% confidence interval 4.7-5.4 cm). Both patients with ruptured aottic aneurysms were outside these confidence limits and were known hypertensives whose perioperative control of hypertension was questionable. The present series of patients is discussed with reference to induction of collagenase activity as a precipitating cause for postoperative rupture of aortic aneurysms, perioperative control of hypertension, transverse aneurysm diameter as a predictor of postoperative rupture and conduct of coincidental procedures in the presence of aneurysmal disease.

Postgraduate Medical Journal, 1993

Graduated compression stockings are frequently used in the prevention of deep venous thrombosis a... more Graduated compression stockings are frequently used in the prevention of deep venous thrombosis and the treatment of venous insufficiency. Two patients are discussed who sustained ischaemic complications after application of graduated compression stockings. Review of the literature demonstrates that low cutaneous pressures significantly decrease local blood flow and that the amount ofpressure exerted by graduated compression stockings increases significantly with increases in leg girth. Ischaemic complications associated with the use of these stockings also appears to be more common than previously thought and any policy of routine prescription to patients should be questioned.

Journal of Vascular Surgery, 1994

Surveillance protocols of infrainguinal vein bypass grafts have almost universal acceptance. To d... more Surveillance protocols of infrainguinal vein bypass grafts have almost universal acceptance. To date corresponding studies of prosthetic grafts have not been carried out. We have performed a prospective 4-year duplex scan follow-up on polytetrafluoroethylene grafts to assess the usefulness of a surveillance program of prosthetic bypass grafts in preventing graft failure. Over 4 years 69 infrainguinal polytetrafluoroethylene grafts in 56 patients were studied at six monthly intervals by our vascular laboratory. Full duplex scan mapping of the grafts and inflow and outflow arteries and standard ankle pressure measurements were performed. A midgraft peak flow velocity was also measured. Over 4 years 27 (39.1%) grafts occluded without any predictive changes in the preceding duplex scan examination. Of the 42 (60.9%) grafts that remained patent, only four developed stenoses (three at the proximal anastomosis and one at the distal anastomosis) that were amenable to intervention. Changes in ankle pressures or midgraft flow velocity did not predict failure. The low yield of remediable disease does not justify the cost of duplex scan surveillance of infrainguinal prosthetic bypass grafts.

Diseases of the Colon & Rectum, 1980

Hanel KC, King DW, McAllister ET, Reiss-Levy E. Single dose parenteral antibiotics as prophylaxis... more Hanel KC, King DW, McAllister ET, Reiss-Levy E. Single dose parenteral antibiotics as prophylaxis against wound infections in colonic operations. Dis Colon Rectum 1980;23:98-101. A study of 77 patients undergoing elective operations on the colon and rectum, where wounds were subject to contamination by fecal flora, did not demonstrate that the addition of a preoperative oral regime to parenteral antibiotics alone further decreased the incidence of wound infection. The authors feel that the use of single-dose clindamycin and cephazolin intravenously preoperatively has been shown to be a very effective method of preventing wound infection in elective colonic resections. [

Digestive Diseases and Sciences, 1981

ANZ Journal of Surgery, 2003

Venous aneurysms are rare vascular anomalies that have been reported to occur throughout the body... more Venous aneurysms are rare vascular anomalies that have been reported to occur throughout the body. We report a unique variation, namely a thrombosed subclavian vein aneurysm. A review of the records of patients with documented venous aneurysms presenting to the St George Hospital and their associated imaging was made. A literature search for articles pertaining to venous aneurysms was performed. Four cases of venous aneurysms were identified; one subclavian vein, one inferior vena cava and two popliteal. The clinical course of these cases is detailed, along with a review of the literature. Venous aneurysms are infrequent findings and indicate that the patient is at significant risk of thrombosis. Popliteal vein aneurysms should be treated surgically.

ANZ Journal of Surgery, 1997

ANZ Journal of Surgery, 1998

ANZ Journal of Surgery, 1999

It has been suggested that graft dilatation following repair of abdominal aortic aneurysm (AAA) i... more It has been suggested that graft dilatation following repair of abdominal aortic aneurysm (AAA) is associated with complications such as anastomotic aneurysm and graft rupture. The purpose of the present study was to document the degree of dilatation observed in grafts after aneurysm repair and to correlate this with any graft-related complications. Between January 1987 and December 1992, 219 patients had elective repair of their AAA at St George Hospital. A follow-up ultrasound scan was available for 154 of these patients. The following factors were examined: age, sex, size of aneurysm, type and size of graft, time of follow-up scan, size of graft at follow-up and any graft-related complications. The mean graft dilatation observed in knitted grafts (42.6%; 95% CI: 39.1-46.1%) was significantly greater than that observed for woven grafts (25.5%; 95% CI: 19.0-32.1%; P < 0.0001). There were no graft-related complications. Graft dilatation is a predictable phenomenon following AAA repair. It is more pronounced in knitted than in woven grafts, but does not necessarily lead to graft-related complications or failure.

ANZ Journal of Surgery, 1999

ANZ Journal of Surgery, 1996

ANZ Journal of Surgery, 1997

The Medical journal of Australia, Jan 26, 1986

Two patients with Hickman catheters that were used for long-term venous access developed major ve... more Two patients with Hickman catheters that were used for long-term venous access developed major venous thrombosis, one with superior vena caval and the other with subclavian vein thrombosis. This represented an incidence of 9% of all Hickman catheters that were inserted over two years in The St George Hospital. Staphylococcus epidermidis was cultured from blood that was sampled through the Hickman catheter in both patients; the organism was also cultured from the tip of the removed catheter in one patient. Transverse thoracic computerized tomographic scanning diagnosed the presence and the site of thrombosis as well as excluding the presence of a mediastinal tumour that was causing extrinsic compression. The catheter had to be removed in one patient; in the other patient, heparinization without removal resulted in the resolution of symptoms.

Annals of The Royal …, 1997

International Journal of Vascular Medicine, 2015

Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign ute... more Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign uterine leiomyoma. Incomplete resection has a recurrence rate of over 30%. Different hormonal treatments have been described following incomplete resection; however no standard therapy currently exists. We review the literature for medical treatments options following incomplete resection of IVL with CE. Methods. Electronic databases were searched for all studies reporting IVL with CE. These studies were then searched for reports of patients with inoperable or incomplete resection and any further medical treatments. Our database was searched for patients with medical therapy following incomplete resection of IVL with CE and their results were included. Results. All studies were either case reports or case series. Five literature reviews confirm that surgery is the only treatment to achieve cure. The uses of progesterone, estrogen modulation, gonadotropin-releasing hormone antagonism, and aromatase inhibition have been described following incomplete resection. Currently no studies have reviewed the outcomes of these treatments. Conclusions. Complete surgical resection is the only means of cure for IVL with CE, while multiple hormonal therapies have been used with varying results following incomplete resection. Aromatase inhibitors are the only reported treatment to prevent tumor progression or recurrence in patients with incompletely resected IVL with CE.

Surgical Laparoscopy Endoscopy & Percutaneous Techniques

ABSTRACT

A consensus exists that aneurysm size is most appropriately assessed by measurement of maximal tr... more A consensus exists that aneurysm size is most appropriately assessed by measurement of maximal transverse aneurysmal diameter in either the anteroposterior or lateral dimensions. We have examined the hypothesis that these dimensions are interchangeable in patients with aneurysm disease. We have followed 56 patients with infrarenal aortic aneurysm disease using ultrasound scanning. These patients have undergone 149 ultrasound assessments of aortic aneurysms. In these patients the corresponding anteroposterior diameter was a mean of 3.71 cm (3.59–3.84, 95% confidence interval [CI]) versus a lateral diameter of mean 4.0 cm (3.88–4.11 cm, 95% CI), p = 0.0001.We believe that aneurysm dimensions are best reflected by transverse anteroposterior diameter, although this may not always be the largest aneurysm diameter.

The New Zealand medical journal, Jan 8, 1994

A review of 5 years' experience with central venous access catheters (CVAC) to examine the re... more A review of 5 years' experience with central venous access catheters (CVAC) to examine the results of catheter placement technique (open or percutaneous) on subsequent CVAC performance. In addition the catheter function and utilisation of both Hickman type and Access Port type of CVAC were reviewed to assess the indications and the types of access devices chosen in selected patients. A retrospective review of CVAC between 1987 and 1991 was undertaken. During this time 113 CVAC were placed by the open (n = 76) or percutaneous (n = 37) method. The type of catheter used was Hickman (n = 79) or Access Port (n = 34). Indications for CVAC placement were haematological malignancy 74.2%, other malignancy 14.1%, and the rest were accounted for by TPN, HIV infection, osteomyelitis, anaemia and haemochromatosis. There was no difference between duration of function for CVAC placed by the open (5.1 months 95% CI, 3.8-6.4) and percutaneous methods (3 months, 95% CI 2.2-3.8). Nor was there a d...

Cardiovascular Surgery, 1995

The clinical course of 76 patients with aortic aneurysmal disease undergoing 107 coincidental sur... more The clinical course of 76 patients with aortic aneurysmal disease undergoing 107 coincidental surgical procedures was analysed in order to examine the relationship between aortic aneurysmal rupture and coincidental treatment. Additionally the incidence of aneurysmal rupture was assessed following 82 endoscopic procedures in 42 patients with aortic aneurysms. Two patients ruptured an aortic aneurysm after operation, one after colonoscopy (maximal transverse diameter 7cm) and one after coronary artery bypass grafting (maximal transverse diameter 5.6cm). The mean maximal transverse diameter of aneurysms in 76 patients was 5.08 cm (95% confidence interval 4.7-5.4 cm). Both patients with ruptured aottic aneurysms were outside these confidence limits and were known hypertensives whose perioperative control of hypertension was questionable. The present series of patients is discussed with reference to induction of collagenase activity as a precipitating cause for postoperative rupture of aortic aneurysms, perioperative control of hypertension, transverse aneurysm diameter as a predictor of postoperative rupture and conduct of coincidental procedures in the presence of aneurysmal disease.

Postgraduate Medical Journal, 1993

Graduated compression stockings are frequently used in the prevention of deep venous thrombosis a... more Graduated compression stockings are frequently used in the prevention of deep venous thrombosis and the treatment of venous insufficiency. Two patients are discussed who sustained ischaemic complications after application of graduated compression stockings. Review of the literature demonstrates that low cutaneous pressures significantly decrease local blood flow and that the amount ofpressure exerted by graduated compression stockings increases significantly with increases in leg girth. Ischaemic complications associated with the use of these stockings also appears to be more common than previously thought and any policy of routine prescription to patients should be questioned.

Journal of Vascular Surgery, 1994

Surveillance protocols of infrainguinal vein bypass grafts have almost universal acceptance. To d... more Surveillance protocols of infrainguinal vein bypass grafts have almost universal acceptance. To date corresponding studies of prosthetic grafts have not been carried out. We have performed a prospective 4-year duplex scan follow-up on polytetrafluoroethylene grafts to assess the usefulness of a surveillance program of prosthetic bypass grafts in preventing graft failure. Over 4 years 69 infrainguinal polytetrafluoroethylene grafts in 56 patients were studied at six monthly intervals by our vascular laboratory. Full duplex scan mapping of the grafts and inflow and outflow arteries and standard ankle pressure measurements were performed. A midgraft peak flow velocity was also measured. Over 4 years 27 (39.1%) grafts occluded without any predictive changes in the preceding duplex scan examination. Of the 42 (60.9%) grafts that remained patent, only four developed stenoses (three at the proximal anastomosis and one at the distal anastomosis) that were amenable to intervention. Changes in ankle pressures or midgraft flow velocity did not predict failure. The low yield of remediable disease does not justify the cost of duplex scan surveillance of infrainguinal prosthetic bypass grafts.

Diseases of the Colon & Rectum, 1980

Hanel KC, King DW, McAllister ET, Reiss-Levy E. Single dose parenteral antibiotics as prophylaxis... more Hanel KC, King DW, McAllister ET, Reiss-Levy E. Single dose parenteral antibiotics as prophylaxis against wound infections in colonic operations. Dis Colon Rectum 1980;23:98-101. A study of 77 patients undergoing elective operations on the colon and rectum, where wounds were subject to contamination by fecal flora, did not demonstrate that the addition of a preoperative oral regime to parenteral antibiotics alone further decreased the incidence of wound infection. The authors feel that the use of single-dose clindamycin and cephazolin intravenously preoperatively has been shown to be a very effective method of preventing wound infection in elective colonic resections. [

Digestive Diseases and Sciences, 1981

ANZ Journal of Surgery, 2003

Venous aneurysms are rare vascular anomalies that have been reported to occur throughout the body... more Venous aneurysms are rare vascular anomalies that have been reported to occur throughout the body. We report a unique variation, namely a thrombosed subclavian vein aneurysm. A review of the records of patients with documented venous aneurysms presenting to the St George Hospital and their associated imaging was made. A literature search for articles pertaining to venous aneurysms was performed. Four cases of venous aneurysms were identified; one subclavian vein, one inferior vena cava and two popliteal. The clinical course of these cases is detailed, along with a review of the literature. Venous aneurysms are infrequent findings and indicate that the patient is at significant risk of thrombosis. Popliteal vein aneurysms should be treated surgically.

ANZ Journal of Surgery, 1997

ANZ Journal of Surgery, 1998

ANZ Journal of Surgery, 1999

It has been suggested that graft dilatation following repair of abdominal aortic aneurysm (AAA) i... more It has been suggested that graft dilatation following repair of abdominal aortic aneurysm (AAA) is associated with complications such as anastomotic aneurysm and graft rupture. The purpose of the present study was to document the degree of dilatation observed in grafts after aneurysm repair and to correlate this with any graft-related complications. Between January 1987 and December 1992, 219 patients had elective repair of their AAA at St George Hospital. A follow-up ultrasound scan was available for 154 of these patients. The following factors were examined: age, sex, size of aneurysm, type and size of graft, time of follow-up scan, size of graft at follow-up and any graft-related complications. The mean graft dilatation observed in knitted grafts (42.6%; 95% CI: 39.1-46.1%) was significantly greater than that observed for woven grafts (25.5%; 95% CI: 19.0-32.1%; P < 0.0001). There were no graft-related complications. Graft dilatation is a predictable phenomenon following AAA repair. It is more pronounced in knitted than in woven grafts, but does not necessarily lead to graft-related complications or failure.

ANZ Journal of Surgery, 1999

ANZ Journal of Surgery, 1996

ANZ Journal of Surgery, 1997