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Biomedical subjects

H L Laws

Publications and source records attributed to H L Laws.

At least 55 records · Page 3Linked to original sources
PubMed1983

A randomized prospective trial of radical (Halsted) mastectomy versus modified radical mastectomy in 311 breast cancer patients.

This study reports the results of a prospectively randomized trial for treatment of carcinoma of the breast comparing standard (Halsted) radical mastectomy to a modified radical mastectomy. Three hundred eleven patients with primary operable carcinoma of the breast were entered in a surgical and adjunctive chemotherapy trial in Alabama between 1975 and 1978. A total of 91 surgeons participated (all Diplomats of the American Board of Surgery and Members of the American College of Surgeons). All operative reports, pathology and therapy were reviewed by referees. Histologically node positive patients were randomized after operation to receive melphalan or C.M.F.(cytoxan, methotrexate, and 5-FU) for 1 year. After a median follow-up of 5.5 years, there was no significant difference in disease-free survival or in overall survival between the two groups. There was a trend toward improved 5-year survival rates in the radical mastectomy group compared to the modified radical mastectomy group (84% vs. 76%, p = 0.14). There was also an increased incidence of local wound recurrence in those patients receiving modified radical mastectomy, but the differences were not statistically significant (p = 0.09). Longer follow-up will be necessary to evaluate these results more fully.

Breast Neoplasms↗
PubMed1983

Substernal and intrathoracic goiter. Reconsideration of surgical approach.

Thirty-one patients were operated on for benign thyromegaly extending to the thorax in an 11-year period at the University of Alabama in Birmingham. Neck mass (65%), dysphagia (36%), and dyspnea (32%) were the most common symptoms. All patients were euthyroid. Five patients had previous thyroid surgery. A thyroid scan was performed on 24-patients. Fourteen (58%) suggested a thoracic extension while ten (42%) failed to identify a thoracic extension. The indications for resection were increasing symptoms, increasing size despite the use of dessicated thyroid therapy, and to establish a diagnosis. The left thyroid lobe extended into the thorax more frequently (70%) than the right. Most patients had multinodular goiter (94%). Three patients had occult carcinoma (10%) and two patients had Hashimoto's disease. Median sternotomy combined with a collar incision to provide exposure for excision of intrathoracic thyroid extension was used in six patients. There was no operative mortality. There was no increase in operative morbidity and a slight increase in average stay from 5.3 days with a collar incision alone to 6.8 days with the combined incisions. Median sternotomy does not increase morbidity or mortality. Specific indications for more liberal use of sternotomy extension of a collar incision are proposed for the management of substernal and intrathoracic goiters.

Adult↗
PubMed1982

Favorable factors in the adjuvant therapy of breast cancer.

One hundred seventy-one patients received one year of melphalan or intermittent cyclophosphamide, methotrexate, and fluorouracil after mastectomy for breast cancer with involved axillary nodes. Analysis with a median follow-up of three years indicates a favorable outcome only for patients with 1-3 positive nodes who were treated with melphalan and who experienced a leukocyte count less than 3,000/mm3 (3.0 X 10(9)/l). Tumor size, average percentage of dose received, menopausal status, and type of chemotherapy were not significant factors in recurrence of disease, after adjustment for the number of positive nodes and leukocyte count nadir during treatment based on a multifactorial analysis. These data suggest that administration of a dose of melphalan which does not produce a leukocyte count of less than 3,000/mm3 is ineffective in preventing early recurrence of disease. Since oral melphalan is known to be erratically absorbed, lack of hematologic toxicity may well be due to variable absorption of the drug on a fixed-dose region. Failure to prevent recurrence of disease in this and other trials using oral melphalan may be due to chemotherapy-related as well as disease-related factors.

Antineoplastic Agents↗
PubMed1982

Pyogenic hepatic abscesses.

A review of pyogenic liver abscess at the University of Alabama in Birmingham revealed 29 cases, of which 22 were single and seven were multiple. Etiology was cryptogenic in 11, secondary to biliary tract disease in seven, trauma in six, and pyelophlebitis in four, and secondary infection in a primary neoplasm in one. No single set of specific diagnostic criteria could be elucidated, but fever occurred in every patient. Leukocytosis, hypoalbuminemia, and elevated alkaline phosphatase were present in more than 80 per cent of patients. Other clinical findings and routine laboratory abnormalities were less consistently present. In suspect patients, a technetium-99 scan was positive in 18 of 19. Ten patients died, including six of seven with multiple abscesses, seven of seven with positive abscess and blood cultures, and seven of 11 in whom liver abscess was not suspected prior to operation or autopsy. Diagnosis demands a high index of suspicion, in patients in whom suggestive factors are present, and liberal use of the technetium-99 scan. Successful treatment requires exploratory laparotomy, with care of discern any underlying septic focus or the presence of multiple abscesses, and wide drainage of the abscesses, as well as vigorous supportive care and appropriate antibiotics.

Adolescent↗
PubMed1982

Major hepatic resections: analysis of 51 cases.

The experience with 51 patients who underwent major hepatic resections is analyzed. The operations performed were right lobectomy (in 13 patients); partial right lobectomy (in six patients); lateral left segmentectomy (in 15 patients); and medial left segmentectomy (in one patient). Traumatic injuries determined the need for resection in 31 patients; there were nine (29%) operative deaths. The remaining 22 patients left the hospital and returned to active life. Other indications for hepatic resection were: hepatic abscess (in four patients); primary hepatic tumors (in 11 patients - seven benign, 4 hepatomas); and metastatic tumors (in five patients). Three patients (15%) died in the hospital. All patients who underwent operations for hepatic abscess and benign tumors survived and remained well. Two patients with hepatomas died after operation; the other two patients survived a few months. One patient who underwent operation for a metastatic tumor died after operation; four patients survived 16-36 months. These observations suggest that major hepatic resections benefit patients with severe hepatic injuries that devitalize large segments of hepatic parenchyma, some selected patients with multiple recurrent hepatic abscesses, patients with benign hepatic tumors that are an impending threat to their survival, and perhaps to patients with localized metastatic hepatic tumors. Hepatectomy was of limited benefit to patients with hepatomas.

Adult↗
PubMed1981

Standardized gastroplasty orifice.

Consistent weight reduction by gastroplasty requires precise construction of an appropriately sized stoma that will not dilate. The technique described constructs such a stoma around a 32 French Hurst dilator with an external ring of Silastic tubing over polypropylene suture.

Dilatation↗
PubMed1981

Superior gastric reduction procedure for morbid obesity: a prospective, randomized trial.

A prospective randomized clinical trial was undertaken to compare the effects of gastric bypass with Roux-en-Y gastrojejunostomy and a gastric partitioning procedure. Operative groups were comparable, with regard to preoperative weight, age, sex, historic findings and operative complications. Post-operative weight loss was followed for one year. Patients receiving the gastric partitioning procedure showed significantly poorer weight loss as early as three months postoperatively than did those receiving gastric bypass. This poorer performance persisted throughout the study period.

Adult↗
PubMed1981

Successful management of heart rupture from blunt trauma.

Seven patients with cardiac rupture from blunt trauma were encountered at the University Hospital, University of Alabama School of Medicine, in a 15-year period. Five of seven patients survived, including three with left atrial injuries and one each with right ventricular and left ventricular injuries. Useful diagnostic features included systolic hypotension, distended neck veins, and elevated central venous pressures. Associated injuries averaged four per patient. Successful management demands a high index of suspicion of cardiac injury, prompt diagnosis, and immediate median sternotomy. After repair of the heart the incision should usually be extended to allow exploratory laparotomy.

Adolescent↗
PubMed1980

Thoracic epidural vs balanced anesthesia in morbid obesity: an intraoperative and postoperative hemodynamic study.

Thirty-eight morbidity obese patients undergoing gastric bypass were divided into two groups. All patients received general endotracheal anesthesia with muscle relaxation and controlled respiration with N2O-O2 mixture. In addition, group I, 17 patients, received balanced anesthesia, while the remaining 21 patients, group II, received thoracic (T-5) epidural analgesia. Postoperative analgesia was achieved with morphine intravenously in group I and with 0.5% bupivacaine epidurally in group II. Circulatory function was measured and calculated using radial artery cannulation and pulmonary artery catheterization with Swan-Ganz thermodilution catheters. A significant decrease in cardiac index (10% and 14% in groups I and II, respectively), in left and right ventricular stroke work (12% to 30%), systolic blood pressure-heart rate product (16% and 28% in groups I and II, respectively), in arterial venous oxygen content difference and oxygen consumption (31% and 39% in groups I and II, respectively) was observed during surgery. A decrease in intrapulmonary shunt from 20% +/- 2.9% before anesthesia to 15% +/- 2.1% intraoperatively was seen in patients given epidural anesthesia. Postoperatively epidural analgesia was associated with a decrease in left ventricular stroke work 12%), systolic pressure-heart rate product (10%), arteriovenous oxygen content differences (17%), and oxygen consumption (20%), compared with values observed when patients experienced pain. Morphine given for relief of postoperative pain was not associated with significant changes in cardiovascular function. Continuous epidural analgesia used postoperatively for relief of pain in morbidity obese patients, following upper abdominal surgery, slightly decreases oxygen requirement and benefits cardiovascular function as reflected by a decrease in left ventricular stroke work.

Adult↗
PubMed1980

Injuries of the diaphragm.

Injuries of the diaphragm in 86 patients occurring over a 10-year period were retrospectively reviewed. Blunt trauma victims experienced injury on the right and left with nearly equal frequency, representing a strikingly different experience from those reporting before 1970 when left-sided injuries predominated. Patients' complaints and physical findings were not reliable indicators of diaphram injury, but were usually manifestations of associated injury. Ninety-five per cent of our acute victims had other injuries. Routine chest X-rays were the most reliable diagnostic tools, yet these were normal in 1/4 of the patients. Diagnosis depends on high index of suspicion before operation and careful inspection of the diaphragm at operation. Initial thoracotomy required subsequent laparotomy to complete management in seven of 15, whereas laparotomy required supplemental thoracotomy only once in 65 instances. The superior operative approach, therefore, for either right or left diaphragmatic injury is initial laparotomy.

Adolescent↗
PubMed1979

How and when to use barium for diagnosis of small bowel obstruction.

The diagnosis of intestinal obstruction is readily made when a patient presents with typical history and signs, and when plain films of the abdomen display characteristic findings. Some patients, however, constitute diagnostic problems because abdominal roentgenograms are still equivocal, even after repetition in four hours. In the unclear case, use of a barium meal will safely, promptly, and routinely prove or disprove small bowel obstruction. Intestinal obstruction in which the initial abdominal films tend to be either unrevealing or equivocal include high obstructions, including the superior mesenteric artery syndrome; presence of strangulation; partial small bowel obstruction; and fluid-filled proximal bowel. In intestinal obstruction, characteristic roentgenographic findings with use of barium meal are normal to rather rapid transit time to the point of obstruction; homogenous dilution of barium in dilated proximal loops; and inhomogenous, scattered, and fragmented collections of barium in the distal, collapsed loops.

Administration, Oral↗
PubMed1979

Splenectomy for hematologic disease.

One hundred and thirty splenectomies were performed at the University Hospital in Birmingham for hematologic disorders during a 12 year period. There were seven deaths of which four were related to sepsis in patients with malignant growths which probably impaired immune competence. Splenectomy was found to be uniformly satisfactory for hereditary hemolytic anemia, for hypersplenism complicating rheumatoid arthritis and for the rare instance of primary hypersplenism. Splenectomy was usually salutary in didopathic thrombocytopenic purpura and in antoimmune hemolytic anemia. When done for diagnosis, splenectomy was definitive in about 50 per cent of the instances. Individual patients with thrombotic thrombocyeosinophilia syndrome benefited. Splenectomy for hypoplastic or aplastic anemia in an actual circulation offered only questionable benefit and is rarely necessary for hyperplenism secondary to portal hypertension.

Adult↗
PubMed1978

Training and use of surgeon's assistants.

"Physician extenders" of various types have been produced in the past few years. The University of Alabama in Birmingham has trained surgeon's assistants over the past 9 years, graduating 53 individuals after a 2-year course of didactic, laboratory, and clinical instruction. The graduates have performed satisfactorily, working with surgeons in the community setting and as part of highly specialized teams in large medical centers. One third work in general surgery, one third in cardiovascular thoracic surgery, and one third in other special areas. The authors conclude that these individuals will play an increasing role in allowing surgical therapy to be delivered in an efficient and effective manner.

Alabama↗