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Biomedical subjects

H L Laws

Publications and source records attributed to H L Laws.

At least 73 records · Page 4Linked to original sources
PubMed1978

Management of small bowel obstruction.

Preventable deaths from small bowel obstruction result from misdiagnosis, inappropriate delay in operation, inadequate preoperative preparation, and a poorly performed operative procedure. A systematic approach to each of the factors includes repeat physical examination, x-rays and CBC four hours after initial study in questionable cases, a pre-planned therapeutic interventions timetable, adequate intravascular volume and electrolyte levels, and a carefully designed operation which includes as little bowel manipulation and entrance as possible.

Anti-Bacterial Agents↗
PubMed1977

Bilateral catamenial pneumothorax.

Bilateral catamenial pneumothorax occurred in a 32-year-old parous woman. The 41 previously reported cases of catamenial pneumothorax occurred on the right side. This patient was treated with left-sided pleurodesis and, subsequently, with hysterectomy and bilateral salpingo-oophorectomy. The pathologic mechanism of this peculiar syndrome has been attributed to reflux of air via the genitalia and fenestrations in the diaphragm, menstrual shedding of endometrial cells growing in the visceral pleura, or, possibly, aveolar tissue damage secondary to vascular and bronchiolar spasm resulting from dinoprost tromethamine released from menstrual debris. Treatment needs to be tailored to fit the individual patient's specific pelvic and intrathoracic pathology and procreative desires.

Adult↗
PubMed1977

Surgical treatment of the celiac axis compression syndrome.

Six patients with symptomatic celiac axis compression syndrome are reported on. Four were treated surgically with arterial reconstruction. None of these four patients was benefited more than temporarily by the corrective surgery. One patient had an abdominal exploration and highly selective vagotomy unrelated to the celiac axis and is symptom-free ten months after surgery. One patient had no surgery and remains symptomatic. Angiographic evaluation in all patients demonstrated that despite high grade stenosis of the celiac axis, there was no radiographically discernible reduction in constrast flow to the celiac axis because of well developed collaterals from the superior mesenteric artery. These results indicate that compression of the celiac axis may be merely an incidental angiographic finding, so this syndrome needs cautious evaluation.

Adult↗
PubMed1977

Emergency embolization in blunt hepatic trauma.

The right hepatic artery in a patient with traumatic liver tear was embolized with Gelfoam to stop an otherwise uncontrollable hemorrhage. The procedure was probably life saving in this patient. Transient elevated transaminase and bilirubin levels returned to normal 3 weeks after embolization. A repeat hepatic arteriogram 4 months after embolization demonstrated good revascularization of the right hepatic lobe from the left hepatic, left gastric, and gastroduodenal arteries. This case demonstrates the therapeutic value and safety of selective hepatic arterial branch embolization in massive life-threatening hemorrhage.

Adolescent↗
PubMed1977

Intestinal infarction complicating low cardiac output states.

Nonocclusive mesenteric ischemia, leading into intestinal infarction, frequently complicates and causes the fatal outcome in otherwise treatable instances of low cardiac output states. Once intestinal necrosis occurs in these patients, the mortality is almost 100 per cent. A high risk group of patients in whom intestinal infarction occurs because of low cardiac output can be readily identified. A high index of suspicion for the occurrence of intestinal ischemia in these patients should facilitate recognition of the disease during its early stages. The disastrous results experienced by us and others warrant the use of more aggressive methods for the diagnosis and treatment of patients with this condition. A high index of suspicion in a recognizable group of patients observed by selective mesenteric arteriography affords a method for confirmation of the diagnosis of mesenteric vasoconstriction. Once the diagnosis is established, a patient management protocol program should be followed. Sustained infusion of papaverine into the mesenteric artery is useful in reversing mesenteric vasoconstriction. Additionally, the judicious use of celiotomy and intestinal resection, preceded and followed by the sustained infusion of papaverine into the superior mesenteric artery, offers hope for the survival of some of these patients and warrants further use.

Aged↗
PubMed1976

Polyarteritis nodosa causing severe intestinal bleeding.

Rupture of an aneurysm of the mesentergic artery caused severe intestinal hemorrhage in a 50-year-old woman with polyarteritis nodosa. Abdominal angiography not only established diagnosis of polyarteritis nodosa by demonstrating multiple visceral aneurysms but also localized the site of bleeding.

Aneurysm↗
PubMed1976

Small-bowel obstruction: a review of 465 cases.

A retrospective review of experience with small-bowel obstruction at the University Hospital in Birmingham for a ten-year period (January 1963 through December 1972) revealed 465 episodes of obstruction in 415 patients. The mortality was 4% in obstruction due to adhesions, and 28% in obstruction caused by carcinoma; overall mortality was 8%. Intra-abdominal adhesions were the cause of 69% of cases. Malignant obstruction (mostly from metastatic disease) was the second most common cause of obstruction, and external hernia was third. Delay in diagnosis and inappropriately prolonged used of long intestinal tubes added to the mortality and can be avoided. We suggest a plan for prompt, consistent diagnosis and recommend more liberal use of the barium meal in questionable cases.

Adolescent↗
PubMed1975

Factitial mesenteric avulsion.

Colon exteriorization procedures were done in two patients who also were, or became, psychotic. Each patient pulled on the exteriorized loop, causing severe bowel injury. In known or potential psychotics some other form of colonic injury management--other than exteriorization--should be utilized, or extreme caution should be taken to prevent inadvertent self-injury by the patient.

Adult↗