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Biomedical subjects

L A Gray

Publications and source records attributed to L A Gray.

At least 91 records · Page 5Linked to original sources
PubMed1977

Stilboestrol (diethylstilbestrol) and the risk of ovarian cancer.

A follow-up survey of 908 women who had received 'Premarin' (conjugated equine oestrogen) for menopausal symptoms revealed 8 cases of ovarian cancer. This risk was 2 to 3 times greater than expected. The risk increased with the strength of premarin tablet usually taken, but not with the duration of use or total dose ingested. The excess risk of ovarian cancer in this group occurred primarily among 21 women who had also used stilboestrol (diethylstilbestrol). The results of this small trial are consistent with the increasing incidence of ovarian cancer in post-menopausal women in the U.S.A., and with the occurrence of stilboestrol-induced ovarian neoplasms in dogs.

Cocarcinogenesis↗
PubMed1977

Diverticulitis in women: an unappreciated clinical presentation.

A final diagnosis of diverticulosis or diverticulitis was made in 1,031 women over a 10 year period. The 69 patients who underwent abdominal operation for what proved to be diverticulitis are discussed in detail. Thirty-eight per cent of these women were believed to have gynecologic disease because of the presence of a pelvic mass. Diverticulitis is an important differential diagnosis of a pelvic mass with or without clinical and laboratory indications of infection and with or without history of diverticulosis or diverticulitis. The increasing awareness of ovarian carcinoma and its ominous prognosis make this differential diagnosis especially important. Diverticular disease should always be considered among such patients and preparations made to allow optimal treatment at that operation, whatever the ultimate cause of the mass.

Adult↗
PubMed1977

Indications for thoracotomy following penetrating thoracic injury.

The treatment of penetrating thoracic injuries has been reviewed in both civilian and military series. Although most surgeons agree that closed that closed thoracostomy drainage is the initial treatment of choice, the timing of early thoracotomy and perhaps cardiorrhaphy upon patients with penetrating thoracic injuries remains controversial. The purpose of this study was to determine which patients will require immediate thoractomy or cardiorrhaphy following penetrating chest injury. Over a two-year period 190 patients with penetrating thoracic injuries were treated. Of 53 patients who required immediate thoracotomy, 31 suffered cardiac wounds. Seventy-nine patients required laparotomy for associated intra-abdominal injuries. The mortality rate was related to exsanguinating hemorrhage or postoperative intra-abdominal sepsis. Cardiopulmonary complications were rare in the absence of intra-abdominal sepsis and could not be attributed to the thoracic injury or thoracotomy. Indications for immediate cardiorrhaphy or thoracotomy are: 1) location of the entrance wound (70% in upper mediastinum); 2) blood pressure on admission less than 90; 3) initial thoracostomy blood loss greater than 800 cc; 4) radiographic evidence of retained hemothorax; and/or 5) clinical evidence of pericardial tamponade.

Drainage↗
PubMed1977

Estrogens and endometrial carcinoma.

A group of 205 women with endometrial carcinoma was matched for age, parity, and year of operation with a group of 205 women who had had hysterectomies for benign disease. In the former group, 32 patients had used conjugated estrogens, while in the latter group 12 had used this hormone, yielding a relative risk of 3.1 (P = 0.0008). Users of other forms of systemic estrogens showed similar elevations in relative risk. Relative risk was related to duration of use, progressing from no evidence of risk among those using the hormone for less than 5 years to an 11.5-fold greater risk for those using it for 10 years or more. Risk was also related to the strength of the medication. The relative risk for users of the 1.25-mg tablets was 12.7 as compared to a two- to fourfold greater risk among users of lesser strength tablets.

Age Factors↗
PubMed1977

Surgical treatment of coronary artery aneurysm with rupture into the right atrium.

Considering the increasing number of patients with chest pain who undergo routine coronary artery arteriography, coronary artery aneurysm may be found more frequently. To know how to manage these aneurysms, we must understand their possible complications. The aneurysms can produce symptoms of angina or acute myocardial infarction by total thrombosis of the aneurysm and vessel, embolism to the distal vessel, or progressive enlargement and encroachment upon the distal vessel until it is occluded. Moreover, the aneurysm may enlarge and rupture into the free pericardium or produce a fistula by eroding into a chamber of the heart. The case described herein may represent the first reported case of a coronary artery aneurysm eroding into a cardiac chamber and causing an arteriovenous fistula. The treatment of choice is resection of the aneurysm, closure of the fistula, and re-establishment of continuity of the distal coronary artery with a saphenous vein bypass graft.

Aneurysm↗
PubMed1976

Menopausal estrogens and breast cancer.

1891 women given conjugated estrogens for the menopause were followed for 12 years (mean) for incidence of breast cancer. Overall, 49 cases were observed; 39.1 were expected on the basis of rates in the general population (relative risk = 1.3, P = 0.06). The relative risk increased with follow-up duration, progressing to 2.0 after 15 years (13/6.6, P = 0.01). The excess risk after 10 years was not due simply to prolonged estrogen use, since there was no clear dose-response relation to accumulated years of use. However, higher risk accrued to women using higher-dose tablets and those taking the medication on an other than daily basis. In addition, after 10 years of follow-up observation, two factors related to low risk of breast cancer, multiparity and oophorectomy, were no longer so related. Finally, estrogen use was related to an especially high risk of breast cancer among women in whom benign disease developed after they had started the drug.

Aged↗
PubMed1976

Microinvasive carcinoma of the uterine cervix: A long-term followup study of eighty cases.

One hundred and eleven patients with microinvasive carcinoma of the uterine cervix were studied over a 21-year period. Thirty-five cases of carcinoma in situ with questionable stromal invasion were excluded. Cases with pathologic examination of less than a cervical cone or the entire cervix were not accepted. The sole pathologic criterion for inclusion was unequivocal invasion to a depth of no more than 5.0 mm. Ninety-one patients were followed for 5 years or until death, and 80 patients for 10 years or until death. One patient was lost to follow-up at 5.5 years. The two deaths officially attributed to cervix cancer prior to 10 years were signed out by nonphysician assistant coroners. Available clinical evidence indicates that at least one of these patients, and probably both, did not die of cervix cancer. From these data, simple hysterectomy would seem to be the maximal treatment indicated. Since the prognosis of microinvasive carcinoma is similar to that of carcinoma in situ, it is suggested that such cases not be included when considering the end results of Stage I cervix cancer.

Adult↗
PubMed1976

The treatment of acute traumatic rupture of the aorta: a 10-year experience.

Forty-three patients with aortic rupture secondardy to blunt trauma have been treated at the University of Micigan within the past 10 years with an overall salvage rate of 70%. The diagnosis should be suspected in anyone who has sustained a high speed decelerating injury, if the chest roentgenogram shows media-stinal widening, whether or not there is hypertension of the upper extremities; systolic murmur, or external evidence of chest injury. Aortography should be employed to confirm the diagnosis and to determine the site or sites of rupture. Repair of the lesion should be undertaken as soon as possible and takes priority in most instances over associated injuries. Repair in almost all cases can be accomplished safely and quickly using a bypass shunt without the aid of extracorporeal circulation.

Accidents, Traffic↗
PubMed1976

Echocardiographic diagnosis of a stuck Bjork-Shiley aortic valve prosthesis.

A 55-year-old man who had been asymptomatic after replacement of his aortic valve with a Bjork-Shiley prosthesis, suddenly developed heart failure. The clinical suspicion of prosthetic malfunction was not only confirmed, but specified as being a stuck disc secondary to a large thrombus. Surgical removal of the clot resulted in restoration of normal function and return to the expected findings on echocardiogram. The value of echocardiography in such instances, as well as in routinely following-up patients with prostheses postoperatively, is emphasized.

Aortic Valve↗
PubMed1976

Surgical treatment of thrombosed Björk-Shiley aortic valve prosthesis.

Massive thrombosis of a Björk-Shiley aortic valve prosthesis occurs with significant frequency when adequate anticoagulation has not been attained. The converse is also true: This complication is extremely rare in patients receiving anticoagulant therapy. Therefore, we recommend anticoagulants for all patients with Björk-Shiley aortic valve prostheses. Once a diagnosis of a thrombosed prothesis is made, however, immediate operation is indicated. Declotting of the valve without removal of the disc is adequate treatment. After thrombectomy, it is extremely important to evaluate the entire prosthesis critically, with particular attention to the area of the hinge and the occluder. If any wear is observed, the entire prosthesis should be replaced. Excellent long-term results can be expected if the patient is maintained on adequate anticoagulation postoperatively.

Aortic Valve↗
PubMed1975

Open cuff method of abdominal hysterectomy.

An open cuff technic was employed in 2421 consecutive patients with total abdominal hysterectomy. Extraperitoneal drainage was purpose of the method. The two most serious complications were postoperative hemorrhage (7 cases, 0.28 percent) and intestinal obstruction (6 cases, 0.24 percent). The morbidity rate was 20.8 percent. Of those without colporrhaphy (two-thirds), the morbidity rate was 18.2 percent. Prophylactic antibiotics were not used in the latter group. In no instance was a pelvic abscess or cluff abscess recognized. Death occurred in 1 case (0.041 percent). This method may diminish the occurrence of apical infections above a closed vagina by allowing immediate extraperitoneal drainage. Postoperative bleeding and intestinal obstruction, along with other rare conditions, continue to represent occasional but severe complicantions.

Anti-Bacterial Agents↗