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Biomedical subjects

L W Baker

Publications and source records attributed to L W Baker.

At least 37 records · Page 2Linked to original sources
PubMed1984

Control of major haemorrhage associated with pancreatic pseudocysts by transcatheter arterial embolization.

Massive haemorrhage from a pancreatic pseudocyst is an uncommon cause of upper gastrointestinal bleeding. The condition carries a high mortality and presents a major clinical problem both in terms of timely diagnosis and appropriate surgical therapy. Four patients are presented with pseudocyst-related bleeding arising from the gastroduodenal artery. In all instances the bleeding was successfully controlled by transcatheter embolization with gelfoam. No untoward sequelae were noted and the occlusion remained effective as shown by follow-up angiography 2 months later. The importance of early diagnostic angiography is stressed and it is concluded that interventional angiography may obviate the need for high risk emergency surgery.

Adult↗
PubMed1984

Penetrating injuries of the pleural cavity.

Two hundred and fifty one cases of penetrating wounds of the chest were studied prospectively. Clinical evidence is presented to show that: basal intercostal drains are adequate to remove both air and fluid from within the pleural cavity; frequent chest radiographs are unnecessary and intercostal drains may be removed on clinical grounds alone; long term antibiotic prophylaxis is unnecessary; eight per cent of those undergoing initial observation will develop a delayed haemothorax or pneumothorax of sufficient size to require drainage; subcutaneous emphysema is of no prognostic significance in the symptomless patient with minimal intrapleural damage on admission; and outpatient follow up is not required.

Adolescent↗
PubMed1983

Segmental artery occlusion for sequential renal injuries. A case report.

We report on a patient who experienced life-threatening haemorrhages in 1974 and 1980 after receiving stab wounds to the same kidney. Treatment by means of segmental artery occlusion was successful. Nephrectomy would have been necessary to control exsanguinating bleeding in both instances. Successful evasion of nephrectomy on two occasions for trauma to the same kidney has not been reported previously.

Adult↗
PubMed1983

Rectal administration of metronidazole in severely ill patients.

Ten severely ill patients with life threatening sepsis received metronidazole as suppositories and blood concentrations of the drug were measured twice daily over five days. Therapeutic blood concentrations of metronidazole were maintained at all times in all patients. Rectal administration of metronidazole is accepted as effective prophylaxis against infection associated with surgery and as treatment of established infection. This study shows that in gravely ill patients metronidazole administered as suppositories gives perfectly adequate therapeutic serum concentrations of the drug, but that to achieve these concentrations rapidly the first suppository should be given with an intravenous loading dose.

Adolescent↗
PubMed1983

Total parenteral nutrition--progress with the 3-litre bag.

Recently a disposable 3-litre plastic bag in which the 24-hour nutrient requirements for total parenteral nutrition can be mixed to provide a single solution was introduced to South Africa. We report our initial experience with the 3-litre bag (379 'catheter days'), comparing it with the conventional multiple-bottle system (267 days) in a series of 10 patients. The 3-litre bag system proved easier to administer and also reduced nursing supervision, improved metabolic control and reduced complications. In particular, the control of blood sugar levels in glucose-intolerant patients was significantly better. The 3-litre bag appears to be a major advance in the field of parenteral nutrition, resulting in improved patient care and management.

Evaluation Studies as Topic↗
PubMed1983

Neurological deficit and injuries involving the neck arteries.

The management of 85 patients with penetrating injuries involving the external (n = 19), internal (n = 6) and common carotid (n = 46), vertebral (n = 10) and brachiocephalic (n = 4) arteries over a 5-year period in one hospital is reviewed. Sixty-three patients had no peroperative neurological deficit; 22 presented with localizing neurological signs. Where there was no deficit, the external carotid (n = 19) and vertebral (n = 10) arteries were ligated without adverse sequelae. Arterial reconstruction was performed of the internal carotid (n = 2) which resulted in a temporary neurological deficit in 7 patients and death in 3. Among the 22 patients with a preoperative neurological deficit, arterial reconstruction was performed in 18, which involved the common carotid in 17 patients and the internal, carotid in 1 patient. There was complete neurological recovery in 11 patients and 2 patients died. Four comatose patients had cerebral revascularization performed without fatality and with complete recovery in 3 of them. CT head scanning was not routinely employed for logistic reasons but has proved of limited value. No intraluminal arterial shunts were used in this series. It would seem that arterial reconstruction is not harmful and may well be beneficial to the young patient with extracranial cerebral arterial injury associated with a neurological deficit. Shunts are probably unnecessary for routine use.

Adolescent↗
PubMed1981

Cervicomediastinal arterial injuries. A surgical challenge.

The initial clinical observations and methods and results of treatment in 104 patients with subclavian (48), vertebral (four), and carotid (52) artery injuries are reported. Delayed hemorrhage ten days after misdiagnosed subclavian artery injuries resulted in false aneurysms causing compressive brachial plexus palsies. A conservative approach to penetrating cervicomediastinal wounds was adopted with selective use of arch aortography when arterial injury was suspected by defined criteria. This proved safe, accurate, and invaluable for planning operative approach. Partial median sternotomy without entering the pleura proved optimal for superior mediastinal access; simple clavicle transection provided adequate distal subclavian exposure. External carotid and vertebral arteries were ligated. No shunts were employed for common and internal carotid repair. None of the 14 patients revascularized in the presence of a neurologic deficit died and none was made worse by carotid reconstruction.

Adolescent↗
PubMed1980

Nutritional support in high-output fistulas of the alimentary tract.

A total of 63 patients with high-output alimentary tract fistules was treated during a 3-year period, using three different regimens of nutritional support. The fistula closed spontaneously in 46 patients (73%), and 7 patients (11%) were cured by direct surgical closure. Nine patients died, a mortality rate of 14.3%. The combination of nutritional support, skin protection, and timed surgical intervention can reduce the mortality rate to below 10%.

Adolescent↗
PubMed1979

Late revascularization of the lower limb following acute arterial occlusion.

Thirty-four patients presenting with signs of grave ischaemia of the lower limb following acute arterial occlusion had revascularization procedures performed. Fifteen of the incidents followed embolism or thrombosis and 19 were due to a traumatic cause. Limb salvage was achieved in 67 per cent of the nontraumatic group and in 56 per cent of the traumatic group. Severe complications such as crush syndrome and disseminated intravascular coagulation occurred but there were no deaths. No significant adverse factors with regard to limb prognosis could be defined. We feel that late revascularization in the absence of major gangrene is worth while provided that facilities for critical postoperative care exist.

Adolescent↗
PubMed1978

Diminished cellular immunity due to impaired nutrition in oesophageal carcinoma.

The nutritional status of 15 Negro patients suffering from unresectable carcinoma of the midthoracic oesophagus was evaluated before and after palliative pulsion intubation. All were shown to be in negative nitrogen balance and to have a compromised non-specific cellular immune response. Correction of protein-calorie malnutrition and the achievement of positive nitrogen balance were associated with an increase in absolute lymphocyte and T lymphocyte numbers and a significant increase in lymphocyte response to PHA. The improvement in immunological reactivity occurred without any attempt at therapeutic reduction in tumour bulk.

Adult↗
PubMed1978

Major arterial trauma: review of experience with 267 injuries.

Experience with 267 arterial injuries treated over a 3--4-year period is reported. Vessels in the lower limb were involved most commonly (43 per cent), but there was also a relatively high incidence of carotid (13 per cent) and subclavian (9 per cent) injuries in this series. Penetrating wounds (stab and gunshot) were most commonly responsible. We found that serious distal ischaemia is uncommon in upper limb injuries, but expanding haematoma at the root of the limb is a cause of mortality and serious morbidity. Selective use of preoperative angiography is recommended. Successful results follow liberal use of interposition grafts after wide excision of doubtful vessel, rigorous wound excision, delayed primary closure and fixation of associated fractures. Repair of concomitant venous injuries should always be attempted but is more important in the lower than the upper limb. Late revascularization in the presence of critical ischaemia yields a 50 per cent limb salvage rate, but great care must be taken to avoid renal insufficiency and, if it occurs, energetic treatment is necessary for survival.

Adult↗