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Biomedical subjects

L W Baker

Publications and source records attributed to L W Baker.

At least 55 records · Page 3Linked to original sources
PubMed1978

Colorectal carcinoma in young black patients: a report of eight cases.

Colorectal carcinoma in the black population of South Africa is very uncommon when compared with incidence among whites. Even in whites the proportion of patients with colorectal carcinoma under 25 years of age is less than 1% (Hardin, 1972). Eight cases of colorectal carcinoma in black patients under 25 years of age are presented. None had any evidence of premalignant lesions of the colon. The prognosis of colorectal carcinoma in young adults is poor in most series and this group of patients was no exception. Reasons for this poor prognosis are mentioned. A more aggressive approach to the early detection and treatment of the lesion in young patients is essential.

Adenocarcinoma, Mucinous↗
PubMed1978

Delayed presentation of traumatic diaphragmatic hernia.

Twenty-five patients with traumatic diaphragmatic hernia discovered at least five months after injury are described, of whom 18 were male and seven female. All but one hernia occurred on the left side. Stab wounds were the etiological factor in 22 patients and blunt trauma in three. The diagnosis was most often made by a chest or abdominal radiograph, but barium ingestion confirmed the diagnosis in ten patients. Intercostal drainage of gastric contents provided the diagnosis in two patients. In all nine patients initially approached by a thoracotomy or a thoracoabdominal incision, the hernia was easily reduced and the defect repaired. Although reduction and repair were easily accomplished by the abdominal route in seven patients, this approach was unsatisfactory or inadequate in six others. The colon and stomach were usually in the chest, and strangulation occurred in five patients. The mortality was 20% but rose to 80% when gangrene was present.

Adult↗
PubMed1978

Arterial trauma involving the lower limb.

Experience with 105 lower limb arterial injuries in 103 patients in a general hospital is described. The pathology is discussed: it is noted that spasm per se could not be incriminated as a cause of ischemia. Management of the injuries and associated fractures is outlined. A plea is made for use of external fixation in compound injuries. An aggressive approach to the degloved limb, open three-compartment fasiotomy for severe vascular injury with signs of ischemia, and delayed primary closure for wounds with septic complications are recommended. Associated soft-tissue injury requires arterial reconstruction even in the presence of muscle rigor and anesthesia.

Adolescent↗
PubMed1977

Gastric volvulus unassociated with hiatal hernia.

Although para-oesophageal hiatal hernia is the commonest cause of gastric volvulus, other causes of gastric volvulus require emphasis and 16 cases of gastric volvulus unassociated with hiatal hernia are reported. Delayed presentation following diaphragmatic injury was common. It is recommended that a thoracolaparotomy be performed in these patients to facilitate reduction of the volvulus, and division of intrathoracic adhesions under direct vision. In the secondary type of gastric volvulus accurate diagnosis is mandatory. Failure to recognize and treat associated disease will result in recurrence of the volvulus. A rational approach to the management of gastric volvulus is proposed.

Acute Disease↗
PubMed1977

Appendiceal injuries: a report of 3 cases.

Three patients with traumatic injuries of the appendix are reported. Penetrating injuries produce clinical signs early and allow prompt diagnosis and treatment, as opposed to blunt injuries. The clinical details of the 3 patients are presented to illustrate this.

Adult↗
PubMed1977

The treatment of established iliofemoral deep vein thrombosis with streptokinase.

Sixteen patients (mainly Blacks) with iliofemoral deep vein thrombosis were treated with streptokinase and the results assessed by venography. Clear improvement in the venographic appearance was limited to 3 patients, but clinical improvement in the affected leg occurred in all patients. The thrombolytic effect of streptokinase cannot be assessed on clinical criteria alone. The purpose of this report is to draw attention to the poor clearing of main venous channels by streptokinase therapy.

Adult↗
PubMed1977

Tumour metastasis to the thyroid gland.

Ten cases of tumour metastasis to the thyroid gland are reviewed. Thyroid involvement implies disseminated malignant disease, but metastatic tumours may simulate a primary thyroid tumour. It is suggested that thyroid involvement by metastasis is more common than previously assumed. Needle biopsy of the thyroid gland permits accurate histopathological diagnosis.

Adult↗
PubMed1977

Tests for completeness of vagotomy.

A battery of tests was applied to 60 patients at periods varying from 2 to 24 months after they had undergone truncal vagotomy (42 with pyloroplasty, 18 with gastro-enterostomy). The major comparison was between those with endoscopic evidence of recurrent duodenal ulcers, and those in whom endoscopy showed no abnormality. Tests which differentiated between the two groups to a statistically significant extent were those for increased acid concentration in the first hour after insulin and serum gastrin, which was lower in this group. Useful, but statistically not significant tests, in patients with no endoscopic evidence of recurrent ulcers, were a postoperative decrease in basal acid output and maximal acid output after pentagastrin or insulin. Symptoms, the combined pentagastrin-insulin test, the volume of acid secreted after insulin, and the acid concentration in the second hour after insulin stimulation were poor indicators for differentiating between patients with recurrent ulcers and those without ulcers. Almost as much information was obtained by the postoperative basal acid output alone as by the pentagastrin and insulin stimulatory tests.

Duodenal Ulcer↗
PubMed1977

Subclavian and axillary artery injuries.

Experience with 36 Black patients with disruption of the subclavian or axillary arteries is reported. The clinical presentation and operative approaches are described. The average time interval between injury and diagnosis of arterial injury was 10 days. Two case reports which illustrate the adverse consequences of delayed treatment are presented. Careful clinical assessment of penetrating injuries in the neck and shoulder region is necessary to exclude major arterial injury. Arch aortography is indicated if arterial injury is suspected.

Adolescent↗
PubMed1976

Villous tumour of the duodenum.

The occurrence of a villous tumour of the duodenum in an 18-year-old female patient is reported. This is the youngest patient who has been recorded as having this type of tumour. Fibre-optic endoscopy with biopsy of the tumour permitted a pre-operative diagnosis to be made.

Adolescent↗
PubMed1976

Tuberculous renal artery aneurysm: a case report.

Tuberculous renal artery aneurysm in a 36-year-old Black man is reported. This is thought to be the first case reported in the English language medical literature. The literature is reviewed with regard to presentation and management of renal artery aneurysm in general, with specific reference to tuberculous arterial infection.

Adult↗
PubMed1976

Acid secretion in Zulu and Indian patients with duodenal ulcers.

Pentagastrin-stimulated maximal acid output (MAO) was measured in 337 male patients with duodenal ulcers, 209 of whom were Indian, and 128 of whom were Zulus. The mean MAO standard deviation (SD) value for Zulu patients with uncomplicated ulcers was 36,2 +/- 10,5 mEq/h. In the patients with complicated ulcers, the maximal acid output was 38,5 +/- 6,3 mEq/h in patients with pyloric stenosis, 31,5 +/- 13,7 mEq/h in patients with haemorrhage and 42,9 +/- 9,2 mEq/h in patients with perforation. A statistically significant difference was obtained only in the group with perforation (Pless than0.05). The mean MAO +/- SD value for Indian patients with uncomplicated ulcers was 29,2 +/- 17,0 mEq/h. In those with complicated ulcers, the MAO value in pyloric stenosis was 30,5 +/- 5,5 mEq/h in those with haemorrhage 22,0 +/- 13,7 mEq/h and for patients with perforation, 27,8 +/- 7,5 mEq/h. A statistically significant difference in values was not obtained in Indian patients. In the Zulu patients, 77,6% had MAO values above the upper limit of normal (mean + 2 SD), while in Indian patients only 17.6% had MAO values above the upper limit of normal. The difference between the 2 percentages is highly significant (Pless than0,0001). The proportion of male patients with stimulated acid secretion measurements above the upper limit of normal in other reported series is 30-50%.

Adult↗
PubMed1975

Typhoid perforation of the ileum: A therapeutic dilemma.

Thirty-eight cases of typhoid perforation of the terminal ileum were encountered during a three-year period. Fourteen cases were treated conservatively, with a mortality of 36%. During the same period, the surgical mortality improved from 50% in 1972 to 11% in 1974. It is recommended that typhoid perforation be treated by operation.

Adolescent↗