Biomedical subjects
P R Walbaum
Publications and source records attributed to P R Walbaum.
Aetiology of unresolved pneumonia.
Preoperative histological or cytological confirmation of a diagnosis of bronchogenic carcinoma is not always possible, so occasionally non-neoplastic lesions are resected. Of these lesions a significant number are described by pathologists as 'unresolved pneumonia'. We studied the case notes and histopathology of 30 patients from whom lung had been resected and which had been classified as pneumonia. Other non-neoplastic lesions, such as pulmonary infarction, bronchiectasis, and tuberculosis, were excluded. All had a preoperative diagnosis of probable bronchial carcinoma. On review very few appeared to be the consequence of an infective, pneumonic episode. In 11, foreign material was identified, including one typical example of a paraffinoma. Aspiration of foreign material may lead to a localised lesion which simulates carcinoma of the bronchus both clinically and radiographically.
Intrathoracic neural tumours.
The experience of one regional thoracic surgical unit in managing intrathoracic neural tumours over a 25-year period is presented. Neural tumour was diagnosed in 55 patients, of whom 41 were asymptomatic. In 11 patients complete resection was not achieved--the reasons for this and its effect on the outcome of the patient are discussed. There were 52 posterior mediastinal and three lateral chest wall tumours. The pathological distribution was as follows--benign nerve sheath tumours (neurofibroma, neurilemoma) 39, ganglioneuroma 13, and neuroblastoma 3. One neurofibroma recurred as a neurosarcoma six years after its apparently complete resection and was removed by an extensive resection at reoperation. One neuroblastoma recurred within the spinal canal four years after incomplete excision at thoracotomy--this patient died subsequently of widespread metastatic neuroblastoma. No other tumour is known to have recurred.
Development of left ventricular--coronary sinus fistula following replacement of mitral valve prosthesis.
The features and course of a patient in whom a fistula developed between the left ventricle and the coronary sinus following replacement of a faulty mitral valve prosthesis are described. The subsequent deterioration of her condition was associated with a pansystolic murmur and periprosthetic regurgitation. Replacement by a third prosthesis was complicated in addition by tricuspid regurgitation. The fistula was not suspected until the fourth operation, when the right atrium was opened for tricuspid annuloplasty. The fistula was repaired successfully, and the woman has made good progress postoperatively.
Hypertrophic pulmonary osteoarthropathy and its occurrence with pulmonary metastases from renal carcinoma.
The literature of hypertrophic pulmonary osteoarthropathy is reviewed with special reference to its occurrence with pulmonary metastases from extrathoracic tumours. The present theories on aetiology are discussed, and the relationship to finger clubbing and bronchogenic carcinoma is reviewed. A case is reported of hypertrophic osteoarthropathy as the presenting feature of pulmonary metastases from renal carcinoma, and of its relief by pulmonary resection.
The malignancy of bronchial adenoma.
The literature on bronchial adenoma has been reviewed and controversy found to exist about certain aspects of these tumors, particularly their malignancy. A retrospective study of 79 cases managed in Edinburgh since 1946 is presented. Seventy-one were of the carcinoid type, 7 were adenoid cystic carcinomas, and there was a single example of mucoepidermoid carcinoma. All types show a definite malignant potential, greatest in the rare mucoepidermoid tumor and least in the common carcinoid variety. Adenoid cystic carcinoma occupied an intermediate position in frequency and malignancy.
Production of a corticotrophin-like intermediate lobe peptide and of corticotrophin by a bronchial carcinoid tumour.
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Haemodynamic results of replacement of mitral and aortic valves with autologous fascia lata prostheses.
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Cystic intrathoracic derivatives of the foregut and their complications.
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Wound colonisation following cardiac surgery. Reduction by adjuvant use of preincisional, presternal antibiotic infiltration: a double blind prospective randomised study.
In a double blind, prospective, randomised study of 100 patients undergoing elective cardiac surgery, a significant (p less than 0.01) reduction in wound colonisation, defined as positive culture of any wound discharge irrespective of wound appearance, occurred in those receiving preincisional presternal antibiotic infiltration (2%) as compared to a control group who received a similar volume of normal saline by the same route (24%). Both groups received, in addition, the same conventional intravenous regimen of broad spectrum antibiotic. A comparable concurrent group of patients, not entered into the study, demonstrated a wound colonisation rate similar to the trial control group (22%), thus excluding an adverse bias from the control saline infiltration. Analysis of control cases demonstrated a significant (p less than 0.001) discriminant effect in the degree of preoperative haemodilution with haematocrit falling on bypass by a mean of 25% in those who developed wound colonisation as compared to 13% in those who did not.