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Biomedical subjects

R A Williams

Publications and source records attributed to R A Williams.

At least 109 records · Page 6Linked to original sources
PubMed1992

Subcapsular hematoma as a predictor of delayed splenic rupture.

Over the past 46 months at a level I trauma center, 966 computed tomography (CT) scans were performed for blunt abdominal trauma. Eighty-three (8.6%) demonstrated splenic injury, and 31 (3.2%) of these showed a subcapsular hematoma with or without associated parenchymal damage. Of the 31 patients, 23 were managed conservatively, based initially upon surgeons' preference (14 patients) and after March 1990 to conform to the authors' splenic trauma protocol (nine patients). The eight patients operated upon were hemodynamically stable and all underwent splenectomy. Subcapsular hematoma, as diagnosed by preoperative CT scan, was confirmed in each of the eight celiotomies. Parenchymal involvement, which had also been identified in these eight patients by CT, was evident at operation in all, and hilar involvement occurred in three. None of the 23 observed patients developed delayed splenic rupture. All were discharged home with outpatient follow-up in surgical clinic to at least 1 month without further complication. The authors came to the following conclusions: 1) Subcapsular hematoma is neither a predictor for delayed splenic rupture, nor by itself an indication for operative management of the injured spleen in the hemodynamically stable patient; 2) Degree of parenchymal injury based on CT morphology, specifically hilar involvement, signifies the need for laparotomy with splenectomy; 3) Splenorrhaphy has a reduced role in splenic trauma because most injuries now operated upon are severe.

Blood Transfusion↗
PubMed1991

Nuclear DNA profiles in primary melanomas and their metastases.

DNA-aneuploid primary melanomas are said to show a greater propensity to metastasize than those without an aneuploid profile. A higher aneuploid rate has also been reported in metastatic melanomas than in primary lesions. The ploidy profile was determined of 26 primary melanomas and their first subsequent secondaries on Feulgen-stained sections from routinely processed material using a computerized video image-analysis system. In 18 of 26 cases, both primary and secondary tumor showed similar corresponding DNA patterns. These were aneuploid in 13 of 18 of the cases. A hyperdiploid pattern was present in one case in both the primary and its metastasis, and a diploid pattern was seen in four cases. There were only eight cases in which a disparity between the nuclear ploidy profile in the primary and secondary tumor was evident. Although the results suggest that ploidy studies are not useful for predicting the metastatic potential of a primary melanoma, the maintenance of similar DNA profiles in the metastases in most of these cases was interesting in regard to tumor biology.

Aneuploidy↗
PubMed1991

Chylous ascites following abdominal aortic surgery.

Three patients, two women, one man (mean age 74 years), who had abdominal aortic aneurysms (2) or aortobifemoral surgery (1), developed chylous ascites postoperatively. They were studied to determine their clinical course and develop a plan for management of this complication. In each patient, the ascites was not manifest until abdominal swelling developed two weeks after operation, and the problem was confirmed by the finding of milky fluid on paracentesis. A low serum albumin (mean 2.6 gm) was also characteristic. The ascites was not altered by parenteral nutrition or reduction of dietary fat and ingestion of medium chain triglycerides. In one patient (man, age 93) the ascites resolved spontaneously two months after abdominal aortic aneurysm surgery. Another (woman, age 70) was cured following operative ligation of a lymphatic fistula identified at operation five weeks after abdominal aortic aneurysm repair. In the third (woman, age 60), the ascites resolved immediately following placement of a peritoneal venous shunt six weeks after an aortobifemoral bypass. Chylous ascites is rare after aortic surgery and manifests itself about two weeks after operation, at times after discharge from hospital. It has an indolent course, but may resolve spontaneously up to two months after operation. Its course appears not to be foreshortened by diet, including omission of fat, but can be successfully treated surgically with a shunt or fistula ligation. If done early a protracted hospital course may be avoided.

Aged↗
PubMed1991

Injuries in infants and small children resulting from witnessed and corroborated free falls.

The height of a free fall necessary to cause injury to infants and small children is a confusing and controversial issue among health care, law enforcement, and legal professionals responsible for evaluating cases of possible child abuse. To resolve this confusion, the circumstances of falls were recorded prospectively for 398 consecutive victims of falls seen at Children's Hospital, Oakland, California. From these cases, 106 were selected for further analysis where the falls were witnessed by a second person other than the caretaker and the circumstances of the fall were documented. No injuries occurred in 15 patients, including seven falling more than 10 feet. Mild bruises, abrasions, or simple fractures occurred in 77 patients, including 43 falling more than 10 feet. Severe injuries, including intracranial hemorrhages, cerebral edema, depressed skull fractures, and compound or comminuted fractures occurred in 14 patients falling between 5 and 40 feet. However, no life-threatening injuries occurred in the 3 patients who fell less than 10 feet. These three had small, depressed skull fractures without loss of consciousness, from falling against an edged surface. Only one death occurred in this series, resulting from a fall of 70 feet. In conclusion, infants and small children are relatively resistant to injuries from free falls, and falls of less than 10 feet are unlikely to produce serious or life-threatening injury.

Accidental Falls↗
PubMed1991

Comparative ploidy studies using cytological and paraffin section preparations.

The ploidy profiles of benign and malignant tumours can be obtained using image analysis. However, the results of ploidy studies have varied according to the type of specimen used. We compared the ploidy profiles of paraffin embedded thin sections, cytospin preparations of disaggregated cells, and cytological smears from the same specimen as defined by image analysis. Ten benign breast lesions, 10 breast carcinomas and 10 malignant melanomas were investigated in this way. Preparations stained by the Feulgen technique were examined using the MD20 video image analysis densitometry system. Ploidy profiles were obtained by measuring the integrated optical density of at least 200 nuclei. By paying proper attention to the quality of fixation and presence or absence of cytoplasm around cells, comparable results were found for all preparations in each case. We therefore conclude that if careful attention is paid to the technical quality of the material, reliable ploidy results can be obtained by image analysis.

Aneuploidy↗
PubMed1991

Nuclear ploidy in neuroendocrine neoplasms of the larynx.

Seventeen neuroendocrine neoplasms of the larynx were examined for DNA ploidy. Twelve tumours were atypical carcinoids, four paragangliomas and one a small cell neuroendocrine carcinoma. Seven atypical carcinoids were aneuploid, one diploid and one tetraploid, with metastasis being aneuploid. In three cases only skin metastases were available for study, which were aneuploid. The small cell neuroendocrine carcinoma was aneuploid. Two of the paragangliomas were aneuploid and two diploid. Like other sites, neuroendocrine neoplasms of the larynx have a high rate of aneuploidy. Determination of DNA ploidy did not provide useful diagnostic or prognostic information.

Aged↗
PubMed1991

Cardiomyopathy in blacks.

The intent in this chapter has been to bring to general awareness the fact that myocardial dysfunction represents a significant proportion of cardiovascular disease affecting blacks; in particular, dilated cardiomyopathy is a new frontier in cardiology, which demands an aggressive approach. At present, the prognosis is not good in the majority of cases; despite the best medical therapy, most of those with cardiomyopathy are doomed to death within a few years after the onset of congestive heart failure. Many of these are young African-American men in the prime of their lives. Cardiac transplantation offers some hope from this desperate situation, but donor shortages as well as restrictive criteria for prospective recipients and socioeconomic constraints, which may deny many blacks the opportunity to receive a transplant, make this option less than ideal.

Black People↗
PubMed1990

Operating on HIV-positive patients. What are the risks to healthcare workers? To patients?

Is the degree of risk involved in providing health care to people infected with human immunodeficiency virus (HIV) acceptable? Every health care worker, even if only for a few anxious minutes, has certainly worried about this risk. Drs Wilson, Williams, and Robinson discuss these concerns and summarize the indications and prognoses for surgery to treat some common AIDS-related syndromes.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Exertional disruption of axillofemoral graft anastomosis. 'The axillary pullout syndrome'.

Five cases of exertional disruption of the axillary anastomosis occurred at intervals of 13 to 30 days after axillofemoral polytef (polytetrafluoroethylene [PTFE]) graft insertion. Graft evulsion was preceded by effort and heralded by axillary pain, an expanding hematoma, and a pseudoaneurysm formation. Proximal control of the subclavian artery by a supraclavicular approach or balloon allowed safe wound exploration. Successful reconstruction required lengthening of the graft or replacement. Secondary disruption occurred with simple repair. Although temporary postoperative brachial plexus neuropathy was common, no significant hand ischemia was noted. Twenty-two reports of axillary anastomotic disruption were made to the Food and Drug Administration, Washington, DC, during a 2-year period, and one manufacturer of polytef grafts provided data on 10 reports received throughout 7 years. Surface anatomy measurements in 20 control patients demonstrated that arm abduction and lateral flexion of the body increased the distance between the axillary and femoral arteries by a mean of 15.5%. Similar measurements taken from the proximal axillary artery showed a mean length increase of less than 10%. This complication may be avoided by inserting the polytef graft with several centimeters of excess length and positioning the axillary anastomosis medial to the pectoralis minor muscle.

Adult↗
PubMed1990

S100 protein, neurone specific enolase, and nuclear DNA content in Spitz naevus.

The differentiation between Spitz naevus and melanoma is at times difficult. The present study was undertaken to define means to positively identify such melanocytic tumours of doubtful malignancy. Immunohistochemical staining intensity for S100 protein and neurone specific enolase (NSE) was measured in sections of 35 Spitz naevi using a microcomputer image analysis system. The data were compared with results previously obtained from 19 cases of malignant melanoma and 16 benign compound naevi. Disaggregated cells from paraffin-embedded material were stained by the Feulgen technique for DNA estimation. The nuclear DNA content distributions were measured using the same image analysis system. Compared with the malignant cases, the Spitz naevi showed significantly lower staining intensity for both S100 protein (P less than 0.0001) and NSE (P less than 0.0001). When compared with the benign compound naevi, the staining intensity was significantly lower for S100 protein (P = 0.003). The nuclear DNA distribution in Spitz naevi proved to be a normal diploid pattern in 31 cases. Four cases showed a small proportion of hyperdiploid nuclei. The results show that Spitz naevi can be significantly distinguished from malignant melanoma by staining intensity for S100 protein and NSE. A normal diploid DNA content distribution appears to be typical for Spitz naevi. Spitz and benign compound naevi show dissimilar expression of S100 protein which may indicate different patterns of differentiation in these two types of lesion. The image analysis equipment used in this study is accurate, simple to use, produces results rapidly, and is economic. Therefore, it is clinically practicable.

Biomarkers, Tumor↗
PubMed1990

Stress, coping, and adjustment in mothers and young adolescents in single- and two-parent families.

Compared stress, coping, and psychological adjustment in single (divorced or separated) and married mothers and their young adolescent children. Single mothers reported more daily hassles related to economic, family, and personal health problems, and more symptoms of depression, anxiety, and psychoticism. Single mothers also reported using more coping strategies related to accepting responsibility and positive reappraisal. After controlling for level of family income, differences in family hassles and coping strategies remained significant. The two groups did not differ on subtypes of symptoms after controlling for income, but single mothers still reported more total psychological symptoms. No differences were found between children in these two family constellations on maternal reports of emotional/behavioral problems or on children's self-reported emotional/behavioral problems, stressful events, or coping. Implications of these findings for adjustment to life in single-parent families are discussed.

Adaptation, Psychological↗
PubMed1990

Symptoms that precede preterm labor and preterm premature rupture of the membranes.

Great emphasis has been placed on recognition of the early warning symptoms of preterm labor by both pregnant women and health care providers. In addition to the expected increase in both painless and painful uterine contractions, several symptoms have been commonly cited in textbooks and patient educational materials as preceding preterm labor including menstrual-like cramps, backache, pelvic pressure, and an increased amount of vaginal discharge. We interviewed 107 women with preterm labor, 102 women with preterm prematurely ruptured membranes, and 106 ambulatory normal pregnant women to ascertain the frequency of each of eight putative warning symptoms of preterm labor in each group. Preterm labor patients were distinguished as expected from both normal women and amniorrhexis patients by a greater frequency of painful and painless contractions. Menstrual cramps, backache, and increased vaginal discharge, symptoms often said to be normally present in pregnancy, were also significantly more common in preterm labor patients than in women with preterm membrane rupture and in normal subjects.

Adolescent↗