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Biomedical subjects

R A Williams

Publications and source records attributed to R A Williams.

At least 145 records · Page 8Linked to original sources
PubMed1988

Cardiac risk index as a predictor of long-term survival after repair of abdominal aortic aneurysm.

Life expectancy after aneurysm surgery was analyzed for male patients over the age of 60 years with known risk factors classified by the Goldman cardiac risk index, which has previously been utilized for prediction of immediate perioperative risks of surgery and anesthesia. The preoperative risk factors, Goldman cardiac risk index, and long-term survival rates were tabulated for each of 96 male patients over the age of 60 years who had elective repair of infrarenal abdominal aortic aneurysm. Follow-up data of up to 14 years (mean 4.2 years) was entered into a SurvPak-PC biostatistical software program for construction of Kaplan-Meier survival curves and actuarial life tables to measure differences in survival between groups and for performance of nonparametric analysis (by log rank test) of the influence of preoperative risk factors. The operative mortality rate was 3.1 percent and the 5 year survival rate for the whole group was 61 percent, with a median survival of 8.7 years. Five year survival rates for patients in three age groups (60 to 70 years, 71 to 80 years, and greater than 80 years), when compared with age-matched populations, were 67 percent versus 88 percent, 50 percent versus 73 percent, and 35 percent versus 39 percent, respectively. Patients in Goldman class 1, 2, and 3 or 4 had 5 year survival rates of 79 percent, 53 percent, and 41 percent, respectively. Factors that adversely affected long-term survival were Goldman classes 3 or 4 (median survival 2.1 +/- 0.4 years, p = 0.001), cerebrovascular disease (median survival 1.9 +/- 0.6 years, p = 0.004), history of cardiac disease (median survival 3.2 +/- 0.6 years, p = 0.012), and creatinine concentration greater than 3 mg/100 ml (median survival 3.1 +/- 1.6 years, p = 0.034), whereas Goldman class 2 or the presence of hypertension, pulmonary disease, diabetes mellitus, peripheral vascular disease, and size of the aneurysm, although associated with a shortened length of survival, as independent variables did not reach statistical significance. A combination of any three of these risk factors, however, shortened the survival time markedly (median 1.9 +/- 0.7 years, p = 0.003). We believe that the Goldman cardiac risk index classification correlates with long-term survival in patients undergoing elective aortic surgery.

Actuarial Analysis↗
PubMed1988

Cadaveric renal transplantation: surgical results and expectations in the cyclosporine era.

During a 36-month period 100 patients received 104 cadaveric renal transplants with cyclosporine-based immunosuppression. Of the patients 26 required 31 additional operations. Of the 19 secondary operations performed 1 month after transplantation 18 were emergency in nature, whereas beyond this period the majority of the procedures were elective. Both deaths in this series were related to the operation. Only 1 graft loss was directly attributed to a secondary operation. The patient undergoing cadaveric renal transplantation is at significant risk (25 per cent) of requiring at least 1 additional operation. However, despite this high probability of reoperation, graft loss and patient death after such procedures should be rare.

Adult↗
PubMed1988

Correlation of serum amylase levels with pancreatic pathology and pancreatitis etiology.

Fifty-one patients, 35 men and 16 women, with acute pancreatitis were studied prospectively with early computed tomography (CT). Etiological factors for acute pancreatitis were alcohol abuse (n = 28), gallstones (n = 14), pancreas cancer (n = 3) and miscellaneous (n = 6). Admission serum amylase levels ranged between 68-5,856 U/L with a mean of 1,090 +/- 1,369 U/L. The mean serum amylase level was significantly different between patients with alcoholic pancreatitis (439 +/- 302 U/L) and gallstone pancreatitis (2,480 +/- 1,575) (p less than 0.001). The initial pancreatic CT findings and corresponding mean serum amylase levels were in CT grade A (pancreas normal) 1,499 +/- 1,569 U/L (n = 11), in CT grade B (pancreatic enlargement with inflammation confined to pancreas) 1,144 +/- 1,542 U/L (n = 18), in CT grade C (inflammatory extension into one peripancreatic space) 722 +/- 962 U/L (n = 13) and in CT grade D (inflammatory extension into two or more peripancreatic spaces) 590 +/- 369 U/L (n = 9). However, on separating the etiology subgroups, there was no increase or decrease in the serum amylase level with increasing pancreatic inflammatory involvement. Pancreatic complications (pseudocyst, abscess, necrosis) requiring surgical intervention developed only in patients with CT grades C and D. We conclude that within the etiologic subgroups there is no correlation between the initial serum amylase level and the extent of pancreatic involvement visualized by CT. These findings provide a pathological basis for the clinical observation that the initial serum amylase level cannot predict the outcome in acute pancreatitis.

Acute Disease↗
PubMed1988

Surgical options in acute diverticulitis: value of sigmoid resection in dealing with the septic focus.

The outcome of 78 patients hospitalized with acute diverticulitis was analysed to determine the indications for emergency operation and to examine the safety of sigmoid resection. Forty patients improved on medical therapy, but four relapsed soon after discharge. Forty-two (55%) patients had emergency operations for non-resolution of clinical sepsis (25), persistent symptoms or mass (14) and fistula (three). Operations performed were: sigmoid resection and primary anastomosis (23) with covering colostomy (six). Hartmann's operation (10), drainage with/without colostomy (seven) and right hemicolectomy (two). Findings at operation were: abscess (19), phlegmon (14), generalized peritonitis (six), colovesical fistula (three) and chronic diverticulitis (three). Complications included wound infections (six), respiratory complications (five) and one death. Six patients having drainage of the sigmoid inflammation alone as the first operation required subsequent resection, with prolonged and often complicated hospitalization. Minimal morbidity and shorter hospitalization were achieved when sigmoid resection was performed at the initial procedure.

Abscess↗
PubMed1988

Acute diverticulitis: safety and value of contrast studies in predicting need for operation.

Results of treatment of 70 patients hospitalized with acute diverticulitis were analysed to determine the value of early contrast enema in management. A water-soluble enema done during the first week of hospitalization in 48 patients showed diverticulosis with spasm (30), a leak or peridiverticulitis (16) and a normal study (two). No complications were caused by the study. Forty patients improved on medical therapy, but four relapsed after discharge. Thirty-four (49%) patients had urgent operation during hospitalization for the acute episode of diverticulitis. Findings on contrast enema correlated with the need for surgery during the acute phase: 13 of 16 with peridiverticulitis or a leak compared with three of 30 with diverticulosis/spasm (P less than 0.001). Operations performed were: sigmoid resection and primary anastomosis (17) with covering colostomy (five). Hartmann's operation (eight), colostomy and/or drainage (seven), right hemicolectomy (two). Findings at surgery were: abscess (15), phlegmon (12), peritonitis (five) and colovesical fistula (two). It is concluded that early contrast enemas of the distal colon done with appropriate precautions are useful in confirming the diagnosis of diverticular disease: only two of 48 studies were falsely negative. A pericolic extravasation (as opposed to a small sinus tract) or abscess usually indicates need for operation, whereas the finding of diverticulosis/spasm suggests a favourable outcome of conservative management.

Acute Disease↗
PubMed1988

In situ saphenous vein bypass: prevention and management of early complications.

Since adopting the in situ, non-reversed saphenous vein technique for bypass procedures in the leg early in 1986, 50 bypasses have been performed in selected patients, primarily for limb salvage. A Mills valvulotome was used for retrograde disruption of the saphenous valves, after exposure of the whole length of vein. Significant peri-operative complications occurred in nine patients and were strongly associated with technical factors. Early graft occlusion (n = 2) and residual arteriovenous fistulae (n = 2) were revised by timely reoperation, resulting in early (30 day) patency of all but one graft. In seven patients, angioscopic visualization of the valve division process was tested as a method of ensuring complete valvulotomy, while avoiding trauma to the vein wall. Distal anastomosis to the popliteal artery above the knee or close below the knee caused a considerable degree of graft angulation, which was exacerbated by flexion of the leg, whereas anastomosis to the more distal popliteal artery or tibial vessels resulted in a favourable curvature of the graft. Lessons learned during this initial experience and aspects of technique for prevention of complications are presented.

Aged↗
PubMed1988

Properties of Thermus ruber Strains Isolated from Icelandic Hot Springs and DNA:DNA Homology of Thermus ruber and Thermus aquaticus.

Seventeen pink-pigmented strains of the genus Thermus were isolated from samples collected from thermal areas of Iceland. The strains were examined by using phenotypic characterization and DNA:DNA homology and were compared with recognized strains. Visually, the strains could be divided into three groups based on their pigmentation; however, spectroscopic studies of the pigments indicated little difference among them. Most strains required a vitamin supplement for growth and used fructose, maltose, mannose, or sucrose as the sole carbon source. In the presence of nitrate, two strains were able to grow under anaerobic conditions. The optimum growth temperature was 60 degrees C; growth did not occur at 30 or 70 degrees C.

Journal Article↗
PubMed1988

Dieulafoy's lesion associated with truncus arteriosus type IV: an unusual cause of upper gastrointestinal hemorrhage.

Dieulafoy's lesion is an abnormal submucosal artery in the stomach characterized by massive and often fatal upper gastrointestinal hemorrhage. Diagnosis is usually made at operation, as endoscopy and arteriography frequently fail to identify the lesion. Embolization may be helpful, but surgery is generally the treatment of choice. We present the first reported case of Dieulafoy's lesion in a 17-yr-old boy with type IV truncus arteriosus. This congenital cardiac anomaly may have predisposed this patient to early manifestation of Dieulafoy's lesion, a rare and frequently unrecognized disorder.

Adolescent↗
PubMed1987

Surgery in patients with acquired immunodeficiency syndrome.

Between 1982 and 1985, 21 patients with acquired immunodeficiency syndrome (20 men and one woman; mean age, 36 years) underwent 31 surgical procedures at the Harbor/UCLA Medical Center, Torrance, or the UCLA Medical Center (skin, lymph node, and endoscopic biopsies were excluded). The operations included seven emergencies and 24 elective operations (eight major and 16 minor). Pathologic findings included cytomegalovirus colon perforation (two), disseminated Kaposi's sarcoma (KS) of the small and large bowel (one), cystic duct obstruction by KS (one), poorly differentiated gastrointestinal lymphoma (one), Candida acalculous cholecystitis (one), central nervous system toxoplasmosis (two), amebic encephalitis with abscess (one), staphylococcal botryomycosis of the pericardium (one), pulmonary KS (one), and cytomegalovirus (one). The overall operative (30 days) mortality rate was 48% (10/21). The emergency surgery rate was 57% (4/7), elective, 43% (6/14). The high operative mortality rate in these patients was usually due to progression of opportunistic infections or malignancy.

Abdomen↗
PubMed1987

Analysis of the morbidity, mortality, and cost of colostomy closure in traumatic compared with nontraumatic colorectal diseases.

One hundred sixteen patients with acute colorectal diseases, operated upon emergently and needing an intestinal stoma, were reviewed to determine the cost and morbidity of treatment of patients with colorectal trauma compared to other surgical illnesses. The first group (57 patients) perforating colonic or rectal trauma, the second (30 patients) perforated colonic disease, the third (24 patients) nonperforated colonic disease, and the fourth (five patients) a colonic injury, unrecognized initially but requiring subsequent treatment with a stoma. For the initial operation, hospital stay, complications, mortality, and costs were less for patients in group 1 (colonic injury) than in groups 2 and 3 (inflammatory or neoplastic diseases). Colostomy closure, whatever the antecedent disease or injury, required an average ten-day hospitalization, had no mortality, a complication rate of 0 to 6 percent, and an average hospital cost of $6,500. The hospital stay and costs for the total treatment were slightly higher for nontraumatic illnesses, although the rate of colostomy closure was significantly less (68 and 77 percent versus 86 percent, P = .05).

Adult↗
PubMed1987

Quantitative assessment of atherosclerotic lesions in mice.

The well-defined genetic systems of the mouse are proving useful in experimental studies of atherosclerosis. Inbred mouse strains differ in atherosclerosis susceptibility, and several variants of apolipoproteins have been identified and mapped. This report explores the location and timing of lesion formation in the mouse in an effort to provide a basis for quantitatively comparing groups of mice. After 14 weeks on an atherogenic diet containing 1.25% cholesterol, 15% fat, and 0.5% cholic acid, C57BL/6J female mice had aortic lesions at each of the intercostal arteries, at the junction of the aorta to the heart, and in scattered areas covering 1.1% +/- 0.5 (SD) of the aortic surface. After 9 months on the atherogenic diet, those lesions near the heart and intercostal arteries were extensive, 8% +/- 3 (SD) of the remainder of the aorta was involved in lesions, and lesions were found in the coronary arteries. Results indicated that one suitable location for scoring lesions was in a 300 micron area of the aorta just beyond the aortic sinus. The mean number of lesions/mouse in the selected area after 14 weeks on the atherogenic diet was 1.1 +/- 0.3 (SD). The results were reproducible over 10 separate experiments. The number of lesions per mouse fit a Poisson distribution indicating that the presence of one lesion did not predispose the mouse to acquiring a second lesion. Lesion formation and cholesterol levels did not vary with the season of the year as demonstrated by 9 separate experiments over more than 12 months. Methods of evaluating the number and size of lesions were compared including sizing with a microscope eyepiece grid and computer-assisted planimetry. The resulting data provide reproducible methods of quantitatively comparing lesion formation in various strains or groups of mice, thereby increasing the usefulness of the mouse as an experimental system for atherosclerosis research.

Animals↗
PubMed1987

Lower incisor space analysis: a contrast of methods.

Two current methods to assess spacing-crowding among lower anterior teeth are described and contrasted. These are the anterior space analysis of Merrifield and the irregularity index of Little. There is only a modest correlation between these methods (rs = +0.53) because they provide complementary information; space analysis is more attuned to tooth displacements while the irregularity index is susceptible to axiversions. Cases illustrating major divergences between the two methods are illustrated.

Adolescent↗
PubMed1987

Cerebral cysticercosis in a 22-month-old infant.

A case of cerebral cysticercosis is described in a 22-month-old infant from northern California who presented with a right-sided focal seizure. Unusual features were her young age; a single, enlarging, frontoparietal mass lesion; and apparent lack of history of exposure to an endemic area.

Blood Cell Count↗
PubMed1987

Multifocal invasive carcinoma of the vulva in a 25-year-old woman with Bowenoid papulosis.

This case report documents malignant progression associated with wart virus infection of the vulva in a 25-year-old female. The initial condition of Bowenoid papulosis and carcinoma in situ of the vulva was diagnosed on colposcopic biopsies performed to investigate chronic pruritus and superficial dyspareunia. This condition failed to resolve with local ablative therapy and progressed over a period of 8 months to multifocal invasive carcinoma of the vulva requiring radical surgery. Deoxyribonucleic acid hybridization studies on the operative specimen revealed the presence of human papilloma virus type 16. The role of human papilloma virus in the aetiology of Bowenoid papulosis and neoplasia of the vulva is discussed.

Adult↗
PubMed1987

Patient selection and complications of transhepatic cholangiography.

The most common diagnoses of transhepatic cholangiography (THC) among 58 surgical patients were pancreatic adenocarcinoma, choledocholithiasis and cholangiocarcinoma. THC was complicated in 17 of 58 patients or 18 of 68 attempts due to bacteremia or fever in four, subcapsular hematoma in two and Ring catheter shearing and apical pneumothorax in one each. THC related deaths occurred in four patients. In uncomplicated THC, the mean hematocrit value decreased from 35.9 +/- 5.8 (n = 39) to 34.1 +/- 4.8 (n = 39) (p less than 0.02). Of THC attempts, 8.8 per cent failed; before THC, ultrasonography (UTZ) in most of these showed no dilation of the bile ducts. THC showing dilated ducts had a significantly higher (p less than 0.01) bilirubin and alkaline phosphatase levels (14.8 +/- 8.7 milligrams per cent, n = 46 and 414 +/- 283.9 units, n = 46) compared with the THC showing no dilation (5.29 +/- 5.45 milligrams per cent, n = 13 and 235 +/- 294.1 units, n = 13). Of the 30 patients given ampicillin and gentamicin before THC, only three had bacteremia develop; two of six who were untreated and nine of 47 of those pretreated with other antibiotics had bacteremia develop. Of seven instances of stones of the common bile duct found at operation, computed tomography diagnosed zero of seven; UTZ, two of seven, and THC, seven of seven. No THC gave a misleading diagnosis. Eighteen palliative transhepatic drains were attempted with the THC (15 successfully). A significant (p less than 0.01) 50 per cent decrease in the bilirubin and alkaline phosphatase levels were obtained by catheter drainage but neither test returned to normal. THC is not a benign procedure and should be done only if bilirubin or alkaline phosphatase, or both, are elevated above 5 milligrams per cent and 200 units, respectively, and UTZ shows dilated biliary ducts. Pretreatment with antibiotics and operating room availability are important to limit THC morbidity.

Adolescent↗
PubMed1987

A comparison of cefotaxime versus cefamandole in prophylaxis for surgical treatment of the biliary tract.

Fiscal considerations prompted comparison of cefotaxime (a third generation cephalosporin) with cefamandole (a second generation cephalosporin) for prophylaxis in the surgical treatment of the biliary tract. One hundred and eight patients who underwent an operation upon the biliary tract received three 1 gram doses of cefotaxime (54 patients) or cefamandole (54 patients) at induction of anesthesia and then one and three hours later. The study was prospective, blinded and randomized. The groups (cefotaxime versus cefamandole) were statistically comparable for age, sex, diagnosis, type and duration of operation and positive cultures. The most prevalent bacteria isolated from qualitative aerobic and anaerobic cultures of bile and the wall of the gallbladder were Escherichia coli, Streptococcus and Klebsiella. The incidence of bactibilia in patients with one of these conditions was: 75 per cent for cancer; 69 per cent for patients more than 60 years old; 33 per cent for jaundice; 58 per cent for pancreatitis; 60 per cent for exploration of the common bile duct, and 22 per cent for acute cholecystitis. Microbiologic agar diffusion assays of tissue from the wall of the gallbladder, subcutaneous fat and rectus muscle and samples of bile and serum obtained 30 minutes after the second dose of antibiotic showed a statistically significant greater concentration of cefamandole in the wall of the gallbladder. Otherwise there was no difference between the concentration of cefamandole and cefotaxime. The groups showed no statistical difference for temperature of more than or equal to 38 degrees C. on two consecutive measurements, postoperative wound and urinary infections, postoperative hospital stay and days in the intensive care unit and incidence of readmission within a month. Prophylactic use of cefotaxime in a three dose regimen provided no advantage in prophylaxis compared with cefamandole.

Adult↗