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Biomedical subjects

R E Ward

Publications and source records attributed to R E Ward.

116 records · Page 7Linked to original sources
PubMedDate not supplied

Steal phenomenon at unclamping during carotid endarterectomy.

A patient is reported who during vigorous back bleeding after unclamping of the internal carotid artery during endarterectomy had EEG slowing and a postoperative increase in neurological deficit. This phenomenon, an apparent steal, has not been reported and suggests that EEG monitoring is as vital at unclamping as it is after clamping. The patient also raises questions about the risk of early endarterectomy for those who have persistent deficits, even with unobstructed vessels.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Measurement precision and reliability in craniofacial anthropometry: implications and suggestions for clinical applications.

Craniofacial anthropometry has become an important tool used by both clinical geneticists and reconstructive surgeons. Yet little attention has been paid to the potentially serious problem of measurement error. This paper examines intra-observer measurement error and precision (also called repeatability or reliability) for 52 commonly used anthropometric variables of the head and face. Two factors proved critical to reliability: magnitude of the measurement in question and the degree to which its constituant landmarks could be readily identified. Thus, all of the measurement variables with means above 10 cm proved to have good or excellent reliability. In contrast measurement variables with means below 10 cm were more likely to have poor reliability. This trend was especially evident in variables with means of 6 cm or less where 18 of the 20 variables in this range had poor reliability. The least reliable variables were those like philtrum breadth, columella breadth, and nasal root breadth that combine small magnitude with difficult to define landmarks. While these results suggest that it may be prudent to avoid using craniofacial variables with small dimensions this may be neither practical nor desirable. In such cases repeat measurements may be the best means for optimizing reliability.

Adult↗
PubMedDate not supplied

Improved results with surgical treatment of renovascular hypertension: an individualized approach.

During a one-year period, 20 patients were treated for renal artery occlusive lesions causing renovascular hypertension. Diagnosis depended on angiography, isotopic renography, and selective renal vein renin determinations in certain patients. Treatment included saphenous aortorenal bypass, 9 patients; endarterectomy, 3 patients; percutaneous angioplasty, 5 patients; and nephrectomy in 3 patients. There was no operative mortality. Eighty-five percent of the patients were improved or cured of hypertension, and the average number of antihypertensive medications required decreased from 3.1 to 1.6. The mean serum creatinine of all patients decreased from 3.6 mg/dl to 2.2 mg/dl. In one subset of patients expanding suprarenal aneurysms caused renal artery stenosis or occlusion. Aortic replacement with renal artery endarterectomy or bypass is the only treatment option for these patients. High risk patients with normal renal function and a glomerular filtration rate less than 15% in the affected kidney can be treated with nephrectomy. Our results demonstrate that an individualized approach to therapy and attention to operative detail is mandatory for successful treatment of renovascular hypertension.

Adult↗
PubMedDate not supplied

Spontaneous internal carotid artery dissection associated with fibromuscular dysplasia.

Spontaneous dissection of the internal carotid artery is a rare condition. It is not usually associated with underlying arterial disease. A case of spontaneous dissection associated with fibromuscular dysplasia of the internal carotid artery is described. After complete resolution of the dissection the patient was left with a classic picture of fibromuscular dysplasia on cerebral angiography. This was treated with a graduated dilatation of the right internal carotid artery with resolution of symptoms.

Adult↗
PubMedDate not supplied

Inadequate follow-up of abnormal mammograms.

Routine mammographic screening increases detection of nonpalpable breast cancer. Timely follow-up of abnormalities is essential because delays may lead to postponement of treatment and decreased survival for women who have cancer. The purpose of this study was to determine the percentage of women with an abnormal mammogram who do not have adequate follow-up and to determine factors associated with inadequate follow-up. The study was conducted in a metropolitan health system that includes a large urban teaching hospital in Detroit and 26 ambulatory care centers. From the radiology database, all women with an abnormal screening mammogram performed between January 1, 1992, and July 31, 1992 were identified. We defined adequate follow-up as follow-up within three months of due date. Follow-up status was determined using medical records and telephone interviews. The percentage of women with inadequate follow-up was calculated. Relative risks compared percentages of women with inadequate follow-up according to demographic and screening-related variables. We calculated adjusted relative risks using multivariate binomial regression. We identified 1,249 women with abnormal screening mammograms. Inadequate follow-up occurred for 226 (18.1%) of the women. Among women with follow-up recommended in 4-6 months, 36.8% had inadequate follow-up. Among women with immediate follow-up recommended (obtain additional views or outside films for comparison, ultrasound, biopsy, or surgical referral), 7.2% had inadequate follow-up. Inadequate follow-up was associated with lower estimated household income and no history of previous mammogram. Among women with inadequate follow-up who were interviewed, 87% reported that they had been notified of their results. We found that the percentage of women with inadequate follow-up of abnormal mammograms is high, especially among women who require six-month follow-up. Women with low income and no history of a previous mammogram were at greatest risk for inadequate follow-up. These results document a previously unrecognized problem with mammography screening and suggest that the implementation of tracking systems to ensure timely follow-up of abnormal screening mammograms is essential. Medical Subject Headings (MeSH): mammography, follow-up, screening.

Adult↗