Biomedical subjects
Publications and source records attributed to T E Williams.
In some patients with patent ductus arteriosus, it is especially difficult to obtain an adequate length of the ductus for its safe division. In these patients, additional length can be obtained by pharmacological reduction of the blood pressure with sodium nitroprusside. The management of 2 such patients is reported.
The nutritional status of 57 patients with hemophilia was studied at the South Texas Comprehensive Hemophilia Center, San Antonio. Dietary and anthropometric analyses were assessed as part of the nutrition evaluation. Calcium and vitamin A were two nutrients whose consumption was most often reported to be below one-half of the RDA. No statistically significant difference in caloric or nutrient intake was found between below-poverty income level groups. Participation in supplemental food programs produced some improvement in dietary intake. Some patients with hemophilia were overweight and some were underweight for their heights. When the weights of patients with hemophilia were compared to standards for age-adjusted ideal, desirable body weight, more than one-half of the subjects 25 years old or older exceeded the weight range for large frame men. Weight control should be emphasized for the patients who lead a sedentary life because of the physical limitations imposed by the complications of hemophilia.
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A method for exposure of the heart, ascending aorta, aortic arch vessels, and descending thoracic aorta in a single surgical field is presented. Five illustrative cases are reviewed. Indications for use include trauma to the aorta and arch vessels, aneurysms or dissections, ductus aneurysms, or complex or secondary coarctations of the aorta.
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The usefulness of the electrocardiographic sign of "low voltage" in the diagnosis of pericardial effusion was investigated in 122 patients comprising three study groups. Sixty-four patients (group 1) had a pericardial effusion detected and measured by echocardiographic studies. The volume of the effusion showed no correlation with electrocardiographic voltage. A second group of 36 patients was identified as having low voltage on routine electrocardiograms. Only 13 (36 percent) had echocardiographically demonstrable pericardial effusion. Group 3 consisted of 22 patients who required pericardiocentesis. The ECGs obtained immediately after pericardiocentesis showed an increase in average voltage of 0.48 mm in the limb leads and 0.83 mm in the precordial leads for each 100 ml of fluid removed. This study demonstrates that a single ECG with "low voltage" is not useful in the diagnosis of pericardial effusion but that a reduction in the voltage of serial ECGs may suggest the development of pericardial effusion.
Neuroblastoma is the most commonly encountered soft tissue malignant tumor of childhood. Over the past 30 years we have treated 180 patients with neuroblastoma. Sixty-five percent had primary abdominal tumors and 20 percent (41 patients) had primary chest tumors. For the 22 patients under the age of 2 years, the 2 year survival rate was 87 percent. There were 19 patients who were 2 years of age or older, and of these only seven patients have survived 2 years after the diagnosis was made. The vast majority of these patients were treated with surgery (debulking type procedure) and postoperative radiation and chemotherapy. Patients with the most differentiated tumors had a remarkably good survival rate, with no deaths. However, the tumors with lesser differentiation did not stratify enough focus to draw conclusions as to survival. Staging correlated the least with survival when compared to age or grading. The 2 year survival rates for patients with Stage I, II, III, IV, and IV-S disease were 75, 82, 100, 17, and 80 percent, respectively. In conclusion, 41 cases of documented primary thoracic neuroblastoma are reviewed, with follow-up from 2 to 27 years (average 9.3 years). We have concluded from this experience that age is the main determining factor influencing survival. Heroic and/or radical surgery is contraindicated in this disease.
Forty-eight pulmonary resections were performed in 45 children. The principal indications for operation were bronchiectasis, congenital cysts, and lobar emphysema. Nine complications occurred in five children. There were three deaths, a mortality of 6.7%. While resection can be performed safely in most children, a high-risk group is identified as those with severe congenital cardiopulmonary disease complicated by chronic or recurrent infection.
A simplified method for managing chylothorax in neonates and infants is presented. Use of an elemental diet markedly reduces the volume of the chyle leak while supporting total caloric intake. Either prolonged drainage or reexploration often can be avoided by the use of the described regimen.
Although it had been recommended that children with malignant diseases be immunized against influenza, few data were available to indicate the immune response or reactions that might be expected from this group. Forty-six children with malignant diseases received various dosages of killed split or whole bivalent (A/New Jersey/76-A/Victoria/75) influenza vaccine or a placebo by the intramuscular route. Two doses were administered four weeks apart. The children were receiving various regiments of cancer chemotherapy. The response to A/New Jersey/76 antigen in the children with malignant diseases was similar to that found in normal children who were immunized with bivalent or monovalent (A/New Jersey/76) vaccine in the National Influenza Immunization Trials. Fourteen of 26 children had antibodies to A/Victoria/75 before immunization; nine of the 12 children without these antibodies developed them after the first dose of vaccine. Adverse reactions after vaccination were minimal.
Twenty-seven patients underwent surgical repair for nonpenetrating injuries of the thoracic aorta. Emergency operation was performed in 19 patients with acute aortic injury and there were 12 survivors. Left heart bypass (LHB), external shunts, and simple aortic cross-clamping were methods employed during repair. All operative deaths occurred in the left heart bypass group. Morbidity, hospital stay, operative time, and blood loss all were markedly less in patients repaired with an external shunt or simple cross-clamping. Systemic heparinization related adversely to mortality and morbidity. Eight patients had repair of chronic post-traumatic descending aortic aneurysms. One of these had previous repair elsewhere with paraplegia and subsequent mycotic aneurysm at the graft repair site. He presented to us with massive hemoptysis. Surgical correction in the chronic group was performed using either left heart bypass, external shunt, or simple aortic cross-clamp with graft interposition. The only death occurred in a patient repaired on left heart bypass.
An independent study program (ISP) was instituted in 1970 for a group of 32 preclerkship medical students picked randomly from a group of 64 volunteers. The academic achievements of these classes, as measured by mean National Board scores, is compared with their classmates in the lecture discussion (LD) program where possible. The significant differences noted obtain even when the ISP students are compared only with LD students matched for premedical point-hour ratios and Medical College Admissions Test scores. These data attest to the overall success of the ISP program. The differences appear to us to be due mainly to factors related to motivation and maturity. The ease of preparations, convenience, and economy of the associated computer-assisted instruction make these methods attractive for use in residency training and continuing medical education where maturity and motivation may well be presumed.
A 6-year-old girl with lymphosarcoma developed Cushing's syndrome. Suppression-stimulation studies verified adrenal hyperfunction secondary to bilateral adrenocortical hyperplasia, and the course suggested the possibility of "ectopic ACTH" production by the neoplasm as the etiology.
A patient with basal-cell epithelioma occurring in a smallpox vaccination site is reported. The association is probably not a chance occurrence.
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