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Biomedical subjects

W A Dale

Publications and source records attributed to W A Dale.

At least 19 recordsLinked to original sources
PubMed1985

Perigraft seromas complicating arterial grafts.

A collection of clear, sterile fluid, confined within a nonsecretory fibrous pseudomembrane surrounding a vascular graft, is a specific clinicopathologic entity termed perigraft seroma. Our experience with four such cases prompted a clinical study of our own material and that of others. A comprehensive survey, including the entire North American Chapter of the International Society for Cardiovascular Surgery membership, provided 279 cases for detailed analysis. Material most commonly involved were knitted Dacron (54%) and polytetrafluorethylene (34%), with knitted Dacron in the axillofemoral position accounting for 31% of the cases. The fluid was documented as serum by biochemical and electrophoretic analysis. Histopathologically, the grafts were noted to be poorly incorporated into the surrounding tissues, and the graft lining was covered by a flimsy, fibrous layer with a degenerated fibrin-protein matrix noted in the interstices of the graft. These findings pertained to both polytetrafluoroethylene and Dacron; neither acute nor chronic inflammatory changes were noted. The cyst membrane was comprised of nonsecretory cells, primarily fibroblasts. Treatment was highly variable. Graft replacement provided a 92% cure rate, and the authors advocate removal of the original graft and cyst membrane with placement of a new graft of material other than the original along a different anatomic route. However, in elderly, poor-risk patients, resolution may occasionally be achieved by "watchful waiting" with or without multiple aspirations.

Adult↗
PubMed1984

Differential management of acute peripheral arterial ischemia.

Retrospective study of 140 consecutive cases of nontraumatic acute ischemia of the extremities of 48 hours or less duration emphasizes differences in diagnostic features, treatment, and results among 71 patients with arterial embolism (11% mortality rate) and 69 with acute atherosclerotic thrombosis (3% mortality rate). The following principles of management have evolved. (1) Although it is often difficult, differentiation between embolisms and acute thromboses is important. (2) Preoperative angiography is useful. (3) Immediate heparinization is indicated. However, it is not a suitable substitute for a necessary operation. (4) Long-term heparin therapy (instead of operation) does not produce better results for an embolism. However, it is useful for recent acute thrombosis with a viable limb. (5) Thrombectomy alone is not sufficient for acute atherosclerotic thrombosis. (6) Completion angiography is required. (7) Embolisms are more dangerous than acute thromboses, probably because of more serious accompanying cardiac lesions.

Adult↗
PubMed1982

Thoracic outlet compression syndrome. Critique in 1982.

Experienced surgeons recommend different approaches and operations for thoracic outlet compression syndrome. I reviewed my recent 76-patients series (55% had excellent results; 35%, good; and 9%, failure), series reported by others, and the results of a national survey of complications of the transaxillary first-rib resection reporting 273 partial or complete postoperatively brachial plexus injuries, 52 of which failed to recover completely. The difficulties with diagnosis, variability of results, and the potential of serious neurologic sequelae suggest reevaluation of indications and techniques of surgical therapy. Operation should be reserved as a last resort. Modern results with scalenectomy (not simple division of the muscle) suggest its use with reservation of first-rib resection for failures.

Adult↗
PubMed1980

Practical value of phlebography.

Phlebography is a useful examination if a standardized technic is carefully used, and it can be relied upon to diagnose acute thrombophlebitis definitively or to rule it out. The 200 consecutive phlebograms reviewed produced no mortality or pulmonary embolism, and only minimal morbidity. Phlebograms are also useful in mapping before varicose vein surgery and in distinguishing the leg swelling of the postphlebitic state from that of lymphedema.

Diagnosis, Differential↗
PubMed1979

Reconstructive venous surgery.

Experience with 60 reconstructions of large peripheral veins is summarized. No deaths occurred and complications were minimal. Most patients had excellent or good results.

Adult↗
PubMed1978

Antibiotic prophylaxis in vascular surgery.

Preoperative and intraoperative antibiotic prophylaxis of infection in peripheral vascular surgery has been widely used although controlled studies have been lacking. A randomized, a prospective, double-blind study of cefazolin versus placebo during 565 arterial reconstructive operations was performed at this hospital from February 1976 through August 1977. Among the 462 patients undergoing surgery of the abdominal aorta and lower extremity vasculature, there was a highly significant difference in the infection rates: 6.8% for placebo recipients versus 0.9% for cefazolin recipients (p less than .001). Of the 18 infections, four involved vascular grafts and all four graft infections occurred in the placebo group. Over 8% of abdominal wounds of patients receiving placebo became infected versus 1.2% of cefazolin patients (p less than .05). Groin wounds were infected infrequently, 1.1% for placebo patients versus none for cefazolin patients. No infections occurred among 103 brachiocephalic procedures. Skin antisepsis was analyzed retrospectively. Infection rates were significantly higher (p less than .01) following hexachlorophene-ethanol versus a povidone-iodine skin preparation. Adverse effects of cefazolin were carefully monitored: no rash, phlebitis, or emergence of resistant strains was observed. A breif perioperative course of cefazolin and povidone-iodine skin antisepsis are recommended in vascular reconstructive surgery of the abdominal aorta and lower extremity vasculature.

Antisepsis↗
PubMed1977

Management of early postoperative complications of arterial repairs.

Of 1,703 patients undergoing arterial procedures during a three-year period, 81 (4.7%) required reoperation within 72 hours because of early complications. Thrombosis (58 patients) and hemorrhage (19 patients) were the most frequent complications encountered. Reoperation was successful in salvaging a successful outcome in the majority of patients after both hemorrhagic and thrombotic complications. The results seem to justify a continued aggressive approach to the management of early complications following vascular reconstructive procedures.

Aorta, Abdominal↗
PubMed1976

Further experiences with bovine arterial grafts.

Following favorable laboratory experience with the chemically modified bovine arterial graft (reported previously), we have used it for arterial reconstruction of the lower extremity in 84 operations upon 79 patients. The over-all patency rate was 42%. There were 7% infections, which usually occurred in secondary and tertiary procedures. Five percent of the grafts became aneurysmal. These results, published reports, and the results of a questionnaire mailed to vascular surgeons indicates similarity of experience. The disadvantages of frequent early thrombosis of undetermined cause, aneurysmal degeneration in approximately 4%, the considerable cost, and the nonavailability of the graft in different dimensions have resulted in our discontinuation of use for arterial reconstructions.

Aneurysm↗