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Biomedical subjects

W A Ward

Publications and source records attributed to W A Ward.

10 recordsLinked to original sources
PubMed1996

Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis.

A prospective study was undertaken to compare vascularized fibular grafting (VFG) with core decompression for Ficat Grade II and III femoral head osteonecrosis. The study group included 39 hips in 34 patients-20 VFGs and 19 core decompressions. Independent evaluation of results was performed by an orthopedic surgeon and a radiologist at a minimum of 2 years postoperatively (range: 2 to 5 years). Disease extent was assessed by Ficat radiographic gradings. VFGs failed (conversion to total hip arthroplasty for functionally incapacitating pain) at a rate of 20%, significantly lower than the 58% failure rate of core decompressions (P = .025). Complications included 2 proximal femur fractures in each group, ankle pain in 6 VFGs, and graft vessel thrombosis in 1 VFG. Vascularized fibular grafting appears superior to core decompression in prolonging hip joint survivorship for Ficat Grades II and III femoral head osteonecrosis.

Adult↗
PubMed1995

Management of finger ulcers in scleroderma.

Twelve patients (15 hands) with documented scleroderma and chronic nonhealing digital ulcers were followed for their response to nonoperative and operative treatment. The patients were initially managed with nifedipine, biofeedback, digital xylocaine blockade, and silver sulfadiazine topical ointment and cessation of all vasoconstrictive agents. Ulcerations healed in 6 of 15 hands and remained healed at a 2-year follow-up examination. The remaining nine hands in seven patients failed nonoperative treatment and underwent a palmar digital sympathectomy. These chronic digital ulcerations healed within 6 weeks after surgery. After a 26- to 64-month follow-up period, six of the nine hands remained free of all digital ulcerations. Two patients (three hands) had partial recurrence of the ulceration. Digital sympathectomy can be an effective procedure for treating nonhealing digital ulcers in scleroderma patients after nonoperative treatment has failed. Significant vaso-occlusive disease is likely to be present in these patients, as demonstrated by arteriography. Our initial approach is cessation of all vasoconstricting agents, nifedipine biofeedback, and local antibiotic ointment. Wrist blocks with xylocaine and marcaine are offered if these modalities fail. If these methods do not result in healing of the ulcer within 12 weeks, then digital sympathectomy is considered.

Adult↗
PubMed1992

Standardized extracts.

Until recently, physicians practicing allergy have not had the benefit of using allergenic extracts with potencies expressed in uniform, meaningful units. Technologic advances have provided accurate and reproducible methods for qualitative and quantitative analyses of these products, and assignment of meaningful units can be accomplished by using a threefold serial dilution titration skin test and appropriate in vitro methods. Although the perfect method for standardization of allergenic extracts has not yet been developed and some confusion has been created in the process, significant improvement in the quality of allergenic extracts has resulted. Collaborative efforts of regulatory agencies, manufacturers, specialty organizations, and clinicians should continue to produce standardized extracts that offer significant advantages to physicians practicing allergy.

Allergens↗
PubMed1991

Per Primam thumb replantation for all patients with traumatic amputations.

Forty-two complete thumb replantations performed between 1980 and 1984 were reviewed. The mean follow-up time was 14 months. Replantation was attempted for all thumb amputations regardless of mechanism or severity of injury. Sixteen (38%) failed intraoperatively or postoperatively. Thumbs with narrow zones of injury showed a significantly higher survival rate than those with wide zones of injury. Eighty percent of those with poor arterial flow intraoperatively ultimately failed, despite pharmacologic treatment and multiple vein-graft anastomoses. Two thumbs with no vein repairs ultimately survived. Reexploration for loss of perfusion succeeded in 60% of cases. Total metacarpophalangeal and proximal interphalangeal active motion postoperatively averaged 68 degrees. Median static two-point discrimination returned to 11 mm. Avulsed thumbs survived in 46% of cases. Replantation should be attempted in all cases of thumb amputation, as success cannot be predicted by mechanism or severity of injury. Thumbs with poor intraoperative flow (20%) or no venous return (50%) can survive and should not be primarily amputated. Vein grafting is not mandatory if shortening allows anastomoses to be tension free. Prompt reexploration of acute vascular occlusions is worthwhile.

Adult↗
PubMed1989

Efficacy of alternative tests for delayed-cyclic food hypersensitivity.

With the oral challenge food test (OCFT) used as the standard for delayed-cyclic food hypersensitivity diagnosis, blinded comparison studies were accomplished with 175 in vitro food specific IgE and 180 IgG radioallergosorbent tests, 180 food enzyme-linked immune complex assays, and 155 in vivo Multi-Test prick tests. The study was multi-centered, eight physicians and 37 patients participating. All of the compared tests were shown to be approximately 50% efficient when compared with the OCFT results, and, thus, nonefficacious.

Double-Blind Method↗
PubMed1988

Provocation-neutralization: a two-part study. Part I. The intracutaneous provocative food test: a multi-center comparison study.

This study investigated the clinical usefulness of the intracutaneous provocative-neutralization food test (IPFT). Thirty-seven patients were tested for five identical food allergies by eight physicians in different geographical locations. Throughout the study, comparison was made between the IPFT when interpreted by skin response (IPFT SK) and when interpreted by symptom provocation (IPFT PR). Double-blind IPFT results were compared with those of previously accomplished oral challenge food tests (OCFT). IPFT reliability was determined by a double-blind comparison of the initial IPFT, with two subsequent IPFTs performed 7 days apart. Correlation of the IPFT SK and IPFT PR with the OCFT provided validity coefficients of 0.78 and 0.61 respectively, both significant beyond the 0.01 level of confidence. Reliability of the IPFT SK and IPFT PR was shown to be 0.68 and 0.40, respectively. The IPFT SK was significant beyond the 0.01 level of confidence and the IPFT PR was significant beyond the 0.05 level of confidence.

Adolescent↗
PubMed1988

Provocation-neutralization: a two-part study. Part II. Subcutaneous neutralization therapy: a multi-center study.

Presented is a triple-blind crossover study that investigates the efficacy of subcutaneous neutralization food hypersensitivity therapy. Seven physicians and thirty-three patients from various parts of the country participated. Each patient underwent three 2-week treatment sessions, with 1 week off treatment between each session. During each treatment session, one injection a day was given. The injection consisted of a placebo for one 2-week session, and the active allergen during the other two sessions. The active dose was determined by earlier intracutaneous provocative food testing. The diet during the study period was not varied. Medication-symptom diaries were maintained and treatment result evaluations for both individual complaints and overall results were detailed on a standard form at the end of each treatment session. While the number of foods treated per patient varied from 1 to 13, the majority were treated with 3 to 5 foods. Treatment with the active medication was more efficacious than with placebo. A few patients' symptoms were aggravated with the active medication. This indicates a correct diagnosis, but incorrect treatment dose. In the clinical setting such adverse response should be reversed. Overall, neutralization subcutaneous treatment should be beneficial approximately 75% of the time, and further enhanced by supplemental diet manipulation.

Allergens↗
PubMed1985

Ruptured epidermal inclusion cyst of the palm presenting as collar-button abscess.

Two cases of epidermal inclusion cysts that ruptured as a result of trauma and then mimicked pyogenic collar-button abscesses are reported. Rupture of the cyst into the palmar subcutaneous tissue produced an inflammatory response that led to the sterile abscesses drained at surgery. Presentation of a deep space abscess without history of penetrating injury should suggest this diagnosis.

Abscess↗
PubMedDate not supplied

Distribution and incidence of North American pollen aeroallergens.

Using standardized aerosampling procedures, ambient pollen samples were collected at 15 locations in six regions of North America. The results provide baselines for examining human exposure to inhalant pollen allergens throughout the year on a broad geographic scale. In eastern temperate areas, pollen shed was closely linked to plant flowering seasons, with trees releasing pollen in the spring, grasses in the early summer, and weeds in the later summer and fall. Variations to this fundamental pattern were observed to the south and west; understanding these differences is essential if atopic persons suffering from allergic symptoms are to be assisted. For example, highly diverse tree pollen was found in North Carolina and Georgia for prolonged periods at high levels. These data suggest that a more sensitized population in the southeastern United States manifests allergic symptoms longer. Further south and southwest, pollen was captured throughout the year and sometimes at unexpected times. For instance, bimodal releases of grass pollen in both the spring and fall allow dual exposures of atopic persons, extending possible hypersensitivity to multiple seasons. Enhancing pollen exposure further, our data show limited overall variation in morning and afternoon levels, implying a continuous absorption of all major pollen types during daylight hours.

Air Pollution↗