Biomedical subjects
Publications and source records attributed to W Ahmad.
Freezing of an extremity permits delay in amputation, and the time gained can be devoted to such intensive therapy as may be indicated. A safe, efficient, and convenient technic is described.
The condition of many patients with early or late thrombosis after an aortic bypass operation can be improved by appropriate secondary operations. Late thromboses generally occur in patients with impaired arterial outflow. Restoration or establishment of good outflow is the most critical part of most secondary operations. Thrombectomy is an expedient procedure and, if properly monitored by arteriography, can in many instances permit retention of the graft limb as a satisfactory conduit, particularly in emergency limb salvage attempts.
Patients requiring a major amputation for ischemia are frequently gravely ill. Physiologic amputation obtained by freezing the leg, usually with a tourniquet, will permit delay and intensive preoperative therapy. In an efficient, safe, and convenient method which we have developed and used in 46 patients, a pump circulates antifreeze solution through a specially constructed boot. The last 32 patients so treated have been analyzed as to indications and results. Advantages obtained control of sepsis, correction of diabetic coma, dialysis for chronic renal failure, improvement in congestive heart failure, and improvement in pulmonary function. Four patients had successful below-knee amputations after control of infection that had previously seemed to dictate above-knee amputation. The control of pain and odor, the resultant appreciation of the family, and the lessened demand on nursing staff offer worthwhile benefits in many of the patients, even in some in whom advanced systemic disease prevented survival.
Twenty-three patients bleeding from varices had mesocaval H-grafts using Dacron prosthetic material. There were 21 men and two women with ages ranging from 37 to 60 years. There were 11 elective and 12 emergency procedures. Five patients (17%) were classified as Child's class A, seven (34%) as class B, and 11 (49%) as class C. An operative mortality of 17% was noted in the entire group, with one late death due to hepatic failure. All deaths occurred in emergency cases belonging to class C. Technical difficulties were encountered more often in the hands of less experienced surgeons. A high rate of shunt patency and minimal problems with postoperative encephalopathy were noted despite abnormal results of ammonia tolerance tests postoperatively. Lack of hepatopedal flow was noted postoperatively compared with preoperative angiograms. There were no serious adverse effects from diversion of blood from the liver in our surviving patients. The interposition mesocaval shunt is a technically safe and easy procedure in the hands of experienced surgeons. We continue to recommend the mesocaval shunt until other methods prove better than this operation.
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To determine the effectiveness of clinical evaluation and peritoneal lavage in blunt abdominal trauma, a prospective study was undertaken in 315 consecutive patients suspected of having this injury. Conscious patients with obvious physical findings were operated on without peritoneal lavage, and a diagnostic accuracy of 96% was achieved. In patients with altered states of consciousness, peritoneal lavage was studied prospectively for equivocal physical findings. An overall accuracy of 97% was achieved in such patients by peritoneal lavage. Peritoneal lavage was helpful in reducing the rate of normal findings at laparotomy by 50% in patients with altered states of consciousness and equivocal physical findings. Patients with normal findings on peritoneal lavage and subsequent deterioration had normal findings at laparotomy, which points to the value of further evaluation in such patients before laparotomy is carried out. Mortality is ultimately determined by the severity of the injury, despite early and definitive diagnosis and aggressive management.
A comparative experience of 474 patients with primary carcinoma of the colon and rectum has been evaluated in several hospital settings, with particular respect to patient populations, geographic distribution, and surgical characteristics. The differences and similarities are interpreted with caution but may provide a format by which significant objective determinants become the basis for subsequent assessment of quality care in an illness which is prevalent and amenable to relatively standardized operative management. No difference in quality of medical care provided was detectable across the sociologic and geographic boundaries studied. Notable increases in extent of neoplasm and severity of co-existent illness in the urban, "indigent" population adversely influenced both short and long-term mortality rates.
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A case is reported in which extensive mesocolonic and retroperitoneal granulomatous and fibrotic disease were apparently due to occult diverticulitis. The patient later had a good result from aggressive but limited operation for obstructions of the ureter and colon.
A new syndromic form of X-linked mental retardation associated to obesity, MRXS7, has been localised to Xp11.3-Xq23 in a large Pakistani family. The ten affected males show clinical manifestations of mental retardation, obesity and hypogonadism. The family was genotyped by a set of microsatellite markers spaced at approximately 10 cM intervals on the X chromosome. Linkage to five adjacent microsatellite markers, mapping in the pericentromeric area, was established and a maximum two-point lod score of 3.86 was reached at zero recombination with marker DXS1106. Reduced recombination events around the centromere prevented precise mapping of the gene.