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Biomedical subjects

W B Stewart

Publications and source records attributed to W B Stewart.

At least 91 records · Page 5Linked to original sources

Early medicine and surgery in New Brunswick.

The author discusses some of the major events in medicine and surgery in New Brunswick prior to 1900. The influences of Indian medicine, of early French and Acadian surgeons, of the British colonial surgeons at the siege of Fort Beausejour, of the pre-Loyalist and Loyalist surgeons all led up to the building of marine hospitals and quarantine stations. The introduction of anesthesia with ether and chloroform hastened progress towards"modern surgery" which was carried out in the many general hospitals that were built following the opening, in 1865, of New Brunswick's first general hospital, the General Public Hospital (now the saint John General Hospital).

England↗

Fibrous histiocytoma metastatic to the orbit.

The term fibrous histiocytoma encompasses a heterogenous group of tumors believed to have a common origin in the histiocyte. These tumors demonstrate a wide histopathologic spectrum ranging from a predominantly cellular to a predominantly fibrous pattern. No clinical or histological criteria have been identified that can predict malignant behavior. Although generally characterized by local recurrence, a metastatic potential does exist. Fibrous histiocytoma of the thigh metastasized to the orbit.

Diagnosis, Differential↗

Eyelid reconstruction by the semicircle flap technique.

The semicircle flap technique of eyelid reconstruction is a modified lateral advancement-rotation flap. The procedure combines the use of selective lysis of the limbs of the lateral canthal tendon with a semicircular skin-muscle flap confined to the region of the lateral canthus within the boundary established by the lateral eyebrow and the arc it defines. Reconstruction of one half to more than three fourths of the lower or upper eyelid can be accomplished without borrowing tissue from the eyelids, nose, ear, or mouth. Large forehead, brow, or cheek flaps are elininated, as is the need for closure of the palpebral fissure during the early healing course. The procedure has been used in the reconstruction of 36 lower eyelids and five upper eyelids in 40 patients, with a follow-up period of six months to six years. The usual indication for the use of this procedure is reconstruction of a central, marginal lid defect following the excision of a neoplasm. However, it may also be useful in cases of tissue loss caused by trauma, or for severe lid malpositions for which major kid reconstruction is necessary. The early and long-term cosmetic and functional results have been gratifying.

Eyelids↗

Silicone in ophthalmic plastic and reconstructive surgery: a review and laboratory trial.

Silicone is a material with wide application as an exogenous implant in ophthalmic surgery. Animal trials have indicated that extreme care must be taken in the use of this material in the presence of a viable eye. Acute corneal injury was seen in 10 of 14 rabbit eyes tested with a topical application of RTV silicone in the conjunctival cul-de-sac. Two of the 10 eyes demonstrated delayed healing of the corneal injury. Pretreatment with a viscous ocular lubricant, limited corneal contact time of the hardened forms, thorough and frequent corneal evaluation and prompt appropriate treatment of abnormalities are recommended for the successful use of silicone as an orbital molding material in the presence of the viable globe. For use as an orbital expander or as a stent after soft tissue socket reconstruction, despite its relative softness compared to acrylic orbital conformer, similar precautions must be observed to prevent mechanical corneal injuries.

Animals↗

Orbital surgery.

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Bone Diseases↗

Sebaceous adenocarcinoma of the eyelid. Definition of surgical margins.

Carcinoma of the sebaceous glands of the eyelid carries a serious prognosis. Although uncommon, the diagnosis must be frequently considered owing to the similarity of the early signs of adenocarcinoma to those of chalazion. Three cases with proved sebaceous adenocarcinoma of the eyelid are reviewed to relate subtle evidence of clinical and histopathological malignancy to surgical management.

Adenocarcinoma↗

Carotid bruit as a risk factor in aortoiliac reconstruction.

Records of 248 patients undergoing aortoiliac reconstruction for occlusive disease between 1957 and 1975 were reviewed. Carotid bruits were ausculted in 35 patients (14%). Five of the patients with bruits also were thought to have symptoms of transient ischemia. Strokes occurred after operation in four of the 248 patients (1.6%). No patient with a previously noted bruit developed postoperative stroke. Two patients with transient cerebral ischemia and no confirmed bruit before operation did develop postoperative strokes. Cerebral angiography was performed in 18 of the patients with carotid bruits. Two of these patients underwent carotid endarterectomy prior to aortoiliac reconstruction. None of these 18 patients developed strokes following their carotid surgery of aortoiliac reconstruction. A third patient with no bruit but with retinal cholesterol emboli also underwent arteriography and endarterectomy without complication. The results suggest that the asymptomatic carotid bruit alone does not indicate an increased risk of stroke during aortoiliac reconstruction. The authors conclude that their experience does not support prophylactic carotid endarterectomy in the asymptomatic patient prior to aortoiliac reconstruction.

Aorta↗

Anesthetic-dependent field potential interactions in the olfactory bulb.

The effect of anesthetic upon olfactory bulb field potentials evoked by paired stimuli to the lateral olfactory tract (LOT) was examined in male rats. Experiments were performed on rats anesthetized with urethane or barbiturates and on unanesthetized rats with midcollicular brain stem sections. Anesthetic doses of urethane (1.5 g/kg) produced an increse in the test response for condition-test intervals of 15-60 msec or more. With barbiturate anesthesia there was a decrease in the test response for all intershock intervals up to 150 msec. In unanesthetized rats with midbrain sections there was an increase in the test response with low intensity shock pairs and a decrease in the test response with high intensity shock pairs. Simultaneous use of both anesthetics produced either an increase or a decrease in the test response, depending upon the relative doses and upon the stimulus intensity. Paired stimuli to the olfactory nerve produced results similar to those with LOT stimulation. Augmentation of the olfactory bulb field potential produced by paired olfactory nerve shocks was not abolished by lesions which sectioned the LOT and produced extensive damage of the anterior olfactory nucleus.

Animals↗

Surgical correction of superior sulcus deformity occurring after enucleation.

A prefabricated, sculptured, subperiosteal orbital floor implant was used in six cases of cosmetically unacceptable deep superior eyelid sulcus that occurred after enucleation. The implant provided anterior and superior displacement of orbital contents. Surgical placement was similar to the approach for implant placement in orbital floor fracture and provided satisfactory cosmetic and functional results.

Eye, Artificial↗

Beagle puppy model of perinatal asphyxia: alterations in cerebral blood flow and metabolism.

Perinatal asphyxia remains a major cause of neurodevelopmental handicap. The neuropathologic and clinical sequelae of perinatal asphyxia are likely attributable to alterations in cerebral blood flow (CBF) to the developing brain with uncoupling of CBF and metabolism. The newborn beagle puppy model was used to study the control of CBF in physiologic and pathologic conditions in the developing brain. Pups, 2-10 days of age, were randomized to asphyxial insult (i.e., ventilator lines clamped for 5 min) or no insult. In the first series, pups underwent radioactive microsphere determinations of CBF immediately prior to insult (t = 0), at the end of insult (t = 5), and after 60 min of observation (t = 65). In the second series, utilizing a 2.0 tesla superconducting magnet, pups underwent continuous serial in vivo 31P nuclear magnetic resonance spectral analysis of cerebral hemispheric metabolic state. Animals exposed to insult had significant alterations in PO2, PCO2, pH, and mean arterial pressure at the end of insult compared to control pups (all pups: p less than 0.001). Serial CBF data demonstrated decreases in flow in cortical gray and white matter regions during insult and return to baseline 1 hour later; brainstem structures were hyperemic during insult. Analysis of phosphorylated metabolites inorganic phosphorus (Pi), phosphocreatine (PCr), and ATP demonstrated that during insult both the PCr/Pi and ATP/Pi ratios were depressed but by 20-30 min following insult, these ratios of cerebral phosphorylated metabolites had almost returned to baseline values. These data demonstrate that even after a severe asphyxial episode which results in electrocerebral silence, CBF and metabolism may return to normal.

Acid-Base Equilibrium↗

Beagle puppy model of perinatal asphyxia: blockade of excitatory neurotransmitters.

The N-methyl-D-aspartate receptor antagonist MK801 has been reported to prevent neuronal change in models of ischemia in adult animal systems. We studied the hypothesis that blockade of the N-methyl-D-aspartate receptor would prevent the depression of cerebral high-energy phosphates found in perinatal asphyxia without producing alterations in cerebral blood flow, and thus prevent neuropathologic damage. Newborn beagle puppies were anesthetized, tracheotomized, ventilated, and randomized to asphyxial insult (I = discontinuation of ventilatory support for 5 min) or no insult (NI) and drug treatment with MK801 (10 mg/kg intravenously) or an equal volume of saline (S). Puppies received MK801 or saline 15 min prior to I/NI. In S/I pups during insult, blood flow increased to brainstem structures but decreased elsewhere. MK801 had no effect on cerebral blood flow in either control or insulted puppies. 1H NMR studies demonstrated no effect of the MK801 on NI brains. Phosphocreatine levels were 1.7 +/- 0.1, 0.6 +/- 0.1, and 0.9 +/- 0.1 mmole/kg (mean: +/- S.D.) for the S/NI, S/I, and MK801/I pups, respectively. Cerebral lactate was 1.3 +/- 0.2, 3.0 +/- 0.7, and 2.0 +/- 0.4, respectively. The pH fell 0.8 units in the S/I puppies, compared to 0.4 units in the MK801/I puppies. We conclude that pretreatment with the N-methyl-D-aspartate receptor antagonist MK801 in part protects the developing brain against severe metabolic insult.

Animals↗

Perinatal cerebral insults: hemorrhage and ischemia.

The incidence of major neurodevelopmental handicaps in the survivors of newborn special care has remained essentially unchanged over the past decade despite the development of sophisticated perinatal care. Preterm infants with parenchymal involvement of intraventricular hemorrhage and neonates of all gestational ages with cerebral infarction are believed to be at higher risk for both neurologic and developmental abnormalities than infants without these problems. Both lesions are thought secondary to alterations in cerebral blood flow to the developing brain, and many infants demonstrate evidence for both hemorrhage and ischemic insult.

Brain Ischemia↗