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Biomedical subjects

W F Barker

Publications and source records attributed to W F Barker.

At least 19 recordsLinked to original sources
PubMed1997

Venous interruption for pulmonary embolism: the illustrative case of Richard M. Nixon.

This politically prominent patient was seen in consultation on October 26, 1974 because of chronic venous thrombosis and a recent pulmonary embolism. His problems had begun in 1965 when he developed venous thrombosis in the left leg after a length trip by air. His treatment had been sporadic and his compliance with treatment less than satisfactory. Because of detailed phlebography demonstrating (1) no clots in the veins of the right leg, (2) extensive loose lying clot filling the superficial, deep, and external iliac veins on the left, and (3) because of prior difficulties with patient compliance unilateral interruption of the left external iliac vein above the top of the clot was proposed. Despite some postoperative complications, the patient made a full recovery and lived 19 years on warfarin therapy before death from unrelated causes. He suffered no significant edema or other postphlebitic symptoms in the affected leg. The history of the use of venous interruption under these circumstances is reviewed to justify the operation that was performed.

Anticoagulants↗
PubMed1994

The efficacy of cervical extension-compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: a pilot study.

OBJECTIVE: To experimentally investigate the effect of cervical extension-compression traction combined with diversified chiropractic manipulation and drop table adjusting in establishing or increasing cervical lordosis. DESIGN: Blinded, before and after trial with pre- and postlateral cervical radiographic measurement. SETTING: Primary care private chiropractic clinic in Saugus, MA. SUBJECTS: A) Control group--convenience sample who had no health care for 10-14 wk, 30 persons. B) Treatment group 1, nonrandomized control trial, 35 persons, whose pre- and postlateral cervical radiographs were taken 10-14 wk apart and whose radiographs clearly depicted C1 through C7. C) Treatment group 2, nonrandomized control trial, 30 persons, whose pre- and postlateral cervical radiographs were taken 10-14 wk apart and whose radiographs clearly depicted C1 through C7. INTERVENTIONS: Treatment group 1: diversified spinal manipulation, drop table adjustments and cervical extension-compression traction five times per week for 10-14 wk (12 wk +/- 2). Treatment group 2: diversified spinal manipulation and drop table adjustments five times per week for 10-14 wk (12 wk +/- 2). MAIN OUTCOME MEASURES: Anterior head translation millimeters, C2 to C7 absolute rotation angle, angle of C1 to horizontal (atlas plane angle), five relative rotation angles (C2-3, C3-4, C4-5, C5-6, C6-7) and qualitative classification of lordotic configuration. RESULTS: No statistically significant changes existed between the pre- and posttests for the control group except in the C6-7 relative rotation angle. In the treatment group 1, statistically significant differences were found in all X-ray markings. Twenty-nine of 35 members have a lordosis after treatment compared to 11 of 35 before treatment. The C2 to C7 angle changed an average 13.2 degrees, C1 to horizontal changed an average 9.8 degrees, the anterior head translation reduced an average of 6.8 mm, the average relative rotation angle changed: C2-3: 3.1, C3-4: 5.5, C4-5: 4.80, C5-6: 2.7 and C6-7: 1.1. In the treatment group 2, no statistically significant changes existed between the pre- and posttests except atlas angulation to horizontal which increased an average of 3.0 degrees. CONCLUSIONS: A transformation to a lordotic configuration or increase in lordotic configuration occurred and was measured in the majority of treatment group 1 subjects, while no change in the control group and essentially no change in treatment group 2 was measured. Extension-compression traction combined with diversified chiropractic manipulation and drop table adjusting procedures may improve or partially reestablish the cervical lordosis in 10-14 wk of daily care.

Adult↗
PubMed1989

An historical look at the thoracic outlet compression syndrome.

The story of the thoracic outlet compression syndrome begins with the identification of the anatomical abnormality of the cervical rib, and the symptoms related to it. Resection of the cervical rib, however, was soon followed by the recognition that symptoms could occur in the absence of a cervical rib. The scalenus anticus was then held to be the culprit, although several different mechanisms were advanced to explain the development of symptoms. Subsets of the thoracic outlet compression syndrome were then codified; costoclavicular compression; compression under the coracoid process during hyperabduction; primary symptoms related to arterial compression; and the syndrome that appears when neural and arterial compression are absent but venous occlusion is present. The importance of the first rib as a common denominator has brought about the idea that first rib resection is the best method of extirpating this common anatomic factor. That thesis is not accepted universally, however.

History, 19th Century↗
PubMed1988

Practical aspects in the diagnosis and management of cystosarcoma phyllodes.

Thirty-five cases of benign cystosarcoma phyllodes, 13 cases of malignant cystosarcoma phyllodes, and ten cases of giant fibroadenoma were studied. The diagnosis of benign or malignant cystosarcoma phyllodes was based on a combination of histological features. Clinical and gross pathologic findings were not found to be useful in distinguishing between benign and malignant tumors. Giant fibroadenomas occurred primarily in black adolescents and were histologically distinct. Positive surgical margins were found to be the best predictor of local recurrence of benign or malignant cystosarcoma phyllodes. Systemic metastases occurred in only one case of malignant cystosarcoma phyllodes. Most benign and malignant cystosarcoma phyllodes may be treated by wide local excision with tumor-free margins. Giant fibroadenomas should be treated by simple excision to preserve normal breast tissue.

Adolescent↗
PubMed1988

A century's worth of arterial sutures.

In light of the advanced state of vascular surgery today, it is hard to realize that the technique of vascular suturing is barely 100 years old. Even more remarkable is the skill with which the early surgeons applied almost all of the techniques we use today. Eck's experiments in the laboratory with portal vein-to-vena caval anastomoses were followed by pessimistic predictions concerning the future of arterial sutures. Jassinowsky had just performed the first successful arterial suture when he did a clinical arterial repair and, within 15 years, Carrel had developed nearly all the technical maneuvers which we use today. Knowledge of Carrel's work spread rapidly, and practical application of his work was reflected in the development of vascular replacements, such as venous grafting, the bypass technique used for vein grafts before World War I. There was, however, a lag in further developments until the end of the forties when dos Santos and Kunlin revived old methods and opened the way for further arterial surgical advances. These early developments are well-documented, but the reasons for delaying the acceptance of their applications remain a matter for speculation.

Arteries↗
PubMed1984

Determinants of failure in the treatment of ruptured abdominal aortic aneurysm.

One must identify those fatal errors in the treatment of patients with ruptured abdominal aortic aneurysms (AAAs) to improve future treatment and reduce mortality. Our vascular registry identified 29 patients with ruptured AAAs who died following admission to the UCLA Hospital, Los Angeles, and the Sepulveda (Calif) Veterans Administration Hospital between 1971 and 1981. Review of the records identified four categories of error that contributed to death. These included failure to proceed with elective aneurysmectomy in 12 patients with known AAAs, error in the diagnosis of aortic rupture that led to delay in getting nine patients to the operating room, intraoperative technical error that produced venous injury in eight patients, and undue delay in anesthetic induction in four patients. Following the outline of a careful treatment approach should further reduce the mortality in the treatment of patients with ruptured AAAs.

Aged↗
PubMed1984

Early intervention with retarded children: some encouraging results.

The changes in IQ for 35 preschool retarded children evaluated and then treated in a special hospital-based program which emphasized parent participation were compared with those of 36 retarded children evaluated at the same hospital clinic, most of whom received preschool services in the community. Over an average of 16 months, the group in the hospital-based program showed a mean gain of 8.1 IQ points, and 11 children increased by 15 points or more. In contrast, the mean improvement for the community group was 0.8 IQ points, and only two children had increases of 15 points or more. With the exception of serious neglect/deprivation, there was no relationship between medical diagnosis and amount of IQ change. Children from backgrounds of poverty, with unknown and presumably non-biological etiologies, did no better than children in better social circumstances with clear organic causes. Outcome was unaffected by sex, initial IQ level, initial age or social class.

Autistic Disorder↗
PubMed1984

Bacteriologic and surgical determinants of survival in patients with mycotic aneurysms.

Mycotic aneurysms are a fulminant infectious process frequently resulting in rupture and death if not properly treated. A review of the University of California, Los Angeles, medical records identified 10 patients with extrathoracic, extracranial mycotic aneurysms. In addition, a search of the English literature revealed 178 patients with 243 mycotic aneurysms. These patients were reviewed to identify the aneurysm location, etiology, bacteriology, and modality of treatment in order to determine the relationship between these factors and the outcome. The femoral artery was the most common site (38%), followed by the abdominal aorta (31%). Arterial trauma was the primary etiology in 42% of mycotic aneurysms. In 25% no clear source of infection could be identified. Staphylococcus aureus was cultured from 28% of mycotic aneurysms, and Salmonella from 15%. A trend toward the involvement of more gram-negative aerobes and anaerobes is noted. Aortic aneurysms were repaired with in situ Dacron in 61% of patients with a 32% mortality rate and 16% reinfection rate. Simple ligation of femoral artery mycotic aneurysms resulted in a 34% incidence of ischemia necessitating amputation. Methods of treatment of superior mesenteric, carotid, iliac, and peripheral arteries are also analyzed. On the basis of these data, specific surgical procedures are recommended for the treatment of mycotic aneurysms.

Adolescent↗
PubMed1983

Cause and noninvasive detection of restenosis after carotid endarterectomy.

The incidence of significant restenosis after carotid endarterectomy was studied with ocular pneumoplethysmography. Of 105 operations, symptomatic restenosis occurred in 4.8 percent and asymptomatic restenosis in 6.6 percent. No preoperative factors were identified to be associated with subsequent recurrence. However, technical problems with the end-point of the endarterectomy were associated with restenosis. Half of the restenoses occurred in the first 6 months of operation. The results focus on the need for special attention to the technical management of end-point problems and the need for early noninvasive follow-up to detect a substantial proportion of early restenoses.

Arterial Occlusive Diseases↗
PubMed1983

Aortic saddle embolus. A twenty-year experience.

Clinical experience with aortic saddle embolus (ASE) is not extensive due to the relative infrequent lodging of emboli at the aortic bifurcation. During the period 1962-1982, 26 patients (mean age, 56 years) were treated at the UCLA Medical Center for ASE and followed from 2 to 158 months (mean, 45 months). These cases were reviewed in order to identify features of diagnosis, anticoagulation, and operation which impact on results. All 26 patients presented with bilateral lower extremity ischemia with or without extension of clot to the iliac bifurcation. Ninety-six per cent of emboli were of cardiac origin and one-third occurred in patients who had previous symptoms of chronic lower extremity ischemia. Rest pain and motor/sensory deficits were main complaints in 92% of the patients, but did not become manifest until more than 6 hours, unlike more distal emboli which have an earlier presentation. Preoperative angiography, even in the patient with a history of claudication, has a small role in planning the surgical approach to patients with ASE and, although performed in 11 patients, it influenced operation in only two. Operation within the "golden period" of 6 hours after embolization did not significantly influence outcome after ASE, since 20 patients were operated on more than 6 hours after embolization, with results similar to six patients who were operated on less than 6 hours after embolization. Early high-dose heparinization, used in all patients and maintained for a mean of 12 days, may have contributed to this effect. In 22 patients (85%) Forgarty catheter extraction via bilateral groin approaches was used with a mortality of 14%; only one death was directly attributed to the catheter embolectomy. In 15% of patients, a direct approach on the aorta was selected with a zero mortality rate. Postoperative functional result was excellent with an amputation rate of only 2% (one limb). Re-embolization occurred in seven patients (27%) after discharge, five of whom had not been maintained on Coumadin and two who were not anticoagulated adequately. The authors conclude that the keys to successful treatment of ASE include high dose heparin which is maintained through the perioperative period, embolectomy without preoperative angiography, and maintenance of long-term oral anticoagulation.

Adult↗
PubMed1982

Natural history of nonstenotic, asymptomatic ulcerative lesions of the carotid artery. A further analysis.

The natural history of 153 asymptomatic, nonstenotic ulcerative lesions of the carotid bifurcation in 141 patients was reviewed. A technique for quantitatively defining small (A), large (B), and compound (C) ulcers was developed. During the course of study, extending up to ten years, 3% of patients with A ulcers, 21% with B ulcers, and 19% with C ulcers had hemispheric strokes without antecedent transient ischemic attacks (TIAs), on the side appropriate to the lesion. The interval annual stroke rate was 4.5% for B ulcers and 7.5% for C ulcers. Because these interval stroke rates are comparable to the 6% annual stroke rate occurring in patients with TIAs, a well-accepted indication for operation, we recommend prophylactic operation for these lesions in good surgical candidates, to be performed by surgeons who have demonstrably low operative stroke rates.

Actuarial Analysis↗
PubMed1982

Femoropopliteal tibial bypass: what price failure?

The consequences of failure in 235 femoropopliteal and femorotibial operations are reviewed and compared with the benefits of success so that an accurate perspective of risk-benefit analysis can be achieved. In 72 operations performed for claudication, 10 grafts thrombosed early. The cost included nine reoperations to achieve eight patent grafts and a 12 day average increase in hospital stay. There were no deaths. The benefit obtained was 70 of 72 (97 percent) asymptomatic limbs. In 163 grafts placed for limb salvage, there were 58 initial thromboses. Reoperation in 28 produced an additional 14 patent grafts. The cost of thrombosis was an increase in mortality from 5.6 to 10.7 percent, a 12 day average increase in hospital stay, and raising of preoperative predicted amputation level from below to above the knee in 11 patients with thrombosed grafts whose distal anastomoses were below the knee. This contrasted with a 73 percent limb salvage rate in 104 patients whose preoperative predicted amputation level was below the knee, and a 54 percent limb salvage and a 12 percent lowering of amputation level in 39 patients whose preoperative amputation level was above the knee. Of patients with patent grafts, 89 percent achieved limb salvage. We conclude that the benefits of success in attempted vascular reconstruction for threatened limb loss far outweigh the risks of failure and that the combined results were far superior to the expected outcome in comparable patients undergoing primary amputation.

Amputation, Surgical↗