Central retinal artery occlusion after neck irradiation.
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Adult↗
Biomedical subjects
W H Baker
Publications and source records attributed to W H Baker.
Histopathologic effects of soluble glucan and WR-2721, independently and combined in C3H/HeN mice.
Soluble glucan, an immunomodulator, and Walter Reed (WR)-2721, a radioprotectant, increase postirradiation survival when administered before and after exposure, respectively. Combined, these agents act synergistically through WR-2721's ability to spare hematopoietic stem/progenitor cells from radiation injury and glucan's ability to subsequently stimulate spared cells to proliferate. In this study, the histopathologic effects of WR-2721 (200 mg/kg, ip) and glucan (250 mg/kg, iv), at doses capable of increasing survival in lethally irradiated mice, were evaluated in unirradiated and irradiated female C3H/HeN mice. After treatment, whole body weights and wet organ weights of liver, spleen, and kidney, as well as gross and histologic changes in these and other tissues, were monitored on Days 1, 4, 7, 11, 15, 21, and 28. Morphometric studies of splenic white and red pulps were also performed. Soluble glucan, with or without WR-2721, in unirradiated groups, was associated with splenomegaly, transient morphometrically determined perturbations of white and red pulp areas, and histologic alterations of white pulp. In irradiated mice, splenic weight loss was initially dampened in glucan groups and accompanied by morphologic and histologic changes similar to those seen in unirradiated counterparts. The subsequent rebound of splenic parameters in irradiated mice was limited to WR-2721-treated mice and was associated with hematopoietic reconstitution. Glucan, with or without WR-2721, in unirradiated groups was associated with transient hepatomegaly and associated histologic changes. Similar changes in irradiated animals were seen only in the combined treatment group.
Amifostine↗
Standards in noninvasive cerebrovascular testing. Report from the Committee on Standards for Noninvasive Vascular Testing of the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery.
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Cerebral Arteries↗
Selection process for surgeons in the Asymptomatic Carotid Atherosclerosis Study.
BACKGROUND AND PURPOSE: The Asymptomatic Carotid Atherosclerosis Study is a prospective, multicenter, randomized clinical trial of carotid endarterectomy for the treatment of asymptomatic hemodynamically significant stenosis. This report describes the selection process for participating surgeons in the trial. METHODS: The Surgical Management Committee established guidelines for minimal annual experience and maximum neurological morbidity and mortality for surgeons to qualify to participate in the study. For approval, a surgeon must perform at least 12 carotid endarterectomies per year. Based on a review of the surgeon's last 50 consecutive endarterectomies, the combined neurological morbidity and mortality rate must be no greater than 5% for all indications and no greater than 3% for endarterectomies performed on asymptomatic patients. RESULTS: One hundred sixty-four surgeons from 48 centers applied for approval: 117 were approved, 17 were rejected, and 30 were not reviewed. The 117 approved surgeons submitted a total of 5,641 endarterectomies with a combined mortality and neurological morbidity rate of 2.3% for the variety of indications for operation. CONCLUSIONS: This overall experience with carotid endarterectomy is one of the largest series reported to date. The data from approved surgeons are well within the range of acceptable neurological morbidity and mortality rates recommended by the Stroke Council of the American Heart Association, which attests to the overall quality of the surgeons participating in the study.
Carotid Artery Diseases↗
An evaluation of external jugular vein patch angioplasty after carotid endarterectomy.
Seventy-six patients had 91 internal carotid endarterectomies closed with patch angioplasty. There were 36 redo and 55 primary procedures. External jugular vein was used as the patch material in 38, facial vein in nine, Dacron in seven, polytetra flour ethylene (PTFE) in nine, and saphenous vein in 28 operations. There were no perioperative deaths. Five patients required reoperation, but only one required replacement of a defective facial vein. There were five postoperative strokes, but two were related to a contralateral occlusion. Two of the three ipsilateral strokes had a temporary indwelling shunt. Only one patient returned with recurrent neurologic symptoms. Five other restenoses of greater than 75 per cent were noted in three patients. One false aneurysm occurred three months after an external jugular vein patch angioplasty. External jugular vein, although requiring careful handling, is conveniently located in the operative field, does not appear to be associated with increased complications, has excellent long-term results, and allows preservation of the saphenous vein for other bypass surgery.
Adult↗
Use of sequential B-mode ultrasonography to manage abdominal aortic aneurysms.
The utility and safety of sequential B-mode ultrasonography to treat male patients with small (less than 6.0 cm in diameter) abdominal aortic aneurysms (AAAs) were studied retrospectively in 149 consecutive patients. Sixty-three of these patients have had operative repair of the AAA. Eight-six remain unoperated on. Mean growth rate was 0.79 cm/y (1.06 cm/y in the operated-on group and 0.36 cm/y in the unoperated-on group). Seven patients sustained rupture of the AAA during follow-up and 4 patients died as a consequence of elective repair, for a combined mortality rate of 7.4% (11/149). Only one AAA that was less than 5.0 cm ruptured. This has proved to be an effective way to manage AAAs in this population.
Aged↗
Quality and duration of survival in glioblastoma multiforme. Combined surgical, radiation, and lomustine therapy.
A retrospective evaluation of the quality and length of survival of 74 patients nonrandomly receiving lomustine, 100 to 110 mg/sq m, following craniotomy and irradiation for glioblastoma multiforme was performed. After surgery all patients were capable of at least partial self-care. Patients receiving postoperative irradiation and lomustine had a median survival of 11.5 months. While receiving chemotherapy, 40% of these patients were capable of at least partial employment; 75% were able to care for themselves. These levels of function were stable for 70% of the average postoperative course (8.0 months), following which a decline ensued.
Activities of Daily Living↗
Comparison of hemodynamic, pulmonary, and renal effects of use of three types of fluids after major surgical procedures on the abdominal aorta.
Hemodynamic, pulmonary, and renal variables were measured in 24 patients scheduled for major abdominal aortic operations. Control values were obtained before preoperative medications were given. All patients received 5% dextrose in Lactated Ringer's solution intraoperatively. Postoperatively, group 1 patients received 5% dextrose in water plus albumin, group 2 received 5% dextrose in 0.45 sodium chloride solution, and group 3 received 5% dextrose in lactated Ringer's solution. There were significant increases in Qs/Qt and AaDO2, 48 hours after operation in group 3. Oxygen consumption and cardiac output increased in all groups 24 hours after operation. Twenty-four hours later, these two variables returned to control values in group 1 but continued to rise in the other two groups. Significant diuresis occurred in group 1, 48 hours postoperatively, whereas the other two groups continued to retain water. Use of albumin and 5% dextrose in water in the postoperative period seemed to produce less deviations from control values of most measured variables, than the other two groups.
Albumins↗
Diagnosis of peripheral occlusive disease: comparison of clinical evaluation and noninvasive laboratory.
One hundred and two patients with peripheral vascular disease were evaluated by the attending surgeon, residents and students, and the vascular laboratory prior to arteriography to test their ability to make a correct anatomic diagnosis. The attending surgeons made a correct anatomic diagnosis in 98 patients and were at least partially correct in the other four. Surgical housestaff and students were 62% totally correct, 35% partially correct, and 3% totally wrong. The vascular laboratory results were almost identical with the attending surgeon, but two patients could not be evaluated because of calcified arteries. The operation that was eventually performed was suggested initially by the laboratory and the attending surgeon in 98% of the patients.
Arterial Occlusive Diseases↗
Value of concomitant sympathectomy in aortoiliac reconstruction. Results of a prospective, randomized study.
The efficacy of concomitant lumbar sympathectomy in improving results of aortoiliac reconstruction was assessed by a prospective, randomized study of 51 patients undergoing operation for occlusive or aneurysmal disease. Sympathectomy was performed on 50 limbs, while 52 extremities served as controls. Sympathectomy resulted in a significant reduction in foot vascular resistance determined by plethysmography. However, the procedure had no effect on leg circulation, assessed by ankle/arm pressure indices determined by Doppler ultrasound. In the sympathectomy group, there were three early postoperative amputations for ischemia, despite patent grafts. In the control group, there was one late graft occlusion, caused by progressive atherosclerotic disease. Although sympathectomy may improve pedal circulation, the procedure does not appear to improve the results of aortoiliac reconstruction.
Adult↗
Staged intracranial and extracranial revascularization.
Twenty patients with a combination of intracranial and extracranial cerebrovascular lesions were identified in a series comprised of 118 candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Ten patients had internal carotid (ICA) occlusion and contralateral ICA stenosis, seven patients had combinations of ipsilateral lesions, usually ICA occlusion and external carotid (ECA) stenosis, and three patients had multiple lesions. Eighteen patients had a STA-MCA bypass performed; 11 of these had contralateral reconstruction for ICA stenosis, and seven had ECA stenosis corrected. Two additional patients became asymptomatic after ECA endarterectomy only and their proposed STA-MCA bypass has been postponed. There were two deaths, one early and one late. Eleven patients are asymptomatic, five are improved, one is unchanged, and one is neurologically worse.
Adult↗
The healing of below-knee amputations: a comparison of soft and plaster dressing.
To evaluate the effect of wound dressing upon wound healing, fifty-one patients undergoing below-knee amputation using a long posterior myocutaneous flap technic were randomly allocated into a soft or plaster dressing group. Neither wound dressing technic proved superior, as wounds healed in 85.2 per cent of the plaster dressing group and 83.3 per cent of the soft dressing group.
Adult↗
Minor forefoot amputation in patients with low ankle pressure.
Ankle pressures were obtained using Doppler ultrasound in fifty-seven patients undergoing forefoot amputations. Contrary to other reports, no amputations healed with a pressure of less than 60 mm Hg.
Adult↗
The cerebrovascular Doppler examination in patients with non-hemispheric symptoms.
The cerebrovascular Doppler examination indicated a significant stenosis in only 19 of 53 patients with non-hemispheric TIA'S. There were no false negative or false positive examinations. Fourteen of 19 patients with an abnormal examination and 23 of 31 patients with a normal examination became asymptomatic after a carotid endarterectomy. Eleven patients were improved and two were unchanged. Therefore the cerebrovascular Doppler examination can not be used to predict therapeutic success or failure of carotid endarterectomy for non-hemispheric TIA's.
Adult↗
Carotid endarterectomy: is an indwelling shunt necessary?
Three hundred and four consecutive endarterectomies were performed with general anesthesia and without a temporary indwelling shunt. Eight patients (2.6%) awoke from anesthesia with a new neurological deficit. Eight additional patients later developed neurological symptoms, suggesting that the absence of a shunt did not contribute to their complication. Of these 16 patients, two (0.6%) died, nine (3.0%) had a temporary neurological deficit, and five (1.6%) had a permanent neurological deficit. A prolonged occlusion time, a stump pressure of less than 50 mm Hg, or the presence of additional carotid lesions did not show a significant statistical relationship to postoperative neurological deficit.
Adult↗
Bypass of superior vena cava with spiral vein graft.
The superior vena cava was successfully bypassed in a patient with superior vena cava syndrome due to granulomatous mediastinitis. A spiral vein graft constructed from autogenous vein was utilized. Complete relief of symptoms and graft patency documented by venography six months after the operation confirm the usefulness of this procedure in patients with superior vena cava obstruction.
Cardiopulmonary Bypass↗
Pedal vasomotor tone following aortofemoral reconstructions: a randomized study of concomitant lumbar sympathectomy.
A prospective randomized trial was undertaken to evaluate effects of lumbar sympathectomy as an adjunct to reconstructive surgery of the lower limb. The objective of this study was to assess the early postoperative effect of these procedures on pedal vasomotor tone. A pedal arterial resistance index (PARI) at rest was derived from the ratio of the ankle-digit systolic pressure gradient and pedal blood flow measured plethysmographically. Studies were performed on 32 normal individuals and pre- and postoperatively in 29 patients undergoing aortic reconstruction, 12 of whom were randomly chosen to have lumbar sympathectomy. The mean postoperative PARI in 17 patients who had reconstructions alone was 42+/-7 (S.E.M.) units which approximated the preoperative PARI (43+/-9 units) and normal control values (45+/-6 units). In contrast, 12 patients who had a concomitant lumbar sympathectomy had a significant reduction in the postoperative PARI (8+/-1 units, Pless than 0.005). These initial results indicate that the addition of lumbar sympathectomy to an aortic reconstruction may enhance blood flow to the foot by significantly reducing outflow resistance.
Adult↗