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Biomedical subjects

W H Edwards

Publications and source records attributed to W H Edwards.

At least 73 records · Page 4Linked to original sources
PubMed1987

Infected abdominal aortic aneurysms.

We report five cases of infected abdominal aortic aneurysm managed at the St. Thomas Hospital between 1975 and 1985. Two patients died, one before operation, and another during surgical repair of aneurysmal rupture. Three patients survived, all of whom had primary repair of the aorta or in situ Dacron graft reconstruction. One patient is still living nine years after operation. The availability of organism-specific antibiotic agents has enabled us to use the in situ reconstruction method to successfully manage these patients without increased morbidity or mortality from recurrent infection. A high index of suspicion, prompt surgical resection, and aggressive specific antibiotic therapy are necessary for patient survival.

Aged↗
PubMed1987

External ventricular drainage for initial treatment of neonatal posthemorrhagic hydrocephalus: surgical and neurodevelopmental outcome.

Thirty-seven infants were treated for posthemorrhagic hydrocephalus (PHH) with external ventricular drainage (EVD) in 1977-1985. The mean age at EVD placement was 13 days; the mean duration of drainage was 21 days, and an average of 1.8 drains was used per patient. Complications were apnea (10%), hemorrhage (8%) and ventriculitis (6%). Ten infants died from pulmonary disease unrelated to the surgery. Thirty-two percent of the survivors did not require a permanent shunt. Neurodevelopmental outcome was evaluated at a mean age of 38 months. Eighteen of the twenty-seven survivors (67%) had normal cognitive function, 3 had borderline and 6 (22%) had moderate to profound mental retardation. Nine of the children (33%) had a normal neuromuscular exam. One child had mild, 11 had moderate and 6 had severe cerebral palsy. Four children had serious visual impairment. The worst outcomes were in the children with parenchymal or large intraventricular hemorrhages.

Cerebral Hemorrhage↗
PubMed1987

Primary graft infections.

An amputation rate of 8% to 52% and a mortality rate of 13% to 58% make vascular prosthetic graft infections the most dreaded complication facing a vascular surgeon. In 1978 a randomized prospective double-blind study reported a statistically significant decrease in wound infections in patients treated with prophylactic antibiotics whereas the graft infection difference only approached statistical significance. The present study reviews 2614 arterial prosthetic grafts implanted from January 1975 through June 1986. Twenty-four patients were identified as having a prosthetic graft infection, yielding an overall infection rate of 0.92%. Staphylococcus aureus was the most common organism, occurring in one third of the cases. The most common graft material was polytetrafluoroethylene (PTFE) (33%) followed by Dacron (29%), composite PTFE and Dacron (20%), and umbilical vein grafts (9%). Diabetes was a common factor in one third of the patients. Symptoms of infection were present in 15 patients (63%) within 3 months of operation, with 11 patients showing symptoms within 30 days. The longest interval between operation and onset of symptoms was 48 months. Prophylactic antibiotics were administered to 22 of the 24 patients, but in only 7 of the 22 (29.5%) were they given according to our usual practice. All patients required removal of the infected prosthesis, with limb loss in 17% and death in 17%.

Anti-Bacterial Agents↗
PubMed1987

Experimental evaluation of a new albumin-impregnated knitted dacron prosthesis.

The performance of a new albumin-impregnated, knitted vascular graft stored damp in saline was assessed by a comparative study in the canine aorta. Knitted grafts interposed into the descending thoracic aorta for 4 weeks included: albumin-coated and stored damp in saline (damp albuminated) (n = 6), albumin-coated and freeze-dried (dry albuminated) (n = 5), collagen-coated (n = 4), and uncoated (n = 4). The results of macroscopic and microscopic evaluation were subjected to one-way analysis of variance (Newman-Keuls). Damp albuminated grafts had significantly less transinterstitial blood loss than uncoated grafts (P less than 0.05). No significant differences in thrombogenicity, thrombus-free surface area, tissue ingrowth, or endothelial coverage existed between the damp albuminated and the uncoated grafts. However, significantly less thrombogenicity (P less than 0.05) and more endothelial cell coverage (P less than 0.05) were present in the damp albuminated grafts than in the collagen-coated grafts. No evidence for delayed graft hemorrhage or distal embolization was found in any group. The new damp albuminated graft is a minimally thrombogenic prosthesis combining low implantation porosity with relative ease of handling. It should function well as a low porosity graft for great vessel replacement.

Animals↗
PubMed1987

Primary non-Hodgkin's lymphoma of the liver.

A patient with irresectable primary non-Hodgkin's lymphoma of the liver (histiocytic type, Rappaport classification) is presented. Systemic chemotherapy combined with local irradiation were successful in achieving a disease-free interval in a follow-up of 36 months. Review of the literature disclosed 19 other patients previously reported, with considerable variations in extent of disease at presentation. Criteria for the diagnosis of primary non-Hodgkin's lymphoma are proposed, and 11 patients met these criteria. Hepatic resection is advocated for localized tumour, while systemic chemotherapy and local irradiation in patients with irresectable tumours were found effective in achieving local and systemic control in a mean follow-up of 37 months.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Airway injuries. The first priority in trauma.

During the last 12 years, 20 patients with significant airway injuries have been treated for lesions involving the trachea, larynx, and/or bronchus. Fourteen of the injuries were the result of penetrating wounds, nine gunshot wounds, and five stab wounds. Six patients presented with blunt trauma, four as a result of motor vehicle accidents, one from a clothesline injury, and one from a crush injury. Sixteen of the 20 were males; average age was 29.6 years. Eleven patients had injuries involving only the trachea, six had isolated laryngeal injuries, two had bronchial injuries, and one patient had a combined injury of the trachea and larynx. Eleven had subcutaneous emphysema, four had hemoptysis, and three stable patients experienced sudden respiratory arrest while being evaluated for the repair of their injuries. Twelve patients required immediate intubation or tracheostomy. Most airway injuries were closed primarily. In one instance segmental resection of a perforated trachea and primary anastomosis was necessary. Two patients died after proper management of the airway injury. One died of an associated brain stem injury and the other of profuse hemorrhage from a liver injury. Of the 18 surviving patients, all but two recovered totally without residual impairment. Described here is a protocol for the evaluation and immediate treatment of airway injuries that is consistent with the guidelines of the Subcommittee of Advanced Trauma Life Support of the American College of Surgeons Committee on Trauma. Aggressive initial management, high index of suspicion for injury, and meticulous repair of the injured airway are equally important steps in the successful management of these patients.

Accidents, Traffic↗
PubMed1987

Recurrent carotid stenosis. Incidence and management.

The actual incidence of recurrent carotid occlusive disease is not known. From January 1974 through December 1984, fifty-four patients underwent at least one second carotid endarterectomy or reconstructive procedure at St. Thomas Hospital in Nashville. Five patients required a third carotid operation. This retrospective study examines case reports, risk factors, patient presentation, interval of recurrence, and pathology involved. Surgical techniques and results are described. Complications occurred in six patients undergoing a total of 66 operations for an overall incidence of 9 per cent. Thrombosis was minimized by the use of antiplatelet drugs. Follow-up of patients ranged from one to 84 months. Four main causes for restenosis are discussed.

Aged↗
PubMed1986

Surgical reconstruction of the proximal subclavian and vertebral arteries.

The diagnosis and management of atherosclerotic lesions of the extracranial internal carotid artery has become fairly well established. Symptoms of basilar artery hypoperfusion may be due to stenotic lesions at the origin of either or both vertebral arteries or the proximal subclavian artery. Surgical correction can offer relief of symptoms. For the past decade, we have used a direct anastomosis from the vertebral or subclavian artery distal to the lesion to the adjacent common carotid artery. We have done this procedure 579 times, with one death and no neurologic deficit. A lymph fistula required closure in one patient, and reoperation was necessary in three patients because of bleeding. The results have been excellent, and we continue to offer this method of restoring arterial circulation in patients with cerebellar symptoms and vertebral hypoperfusion.

Adult↗
PubMed1985

A cranial nail for fetal shunting.

A small number of human fetal hydrocephalics have been treated by ventriculoamniotic shunts of silastic tubing. The Colorado device appears to be the one most commonly used. The original experimental device tested on a primate model resembled a hollow shingle nail. This was designed by Michedja and Hodgen, contained a spring valve, measured approximately 32 X 4 mm and was placed by hysterotomy. An attractive feature of this design was its fixation by impaction in the skull, preventing displacement by fetal activity, a reported disadvantage with the silastic devices. To our knowledge, no one has used this nail-like design and tailored it to transuterine percutaneous placement in a human case.

Adult↗
PubMed1985

Unusual pulmonary reaction to respiratory therapy in a premature newborn.

The case of an infant with the clinical features of bronchopulmonary dysplasia but with pathologic features unlike those usually associated with this condition is reported. The condition of this infant was probably related to respiratory therapy and may have been a variant of bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗
PubMed1985

The role of antiplatelet drugs in carotid reconstructive surgery.

Neurologic events following carotid reconstructive surgery for symptomatic cerebral occlusive disease are generally reported to be one to two per cent. One of the events leading to this incidence is thrombosis of the endarterectomized internal carotid artery (ICA) after surgery. Since antiplatelet drugs have been found to be effective in altering platelet-induced thrombosis, we undertook a clinical trial of administration of aspirin (or aspirin-like) drugs to a group of patients who were to undergo ICA endarterectomy. This group was then compared to a comparable group from the previous year in whom drugs had not been administered. Thrombosis resulting in hemiparesis occurred on six occasions in five patients in the group that did not receive drugs. Thrombosis was not observed in two patients exhibiting hemiparesis in the drugs group. On the basis of these results, we concluded that the incidence of neurological complications following carotid reconstructive surgery can be further reduced by the use of aspirin and aspirin-like drugs.

Adult↗
PubMed1985

The surgical reconstruction of the proximal subclavian and vertebral artery.

Endarterectomy, bypass, or direct arterial anastomosis are used to restore flow in a compromised vertebral or subclavian artery. During 20 years of experience in surgical relief of stenosis of the proximal vertebral and subclavian arteries, we now prefer an anastomosis between the involved vertebral or subclavian artery. We have performed 411 such procedures. There has been one death (0.2%), with reoperation necessary in three patients (0.0%). No neurologic morbidity has been associated with this procedure.

Carotid Arteries↗
PubMed1984

Combined aortic and renal arterial reconstruction.

Vascular surgeons often suggest that combining renal arterial procedures with aortic replacement greatly increases morbidity and mortality. To evaluate this hypothesis we retrospectively reviewed 102 consecutive primary operations involving both renal arterial and aortic reconstruction. The patient population included 69 men and 33 women with an average age of 63 years. All aortic replacements were knitted Dacron grafts. One hundred twenty-eight renal arteries were revascularized with 104 vein or synthetic aortorenal bypass grafts, 12 arterial reimplantations, and three endarterectomies with vein patch. Thirty-five complications occurred in 24 patients with four hospital deaths. Postoperative hospitalization averaged less than 11 days. This study suggests that under optimal conditions renal arterial and aortic reconstructions can be combined without significantly increasing patient risk.

Aged↗
PubMed1984

Newborn puppy cerebral acid-base regulation in experimental asphyxia and recovery.

We hypothesized that part of the newborn tolerance of asphyxia involves strong ion changes that minimize the cerebral acidosis and hasten its correction in recovery. After exposure of newborn puppies to 15 or 30 min experimental asphyxia (inhalation of gas with fractional concentration of CO2 and of O2 in inspired gas = 0.07-0.08 and 0.02-0.03, respectively), blood lactate increased to 13.2 and 23.4 mmol/l, respectively, brain tissue lactate increased to 14.4 and 19.7 mmol/kg, and cerebrospinal fluid (CSF) lactate increased to 7.6 and 14.4 mmol/l. We presume that the tissue lactate increase reflects increases in brain cell and extracellular fluid lactate concentration. The lactate increase, a change that will decrease the strong ion difference (SID), [HCO3-], and pH, was accompanied by increases in Na+ (plasma, CSF, brain), K+ (plasma, CSF), and osmolality without change in Cl-. After 60-min recovery, plasma and brain lactate decreased significantly, but CSF lactate remained unchanged. [H+] recovery was more complete than that of the strong ions due to hyperventilation-induced hypocapnia. We conclude that during asphyxia-induced lactic acidosis, changes in strong ions occur that lessen the decrease in SID and minimize the acidosis in plasma and CSF. To the extent that the increase in brain tissue sodium reflects increases in intra-and extracellular fluid sodium concentration, the decrease in SID will be less in these compartments as well. In recovery, CSF ionic values change little; plasma and brain tissue lactate decrease with a similar time course, and the [H+] is rapidly returned toward normal by hypocapnia even while the SID is below normal.

Acid-Base Equilibrium↗