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Biomedical subjects

W H Edwards

Publications and source records attributed to W H Edwards.

At least 91 records · Page 5Linked to original sources
PubMed1983

The role of graft material in aortic reconstructive surgery.

Graft replacement of an aneurysmal abdominal aorta and bypass grafting for aorto-iliac occlusive disease has proven effective since synthetic materials were introduced three decades ago. During the period 1978-1981, 584 patients underwent aortic reconstruction for aneurysmal or aorto-iliac occlusive disease. Two hundred fifty-four patients (43%) were operated for aneurysms while 330 (57%) patients had symptomatic aorto-iliac occlusive diseases. There were 508 (87%) men and 76 (13%) women. Associated disease was common, with 245 patients (42%) having arteriosclerotic heart disease, 291 (50%) hypertensive, 128 (22%) having manifestations of extracranial occlusive disease, and 50 (8.6%) having diabetes mellitus. Sixty-four (10%) patients in this series had coronary revascularization prior to their aortic graft. One hundred five (17.9%) carotid endarterectomies had been performed previously or immediately prior to aortic grafting. Distal reconstructive operations had been performed in 106 patients (18%). Renal or mesenteric revascularizations were performed concomitantly in 87 and eight patients, respectively. One hundred two femoral reconstructions or distal bypasses were also performed to assure adequate outflow. Thirteen (2.27%) deaths occurred during the first 30 days. Cardiac problems accounted for eight of these deaths. Graft occlusion occurred in the immediate postoperative period in four (0.4%) limbs. During the follow-up, an additional seven limbs (1.04%) have occluded. There have been no other complications associated with the grafts during the follow-up period. Results in this series affirm the authors' strong commitment to direct aortic reconstruction.

Adult↗
PubMed1983

The management of brachiocephalic occlusive disease.

The pathophysiology of transient ischemic attacks (TIAs) is fairly well established. Hemispheric TIAs associated with extracranial carotid lesions have been evaluated extensively. Brain stem insufficiency accounts for between five to 15 per cent of patients with nonneurologic strokes. Basilar artery insufficiency is characterized by "drop attacks," syncope, or bilateral paresthesias. In evaluating some 2,300 patients with cerebral symptoms, we found 361 with brachiocephalic occlusion of such degree that surgery was recommended. We prefer direct anastomosis of the distal subclavian or vertebral artery to its adjacent common carotid artery. We have performed the operation 276 times with a 0% mortality and minimal morbidity. There have been no neurologic deficits as a result of interruption of cerebral flow.

Arterial Occlusive Diseases↗
PubMed1983

Heinz body hemolytic anemia in newborns and failure of laboratory studies to implicate a phenolic disinfectant.

Two unrelated, white, female, premature infants in the same hospital nursery contemporaneously exhibited features of an acute, Heinz body hemolytic anemia: decreased levels of hemoglobin and hematocrit, anisocytosis, fragmented cells, hyperbilirubinemia, reticulocytosis, and red cell inclusion bodies. Physical examination and laboratory studies failed to reveal the etiology of this process. Epidemiologic studies indicated a possible association between the reaction and the improper use and inappropriately high concentration of a phenolic disinfectant. Such an association has been suggested previously between similar products and epidemics of hyperbilirubinemia. Despite extensive experimental efforts (four species, six routes of administration, newborn rats, splenectomized rats, direct incubation with age-matched human cord blood), the reaction could not be produced in the laboratory. It may be highly specific for the intact, human, premature infant. Perhaps the hyperbilirubinemia reported previously had an erythrocytic rather than hepatic origin.

Anemia, Hemolytic↗
PubMed1982

Vascular reconstruction in the octogenarian.

The octogenarian has usually been considered too old to have resection of a 6 cm abdominal aortic aneurysm, which is as life-threatening as a carcinoma of the colon. Other vascular lesions can also be a threat to the mobility of the elderly person. Our approach to debilitating lesions such as these has been to offer reconstructive surgery if the patient's general condition warrants. Improvements in monitoring and patient care have allowed us to perform 174 primary vascular procedures in 144 patients with a hospital mortality of 5.5%. We believe the complication rate (13.8%) also to be acceptable. Cerebrovascular reconstruction was performed 52 times in 45 patients. Significant complications occurred twice and two patients died. Twenty-one aortic aneurysms were resected; five were ruptured. Death occurred in three patients. Lower extremity revascularization was performed 85 times in 65 patients. Embolectomy was done in 14 patients and upper extremity revascularization in two. Three patients in these last groups died. These results lead us to believe that, in a hospital with excellent support systems, an operative approach to debilitating vascular problems is justified.

Aged↗
PubMed1982

Collection methods and contamination of bank milk.

Bank milk collected by manual expression was less likely to be contaminated than milk collected by other methods. Contamination with coliforms and gentamicin-resistant Gram-negative rods was related to the pumps used by donors in their homes. Stringent precautions reduced but did not eliminate contamination.

Bacteria↗
PubMed1981

CSF acid-base regulation and ventilation during acute hypercapnia in the newborn dog.

We studied the response of blood, cerebrospinal fluid (CSF), and brain ionic composition and acid-base status as well as ventilation to acute respiratory acidosis (FICO2 0.08) in lightly anesthetized newborn puppies. Control puppy plasma ions and CSF-plasma ionic distribution ratios were essentially adultlike while in blood a mild, compensated respiratory acidosis was present, and in CSF, PCO2 and [HCO3-] were slightly higher than in adults. Brain tissue water content was higher in puppy vs. adult; the Cl- space was greater; the content of [Na+], [Cl-], and [HCO3-] were higher and [K+] lower. During respiratory acidosis, CSF [HCO3-] increased 2.0 mmol/l by 15 min and 6.2 mmol/l by 3 h, a response quantitatively like that observed in the adult. The quantity, CSF [Na+] -- [Cl-], increased stoichiometrically with CSF [HCO3-], indicating the mechanistic involvement of these ions in the CSF [HCO3-] response. In brain tissue, water content, [Cl-], and the [Cl-] space were unchanged, but by 3 h [Na+] and [HCO3-] were increased. Ventilation was stimulated but the response expressed as ml.min-1.Torr-1.body wt-1 was less in puppy than in adult.

Acid-Base Equilibrium↗
PubMed1981

Brain and CSF water and ions in newborn puppies during acute hypo- and hypernatremia.

We studied the fluid and electrolyte response of the brain and cerebrospinal fluid (CSF) in the lightly anesthetized newborn puppy exposed to acute (1-3 h) mild hyponatremia (12% decrease) and hypernatremia (7% increase). The changes in CSF osmolality, sodium, and chloride were equal to those in plasma. Blood acid-base values and CSF PCO2 remained normal, but in CSF there was a transient dilution acidosis in hyponatremia and contraction alkalosis in hypernatremia. In brain tissue, with hyponatremia, brain water increased in proportion to the osmotic stress (a change which was greater than that previously observed in adults) and the chloride space increased in the puppy (a change that was opposite to that observed in adults). There were no significant changes in dry tissue potassium, sodium, or chloride content. In hypernatremia, brain water decreased less than predicted by the osmotic change, the chloride space was unchanged, dry tissue potassium and chloride increased, and sodium was unchanged. In the newborn puppy, brain cell and extracellular volume regulation is not apparent with acute hyponatremia but is with hypernatremia.

Acute Disease↗
PubMed1981

External ventricular drainage for control of posthemorrhagic hydrocephalus in premature infants.

Over a 3-year period, 11 premature infants with intraventricular hemorrhage and posthemorrhagic hydrocephalus were managed initially with prolong external ventricular drainage via a subcutaneously tunneled catheter. The mean duration of drainage for this group was 20.7 days. Although two patients died before shunting was considered, no morbidity or mortality was observed to result from this technique. Seven patients required a shunt after stabilization of their medical problems. Two patients, followed for 24 and 40 months, have not required shunting procedures. External ventricular drainage via a subcutaneously tunneled catheter has been found to be a safe and reliable initial method of treating posthemorrhagic hydrocephalus in premature infants.

Cerebral Hemorrhage↗
PubMed1980

The role of graft material in femorotibial bypass grafts.

"Newer" graft substitutes are being widely used in arterial reconstructive procedures in the infrafemoral region. A retrospective study of 101 consecutive femorotibial bypass grafts compares autogenous saphenous vein (ASV), polytetrafluoroethylene (PTFE), and glutaraldehyde tanned (GA) human umbilical cord vein. Symptoms prompting arterial reconstruction was rest pain or tissue necrosis in 90%. Asv (57 bypasses) was the material of choice, but when inadequate or unavailable PTFE, (29 bypasses) or GA (15 bypasses) were used. The immediate and one year patency in ASV was 92--82%. A high incidence of failure occurred in both the PTFE and GA grafts so that patency at one year was 24 and 10% respectively. An overwhelming statistical significance occurs with respect to patency in the three groups of grafts (p = 0.0002). This extremely high incidence of failure in these graft materials has prompted us to use cephalic and basilic veins in those patients which we feel require arterial reconstruction for relief of symptoms.

Adult↗
PubMed1980

Improved survival after ruptured abdominal aortic aneurysm.

Rupture of an abdominal aortic aneurysm continues to be the most imminently catastrophic situation facing the peripheral vascular surgeon. Without emergency resection the mortality is 100%, and in the past, even with operation, few patients have survived. Numerous recent reports continue to show mortality rates exceeding 50%. Our survival rates have been significantly improved by an aggressive, preplanned approach to all patients with abdominal pain and aneurysms. Mortality rates have improved from 69% for 22 patients operated on between 1962 and 1970 to 23% for 35 patients operated on from 1971 to 1978. Successful management requires coordinated effort by the blood bank, emergency room, and operating room facilities, as well as rapid and definitive operative technic to control and replace the aneurysm. Compression of the aorta at the diaphragm, systemic heparinization, and limiting the resection to the aorta whenever possible have proved useful.

Aged↗
PubMed1980

The effects of acute total asphyxia and metabolic acidosis on cerebrospinal fluid bicarbonate regulation in newborn puppies.

We evaluated CSF [HCO3-] regulation in lightly anesthetized newborn puppies following: (1) acute total asphyxia; (2) metabolic acidosis; and (3) metabolic acidosis induced after acute asphyxia. Five and one-half min of total asphyxia resulted in a 4.4 mM/liter decrease in mean CSF [HCO3-]. During 65 min of recovery with mechanical ventilation mean CSF [HCO3-] increased 1.7 mM/liter. Mean plasma [HCO3-] decreased 7 mM/liter and recovered 4.5 mM/liter in the same period. We produced a stable metabolic acidosic for 4 hr using a peritoneal dialysis technique with PaCO2 maintained at the normal value. With acidosis in nonasphyxiated control puppies, CSF [HCO3-] decreased steadily. At 4 hr, the ratio, delta CSF [HCO3-]/delta plasma [HCO3-], was 0.43, a value close to that observed in adults of many species with metabolic acid-base disturbances, 0.41. With acidosis in asphyxiated puppies allowed 1 hr of recovery, the time course and mean values of plasma and CSF [HCO3-] were indistinguishable from those of the nonasphyxiated acidotic controls. Newborn puppies appear to regulate CSF [HCO3-] in response to acute asphyxia or metabolic acidosis, and acute asphyxia does not impair the puppy's ability to regulate CSF [HCO3-] in metabolic acidosis.

Acidosis↗
PubMed1980

The current status of femoropopliteal bypass grafting.

Results of saphenous vein bypass grafts for femoral occlusive disease justify their use in the management of patients with threatened limb loss and in selected patients with intermittent claudication. Early results with PTFE and umbilical vein grafts indicate that successful bypass is feasible in patients with absent or inadequate saphenous veins. Currently, however, long-term follow-up with these new grafts is lacking and continued use of saphenous vein grafts whenever possible is preferred.

Arterial Occlusive Diseases↗
PubMed1980

The surgical approach to significant stenosis of vertebral and subclavian arteries.

Nonhemispheric transient ischemic attacks (TIAs) occur as a result of diminished flow to the basilar artery and its branches. The importance of the four major sources of blood supply have been emphasized. Angiographic evaluation of 1,700 patients with cerebral symptoms revealed significant subclavian or vertebral stenosis in 244. Since 1972 a direct anastomosis to the adjacent common carotid artery has been the selected operative procedure to restore flow to distal arteries. Exposure and completion of the anastomosis requires only a supraclavicular approach and can be performed safely. No deaths or neurological deficits as a result of interruption of cerebral flow have occurred. Complications have been minor.

Adult↗
PubMed1978

Vascular reconstructive surgery following myocardial revascularization.

Survivors of successful coronary bypass have a life expectancy close to normal. Myocardial infarction has been the major cause for morbidity and mortality in patients requiring surgery. Current data suggests that patients who have undergone CAB are not only acceptable risks for subsequent surgery, but may in fact have a lesser cardiac risk than the routine patient. The selection of the proper sequential surgical procedures is critical for patient survival. We reviewed 74 major vascular reconstructive procedures in 53 patients. Twenty-nine cerebrovascular procedures, 20 femoro-popliteal bypasses, aneurysmectomy nine times, and aortic bypass in 16 patients were the procedures performed. Twenty-two abdominal operations were performed with no significant morbidity or mortality. Two patients died during the postoperative period and three have subsequently died. The 48 survivors continue to do well.

Adult↗
PubMed1978

Antibiotic prophylaxis in vascular surgery.

Preoperative and intraoperative antibiotic prophylaxis of infection in peripheral vascular surgery has been widely used although controlled studies have been lacking. A randomized, a prospective, double-blind study of cefazolin versus placebo during 565 arterial reconstructive operations was performed at this hospital from February 1976 through August 1977. Among the 462 patients undergoing surgery of the abdominal aorta and lower extremity vasculature, there was a highly significant difference in the infection rates: 6.8% for placebo recipients versus 0.9% for cefazolin recipients (p less than .001). Of the 18 infections, four involved vascular grafts and all four graft infections occurred in the placebo group. Over 8% of abdominal wounds of patients receiving placebo became infected versus 1.2% of cefazolin patients (p less than .05). Groin wounds were infected infrequently, 1.1% for placebo patients versus none for cefazolin patients. No infections occurred among 103 brachiocephalic procedures. Skin antisepsis was analyzed retrospectively. Infection rates were significantly higher (p less than .01) following hexachlorophene-ethanol versus a povidone-iodine skin preparation. Adverse effects of cefazolin were carefully monitored: no rash, phlebitis, or emergence of resistant strains was observed. A breif perioperative course of cefazolin and povidone-iodine skin antisepsis are recommended in vascular reconstructive surgery of the abdominal aorta and lower extremity vasculature.

Antisepsis↗