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Biomedical subjects

W M Flowers

Publications and source records attributed to W M Flowers.

At least 19 recordsLinked to original sources
PubMed2000

Accuracy of clinical evaluation in the determination of brain death.

BACKGROUND: The accuracy of the clinical diagnosis of brain death has never been established. METHODS: Seventy-one consecutive clinically brain dead patients were studied retrospectively. Inclusion criteria were complete cessation of brain function with profound coma of known cause, complete absence of brain stem reflexes, and apnea, all persisting for a least 6 hours. A formal apnea test with a documented Pco2 of > 60 mm Hg was required. All evaluations were done by experienced neurosurgery or neurology resident or staff physicians. The clinical diagnosis was compared with the results of radionuclide angiography and with the clinical course and final outcome. RESULTS: Seventy patients had no arterial blood flow on radionuclide angiography. One blood flow study was considered to have yielded a false-negative result. No patient recovered or survived. CONCLUSIONS: The clinical diagnosis of brain death is highly reliable when made by experienced examiners using established criteria. In this study, the accuracy was 100%.

Adolescent↗
PubMed2000

Persistence of cerebral blood flow after brain death.

Persistent cerebral blood flow occasionally confounds confirmatory tests for brain death and results in the anguish of delayed diagnosis, unnecessary use of expensive resources, and loss of transplant opportunities. We reviewed the literature to examine the reasons, frequency, and meaning of this problem. We found that this phenomenon occurs: (1) before increasing intracranial pressure completely shuts down flow; (2) in infants with pliable skulls; and with (3) decompressing fractures, (4) ventricular shunts, (5) ineffective deep brain flow, (6) reperfusion, (7) brain herniation, (8) jugular reflux, (9) emissary veins, and (10) pressure injection artifacts. Isolated venous sinus visualization is common (occurring in up to 57%) but represents trivial blood flow and confirms brain death. Arterial flow is much less common (2.6% incidence in our series). Normal flow occurs but is rare. Arterial flow does not exclude brain death, but the diagnosis should be confirmed by repeated studies or other means.

Brain Death↗
PubMed1999

Sometimes doctors need help too--the Mississippi Recovering Physicians Program.

Fully 10 to 15% of medical doctors will develop chemical dependency during their lifetimes. This results in addiction to alcohol or other mood altering drugs. The Mississippi Recovering Physicians Program provides a confidential, non-punitive alternative to disciplinary sanctions for impaired physicians who voluntarily seek or are motivated to accept intervention, treatment, counseling, and rehabilitation for their impairement. With proper treatment, the prognosis is excellent.

Confidentiality↗
PubMed1997

Systemic radionuclide therapy with strontium chloride Sr 89 for painful skeletal metastases in prostate and breast cancer.

Systemic radionuclide therapy with strontium chloride Sr 89 is a rediscovered alternative to relieve pain from bony metastases. Although numerous advances have been made in the diagnosis and treatment of cancer, pain remains a serious and debilitating disease complication. An increasing number of clinical trials are reporting satisfactory results with 89Sr-chloride therapy, now available for widespread clinical use. We have treated 11 patients with this radionuclide; of these patients, 8 had excellent to dramatic pain relief and 3 had mild to moderate improvement. Clinical response was based on subjective pain relief, increased mobility, decreased analgesic uptake, and/or improvement in daily activities, including work habits.

Activities of Daily Living↗
PubMed1997

Radionuclide angiography as a confirmatory test for brain death: a review of 229 studies in 219 patients.

BACKGROUND: Radionuclide angiography (RA) has been used for many years to confirm the clinical diagnosis of brain death, but quantitative data regarding the technique are unavailable. METHODS: We conducted a retrospective review of 229 RA procedures done in 219 patients. RESULTS: Of 206 patients who had interpretable studies and met clinical criteria for brain death (profound coma, absent brain stem reflexes, and apnea), including 10 patients who had repeated studies, 203 (98.5% sensitivity) had positive studies, and 6 (2.9%) had negative studies. Of nine patients who had interpretable studies and did not meet the clinical criteria for brain death, five (56% specificity) had positive studies and four (44%) had negative studies. CONCLUSIONS: Radionuclide angiography is a sensitive confirmatory test of brain death. The study does not evaluate the posterior fossa circulation, and an occasional patient may have residual brain stem function. The examination is most reliable when the patient is in a deep coma, has no brain stem reflexes, and has failed a formal apnea test.

Adolescent↗
PubMed1992

Evaluation of mammographic calcification.

Breast calcifications can be classified into ductal, lobular, or miscellaneous types. Analysis is less difficult using this classification. Frequently, the characterization of miscellaneous types is straightforward. The analysis of ductal type and lobular type microcalcifications is more challenging. If they are scattered, the most important determination is whether or not there are casting calcifications present. If so, malignancy cannot be excluded. If clustered, then analysis of their form becomes critical. Teacup or pearl type calcifications are benign. Granular or casting calcifications are malignant. Mammographic calcifications that appear obviously malignant or highly suspicious for malignancy warrant biopsy whether or not a mass is clinically palpable. If calcifications are obviously benign, then routine follow-up at four to six month intervals if there is a high probability that they are benign. Otherwise, they are biopsied at the discretion of the clinician.

Breast Neoplasms↗
PubMed1992

Evaluation of mammographic stellate lesions.

Breast masses can be classified into circumscribed masses and stellate masses. Stellate masses are more difficult to detect but are easier to analyze. Good technique, proper processing, proper viewing conditions, and critical comparison of right vs. left and current vs. old can aid in the detection of stellate masses. Once detected, analysis is straightforward. Most will be scirrhous carcinomas. A few will be radial scars, traumatic fat necrosis, or rare benign lesions. Additional signs such as architectural distortion and microcalcifications can be very important. Additional views, including spot compression films, may be decisive. Not all stellate lesions are malignant, but most will require biopsy. Traumatic fat necrosis may be differentiated on the basis of history or radiographic appearance and does not need intervention. Lesions suspicious for carcinoma and radial scars should be excised and examined histologically.

Breast Neoplasms↗
PubMed1979

Acute pulmonary edema after the intravenous administration of contrast media.

Acute pulmonary edema developed in two young, previously healthy women immediately after the intravenous administration of contrast media. The pulmonary edema, rare in young persons, could not be explained by classical anaphylaxis, contrast media overdose, sodium and fluid overload, or acute myocardial infarction. A nonimmunologic osmotic mechanism causing reversible pulmonary capillary leak might explain the clinical events observed in both patients. Both responded to continuous positive airway pressure (CPAP), indicating the possible utility of CPAP in treating pulmonary capillary-leak contrast reactions.

Adolescent↗