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Biomedical subjects

W P Graham

Publications and source records attributed to W P Graham.

At least 55 records · Page 3Linked to original sources
PubMed1981

Primary hyperparathyroidism: four- to eight-year postoperative follow-up demonstrating persistent functional insignificance of microscopic parathyroid hyperplasia and decreased autonomy of parathyroid hormone release.

Thirty-nine patients with primary hyperparathyroidism were studied four to eight years after their initial operation. In six patients, both the pathologist and surgeon agreed on the diagnosis of solitary adenoma; in 16 patients, the surgeon diagnosed solitary adenoma and the pathologist parathyroid hyperplasia (microscopic hyperplasia). In 16 patients, primary chief cell hyperplasia was agreed upon by the pathologist and surgeon. In the 16 patients with microscopic hyperplasia, there have been no long-term recurrences of hypercalcemia, but, in two patients, plasma parathyroid hormone levels are high. Parathyroid hormone--total calcium regression curves demonstrate significant preoperative correlation in solitary adenoma, p less than 0.01, and primary chief cell hyperplasia, p less than 0.05. After operation, significant correlations were not found between parathyroid hormone and total calcium. T-testing slope differences of pre- and postoperative parathyroid hormone--total calcium regression curves demonstrates a significant (p less than 0.01) shift to the right of the microscopic hyperplasia patients after operation, moving them to a broader range of total calcium per picogram parathyroid hormone. We conclude that 1) in primary hyperparathyroidism, positive regulation of total calcium by autonomously released parathyroid hormone exists in patients with solitary adenoma and chief cell hyperplasia; 2) autonomously functioning parathyroid tissue has been removed by operation for solitary adenoma with coexistent microscopic parathyroid hyperplasia. In this four- to eight-year follow-up period, it is clear that microscopic parathyroid hyperplasia is not associated with recurrent hypercalcemia. Two functionally distinct forms of parathyroid suppression are suggested; positively regulated microscopic hyperplasia and negatively regulated pathologically suppressed glands.

Adenoma↗
PubMed1981

Escharotomies.

Explore the source record for details and available documents.

Burns↗
PubMed1980

The circular excision.

A simple, practical alternative to the traditional method of excising small cutaneous lesions is described. It has the advantages of decreased length of final closure and flexibility in determining the orientation of final incisions in areas where it may be difficult to accurately determine skin tension lines.

Facial Dermatoses↗
PubMed1979

Effects of tourniquet ischemia and postischemic edema on muscle metabolism.

In vivo interstitial muscle pressures measured by wick catheter, tissue gas tensions measured by mass spectrometer, and glucose and high-energy phosphate metabolism measured fluorometrically were studied in the anterior tibial (AT) and vastus lateralis (VL) muscles of primate limbs during and following tourniquet ischemia (2.5 hours; 400 mm Hg) to elucidate postischemic edema and its metabolic consequences. During ischemia, interstitial pressure in the VL rose, while in the AT it decreased, but 24 hours later pressures in both experimental muscles were significantly greater than those in the controls. In both experimental muscles PO2 decreased significantly within 15 minutes of ischemia. PCO2 increased significantly in the AT at 30 minutes and at 75 minutes in the VL muscle. Twenty-four hours later only PO2 in the experimental AT was significantly different than its matched control. During ischemia glucose and phosphocreatine (CrP) decreased significantly, and G-6-P and lactate increased significantly in both muscles, but at 24 hours glucose levels were 25% lower and G-6-P 16.2% higher in the experimental AT and CrP 34% lower in the experimental VL. This study shows that there are significant acute and delayed alterations in primate muscle metabolism following tourniquet ischemia and suggests that these changes may be related to the anatomic location of the muscle studied and the type of trauma it has sustained.

Animals↗
PubMed1979

Hemangioma of the temporalis muscle: a case report and review of the literature.

Hemangiomas are the most common benign tumors of infancy and childhood. Most involve skin and subcutaneous tissues and are readily visible. Intramuscular hemangiomas are very uncommon, and rarely appear in the musculature of the head and neck. A 59-year-old woman who had had a lipoma excised from her left temporal region many years earlier underwent excision of a hemangioma of the left temporalis muscle. Intramuscular hemangiomas do not spontaneously involute and should be removed as soon as they are diagnosed, in order to obviate later destruction of the involved muscle and adjacent tissues. Preoperative embolization of the hemangioma may reduce intraoperative hemorrhaging.

Eyeglasses↗
PubMed1979

Intravascular coagulation and fibrinolysis within primate extremities during tourniquet ischemia.

A common although infrequently recognized complication associated with the use of a pneumatic tourniquet is profuse bleeding from the wound after deflation of the tourniquet. The purpose of this study was to determine whether intravascular coagulation and fibrinolysis could be induced in subhuman primates by tourniquet ischemia, and whether this phenomenon could be altered by pretreatment of the animal with heparin. It was shown that, after 2(1/2) hours of tourniquet ischemia, (400 mmHg) to one lower limb, fibrinogen levels were significantly lower (p < .005), antithrombin III levels were significantly lower (p < .05), plasminogen levels were significantly lower (p < .05), fibrin split products significantly higher (p < .025) and fibrinopeptide A levels were significantly higher (p < .02) than values measured simultaneously in the control limbs. After pre-treatment with sodium heparin, 30 units/kg, there was no change in antithrombin III levels or fibrinogen levels, but fibrin split products in the experimental limbs were significantly elevated (p < .05) when compared to control limbs. In both groups the abnormal levels returned to control levels 5-30 minutes after tourniquet deflation. We conclude that intravascular coagulation and fibrinolysis develop within ischemic subhuman primate limbs during tourniquet ischemia. Pretreatment with heparin prevents the consumption of fibrinogen and antithrombin III but does not prevent the increase in fibrin split products which was observed. It is possible that intravascular coagulation and fibrinolysis contribute to post tourniquet bleeding.

Animals↗
PubMed1978

Wife abuse. The diagnosis and its implications.

Wife abuse is receiving widespread attention in the lay press, but its discussion in the medical literature has been rare. Identifying a victim of wife abuse is complicated, since these women will seldom volunteer that information. There are no economic, educational, or class predictors of wife abuse. Suspicion of abuse should be aroused if there is (1) a substantial delay between time of injury and presentation of treatment, (2) evidence of repeated injuries to the face and neck, or (3) a previous history of abuse. Social agencies for the care and counseling of these victims exist and should be used.

Adult↗
PubMed1978

The acute effects of tourniquet ischemia on tissue and blood gas tensions in the primate limb.

Tourniquet ischemia results in tissue hypoxia which has been measured indirectly by blood gas analysis. The Medspect mass spectrometer allows direct measurement of gas tension in different tissues and may provide more useful information regarding safe tourniquet times. Calibrated Teflon catheters were inserted into the subcutaneous tissue (11 animals), tibial medullary cavities (bone) (nine animals), and tibialis anterior muscles (10 animals) in both lower extremities of anesthetized stumptail monkeys. Tourniquet ischemia was maintained for 1 hour at 400 mm Hg. Tissue and venous blood gas tensions were recorded from both limbs for 1 1/2 hours. Comparisons between gas tensions in each tissue group were made on the basis of their percentage change from control values. In the ischemic limb within 5 minutes muscle PO2 fell 42 +/- 4% (p is less than 0.001), whereas bone and subcutaneous PO2 dropped 25 +/- 4% (p is less than 0.05). Blood PO2 fell 29 +/- 3% and differed only from that of muscle (p is less than 0.01). One hour after tourniquet inflation, blood PO2 levels has fallen 90 +/- 5% (p is less than 0.001) from their control. Changes in tissue PCO2 were less dramatic and did not vary significantly from those recorded in venous blood. After deflation, blood PO2 exceeded its control by 20 +/- 6% (p is less than 0.005) in 5 minutes, but tissue tensions remained 50 +/- 6% below their control values. These studies indicate that tissue gas tensions are a more sensitive indicator of tourniquet hypoxia than are blood gases within the ischemic extremity.

Animals↗
PubMed1978

Power take-off injuries.

Power take-off injuries are uncommon, but serious and potentially fatal. Seven cases are reported demonstrating the violent trauma that can be incurred. The danger associated with use of machines with this and other power equipment is emphasized. Safety shields should be improved, and operators educated about the importance of retaining the shields and using machinery properly at all times.

Accidents, Occupational↗
PubMed1978

Management of fractures of the supraorbital rim.

The frequency of supraorbital rim fractures is increasing as incidence of motorcycle and bicycle accidents increases. These fractures are frequently depressed, comminuted, and often extend into the frontal sinus. Open reduction and fixation are the treatment of choice. Adequate debridement and cleansing with preservation of periosteum and blood supply are recommended. Unstable fragments can be fixed to the frontal bone or stabilized by suturing the torn periosteum. Severely comminuted supraorbital frontal sinus fractures may require stabilization via frontal sinus pack or balloon. We feel the latter is preferable and both Foley and Fogarty catheters have been successfully used.

Adolescent↗
PubMed1978

Craniosynostosis associated with limb reduction malformations and cleft lip/palate: a distinct syndrome.

Craniosynostosis associated with short stature, radial and fibular aplasia, and cleft lip and/or palate represents a distinct syndrome. One original case and one previously undiagnosed case from the literature were found to have many distinct features in common, permitting them to be separated from craniosynostosis with radial or fibular aplasia, Robert's syndrome, pseudothalidomide or SC syndrome, and the hypomelia-hypotrichosis-facial hemangioma syndrome. Each had multiple craniofacial abnormalities: dysplastic ears, hypertelorism, strabismus, and malocclusion. Ulnae and humeri were hypoplastic; tibiae were bowed and hypoplastic. Testes were small. Associated mild to moderate mental retardation may be related to early institutionalization.

Abnormalities, Multiple↗
PubMed1978

The team approach to treatment of the cleft lip and palate.

The team consists of a family physician, plastic surgeon, orthodontist, prosthodontist, otolaryngologist, speech therapist, audiologist and social worker. A cleft lip is usually repaired when the child weighs 10 lb., is 10 weeks old and has 10 Gm. of hemoglobin. Defects of the secondary palate are repaired between one and two years of age; residual lip or nasal deformities are corrected before the child starts school. Further cosmetic surgery is delayed until adolescence, when facial growth has been completed.

Child↗