Thoracoabdominal aortic aneurysms.
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Aorta, Abdominal↗
Biomedical subjects
W S Edwards
Publications and source records attributed to W S Edwards.
A-V fistula after venous reconstruction. A simplified method of producing and obliterating the shunt.
To improve patency of the low flow, low pressure crossover venous graft for unilateral iliac venous occlusions, complementary arteriovenous fistula has been effective. Two additional anastomoses are usually required to construct a complementary A-V fistula, and a sometimes difficult and potentially dangerous dissection may be required to take down the fistula. A technique has been developed for producing an A-V fistula with only one additional anastomosis. This fistula can be obliterated later by tightening a previously placed loop left in a subcutaneous position. This technique has been used successfully in two patients.
Adult↗
A practical evaluation system for preclinical restorative dentistry.
This paper describes an attempt to build a functional evaluation system incorporating several aspects of the evaluation process that have been advocated in educational research. The system--which employs performance criteria, analytical grading, rater calibration, student self-evaluation, mark-sense grading forms, and computer tabulation--has been in effect for six years at the Medical College of Georgia School of Dentistry. The main advantages of this approach are prompt, specific feedback to students concerning their performance on practical exams and diagnostic aids to course directors. In addition, rater calibration has resulted in interrater reliability usually around 0.80 or higher. The major disadvantages of the system are the faculty time required and dependence on a computer.
Clinical Competence↗
Visiting faculty as clinical evaluators for mock board examinations.
Applicants may fail state board examinations because of lack of practice under similar test conditions. Mock state board examinations employing visiting faculty as evaluators help students experience the stress of a real state board exam. Students become accustomed to strangers evaluating their work and receive unbiased evaluations. Other advantages and problems are discussed.
Clinical Competence↗
Bilateral bleb excision through median sternotomy.
We believe that when the indications for operation for spontaneous pneumothorax are met, the procedure of choice is bilateral resection of apical blebs and pleural abrasion through a median sternotomy. This approach allows easy access to both lungs and pleural spaces for a condition that is bilateral 100 per cent of the time. The operative morbidity is minimal and it essentially eliminates both ipsilateral and contralateral recurrence of pneumothorax with an operation that is of lesser rather than greater magnitude.
Adolescent↗
Late arterial embolization complicating total hip replacement. A case report.
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Aged↗
Arterial grafts: past, present, and future.
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Animals↗
Fabrication of a single posterior intermediate restoration.
Intermediate or temporary crowns are important in cast restoration procedures. A techniques is suggested whereby a metal shell crown is relined with autopolymerizing acrylic resin. It produces a restoration that (1) has good adaptation, (2) maintains gingival tissue health, (3) provides proximal and occlusal contacts, and (4) maintains tooth position.
Acrylic Resins↗
Fabrication of a single anterior intermediate restoration.
A technique of modifying a polycarbonate shell crown with an acrylic resin reline has been presented. The advantage in using this procedure is that it results in a satisfactory treatment restoration that is functionally and esthetically acceptable to the patient.
Carbonates↗
Systemic thermotherapy: description of a method and physiologic tolerance in clinical subjects.
A safe, effective method of inducing total body hyperthermia to 42 degrees C (108 degrees F) has been developed and applied to clinical subjects with advanced malignancy. Physiological and biochemical parameters have been studied to determine tolerance and detect toxicity. Treatments were well tolerated with appropriate life support measures, mainly fluid and electrolyte replacement. Occasional arrhythmias and superficial cutaneous burns were the major complications. No evidence of central nervous system dysfunction was detected. Serum enzyme elevations after treatment appeared to indicate hepatic cellular injury but no clinical problems resulted. Renal, pulmonary, and hematologic parameters showed no significant changes from baseline values. Two early deaths occurred in patients with massive liver replacement with tumor and such patients may not be appropriate subjects for hyperthermia.
Adult↗
Major surgery in patients with chronic renal failure.
To determine the risks of performing major surgical procedures on patients with chronic renal failure, the charts of twenty-nine hemodialysis patients who underwent thirty-eight elective and nine emergency operations were reviewed. Preoperative preparation included adequate hemodialysis of the patients, 88 per cent of whom were dialyzed within 24 hours of surgery. Azotemia was well controlled prior to administration of anesthesia. The average preoperative hematocrit was 26 per cent, and only one patient was hyperkalemic preoperatively. There were no intraoperative complications attributable to the patients' impaired renal function. Postoperative complications were frequent and are discussed in detail. Hemodialysis was done immediately postoperatively in five patients and on the first postoperative day in twenty-three additional patients with no problems. There were only two deaths (4.3 per cent) in the series. With careful monitoring during the perioperative period, major surgical procedures can safely be performed on patients with chronic renal failure.
Adolescent↗
The effects of examiner race on the articulation responses of black school-aged children.
Ninety 6-, 7-, and 8-year-old black children were administered the Watts Articulation Test for Screening by a white examiner and by a black examiner. The subjects' obtained significantly better articulation scores when the test was administered by the white examiner than when it was administered by the black examiner. Age of subjects and the interactions of age and sex, and of examiner age and sex were found to be significant.
Black or African American↗
Current status of certification of training programs in vascular surgery.
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Certification↗
Immunologic function in humans before and after hyperthermia and chemotherapy for disseminated malignancy.
Multiple immunologic parameters were studied in three patients prior to and after hyperthermia treatment for disseminated malignancy. Two patients had malignant melanoma and received chemotherapy during the hyperthermia treatment. One had adenocarcinoma of the stomach and received no concomitant chemotherapy. Rapid rosettes as a measure of thymus-derived lymphocytes (T-lymphocytes) were found to increase significantly after therapy (P less than 0.05) both in percentage and absolute numbers. There was no change in the numbers or percentages of other markers for T-lymphocytes or bone marrow-derived B-lymphocytes. Complement profiles revealed a significant decrease in C3 (P less than 0.005) after hyperthermia but no change in levels of other components of the alternate pathway. Antibody-dependent lymphocyte-mediated cytotoxicity and polymorphonuclear cell-mediated antibody-dependent cytotoxicity were also depressed after hyperthermia. No change was observed in immunoglobulin levels with hyperthermia therapy. Results indicated that hyperthermia may favorably alter the immune balance between tumor and host in selected instances.
Adenocarcinoma↗
Elastic compression in the prevention of venous stasis. A critical reevaluation.
The effect of elastic compression on venous flow in the legs provided by carefully fitted stockings has been measured by a venographic technic. The stocking used provides a gradually decreasing compression from ankle to groin. Clearance of stagnant blood from behind venous valves is clearly improved and the differences observed are statistically highly significant. These data suggest that the routine use of carefully fitted compression stockings will result in a decreased incidence of deep vein thrombosis (DVT) and provide a singularly safe, convenient, and noninvasive method of prophylaxis. Evidence presented suggests that at least two investigators have failed to show a decreased incidence of DVT in limbs subjected to elastic compression because the method of compression was inadequate .
Adult↗
Multiple sequential femoral tibial grafting for severe ischemia.
For the past decade a common procedure used to salvage severely ischemic limbs has been autogenous vein bypass grafting to the distal popliteal artery or, if the popliteal trifurcation is occluded, to one of the tibial-peroneal branches. Reported limb salvage rate and long-term graft function varies considerably but in most series is low. To increase graft flow and to decrease resistance in femoral-poplitical-tibial grafts and thereby to perfuse the ischemic foot more effectively, we have employed multiple sequential anastomoses of a single vein graft to distal branches--a technique similar to that used occasionally in aortocoronary bypass grafting. The autogenous vein graft alone, or in combination with bovine heterograft, has been used in six patients with gangrenous toes or far advanced ischemia and in one patient with severe claudication. Multiple anastomoses below the knee were carried out in each patient. Anastomosis has been to a blind popliteal segment, then to a tibial or peroneal in four patients, to both tibials in another two patients, and to both tibials and the peroneal in one patient. Flow rates measured on the operating table clearly demonstrated a significant increase in flow through the graft with each additional anastomosis. There has been a greater response to surgery with return of pulses, warmth of the foot, and rapid healing as compared with previous patients having single femoral-tibial anastomoses. One failure occurred acutely from a technical problem early in the series; one failed at 3 months in a patient with pancreatic cancer and another patient died 2 weeks after operation of a myocardial infarct.
Adult↗
Total body hyperthermia and preliminary results in human neoplasms.
We believe the hyperthermia is an effective adjunct to current modes of cancer therapy and warrants further study. The method described is safe and effective in achieving controlled total body hyperthermia. Monitoring techniques and life support measure are discussed. Limits of tolerance in humans are defined in this series as 41.8 C for 5 hr and 42 C (108F) for 2 hr, with the heart and liver as the limiting organs.
Fever↗
The management of atheromatous emboli to the lower extremities.
Atheromatous emboli to the small vessels of the feet usually cause painful, cyanotic areas on the distal portions of the extremity. Complete resolution of the symptoms is the rule, and recurrent episodes are common. Atheromatous emboli to the major vessels of the leg often cannot be distinguished from emboli originating from other sources, unless characteristic gross or microscopic features are present in the embolous material. If the embolus contains atheromatous debris or if the origin is uncertain, aortic arteriograms are indicated to determine if an ulcerated lesion may have been the source. Apparently, two mechanisms of embolization exist; they are fragmentation with distal embolization of atheromatous material and embolization of plateletfibrin thrombus material from ulcerated plaques. Endarterectomy of the involved segment of aorta has been uniformly successful in preventing recurrent episodes of embolization.
Adult↗