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Biomedical subjects

W S Fields

Publications and source records attributed to W S Fields.

At least 55 records · Page 3Linked to original sources

Systemic air embolism following induction of artificial pneumothorax under anaesthesia, with successful management.

Systemic air embolism occurred in a patient during general anaesthesia, with positive pressure ventilation, following induction of artificial pneumothorax to assist in the diagnosis of a mediastinal mass. A sudden change in vital signs together with neurological abnormalities suggested involvement of both coronary and cerebral arteries. A trace of blood was noticed in the syringe which the surgeon had used to create the artificial pneumothorax. The patient was treated with hyperbaric oxygen and recovered satisfactorily, despite a 10-h interval between the air embolus and the institution of definitive therapy.

Adult↗

Role of antiplatelet agents in cerebrovascular disease.

It is now generally accepted by neurologists that most transient ischaemic attacks, particularly in the carotid artery territory, have a thromboembolic basis. These emboli are, for the most part, fibrin-platelet aggregates. Others which contain atheromatous debris are more likely to produce longer lasting neurological deficits. If one assumes this hypothesis then it is reasonable to employ drugs which interfere with platelet aggregation in order to prevent cerebrovascular symptoms and signs. Acetylsalicylic acid (aspirin) prevents aggregation by inhibiting the 'release reaction' initiated by thromboxane A2. This inhibition lasts for the life of the affected platelets. Recent trials in the United States and Canada have demonstrated a positive clinical benefit from the employment of aspirin in patients suffering from transient cerebral ischaemic attacks and amaurosis fugax. There was a reduction or cessation of the attacks in both males and females and a 50% reduction of stroke morbidity and mortality in males.

Aspirin↗

Joint study of extracranial arterial occlusion. X. Internal carotid artery occlusion.

One cannot now predict with accuracy the degree of deficit that may be anticipated following a carotid occlusion even when the condition of the opposite artery is known. When symptoms and signs occur, they are most likely related to the hemisphere or eye on the side of the occlusion. In patients with carotid occlusion, a higher rate of severe complications and mortality was encountered following arteriography than in the general study population. Among randomized patients with a carotid occlusion and a contralateral carotid stenosis, 63% of medically treated patients were alive at the end of a 66-month follow-up, whereas only 34% of surgically treated patients were still living. Surgical mortality was extremely high in patients with a carotid occlusion. Sixty-seven percent mortality occurred in patients undergoing surgery within one week of a cerebral infarction.

Adult↗

Joint study of extracranial arterial occlusion. IX. Transient ischemic attacks in the carotid territory.

This prospective analysis of 79 patients with transient carotid ischemic attacks (TIAs) showed that only 15% of them subsequently had strokes causing serious disability or death. They were followed up from one to nine years. All had arteriography during initial evaluation. Most of the patients who suffered strokes had at least one additional risk factor for stroke, such as hypertension or a cardiac problem. Today it is probably impossible to collect data on the natural history of untreated TIAs, inasmuch as virtually all patients are receiving either specific medical or surgical therapy.

Age Factors↗