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Biomedical subjects

W Walker

Publications and source records attributed to W Walker.

136 records · Page 8Linked to original sources
PubMedDate not supplied

Traumatic rupture of the aortic isthmus: an emergency?

The objectives of this study were to explore the hypotheses that: (1) patients with traumatic rupture of the aortic isthmus (TRA) who have not exsanguinated into the pleural cavity upon hospital presentation are unlikely to develop rupture of the hematoma during the time necessary to investigate all injuries and attend to those of more immediate danger; and (2) appropriate medical therapy can prevent free rupture of the hematoma. The medical records of 112 patients who were proved to have TRA at the isthmus resulting from injury within the preceding 7 days were reviewed. Fifty of these patients received medical treatment aimed at decreasing aortic wall stress; 46 were managed under a formal protocol. The available English language and European literature for the past 15 years was surveyed for evidence of the effects of delay between injury and aortic repair. Eight patients died before aortic repair, six of aortic exsanguination (all within 4 hours of injury). Of 77 patients for whom the time of injury was recorded and the aorta was repaired, 36 were repaired within 12 hours of injury and 41 between 12 hours and 24 weeks; none developed aortic hemorrhage. No patient receiving adequate medical therapy died of rupture of the hematoma. Other major surgery preceded aortic repair in 33 patients. We conclude that the concept that traumatic rupture of the aorta should always take priority over other injuries is incorrect. Pharmacologic reduction of wall stress appears to decrease the probability of rupture of the periaortic hematoma.

Adolescent↗
PubMedDate not supplied

Volunteer blood donors who fail the copper sulfate screening test. What does failure mean, and what should be done?

Volunteers attending blood donor sessions who fail the copper sulfate screening test merit an explanation of why they are considered ineligible to donate. During a 30-month period, 0.24 percent of men and 2.8 percent of women attending blood donor sessions in the northern region of England failed this test. Their hematologic status was determined by performing complete blood counts on a venous blood specimen and measuring ferritin as an indication of iron stores in a representative sample of approximately 10 percent. Normal blood counts were found in some donors, while others had severe degrees of anemia, and such discrepancies could be clarified only by hemoglobin determinations. Iron deficiency was very common in deferred donors, including 36 of the 88 with normal blood counts in whom ferritin assays were performed. Microcytic blood cells, a hallmark of iron deficiency, were found to be a relatively insensitive measure of low iron stores, except at low levels of hemoglobin. By a check of a venous sample, the hematologic status of most volunteers failing the copper sulfate screening test can be ascertained, and appropriate review, investigation, and treatment can be undertaken.

Blood Donors↗
PubMedDate not supplied

Aneuploidy and isolated mild ventriculomegaly. Attributable risk for isolated fetal marker.

BACKGROUND: Does the prenatal ascertainment of isolated mild ventriculomegaly increase the a priori risk for aneuploidy when isolated or not associated with advanced maternal age? Does isolated mild ventriculomegaly increase the risk for pediatric developmental delay? METHODS: The Wayne State University (WSU) Reproductive Genetics abnormal case data base and the Madigan Army Medical Center (MAMC) experience were reviewed to compare the rates of aneuploidy for cases with fetal ventriculomegaly. Cases were classified by maternal age and associated sonographic markers of aneuploidy. Aneuploidy rates were compared between the isolated ventriculomegaly, ventriculomegaly with advanced maternal age (AMA), and ventriculomegaly associated with multiple anomalies. Rates of aneuploidy were compared to identify association. RESULTS: A total of 118 cases with ventriculomegaly were identified for comparison. Ninety-four cases were identified in the WSU cohort; 46 demonstrated isolated ventriculomegaly alone, and aneuploidy was present in 3/25 (12%) with invasive fetal testing, 0/24 (0%) cases in the MAMC cohort demonstrated aneuploidy. Isolated mild ventriculomegaly cases at MAMC were identified for further tests. DISCUSSION: Although the two study populations vary in age and risk distributions, the attributable risk for isolated mild ventriculomegaly poses a counseling conundrum due to the neurodevelopmental implication of this minor dysmorphism more so than its association with aneuploidy.

Aneuploidy↗
PubMedDate not supplied

Abnormal hormone levels in men with coronary artery disease.

Plasma concentrations and urinary excretions of various hormones and hormone metabolites were measured in four groups. Group 1 was composed of 13 men with prior myocardial infarction; Group 2 contained 35 clinically normal men; Group 3 consisted of 44 men with normal coronary arteriograms; and Group 4 was composed of 25 men with severe coronary artery disease shown on arteriogram but no infarction. There were four major findings: Group 1 had significantly higher 24-hour mean plasma concentrations of estrone (E1), dehydroisoandrosterone (DHA), and dehydroisoandrosterone sulfate (DHAS) than Group 2, while Group 3 had the same levels as Group 4; Group 4 had significantly lower urinary excretion of androsterone glucuronide (AG) than Group 3, while Group 1 excreted normal amounts. There are three possible explanations for these findings: 1) myocardial infarction occurring in men with coronary artery disease may elevate the plasma levels of E1, DHA, and DHAS and eliminate the preinfarction depression of urinary AG levels; 2) higher than average levels of E1, DHA, DHAS, and AG may favor the development of infarction in men with coronary artery disease; 3) higher than average levels of E1, DHA, DHAS, and AG may favor survival from any infarction that occurs in men with coronary artery disease. Experimental and epidemiological evidence seems to favor the third possibility.

Adult↗
PubMedDate not supplied

Analysis of demographic and functional subacute (transitional) rehabilitation data.

Demographic and functional data were obtained on 102 patients from three subacute rehabilitation units specializing in low-level traumatic brain injury (TBI) patients. Functional assessment evaluation was performed using the Disability Rating Scale (DRS). The average admission and discharge DRS scores were 17.4 and 13.6, respectively. On average this patient population improved from an extremely severe level of disability to a severe level. The TBI patient subset improved on average from 20.4 to 13.1. Significant correlation exists between admission, discharge, and differential DRS scores, as has been demonstrated previously in the evaluation of this scale among only TBI patients. No significant correlation was demonstrated between demographic information and DRS scores. Thus, no demographic predictors of good or bad functional outcome were identified. In addition, analyses of relationships between diagnosis, length of stay, and age will provide information about subactute rehabilitation, an emerging but little-studied branch of rehabilitation medicine.

Activities of Daily Living↗