Biomedical subjects
Publications and source records attributed to W Williams.
Erectile impotence is a common complaint, and competent management demands a systematized approach to diagnosis and treatment. The purpose of this article is to offer a practical schema for evaluating and treating a patient who presents complaining of this difficulty.
Aneurysms of the gluteal arteries are an uncommon complication of trauma to the gluteal region. A case report is presented following a gunshot wound to the buttock in a 36-year-old female. Diagnosis and management are discussed, with a review of the recent surgical literature.
The efficacy of blood microfilters in removal of the gaseous emboli produced during the warming of blood for transfusion is demonstrated experimentally. It is suggested that when blood microfilters are used they should be placed distal to any blood warming device.
The syndrome of male childhood transsexualism is described and the case history of a six year old boy is reported. Treatment strategies are explained in detail and the results of ongoing therapy over an 18 month period are presented.
A mult-faceted inpatient programme for overcoming severe female sexual of dysfunction using behavior modification techniques is described. The results obtained in a pilot study on 17 consecutive patients are presenre present.
The effect of myocardial revascularization on bipolar epicardial electrograms was recorded with fixed wire electrodes from revascularized left ventricular sites and from control sites on the right ventricle. Studies were performed during and after surgery in 19 patients undergoing aorta-coronary bypass grafting for occlusive coronary artery disease and in 6 additional patients having aortic valve replacement for isolated aortic valve disease. In the latter 6 patients, neither left nor right ventricular electrogram voltage changed immediately following aortic valve replacement; however, left ventricular electrogram voltage gradually decreased for 5 days postoperatively. In the 19 patients with coronary artery disease, electrogram voltage in the revascularized area increased immediately following coronary bypass grafting (+40 to +300 per cent) in 13 patients (68 per cent) and immediately decreased (-20 to -70 per cent) in 6 patients (32 per cent). In 5 of the patients showing immediate increases, temporary occlusion of the bypass grafts for 3 minutes during surgery resulted in a decrease of electrogram voltage in the distribution of the occluded bypass, followed by return to preocclusion levels after release. Postoperative monitoring of electrogram voltage for 5 days in all patients with coronary artery disease revealed that the electrogram voltage in the revascularized area decreased to or below control levels in 16 patients (84 per cent) and remained increased in 3 patients (16 per cent). These observed changes did not correlate with preoperative hemodynamics, number of grafts, graft flow rate, aortic cross-clamp time, cardiopulmonary bypass time, and the early postoperative course. These preliminary observations suggest that coronary bypass grafting does affect the electrophysiological state of the revascularized myocardium. However, the mechanism by which it occurs and its clinical implications remain to be determined.
Behavioural analysis and psychodynamic hypotheses were used to develop a comprehensive behaviour modification programme for the treatment of primary anorexia nervosa. This was applied to six female patients and the results obtained are reported.
In order to establish criteria for elective use of the intra-aortic balloon pump (IABP) in patients having cardiac surgery, we conducted a retrospective study of 43 patients who required counterpulsation, because of inability to be weaned from cardiopulmonary bypass, between May, 1972, and June, 1974. Patients in cardiogenic shock preoperatively were excluded. The 43 patients included 23 (Group A) who had severe preoperative left ventricular dysfunction with a mean cardiac index less than 1.8 L. per minute per square meter, ejection fraction less than 30 per cent, and end-diastolic pressure greater than 22 mm. Hg; 20 patients (Group B) had a combination of moderate cardiac dysfunction (cardiac index less than 2.2, ejection fraction less than 40, end-diastolic pressure less than 18) in the presence of acute infarction or severe aortic stenosis (gradient greater than 80 mm. Hg) with or without coronary disease. An inverse relationship was noted between survival and delay from completion of operation to the use of 1ABP. Thirty-two of 43 patients were weaned off bypass and were balloon assisted for 12 to 96 hours postoperatively; 25 patients were discharged (58 per cent). In Subgroup A, 14 of 23 (60 per cent) and, in Subgroup B, 9 of 20 (45 per cent) were long-term survivors. Based on these findings, 45 patients were operated upon between June, 1974, and December, 1975, with elective use of 1ABP and were assessed by serial hemodynamic studies. Sixteen had severe preoperative left ventricular dysfunction similar to Subgroup A and 29 had moderate dysfunction in combination with pathology similar to Subgroup B. Fifteen of these patients were hemodynamically unstable at time of arrival in the operating room; 1ABP was inserted under local anesthesia. Thirty-nine patients (87 per cent) were weaned off bypass and were hospital survivors. In Subgroup A, 13 of 16 (81 per cent) and, in Group B, 21 of 29 (72 per cent) were long-term survivors. Criteria for elective use of 1ABP in cardiac surgery should include severe preoperative left ventricular dysfunction or a combination of moderate dysfunction with coronary or valvular pathology. Elective 1ABP improves the survival with trivial iatrogenic morbidity.
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Plastic bronchitis is a rare, potentially life-threatening condition in which protein casts form within and occlude the bronchus, resulting in pulmonary failure, and has been identified as a complication after the Fontan procedure. We present a case of a 5-year-old girl who had undergone an extracardiac fenestrated Fontan repair as a component of staged palliation for tricuspid atresia. Six weeks following surgery, the patient presented with airway obstruction, coughing a bronchial cast. Medical therapies to optimize heart function and attempt to control cast formation were implemented, with little clinical impact. Following cardiac catheterization to stent open the fenestration, the symptoms of plastic bronchitis resolved. Cast expectoration recurred following spontaneous closure of the stented fenestration and again resolved with recreation of the baffle defect. Fenestration of the Fontan circuit alters hemodynamics, thereby providing an additional therapeutic option for this devastating disorder.
BACKGROUND: Revascularization of occluded coronary arteries after myocardial infarction (MI) may restore flow to viable myocardium and improve ventricular function. The aim of this pilot study was to determine the potential utility of thallium-201 viability imaging for the prediction of recovery of regional ventricular function in patients undergoing revascularization of total or subtotal occlusion of infarct-related arteries (TIMI 0-2 flow) during the convalescent period after MI. METHODS: Twenty-three patients were identified < 6 weeks after MI and underwent Tl-201 viability imaging (rest imaging, n = 16; stress/reinjection imaging, n = 7) and radionuclide angiography. Patients were revascularized with percutaneous transluminal coronary artery in 10, stent in 10, and bypass in 3. Follow-up radionuclide angiography at 3 months was used to assess recovery of regional wall motion. RESULTS: Among 41 abnormal wall motion segments in the infarct territories, the sensitivity, specificity, and accuracy for Tl-201 imaging in the prediction of recovery of regional function were 89% (25/28), 54% (7/13), and 78% (32/41), respectively. When 8 segments supplied by vessels with restenosis to >70% were excluded, specificity improved to 70%. Wall motion scores improved in those with adequate revascularization (1.6+/-1.4 vs 2.7+/-1.6; P < .001) but not in those with restenosis or occlusion (1.8+/-1.0 vs 2.0+/-1.6; P = NS). CONCLUSIONS: In patients with an occluded artery after MI, Tl-201 viability imaging can detect recoverable myocardium with reasonable accuracy and may help select which patients will most benefit from revascularization.
The attenuation performance of a hearing protector is used to estimate the protected exposure level of the user. The aim is to reduce the exposed level to an acceptable value. Users should expect the attenuation to fall within a reasonable range of values around a norm. However, an analysis of extensive test data indicates that there is a negative relationship between attenuation performance and the standard deviation. This result is deduced using a variation in the method of calculating a single number rating of attenuation that is more amenable to drawing statistical inferences. As performance is typically specified as a function of the mean attenuation minus one or two standard deviations from the mean to ensure that greater than 50% of the wearer population are well protected, the implication of increasing standard deviation with decreasing attenuation found in this study means that a significant number of users are, in fact, experiencing over-protection. These users may be disinclined to use their hearing protectors because of an increased feeling of acoustic isolation. This problem is exacerbated in areas with lower noise levels.
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This study examined the potential risk of hearing loss by commercial radio announcers. This risk is developed through the regular use of headphones. These headphones are used to monitor broadcast transmission and communication information from program producers. To our knowledge there are no published studies of the noise exposure of radio announcers. The experimental method utilised a headphone parallel to the one in use mounted on a wideband, artificial ear. A Sound Level Meter was then used to measure the sound level and then calculate the exposure level. Depending on the feedback level applied to their headphones radio announcers are exposed to potentially damaging levels of noise. Levels measured correlate with results from other studies of long-term average speech spectrum and voice level measurements.