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Biomedical subjects

A L Watne

Publications and source records attributed to A L Watne.

At least 37 records · Page 2Linked to original sources
PubMed1980

Operative risk factors of colon resection in the elderly.

Between January 1, 1974, and December 31, 1978, patients over 50 years of age underwent colon resections in three West Virginia Hospitals. The patients were studied by decades of age to compare the operative risks in younger and elderly patients. Preoperative assessments of cardiovascular, pulmonary, renal, hepatic, metabolic and nutritional states were compared with the postoperative morbidity and mortality rates. Complications occurred in 33% of all the patients who had resections, with 17 (4.8%) deaths. Mortality rates compared by decades of age correlated with the number of pre-existing conditions, and not with age as an isolated factor. There were no deaths in patients with no pre-existing conditions. The rate of infectious complications increased because the number of emergency procedures increased. This was also true for the mortality rate. Preoperative pulmonary and nutritional problems were significant contributing factors in the patients who died from sepsis. Careful preoperative assessment, correction of pre-existing pulmonary and nutritional deficiencies, and avoidance of emergency procedures may improve the morbidity and mortality rates associated with colon resections in elderly patients.

Age Factors↗
PubMed1980

Preliminary results with the use of expanded microporous polytetrafluoroethylene in vascular occlusive disease of the lower extremity.

The use of expanded microporous polytetrafluoroethylene (PTFE) as a small arterial substitute has been increasing. In this study 22 patients, averaging 66 years of age, underwent femoral popliteal or femoral distal tibial bypass. Risk factors included 1) previous atherosclerotic heart disease in 52 per cent, 2) previous myocardial infarctions in 43 per cent, 3) hypertension in 33 per cent, 4) diabetes mellitus in 27 per cent, 5) chronic obstructive pulmonary disease in 14 per cent, and 6) previous cerebral vascular accident in 14 per cent. The initial 30-day patency rate was 81 per cent, with long-termpatency being 73 per cent. Average operative time was 2 3/4 hours, with 81 per cent of patients undergoing intraoperative arteriography. Follow-up ranges from three to 13 months. The average pre- and postoperative ankle pressures were 54 mmHg and 100 mmHg, respectively. Four patients with failed grafts required amputation. One patients with a patent graft required amputation for gangrene secondary to diabetes. Other complications included multiple toe amputations, two superficial wound infections, one perforated cecum, and one pulmonary embolus. The initial and long-term patency rates of 81 per cent and 73 per cent, respectively, compare favorably to previous studies using autogenous saphenous vein. This suggests that expanded PTFE may be the initial arterial prosthesis of choice in high-risk or elderly patients. Longer follow-up is needed to determine if it will be a satisfactory substitute for autogenous saphenous vein in routine elective bypass for lower extremity occlusive disease.

Adult↗
PubMed1978

Penetrating wounds of the neck and upper thorax.

During the past decade, a method utilizing individual case assessment has been employed in the treatment of 51 patients with penetrating wounds of the neck and upper thorax. Only those wounds penetrating the platysma are included. Thirty-five patients (68.6%) underwent neck exploration; 16 patients (31.4%) were managed nonoperatively. Overall, five patients died, four patients following operative treatment and one treated nonoperatively, for a mortality rate of 9.8%. In the nonoperative group, a mortality of 6.2% (one death) compares favorably with an operative mortality of 11.4% (four deaths). Ten patients (29%) in the neck exploration group exhibited significant later morbidity compared to seven patients (44%) in the patients not explored. Therefore the morbidity from a negative neck exploration was only 2% (one of 20 patients). The techniques for exploring the neck are discussed. Adequate surgical exposure is largely dependent on the possibility of vascular injury, the most common cause of death in this series.

Adult↗
PubMed1977

The diagnosis and surgical treatment of patients with Gardner's syndrome.

Of one hundred and twenty-six patients with Gardner's syndrome, 60% showed soft tissue tumors, 32% showed osteomatosis, 67% polyposis, and 20% the complete triad. Bowel cancer developed in 32% of the patients. The frequency of other diseases in these patients showed fibrous tumors in 8%, and two patients with cancer of the ampulla of Vater; otherwise the diseases seen did not show any major variation from what might be expected for the group at risk. Laboratory evaluation has included the demonstration of increased fecal cholesterol and primary bile acids in these patients. The recommended surgical treatment is colectomy and ileorectal anastomosis at a measured 12 cm level. This level of ileorectal anastomosis may be vital in giving a regression of rectal polyps, which was seen in 15 to 17 patients so treated. The conversion of an ileosigmoid to an ileorectal anastomosis resulted in polyp regression in one patient. The oral administration of ascorbic acid gave polyp regression in seven of 10 patients. There may be a possible relationship of fecal coprostanol and cholesterol levels and polyp regression.

Adolescent↗
PubMed1976

Fecal steroids and bacterial flora in patients with polyposis coli.

Fecal neutral and acid steroids and bacterial flora have been studied in a series of patients with polyposis coli and normal controls. The patients with polyposis coli showed a higher concentration of cholesterol and primary bile acids, which increased still more after ileorectostomy. The bacterial flora of the patients with polyposis coli showed an anaerobe/aerobe ratio of 2.7/1 with a relative increase in clostridia and bifidobacteria and decrease in eubacteria and bacteroides. After ileorectostomy clostridia disappear, as do rumenococcus, peptostreptococcus, and fusobacteria, whereas eubacteria and lactobacilli decrease and bifidobacteria and bacteroides increase. Eubacteria showed a decrease from normal in the pre- and postoperative patients with polyposis coli and paralleled the reduction of cholesterol to coprostanol.

Adult↗
PubMed1975

Gardner's syndrome.

The clinical manifestations of Gardner's syndrome were studied in 280 patients from 11 families. Forty-five per cent of the patients at risk inherited the syndrome. Forty-one patients had carcinoma of the intestine develop, with only a 27 per cent survival rate for this type cancer. Eight per cent of the patients with the syndrome showed peritoneal fibrosis and fibrous tumors. They also had carcinomas of the ampulla of Vater, liver, bldder and ovary develop as well as osteogenic sarcoma. The patients without the syndrome had carcinomas of the pancreas and breast develop as well as melanoma and leukemia. Twelve of the 16 patients having had a colectomy and ileoproctostomy showed regression of the remaining polyps of the rectum.

Adolescent↗