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Biomedical subjects

P H Walter

Publications and source records attributed to P H Walter.

5 recordsLinked to original sources
PubMed1998

The progression of an infundibulum to aneurysm formation and rupture: case report and literature review.

OBJECTIVE AND IMPORTANCE: Infundibula (IFs) are funnel-shaped symmetrical enlargements that occur at the origins of cerebral arteries and are apparent on 7 to 25% of otherwise normal angiograms. They are frequently considered as normal anatomic variants of no pathogenic significance. CLINICAL PRESENTATION: We report the case of a ruptured posterior communicating artery aneurysm that had developed at the site of a previously known IF in a 49-year-old hypertensive woman. She had a poor conscious level at admission, with widespread subarachnoid hemorrhage and obstructive hydrocephalus. INTERVENTION: The patient was immediately ventilated, and an external ventricular drain was inserted. The aneurysm was successfully clipped; however, secondary hemorrhage occurred both before and during craniotomy. She developed marked hypernatremia and subsequently died. CONCLUSION: This is the 11th case of IF-to-aneurysm progression reported. It suggests that in certain cases, serial investigations may be indicated with IFs to detect aneurysm formation and preempt rupture.

Aneurysm, Ruptured↗
PubMed1993

Audit in the management of gliomas.

A retrospective study of 139 glioma patients was conducted in an effort to audit management. Factors affecting survival were studied using a Cox Proportional Hazard Model. These factors included age, sex, location, grade, type of surgery, use of radiotherapy, presenting symptoms, Karnofsky score on admission and Karnofsky score 3 months following surgery. Lower grade, high Karnofsky score on admission, radiotherapy and frontal location were associated with better survival. There was statistically insignificant evidence that the other factors had an influence on survival. Patients presenting with a poor neurological score were treated with burrhole biopsy alone. Only 10% of these patients survived more than 6 months. On the other hand, 26% of patients who had craniotomy on the basis of reasonable clinical status lived less than 6 months. Sixty-six per cent of patients in this craniotomy group were aged 60 years or over, and 66% of those aged over 60 had a Karnofsky score of less than 70. We conclude that careful judgement is required before subjecting patients aged over 60, especially those with a low Karnofsky score, to radical therapy.

Adolescent↗
PubMed1993

Burn wound management.

Management of a burn wound is interrelated with many patient care protocols. After the patient has received initial care, is in stable condition, and has been transported to the appropriate medical facility, the selection of burn wound treatment protocols is based on patient population. Hydrotherapy, debridement, topical antimicrobial agents, and dressings reduce bacterial colonization until the wound closes. Supportive care is essential to the preservation of viable tissue. Excision and autografting are the primary method of wound management. The practical application of cultured autograft and growth factors is under study.

Anti-Infective Agents, Local↗