PubMed Health⌕ Search

Biomedical subjects

R E Welling

Publications and source records attributed to R E Welling.

At least 19 recordsLinked to original sources
PubMed1992

Experience with desmoid tumor in a community teaching hospital.

Desmoid tumors are rare fibroblastic proliferations that occur primarily in the abdomen and extremities. They have an estimated incidence in the United States of two to four per million inhabitants per year. A recent case of desmoid tumor prompted us to review past medical records for previous cases with the same diagnosis. Since 1985, our institution has treated five patients with a total of eight desmoid tumors. Four patients (80%) were female with ages ranging from 24 to 32 years. The other patient was a 22-year-old male with a history of Gardner's syndrome and recurrent desmoid tumors. The majority of our patients were females in the fertile age group, substantiating the hormonal effects believed to play a role in the development of these lesions. In addition, it became obvious that more investigations must be done in appropriate treatment of desmoid tumors and the documentation of these tumors in registries would be of significant benefit.

Abdominal Muscles↗
PubMed1992

Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis.

This two-part meta-analysis combined data from eight prospective randomized trials designed to compare the nutritional efficacy of early enteral (TEN) and parenteral (TPN) nutrition in high-risk surgical patients. The combined data gave sufficient patient numbers (TEN, n = 118; TPN, n = 112) to adequately address whether route of substrate delivery affected septic complication incidence. Phase I (dropouts excluded) meta-analysis confirmed data homogeneity across study sites, that TEN and TPN groups were comparable, and that significantly fewer TEN patients experienced septic complications (TEN, 18%; TPN, 35%; p = 0.01). Phase II meta-analysis, an intent-to-treat analysis (dropouts included), confirmed that fewer TEN patients developed septic complications. Further breakdown by patient type showed that all trauma and blunt trauma subgroups had the most significant reduction in septic complications when fed enterally. In conclusion, this meta-analysis attests to the feasibility of early postoperative TEN in high-risk surgical patients and that these patients have reduced septic morbidity rates compared with those administered TPN.

Adult↗
PubMed1991

Non-operative management of blunt splenic trauma: a 10-year experience.

There is growing awareness that the majority of traumatic splenic injuries should be managed non-operatively. This review of all traumatic spleen injuries at a large community teaching hospital over a 10-year period (1978-1988) confirms that principle. The study generated selection criteria and principles of non-operative management. Of a total of 91 patients, 23 were initially treated non-operatively. The average age was 27 years and all but two were adults. Splenic injury was confirmed by computed tomography scan in 20 patients (87 per cent) and by liver/spleen scan in three patients (13 per cent). Of the 23 patients, 21 (91 per cent) were successfully treated non-operatively. Of these, 14 had intraparenchymal or subcapsular haematomas and seven had splenic lacerations with haemoperitoneum. Two patients (9 per cent) initially treated non-operatively required splenectomy. Haemodynamically stable adult patients with blunt splenic injuries can be managed non-operatively if monitored in a setting where immediate operative intervention is available. Operative intervention is indicated not only in haemodynamically unstable patients, but also in patients who require more than four units of blood during a 48-h period.

Adolescent↗
PubMed1991

Antiseptic effectiveness with fibroblast preservation.

The efficacy of topical antiseptic therapy for wounds and skin ulcers has been shown to be at the expense of fibroblast and leukocyte function and, in general, wound healing. Specifically, continued fibroblast function after exposure to antiseptics has been correlated to the concentration of the antiseptic. At concentrations that preserve fibroblast function, 0.005% sodium hypochlorite, 0.001% providone-iodine, 0.0025% acetic acid, and 0.003% hydrogen peroxide were tested for their effectiveness against various clinical isolates. Staphylococcus aureus, Escherichia coli, Group D enterococci, Pseudomonas aeruginosa, and Bacteroides fragilis were exposed to the antiseptics and plated in a standard microbiological fashion. The cultures showed that sodium hypochlorite inhibited the growth of all the bacteria (p less than 0.001), whereas povidone-iodine reduced the colonies of S. aureus and acetic acid inhibited P. aeruginosa. Our study suggests that 0.005% sodium hypochlorite can be used as a debriding and topical antibacterial agent for wounds and skin ulcers without inhibiting fibroblast activity essential to normal wound repair.

Anti-Infective Agents, Local↗
PubMed1990

Cryoprobe as a "handle" for resection of metastatic liver tumors.

Resection of metastatic liver tumors can be a difficult and risky procedure. Using a cryoprobe as a "handle" can greatly facilitate resection by providing a taut surface for transection and improving visualization of ductal and vascular structures. In addition, this technique may decrease the risk of contaminating surrounding tissues with cancer cells, and may inhibit tumor recurrence within the margins of resection.

Cryosurgery↗
PubMed1990

Needle-localized biopsy of the breast.

Our experience with needle-localized biopsy for effective early detection and evaluation of carcinoma of the breast is discussed. Between January 1984 and December 1987, 266 women underwent 279 needle-localized biopsies of the breast performed at a large community teaching hospital. The majority of the women (221 of 266) were found to have benign disease of the breast and 162 of 221 of these were considered to have no increased risk of future carcinoma of the breast as determined by pathologic criteria. Thirty-eight women had primary malignant conditions. Seven patients had recurrent carcinomas after initial treatment with segmental mastectomy. The majority of both the primary and recurrent malignant lesions were infiltrating carcinoma. Using the Fischer exact test, a significant correlation (p less than 0.0004) was found between primary infiltrating carcinoma and a soft tissue mass on mammography. A significant correlation (p less than 0.03) was also found between primary intraductal carcinoma and clustered microcalcifications on mammography. Needle-localized biopsy of the breast provides early detection of carcinoma of the breast and identification of those at risk for subsequent carcinoma of the breast.

Aged↗
PubMed1990

Clinical significance of free-floating venous thrombi.

To evaluate the fate of free-floating venous thrombi, venous duplex scans of 5238 consecutive lower extremities over a 2 1/2 year period were reviewed. Acute deep venous thrombosis was found in 732 cases. Eighty-two free-floating deep venous thrombi were diagnosed in 73 of these patients. Nine of 72 patients (13%) had pulmonary emboli as diagnosed by ventilation perfusion scanning or pulmonary angiography or both. Seven of these patients (78%) had a pulmonary embolus before the initial duplex scan. Two (22%) had a pulmonary embolus after the diagnosis of free-floating thrombus. Thirty-three of 73 patients (45%) had follow-up of free-floating thrombi by duplex scanning performed in the acute period (less than 30 days): 18 (55%) showed attachment of the free-floating thrombus, three (9%) showed progression in size of the free-floating tail, and eight (24%) showed decrease in size or resolution of the free-floating thrombus. Four (12%) showed persistent thrombus without evidence of resolution, propagation, or attachment. In conclusion, free-floating venous thrombi occurred in 10% of cases of acute deep venous thrombosis. Only 13% of free-floating thrombi were associated with clinically significant pulmonary emboli, confirmed by ventilation perfusion scanning. Usually the embolus occurred before diagnosis of free-floating thrombus. Most free-floating thrombi followed noninvasively by duplex scanning do not embolize, but rather they become attached to the vein wall or resolve.

Adult↗
PubMed1989

Infiltrating lobular carcinoma of the breast treated with segmental and modified radical mastectomy.

Conservative treatment of infiltrating lobular carcinoma (ILC) has previously been examined only in terms of general breast carcinoma studies. However, this lesion has been shown to differ from the more common infiltrating ductal carcinoma (IDC) in estrogen receptor (ER) status, metastatic patterns, and bilaterality. Therefore, it is necessary for the physician to consider these distinctions when planning both pre- and post-operative treatment. To determine the effectiveness of both segmental and modified radical mastectomies, the medical records of 26 patients with ILC were reviewed, and follow-up information was obtained. In addition to surgical treatment, hormonal manipulation and/or radiotherapy were used when appropriate. We found the results of a conservative approach in the treatment of this disease to be comparable to the more radical procedures with respect to overall survival and disease-free intervals. The single factor that most affected a patient's prognosis was involvement of the axillary nodes.

Adult↗
PubMed1989

Splenic rupture in leukemia.

We present a review of the incidence, differential diagnoses, mechanism of rupture, laboratory findings, and signs and symptoms of splenic rupture in leukemia. The types of leukemia most often associated with ruptured spleen are described. The treatment of splenic rupture in leukemia is splenectomy, with careful evaluation of the need for transfusion with appropriate blood products. The issue of whether such cases should be referred to as "pathologic" or "spontaneous" is discussed. Indications for prophylactic splenectomy in leukemia are also addressed.

Adult↗
PubMed1989

Blunt arterial injuries associated with multiple trauma.

In this retrospective study, we reviewed the records of 62 patients who were treated at a tertiary care community teaching hospital between 1977 and 1987 for major arterial injury caused by blunt trauma. Nearly half (45%, 28/62) of the injuries were to the thoracic aorta, 24% (15/62) were to arteries of the head and neck, 21% (13/62) were to the arteries of the extremities, and 10% (6/62) were to abdominal arteries. Twenty-eight thoracic aortic transections were repaired, 25 with Dacron grafts and three by primary repair. One patient developed an adventitial hematoma in the thoracic aorta, which was evacuated. Two patients required nephrectomies secondary to renal artery injury. Ten patients with internal carotid artery dissection were successfully treated with anticoagulation therapy. Eight (13%) of the 62 patients died: four from exsanguination, one from cardiac tamponade, one from renal failure, one from pulmonary emboli, and one from cerebral infarction secondary to intracerebral edema. Such injuries are amenable to treatment, with patient and end-organ viability, if recognized and treated promptly by the trauma surgeon.

Abdomen↗
PubMed1989

Cervical wound hematoma after carotid endarterectomy.

Between 1974 and 1984, 1222 patients underwent carotid endarterectomy at a large community teaching hospital. Twenty-three (1.9%) of these patients required reexploration for hematoma at the endarterectomy site. We reviewed the records of these 23 patients with regard to the incidence of perioperative hypertension; the use of platelet-altering medication, heparin, protamine sulfate, and low molecular weight dextran; and the findings at reoperation. We also reviewed the records of 122 randomly selected patients who did not develop wound hematoma after carotid endarterectomy. The incidence of intraoperative and postoperative hypertension was significantly higher in the hematoma group than in the control group. The incidence of preoperative hypertension was not significantly different between the two groups. More hematoma patients received preoperative platelet-altering medication (43% versus 25%), and fewer received intraoperative protamine sulfate to reverse the effects of heparin (48% versus 66%), but these differences were not significant. This study emphasizes the importance of careful hemodynamic monitoring during and immediately after carotid endarterectomy.

Aged↗
PubMed1989

Traumatic dislocation of the knee.

The incidence, classification, anatomy, and biomechanical etiology of traumatic dislocation of the knee are reviewed. This injury occurs rarely, but it can result in significant long-term disability. The popliteal space must be carefully evaluated because of the high frequency of associated neurovascular injuries. If gross deformity is present, closed reduction should be performed immediately, followed by radiography to delineate possible fractures and by immobilization in a posterior splint. However, posterolateral dislocation is often irreducible by closed manipulation. The neurovascular status should be reassessed following closed reduction; liberal use of angiography is recommended. Complications from untreated vascular injury can include thrombosis. Peroneal nerve injury, less frequent than vascular damage, has a poor prognosis for long-term function recovery, and surgical repair has been of no value. Treatment of ligament injuries associated with knee dislocations has ranged from closed reduction and immobilization to open partial or total repair. Operative repair is most appropriate for young patients, active older patients, and patients with torn collateral ligaments. One study has concluded that early physical therapy, regardless of treatment, is crucial to a good outcome.

Humans↗
PubMed1988

Implantofix vascular access system: an experience with 19 patients.

The use of implantable vascular access devices has increased rapidly in recent years. We have placed the new Implantofix Implantable Drug Delivery System 7500 in 19 patients. The patients reported only minor discomfort. The majority of the nurses found the Implantofix port easier to access than other ports, and some reported less swelling and soreness at the port site. Some of the physicians had difficulty visualizing the radiopaque catheter on X-ray; Burron is currently developing a more radiopaque system. The Implantofix system offers several important benefits. Its compact size assures minimal discomfort for the patient. A new peel-away sheath offers a choice of insertion methods. The system is particularly economical because it can be implanted in an ambulatory care facility or an outpatient surgery room equipped with fluoroscopic capabilities.

Ambulatory Care↗
PubMed1987

Regional adjuvant irradiation for adenocarcinoma of the cecum.

Forty patients with adenocarcinoma of the cecum who underwent right hemicolectomy received regional irradiation for 40-45 Gy/4-5 weeks and weekly 5-Fluorouracil (5-FU). Thirty-four patients received this adjuvant therapy: 12, 10, 5, 4 with Stage B2, B3, C2, C3, respectively, and 3 with abdominal metastasis. Another six patients were similarly treated for palliation because of tumor bed recurrences. Patients were followed for a median of 4 years, 21/31 patients in the adjuvant group with Stage B and C were free of disease with a median survival of 48 months (63% 5-year actuarial disease-free survival). The total local failure rate among the adjuvant group for Stage B and C was 4/31 (13%) with local failure alone occurring in 1 of 4 patients (3%). In the patients treated at our Hospital, there was significant improvement in the 5-year actuarial survival (p = 0.001) for patients with lymph node metastases who received adjuvant irradiation compared to surgery-alone. Acute radiation enteritis occurred in seven out of 40 patients (17.5%) and was severe in 2 (5%). There were no delayed complications. We conclude that adjuvant therapy markedly lowered regional recurrence and seems to improve survival in patients with lymph node metastasis when compared to a group of patients treated by surgery alone in the same institution.

Adenocarcinoma↗
PubMed1987

Management of blunt injury to the internal carotid artery.

The management of vascular injury to the internal carotid artery (ICA) is controversial. We undertook a retrospective review of 14 patients with blunt injuries to the ICA and found three types of ICA injury, often presenting with delayed symptomatology. Six patients had intraluminal arterial stenosis or obstruction and were treated with anticoagulants. Five patients had pseudoaneurysms. Three of these were treated with balloon occlusion of the ICA above and below the orifice of the aneurysm, one with aneurysmorrhaphy, and one with resection and interposition vein graft. Three patients sustained a carotid cavernous fistula and were treated by balloon occlusion of the fistula while patency of the ICA was maintained. Treatment rendered all patients either asymptomatic or with residual deficits only. Angiography is essential to anatomically delineate the injury. The vascular surgeon, the neurosurgeon, and the interventional radiologist all make important contributions to the successful treatment of patients with blunt ICA injuries.

Adult↗
PubMed1986

Gastrointestinal complications after cardiac surgery.

From 1975 to 1985, a total of 1596 coronary artery bypasses or valve replacements resulted in 18 gastrointestinal tract complications in 16 patients at Good Samaritan Hospital in Cincinnati. Twelve patients were treated surgically (hemorrhagic duodenal ulcer, one patient; perforated duodenal ulcer, one patient; cholecystitis: acalculous, gangrenous, two patients, and calculus, one patient; perforated cecum, one patient; ischemic colitis, one patient; and perforated diverticulitis of the colon, five patients). Six patients were treated conservatively by either nasogastric intubation or nothing by mouth and intravenous therapy (ileus, three patients; acute sigmoid diverticulitis, one patient; and active peptic ulcer disease, two patients). Multisystem failure caused two deaths. The etiology of hollow viscus complications seems to be related to a low-flow state, impairing normal tissue perfusion that can initiate an ischemic change. This change can lead to acute inflammation, perforation, or both or late stricture. When evidence of an acute abdominal disorder is observed or when conservative treatment falls to alleviate symptoms, prompt surgical intervention should be performed.

Aged↗