PubMed Health⌕ Search

Biomedical subjects

R H Hayward

Publications and source records attributed to R H Hayward.

At least 19 recordsLinked to original sources
PubMed1994

Sternal dehiscence. Early detection by radiography.

A study was conducted to look for radiographic indicators that might provide a clue to threatened separation of the median sternotomy closure. To evaluate this problem, we studied two groups of patients. In group A the postoperative plain chest roentgenograms of 50 consecutive patients having cardiac operations were reviewed until the time of their complete recovery from the operation. Sternal problems were not identified in these patients clinically. However, chest roentgenograms showed that one patient had a displaced sternal wire and another had a classic sternal separation as judged by the change in wire topography. In the second series of patients, group B, 10 patients with clinical separation of the sternum were similarly evaluated. In seven of the 10 an early subtle change in position of one or more sternal wires preceded clinical detection of separation by 1 to 8 days, and a gross change in the sternal wire positions preceded clinical diagnosis in five patients by 1 to 6 days. The appearances of the wires by roentgenogram showed four common patterns. These findings indicate that thoracic surgeons and radiologists alike do not always carefully examine the appearance of the sternal wires on the postoperative roentgenograms. Subtle changes or gross changes in the position of the wires is an indicator of sternal separation. Therefore, the topography of the sternal wires should be scrutinized along with the other postoperative changes seen on roentgenograms after median sternotomy.

Bone Wires↗
PubMed1994

Access to the thorax by incision.

BACKGROUND: For years the standard access to the thorax has been by posterolateral or other muscle cutting thoracotomy incisions. These are accompanied by significant discomfort and often limitation of shoulder girdle movement. To obviate these distressing features, the less traumatic median sternotomy was recommended. In the last ten years, several types of mini or axillary thoracotomies have been described. We believe that the vertical axillary thoracotomy is the best of these incisions as no major muscles are divided, it can be created rapidly, and exposure is excellent. STUDY DESIGN: We compared the operative approaches from the point of view of the duration of postoperative hospitalization, the length of the operating time, the incidence of postoperative atelectasis, and persistence of incisional pain. RESULTS: The vertical axillary thoracotomy showed a definite advantage in all these categories. CONCLUSIONS: These findings suggest that the vertical axillary thoracotomy is the incision of choice for most thoracic procedures as the incision is small and quickly made. Because there is limited division of muscles, the convalescence is smooth and uncomplicated.

Axilla↗
PubMed1991

Long-term follow-up of the Vineberg internal mammary artery implant procedure.

This report describes the 20-year follow-up of a patient who had undergone a double internal mammary implantation for coronary occlusive disease. A lack of similar reports in the literature suggests that such survival is rare, but this case indeed documents the fact that the internal mammary arteries can revascularize the myocardium, and this patient's continued survival appears to depend entirely on this collateral blood flow.

Coronary Angiography↗
PubMed1986

Carcinoma of the esophagus.

Carcinoma of the esophagus remains difficult to detect while it is localized to the mucosa. The ideal treatment is removal of all tissue that contains tumor. Usually reconstruction using the stomach is preferred over the use of gastric tubes, colon, and jejunum, although these will serve satisfactorily. Maximal palliation with relief of dysphagia is best achieved by removal of the obstructing lesion when possible, even if some tumor remains. When resection is not practical, bypass anastomoses proximal to the tumor occasionally may be used to relieve the obstruction and the associated dysphagia. Irradiation and chemotherapy may improve the results of therapy. To permit earlier detection, better screening tests are needed.

Combined Modality Therapy↗
PubMed1985

Coronary artery bypass surgery in elderly patients.

Seventy-five patients 65 years of age and older had coronary artery bypass surgery during 2 years at Scott and White Memorial Hospital with a 4 per cent mortality rate. An average of 3.1 grafts were placed and 5.1 units of blood were used during 13 days of postoperative hospitalization. Sixty-one patients were in New York Heart Association Class IV, 12 were in Class III, and 2 had other indications for coronary artery bypass. One year following surgery there were 60 patients in Class I, 6 in Class II, 3 in Class III, and 1 in Class IV; 1 patient was dead, and 4 were lost to follow-up. Our conclusion is that coronary artery bypass grafting can be performed with an acceptable mortality rate in the elderly and that age alone should not be considered a contraindication to the operation.

Aged↗
PubMed1979

Duodenal ulcer: its treatment by parietal cell vagotomy at the time of cardiovascular operation.

The existence of duodenal ulcer disease constitutes a potential threat during the recovery that follows any major operative procedure. At the time of cardiovascular operations, it would be desirable to treat the coexisting duodenal ulcer disease with a definitive ulcer operation if it could be done without entering the gastrointestinal (GI) tract, thereby eliminating the risk of graft contamination. Parietal cell vagotomy with pyloroplasty meets these conditions. During an 18-month period, 309 patients underwent cardiovascular procedures; ten underwent parietal cell vagotomy at the same time for treatment of duodenal ulcer. None of the patients experienced GI complications or the development of any other operative complications referable to the gastric procedure. Parietal cell vagotomy for active duodenal ulcer disease seems to be eminently suited as a companion for cardiovascular procedures that must be expedited.

Aged↗
PubMed1979

Sputum cytology in the diagnosis and treatment of lung cancer.

To evaluate the contribution of sputum cytology to the diagnosis and treatment of lung cancer, 918 cases of lung cancer were reviewed. Of 105 patients with positive sputum cytology, 93 had other invasive procedures to establish the cell type or stage or to attempt to cure the disease. In 12 patients the presence of positive sputum prevented further invasive evaluation. Thus, the real benefit of sputum cytology was reduced to 12 patients, or little over 1% of the total number of lung cancer patients. It is concluded that sputum cytology is not an effective diagnostic approach to suspected lung cancer. It rarely precluded invasive proceudres because it failed to contribute to the staging of the disease. Therefore, it should be used in only those patients in whom the yield of positive sputum would direct therapy other than surgery.

Bronchoscopy↗
PubMed1978

A new coronary perfusion cannula.

A flexible but rigid-walled nontraumatic cannula has been developed for perfusion of the coronary arteries or visceral branches of the aorta.

Cardiopulmonary Bypass↗
PubMed1976

Clamp for wire closure of sternum.

A modification of the Kocher clamp used for wire closure of the sternum is described. With the clamp applied securely to the individual strands, the wire can be readily twisted; the shorter length of the clamp allows the surgeon a much firmer grip on the wire and saves considerable time during closure.

Cardiac Surgical Procedures↗