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Biomedical subjects

Richard McWilliams

Publications and source records attributed to Richard McWilliams.

4 recordsLinked to original sources
PubMed2006

Aorto-bronchial fistula following aortic and bronchial stenting of a thoracic aneurysm.

A 66-year-old man underwent repair of an abdominal aortic aneurysm and synchronous stenting of a thoracic aneurysm compressing his left main bronchus. This resulted in further bronchial compression which was also stented. An aorto-bronchial fistula resulting in severe haemoptysis occurred a few weeks later. This was successfully treated with repeat endovascular stenting and left pneumonectomy. Open repair should be the treatment of choice for thoracic aneurysms with bronchial compression.

Aged↗
PubMed2003

Ultrasonic locating devices for central venous cannulation: meta-analysis.

OBJECTIVES: To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation. DATA SOURCES: 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature. DESIGN: Systematic review and meta-analysis of randomised controlled trials. Populations Patients scheduled for central venous access. INTERVENTION REVIEWED: Guidance using real time two dimensional ultrasonography or Doppler needles and probes compared with the anatomical landmark method of cannulation. DATA EXTRACTION: Risk of failed catheter placement (primary outcome), risk of complications from placement, risk of failure on first attempt at placement, number of attempts to successful catheterisation, and time (seconds) to successful catheterisation. DATA SYNTHESIS: 18 trials (1646 participants) were identified. Compared with the landmark method, real time two dimensional ultrasound guidance for cannulating the internal jugular vein in adults was associated with a significantly lower failure rate both overall (relative risk 0.14, 95% confidence interval 0.06 to 0.33) and on the first attempt (0.59, 0.39 to 0.88). Limited evidence favoured two dimensional ultrasound guidance for subclavian vein and femoral vein procedures in adults (0.14, 0.04 to 0.57 and 0.29, 0.07 to 1.21, respectively). Three studies in infants confirmed a higher success rate with two dimensional ultrasonography for internal jugular procedures (0.15, 0.03 to 0.64). Doppler guided cannulation of the internal jugular vein in adults was more successful than the landmark method (0.39, 0.17 to 0.92), but the landmark method was more successful for subclavian vein procedures (1.48, 1.03 to 2.14). No significant difference was found between these techniques for cannulation of the internal jugular vein in infants. An indirect comparison of relative risks suggested that two dimensional ultrasonography would be more successful than Doppler guidance for subclavian vein procedures in adults (0.09, 0.02 to 0.38). CONCLUSIONS: Evidence supports the use of two dimensional ultrasonography for central venous cannulation.

Adult↗
PubMed2002

Multiple stenting in Takayasu arteritis.

PURPOSE: To illustrate the possible peri- and postprocedural complications of stent treatment for Takayasu arteritis and suggest ways of reducing these risks. CASE REPORT: A 69-year-old woman with Takayasu arteritis had multiple stents implanted in the aortic arch (3 Memotherm) and main branches of the thoracic aorta (individual Corinthian stents in the subclavian and brachiocephalic arteries) following balloon dilation. She suffered reperfusion injury with cerebral hemorrhage following the procedure, preventing the use of anticoagulation or antiplatelet therapy. Further cerebral infarctions/hemorrhages over the ensuing months led to her death. CONCLUSIONS: Severe vascular disease of any cause confers a poor prognosis. Endovascular stenting may seem an attractive option for management of these patients, but there is often significant morbidity and mortality associated with the underlying disease as well as the stent.

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