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Biomedical subjects

T Welch

Publications and source records attributed to T Welch.

10 recordsLinked to original sources
PubMed1990

Multiple aortic aneurysms: the results of surgical management.

During the past 2 decades 102 consecutive patients (77 men and 25 women) with multiple aortic aneurysms underwent 201 aortic reconstructions. These procedures (174 elective and 27 emergent) represented 3.4% of the 5837 aortic aneurysm operations performed. Seventy-five (30.9%) of the 243 aneurysms occurred in the infrarenal aorta, 65 occurred in the descending aorta (26.7%), 56 occurred in the thoracoabdominal aorta (23.0%), and 47 occurred in the ascending aorta or arch (19.3%). Ages ranged from 20 to 81 years (mean 63.3 years). Smoking history and abnormal electrocardiographic tracings were present in 84.3% of the patients, hypertension was present in 77.5%, and obstructive lung disease was present in 60.8%. Multiple aortic aneurysms were present at the time of the first repair in 55 patients (53.9%). Twelve patients had one procedure, 81 had two, and nine had three. Sixteen (17.8%) of the 90 patients who had multiple operations had a subsequent operation for complications of the unrepaired aneurysm (rupture 12, symptoms 4). Fourteen perioperative deaths occurred among the 174 elective repairs (8.0%), and 11 occurred among the 27 emergent procedures (40.7%). Procedure mortality increased with the ordinal number of elective operations and was 4.4% for the first, 10.4% for the second, and 33.3% for the third. Seven of 21 patients (33.3%) who had simultaneous repair of at least two aortic aneurysms died in the perioperative period. Overall, 77 of the 102 patients (75.5%) survived all surgical procedures to repair their multiple aortic aneurysms; of these, 63 had complete resection of all known aneurysms. Follow-up was complete in all patients and averaged 6.3 years (ranges: 1 month to 19 years). There were 30 late deaths; the most frequent cause was myocardial infarction. Kaplan-Meier 5-year survival including perioperative deaths for all patients after the first operation was 76% and after the last operation 40%. We conclude that multiple aortic aneurysms can be safely managed, usually with staged repairs, and that long-term survival is probably. After the first aortic operation the presence of multiple aneurysms mandates close observation with timely surgical intervention.

Adult↗
PubMed1990

Testing a policy for skull radiography (and admission) following mild head injury.

There has been, and continues to be, conflicting advice regarding skull radiography following an apparently uncomplicated head injury. Policies on admission are often ill defined. In 1983, representatives of the Royal College of Radiologists met neurosurgeons at a seminar in Harrogate organized by the DHSS and laid down clear, but little publicized, joint recommendations: "The Harrogate Criteria". The survey described here evaluated an existing liberal policy for skull radiography (and a loose policy for admissions) against these recommendations, and it was concluded that the number of patients having skull radiography (74% of head injury attenders) was excessive. Measured against the "Harrogate Criteria", requests for 36% of the adult and 47% of children's skull radiographs did not fulfil these criteria. As a corollary, it was also concluded that loose admissions policies could usefully be altered to comply more closely with the Harrogate recommendations. This would not necessarily reduce the numbers admitted, but would provide casualty officers with a framework on which to base this crucial aspect of clinical decision making, where presently there is often very little structure at all. The authors suggest that all the options have not been fully explored, and that a simple but important alteration to the Harrogate guidelines would provide an even closer link between policy on skull radiography and patient admission. Specifically, most patients who are to be admitted do not need skull radiographs.

Adult↗
PubMed1985

Reducing errors in the accident department: a simple method using radiographers.

The assessments by radiographers of 1628 consecutive patients referred for radiography in the casualty department were analysed. The radiographers missed abnormalities in the radiographs in 68 of the cases. Casualty officers missed abnormalities in 63 cases, but only 35 patients were common to both groups. Twenty eight of the radiographs interpreted wrongly by casualty officers were interpreted correctly by radiographers; 16 of these 28 were thought by the accident and emergency consultant to be clinically important. It is suggested that a system whereby radiographers signal abnormalities should be standard practice.

Diagnostic Errors↗
PubMed1978

Toxic-shock syndrome associated with phage-group-I Staphylococci.

Seven children (aged 8--17 years) presented with a high fever, headache, confusion, conjunctival hyperaemia, a scarlatiniform rash, subcutaneous oedema, vomiting, watery diarrhoea, oliguria, and a propensity to acute renal failure, hepatic abnormalities, disseminated intravascular coagulation, and severe prolonged shock. One patient died, one had gangrene of the toes, and all have had fine desquamation of affected skin and peeling of palms and soles during convalescence. Five patients were studied prospectively. Staphylococcus aureus related to phage-group I was isolated from mucosal (nasopharyngeal, vaginal, tracheal), or sequestered (empyema, abscess) sites, but not from blood. This organism produces an exotoxin which causes a positive Nikolsky sign in the newborn mouse and which is biochemically, pathologically, and immunologically distinct from phage-group-II stapphylococcal exfoliatin.

Acute Disease↗
PubMed1978

Malfunction of Cutter-Smeloff mitral prosthesis. An echocardiographic diagnosis.

Progression of intermittent partial or total impaction of the poppet from a prosthetic mitral valve may be difficult to evaluate in patients with chronic obstructive pulmonary disease and atrial fibrillation. Heart sounds may be distant; opening and closing clicks of the poppet are muffled and irregular. Echocardiography provides a noninvasive method to detect early prosthetic malfunction at a time when the patient is clinically asymptomatic.

Atrial Fibrillation↗
PubMed1976

Carbaryl effects on growth and development in suspension cultures of wild carrot.

Carbaryl has been demonstrated to inhibit growth of carrot suspension cultures at 10 and 20 ppm. The specific activities of RNA and protein increased at 20 ppm. Total RNA was relatively unchanged at any concentration while total protein was reduced considerably at 20 ppm. Embryo development was inhibited by increasing concentrations of carbaryl. Thin layer chromatography indicated considerable degradation of carbaryl to 1-naphthol. When 1-naphthol was tested in this system it was shown to elicit the same inhibitory effects on growth as carbaryl, suggesting that the 1-naphthol residue is itself a potent inhibitor of tissue growth and development.

Carbaryl↗