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Biomedical subjects

W A Dale

Publications and source records attributed to W A Dale.

At least 19 recordsLinked to original sources
PubMed1985

Perigraft seromas complicating arterial grafts.

A collection of clear, sterile fluid, confined within a nonsecretory fibrous pseudomembrane surrounding a vascular graft, is a specific clinicopathologic entity termed perigraft seroma. Our experience with four such cases prompted a clinical study of our own material and that of others. A comprehensive survey, including the entire North American Chapter of the International Society for Cardiovascular Surgery membership, provided 279 cases for detailed analysis. Material most commonly involved were knitted Dacron (54%) and polytetrafluorethylene (34%), with knitted Dacron in the axillofemoral position accounting for 31% of the cases. The fluid was documented as serum by biochemical and electrophoretic analysis. Histopathologically, the grafts were noted to be poorly incorporated into the surrounding tissues, and the graft lining was covered by a flimsy, fibrous layer with a degenerated fibrin-protein matrix noted in the interstices of the graft. These findings pertained to both polytetrafluoroethylene and Dacron; neither acute nor chronic inflammatory changes were noted. The cyst membrane was comprised of nonsecretory cells, primarily fibroblasts. Treatment was highly variable. Graft replacement provided a 92% cure rate, and the authors advocate removal of the original graft and cyst membrane with placement of a new graft of material other than the original along a different anatomic route. However, in elderly, poor-risk patients, resolution may occasionally be achieved by "watchful waiting" with or without multiple aspirations.

Adult↗
PubMed1979

Reconstructive venous surgery.

Experience with 60 reconstructions of large peripheral veins is summarized. No deaths occurred and complications were minimal. Most patients had excellent or good results.

Adult↗
PubMed1978

Antibiotic prophylaxis in vascular surgery.

Preoperative and intraoperative antibiotic prophylaxis of infection in peripheral vascular surgery has been widely used although controlled studies have been lacking. A randomized, a prospective, double-blind study of cefazolin versus placebo during 565 arterial reconstructive operations was performed at this hospital from February 1976 through August 1977. Among the 462 patients undergoing surgery of the abdominal aorta and lower extremity vasculature, there was a highly significant difference in the infection rates: 6.8% for placebo recipients versus 0.9% for cefazolin recipients (p less than .001). Of the 18 infections, four involved vascular grafts and all four graft infections occurred in the placebo group. Over 8% of abdominal wounds of patients receiving placebo became infected versus 1.2% of cefazolin patients (p less than .05). Groin wounds were infected infrequently, 1.1% for placebo patients versus none for cefazolin patients. No infections occurred among 103 brachiocephalic procedures. Skin antisepsis was analyzed retrospectively. Infection rates were significantly higher (p less than .01) following hexachlorophene-ethanol versus a povidone-iodine skin preparation. Adverse effects of cefazolin were carefully monitored: no rash, phlebitis, or emergence of resistant strains was observed. A breif perioperative course of cefazolin and povidone-iodine skin antisepsis are recommended in vascular reconstructive surgery of the abdominal aorta and lower extremity vasculature.

Antisepsis↗
PubMed1977

Management of early postoperative complications of arterial repairs.

Of 1,703 patients undergoing arterial procedures during a three-year period, 81 (4.7%) required reoperation within 72 hours because of early complications. Thrombosis (58 patients) and hemorrhage (19 patients) were the most frequent complications encountered. Reoperation was successful in salvaging a successful outcome in the majority of patients after both hemorrhagic and thrombotic complications. The results seem to justify a continued aggressive approach to the management of early complications following vascular reconstructive procedures.

Aorta, Abdominal↗
PubMed1976

Further experiences with bovine arterial grafts.

Following favorable laboratory experience with the chemically modified bovine arterial graft (reported previously), we have used it for arterial reconstruction of the lower extremity in 84 operations upon 79 patients. The over-all patency rate was 42%. There were 7% infections, which usually occurred in secondary and tertiary procedures. Five percent of the grafts became aneurysmal. These results, published reports, and the results of a questionnaire mailed to vascular surgeons indicates similarity of experience. The disadvantages of frequent early thrombosis of undetermined cause, aneurysmal degeneration in approximately 4%, the considerable cost, and the nonavailability of the graft in different dimensions have resulted in our discontinuation of use for arterial reconstructions.

Aneurysm↗
PubMed1975

Management of thoracic outlet syndrome.

This overall management program for thoracic outlet compression syndrome is based upon experience with 153 extremities in 149 patients and the results of others. The following conclusions are documented and discussed. 1) Diagnosis is based chiefly upon history; physical signs are inconstant and often absent. 2) Major vascular problems are unusual; angiography is not always necessary. 3) Electromyography is not always critical but does aid in diagnosis of carpal tunnel syndrome. 4) Non-operative treatment relieves most patients; operative decompression is indicated for a minority. 5) Transxillary first rib resection, with removal of cervical rib is the best operation. 6) Carpal tunnel decompression should be done concomitantly when needed. 7) Operation is relatively safe.

Adult↗
PubMed1975

Unusual problems of venous thrombosis.

Although venous thrombosis (thrombophlebitis) is well known, there are uncommon manifestations which are seen infrequently, discussed rarely, and documented poorly. Experiences with 38 patients in seven categories are discussed in terms of our results and the pertinent reports of others. Pulmonary necrosis after embolic pulmonary infarction (six patients) may require tube thoracotomy and/or lung resection and contraindicate further heparin therapy. Iliac and/or femoral vein thrombosis occasionally fails to recanalize. Long-standing occlusion (18 patients) may be benefited by a cross-over saphenous vein graft. Left iliac venous occlusion secondary to pressure from the crossing right iliac artery (four patients) may indicate repair or bypass. Budd-Chiari syndrome (thrombosis of the hepatic venous outflow) was, in a single patient, carried past a critical period by a long Dacron tube shunt graft from the umbilical vein to the azygos vein. Subclavian and axillary venous thrombosis due to thoracic outlet pressure syndrome (three patients) often responds to heparin but may require thrombectomy; later resection of the first rib is indicated. Phlegmasia cerulea dolens (blue phlebitis) with tissue gangrene (three patients) requires immediate venous thrombectomy and subsequent heparinization. The occluded inferior vena cava (three patients) remains a challenging unsolved problem.

Adult↗
PubMed1973

The swollen leg.

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Cellulitis↗