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Biomedical subjects

W C McLean

Publications and source records attributed to W C McLean.

17 recordsLinked to original sources
PubMed2000

Nonsurgical management of macular hemorrhage secondary to retinal artery macroaneurysms.

OBJECTIVE: To report visual acuity outcomes of nonsurgical management of macular hemorrhage secondary to retinal artery macroaneurysms. METHODS: Forty-one patients at multiple centers with macular hemorrhage secondary to retinal artery macroaneurysms managed with observation alone were reviewed. Time to clearance of macular hemorrhage, visual acuity at final follow-up, and presence or absence of macular pigmentary changes after absorption of the hemorrhage were recorded for each patient. RESULTS: On initial examination, visual acuity was 20/200 or worse in all except 4 patients (3 with 20/70, 1 with 20/80). At an average follow-up of 15. 7 months, a final visual acuity of 20/40 or better was achieved in 15 eyes (37%), between 20/50 and 20/100 in 12 (29%), and 20/200 or worse in 14 (34%). Macular pigmentary abnormalities were noted after clearance of the hemorrhage in 23 (56%) of 41 cases, and these eyes generally had worse visual acuity outcomes. CONCLUSIONS: In eyes with macular hemorrhage secondary to retinal artery macroaneurysms managed with observation alone, good visual acuity outcomes can often be achieved. Poorer visual acuity outcomes are associated with macular pigmentary changes after resorption of blood. Arch Ophthalmol. 2000;118:780-785

Adult↗
PubMed1998

Endogenous Aspergillus endophthalmitis. Clinical features and treatment outcomes.

OBJECTIVE: This study evaluated the clinical features and treatment outcomes in patients with endogenous Aspergillus endophthalmitis. DESIGN: The study design was a multicenter retrospective chart review. PARTICIPANTS: Ten patients (12 eyes) with culture-proven endogenous Aspergillus endophthalmitis treated by 1 of the authors were studied. INTERVENTION: Intravitreous amphotericin B injection, pars plana vitrectomy, systemic amphotericin B therapy, and oral anti-fungal therapy were performed. MAIN OUTCOME MEASURES: Elimination of endogenous Aspergillus endophthalmitis and Snellen visual acuity, best corrected, were measured. RESULTS: All patients had a 1- to 3-day history of pain and marked loss of visual acuity in the involved eyes. Varying degrees of vitritis was present in all 12 eyes. In 8 of 12 eyes, a central macular chorioretinal inflammatory lesion was present. Four patients (six eyes) had associated pulmonary diseases and were receiving concurrent steroid therapy. One of these patients with chronic asthma also was abusing intravenous drugs. Overall, six patients (six eyes) had a history of intravenous drug abuse, whereas a seventh patient (one eye) was suspected of abusing intravenous drugs. Blood cultures and echocardiograms were negative for systemic aspergillosis. Management consisted of a pars plana vitrectomy in 10 of 12 eyes. Intravitreous amphotericin B was administered in 11 of 12 eyes. Systemic amphotericin B therapy was used in eight patients. One patient was treated with oral antifungal agents. In three eyes without central macular involvement, final visual acuities were 20/25 to 20/200. In eight eyes with initial central macular involvement, final visual acuities were 20/400 in three eyes and 5/200 or less in four eyes. Two painful eyes with marked inflammation, hypotony, and retinal detachment were enucleated. CONCLUSIONS: Endogenous Aspergillus endophthalmitis usually has an acute onset of intraocular inflammation and often has a characteristic chorioretinal lesion located in the macula. Although treatment with pars plana vitrectomy and intravitreous amphotericin B is capable of eliminating the ocular infection, the visual outcome generally is poor, especially when there is direct macular involvement.

Adult↗
PubMed1991

North Carolina's dominant progressive foveal dystrophy: how progressive is it?

We studied 34 family members at risk of having dominant progressive foveal dystrophy of Lefler, Wadsworth, and Sidbury (also called North Carolina macular dystrophy) and found 17 to be affected. Fifteen of these affected subjects were observed over at least a 10-year period for evidence of progressive macular degeneration. Only one subject showed objective evidence of progressive deterioration in only one eye. Our findings further substantiate that this dystrophy generally has a stable course, contrary to its original description.

Adolescent↗
PubMed1990

Vascular injury following foreign body perforation of the esophagus. Review of the literature and report of a case.

Esophageal perforation resulting from foreign body ingestion is a rare occurrence. Most of the complications associated with this event, such as retroesophageal abscess, mediastinitis, pericarditis, pneumothorax, and pneumomediastinum, are widely recognized. However, little attention has been directed to the possibility of vascular injury caused by the perforating object. Isolated case reports have described significant morbidity and mortality subsequent to major vascular trauma resulting from an esophageal foreign body, usually emphasizing the presence of a "signal" hemorrhage from the gastrointestinal tract as a key to diagnosis. This report describes a case of esophageal perforation caused by an ingested fishbone that resulted in significant aerodigestive hemorrhage, possibly as the result of an unusual isolated vascular injury. The literature on vascular trauma following foreign body perforation of the esophagus is reviewed, and suggestions for the diagnosis and treatment of these dreaded complications are made.

Adult↗
PubMed1988

Acute frosted retinal periphlebitis.

We examined three previously healthy young patients who suffered acute visual loss associated with diffuse bilateral retinal periphlebitis. Each patient developed thick, inflammatory infiltrates surrounding all of the retinal veins, creating the appearance of frosted tree branches. Initial visual acuities ranged from 20/20 to hand motions (median, counting fingers). All patients showed rapid improvement after starting oral corticosteroid therapy, and all but one of the six affected eyes regained a visual acuity of 20/20. The clinical appearance and course of these patients matched those of a condition previously described in Japan and labeled frosted branch angiitis. The term "acute frosted retinal periphlebitis" seems to describe more accurately the clinical findings.

Acute Disease↗
PubMed1986

Esthesioneuroblastoma: the University of Virginia experience 1960-1985.

Twenty-six cases of esthesioneuroblastoma were treated by the Department of Otolaryngology-Head and Neck Surgery from 1960 to 1985. This period was divided into the precraniofacial period (1960 to 1975) and the craniofacial period (1976 to 1985) to denote the transition to a more aggressive combined therapeutic approach. Of the eight patients in the precraniofacial group (group I), only 37.5% are alive without disease. In group II (the craniofacial group), 82% of the patients are alive without disease with an average follow-up of 4 years. This latter survival rate compares favorably with the survival rate of group I and the cure rate of 10% to 67% as stated in other studies.

Adult↗
PubMed1983

Stage II glottic carcinoma: prognostic factors and management.

Three hundred thirty-six patients with squamous cell carcinoma of the glottic larynx treated at the University of Virginia Medical Center from 1960 through 1977 were reviewed. Seventy patients with T2N0M0 disease, grouped according to the criteria of the American Joint Committee on Cancer, 1978, form the basis of this report. The 5-year actuarial survivals, recurrences, salvages, and prognostic factors were examined. Treatment was radiation, surgery, or a combination of radiation and surgery. Impaired vocal cord mobility in Stage II glottic squamous cell carcinoma is the crucial significant prognostic factor in predicting response to therapy, survival, and response to salvage therapy for recurrences. The 90% 5-year recurrence-free rate with freely mobile cords is comparable to that achieved with Stage I lesions. Impaired mobility resulted in a 5-year recurrence-free rate of 73%, which is comparable to that of T3N0 lesions. We support the concept of reclassifying Stage II disease into Stage IIa (mobile cords) and Stage IIb (impaired mobility). Based on this review and those reported in the literature, we recommend radiation therapy for Stage IIa disease. Surgery results in fewer recurrences and in longer survival than irradiation when the vocal cords are not freely mobile (Stage IIb).

Carcinoma, Squamous Cell↗
PubMed1981

Pericranial flap for the closure of defects of craniofacial resection.

Malignant neoplasms involving the ethmoid sinuses mandate en bloc resection via the craniofacial approach. This technique leaves a direct communication between the nasal chamber and the extradural space to be closed. The elevation of dura from the nasal chamber and the extradural space to be closed. The elevation of dura from the anterior chamber and the extradural space to be closed. The elevation of dura from the anterior cranial fossa and cribriform area may result in small dural tears, CSF leak and/or CNS infections. We have utilized an inferiorly based pericranial flap and a laterally based osteoplastic bone flap to successfully close this space and dural defects. The laterally based bone flap allows insetting pericranial flap without compromising the vascularized inferior base and gives generous exposure of the area to be resected. This approach has been used successfully in four patients in the last year. Three patients had esthesioneuroblastomas and the fourth had a squamous cell carcinoma of the maxilloethmoid complex. This communication describes the technique and lists advantages of the inferiorly based pericranial flap.

Adolescent↗
PubMed1981

Acinic cell carcinoma: its occurrence in the laryngotracheal junction after thyroid radiation.

An acinic cell carcinoma of the laryngotracheal junction developed in a 54-year-old woman 46 years after administration of radiation to her thyroid gland. Although salivary gland neoplasia has been associated with a history of radiation therapy during childhood, acinic cell carcinoma in such a setting is rare. In addition, she had parathyroid hyperplasia and multiple thyroid adenomas, lesions that have been associated with prior administration of radiation. A history of exposure to radiation should be sought in patients with salivary gland neoplasms of the larynx or trachea.

Carcinoma↗
PubMed1977

Otitis media: a review.

We have presented recommendations for diagnosis and management of otitis media in children based on a comprehensive review of the pertinent medical literature. For an entity that is so common, there still remain amazingly large numbers of areas of controversy. We have also attempted to stress the importance of appropriate therapy and adequate followup as being very important in the management of otitis media. Newer concepts, particularly the use of the impedance bridge tympanogram, have been mentioned. With all the above background information in mind and with considerations for what is practical for the patient and the medical community, we would recommend the following as the acceptable minimal care for patients with otitis media. When the diagnosis of the acute otitis media is made on the basis of physical findings of myringitis, and/or middle ear fluid, and/or rupture of the tympanic membrane, the following treatment course is advisable: Neonates Culture of middle ear fluid if possible. Ampicillin 200 mg/kg/day intramuscularly. Gentamicin 3/5mg/kg/day intramuscularly. Hospitalize and treat until well and for minimum of seven days. Observe closely for meningitis and other infections and drug toxicity. These should be handled only by physicians experienced in dealing with patients in this age range. Appropriate work-up for septicemia should precede treatment. Switch to specific antibiotic when cultures and sensitivity available. Children. From 2 months to 6 years of age: Ampicillin 50mg/kg/day. Decongestant (if desired). Administer for ten days. Every patient with otorrhea, severe otitis and those not clinically well should be seen for followup ten to 14 days later. They should have a minimum of otologic evaluation including drum mobility. In persistent cases, audiometry and otologic referral are necessary. If patient is allergic to penicillin, erythromycin at 20mg/lb/day may be used. Trimethoprim sulfa may hold promise in the future. Tetracycline is never indicated in this age range because of side effects and high relapse rate secondary to resistant organisms. Patients above 6 years of age: Penicillin pheyoxymethyl 250 mg every six hours for ten days. Decongestant (if desired). Followup and penicillin allergy as above.

Adenoidectomy↗
PubMed1976

Symposium: management of tumors of the parotid gland. IV. Differential diagnosis and management of deep lobe parotid tumors.

The problem of the pathological anatomy, the diagnosis, differential diagnosis and management of tumors of the parapharyngeal space has been discussed. Preoperative biopsy is to be discouraged in all benign lesions of the area. External approach with good adequate exposure is most important. Surgery is the treatment of choice in the benign lesion, by far the most common tumor as reported in the literature. Any tumor or disease of the superficial parotid may also be found in the deep lobe.

Diagnosis, Differential↗
PubMedDate not supplied

Laryngectomy for chronic aspiration.

Most laryngectomies are performed for neoplastic disease. Recently, the authors have managed four patients with chronic aspiration who ultimately required laryngectomy to control leakage of food and saliva into the tracheobronchial tree. Various surgical procedures have been devised to conserve the larynx and protect the lower airway. Although potentially reversible, these procedures are fraught with complications, and the patients seldom recover sufficiently to justify repair of the larynx. The authors feel that those patients with poor prognoses, associated medical problems, and evidence of impaired wound healing should undergo laryngectomy. This approach removes doubt about the cause of the aspiration and spares the patients additional surgical procedures should a more conservative approach fail.

Adult↗
PubMedDate not supplied

Foreign body and caustic ingestion: management 1979.

Most physicians involved in the diagnosis and management of foreign body aspiration and caustic ingestion assume that the numbers of these cases are decreasing. A sizeable number of patients die of caustic ingestion and poisoning annually, and deaths from foreign body ingestion have more than doubled since 1950. Increasing the significance of these needless tragedies is the fact that the most frequent victim is a young, healthy child. Physicians should encourage educational campaigns to alert parents to the dangers of caustic agents and small items capable of being aspirated. They should be conversant with the treatment of both. This paper reviews current opinions regarding management.

Airway Obstruction↗
PubMedDate not supplied

Laryngeal acinic cell carcinoma following thyroid irradiation.

Only three examples of acinic cell carcinoma of the larynx or trachea are found in the recent literature. A case of acinic cell carcinoma of the subglottic larynx and trachea was diagnosed and treated at the University of Virginia Medical Center. To our knowledge this is the first such case with a prior history of radiation to the neck. The patient is a 56-year-old woman who was irradiated for hyperthyroidism 46 years ago. When seen she also had parathyroid hyperplasia and multiple thyroid adenomas, conditions that frequently follow irradiation of the thyroid in children. These findings in this case support the concept that radiation may be responsible for inducing this tumor, which otherwise rarely occurs in this location. The use of electron microscopy was extremely useful in the diagnosis of this tumor. She was treated with total laryngectomy and right neck dissection and is now free of disease one year after surgery.

Adenoma↗