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Biomedical subjects

W E Wheeler

Publications and source records attributed to W E Wheeler.

At least 37 records · Page 2Linked to original sources
PubMed1985

Inadequate tetanus protection among the rural elderly.

Three cases of tetanus occurring in a community in southern West Virginia in five years prompted a survey of the immunization status of the population of this region. An immunization history was obtained from 540 consecutive patients seen at three different health care facilities. Of these, 386 (71.5%) had received prior tetanus protection, 65 (12%) had never been immunized, and 89 (16.5%) were uncertain or had received incomplete immunization. Of the 65 nonimmunized patients, 54 (83%) were older than 50 and only 11 (17%) were younger. Compared to the total group sampled, significantly more nonimmunized patients (both male and female) were older than 50 (P less than .001). Also, significantly more of these never immunized individuals lived in rural areas (P less than .001). In a group of 222 patients identified as being at increased risk of having tetanus, 65 (29%) had never been immunized, 89 (40%) were of uncertain or incomplete status, and 68 (30.5%) had been immunized more than ten years previously. One hundred twenty (54%) high-risk patients were older than 50 and 103 (46%) were younger. Compared to the entire population sampled, high-risk patients included significantly more who were older than 50 (P less than .001). Also, significantly more high-risk patients lived in rural areas (P less than .007). When treating injured patients, it is important to recall that many older adults living in rural areas are not adequately immunized against tetanus. Such patients should receive human tetanus immunoglobulin, as well as tetanus toxoid.

Adolescent↗
PubMed1985

Flexible sigmoidoscopy as a screening procedure for asymptomatic colorectal carcinoma in patients with inguinal hernia.

In patients about to have hernia repair, preoperative screening studies for early colorectal cancer using the rigid proctosigmoidoscope and barium enema have previously shown minimal cost effectiveness and poor patient acceptance. Flexible sigmoidoscopy may be more acceptable to patients and of greater diagnostic value. Between October 1980 and December 1983, 100 consecutive asymptomatic male surgical patients were examined using the Olympus 60 flexible proctosigmoidoscope. All patients were admitted for elective hernia repair. Age ranged from 21 to 88 years (mean 59.7). All patients with stool positive for occult blood on admission were excluded from this study. In addition, patients with any gastrointestinal symptoms, history of colorectal disease, or family history of colorectal polyps or carcinoma were excluded. Examinations were done under direct supervision of an attending surgeon (W.W. or C.S.C.). Of the 22 patients who had one or more benign polyps, three had villous adenomas. Two additional patients had carcinoma. Results of examination were completely normal in 63, while 13 patients were found to have hemorrhoids or diverticular disease. There were no complications and the procedure was well tolerated by all patients.

Adenoma↗
PubMed1985

Etiology and prevention of topical cardiac hypothermia-induced phrenic nerve injury and left lower lobe atelectasis during cardiac surgery.

Left hemidiaphragm elevation is frequently noted following cardiac surgery employing topical hypothermia. We speculate that contact of the left phrenic nerve with ice causes nerve injury, resulting in left hemidiaphragm paresis or paralysis and left lower lobe atelectasis. Left diaphragm elevation was noted on postoperative chest x-ray examination of 36 of 60 (60 percent) consecutive patients in whom topical cooling of the heart with a cold slush solution was administered prior to use of a cardiac insulation pad (CIP, Shiley Laboratories, Irvine, California). Following the use of the CIP in a similar group of 60 consecutive patients, only five (8 percent) showed evidence of diaphragmatic elevation. The difference in the incidence of diaphragmatic elevation between these two groups is statistically significant (p less than 0.001). A comparison of postoperative left lower lobe atelectasis prior to the use of the CIP was also statistically significant (p less than 0.001). There was no significant difference in the aortic cross-clamp time or the volume of intraaortic cardioplegia used in these two groups. The use of topical cardiac hypothermia has been shown to protect the myocardium. Phrenic nerve injury secondary to the use of ice in this method has been documented. The use of a cold solution without ice chips or slush, or the insertion of a CIP prior to the use of topical cardiac hypothermia (when ice chips or slush are used) decreases the exposure of the phrenic nerve to cold injury and decreases the incidence of paresis of the left diaphragm and resultant atelectasis.

Cardiac Surgical Procedures↗
PubMed1983

Factor VIII complex in chronic renal failure: influence of protein C, fibrinolysis and diabetes mellitus.

Chronic renal failure causes elevations of factor VIII coagulant activity and Factor VIII-related antigen even before the patients enter chronic hemodialysis. The change from control of Factor VIII ristocetin cofactor does not reach significance. The elevations are not effected by entering onto hemodialysis. These parameters are the same for non-diabetic and diabetic patients. Protein C, plasminogen and total fibrinolytic capacity are normal in diabetic and non-diabetic patients, with or without hemodialysis for chronic renal failure. However, before entering onto hemodialysis some of these parameters had negative correlation coefficients with parts of the factor VIII complex among the diabetic and non-diabetic patients. These negative correlates turned positive after hemodialysis. Thus, there are differences in these catabolic mechanisms for factor VIII when hemodialysis is used for diabetic and non-diabetic patients with chronic renal failure.

Adult↗
PubMed1977

Combined radiographic and ultrasonographic approach in diagnosis of renal inflammatory lesions.

Seven cases of inflammatory lesions of the kidneys are reported. In 6 of the 7 patients, there were clinical and/or laboratory signs of urinary tract infection. The lesions occurred without any preference to age, sex, or location as to the right or left kidney. The diagnostic approach was individualized, and a correct preoperative diagnosis was made in 6 of the 7 cases. This high diagnostic accuracy was reached by using the following diagnostic principles. The lesions are detected and localized by urography and nephrotomography. Ultrasonography is used to decide whether the mass is solid or cystic. A percutaneous needle puncture is done in cases in which ultrasonography indicates a cystic lesion. The diagnosis of renal cyst is confirmed or excluded by cytology and analysis of the cyst fluid. Renal angiography is performed when the mass displays a solid or mixed ultrasonographic pattern and also in cases of hematuria and in cases in which the clinical symptomatology suggests malignancy.

Adult↗
PubMed1977

Chyluria.

A twenty-four-year-old black female presented through the outpatient department complaining of "white urine". Pertinent history, physical examination, and diagnostic studies are reviewed with special emphasis on lymphangiography. The literature is reviewed particularly with regard to laterilization of the fistula, thoracic duct obstruction, and methods of therapy.

Adult↗
PubMed1976

Angiography and ultrasonography. A comparative study of abdominal aortic aneurysms.

Ultrasound is presently the diagnostic procedure of choice in pulsatile abdominal masses. The ease and accuracy of this method have many advantages over aortography, and ultrasonography can accurately define the size of an abdominal aortic aneruysm. In addition, a normal aorta with an overlying mass, or a tortuous aorta which feels unusually prominent, can be detected, and aortography may not be necessary. Although ultrasound can detect involvement of iliac arteries, it does not allow assessment of the position of the aneurysm relative to the renal arteries, or detect involvement of other branch vessels of the aorta. Ultrasound is more accurate that clinical examination, plain roentgenography, aortography, or isotope aortography in the diagnosis of abdominal aortic aneurysms.

Aorta, Abdominal↗
PubMed1975

Effect of forage-to-concentrate ratio in complete feeds and feed intake on digestion of starch by dairy cows.

In digestion trials, 16 Holstein cows were fed complete mixed feeds of (a) 75:25, (b) 60:40, (c) 45:55, and (d) 30:70 ratios of forage to concentrate on a dry basis. At an intake of feed for maintenance, digestibility of starch ranged from 96.2 to 96.8%. During the lactation phase when intakes of feed were 2.5 to 3.2 times maintenance, digestibility of starch ranged from 84.7 to 88.1%. Starch in feces represented 2.9, 3.7, 5.5, and 5.9% of the intake of dry matter during the lactation phase, and .6, 1.0, 1.3, and 1.6% of intake at maintenance for the respective rations. At high intakes of concentrate, substantial amounts of dietary starch escaped degradation in the rumen and small intestine and were lost in the feces.

Animal Feed↗
PubMed1975

Particulate matter in reconstituted amphotericin B and assay of filtered solutions of amphotericin B.

Amphotericin B colloidal solutions were prepared according to the manufacturer's directions and filtered with membrane filters of different porosity to test for particulate matter; and the concentration and in vitro microbiological activity of filtered and nonfiltered solutions were determined. The amphotericin B solutions contained numerous particles. Filtration through 0.85- and 0.45-mum filters did not reduce the in vitro antimicrobial activity, and filtration through 5-, 0.45-, and 0.22-mum filters did not alter the concentration of the drug when assayed spectrophotometrically.

Amphotericin B↗