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Biomedical subjects

W F Barker

Publications and source records attributed to W F Barker.

18 recordsLinked to original sources
PubMed1989

An historical look at the thoracic outlet compression syndrome.

The story of the thoracic outlet compression syndrome begins with the identification of the anatomical abnormality of the cervical rib, and the symptoms related to it. Resection of the cervical rib, however, was soon followed by the recognition that symptoms could occur in the absence of a cervical rib. The scalenus anticus was then held to be the culprit, although several different mechanisms were advanced to explain the development of symptoms. Subsets of the thoracic outlet compression syndrome were then codified; costoclavicular compression; compression under the coracoid process during hyperabduction; primary symptoms related to arterial compression; and the syndrome that appears when neural and arterial compression are absent but venous occlusion is present. The importance of the first rib as a common denominator has brought about the idea that first rib resection is the best method of extirpating this common anatomic factor. That thesis is not accepted universally, however.

History, 19th Century↗
PubMed1988

Practical aspects in the diagnosis and management of cystosarcoma phyllodes.

Thirty-five cases of benign cystosarcoma phyllodes, 13 cases of malignant cystosarcoma phyllodes, and ten cases of giant fibroadenoma were studied. The diagnosis of benign or malignant cystosarcoma phyllodes was based on a combination of histological features. Clinical and gross pathologic findings were not found to be useful in distinguishing between benign and malignant tumors. Giant fibroadenomas occurred primarily in black adolescents and were histologically distinct. Positive surgical margins were found to be the best predictor of local recurrence of benign or malignant cystosarcoma phyllodes. Systemic metastases occurred in only one case of malignant cystosarcoma phyllodes. Most benign and malignant cystosarcoma phyllodes may be treated by wide local excision with tumor-free margins. Giant fibroadenomas should be treated by simple excision to preserve normal breast tissue.

Adolescent↗
PubMed1988

A century's worth of arterial sutures.

In light of the advanced state of vascular surgery today, it is hard to realize that the technique of vascular suturing is barely 100 years old. Even more remarkable is the skill with which the early surgeons applied almost all of the techniques we use today. Eck's experiments in the laboratory with portal vein-to-vena caval anastomoses were followed by pessimistic predictions concerning the future of arterial sutures. Jassinowsky had just performed the first successful arterial suture when he did a clinical arterial repair and, within 15 years, Carrel had developed nearly all the technical maneuvers which we use today. Knowledge of Carrel's work spread rapidly, and practical application of his work was reflected in the development of vascular replacements, such as venous grafting, the bypass technique used for vein grafts before World War I. There was, however, a lag in further developments until the end of the forties when dos Santos and Kunlin revived old methods and opened the way for further arterial surgical advances. These early developments are well-documented, but the reasons for delaying the acceptance of their applications remain a matter for speculation.

Arteries↗
PubMed1979

Late results of extra-anatomic bypass.

Clinical progress and results were reviewed in 100 consecutive patients who underwent extra-anatomic bypass procedures for brachiocephalic and aortoiliac occlusive disease during the past 15 years. Of 113 procedures in this group, extra-anatomic bypass of the brachiocephalic vessels, axillo-femoral bypass, and femorofemoral bypass were performed. Although these procedures were performed in high-risk patients to avoid intrathoracic and intra-abdominal reconstruction or to circumvent undesirable anatomic areas, a low operative mortality was achieved. Symptomatic improvement, augmented Doppler ankle pressure index, and high limb-salvage rate were noted. Life-table analysis has confirmed prolonged five-year graft patency. The suspected high-risk characteristic in this group was corroborated by high progressive mortality observed particularly after axillo-femoral bypass and was due primarily to the severity of associated diseases. Analysis of the late results of extraanatomic bypass confirms the safety and effectiveness of this procedure in poor-risk patients.

Adult↗
PubMed1978

Evaluation of extracranial cerebrovascular disease with ocular pneumoplethysmography.

The results of OPG studies performed on 121 patients between 1974 and 1977 are compared with the results of biplane angiograms. By adding criteria based on the ratio of AOP:BAP, the overall accuracy was increased from 76.9 to 91.7 per cent. This improvement was obtained by establishing criteria that identified bilateral significant lesions. The results have confirmed the value of OPG in noninvasive assessment of carotid artery disease.

Air↗
PubMed1978

A modification in the technique of making the Koch ileostomy pouch.

This minor modification in the original technique assures greater security and permanence of the nipple, yet takes no longer to perform than the original procedure. The steps have been defined in a manner calculated to simplify the technique for the surgeon who is not already familiar with the operation.

Humans↗
PubMed1977

Noninvasive methods for evaluation of extracranial cerebrovascular disease. A comparison.

Sixty-five patients with clinical evidence of carotid occlusive disease were evaluated by the Doppler ophthalamic test, ophthalmodynamography, and oculopneumoplethysmography prior to angiography. Clinical assessment was accurate 68% of the time, with 32% of patients having no arteriographic evidence of significant disease. The sensitivity of the noninvasive tests was dependent on the extent of the carotid stenosis. When the extent was greater than 60% of the cross-sectional diameter, the Doppler ophthalmic test was accurate 54% of the time; the ophthalmodynamography test, 61% of the time; and the oculopneumoplethysmographic test, 97% of the time. In lesions encompassing 50% to 60% of the vessel diameter, the Doppler ophthalmic test was accurate 15% of the time; the ophthalmodynamography test, 17% of the time; and the oculopneumoplethysmographic test, 10% of the time. With less than 50% stenosis, none of the noninvasive tests detected atherosclerotic lesions. Although many diseased vessels were missed, the low incidence of false-positive tests enhanced the usefulness of these methods in augmenting the accuracy of clinical evaluation.

Carotid Artery Diseases↗
PubMed1977

Breast reconstruction after mastectomy.

Reconstruction of the breast contour and areolanipple complex can be undertaken in patients who have had mastectomy for carcinoma of the breast. Although the reconstructed breast is not normal, the restored contour and simulation is gratifying for those patients who have sought this procedure.

Adipose Tissue↗
PubMed1976

Effect of cardiac dysrhythmia on cerebral perfusion.

Extracranial carotid arterial obstructive disease has been the entity most commonly associated with transient cerebrovascular insufficiency. A nonobstructive, frequently overlooked cause of cerebral ischemia is cardiac dysrhythmia. We have explored this by observations of experimental animals and of man. Blood flow and pressure in the carotid arteries of dogs were shown to be decreased by mechnically induced premature ventricular contractions. The significance of the cardiogenic contribution to altered cerebrovascular perfusion was studied by ocular and brachial plethysmography in 210 patients suspected by history of having carotid arterial insufficiency. Of the 210 patients, 62 demonstrated abnormal ocular plethysmographic recordings, and of those, nine had dysrhythmias associated with significant deficits of ocular perfusion. Five patients whose recordings were technically suitable for publication are presented to demonstrate the bizarre ocular plethysmographic recordings seen during the dysrhythmic cycle.

Adult↗
PubMed1975

Ophthalmic arterial blood pressures measured by ocular plethysmodynamography.

The indirect measurement of ophthalmic arterial blood pressure is an important index in the understanding of cerebral vacsular hemodynamics. Ophthalmodynamometry (ODM), the prototype for such measurement, is, however, replete with difficulties that have limited its widespread use. A preliminary evaluation of a new technique for ODM identified as ocular plethysmodynamography, has yielded accurate opthalmic blood pressure data without the attendant problems. Reproducible values for bilateral ophthalmic arterial pressure levels have been determined in 30 normal volunteers and the levels correlated to brachial arterial pressure levels. In a series of patients with arteriographically demonstrable carotid obstructive lesions, the preoperative and postoperative ophthalmic arterial blood pressure relationships exhibited excellent correlation with the roentgenographic and intraoperative data.

Adult↗
PubMed1975

Autogenous vein bypass grafts: biological effects of mechanical dilatation and adventitial stripping in dogs.

To evaluate whether mechanical vein dilatation and stripping of adventitia at the time of harvest may adversely alter the long-term fate of autogenous vein grafts, dogs were subjected to reversed femoral vein interposition grafting with either normal veins, mechanically dilated veins, or adventitially stripped veins. Vein segments taken before grafting and veins exposed in situ but not grafted served as controls. Animals were killed at 3 months, and five vein segments in each category were evaluated for gross and microscopic changes. All grafts subjected to arterial interposition displayed marked neointimal proliferation and fibrosis of the media and adventitia. Notably, both dilated and stripped veins appeared to be similar and were indistinguishable from normal veins that had been subjected to arterial interposition for the same duration. Veins exposed in situ but not subjected to arterial flow remained essentially normal. Adverse alterations attributed to vein dilatation or adventitial stripping were not apparent and should not be invoked in the mechanism of graft failure at 3 months' duration.

Animals↗