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Biomedical subjects

W H Baker

Publications and source records attributed to W H Baker.

At least 109 records · Page 6Linked to original sources
PubMed1983

The normal Doppler venous examination.

The clinical diagnosis of acute deep vein thrombosis (DVT) is but 50% accurate when compared to the results of contrast venography. This clinical inaccuracy had led to the dependence of the physician upon laboratory diagnosis. Whereas contrast venography is the gold standard of diagnosis, its expense, special equipment, personnel, and discomfort make it unsuitable for evaluating large numbers of patients. For this reason, numerous noninvasive tests utilizing plethysmographic and Doppler techniques have been developed to evaluate patients with suspected venous disease, and when expertly performed have a degree of accuracy of approximately 90%. This degree of accuracy coincides with the experience of our peripheral vascular laboratory using the Doppler venous examination. Based on these statistics, our current practice is to evaluate patients suspected of having DVT with a Doppler venous examination (Figure 1). If the test is abnormal or equivocal, contrast venography is usually obtained and anticoagulation recommended. Contrariwise, if the Doppler venous examination is normal, venography is not obtained, and anticoagulation treatment is not recommended. This practice should reduce the number of venograms in a patient population that is not at an increased risk of pulmonary embolism or repeated deep venous thrombosis. To evaluate the validity and safety of this practice, one hundred eighty-six patients with normal Doppler venous examinations in whom contrast venography was not obtained were evaluated and form the basis of this report.

Angiography↗
PubMed1983

Durability of carotid endarterectomy.

Carotid endarterectomy is the preferred treatment for patients with transient ischemic attacks and carotid stenosis. Although clinically these patients do well, the long-term fate of the operated carotid artery has not been well documented. To address this question, repeated noninvasive testing has been employed to follow our carotid endarterectomy patients since 1976. Supraorbital Doppler examination, oculoplethysmography-Kartchner, carotid phonoangiography and, later in this series, spectral analysis of the carotid Doppler velocities were performed after 193 endarterectomies. One hundred fifty-eight patients were initially tested within 3 months of operation, and 35 were initially tested 3 or more months after operation. Twenty-four arteries, four of which were symptomatic, had an initial abnormal test and are excluded from this study of carotid artery durability. Of the 169 patients with normal carotid tests, 36 had no further evaluation. Among the 133 patients who returned for serial testing from 1 to 60 months (mean 20 months), 115 carotid arteries continued to test normal at late follow-up but 18 subsequently developed test abnormalities. Ten had more than 75% stenosis, eight had 50% to 75% stenosis. Eight of these patients had contrast studies: three had normal findings; the five that had abnormal findings underwent reoperation. Interestingly, only two patients presented with symptoms appropriate to the abnormal test. The findings suggest that carotid endarterectomy is a reasonably durable operation. Recurrent stenosis was presumed or proven in 10% of 133 serially tested carotid arteries. This threat of restenosis makes long-term follow-up of these patients mandatory.

Arterial Occlusive Diseases↗
PubMed1982

Immediate and long-term outcome of acute arterial occlusion of the extremities. The effect of added vascular reconstruction.

Patients with acute arterial occlusion in immediate danger of limb loss, are frequently high-risk surgical candidates, yet a simple balloon thromboembolectomy often does not suffice for limb salvage. With this in mind, we studied 61 male patients with acute arterial occlusions to assess the effects of added vascular procedures at the time of initial thromboembolectomy. Forty-three patients had only thromboembolectomy, but 18 required additional vascular reconstructive procedures. Immediate limb salvage (83.3%) and long-term limb salvage (67%) in these 18 patients, who had no operative deaths, were similar to those of the other 43 patients. Surgical therapy including needed additional vascular reconstruction of acute arterial occlusions results in not only satisfactory short-term but also good long-term functional outcome.

Acute Disease↗
PubMed1980

Management of polytetrafluoroethylene graft occlusions.

Forty-two femoropopliteal-tibial bypass grafts were performed in 37 patients. Autogenous vein was used in 15, a composite polytetrafluoroethylene (PTFE)-vein in 15, and PTFE in 12. Two vein grafts occluded acutely because of veins of inadequate size. Three acute occlusions of PTFE grafts were due to primary thrombosis. Whereas no late vein graft occlusions have occurred, eight of 17 composite and eight of 12 PTFE grafts have subsequently occluded. Satisfactory vein grafts do not commonly occlude unless inadequate inflow or outflow exists. Contrariwise, PTFE grafts have an inherent risk of both early and late thrombosis. Therefore, repeated thrombectomy, may be required to maintain PTFE graft patency. Seventeen thrombectomies or revisions of PTFE or composite grafts in 12 limbs have resulted in seven patent grafts, thus underlining the value of this aggressive surgical approach. Composite grafts offer little advantage over PTFE grafts. The role of anticoagulation has yet to be established.

Aged↗
PubMed1979

Quality and duration of survival in glioblastoma multiforme. Combined surgical, radiation, and lomustine therapy.

A retrospective evaluation of the quality and length of survival of 74 patients nonrandomly receiving lomustine, 100 to 110 mg/sq m, following craniotomy and irradiation for glioblastoma multiforme was performed. After surgery all patients were capable of at least partial self-care. Patients receiving postoperative irradiation and lomustine had a median survival of 11.5 months. While receiving chemotherapy, 40% of these patients were capable of at least partial employment; 75% were able to care for themselves. These levels of function were stable for 70% of the average postoperative course (8.0 months), following which a decline ensued.

Activities of Daily Living↗
PubMed1979

Comparison of hemodynamic, pulmonary, and renal effects of use of three types of fluids after major surgical procedures on the abdominal aorta.

Hemodynamic, pulmonary, and renal variables were measured in 24 patients scheduled for major abdominal aortic operations. Control values were obtained before preoperative medications were given. All patients received 5% dextrose in Lactated Ringer's solution intraoperatively. Postoperatively, group 1 patients received 5% dextrose in water plus albumin, group 2 received 5% dextrose in 0.45 sodium chloride solution, and group 3 received 5% dextrose in lactated Ringer's solution. There were significant increases in Qs/Qt and AaDO2, 48 hours after operation in group 3. Oxygen consumption and cardiac output increased in all groups 24 hours after operation. Twenty-four hours later, these two variables returned to control values in group 1 but continued to rise in the other two groups. Significant diuresis occurred in group 1, 48 hours postoperatively, whereas the other two groups continued to retain water. Use of albumin and 5% dextrose in water in the postoperative period seemed to produce less deviations from control values of most measured variables, than the other two groups.

Albumins↗
PubMed1978

Diagnosis of peripheral occlusive disease: comparison of clinical evaluation and noninvasive laboratory.

One hundred and two patients with peripheral vascular disease were evaluated by the attending surgeon, residents and students, and the vascular laboratory prior to arteriography to test their ability to make a correct anatomic diagnosis. The attending surgeons made a correct anatomic diagnosis in 98 patients and were at least partially correct in the other four. Surgical housestaff and students were 62% totally correct, 35% partially correct, and 3% totally wrong. The vascular laboratory results were almost identical with the attending surgeon, but two patients could not be evaluated because of calcified arteries. The operation that was eventually performed was suggested initially by the laboratory and the attending surgeon in 98% of the patients.

Arterial Occlusive Diseases↗
PubMed1977

Value of concomitant sympathectomy in aortoiliac reconstruction. Results of a prospective, randomized study.

The efficacy of concomitant lumbar sympathectomy in improving results of aortoiliac reconstruction was assessed by a prospective, randomized study of 51 patients undergoing operation for occlusive or aneurysmal disease. Sympathectomy was performed on 50 limbs, while 52 extremities served as controls. Sympathectomy resulted in a significant reduction in foot vascular resistance determined by plethysmography. However, the procedure had no effect on leg circulation, assessed by ankle/arm pressure indices determined by Doppler ultrasound. In the sympathectomy group, there were three early postoperative amputations for ischemia, despite patent grafts. In the control group, there was one late graft occlusion, caused by progressive atherosclerotic disease. Although sympathectomy may improve pedal circulation, the procedure does not appear to improve the results of aortoiliac reconstruction.

Adult↗
PubMed1977

Staged intracranial and extracranial revascularization.

Twenty patients with a combination of intracranial and extracranial cerebrovascular lesions were identified in a series comprised of 118 candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Ten patients had internal carotid (ICA) occlusion and contralateral ICA stenosis, seven patients had combinations of ipsilateral lesions, usually ICA occlusion and external carotid (ECA) stenosis, and three patients had multiple lesions. Eighteen patients had a STA-MCA bypass performed; 11 of these had contralateral reconstruction for ICA stenosis, and seven had ECA stenosis corrected. Two additional patients became asymptomatic after ECA endarterectomy only and their proposed STA-MCA bypass has been postponed. There were two deaths, one early and one late. Eleven patients are asymptomatic, five are improved, one is unchanged, and one is neurologically worse.

Adult↗
PubMed1977

The healing of below-knee amputations: a comparison of soft and plaster dressing.

To evaluate the effect of wound dressing upon wound healing, fifty-one patients undergoing below-knee amputation using a long posterior myocutaneous flap technic were randomly allocated into a soft or plaster dressing group. Neither wound dressing technic proved superior, as wounds healed in 85.2 per cent of the plaster dressing group and 83.3 per cent of the soft dressing group.

Adult↗
PubMed1977

The cerebrovascular Doppler examination in patients with non-hemispheric symptoms.

The cerebrovascular Doppler examination indicated a significant stenosis in only 19 of 53 patients with non-hemispheric TIA'S. There were no false negative or false positive examinations. Fourteen of 19 patients with an abnormal examination and 23 of 31 patients with a normal examination became asymptomatic after a carotid endarterectomy. Eleven patients were improved and two were unchanged. Therefore the cerebrovascular Doppler examination can not be used to predict therapeutic success or failure of carotid endarterectomy for non-hemispheric TIA's.

Adult↗
PubMed1977

Carotid endarterectomy: is an indwelling shunt necessary?

Three hundred and four consecutive endarterectomies were performed with general anesthesia and without a temporary indwelling shunt. Eight patients (2.6%) awoke from anesthesia with a new neurological deficit. Eight additional patients later developed neurological symptoms, suggesting that the absence of a shunt did not contribute to their complication. Of these 16 patients, two (0.6%) died, nine (3.0%) had a temporary neurological deficit, and five (1.6%) had a permanent neurological deficit. A prolonged occlusion time, a stump pressure of less than 50 mm Hg, or the presence of additional carotid lesions did not show a significant statistical relationship to postoperative neurological deficit.

Adult↗