PubMed Health⌕ Search

Biomedical subjects

W L Old

Publications and source records attributed to W L Old.

10 recordsLinked to original sources
PubMed1985

The results of valve replacement for mitral valve prolapse.

Between January, 1975, and December, 1982, 33 patients underwent mitral valve replacement for mitral valve prolapse secondary to myxomatous degeneration. The majority were in the seventh decade of life (median age, 62 years), and all were seen with symptoms of mitral regurgitation. Echocardiography was more accurate in making the diagnosis of mitral valve prolapse more often (75%) than angiography (66%). Thirty-eight percent of the patients who underwent cineangiography had concomitant coronary artery disease and had coronary artery bypass grafting as well as mitral valve replacement. There was 1 operative death, an operative mortality of 3%. There were 6 late deaths, a late mortality of 18%. Of the 26 long-term survivors, 23 (88%) were in New York Heart Association Functional Class I and 3 (12%) were in Class II. The average length of follow-up was 33.25 months, and the 5-year actuarial survival was 76%. There was only one incident of thromboembolism (3%). Short-term and long-term survival were not related to the severity of mitral regurgitation but to the status of the left ventricle and the overall condition of the patient. These data suggest that older patients with severe mitral regurgitation secondary to mitral valve prolapse can undergo valve replacement with low operative mortality and gratifying long-term results.

Actuarial Analysis↗
PubMed1984

Clavicular excision in management of vascular trauma.

The problems of surgical management of injury to blood vessels of the thoracic outlet are illustrated by a case report of clavicular excision to gain direct access to the damaged vessels. The article reviews the surgical procedure and documents its efficacy and the lack of subsequent deformity or dysfunction. It recounts the hazards of unsuccessful attempts to repair the clavicle. Last, it discusses the beneficial effects of clavicular resection carried out for reasons other than vascular injury.

Adult↗
PubMed1983

Cholecystectomy concomitant with other intra-abdominal operations. Assessment of risk.

In a retrospective study, 1,416 cholecystectomies performed during a three-year period were reviewed to define the risk of cholecystectomy when combined with another intra-abdominal procedure. Group 1, cholecystectomy alone (1,148 patients), with subsets of cholangiography and/or common bile duct exploration, had a complication rate of 14.29% and a mortality of 0.52%. Group 2, primary cholecystectomy combined with secondary intra-abdominal surgery (214 patients), had a complication rate of 19.63%. Group 3, primary intra-abdominal surgical procedure with incidental cholecystectomy (54 patients), had a complication rate of 20.37%. Mortality for groups 2 and 3 was 2.24%. The rate of nonfatal complications was increased slightly when a second surgical procedure was performed (14.29% v 19.78%). Pairing cholecystectomy with other intra-abdominal surgery is advised only when surgical exposure is adequate, the patient's condition is satisfactory, and operating time is not prolonged greatly.

Abdomen↗
PubMed1979

Granular cell myoblastoma of the head and neck: review of the literature and 10 year experience.

The literature on granular cell myoblastoma (Abrikossoff's tumor) is reviewed and 16 new cases are presented. The etiology of this tumor remains uncertain, although a neurogenic origin appears likely. Individual tumors are usually small, nodular, and nonulcerating. There appeared to be no predilection for either sex in our series, and most tumors occurred between the third and sixth decades of life. Pseudoepitheliomatous hyperplasia is frequently associated with granular cell myoblastoma, and this combination must be distinguished from squamous cell carcinoma. Wide local excision, the treatment of choice, should be curative, although the incidence of multicentricity may exceed 15%. Thus, despite the usually benign nature of granular cell myoblastoma, its propensity for local invasion, multicentricity, and associated pseudoepitheliomatous hyperplasia should alert surgeons to its potential hazards, to the probability of recurrence if it is only marginally excised, and to the possible later development of similar lesions.

Adolescent↗
PubMed1979

Preventing disruption of abdominal wounds.

The use of silver wire retention sutures requires added operating room time and expense, and it incurs the potential hazards of caught viscera, the possibility of more adhesions, leakage of intraperitoneal fluid through the exit wound, mild infection of exit wounds, and, on removal of the sutures, pain despite sedation, cutting of viscera, and a residual cross-hatched scar. Nevertheless, we believe that use of the technic is amply justified by the prevention of abdominal wound disruption, ease in visualization of the wound, ease in providing equal distribution of wound tension and periodic adjustment of it, and in reapproximation of superficial tissues in the event of wound breakdown, as well as in the elimination of need for any external supportive device. The existence of a voluminous literature on the placing, making, and closing of abdominal incisions suggests that no single ideal method exists. Major disruption of abdominal wounds continues to be a serious problem, despite the infrequency of its occurrence. The use of through-and-through semirigid silver wire retention sutures with adjustable tension as a complement to the routine layered closure can prevent disruption of abdominal wounds while causing only minor complications.

Abdominal Injuries↗
PubMed1978

Pelvic lipomatosis.

Although usually in the domain of the urologist, pelvic lipomatosis sometimes first may present to the general surgeon. Often called perivesical lipomatosis, this process of unknown etiology has been defined as a nonmalignant overgrowth of normal fatty tissue limited primarily to the perirectal and perivesical spaces in the pelvis. Typically it occurs in middle-aged, nonobese, men presenting with dysuria and sometimes with suprapubic fullness. High position of the prostate may be noted on rectal examination. Urinary tract roentgenograms show a high, gourd-shaped bladder with the surrounding radiolucency of fatty tissues. Elongation of the urethra usually makes cystoscopy difficult. Sigmoidoscopy and barium enema may reveal extrinsic pressure on the rectum. Pelvic venography rarely shows external venous compression; arteriography does not suggest neoplastic vessels. Fat metabolism studies are of little value. The absence of adequate cleavage planes renders direct surgical management difficult. The frequently progressive lower ureteral obstruction eventually may require urinary diversion. Four biopsy-proved cases from the Eastern Virginia Medical School Hospitals are reported, and the 57 previous cases from the literature are reviewed.

Adult↗
PubMedDate not supplied

Tuberculous anal ulcer.

Two patients with anorectal tuberculosis, without prior or concurrent knowledge of active pulmonary infection with mycobacteria, are described. Anal fissure in an unusual location which is slow to heal should have a biopsy performed, with appropriate stains and cultures carried out, to rule out tuberculous disease. Chemotherapy is then highly effective for ulcerative perianal tuberculosis.

Adult↗