Walter Reed General Hospital Research Articles

Clinical and histologic studies of donor tissues utilized for free grafts of masticatory mucosa.

Journal of PeriodontologyVolume 44, Issue 12 p. 727-741 Clinical and Histologic Studies of Donor Tissues Utilized for Free Grafts of Masticatory Mucosa Stephen E. Soehren, Stephen E. Soehren Resident, Periodontics Service, Dept. of Dentistry, Walter Reed General Hospital, Washington, D.C. 20012.Search for more papers by this authorAndrew L. Allen, Andrew L. Allen Resident, Periodontics Service, Dept. of Dentistry, Walter Reed General Hospital, Washington, D.C. 20012.Search for more papers by this authorDuane E. Cutright, Duane E. Cutright Chief, Division of Oral Pathology, U.S. Army Institute of Dental Research, Walter Reed Army Medical Center, Washington, D.C. 20012.Search for more papers by this authorJay S. Seibert, Jay S. Seibert Professor and Chairman, Dept. of Periodontics, School of Dental Medicine, University of Pennsylvania, 4001 Spruce Street, Philadelphia, Pa. 19104. Formerly, Chief of Periodontics, Walter Reed Army Medical Center.Search for more papers by this author Stephen E. Soehren, Stephen E. Soehren Resident, Periodontics Service, Dept. of Dentistry, Walter Reed General Hospital, Washington, D.C. 20012.Search for more papers by this authorAndrew L. Allen, Andrew L. Allen Resident, Periodontics Service, Dept. of Dentistry, Walter Reed General Hospital, Washington, D.C. 20012.Search for more papers by this authorDuane E. Cutright, Duane E. Cutright Chief, Division of Oral Pathology, U.S. Army Institute of Dental Research, Walter Reed Army Medical Center, Washington, D.C. 20012.Search for more papers by this authorJay S. Seibert, Jay S. Seibert Professor and Chairman, Dept. of Periodontics, School of Dental Medicine, University of Pennsylvania, 4001 Spruce Street, Philadelphia, Pa. 19104. Formerly, Chief of Periodontics, Walter Reed Army Medical Center.Search for more papers by this author First published: 01 December 1973 https://doi.org/10.1902/jop.1973.44.12.727Citations: 57AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume44, Issue12December 1973Pages 727-741 RelatedInformation

Steroid-Responsive Hypercalcemia in Disseminated Bone Tuberculosis

There are many established causes of hypercalcemia. These include hyperparathyroidism, malignancies with or without bony metastases, sarcoidosis, bone atrophy, thyroid dysfunction, Addison disease, vitamin D intoxication, and the milk-alkali syndrome. 1 Hypercalcemia with disseminated bone tuberculosis is extremely rare. However, a case of miliary tuberculosis in which symptomatic hypercalcemia developed was reversed by corticosteroid therapy. Patient Summary A 28-year-old officer began serving a tour of duty in the Republic of Vietnam in September 1969. In March 1970, the patient noted the onset of fever, chills, nausea, and vomiting. A chest roentgenogram was normal, and peripheral blood smears revealed falciparum malaria. Despite several courses of antimalarial therapy and clearing of the parasitemia, fever persisted; and in late May, he was transferred to Walter Reed General Hospital. On admission, the patient complained of weakness, anorexia, and had a 9.04-kg weight loss. He was a thin, chronically ill appearing, white man in no

Therapeutic Misadventures With Oxygen Delivery Systems

Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, and Veterans Administration Hospital, Palo Alto, California 94304. Read at the 46th Congress of the International Anesthesia Research Society, March 12–16, 1972, Las Vegas, Nevada. ☆ RICHARD I. MAZZE, M.D., is a graduate of the State University of New York, Downstate Medical Center, Brooklyn, and interned at Brooke General Hospital, San Antonio, Texas. After his Residency in Anesthesiology at Walter Reed General Hospital, Washington, D.C., he was associated with the Department of Cardiorespiratory Diseases at the Walter Reed Army Institute of Research. Dr. Mazze is presently Associate Professor of Anesthesiology at Stanford Medical Center, Stanford, California, and Chief, Anesthesiology Service, Palo Alto V.A. Hospital, Palo Alto.

Measuring Oral and Rectal Temperatures of Febrile Children

When febrile children attending the Walter Reed General Hospital Pediatric Clinic had their temperatures measured in an environmental temperature of 70° to 82° Fahrenheit, 50 boys and girls required an optimum placement time of seven minutes for oral temperature measurements, and 40 children required four minutes for accurate measurements of rectal temperatures. Although girls and boys reached optimum oral temperatures in a relatively similar time span, girls required a longer time to reach their optimum rectal temperatures than boys.

Evaluation and use of the ventriculoperitoneal shunt in hydrocephalus.

✓ The high rate of complications associated with ventriculocardiac shunts at the Walter Reed General Hospital led to the evaluation of a new ventriculoperitoneal shunt procedure. Results with the ventriculoperitoneal shunt have shown a marked decrease in total complications and malfunctions and total absence of all cardiovascular-pulmonary complications, early and late. The Silastic peritoneal catheter has not become occluded, and is adaptable to other diagnostic procedures and injections. When lengthening of the peritoneal catheter is finally required due to the patient's growth, it should be easy to perform.

Plasmodium vivax from Vietnam. Response to chloroquine-primaquine.

From 1965 to 1968 in Vietnam, there was a dramatic increase in the proportion of malaria infections caused by Plasmodium vivax. We studied 30 patients with acute vivax malaria in Vietnam and 12 at Walter Reed General Hospital to assess the responsiveness of their infections to suppressive amounts of chloroquine with primaquine (C-P). Each patient was treated with a single C-P tablet containing chloroquine (base) 300 mg and primaquine (base) 45 mg. Clinical and parasitological responses were prompt in all patients. No urine-chloroquine tests performed upon the patients on admission to the hospital in Vietnam showed detectable chloroquine excretion owing to previous drug administration. Failure to take the prescribed C-P chemoprophylaxis probably accounts for the high proportion of vivax malaria in Vietnam.

Collaternal circulation in arterial injuries.

Of more than 1,100 Vietnam casualties with vascular injuries seen at Walter Reed General Hospital, representative cases are reviewed because they emphasize the ability of collateral circulation to maintain viability in a limb deprived of its major blood supply. Improvement in collateral circulation over various periods of time are documented by plethysmographic and Doppler techniques.

Iatrogenic ototoxic hearing loss.

From the Army Audiology and Speech Center, Walter Reed General Hospital, Walter Reed Army Medical Center, Washington, D. C. 20012

Retained intracranial bone fragments: analysis of 42 patients.

Forty-two patients with retained intracranial bone fragments from Vietnam war wounds were evaluated and treated at the Walter Reed General Hospital. Forty required further debridement, 16 had positive wound cultures while they were on antibiotic therapy, 23 had gross evidence of infection, and the remainder also had debris and necrosis at the retained bone fragment sites. There were eight in-hospital deaths. All surviving patients available to follow-up have been free of infection. Retained intracranial fragments of bone should be removed as early as is possible.

Value of the ultrasonic flow detector in the management of peripheral vascular disease

Summary A transcutaneous ultrasonic flow detector was employed to determine arterial and venous flow in patients with peripheral vascular disease at Walter Reed General Hospital. The flow detector provided useful information not obtainable by the usual clinical means and its use often avoided the necessity of angiography. Information on the quality of peripheral arterial flow was particularly useful in patients in whom distal pulses were lacking because of low systemic pressure, early postoperative shivering and vasoconstriction, peripheral edema, and proximal occlusive arterial lesions. The flow detector allowed determination of the patency of venous repairs, aided in the diagnosis of deep vein thrombosis and valvular incompetency, and was useful in the diagnosis and management of arteriovenous malformations. Further evaluation is warranted.

Observations on Intensive Coronary Care at Walter Reed General Hospital

Observations on Intensive Coronary Care at Walter Reed General Hospital

Plastic and maxillofacial Trauma Symposium, Volume One: Proceedings of the Symposium of the Educational Foundation of the American Society of Plastic and Reconstructive Surgeons held at Walter Reed General Hospital, November 30‐December 2, 1967

Medical Journal of AustraliaVolume 1, Issue 23 p. 1171-1171 Book Review Plastic and maxillofacial Trauma Symposium, Volume One: Proceedings of the Symposium of the Educational Foundation of the American Society of Plastic and Reconstructive Surgeons held at Walter Reed General Hospital, November 30-December 2, 1967 First published: 01 June 1970 https://doi.org/10.5694/j.1326-5377.1970.tb84490.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue23June 1970Pages 1171-1171 RelatedInformation

Significance of Complications Associated With Vascular Repairs Performed in Vietnam

Of more than 700 Vietnam casualties with vascular injuries seen at Walter Reed General Hospital, 57 patients with adequately documented complications of their initial arterial repair performed in Vietnam are reviewed. Twenty-four patients required additional vascular operations. Infected vascular repairs usually resulted in hemorrhage from disruption of the vascular repair. Major arterial ligation, required in nine patients, terminated in amputation of three extremities. Thrombosis and stenosis of upper extremity arterial repairs required operative intervention in only four of 27 patients. Concomitant nerve deficits frequently remained the limiting factor. In the lower extremity, thrombosis and stenosis of arterial repairs caused significant intermittent claudication in eight of 13 patients, necessitating additional operative procedures. Periodic evaluation and long-term follow-up of these patients with complications, as well as all patients sustaining vascular injuries in Vietnam are emphasized.

Classification of anterior communicating aneurysms as a basis for surgical approach.

T HE anterior communicating arterial complex provides one of the most common sites for the development of saccular aneurysms. Estimates of frequency of involvement of this area vary from Dandy's early report of 18.8% (25 of 133 cases) to Riggs's report of 60% (79 of 131 cases found in 1437 consecutive autopsies) . 3,~,9,1~-1~,'9 The figure of 27.4% (485 of 1769 aneurysms) in McKissock's series as reported by Bull is probably a representative statistic? The development of this aneurysm when untreated is disastrous; conservative management is associated with a 40% to 70% mortality rate. 1~-15 For this reason various methods of surgical treatment have been advocated and instituted. Successful treatment of aneurysms by intracranial surgery requires careful planning of the surgical approach. Berry aneurysms are most commonly saccular in configuration and most often rupture at their fundi. It is logical, therefore, that they can best be treated if the neck is isolated from the circulation without disturbing the dome. Aneurysms of the anterior communicating complex more than aneurysms of any other location can project in a myriad of directions. Since the area of the anterior communicating artery can be approached from several different directions, it is desirable to separate these aneurysms into groups appropriate to the method by which they can best be attacked. Following this basic philosophy, anterior communicating artery aneurysms are treated by two very distinct approaches at Walter Reed General Hospital. As a result, the preoperative arteriogram has become a key to planning the operative approach. In aneurysms that project superiorly, a subfrontal approach to the anterior communicating complex is used. However, all aneurysms

Clinical Management of Shock. Surgical and Medical.

This book written by an activeduty medical officer covers a wide experience of experimental study and clinical treatment of shock. Shock has been a subject of great interest to COL Hardaway as evidenced by his years of experimental laboratory studies at several hospitals, experience which resulted in numerous publications. With this background, he designed and set up a shock unit at Walter Reed General Hospital. From his staff he picked surgical research teams to go to the Republic of Vietnam to study the numerous aspects of shock in the wounded patient. From these sources the author has brought together information in support of disseminated intravascular coagulation and its relation to shock. He discusses the physiological, histological, and biochemical changes as they pertain to his theory of shock. Clinical information obtained at Walter Reed General Hospital and in Vietnam is presented in the form of numerous tables and patient summaries which

32. Radioisotope studies in isolated perfused and preserved kidneys: G. S. Johnston, J. H. Groenewald, P. D. R. van Heerden, and G. P. Murphy (Radioisotope Section, Walter Reed General Hospital, Washington, D. C., University of Stellenbosch School of Medicine, Bellville, Cape Province, South Africa, and Regional Kidney Center, Roswell Park Memorial Institute, Buffalo, New York)

32. Radioisotope studies in isolated perfused and preserved kidneys: G. S. Johnston, J. H. Groenewald, P. D. R. van Heerden, and G. P. Murphy (Radioisotope Section, Walter Reed General Hospital, Washington, D. C., University of Stellenbosch School of Medicine, Bellville, Cape Province, South Africa, and Regional Kidney Center, Roswell Park Memorial Institute, Buffalo, New York)

Popliteal artery injuries in Vietnam

1. 1. Although generally good results have been obtained in managing more than 2,000 acute vascular injuries in Vietnam, repair of popliteal arteries remains a problem. 2. 2. One hundred fifty of the 300 injuries of the popliteal artery listed in the Vascular Registry are reviewed. 3. 3. Forty-two per cent of patients with these injuries were evaluated at Walter Reed General Hospital, and the remaining patients were evaluated at other hospitals. 4. 4. Associated injuries to bone, nerves, soft tissue, and veins are frequent and have a significant effect on the outcome in extremities with popliteal artery injuries. 5. 5. Of the 124 initial repairs performed in Vietnam, early thrombosis occurred in 34. 6. 6. Delayed recognition of injuries occurred in 7.3 per cent of the patients (eleven false aneurysms and arteriovenous fistulas). 7. 7. The over-all amputation rate for 150 popliteal artery injuries was 32 per cent.

American Society for Plastic Surgeons, Plastic and Maxillofacial Trauma Symposium

This volume presents the proceedings of a Symposium held by the American Society of Plastic and Reconstructive Surgeons at the Walter Reed General Hospital, Nov 3-Dec 2, 1967. It is devoted primarily to injuries of the mandible, maxilla, nose, and zygoma, with relatively little space devoted to orbital floor fractures and lid injuries. It is, therefore, of limited interest to the ophthalmic surgeon other than to serve as background information concerning periorbital injuries which would be ordinarily handled by other specialists.

Radiation myelitis of the dorsolumbar spinal cord.

RADIATIONMYELITIS is a rather rare complication following therapeutic irradiation to neoplasms in which the spinal cord has been unavoidably included in the treatment portals. Since 1940 a total of 15 cases of myelitis involving the thoracolumbar spine has developed in association with the treatment of testicular tumors at Walter Reed General Hospital, Washington, D. C. The present paper is an analysis of these cases and will report on the relative risk of developing injury to the thoracolumbar spinal cord following such irradiation. Methods In the last twenty-eight years over 800 malignant germ-cell tumors of the testicle have been treated at Walter Reed General Hospital. Irradiation has been one of the primary modalities in treatment, principally to the lymphatic pathways draining the testicle following orchiectomy. This irradiation has been given prophylactically or therapeutically, either in conjunctionwith or without a retroperitoneallymphadenectomy. In most patients the fields included the inguinal and iliac lymph nodes on the involved side as well as the para-aortic lymph nodes to the level of the diaphragm. In a number of cases the lymphatic pathways of the mediastinum and left supraclavicular areas were also included. A total of 343 patients who received irradiation to these lymphatic pathways and survived a minimum period of three years is available for study. Of this group there were 313 in whom coplanar anterior and posterior opposing portals included the spinal cord in the field of irradiation. In these the spinal cord dose could be accurately calculated. The remaining 30 patients had angled fieldsor rotational therapy, and insufficient information is available for adequate dose calculations to the spinal cord. The source of radiation for this group of 313 patients is shown in TABLE I. Certain assumptions were made in dosage caIculations to the spinal cord. The overall bone density was taken as 1.40 g/cc. The average bone thickness posterior to the spinal cord was taken as 1.0 cm; the average thickness anterior to the spinal cord was taken as 3.0 ern. All dosage calculations were to the anterior aspect of the spinal canal which approximated 6.5 em depth in the lumbar area, 4.8 ern in the lower thoracic area, and 5.0 em for the high thoracic fields from the posterior skin surface. Clinical Features Symptoms of radiation myelitis with the therapeutic doses of radiation commonly employed are usually delayed and most often appear about one year following irradiation. In the present series the earliest symptom was seen at four months and the longest at thirteen years. Reagan et at. (20) have recently reviewed the clinical findings in radiation myelopathy and grouped the clinical manifestations into 4 major syndromes.

Retinal embolism from calcified vegetations of aortic valve. Spontaneous complication of rheumatic heart disease.

EMBOLI to the retinal arterial system can be classified on the basis of the nature of the embolic material. The purpose of this report is to demonstrate the gross and histopathologic appearance of a calcific embolus observed ophthalmoscopically in a retinal arteriole prior to the patient's death. Report of a Case Clinical History. —The patient, a 45-year-old white woman, had had rheumatic heart disease since the age of 9, with recurrent episodes of acute rheumatic fever at ages 22 and 30. She was otherwise asymptomatic until age 44, when she developed congestive heart failure. Initially this was well controlled, but during the following year her cardiac status deteriorated, and she was admitted to Walter Reed General Hospital because of marked shortness of breath. On physical examination a diagnosis of rheumatic heart disease with aortic insufficiency and congestive heart failure was made. Roentgenographic studies revealed cardiomegaly with left ventricular hypertrophy