Biomedical subjects

A Bothe

Publications and source records attributed to A Bothe.

At least 37 records · Page 2Linked to original sources

PubMed1990

Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial.

OBJECTIVE: To determine whether very low doses of warfarin are useful in thrombosis prophylaxis in patients with central venous catheters. DESIGN: Patients at risk for thrombosis associated with chronic indwelling central venous catheters were prospectively and randomly assigned to receive or not to receive 1 mg of warfarin, beginning 3 days before catheter insertion and continuing for 90 days. Subclavian, innominate, and superior vena cava venograms were done at onset of thrombosis symptoms or after 90 days in the study. RESULTS: One hundred twenty-one patients entered the study, and 82 patients completed the study. Of 42 patients completing the study while receiving warfarin, 4 had venogram-proven thrombosis. All 4 had symptoms from thrombosis. Of 40 patients completing the study while not receiving warfarin, 15 had venogram-proven thrombosis, and 10 had symptoms from thrombosis (P less than 0.001). There were no measurable changes in the coagulation values assayed due to this warfarin dose, except in occasional patients who had become anorectic because of their disease or chemotherapy. CONCLUSIONS: Very low doses of warfarin can protect against thrombosis without inducing a hemorrhagic state. This approach may be applicable to other groups of patients.

Adult↗

PubMed1989

Splenectomy. The treatment of choice for human immunodeficiency virus-related immune thrombocytopenia?

Immune thrombocytopenia is a well-recognized part of the clinical spectrum of infection with the human immunodeficiency virus. From November 1985 to February 1988, 15 patients who were human immunodeficiency virus-positive underwent splenectomy for refractory immune thrombocytopenia. Eight patients had thrombocytopenia only, and 7 others were pancytopenic prior to splenectomy. Three of the 15 patients fulfilled criteria for acquired immunodeficiency syndrome before splenectomy, and acquired immunodeficiency syndrome developed in 5 patients during the follow-up period. The median duration of thrombocytopenia prior to surgical therapy was 6 months. A bone marrow biopsy specimen showed hypercellularity with increased megakaryocytes. All patients had a therapeutic response to splenectomy. Long-term remission from thrombocytopenia/pancytopenia was achieved in 14 of the 15 patients during a follow-up period of 2 to 21 months. Splenectomy can be accomplished with an acceptable morbidity. Pneumonia developed postoperatively in 2 patients, but they did not manifest the characteristic picture of overwhelming postsplenectomy sepsis. They had received vaccinations against encapsulated organisms preoperatively. We conclude that splenectomy provides a durable and lasting response for HIV-related thrombocytopenia. Vaccination for Streptococcus pneumonia and Haemophilus influenzae should be given prior to splenectomy although its efficacy is not clear in this group.

Acquired Immunodeficiency Syndrome↗

PubMed1989

Gastric restrictive operations for morbid obesity.

Gastric restrictive surgery has evolved over the past decade as the treatment of choice for morbid obesity. We reviewed our experience with 289 patients who underwent gastric surgery for morbid obesity. Comorbid diseases included respiratory insufficiency in 19 percent of the patients, hypertension in 36 percent, diabetes in 15 percent, arthritis in 30 percent, and heart disease in 6 percent. Operative mortality was 0. The follow-up rate was 93 percent. Overall mortality was 1 percent, with no death directly attributed to the operative procedure. Weight loss was studied over the 6-year study period. Four to 6 years postoperatively, overall weight loss was 50 to 64 percent of excess weight. The treatment failure rate 12 to 18 months postoperatively was 5 percent. The experience with gastric restrictive surgery in 12 centers involving 5,178 patients was reviewed and compared with our results. Overall operative and late mortality rates were quite similar to observed death rates for nonobese men and women between 25 and 64 years of age. These data suggest that gastric surgery for morbid obesity results in a significant reduction in health risk.

Adolescent↗

PubMed1989

Intraoperative radiation therapy for biliary tract carcinoma: results of a 5-year experience.

The results of a 5-year experience with use of intraoperative radiation therapy (IORT) in the management of locally advanced bile duct carcinoma are presented. Fifteen patients received IORT doses between 5 and 20 Gy for localized disease, which was either primary and resected with microscopic residual (2 patients), primary and unresected (10 patients), or recurrent (3 patients). Thirteen patients also received postoperative radiation therapy. The median survival of the 12 patients with primary disease was 14 months, with disease controlled in the porta hepatis in 5 of 10 evaluable patients. The three patients with recurrent disease survived 2, 9, and 11 months. There were two operative deaths, for an operative mortality of 13%. Acute and chronic complications are reviewed. Cholangitis is the most frequent in both categories. This aggressive approach in the therapy for advanced disease has an acceptable level of morbidity and may warrant the use of IORT as part of the management of biliary tract cancer.

Acute Disease↗

PubMed1987

Metastatic islet cell tumor with ACTH, gastrin, and glucagon secretion. Clinical and pathologic studies with multiple therapies.

A patient with metastatic islet cell carcinoma demonstrated multiple clinical syndromes simultaneously with secretion of ACTH, gastrin, glucagon, and serotonin. Hepatic arterial embolization resulted in an initial decrease in all secretory products, which was sustained for glucagon and serotonin. Recrudescence of the Cushings and Zollinger-Ellison syndrome was managed by surgical extirpation of the primary tumor and regional metastases as well as bilateral adrenalectomy. Electron microscopy and immunocytochemistry of the primary tumor and the metastatic lesions revealed the presence of multiple types of granules within single cells and, different patterns of secretory profiles in different tumor sites.

Adenoma, Islet Cell↗

PubMed1987

Management of recurrent pelvic tumors.

The management of regional tumor recurrence in the pelvis traditionally has been a difficult problem for surgeons and oncologists. The only meaningful therapy for these patients is a potentially curative re-resection. The records and operative reports of 29 patients with regional pelvic tumor recurrence treated between 1981 and 1986 were reviewed. The operative procedures performed included three bowel resections, six abdominoperineal resections, eight pelvic exenterations, eight resections of tumor recurrence, and four conservative procedures. There was one operative death in this group. Significant morbidity was noted in the group but was clustered in a small number of patients operated on early in the series. The median follow-up in this series was 13 months (range, two to 51 months). Nineteen (65%) of the patients are surviving at a median follow-up of ten months (range, two to 51 months). The median survival (following resection) in the ten patients (35%) who died was 18 months. In 15 (52%) of the patients, a complete resection was performed. In this group, the survival is 80% with a median follow-up of 11 months. Seven (37%) are surviving with no evidence of disease. Palliation of symptoms occurred in 23 (79%) of the 29 patients. Radical resection of tumor recurrence in the pelvis can be performed with acceptable mortality and complication rates. This therapy should be considered for further clinical trials combining surgical and adjuvant therapy in patients with regional pelvic tumor recurrence.

Adult↗

PubMed1987

Resection of tumors in irradiated fields with subsequent immediate reconstruction.

With increased use of primary radiation therapy for treatment of cancer and adjuvant radiation therapy after surgical removal of a bulk tumor, recurrence in these fields has posed significant new and increasingly technical and biologic problems. We report our experience with ten such cases in which difficult wounds were reconstructed immediately after major regional resections of advanced or recurrent tumors in fields of previous irradiation. All of these patients could undergo extirpation of their recurrent tumors in irradiated fields because of improved techniques in reconstructive flap surgery allowing large amounts of well-vascularized tissue to be transferred, sometimes over a significant distance. Follow-up of these patients has ranged from three to 18 months (median, nine months). Primary healing, decreased deformity, reduced morbidity, and prolonged disease-free intervals have been achieved with the combination of extirpative and reconstructive techniques.

Abdominal Neoplasms↗

PubMed1987

Management of the urinary tract involved by recurrent cancer.

We present our experience from 1982 to the present in treating 33 patients with recurrent cancers (colorectal, 22; gynecologic, six; breast, two; melanoma, two; and lung, one) secondarily involving the genitourinary tract. All patients had severe symptoms that required palliation. Endoscopically placed stents relieved ureteral obstruction in 18 (75%) of 24 patients with widespread metastatic disease. Two patients required percutaneous nephrostomy tubes, and five required open operations. Good to excellent palliation was achieved in 23 of 24 patients. Mean survival in the group with diffuse metastases was 13 months (range, six to 29 months). Nine patients with localized recurrences underwent surgical procedures. For localized pelvic recurrences, total exenteration (with or without intraoperative radiotherapy) provided excellent palliation with low morbidity. At the time of this report, five of six such patients had no evidence of disease, and one had a small asymptomatic pelvic recurrence, with a mean follow-up of 13 months (range, five to 19 months).

Adult↗

PubMed1987

A prospective, randomized trial of abdominal wound drainage in gastric bypass surgery.

A prospective, randomized trial was conducted in 194 morbidly obese patients who had gastric bypass to determine the effect of subcutaneous closed suction drainage on wound infection rates. There was no difference in the incidence of postoperative wound infection with the use of drains compared with simple abdominal closure. Organisms isolated from infected wounds were predominantly skin flora and did not differ between the two groups. Patients with wound infections had significantly prolonged hospitalizations compared with those without infections, but in the subgroup with wound infections there was no difference in hospitalization time between the drainage or control groups.

Abdomen↗

PubMed1987

Hemolytic-uremic syndrome and acute renal failure in metastatic adenocarcinoma treated with mitomycin: case report and literature review.

Acute renal failure proved fatal in a patient with metastatic breast adenocarcinoma, complicated by the hemolytic-uremic syndrome. Low-grade hemolysis probably was ongoing prior to a third course of chemotherapy that included mitomycin. Terminal renal failure was caused by glomerular infarction and tubular necrosis. Schiztocytes in the blood smear and casts in the urine sediment may be relative contraindications to prolongation of tumor-lysis therapy. Recent advances in "rescue therapy" for hemolytic-uremic syndromes justify dialysis at least on a temporary basis.

Acute Kidney Injury↗

PubMed1986

Pulmonary complications of orthotopic liver transplantation.

Pulmonary complications following orthotopic liver transplantation (OLT) were prospectively evaluated in 18 individuals transplanted at the New England Deaconess Hospital. Of sixteen patients who survived the immediate postoperative period, 12 (75%) sustained a pulmonary complication. Of these complications, 64% were noninfectious--whereas 22% were infectious, and 14% probably infectious. Six of eight documented infections were caused by viruses of the herpes group. In four cases of viral pneumonitis other pulmonary pathogens were isolated (fungi-3, protozoan-1, bacteria-1). Unlike noninfectious complications, pulmonary infections were associated with a fatal outcome in five of six patients who died after OLT. Pulmonary complications are frequent and serious occurrences after OLT, and contribute to both the morbidity and mortality of this procedure. Compared with pulmonary complications seen after transplantation of other organs, OLT was associated with a higher proportion of noninfectious complications but a similar spectrum of pulmonary infections.

Adult↗

PubMed1986

Prophylaxis against central vein thrombosis with low-dose warfarin.

Low-dose warfarin was given to patients to prevent venous thrombosis. Patients at greatest risk for having thrombi adjacent to central venous catheters were detected by the von Kaulla assay. Patients with normal von Kaulla assays had one thrombus per 1844 days at risk while those with accelerated von Kaulla assays had one thrombus per 500 days at risk. Low-dose warfarin therapy given to patients at high risk reduced the incidence of venous thrombosis from one thrombus per 251 days to one thrombus per 1617 days. Thus low doses of warfarin that do not prolong the prothrombin time appear to offer prophylaxis against venous thrombosis in patients at high risk for developing venous thrombosis adjacent to the central venous catheters.

Adolescent↗

PubMed1985

Portoazygous disconnection for bleeding esophageal varices.

Between 1971 and 1982, 20 portoazygous disconnections (modified Tanner's operation) were performed in patients with bleeding esophagogastric varices who were anatomically portosystemic shunting. Immediate control of variceal hemorrhage was achieved in all patients, although rebleeding occurred after eight operations at intervals from 2 days to 7.5 years postoperatively, requiring additional surgery at a mean interval of 2.5 years. There were eight perioperative deaths. Analysis has suggested increased mortality in patients with more severely impaired liver function according to Child's classification, and in patients who require urgent or emergent operations. There was an 80 percent incidence of major and minor complications. Portoazygous disconnection is not a satisfactory alternative to portosystemic shunting, except in a selected group of patients with intact hepatic function and with anatomic characteristics that preclude usual shunting procedures.

Adolescent↗

PubMed1985

Subintimal dissection of peritoneovenous shunt tubing. Demonstration with radionuclide study.

A case report is presented in which malfunction of a peritoneovenous shunt was caused by subintimal dissection of the venous end of the shunt tubing. The radionuclide shunt patency study demonstrated a collection of radioactivity at the venous end of the tubing, representing the abnormal intramural collection of peritoneal fluid. Scintigraphic demonstration of this complication of a peritoneovenous shunt has not been reported previously.

Ascites↗

PubMed1985

Complications and management of implanted venous access catheters.

A totally implanted subclavian venous access system composed of a reservoir and silastic catheter was employed in 92 patients receiving infusion chemotherapy and/or hyperalimentation. The major catheter complication was subclavian or jugular vein thrombosis observed in 15 patients (16%). Thrombosis was observed in the ipsilateral subclavian or jugular vein surrounding the catheter without restricting function, except in two patients with thrombosis in the vein at the end of the catheter. Prophylaxis with low-dose Coumadin was effective in preventing thrombosis in high-risk patients as defined by a history of prior thrombosis. Streptokinase and/or heparin relieved the signs and symptoms of thrombosis, but clot dissolution or reversal of collateral flow was not observed. Explantation of the catheter was not necessary in all patients in that embolic complications of the thrombosis were not observed, and the system was retained and functioned in five patients in spite of the presence of thrombosis around the catheter. Other complications of the implanted system include "pocket" infection, catheter migration, and occlusion. Most complications may be managed without obligate catheter removal.

Anti-Bacterial Agents↗

PubMed1984

Budd-Chiari syndrome. Historical and clinical review with an analysis of surgical corrective procedures.

Seventeen patients who fulfilled the criteria for the Budd-Chiari syndrome (centrilobular congestion and necrosis, a defined postsinusoidal block, and rapid onset of ascites) have been analyzed in terms of cause, prognosis, and treatment. Causal factors included caval web or tumor, hepatic tumor, a hypocoagulable state, myeloproliferative disease, and veno-occlusive disease. Location of the outflow block was suprahepatic (vena cava or major hepatic veins) in 13 patients and intrahepatic in 4. In five patients, a side-to-side portacaval shunt was effective in dissipating ascites with restoration to a normal lifestyle, as were transatrial fracture of a caval web (one patient) and resection of a huge cystadenoma of the liver (one patient). A peritoneal shunt provided effective palliation in three patients.

Budd-Chiari Syndrome↗

PubMed1984

Implantable central venous access system.

Prolonged central venous access for outpatient chemotherapy was achieved in 74 patients utilizing a totally implantable access disc system. The system consists of a stainless steel drug reservoir implanted in the subcutaneous tissue of the anterior chest wall. The reservoir is attached to a Silastic catheter which is then tunneled to a central vein and positioned in the superior vena cava. In 6,762 patient days of observation, there was a high degree of patient acceptance and a low incidence of complications. There were four instances of thrombosis and two of catheter-related sepsis among 17 complications. Seven access discs required removal. The implantable nature of this system offers an attractive alternative to other available methods of prolonged central venous access.

Adolescent↗

PubMed1984

Phase-I study of continuous infusion cyclophosphamide for protracted durations: a preliminary report.

The continuous infusion of cyclophosphamide with an ambulatory infusion pump was employed in 13 patients to establish the optimal daily dose rate for permitting prolonged treatment intervals. Four dose rates were studied: 25, 50, 75, and 100 mg/M2 X day and the median duration of therapy was 39, 13, 20, and 28 days, respectively, with a range of 10-50 days. Dose-limiting toxicity was observed in 4 of 13 patients manifested exclusively as thrombocytopenia. No other drug-related untoward effects were observed and no therapeutic effects were noted. The cumulative cyclophosphamide dose for 3 weeks of continuous infusion is comparable to that achieved by bolus schedules. Drug toxicity, however, is substantially altered with the infusion schedule. For good-risk patients, the recommended daily infusion rate for cyclophosphamide is 100 mg/M2 X day.

Adult↗