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Biomedical subjects

B Langer

Publications and source records attributed to B Langer.

At least 181 records · Page 10Linked to original sources
PubMed1987

Hepatic arterial infusion of mitoxantrone in the treatment of primary hepatocellular carcinoma.

Twenty-three patients (16 male, seven female) with hepatocellular carcinoma (HCC) were treated by hepatic arterial infusion (HAI) of mitoxantrone every 4 weeks. At each treatment, a catheter was inserted percutaneously into the main hepatic artery via the femoral artery under image intensification. Treatment consisted of a 24-hour continuous HAI of mitoxantrone, 6 mg/m2/d X 3 (eight patients) or 10 mg/m2/d X 3 (14 patients) without heparin. Eight patients had only one infusion, nine patients four infusions, five patients three infusions, two patients two infusions, and one patient five infusions. A partial response was seen in six patients, with a median duration of 20 weeks (range, 18 to 38 weeks). Five patients achieved stable disease, with a median duration of 20 weeks (range, 11 to 42 weeks). The median survival of the overall group was 22 weeks. Survivals of responding, stable, and nonresponding patients were 32 weeks, 24 weeks, and 9 weeks, respectively. Complications of catheter placement included asymptomatic dissection of the hepatic artery (one patient), and asymptomatic thrombosis of the hepatic artery (five patients). Three patients experienced mild nausea and vomiting, and six patients had mild to moderate alopecia. Granulocytopenia was frequent at both dose schedules. The granulocyte nadir was greater than 1,000/microL in 34% of evaluable courses, 500 to 1,000/microL in 32%, and less than 500/microL in 34% of courses. Two patients developed neutropenia-associated fever. A platelet nadir below 100,000/microL was seen after only 10% of courses, and only two patients had platelets below 50,000/microL. Seven patients received doxorubicin after progression on mitoxantrone. Four received systemic doxorubicin, 50 mg/m2, and three HAI of doxorubicin, 25 mg/m2, for three days. Two patients achieved partial response (18 weeks and 32 weeks) to HAI doxorubicin. Mitoxantrone has activity in HCC and is well tolerated when administered by HAI. It is not entirely cross-resistant with doxorubicin.

Adult↗
PubMed1987

Transjugular intrahepatic portosystemic shunt: a nonoperative approach to life-threatening variceal bleeding.

Portosystemic venous shunts may be created nonoperatively with a Grüntzig balloon dilatation catheter using the transjugular route. The authors achieved technical success with this shunt in 15 of 20 patients with life-threatening gastrointestinal bleeding from variceal hemorrhage. All patients but one were considered at high risk for surgery because of end-stage liver disease; the exception was a patient in whom two previous operative portosystemic shunts had failed. An average decrease of 5.9 mm Hg in portal vein pressure was measured in 11 patients for whom sequential pressures could be obtained. Two patients survived longer than 12 months without subsequent operative procedures, and the shunt helped temporize in three other patients who later underwent operation. Nine patients with successful shunts died within 30 days of the procedure, comparing favourably with reported operative death rates of 40% to 80% in emergency shunt procedures. Follow-up portal venograms demonstrated shunt patency in six of nine patients, in one after 8 months. Tract patency was determined in four of seven patients on whom autopsy was performed, up to 6 months after the transjugular intrahepatic portosystemic shunt was created.

Adult↗
PubMed1987

Successful treatment of a traumatic hepatic artery-portal vein arteriovenous fistula by interpositional mesocaval shunting.

Hepatic artery-portal vein fistula is an occasional sequel to invasive procedures on the liver, such as biopsy and transhepatic cholangiography. When the fistula is large it may result in portal hypertension, gastrointestinal bleeding and histologic and functional changes in the liver. Treatment is usually directed at the fistula, either embolizing, dividing or resecting it. Portal decompression has been discouraged in the past. The authors describe a case in which recurrent gastrointestinal bleeding, uncontrolled by attempts at embolization, was subsequently managed successfully by portosystemic shunting. They suggest that when the primary symptom related to the fistula is variceal bleeding, portal decompression is a reasonable therapeutic option.

Aged↗
PubMed1987

Immune responses in small intestinal transplantation in the rat: correlation of histopathology and monocyte procoagulant activity.

No predictive serologic marker exists for rejection or graft versus host disease (GVHD) reactions in small intestinal transplantation (SIT). SIT was performed in Lewis (Lew) and Lew X Brown Norway Fl hybrid (LBN) rats in the following combinations: group 1, Lew X Lew; group 2 (isolated rejection), LBN X Lew, and group 3 (isolated GVHD), Lew X LBN. Procoagulant activity (PCA), an index of monocyte immune activation, was measured in the peripheral blood mononuclear cells of graft recipients to assess its value as an immunologic monitor. Histologic findings and PCA were evaluated on days 1, 2, and 3 and every 2 to 3 days after SIT. No pathologic findings of graft or host tissue developed in group 1 (n = 14). Histologic rejection (blunted villi and mononuclear cell infiltration) was seen beginning on day 5 in group 2 (n = 19); early GVHD (loss of nodal and splenic architecture) was first noted on days 5 and 6 in group 3 (n = 17). PCA elevation in SIT was seen to precede histologic evidence of rejection or graft versus host disease in this model and may constitute an important marker for these immunologic events.

Animals↗
PubMed1987

Examination of patient selection and outcome for hepatic resection for metastatic disease.

Hepatic resection for metastatic disease is now an accepted therapeutic option in a selected group of patients. A series of 56 patients undergoing hepatic resection at a single institution from 1974 to 1985 are presented. Resection was carried out in 27 women and 29 men who ranged in age from 23 to 87 years (a mean of 56 years). The site of primary disease was: colorectal in 41, adrenal gland in two and other sites in 13. Of the 56 hepatectomies, 21 were done for synchronous secondary disease discovered before or at operation for the primary disease. Metachronous lesions were found in 35 patients, from two months to 17 years (a mean of 34 months) after excision of the primary tumor. Estimated five year survival rates using the Kaplan-Meier method was 25 per cent in the patients with colorectal primaries and 35 per cent in the entire group. No difference was demonstrated between synchronous and metachronous resections. Patients with multiple hepatic lesions did much poorer than those with solitary tumors. Patients with metastatic tumor consisting of one large lesion with surrounding satellite nodule or nodules had an expected survival time resembling that for those with true solitary metastases and were included in that group. No difference in survival time was observed in patients with carcinoma of the colon and rectum who had involvement of regional nodes at the time of the primary resection, as compared with patients with negative nodes. Hepatic resection for a secondary malignant growth can be performed safely with a real chance for cure in selected instances. We continue to recommend an aggressive approach to hepatic metastases, especially those of a colorectal origin.

Adenocarcinoma↗
PubMed1986

Percutaneous transhepatic sphincterotomy in the management of biliary tract disease.

This report describes a novel modification of existing transhepatic techniques and illustrates successful relief of mechanical obstructive jaundice in 2 patients in whom surgical or endoscopic intervention was contraindicated or impossible. In each, percutaneous transhepatic cholangiogram (PTC) was performed in the usual manner. A standard endoscopic papillotome was then advanced across the stricture into the duodenum. Sphincterotomy was performed at the 11 to 1 o'clock position using blended current for 3-4 seconds. Repeat cholangiography showed successful decompression of the biliary tree in both patients. No morbidity or mortality was directly attributable to percutaneous transhepatic sphincterotomy in these patients. This technique offers a safe and therapeutic alternative to biliary tract obstruction, and should be considered in selected patients who are not candidates for surgery or endoscopy.

Aged↗
PubMed1986

The double stapling technique for low anterior resection of rectal carcinoma.

The double stapling technique (TA-55 and EEA staplers) was used to perform low anterior resections for rectal carcinomas in 79 patients (49 men, 30 women). The mean age was 66 years (range, 38 to 85 years). Curative resections were performed in 68 patients, and palliative resections in 11 patients. The mean level of the cancer from the dentate line was 9 cm (range, 5 to 16 cm). The mean follow-up has been 29 months (range, four to 58 months). Perioperative mortality was 2.5 percent (two patients). Technical problems related to the stapling technique occurred in 6 percent (five patients). The clinical anastomotic leak rate was 8 percent (six patients). There were 11 local recurrences among 68 curative resections (16 percent). Local recurrence according to individual surgeon showed marked variability (range, 0-43 percent, P greater than 0.05). There were no differences in location, differentiation, or stage in those that recurred. The mean distal resection margin for the recurrent cancer group was 3.0 cm and for the nonrecurrent group, 2.9 cm. Disturbances of continence were seen commonly (56 percent) in the first three months after surgery, but 85 percent of patients became fully continent with an acceptable bowel habit at later follow-up. The double stapling technique is useful for the restorative resection of suitable mid and low rectal cancers. The anastomotic leak rate, local recurrence rate, and functional results are acceptable.

Adult↗
PubMed1986

Effects of peritoneovenous shunting on body composition.

The effect of peritoneovenous shunting on body composition has been studied in 7 cirrhotic patients undergoing a successful shunt and 3 patients in whom the shunt was unsuccessful. In the 7 patients with functioning shunts, their weight had decreased by a mean of 9 kg (p less than 0.001) by 6 wk after initial diuresis, natriuresis, and kaliuresis, and was associated with a decrease in total body potassium (TBK) but not total body nitrogen (TBN). This resulted in a significant decrease in the TBK/TBN ratio from 2.12 +/- 0.74 to 1.66 +/- 0.20 (p less than 0.01). By a mean of 14 mo, in these 7 patients there was a significant increase in mean TBN (from 1.54 +/- 0.10 to 1.84 +/- 0.10, p less than 0.005) associated with an improvement in the mean nitrogen index (from 0.74 +/- 0.04 to 0.88 +/- 0.04, p less than 0.005). These changes were associated with a significant increase in nonalcoholic calories, a nonsignificant increase in protein consumption, and a positive nitrogen balance. After the initial kaliuresis, mean potassium balance remained constantly positive (+22.7 +/- 3.4 mmol/day), serum aldosterone levels normalized, and TBK increased. In contrast, 3 patients with failed peritoneovenous shunting continued to lose weight significantly despite the presence of ascites; TBN and nitrogen index also decreased. In conclusion, body composition studies appear to have confirmed the clinical observation that cirrhotic patients with massive ascites have depleted body protein which is gradually repleted only after successful shunting. In this situation TBK, long used as a measure of lean body mass, is less satisfactory than TBN and nitrogen index. This improvement in body protein appears to be explained by an increased dietary intake associated with improved nitrogen balance, but these changes are not found in patients in whom the shunt failed.

Adult↗
PubMed1986

Transplantation of the small intestine.

Experimental use of cyclosporine in animal models following small intestinal transplantation is reviewed. The authors' techniques for monitoring allografts and harvesting the small bowel in humans for transplantation purposes are described.

Cyclosporins↗
PubMed1986

Spindle and histiocytoid (epithelioid) hemangioendothelioma. Primary in lymph node.

A 52-year-old woman presented with a solid spindle cell primary tumor of the lymph node. On light microscopic examination, mitoses and cellular atypia were absent. Electron-microscopic studies showed endothelial cell differentiation. Intracytoplasmic localization of Factor VIII-related antigen was demonstrated by the immunoperoxidase method, which confirmed the endothelial origin of the tumor. Seven-and-a-half years after the resection of this tumor, the patient is alive with no evidence of disease.

Female↗
PubMed1986

Small intestinal transplantation using cyclosporine. Report of a case.

A case of small intestinal allotransplantation is described. Cyclosporine and Solumedrol were used for immunosuppression. A hemolytic episode occurred, caused by anti-A antibodies derived from graft lymphocytes. Sudden severe encephalopathy developed on the ninth postoperative day, followed by intractable hypotension and death. Hepatic and splenic microinfarcts were identified on postmortem examination. Allograft rejection was identified by serial stomal biopsies and correlated with a rise in monocyte procoagulant activity, a potentially useful serologic marker of rejection. The absence of an anatomic circuit for recycling of cyclosporine did not alter serum radioimmunoassay/high-performance liquid chromatography ratios.

Adult↗
PubMed1986

Alveolar cavitational osteopathosis. Manifestations of an infectious process and its implication in the causation of chronic pain.

A recently discovered oral disease process of infectious origin, characterized by nonradiographically detectable, hollow, pathologic, alveolar cavitational lesions of significant size, is described. This oral infectious disease process, termed alveolar cavitational osteopathosis, is causally implicated not only in the genesis of certain craniofacial pain syndromes, among them idiopathic trigeminal neuralgia and atypical facial pain, but also in chronic pain syndromes remote from the craniofacial region including the back, chest, arms, legs and cervical areas. A diagnostic process is presented which serves to define the locus of nonradiographically detectable alveolar cavitational osteopathosis and correlates a given pathological site to a given area of pain. Comprehensive schematics have been developed defining the pain pathways emanating from the oral cavity and their specific relationship to sites of perceived pain both in the craniofacial region and other areas of the body. The treatment modality described serves to induce bone growth within the cavitational lesions, resulting in the subsequent eradication of the cavity. The abolition of osteopathosis results in significant or total disappearance of pain symptomatology.

Alveolar Process↗