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Biomedical subjects

B Langer

Publications and source records attributed to B Langer.

At least 217 records · Page 12Linked to original sources
PubMed1984

Diagnosis and management of hydatid disease of the liver. A 15-year North American experience.

Since 1967, 40 patients with hydatid disease of the liver have been treated at our hospital. Diagnosis was made using clinical criteria, serology, skin tests, and imaging techniques. Thirty-five patients were operated upon. In 18 patients the cyst was uncomplicated (Group I), and in 17 the cyst was infected or communicated with the biliary tract (Group II). Three forms of surgical treatment were used: A) cyst evacuation, scolicidal irrigation, and primary cyst closure, B) evacuation, irrigation, and external drainage, and C) complete or partial cyst resection. Mebendazole was used in six patients, four of whom were also treated surgically. In Group I, one of 11 patients (8%) treated by primary closure had complications, versus four of five patients (80%) treated with external drainage (p less than 0.001). Mean postoperative hospital stay for these two groups was 11.8 versus 20.8 days, respectively (p less than 0.001). Complication rates in Group II were higher, and were evenly distributed among treatments. Patients have been followed yearly, with a median follow-up of 5 years. Active hydatid disease has been found in three patients, who all had known residual disease at initial operation. The best treatment for an uncomplicated hydatid liver cyst is evacuation, scolicidal irrigation, and primary closure. External drainage is used for infected cysts or those communicating with the biliary tract, and excision for extrahepatic and peripheral, easily resectable cysts. Mebendazole is used for intraperitoneal spillage of cyst contents and in patients with inoperable disease.

Adult↗
PubMed1984

Sclerotherapy for esophageal varices: preliminary experience.

There has been a resurgence of interest in injection sclerotherapy as a means of controlling and preventing variceal hemorrhage. This report reviews and evaluates the early experience with this procedure at the Toronto General Hospital. From May 1979 to January 1983, 39 patients underwent 73 separate treatment sessions (rigid 23, flexible 50), during active bleeding (3), during hospitalization for variceal hemorrhage but after cessation of bleeding (35) and during elective admission to hospital expressly for sclerotherapy (35). Follow-up was obtained for 38 patients (98%). The overall rate of rebleeding was 27%. Complications occurred in 13 patients (33%). Ten patients died; in 2, death was directly attributable to a complication of sclerotherapy. From this preliminary experience the authors conclude that complications of sclerotherapy are frequent and potentially life-threatening, so more prospective randomized trials are needed before its role in the treatment of bleeding varices is clear.

Adult↗
PubMed1984

Results and hemodynamic changes after interposition mesocaval shunt.

Forty-seven patients have been treated by interposition mesocaval shunting for portal hypertension and variceal bleeding between December 1973 and March 1980. The average age was 55 years. The underlying diseases were alcoholic cirrhosis in 26 patients (56%), macronodular cirrhosis in 11 patients (23%), and other causes in 10 patients (21%). Thirty-five operations (75%) were performed on an emergency basis for patients who continued to bleed after failure of conservative management. In these patients, the early mortality rate was 43%. Overall survival, rebleeding, and postshunt encephalopathy rates are correlated with the preoperative Child's classification. These figures are similar to those reported for end-to-side portocaval shunts. The improvement in postshunt encephalopathy rates as reported by Drapanas is not borne out by our results. Postshunt angiography was performed in 31 patients and shunt patency was confirmed in 28 (90%). In 26 patients, selective studies to determine portal flow patterns were carried out, and in only three patients was there any evidence of hepatopedal flow. In each of these patients, some kinking of the shunt was noted. Mesocaval shunting is a reasonable alternative to end-to-side portocaval shunts and is associated with similar rates of patency, rebleeding, mortality, and late postoperative encephalopathy. A well-constructed, patent mesocaval shunt totally diverts portal flow.

Adult↗
PubMed1983

The effect of liver cytosol on hepatic regeneration and tumor growth.

This report further evaluates the concept that the interaction of factors that originate within the liver can contribute, regulate or even initiate the actual development of hepatic regeneration after liver cell necrosis or partial hepatectomy. The effect of liver cytosol (100,000 g supernatant), both from intact adult rat liver (NLC) and from adult rat liver remnants that had been regenerating for 24 hours after 70% partial hepatectomy (PH) in posthepatectomy liver regeneration in the rat was studied. The specificity of the growth-controlling properties in liver cytosol was determined using tumor cells. The intraperitoneal administration of NLC after PH resulted in approximately 70-80% inhibition of the peak 3H-DNA specific activity seen in controls at 18 and 24 hours post-PH, with a significant increase in DNA synthesis at 31-40 hours post-PH. The intraperitoneal administration of RLC after PH, augmented the hepatic regenerative response normally produced. Autoradiographic determination of hepatic nuclear labeling confirmed the inhibitory and stimulatory properties of NLC and RLC respectively. Syngeneic NLC or RLC at six and 24 days after subcutaneous tumor inoculation resulted in significant inhibition of tumor growth for both a methylcholanthrene-induced bladder carcinoma (FBCa) and an HTC-hepatoma. The retardation of FBCa growth could be enhanced by administering NLC or RLC every three or seven days. Syngeneic and xenogeneic liver cytosol resulted in dose-dependent inhibition of P815 mastocytoma cell proliferation in vitro. It is apparent from these studies that both stimulatory and inhibitory factors can be extracted from liver tissue that not only influence liver cell regeneration, but also affect tumor growth. Further isolation and characterization of these factors may lead to an understanding of more fundamental problems such as the control of normal and malignant cell growth.

Animals↗
PubMed1983

Double stapling technique for low anterior resection.

A report is given on 26 patients (18 men and 8 women) undergoing low anterior resection for carcinoma of the rectum, using both the TA 55 and EEA staplers. The average age was 65 years (range, 45 to 92 years). The preoperative level of the lesion from the anal verge averaged 9.8 cm (range, 4 to 17 cm). All had well-differentiated or moderately well-differentiated lesions. All lesions were removed using the following technique. The TA 55 stapler was placed across the lower rectum at the distal resection margin. The EEA stapler was introduced into the rectum with the anvil removed. The shaft was then passed through the rectum stump either through or immediately adjacent to the staple line. The anvil was refitted and the anastomosis completed between the more proximal colon and the rectal stump. A defunctioning colostomy was employed in only one patient. There has been no mortality. Follow-up has been 2 to 16 months, and there has been no early recurrence. The postoperative level of the anastomosis averaged 5.5 cm (range, 2 to 11 cm). Stapler-related complications occurred in three patients. One of these patients developed a postoperative anastomotic leak, which necessitated a defunctioning colostomy. Two anastomotic strictures occurred following either an anastomotic leak or postoperative radiation therapy. Early incontinence to gas, night-time anal soilage, and urgency occurred in eight patients (30 per cent). These symptoms improved or disappeared within three months following operation. The authors' preliminary experience has shown the double stapling technique to have definite advantages. It obviates the use of lower purse-string suture and permits a lower and easier anastomosis. It avoids the problem of disparity of sizes of the two ends of the bowel. The rectum is not opened and fecal spillage is minimized. To date, results have been good without excessive complications.

Adenocarcinoma↗
PubMed1983

Small bowel transplantation in the dog using cyclosporine.

The effect of the new immunosuppressant cyclosporine on survival after total small intestinal allotransplantation (TSIA) was studied in a canine model. Successful TSIA was performed in 34 dogs. Eleven dogs were treated with cyclosporine, 25 mg/kg/day i.m., starting the day before the operation and continuing for four weeks. Thereafter the same dose was given orally. Thirteen dogs were given oral cyclosporine only, 25 mg/kg/day from the day after transplantation. Ten dogs served as controls. The dogs treated with intramuscular and oral cyclosporine survived a mean of 103.8 +/- 39.4 days (mean +/- S.E.M.). The longest survivor died after 432 days. Survival in this group was significantly longer than that of the control dogs, which survived 12.5 +/- 4.6 days. The orally treated dogs survived 30.4 +/- 7.6 days. All control dogs, and seven of the orally treated dogs, but only two of the intramuscularly treated dogs, died of acute rejection. It is concluded that cyclosporine is effective in prolonging survival after TSIA in the dog and reduces the incidence of acute rejection.

Animals↗
PubMed1983

Formation of intrahepatic portosystemic shunts using a balloon dilatation catheter: preliminary clinical experience.

Six patients with advanced cirrhosis and portal hypertension had life-threatening upper gastrointestinal hemorrhage from esophageal varices. The varices were obliterated angiographically, using the transjugular approach, after which an intrahepatic portosystemic shunt was created in each case by inflating the balloon of a Grüntzig dilatation catheter in the needle tract between the portal and hepatic veins. All of the patients were expected to succumb quickly to their severe liver disease and massive variceal bleeding, but three of the six survived the initial hemorrhage, and two of these were discharged from hospital. There was an initial reduction of portal venous pressure of 10-15 mm Hg in all patients. All six shunts were patent angiographically 12 hr after the procedure. Two patients had venograms 5 days later and both shunts were patent. All six patients died within 6 months, but in three of the four postmortem examinations the shunts were easily identified and shown to be patent, the last of these 6 weeks after the procedure. These findings suggest that the technique could be of therapeutic value in the management of patients with portal hypertension.

Aged↗
PubMed1983

Hyponatremia and arginine vasopressin secretion in patients with refractory hepatic ascites undergoing peritoneovenous shunting.

Seven patients with persistent hyponatremia but normal or elevated serum arginine vasopressin levels and refractory ascites undergoing peritoneovenous shunting were studied in a Metabolic Unit on a 20 mEq sodium 1200 ml fluid-restricted diet to elucidate the mechanism of this response. The intravascular volume expansion after shunt implantation resulted in improvements in cardiac output, renal plasma flow and creatinine clearance (70.7 +/- 9.5 to 140.1 +/- 18.5 ml/min, p less than 0.005). There was an immediate diuresis (632 +/- 135 to 2450 +/- 323 ml/day, p less than 0.005) and natriuresis (3 +/- 1 to 25.9 +/- 10.6 mEq/24 h, p less than 0.05), and urine osmolality decreased significantly (622 +/- 91 to 251 +/- 76 mosmol/L, p less than 0.05) with a significant rise in serum sodium concentration by 72 hr (131 +/- 2 to 135 +/- 1.6 mEq/L, p less than 0.05) and serum osmolality. Serum arginine vasopressin levels remained elevated at 3.85 +/- 0.94 microU/ml, however, although a transient depression cannot be excluded. Subsequently, a small but significant decrease in serum arginine vasopressin levels to 3.04 +/- 0.65 microU/ml (p less than 0.05) was associated with a further rise in serum sodium levels above baseline values (138 +/- 1.4 mEq/L, p less than 0.01) and in serum osmolality. In conclusion, these results indicate that in this group of cirrhotic patients with refractory ascites, intrarenal factors, such as decreased delivery of filtrate to the distal nephron as well as elevated inappropriate levels of arginine vasopressin, are important in the pathogenesis of hyponatremia.

Aldosterone↗
PubMed1983

Primary perineal wound closure following excision of the rectum.

Management of the perineal wound following rectal excision was assessed in 57 patients at the Toronto General Hospital; 40 had ulcerative colitis, 4 had Crohn's disease, 10 had carcinoma of the rectum, 2 had carcinoma of the anus and 1 had anal incontinence. The preferred technique was careful anatomical dissection with meticulous hemostasis, and primary skin closure with a laterally placed closed Hemovac suction system. Alternatively, wounds were packed and allowed to heal secondarily. Overall, the perineal wound healed primarily in 41 patients (72%). Primary closure was possible in 50 patients (88%); in 41 (82%) the wound healed without complication but in 9 (18%) the wound had to be opened because of hematoma and abscess (8 patients) or bleeding (1 patient). In 41 (91%) of the 44 patients with inflammatory bowel disease the perineal wound was closed primarily; 34 wounds (83%) healed without complication. In seven patients the perineal wound was packed at surgery because of bleeding (four), fecal spillage (two) or sepsis (one). Healing time averaged 6 months. These results indicate that primary closure is the optimal management of perineal wounds. Primary healing is achieved in a high proportion of patients and postoperative morbidity is decreased. Results are excellent in patients with inflammatory bowel disease as well as in those with carcinoma.

Adult↗
PubMed1983

Role of resection in the management of metastases to the liver.

The results of 22 hepatic resections for metastatic disease are reviewed. There were no operative deaths and survival was encouraging. Life-table analysis of all 22 patients predicted a 5-year survival of 56.4%, and if 16 patients who had primary colorectal tumours are considered separately, the expected 42-month survival was 42.2%. Patients with a single metastasis generally lived longer, and there was no difference in survival between hepatic metastases resected synchronously or metachronously. The authors recommend an aggressive approach to the treatment of hepatic metastases.

Actuarial Analysis↗
PubMed1983

Gastroduodenal Crohn's disease: diagnosis and selection of treatment.

Crohn's disease of the stomach and duodenum is uncommon and difficult to diagnose. This study reviews 23 patients with this condition seen at the Toronto General Hospital between 1970 and 1981. In 12 patients the major symptoms were due to coexisting lower intestinal Crohn's disease (primarily distal disease). Diarrhea and crampy abdominal pain were the primary presenting complaints. None had obstructive symptoms. Nine of the 12 were treated medically, 7 with success; 1 required surgical intervention and 1 continued to have pain but no evidence of ulceration. In the remaining 11 patients, the major symptoms were due to their gastroduodenal Crohn's disease (primarily proximal disease) even though 10 had coexisting disease of the intestine. Their symptoms included postprandial vomiting, upper intestinal bloating, hematemesis and epigastric pain. Only one patient was successfully treated medically; the others required surgical intervention. At the time of writing, 9 of the 11 patients had no symptoms. The authors conclude that response to medical therapy occurs only in patients whose gastroduodenal disease is relatively mild and whose symptoms come from distal intestinal disease. In contrast, patients whose main symptoms are from gastroduodenal involvement usually require surgical treatment. Vagotomy with gastroenterostomy is the procedure of choice.

Adolescent↗
PubMed1982

Urinary excretion of alanine-aminopeptidase and N-acetyl-beta-D-glucosaminidase during sequential combination chemotherapy.

The urinary excretion of alanine aminopeptidase (EC 3.4.11.2) and N-acetyl-beta-D-glucosaminidase (EC 3.2.1.30) was determined in 23 patients with testicular cancer during sequential combination chemotherapy with vinblastine/bleomycin and doxorubicin/cis-platinum. Increases in enzyme excretion were more often noticed during therapy with vinblastine/bleomycin than with doxorubicin/cis-platinum. Moreover, the rises during vinblastine/bleomycin therapy were more pronounced. The enzyme activities varied from the normal range up to the 14-fold of the upper limit of the normal range. With few exceptions, enzyme excretions returned to normal or slightly elevated values before the subsequent course. No renal insufficiency could be detected with the commonly used parameters of renal function such as serum creatinine concentrations and creatinine clearance values, which were determined at irregular intervals.

Acetylglucosaminidase↗