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Biomedical subjects

B Langer

Publications and source records attributed to B Langer.

At least 253 records · Page 14Linked to original sources
PubMed1981

Preoperative liver biopsy and survival after portasystemic shunting.

The value of preoperative liver biopsy in predicting the outcome of portasystemic shunting was investigated. Using coded slides, the authors examined liver biopsy specimens from 41 patients with alcoholic cirrhosis who underwent portasystemic shunting. The degree of fatty change, alcoholic hyalin, alcoholic hepatitis, central hyalin sclerosis and the activity and severity of the cirrhosis were assessed and possible correlations were noted with the preoperative Child's classification, postoperative encephalopathy and with early and late mortality. A correlation was found between the presence of alcoholic hyalin in more than 10% of hepatocytes and early mortality; all of the six patients who died within 30 days of operation had this finding in the liver biopsy specimen. Early mortality correlated better with alcoholic hyalin than with the Child's classification. There was some correlation between late mortality and the degree of hyalin sclerosis and with the activity and severity of cirrhosis. The authors conclude that the findings of a liver biopsy done preoperatively are valuable in indicating prognosis and operative mortality in alcoholic cirrhosis.

Biopsy↗
PubMed1980

Cellular transplantation in the treatment of experimental hepatic failure.

The survival of Lewis rats with D-galactosamine-induced fulminant hepatic failure was prolonged if they were given intraperitoneal injections of single-cell suspensions of liver or bone marrow cells from normal rats. Suspensions of liver cells were also effective in prolonging the survival of rats with ischemia-induced hepatic necrosis. The liver cells did not act by repopulating the recipient liver.

Animals↗
PubMed1980

Percutaneous fine-needle aspiration biopsy. I. Its value to clinical practice.

From the experiences in dealing with 2591 cases of transthoracic and transabdominal fine-needle aspiration biopsies (1967-1978), we present our views on the value of this relatively new diagnostic method to clinical practice. Virtually any accessible localized lesion in any organ of the body can be investigated by fine-needle aspiration biopsy, which is considered most useful in patients with suspected malignant disease. Transthoracic and transabdominal fine-needle aspiration biopsy may provide information otherwise obtainable only by thoracotomy or laparotomy. It is an inexpensive and safe method with high accuracy for obtaining a pathologic diagnosis, and can impart some practical significance to clinical practice, especially in clinical management. The pitfalls in cytomorphologic interpretation, which often cause unsuccessful attempts, can be readily avoided with increased practical experience, as indicated by the increase in detection rate of lung cancer by fine-needle aspiration method from 82.8% in 1967-1968 to 93.4% in 1976 at the Toronto General Hospital. The accuracy of cytologic diagnosis plays a major role in spreading this still relatively unfamiliar but excellent diagnostic method. We believe that the method deserves widespread clinical application and when this happens, it will bring about great savings in health care resources.

Abdomen↗
PubMed1980

Complications after peritoneovenous shunting for ascites.

The results and complications in our first 23 consecutive patients receiving the peritoneovenous shunt for intractiable hepatic ascites are presented. A good initial diuretic effect was obtained in 20 of the 23 patients, with reversal of hepatorenal failure in 3 of 5 patients. The postoperative complication rate was high (74 percent). Infection, coagulopathy and complication of the underlying liver disease contributed to a mortality rate of 26 percent. Late complications were related to the primary liver disease. The 6 month survival rate was 58 percent and the 1 hear survival rate 52 percent with five patients followed up for more than 2 years. Because of the significant morbidity and mortality associated with the peritoneovenous shunt, we recommend it only for patients with massive intractable hepatic ascites whose condition is refractory to maximal medical therapy.

Ascites↗
PubMed1980

The subepithelial connective tissue graft.

A technique has been described which can augment concavities and irregularities in edentulous ridges where cosmetics are important. Using the combination of temporary acrylic resin restorations and connective tissue autografts, unattractive con-cavities and ridge irregularities can be corrected.

Alveoloplasty↗
PubMed1980

Allogeneic and xenogeneic hepatocyte transplantation in experimental hepatic failure.

Previous studies have demonstrated the efficacy of syngeneic hepatocyte transplantation in the treatment of D-galactosamine-induced acute hepatic failure in Lewis strain rats. This report describes the efficacy and immunological consequences of allogeneic and xenogeneic hepatocyte transplantation in the same model. The i.p. administration of allogeneic (minor and major histoincompatibility) hepatocytes or xenogeneic (rabbit or porcine) hepatocytes at a dose of 4 x 10(7) cells/rat given at 48 hr after toxin all resulted in significant improvement in survival compared to that of controls, and also comparable to the results obtained with syngeneic hepatocyte transplantation. Sensitization to i.p. allogeneic (WF) hepatocyte administration was demonstrated by in vivo 51Cr release, indirect immunofluorescent technique, and accelerated skin allograft rejection. Similarly, the in vivo 51Cr release assay was able to detect sensitization to porcine hepatocytes. Despite evidence of immunogenicity, redosing with either WF or porcine hepatocytes resulted in no overt toxicity. Furthermore, presensitization by either WF hepatocytes or skin allografts did not adversely affect survival after WF hepatocyte treatment in D-galactosamine-induced hepatic failure in Lewis strain rats. These data demonstrate that histocompatibility is not a constraint to successful hepatocyte transplantation and that repeated treatments are potentially safe and efficacious despite sensitization.

Animals↗
PubMed1980

Orthodontic procedures that improve the periodontal prognosis.

Osseous defects not amenable to conventional resective or regenerative osseous surgery alone may respond to a combination of orthodontic and periodontal techniques. Two orthodontic procedures-correction of mesially tipped teeth and forced eruption-have been described that may enhance the periodontal prognosis. Each procedure is accomplished with use of sectional orthodontic appliances and each requires a short time for treatment. Beneficial results include improvement of the crown-to-root ratio, reception of the forces of occlusion in the long axis of the tooth, and reduction or elimination of infrabony defects.

Adult↗
PubMed1980

A prospective randomized trial of the selective distal splenorenal shunt.

Distal splenorenal shunt has been compared in a prospective randomized way with end-to-side portacaval shunt in patients who have survived a major hemorrhage from esophageal varices. The operative mortality was higher after the elective shunt than after the portacaval shunt. However, most of these deaths occurred in the early phases of the study. Postoperative encephalopathy was significantly lower after the selective shunt than after the portacaval shunt. Follow-up studies to date show no significant difference in late survival.

Adult↗
PubMed1980

Reversal of toxic and anoxic induced hepatic failure by syngeneic, allogeneic, and xenogeneic hepatocyte transplantation.

This report describes the efficacy of syngeneic hepatocyte transplantation in an anoxic model and of xenogeneic (rabbit and porcine) hepatocyte transplantation in a toxic model of fulminant hepatic failure in the rat. Lewis strain rats that received 4 X 10(7) hepatocytes intraperitoneally at 48 hours after hepatic artery ligation had a significantly improved survival rate (79%, n = 14) when compared with control animals (38%, n = 21, P less than 0.05). Xenogeneic hepatocytes (4 X 10(7) cells/rat) given intraperitoneally to D-galactosamine-poisoned Lewis rats at 48 hours after toxin administration were able to significantly improve survival rate as compared with controls (71% versus 14%, n = 14, P less than 0.01 for rabbit; and 75%, n = 14 versus 12.5%, n = 16, P less than 0.001 for porcine). Although an increase in in vivo cytotoxicity could be demonstrated after procine hepatocyte transplantation, no adverse clinical effects were observed. The methodology for the harvest and storage of large numbers of hepatocytes from a large animal liver has been developed, and it is now feasible to proceed to the clinical application of hepatocyte transplantation for human fulminant hepatic failure.

Animals↗
PubMed1979

Use of a glucose controlled insulin infusion system (artificial beta cell) to control diabetes during surgery.

An artificial beta cell has been used to achieve and maintain a preset plasma glucose concentration in five diabetic patients undergoing surgery. These subjects were compared to control groups of normal subjects receiving either saline or glucose, and diabetics receiving glucose intraoperatively. Hyperglycaemia during surgery was seen in normals (mean plasma glucose +/- SEM: 185 +/- 16 mg/dl) and, to a greater degree, diabetics (247 +/- 36 mg/dl) receiving glucose. Insulin and C-peptide levels did not increase during 2 hours of operation in any of the control groups, suggesting beta cell suppression during surgery. As C-peptide levels declined similarly in normal subjects whether they received saline or glucose, the hyperglycaemia seems to be due to an inability to use exogenous glucose. This is confirmed by a correlation of maximal plasma glucose to glucose infusion rate (r = 0.78, p less than 0.01). The artificial beta cell was able to achieve the same plasma glucose after 2 hours of operation (128 +/- 21 mg/dl) as normal subjects receiving saline (110 +/- 7 mg/dl). The artificial beta cell proved to be a safe, convenient and effective way of monitoring and controlling the hyperglycaemia seen in diabetic patients undergoing surgery.

Blood Glucose↗
PubMed1979

Methods of altering crestal levels. Clinical case reports.

Selected cases have been presented using different techniques to alter crestal levels. Self Regeneration or Autogenous bone grafts have been most successful in cases of three-wall and two-wall infrabony lesions. When a hemiseptal lesion occurs on the mesial of a tooth an uprighting procedure can be accomplished. When there is an adjacent tooth a forced eruption technique using orthodontic forces can be used. A surgical elevation technique has been presented which also has shown positive changes in bony topography.

Adult↗
PubMed1979

Elective management of the patient who has bled from esophageal varices.

Variceal hemorrhage can be controlled by nonsurgical means in over 50% of patients. As a result, their general hepatic status can often be improved by preoperative preparation for the elective procedure. The major problem following elective end-to-side portacaval shunting is encephalopathy; it occurs in up to one half of patients who undergo this shunting procedure. Mesocaval shunting has been proposed as a better operation because of lower frequency of encephalopathy; however, the authors' experience has not confirmed this. Distal splenorenal shunting, as shown by the results of a prospective controlled trial, does have a lower frequency of encephalopathy, but the initial morbidity and mortality are higher and an improvement in the duration of survival is not yet evident.

Esophageal and Gastric Varices↗
PubMed1979

Thrombosis of the portal vein following distal splenorenal shunt.

Portal vein thrombosis with a patent shunt is a distinct clinical entity which can follow selective distal splenorenal shunt and should be looked for in patients in whom ascites and abdominal pain develop postoperatively. Possible mechanisms include an increase in blood viscosity and a decrease in portal flow which may be aggravated by inadequate devascularization.

Adult↗
PubMed1979

Periampullary tumours: advances in diagnosis and surgical treatment.

Forty-five carcinomas of the region of the ampulla of Vater were resected at the Toronto General Hospital during a 16-year period. In 26 the presenting symptom was pain and in 32 it was jaundice. The most useful means of investigation was endoscopic retrograde cholangiopancreatography. Angiography was of value in determining resectability prior to operation, and percutaneous aspiration biopsy allowed a preoperative diagnosis in the case of large pancreatic tumours. In 39 patients who had a Whipple procedure the operative mortality was 8%. Total pancreatectomy performed in two patients and local excision of ampullary carcinoma in four patients were attended by no operative deaths. Long-term survival was best in patients with ampullary carcinomas and worst in those with pancreatic cancer.

Ampulla of Vater↗