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Biomedical subjects

B Langer

Publications and source records attributed to B Langer.

At least 271 records · Page 15Linked to original sources
PubMed1979

The renal and hemodynamic effects of the peritoneovenous shunt for intractable hepatic ascites.

Fifteen patients with chronic liver disease having a peritoneovenous shunt for chronic intractable ascites were studied prospectively for renal function and hemodynamic changes during balance studies, pre-, peri-, and postoperatively. Shunt insertion caused a rapid redistribution of ascites into the intravascular compartment with hemodilution and significant rises in cardiac output (9 patients) (P less than 0.025) renal blood flow (3 patients) (P less than 0.025), and creatinine clearance (15 patients) (P less than 0.005), and decreases in plasma renin activity (10 patients) and serum aldosterone levels (9 patients) (P less than 0.025). Despite these changes, small repeated doses of furosemide were required to start and maintain a diuresis and natriuresis with sodium excretion rising from 7.2 +/- 4.1 to 174 +/- 44 meq/day (P less than 0.0005) in the 15 patients. At 2 wk postoperatively, the 15 patients had lost a mean of 7.5 kg in weight associated with a persistent improvement in creatinine clearance and a continued natriuresis, 15.9 +/- 7 mEq/day (P less than 0.005), despite no statistically significant change in cardiac output (7 patients) or renal blood flow (4 patients) compared with preoperative levels. This operation is an effective therapy for refractive ascites, but the incidence of potentially fatal complications makes us hesitate to recommend it except for patients resistant to normal conservative measures.

Adult↗
PubMed1978

Selection of operation in patients with bleeding esophageal varices.

The results of surgical treatment of bleeding esophageal varices over an 8-year period in 155 patients are reviewed. Primary treatment of bleeding was conservative, with intravenous administration of vasopressin and balloon tamponade. Emergency operations were carried out after 48 hours in persons with persistent bleeding who were surgical candidates. Operative mortality was higher in this group (40%) than in those undergoing elective or urgent operations (each 10%). Postoperative encephalopathy occurred in 35% of patients and was correlated closely to late death after establishment of a shunt. The mesocaval shunt is no better than the portacaval but appears to be a good alternative in an emergency. In a controlled trial the distal splenorenal shunt was found to be associated with a lower rate of postoperative encephalopathy than the portacaval shunt, but thus far the long-term survival rates have not differed.

Blood Vessel Prosthesis↗
PubMed1978

Fine needle aspiration biopsy of malignant lesions in and around the pancreas.

A simple method of percutaneous fine needle aspiration biopsy of malignant lesions in and around the pancreas following radiological localization is described. Biopsy was performed in 28 patients. Twenty-three were eventually considered to have malignant disease and biopsy was positive in 19 of these (83%), including 16 of 18 patients with carcinoma of the pancreas (89%). One patient developed an exacerbation of pancreatitis following the procedure. Surgery became unnecessary in 5 of the 18 patients with positive biopsies. From these results and from a review of the literature on percutaneous fine needle aspiration biopsy, we believe that this is a simple, relatively painless, reasonably safe and reliable method of obtaining a preoperative diagnosis and advocate the procedure as desirable in all patients in whom malignant disease is suspected and can be localized radiologically.

Bile Duct Neoplasms↗
PubMed1978

Management of carcinoma of the extrahepatic bile ducts.

The records of 80 cases of carcinoma of the extrahepatic bile ducts were studied. The median duration of survival, in months, of patients who were treated by curative surgery, palliative surgery and radiation, palliative surgery alone and biopsy alone was 21.7, 9.3, 5.5 and 1, respectively. The best results were obtained by excision of the tumour, but only 10% of tumours were considered resectable. A more aggressive surgical approach to tumours still confined to the bile ducts might be expected to increase the resectability rate and improve survival. The use of a U tube is recommended because it ensures greater comfort even though survival is no longer than when a T tube is used. The roles of adjuvant radiotherapy and chemotherapy need further study. Because of some encouraging responses with the use of radiotherapy and the infusion of 5-fluorouracil the authors are currently evaluating these two methods of treatment.

Adenocarcinoma↗
PubMed1977

Combined treatment with BCG and chemotherapy for metastatic gastrointestinal cancer.

The survival of patients who have cancers of the gastrointestinal tract is poor even after surgical resection of all gross disease. In an initial consecutive series of patients with metastatic or recurrent cancers, an attempt to improve survival with combined nonspecific immunostimulation by the intraperitoneal administration of BCG followed by oral BCG cycled with chemotherapy was studied. The results suggested that a population of patients with gastric and colonic cancers showed improved survival with this treatment. A randomized trial of combined chemoimmunotherapy versus chemotherapy alone was begun on November 1, 1974, for all cancers of the stomach and pancreas and all colorectal cancers beyond stage C by Dukes' classification. The initial results with patients entered by December 31, 1975, and followed until March 1, 1976, are reported.

BCG Vaccine↗
PubMed1977

The early reentry procedure.

A technique and rationale for the early reentry of autogenous bone grafts has been described. Rather than wait 1 to 2 years for reentry as has been previously suggested, a 3-month interval was chosen. Results of the study showed: (1) Healing of osseous grafts starts very quickly and we do not have to wait long periods of time to ascertain whether the graft is successful. (2) That all grafts do not fill the defect completely and that there may be an alteration in contour. (3) That it is often important therefore that a reentry procedure be done to contour the bone. (4) Healing after reentry procedure occurred rapidly and uneventfully and minimum sulcular depth was obtained. (5) Reentry of autogenous osseous grafts for evaluation and physiologic recontouring is possible at 3 months without adversely affecting the ultimate clinical maturation and success of the graft.

Bone Transplantation↗
PubMed1977

Adjuvant immunostimulation in malignant melanoma with oral Bacille Calmette-Guérin.

Results of the administration of oral bacille Calmette-Guérin (BCG) as an adjunct to standard treatment in 62 patients with malignant melanoma indicate that this drug is of value in preventing distant spread of the disease when it is limited to one region and in its early stages. BCG increases survival in patients with visceral metastases. In those in whom these metastases are surgically resectable, it inhibits the development of further metastases. Oral BCG treatment does not affect the course of the disease in patients with massive hepatic or intracranial metastases.

Administration, Oral↗