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Biomedical subjects

D E Beck

Publications and source records attributed to D E Beck.

At least 55 records · Page 3Linked to original sources
PubMed1990

Surgical management of anal condylomata in the HIV-positive patient.

A retrospective review of 677 patients who tested positive for the human immunodeficiency virus, evaluated from January 1986 to February 1988, demonstrated 119 patients (18 percent) with anal condylomata. Demographics of these patients were similar to the total human immunodeficiency virus group; ages ranged from 19 to 86 years (mean, 25 years). Ninety-four percent of patients were men, 62 percent were white, 30 percent were black, and 10 percent were other races, primarily Hispanic. Ten percent of the patients admitted to homosexual activity and 2 percent admitted to intravenous drug abuse. Sixty percent of the population had another sexually transmitted illness. The majority of patients were in early Walter Reed Classes (Stage I or II). With follow-up of 4 to 26 months (mean = 12 months), the recurrence rate for anal condylomata was 26 percent after local treatment with podophyllin and 4 percent after fulguration and excision. There were no operative complications. Our study confirmed that anal condylomata and sexually transmitted diseases are common in patients who test positive for the human immunodeficiency virus and that patients who test positive for the human immunodeficiency virus with early Walter Reed stages can be expected to do well with appropriate therapy.

Adult↗
PubMed1990

Proctologic management of the HIV-positive patient.

With the adoption of mandatory testing for human immunodeficiency virus (HIV) in military personnel, a large number of HIV-positive individuals have been identified. From January 1986 to February 1988, 677 HIV-positive patients were evaluated at Wilford Hall USAF Medical Center. Most of these patients had disease in the Armed Forces Walter Reed stage I or II. Other sexually transmitted diseases were found in 407 patients (more than 60%). Of 163 patients (24%) with treatable anorectal conditions, 44 had nonsexually related anorectal conditions and 119 had anal condylomata. Patients with disease in early Walter Reed stages I and II did well with therapy of their anorectal diseases. We present our methods of evaluation, infection control, treatment, and results.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Breast cancer: the military's experience at Wilford Hall USAF Medical Center.

We reviewed the experience with breast cancer at Wilford Hall USAF Medical Center for the years 1978 through 1988. A total of 868 cases were identified in the Wilford Hall Tumor Registry; overall 5-year and 10-year survivals were 63% and 39%, respectively. Infiltrating ductal carcinoma represented the principal histologic category. The other predominant variants included invasive lobular carcinoma, lobular carcinoma in situ, and ductal carcinoma in situ. Until recently, most of these patients (90%) had modified radical mastectomy as their definitive surgical therapy, with chemotherapy reserved primarily for patients with advanced disease.

Actuarial Analysis↗
PubMed1989

Role of the methylene backbone in the antiproliferative activity of polyamine analogues on L1210 cells.

The impact of the polyamine analogues, N1,N11-diethylnorspermine (DENSPM), N1,N12-diethylspermine (DESPM), and N1,N14-diethylhomospermine (DEHSPM) on the growth properties of L1210 murine leukemia cells is compared. The order of antiproliferative activity of the three compounds is shown to be DEHSPM greater than DESPM greater than DENSPM with average 96-h IC50 values of 0.06, 0.18, and 1.3 microM, respectively. Trypan blue exclusion suggests that the cytotoxic behavior of the compounds is not apparent until 96 h after exposure to the analogues. DEHSPM is shown to act more quickly and demonstrates the most profound cytotoxic effects at 144 h. Competitive uptake studies with spermidine reveal DESPM and DEHSPM to have essentially identical Ki values of 1.4 and 1.6 microM, respectively, while DENSPM indicates a substantially higher Ki value of 17 microM. Finally, although the analogues reduce the levels of putrescine, spermidine, and spermine in L1210 cells, if the concentration of polyamines in the cell, including analogues, is expressed on a nitrogen equivalence basis, the total cationic charge with which the polyamines are associated is conserved.

Animals↗
PubMed1989

UTP/CTP ratio, an important regulatory parameter for ATCase expression.

Intracellular nucleotides of Salmonella typhimurium were separated and quantified by high performance liquid chromatography (HPLC). Wild type and specially constructed strains of S. typhimurium, in which uridine and cytidine nucleotides could be manipulated independently, were used in this study. By varying growth conditions it was possible to create different concentrations of uridine and cytidine nucleotides in the cell. The specific activity of ATCase was determined for each condition. Generally, a direct correlation was found: at high nucleotide (UTP) concentrations, maximal repression of ATCase was usually seen; at low nucleotide (UTP) concentrations ATCase was derepressed. However, it was the ratio of the concentrations of UTP-to-CTP rather than either the concentration of UTP or CTP alone that best determined the extent of ATCase expression. This applied to all conditions in the present work as well as to all conditions in work hitherto reported by others. The ratio of UTP/CTP is proposed as a key regulatory parameter for pyr enzyme expression.

Aspartate Carbamoyltransferase↗
PubMed1989

Perianal Bowen's disease associated with Crohn's colitis. Report of a case.

A 24-year-old woman with a two-year history of inflammatory bowel disease, with no anal or perineal involvement, underwent a proctocolectomy and ileostomy. Pathologic evaluation of the specimen revealed Crohn's colitis and unsuspected perianal Bowen's disease. The patient is free of Crohn's and Bowen's disease 6.5 years later. The association of perianal Bowen's disease with Crohn's colitis is discussed.

Adult↗
PubMed1989

Neonatal pneumopericardium with high-frequency ventilation.

Pneumopericardium is an uncommon condition in the neonate and has not, to our knowledge, previously been reported in patients treated with high-frequency ventilation. The results of such treatment in 8 neonates seen in the Neonatal Intensive Care Unit, Wilford Hall USAF Medical Center, San Antonio, Texas, are presented. The mean gestational age was 35 weeks, and birth weight averaged 2.7 kg. The pneumopericardium developed while the patients were on high-frequency ventilation, and the diagnosis was confirmed with a chest radiogram. Treatment included pericardiocentesis with a needle catheter followed by placement of a 10F to 14F chest tube into the pericardial space. The pneumopericardium resolved in all 8 patients. Three of the newborns died of underlying disease; 5 survived and were discharged from the hospital. Pneumopericardium in the neonate is a life-threatening complication, and appropriate therapy includes drainage with a pericardial tube placed under direct vision.

Drainage↗
PubMed1989

Surgical management of colonic inertia.

Fourteen patients with chronic constipation due to colonic inertia were treated with total abdominal colectomy and ileorectal anastomosis at the Cleveland Clinic Foundation from 1981 to 1986. All patients were white women ranging in age from 28 to 64 years (mean 41 years). The duration of symptoms averaged 21 years (range six to 47 years) and the average time between bowel movements was ten days. The preoperative evaluation included barium enema in 12 patients and colonoscopy in five (some patients had both studies). Anorectal dysfunction was excluded by manometry in ten patients and by rectal biopsy in six. Colonic transit studies were accomplished in only two patients. The hospital stay averaged 13 days, and there was no operative mortality. Postoperative morbidity included one case of small bowel obstruction, necessitating operative correction on postoperative day 9. Follow-up ranged from three months to five years. At their last clinic visit, the patients averaged two bowel movements per day. All patients had excellent bowel control and were happy with the procedure.

Adult↗
PubMed1989

Premalignant lesions of the anal margin.

Premalignant lesions of the anal margin include Bowen's disease (intraepithelial squamous cell carcinoma) and Paget's disease (intraepithelial adenocarcinoma). Our experience includes 11 patients with perianal Paget's disease and 37 patients with perianal Bowen's disease treated from 1957 to 1986. The patients with perianal Paget's disease were older, had a higher incidence of invasive cancer, and had a worse prognosis than those with perianal Bowen's disease. The characteristic appearance of these lesions and their failure to respond to conventional therapy should lead the clinician to obtain a biopsy, which readily establishes the diagnosis. Our experience confirms that adequate evaluation followed by wide local excision is the appropriate therapy. Close follow-up is recommended to identify recurrence of the perianal disease or development of other malignancies.

Adult↗
PubMed1988

Perianal Bowen's disease.

Thirty-three patients with perianal Bowen's disease were treated at the Cleveland Clinic Foundation from 1954 to 1986. Twenty-one patients were women and 12 were men, ranging in age from 30 to 69 years (mean, 48 years). Twenty patients (61 percent) presented with symptomatic perianal disease, while 13 patients (39 percent) were noted as having perianal Bowen's disease upon pathologic examination of routine hemorrhoidectomy specimens. Ten of the patients (30 percent) had prior histories of unrelated cancer. Twenty-seven patients were managed by wide local excision, three patients by simple excision, three patients by fulguration, and one patient by an abdominoperineal resection. During a follow-up period averaging 3.7 years (range, 0.3 to 10 years), one patient developed a new invasive skin cancer while a second patient experienced a recurrence of perianal Bowen's disease. The characteristic gross appearance of this lesion and its failure to respond to conventional therapy should prompt the performance of a biopsy, which readily establishes the diagnosis. This experience confirms that wide local excision is adequate therapy for perianal Bowen's disease and that close clinical follow-up is necessary to identify disease recurrence or the development of a malignancy.

Adult↗
PubMed1988

Surgical management of bleeding stomal varices.

A retrospective chart review of nine patients with stomal varices and portal hypertension who required surgical management of bleeding varices from 1978 to 1986 was performed. The patient's mean age at stoma formation was 46 years (range, 36 to 70 years). Three were female, six were male, and all were Caucasian. Three patients had colostomies and six had ileostomies. Indications for creation of the ostomies included inflammatory bowel disease in six patients and carcinoma in three patients. The time from creation of the stoma to the first bleed was 11 to 196 months (mean, 82 months). The average time between this bleed and surgical treatment was six months. The operative procedures performed included nine mucocutaneous disconnections (MCD) in seven patients (one for recurrent bleeding) and two stoma relocations (one for recurrence). MCD is simple, quick, and associated with a lower morbidity and intraoperative blood loss than stomal relocation. Postoperative follow-up has ranged from 4 months to 4.6 years (mean, 2.5 years). During this period there were two episodes of recurrent varices that required surgery. In the select group of patients that cannot be managed conservatively, MCD is favored and relocation considered only if MCD is technically impossible.

Adult↗
PubMed1988

Catheter drainage of ischiorectal abscesses.

We retrospectively reviewed the charts of 55 patients with ischiorectal abscesses treated from 1980 to 1983 at the Cleveland Clinic Foundation. The patients were treated by placement of a 10F to 16F soft latex mushroom catheter into the abscess cavity under local anesthesia as an office procedure. The end of the catheter was shortened to leave 2 to 3 cm exiting the skin, and a bandage was applied. No sutures or irrigations were used, and the drains were removed an average of 12 days after placement. Antibiotics were not given. The patients ranged in age from 17 to 76 years (mean, 40 years) and 36% were female. Four patients had diabetes, and eight had a history of inflammatory bowel disease. Nine patients had been treated previously for anorectal abscesses. There were no complications. Adequate follow-up was obtainable in 31 patients (ten to 63 months; mean, 30 months). Eight of them (26%) were subsequently treated for fistulas found after resolution of the abscess, and an additional eight (26%) had a second abscess form during the follow-up period. The average time to this recurrence was 20 months. Catheter drainage of ischiorectal abscess in selected cases resulted in healing with low morbidity and significant cost savings.

Abscess↗
PubMed1988

Routine bile cultures during elective cholecystectomy.

To assess antibiotic usage and the value of routine intraoperative bile cultures, we retrospectively reviewed 79 patients who had elective cholecystectomy from January to December 1986. Forty patients (57%) received perioperative antibiotics, and 15 (19%) had positive intraoperative bile cultures. During follow-up, the only septic complications identified were wound infections in two patients (3%); one of them had received antibiotics and one had not. Each bile culture cost $60 to $80, and the cultures were not clinically useful. In the absence of risk factors associated with positive bile cultures, the incidence of wound infections or septic complications after cholecystectomy is low. We conclude that routine intraoperative bile cultures and prophylactic antibiotics are not indicated for elective cholecystectomy in low-risk patients.

Adult↗
PubMed1988

Predicting need for pharmacokinetic consultation follow-up using discriminant analysis.

A discriminant function that predicts whether a patient will require more than one intervention by the pharmacokinetic consultation service (PCS) was derived and evaluated prospectively. In phase 1, peak and trough serum aminoglycoside concentrations were evaluated for each of the 150 patients. The patients were then classified into either group 1 or group 2. Group 1 patients required a change in regimen after the initial recommended regimen was begun, while patients in group 2 did not require a change in regimen. Forty-seven variables of group 1 and group 2 were compared by univariate analysis. Stepwise discriminant analysis was then used to develop a model for classifying patients into either group 1 or group 2. In phase 2, the discriminant function derived in phase 1 was applied to a new group of 47 patients. In phase 1, significant variables of the derived discriminant function, in decreasing order of significance, were leukemia, serum creatinine concentration, location in an intensive-care unit (ICU), male sex, actual volume of distribution, therapeutic trough concentration, and number of days in the ICU before consultation. In phase 2, 6 (23%) of the 26 patients who actually required a change were classified into group 2, and 8 (38%) of the 21 patients who were assigned to group 1 for continuous monitoring did not actually require a regimen change. Although the results of the derived discriminant function were significant, the function's clinical utility in predicting the need for a second dosing intervention was poor.

Adult↗
PubMed1987

Perianal Paget's disease.

Over the past 11 years (1974 to 1985) ten patients with perianal Paget's disease were treated. The average age was 64 years and half were male. Two patients were diagnosed as an incidental finding after hemorrhoidectomy and the remainder presented with a symptomatic perianal rash (itching and moisture) that averaged two years in duration. Physical examination in these patients demonstrated characteristic lesions (seven with erythematous or ulcerated, whitish gray lesions and one with a papillary lesion). Three patients presented with invasive carcinomas and, despite aggressive therapy, all developed metastatic disease. Two patients had local excisions with minimal margins and developed associated invasive cancers at four and ten years after diagnosis. The remaining five patients were treated by wide local excision and skin grafts. At present all are free of disease. The characteristic appearance of this lesion and its failure to respond quickly to conventional therapy should lead the clinician to obtain a biopsy which readily establishes the diagnosis. Experience confirms that wide local excision is adequate therapy, but adequate initial evaluation and close follow-up are necessary to identify other malignancies that may develop.

Adult↗