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Biomedical subjects

D Stoll

Publications and source records attributed to D Stoll.

86 records · Page 5Linked to original sources
PubMed1985

Platelet kinetics in patients with idiopathic thrombocytopenic purpura and moderate thrombocytopenia.

We studied ten normal subjects and 20 patients with stable, untreated idiopathic thrombocytopenic purpura (ITP) and platelet counts in the range of 35,000 to 110,000/microL. The diagnosis was made by clinical criteria. Platelet-associated IgG was increased in all nine of the nine patients studied. Autologous platelets were labeled with chromium 51 and reinfused for measurement of mean cell life and platelet production rate. Mean cell life was calculated by two methods, weighted mean and multiple hit, with excellent agreement between the two. As expected, mean cell life was significantly reduced in ITP patients as compared to the normal subjects (2.9 days v. 8.0 days, P less than .001). However, mean platelet production rates in ITP patients and normal subjects, 3.5 and 3.8 X 10(9) platelets/k/d respectively, were not significantly different. Platelet production rate was above and below the normal range (2 to 5.6 X 10(9) platelets/k/d) in two and four patients, respectively. We conclude that the rate of platelet production is not increased in most patients with ITP who have platelet counts greater than 35,000/microL. We did find that platelet size was increased in eight of the 12 patients in whom it was measured, including two of the patients with low platelet production.

Adolescent↗
PubMed1984

A pilot study of combined radiotherapy and chemotherapy for esophageal carcinoma.

Between 9/80 and 9/83, 20 patients with esophageal carcinoma were treated with combined radiotherapy and chemotherapy (5-FU and mitomycin). Thirteen patients with Stages I or II disease received definitive treatment consisting of 6000 rad in 6-7 weeks and 5-FU (1000 mg/m2/24 hours) as a continuous I.V. infusion for 96 hours starting on days 2 and 28. Mitomycin (10 mg/m2) was administered as a bolus injection on day 2. Palliative treatment (5000 rad plus above chemotherapy) was delivered to six patients with Stage III disease (two with extra-esophageal spread, four with distant metastases) and to one patient with an anastomotic recurrence following resection. Two of 13 definitively treated patients were not evaluable due to early death from intercurrent disease. Ten of 11 evaluable patients treated definitively are alive from 4-32 months; the median survival has not been reached at 17 months. Four of 11 evaluable patients treated definitively have relapsed, with only one relapsing within the irradiated field. Among the palliative and definitively treated patients, relief of dysphagia was seen in 16/17, and continued until the time of last follow-up or until death in 13/17. The treatment was well tolerated and no significant hematologic problems were incurred. This combination of radiation therapy with infusional 5-FU and mitomycin appears to be an effective and well-tolerated regimen in the treatment of esophageal carcinoma and is worthy of further study.

Aged↗
PubMed1981

[Repair of loss of substance from the nose with a two-pointed lozenge-shaped flap (author's transl)].

A lozenge-shaped resection is employed to obtain a flap consisting of two triangular elements having a common pedicle. The resulting flap has similar qualities to the one described by Esser-Zymany: available tissue is obtained at a distance from the lesion, with reduced torsion of the pedicle and without deformation of the intermediary zone; use can be made, if necessary, of the lax tissue in the different quadrants surrounding the pedicle; double locking of the graft is possible. The flap has the additional advantage that its borders can be easily adapted. The authors have used it in 16 out of 34 cases treated over a period of 18 months.

Aged↗
PubMedDate not supplied

[Apropos of 2 cases of Scedosporium apiospermum nasosinusal infection].

We report two cases of nasosinusal infection caused by Scedosporium apiospermum and involving the nasal fossa in one case and the maxillary sinus in the other. The course of the disease varied according to the patient's immune status. The otherwise healthy patient (case n. 1) was completely cured by surgery, whereas the immunosuppressed patient (case n. 2) had local extension with pseudotumoral symptoms and lysis of the inter-sinusonasal septum; an early surgical treatment combined with local administration of a specific antifungal agent resulted in an apparent cure, but the patient died a few months later. A review of the literature confirms the invasive potential of this fungus which in immunosuppressed patients (by therapeutic immunosuppressants or by a debilitating disease) becomes a dangerous opportunistic organism. Cultures on Sabouraud's medium provide an accurate diagnosis and enable antifungal drugs to be tested, miconazole being the most regularly effective of them. In healthy subjects surgery is the sole treatment of nasal or sinusal lesions, while in all immunocompromised patients it must be combined with an antifungal treatment.

Aged↗
PubMedDate not supplied

[Inflammatory acute rhinosinusitis].

1. COMMON COLD: A rhinovirus, the causal agent usually found in common cold, stimulates the local abundance of polymorphonuclears resulting from IL8 secretion. Enzymes and free radicals released by these polymorphonuclears explain the subsequent inflammation. 2. TREATMENT: Treatment for viral rhinosinusitis in adults is based on vasoconstrictors, often associated with anti-histamine agents with atropinergic action. The possible contribution of pure atropinergic agents is currently under evaluation. Non-steroidal antiinflammatory drugs (NSAID) appear to have no effect and corticosteroids are not indicated. 3. RHINOSINUSOPHARYNGITIS IN CHILDREN: These childhood diseases, which after adaptation disappear spontaneously around the age of 7 to 8 years, result from viruses, distinct from those observed in adults, which have a more pronounced cytolytic and general effect. Proposed treatments are designed to lower the temperature using physical (warm bath, abundant fluids) and medicinal means. Paracetamol is preferred over aspirin because it has less side effects. NSAID have not been found to provide any efficacy. Decongestants are an ideal indication but their use is limited by age. Antibiotics are not warranted, at least for the non-complicated forms. Familial education is indispensable for proper management without antibiotics. 4. ACUTE BACTERIAL RHINOSINUSITIS: Originating from the relatively constant microbial flora in the nasal cavities, acute bacterial rhinosinusitis in France is basically caused by Haemophilus influenzae, beta hemolytic Streptococcus, Streptococcus pneumoniae, Staphylococcus aureus, and Branhamella catarrhalis. The proportion of Gram negative germs appears to depend on age and rate of recurrence. There is debate about the impact of viral-bacterial interactions; no definite conclusions can be drawn from current knowledge. 5. BACTERIAL INFLAMMATION IN ACUTE RHINOSINUSITIS: Antibiotic therapy is the first intention treatment for bacterial inflammation caused by acute rhinosinusitis. In case of failure, surgery (puncture or microsurgery as needed) may be indicated. 6. NSAID IN BACTERIAL RHINOSINUSITIS: The contribution of NSAID would be limited due to the unfavorable efficacy-adverse effect ratio. Short courses of corticosteroids are commonly used. Two studies conducted with well-designed methodology, have recently proven the efficacy of coticosteroids in reducing the duration and intensity of spontaneous pain in acute maxillary rhinosinusitis in adults. One of these studies demonstrated a reduction in nasal obstruction. These studies confirm the absence of any notable adverse effect in comparison with placebo. 7. ACUTE RHINOSINUSITIS CAUSED BY DENTAL PROBLEMS: Due to the anatomic disposition (sinusal teeth), the rhinosinusitis is generally unilateral, resulting from paradontal or apical infection. Such cases are exceptional (5% to 10% of all cases of acute sinusitis). 8. CONTAMINATING FLORA IN ACUTE RHINOSINUSITIS: Anaerobic and microaerophilic germs predominate, generally coming from the buccal floral or the edodontoid or periodontoid flora. 9. SURGICAL TREATMENT: Associated with dental care, sinus puncture or meatomy may be required for evacuation of the sinus. Antibiotics directed against a wide variety of aerobic germs (amoxicillin-clavulanic acid or pristinamycin are generally recommended) should be given before and after surgery. The role of NSAID is evaluated in terms of the benefit (pain relief)/adverse effect ratio, which in the present situation can be considered to favor the antalgesic action during or before dental care. 10. THE QUESTION OF SHORT COURSES OF CORTICOSTEROIDS: The contribution of short courses of corticosteroids is assessed in the same manner as for maxillary sinusitis resulting from the nasal flora.

Acute Disease↗
PubMedDate not supplied

Surgery of the anterior skull base: total ethmoidectomy for malignant ethmoidal tumors.

The authors report their 17-year experience of total ethmoidectomy using a combined rhinological and neurosurgical approach. As a result of new imaging methods significant progress has been made in the field of pre-operative topographic diagnosis as well as in the operative procedure itself. The optimal skull base reconstruction, which consists of epicranial graft and cryopreserved bone homograft, seems to reduce operative morbidity and mortality. The combined approach technique is shown to be successful in the treatment of both adenocarcinomas and olfactory bulb tumors. However, epidermoid carcinomas still have a poor prognosis due to frequent local recurrences and visceral metastases.

Adenocarcinoma↗