Biomedical subjects
H Silberman
Publications and source records attributed to H Silberman.
Absorbable versus permanent mesh in abdominal operations.
Because previous studies evaluating prosthetic mesh have yielded conflicting results, we compared two permanent (polypropylene and polytetrafluoroethylene) and two absorbable (polyglactin and polyglycolic acid) meshes with respect to histologic appearance, development of adhesions, tensile strength and occurrence of hernias in rabbits in which defects of the abdominal wall measuring 2 by 3 centimeters were repaired with one of the meshes. Twenty experiments were performed with each material, and observations were made at two, five, seven and ten weeks. The inflammatory response was minimal with all products. Adhesions were more marked with polypropylene (Marlex) than with polytetrafluoroethylene (Gore-tex); there was no difference between the absorbable meshes. In vitro tensile strength measurements at ten weeks indicated that Marlex was superior to the other materials, and between the absorbable products, polyglactin (Vicryl) was superior to polyglycolic acid (Dexon). No hernias were observed with the nonabsorbable meshes, but all of the rabbits repaired with absorbable meshes had ventral hernias by the tenth week. Thus, absorbable meshes are not indicated when prolonged tensile strength is required, but they may be useful for other purposes, including the temporary repair of fascial defects, since evisceration was not observed.
Bulk laxative causing esophageal obstruction.
Explore the source record for details and available documents.
Reevaluation of the maximum tolerated dose of continuous venous infusion of 5-fluorouracil with pharmacokinetics.
5-Fluorouracil (5-FU) was administered as a continuous ambulatory venous infusion to 25 patients in a Phase I trial. The principal dose limiting toxic effect observed was mucositis. Skin rash and diarrhea occurred less frequently. Hematological toxicity was modest, and no hepatic toxicity was seen. One partial remission of 138 days duration was seen in a patient with metastatic breast carcinoma who was previously refractory to a 5-FU combination regimen. Patient tolerance of 5-FU delivered in this manner appeared highly variable. On the basis of this trial, we recommend that future studies evaluating the efficacy of long-term venous infusion of 5-FU should utilize a dosage of 450 mg/m2/day.
A randomized phase I and II study of short-term infusion of high-dose fluorouracil with or without N-(phosphonacetyl)-L-aspartic acid in patients with advanced pancreatic and colorectal cancers.
Fifty-two patients with advanced gastrointestinal (GI) malignancies who had not received previous chemotherapy or radiation therapy were randomized to be treated either with 24-hour infusion of weekly fluorouracil (5-FU) or the same plus N-(phosphonacetyl)-L-aspartic acid (PALA). Forty-seven patients were evaluable for the assessment of toxicity and antitumor activity. PALA was administered as an intravenous (IV) bolus over 15 minutes at a fixed dose, 250 mg/m2. The latter agent was administered 24 hours before the start of 5-FU infusion. 5-FU was initially administered at 750 mg/m2 and was incrementally increased to 3,400 mg/m2. In both arms of the randomized study, the courses were repeated every week. In both arms of the study, ataxia and myelosuppression were the dose-limiting toxic effects. At 5-FU dose of 3,400 mg/m2, one patient in each arm developed grade 3 hematologic toxicity. Other reversible side effects included grade 2 skin changes, nausea, and vomiting. During the administration of 2,600 mg/m2 of 5-FU over 24 hours, the steady state plasma 5-FU concentration was approximately 20 mumol/L. The maximum tolerated dose (MTD) for 5-FU for protracted treatment is 2,600 mg/m2 in either arm of the study. Therapeutic response was predominantly seen in the combination arm: there were two patients with complete response (CR) and 11 patients with partial response (PR) of 28 patients in the study. In the 5-FU alone arm there were four PR and 19 patients in the study.
The relation of thyroid indices in the critically ill patient to prognosis and nutritional factors.
Thyroid indices and nutritional assessment values were measured in 73 critically ill euthyroid patients within 48 hours of admission to the medical or surgical intensive care unit. Significantly increased rates of mortality were observed among patients with decreased T3 or T4 levels or elevated T3UR or rT3 values. Alterations in thyroid function tests were associated with changes in certain putative nutritional indices, including serum albumin and transferrin concentrations, triceps skin fold and skin test reactivity. The data indicated that thyroid parameters measured early in the critical phase of illness are predictive of subsequent outcome. The pathogenesis of altered thyroid hormone metabolism is unknown, but nutritional deprivation may be an important contributing factor.
Aggressive management of cholecystitis during pregnancy.
Nonoperative management of symptomatic cholelithiasis has generally been recommended for pregnant patients. However, a review of our experience with 44 patients at the Los Angeles County-University of Southern California Medical Center indicates that conservative management is associated with recurrent episodes of biliary tract symptoms, often requiring multiple hospitalizations, as well as a significant rate of fetal loss; whereas operation performed during the second trimester was associated with little maternal morbidity, no fetal loss, and a substantial reduction in total hospital days.
The influence of hepatitis B infection on the outcome of renal allotransplantation.
Renal allograft and patient survival and liver function abnormalities were studied in a group of HBsAg-negative and -positive recipients. Thirty-five patients were positive, and 20 patients became antigenemic prior to transplantation. Two hundred twenty-four patients were HBsAg-negative. No difference in patient or graft survival was found between patients with hepatitis B antigenemia and antigen-negative cadaver allograft recipients. The incidence of significant hepatic disease was low in comparison with several recently published reports. It is concluded that hepatitis B antigenemia is not an absolute contraindication to transplantation.
Phase II evaluation of etoposide in refractory multiple myeloma: a Southeastern Cancer Study Group Trial.
Explore the source record for details and available documents.
Weekly mitoxantrone therapy for refractory multiple myeloma: a Southeastern Cancer Study Group Trial.
Explore the source record for details and available documents.
Total parenteral nutrition in obstetrics.
Total parenteral nutrition was provided to ten patients during pregnancy. No obstetrical or fetal complications attributable to the nutrition therapy occurred. All infants were at or above the tenth percentile in weight for gestational age. Total parenteral nutrition appears to be safe for the mother and fetus when given after the first trimester; the safety of total parenteral nutrition in the first trimester requires further study.
The role of preoperative parenteral nutrition in cancer patients.
The observations that malnutrition frequently affects cancer patients, that it adversely affects postoperative prognosis, and that it is amenable to intensive nutrition therapy, lead logically to the hypothesis that preoperative parenteral nutrition should have a salutary effect on many patients undergoing oncologic surgery. Available studies evaluating this hypothesis suggest that adequate preoperative intravenous feedings improve the postoperative course of malnourished patients and patients initially well nourished but in whom oral nutrition may be interrupted prior to operation.
Phase III study of BCOP v CHOP in unfavorable categories of malignant lymphoma: a Southeastern Cancer Study Group trial.
A total of 296 evaluable patients with unfavorable categories of malignant lymphoma were randomly assigned treatment with cyclophosphamide, vincristine, and prednisone plus BCNU (BCOP) or doxorubicin (CHOP). In diffuse histiocytic (DH) lymphoma, CHOP produced superior complete (54% v 34%) and total (70% v 46%) response rates. Among the responders to either therapy, no differences were seen in duration of response or survival times. Median duration of response has not been reached with follow-up in excess of 50 months. In categories of lymphoma other than DH (including small-cell, mixed, and nodular histiocytic lymphomas), complete (27% v 29%) and total (48% v 54%) responses were similar for BCOP and CHOP, as were durations of response and survival. These data suggest that BCOP and CHOP are equivalent regimens for other categories of malignant lymphomas. CHOP appears preferable for diffuse large-cell categories, since it resulted in greater overall survival in patients with DH lymphoma; this was due to a significantly greater response rate, since patients with DH lymphoma who did respond to BCOP maintained their response and survived as long as did the CHOP responders.
Actinomycotic otitis externa.
Explore the source record for details and available documents.
Hyperkalaemia after cyclosporin therapy.
Explore the source record for details and available documents.
Lipid-based parenteral nutrition and the immunosuppression of protein malnutrition.
Protein malnutrition has been directly related to impaired immunocompetence. An experimental protocol was designed to determine the efficacy of a lipid-based system of total parenteral nutrition (TPN) in restoring immunocompetence in nutritionally depleted subjects. Thirty rats sensitized to PPD were made anergic by the oral administration of a protein-free diet. Nutritional repletion was instituted with either a complete oral diet or lipid-based TPN. The two groups of animals did not differ significantly in the time required to regain positive skin test reactivity or in the weight gained during the repletion period. The lipid-based system of TPN was comparable to the complete oral diet in reversing the anergy of protein malnutrition.
Hypertension in a renal transplant recipient.
Explore the source record for details and available documents.
Randomized trial of radiotherapy to the thorax in limited small-cell carcinoma of the lung treated with multiagent chemotherapy and elective brain irradiation: a preliminary report.
A total of 304 patients with limited small-cell carcinoma of the lung were treated with a combination of cyclophosphamide, Adriamycin (Adria Laboratories, Columbus, Ohio), and vincristine (CAV) and elective brain irradiation (3,600 rad TD in 14 fractions). The patients were randomized to either receive or not receive thoracic irradiation (4,000 rad TD, split course). Of the 304 patients, 291 were eligible for the study. Two hundred eighteen (75%) were completely evaluable. In each group, 81% of the patients had a Karnofsky index of 80% or higher and 14% had supraclavicular or scalene lymph nodes. Patients treated with CAV and no thoracic irradiation had a complete response (CR) of 48%, in contrast to 63% for those receiving chest irradiation (P = .05). In the first group, the complete and partial response rate was 70%; in the second, 80%. The median survival for the eligible patients treated with CAV and brain radiation therapy was 49 weeks; for those treated with the same regimen plus thoracic irradiation, the median survival was 60 weeks. The actuarial two-year tumor-free survival is 19% in the first group and 28% in the second group. The median survival for the responders in the CAV plus brain irradiation group was 57 weeks and for those receiving thoracic irradiation, 78 weeks (P = .12). Thoracic failure was 52% in patients not treated with thoracic radiation therapy v 36% in those receiving it (P = .06). The distant metastases incidence was 23% in patients not treated with thoracic radiation and 35% in patients treated with thoracic radiation. Hematologic toxicity was comparable in both groups; 30% of the patients had moderate to severe granulocytopenia and 6%, low homoglobin. Two toxicity-related deaths occurred (one in each group). Moderate gastrointestinal toxicity was noted in 41% and severe in 16% of the patients receiving CAV and brain irradiation without thoracic radiotherapy v 44% and 20% in those irradiated in the thorax. Disease-free survival is enhanced in the patients receiving thoracic irradiation. More effective chemotherapy is critically needed to significantly improve overall survival. These preliminary results suggest that thoracic irradiation should be a primary component in the therapy of these patients, although this combined therapy is moderately toxic.(ABSTRACT TRUNCATED AT 400 WORDS)