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Biomedical subjects

J Joffe

Publications and source records attributed to J Joffe.

At least 19 recordsLinked to original sources
PubMed2004

European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG).

Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years. Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively. The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion. Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient. However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure. Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations. Since this guideline is based on the highest evidence level available today, a deviation from these proposals should be a rare and justified exception.

Europe↗
PubMed2001

A simple technique for laparoscopic vertical banded gastroplasty--the JOVO procedure.

A simple technique for laparoscopic vertical banded gastroplasty is described. With the surgeon to the patient's left, four trochars are placed as cephalad as possible. Short gastric vessels are divided and the posterior wall of the stomach mobilized. The ETS-Flex with Articulating Head (Ethicon Endosurgery Inc.) is used to divide the stomach close to a 42-french bougie against the lesser curvature. An additional stapler bite abuts directly against a 28-french bougie to obtain correct stoma size. A ribbon of Prolene mesh is pulled through a tunnel behind the stomach at the apex of the divided gastroplasty and sutured around the distal end of the gastroplasty. To date we have used this method successfully in 5 patients with 1-11 months of follow-up. Although we lack a sufficient number of patients or follow-up for definitive conclusions, we believe this technique will produce good results, as it reproduces exactly that used successfully in open surgery and our early results parallel those following open surgery.

Follow-Up Studies↗
PubMed2001

Impartial long-term review of vertical banded gastroplasty in a low volume community hospital practice.

BACKGROUND: There is some concern whether bariatric surgery can be done well at low volumes or in a community hospital setting. This paper reports an impartial assessment of 25 vertical banded gastroplasties (VBG) over 13 years in a 228-bed non-teaching community hospital. METHODS: Charts were reviewed and patients interviewed by an independent investigator. Complications, weight loss, satisfaction and quality of life were assessed. RESULTS: There were no fatalities, no splenic tears, no stomal stenosis and no symptomatic gastroesophageal reflux. Two reoperations and five incisional hernias were noted. Hypertension was eliminated in 57% and dyspnea in 55%. BMI fell from 44.3 to 34.9 kg/m2 after 6.2 years. BMI decreased more than 10 kg/m2 (10-30) for 15 patients and less than 10 kg/m2 for 10 patients (4-10 for 7, 0 for 1 and a gain for 2). 56% of patients were fully satisfied with the results. Quality of life indicated excellent physical function, physical role and lack of body pain, good general health, social function, emotional role and mental health, but lower vitality. 100% felt better than a year ago. CONCLUSION: Results from a low-volume community hospital general surgical practice are similar to those from specialized series. Obesity is so common, its non-surgical treatment so ineffective and the VBG so well established, that excluding this intervention from community hospitals is untenable.

Adult↗
PubMed2000

Technique and early results of outpatient laparoscopic mesh onlay repair of ventral hernias.

BACKGROUND: This report describes the technique and early results of a simple outpatient laparoscopic ventral hernia repair. METHODS: Data were gathered prospectively for all laparoscopic ventral hernia repairs from January 1996 to December 1997 at a 228-bed hospital. Prolene mesh was stapled to the peritoneal surface of the abdominal wall, leaving sac in situ and mesh uncovered. Patients were seen by the operating surgeon within 2 months, and by an impartial surgeon (J.S.) after 3 to 14 months (average, 7 months; median, 6 months). RESULTS: Repairs involved 44 hernias with orifice sizes 2 to 20 cm in diameter, and an average area of 20 cm(2). Of these 44 hernias, 36 were postoperative and 8 primary. Furthermore, 20% were recurrent hernias. There were four conversions. The outpatient rate was 98%, with one readmission for ileus. The early recurrence rate was 5%. CONCLUSIONS: Laparoscopic mesh onlay repair is a safe, easy, and effective procedure with minimal discomfort and a low early recurrence rate that can be performed safely on an outpatient basis.

Adult↗
PubMed1999

A prospective study of computer-aided design and manufacture of titanium plate for cranioplasty and its clinical outcome.

The use of computerized three dimensional imaging and automated milling of models to produce accurate titanium plates for the reconstruction of craniofacial defects is described. A total of 148 patients have had extensive calvarial defects repaired using this (computer aided design and manufacture) technique developed in our unit. Of these, 141 were repaired secondarily (delayed cranioplasty), whilst seven were repaired immediately following craniectomy (single stage cranioplasty). All cases were assessed for accuracy of fit, restoration of natural skull contour and aesthetics. Seventy-two patients were reviewed after 1 year to determine the effect on adverse preoperative symptoms. Of the plates 97% had an excellent or good intraoperative fit. The modal insertion time was only 15 minutes. Postoperatively 98% resulted in the restoration of natural skull shape and symmetry. After 1 year, 82% of patients had complete resolution or diminution in severity of the adverse symptoms. A staphylococcus infection necessitated the temporary removal of one plate.

Adolescent↗
PubMed1999

Factors contributing to laparoscopic failure during the learning curve for laparoscopic Nissen fundoplication in a community hospital.

This study was done to determine the factors contributing to laparoscopic failure (conversion to open surgery or early reoperation) during the learning curve for laparoscopic Nissen fundoplication in a 228-bed nonteaching community hospital. Data were gathered prospectively for the first 100 consecutive patients booked for elective laparoscopic Nissen fundoplication by the four general surgeons at the hospital. All complications were recorded contemporaneously, and particular note was taken of the factors surrounding conversion to open surgery and reoperation within 100 days of surgery. There were no deaths. The conversion rate was 20% and the early reoperation rate 6%. There were two late recurrences. The average operative time was 117 minutes and the average length of stay 1.8 days; 37 operations were performed on outpatients. The laparoscopic failure rate was 26% (18/68) during a surgeon's first 20 operations and 11% (3/28) thereafter (P < 0.09); the corresponding conversion rates were 22% and 4% (P < 0.05). During a surgeon's first 20 operations, the laparoscopic failure rate rose from 21% (12/57) to 55% (6/11) (P < 0.04) if a second surgeon did not assist. After 20 operations, this difference lost its significance. Intrathoracic herniation of the stomach was found preoperatively in 11 (44%) of 25 operations followed by laparoscopic failure and (8%) 6 of 75 without (P < 0.0002). Laparoscopic failure had no correlation with patient age, sex, ASA classification, duration of symptoms, or referring physician's specialty. The individual learning curve for laparoscopic Nissen fundoplication requires about 20 operations to surmount. Factors leading to laparoscopic failure during the learning curve are the surgeon's inexperience, absence of experienced help, and the presence of intrathoracic herniation.

Adult↗
PubMed1996

Reverse transcriptase-polymerase chain reaction for expression of tyrosinase to identify malignant melanoma cells in peripheral blood.

BACKGROUND: Circulating tumour cells in the peripheral blood may be important for haematogenous spread of disease. The detection of these cells may therefore be a poor prognostic indicator. Reverse-transcriptase polymerase chain reaction (RT-PCR) of target tumour-specific protein expression has been used as a sensitive and specific method for the detection of these tumour cells. Initial reports by our laboratory and other suggested RT-PCR amplification of the enzyme tyrosinase is a useful method for detection of melanoma cells in peripheral blood [1-3]. PATIENTS AND METHODS: In this report, we have evaluated the application of RT-PCR for tyrosinase mRNA as a detection method for melanoma cells in a series of 24 patients with advanced, metastatic malignant melanoma. A single round RT-PCR method is described. RESULTS: The single round RT-PCR was as sensitive as previously described nested PCR methods, and had the advantage of reduced contamination risks. Blood samples from three out of the twenty-four patients were positive. CONCLUSIONS: The frequency of tumour cell detection in peripheral blood from patients with advanced disease was lower than previously reported. It may be only small numbers of circulating tumour cells are present at any one time in the peripheral blood of patients with malignant melanoma. If this is the case increased sampling will improve detection frequency. Alternatively, dissemination of melanoma through peripheral blood may be a rare event. In our experience, RT-PCR for tyrosinase mRNA as a staging test for melanoma patients must be interpreted cautiously.

Adult↗
PubMed1995

Emphysematous pyelonephritis in diabetic patients.

OBJECTIVE: To determine the clinico-pathological profile of patients with emphysematous pyelonephritis (EPN). PATIENTS AND METHODS: The records of 22 diabetic patients who presented with EPN were reviewed. RESULTS: EPN occurred predominantly in female diabetic patients without evidence of ureteric obstruction. The ages of the patients and the duration of the diabetes were variable. EPN occurred in insulin-dependent as well as non-insulin-dependent patients. The patients presented following a prodromal illness of urinary sepsis, with an acute severe illness with symptoms and signs on the affected side. Dehydration and ketoacidosis were common. The diagnosis was made by recognizing gas in the kidney on an X-ray or ultrasound. Eighteen patients were subjected to emergency nephrectomy. CONCLUSIONS: EPN is an uncommon, life-threatening condition characterized by the production of intraparenchymal gas. We believe that vigorous resuscitation and emergency nephrectomy is the treatment of choice.

Adult↗
PubMed1995

Interferon-alpha and survival in renal cell cancer.

OBJECTIVE: To establish whether the use of interferon-alpha might result in improved survival, using two large series of patients with advanced renal cell cancer treated during studies of chemotherapy and biological therapy, respectively. PATIENTS AND METHODS: Patients treated either in the Eastern Cooperative Oncology Group (ECOG) chemotherapy protocols (327 patients) or in protocols employing interferon as part of a European randomized study or phase II studies at the Norwegian Radium Hospital (231 patients) were retrospectively analysed. Groups for comparison were matched by exclusion of those with an ECOG performance status > 2, no prior nephrectomy, brain metastases or prior chemotherapy. Univariate analysis of prognostic factors for survival was performed by the log rank method and multivariate analysis by Cox regression. RESULTS: Univariate analysis of the whole population showed that performance status, time from diagnosis to treatment, sites of metastases and the use of interferon carried the greatest prognostic significance. In multivariate analysis, the use of interferon remained a significant predictor of survival (P < 0.001). Subgroup analysis suggested that the impact of interferon treatment was greatest in those patients with two of the following characteristics: good performance status, an interval of > 2 years from diagnosis to treatment and no more than one site of metastasis. CONCLUSION: Although a prospective randomized trial is needed to establish definite benefit from the use of interferon in advanced renal cell cancer, this analysis supports the rationale for performing such a trial, particularly in patients with relatively good prognostic features. Patients should be entered into the Medical Research Council study comparing interferon with medroxyprogesterone acetate.

Adult↗
PubMed1995

Royal Marsden phase III trial of fluorouracil with or without interferon alfa-2b in advanced colorectal cancer.

PURPOSE: Phase II studies have shown that the combination of interferon alfa-2b (IFN) and fluorouracil (5-FU) is active in patients with metastatic colon cancer. This study was designed to investigate whether treatment with the combination of IFN and 5-FU could improve the response rate, duration of response, or survival compared with treatment with 5-FU alone. PATIENTS AND METHODS: Patients with histologically confirmed advanced colorectal cancer were randomized to receive 5-FU 750 mg/m2/d by continuous infusion for 5 consecutive days followed by weekly bolus 5-FU 750 mg/m2 either with or without IFN 10 MU subcutaneously three times weekly. Treatment was continued until disease progression or unacceptable toxicity for up to 12 months. RESULTS: Radiologic response was observed in 26 of 106 assessable patients (25%): 10 of 52 (19%) in the group that received 5-FU plus IFN (all partial responses [PRs]) and 16 of 54 (30%) in the 5-FU-alone group (three complete responses [CRs] and 13 PRs) (P = .21). There was similarly no significant difference between the two groups in progression-free survival (median, 3 months), 1-year survival, or overall survival (median, 8 months). However, patients who received IFN did experience significantly more toxicity in the form of leukopenia (P = .013), lymphopenia (P = .01), depression (P = .014), and alopecia (P = .002), and were significantly more likely to be withdrawn due to adverse events (P = .003). There were four toxic deaths, all of which occurred in patients who had received IFN. CONCLUSION: At the doses and schedules used in this study, IFN affords no benefit to 5-FU in terms of response and survival and significantly increases toxicity for patients with advanced colorectal cancer.

Adult↗
PubMed1989

Diagnosis of acute myocardial infarction from sequential enzyme measurements obtained within 12 hours of admission to hospital.

A prospective study was made of sequential changes in serum creatine kinase (CK) and CK-MB isoenzyme activity within the 12 hours following admission to the coronary care unit on 65 patients with recent chest pain. CK determinations were performed in the laboratory or in the coronary care unit using a dry reagent strip analyser. Slope values for log CK/hour and log CK-MB/hour were calculated, used to confirm or exclude the diagnosis of myocardial infarction, and compared with diagnosis by conventional means. Compared with retrospective diagnosis using all available information, the CK slope had a sensitivity of 100% and a specificity of 94%. This compared with a sensitivity of 94% and specificity of 90% for diagnosis using upper reference limits alone. Determination of CK slope permits very rapid and accurate biochemical confirmation or exclusion of myocardial infarction and the possibility of performing the measurements on the coronary care unit. It additionally offers the prospect of major cost savings resulting from early discharge or transfer from the coronary care unit.

Adult↗
PubMed1989

Economies of scale in home care.

Home care (HC) demonstration projects have assessed the results of an existing decentralized system rather than evaluate the consequences of changing the system. This paper examines the potential for improving HC cost performance through economies of scale and how these economies can be introduced into HC operations with expansion and consolidation of the market. Theoretical, empirical and policy issues discussed include: (a) specification of the elements of structural redesign of HC service programs focusing on the creation of joint services; (b) a critique of the current method of estimating the size of the market for long term care; (c) empirical measures of uneven HC market size and density with implications for the opportunity to apply economies of scale; (d) the major institutional obstacles to creating the requisite coordination for joint HC services and policy recommendations to overcome these obstacles; (e) housing settings for joint services; (f) HC practices embodying economies of scale in Sweden. Joint services are especially applicable in older northern cities with a high density and a large number of elderly persons. This delivery mode provides a cost savings logic for expanding and consolidating home care services.

Cost Control↗
PubMed1988

Videotaped materials in a school-based smoking prevention program.

The theory used to frame school-based tobacco use prevention programs is general, and such programs are difficult to replicate. This article seeks to offer a model for prevention videotape production, which other researchers can replicate and improve, and to present an analysis of potential merits and drawbacks of such production. To accomplish these goals, this article presents a detailed description of a school-based prevention program and the videotaped materials used in its curriculum. The theoretical and empirical bases for the project are delineated, and the study design is summarized. A detailed outline of the multi-grade curriculum program is presented, including the rationale behind critical program features, a description of specific curriculum strands, and the way in which videotaped materials fit into each strand. The rationale for using videotaped materials within the theoretical framework is discussed. Each videotape is briefly described. An account of video production, a process extending over 4 years, is set forth, including the student feedback data that helped to shape the production process, formatting, script decisions, casting, location, and the actual filming procedure.

Adolescent↗
PubMed1982

[The use of jugular veins as carotid artery substitutes in dogs: a comparison between cryopreservation techniques and the tanning process of vein preservation (author's transl)].

Improved surgical techniques and an aging population have allowed surgeons the opportunity to implant vascular prostheses in patients where the run-off bed is somewhat compromised. We have considered the possibility of homograft venous preservation either by tanning or cryopreservation and now report our preliminary experience in the canine model jugular veins of large mongrel dogs were excised and treated in one of two manners. These veins were preserved for either seven or thirty days and inserted as functional segments in the carotid vessels: each dog received a tanned vein on one side and one which has been cryopreserved on the other side, as either an autograft or allograft. After three months the twenty one dogs were sacrified and the grafts recovered and examined for patency and histology. There appeared to be no difference in patency between the autograft and the allograft groups but there were striking differences in patency between the tanned grafts (8/21) and the cryopreserved grafts (19/21). Tanned grafts showed a fibrous hyperplasia at the anastomotic suture line that seemed to be the causative factor for graft thrombosis. Cryopreserved grafts showed sclerotic degeneration in the midportion of the graft: it was found to be more pronounced in the 30 day preservation specimens. The relatively good results, regarding patency, in the cryopreserved group has sparked our interest to investigate further into this process.

Animals↗
PubMed1980

Evaluating a voluntary second surgical opinion program.

Numerous problem areas were encountered in the evaluation of a voluntary second surgical opinion program. Some problems could be handled only on a conceptual level, while others require for their solution the integration of existing with new data sets. (1) Reliance on program participants to provide medical data was sensitivity tested and found to have minimal impact. (2) Program impact on hospital bed reduction was considered in the context of the total market and political environment in the region, and the anticipated duration of the program. A reasonable judgment was that almost the entire fixed component in the per diem cost of anticipated patient days foregone could be written off as part of the cost savings of the program. (3) As hospital reporting systems identify only average per diem costs, a methodology was developed to separate surgical from nonsurgical case costs. (4) Quality of care evaluation will incorporate a substratum of cases for which there exists a control group within the program user population. Outcome measures obtainable through survey interviews were identified.

Evaluation Studies as Topic↗