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Biomedical subjects

J M Sterchi

Publications and source records attributed to J M Sterchi.

31 records · Page 2Linked to original sources
PubMed1984

The risk of improperly staging Hodgkin's disease with partial splenectomy.

Partial splenectomy has been proposed for staging Hodgkin's disease, but the risk of thereby missing limited splenic involvement is unknown. To assess that risk, we reviewed all spleens removed during staging laparotomies for Hodgkin's disease at our institution, assessing splenic weight, the characteristics of all nodules, and grossly visible subcapsular disease. Among 180 spleens, 65 had splenic disease. Fifty-three had six or more nodules; for 49 of those, other abdominal involvement had been present or the disease was so diffuse that staging by partial splenectomy would have been correct. The remaining 12 spleens (18%) contained five or fewer nodules. Eleven had no grossly visible subcapsular nodules, and five of the 11 were associated with no other abdominal involvement. In four of those five, the disease was localized to one area in such a way that it could have been missed by partial splenectomy. All positive spleens averaged 415 g; the four spleens with localized involvement averaged 287 g. Thus, in four of 65 patients, a few splenic nodules in a localized distribution not visible grossly were the only evidence of abdominal Hodgkin's disease, and if partial splenectomy had been done there would have been a 6.2 per cent risk of understaging their Hodgkin's disease.

Hodgkin Disease↗
PubMed1983

Continuous intravenous infusion of vinca alkaloid using a subcutaneously implanted pump in a canine model.

A major drawback of infusions of the vinca alkaloids is the lengthy period of hospitalization which is often required for this novel technique of cancer therapy. A potentially useful system to deliver outpatient therapy has been investigated in a preclinical study. A self-contained infusion pump powered by a self-charging fluorocarbon system has been implanted SC in three dogs. The performance of two pumps which had been factory-calibrated to deliver 2.5 and 4.5 ml/day, respectively, was evaluated during 22 infusions of the vinca alkaloids (vincristine, 7; vinblastine, 7; and vindesine, 8). Infusions were given over a 5- to 7-day period and were repeated at 3-week intervals. No malfunctioning of the pumps occurred in over 500 cumulative days of use. The flow rates of the pumps were quite stable except in one animal whose increased flow rate was probably a consequence of fever due to self-induced inflammation about the pump pocket. No local or distant tissue reactions to the pump were observed. Decomposition of vincristine and vinblastine in the infusate at the end of 5- or 7-day infusions was minimal as determined by high-pressure liquid chromatography. The amount of decomposition of vindesine in the infusate was variable. Steady-state concentrations of vincristine during infusion were always greater than 10(-9) M, and were similar to those previously determined in our clinical infusion trials using a dosage of 0.5 mg/m2/day. Clinical evaluation of this system for prolonged infusions of vincristine and other vinca alkaloids appears to be warranted.

Animals↗
PubMed1983

A method of securing the arterial catheter for hepatic artery infusion.

The infusion of chemotherapeutic agents through the liver is an important part of the non-surgical treatment of metastatic carcinoma of the liver. A stable catheter position is essential to the maintenance of good hepatic infusion. This technique assures that stable position.

Catheterization↗
PubMed1983

Evaluation of technique for autotransplantation of the spleen in dogs.

Preservation of the human spleen is important in the prevention of overwhelming sepsis, particularly in infants and immunosuppressed patients. When that preservation is not possible, due to disease or severe trauma, it has been suggested that autotransplantation of splenic tissue might provide adequate immunological protection. This study looked at the feasibility of autotransplantation via subcutaneous implantation in the dog. This method is important, since controlled intraabdominal splenosis is very difficult to achieve. The adverse effect of splenectomy, as well as the ineffectiveness of autotransplantation was demonstrated in providing demonstrable in vitro evidence of decreased sheep red blood cell immunization, even though the subcutaneous implantation itself was successful. From this study, the authors suspected, but could not prove, that the ineffectiveness of the splenic autotransplants was related to their lack of critical mass for good bacterial clearance from the blood stream and the fact that they did not lie within the main vascular channels, probably a criterion for proper clearance. The role of splenic preservation by autotransplantation needs to be evaluated in the immature host.

Agglutination Tests↗
PubMed1982

Multiple primary carcinomas of the colon and associated extracolonic primary malignant tumors.

A review of 308 cases of colorectal carcinoma showed 12 cases (3.9%) of colorectal multiple primary malignant tumors and 14 cases (4.5%) of colorectal primary malignant tumor associated with extracolonic primary malignant tumor. A total of 60 tumors was involved: 14 each in the sigmoid and transverse colon; eight in the cecum; six in the rectum; one each in the ascending and descending colons; three each in the bladder and prostate; two each in the breast, cervix, and lung; and one each in the skin, nasopharynx, kidney, and endometrium. Three of the four patients with multifocal cancer were found to have in situ cancer, and 12.7% of concomitant adenomas had malignant changes. Seven patients had regional lymph node metastases. Of the six patients with rectocolonic multiple tumors who had adequate follow-up data, survival in three ranged from 19.5 to 60 months; three were alive and well 15 to 51 months after resection. Survival of patients with primary rectocolonic and extracolonic tumors was similar. From these data and the pathologic study of the resected specimens, we recommend for any patient with cancer of the rectocolon that the entire colon be searched for multiple primary malignant tumors, that extracolonic tumors be considered second primary tumors unless proved to be metastases, and that follow-up be long and include frequent rectocolonic examinations for a second primary tumor.

Adenocarcinoma↗
PubMed1980

Staging laparotomy in Hodgkin's disease.

Staging laparotomy (multiple liver and lymph node biopsies and splenectomy) was performed at the North Carolina Baptist Hospital in 123 patients with Hodgkin's disease. There were no deaths. Wound, pulmonary, intra-abdominal or urinary tract complications developed in 17 patients. Of those complications, one case each of pelvic abscess, subphrenic abscess, small bowel obstruction, staphylococcal peritonitis and subphrenic hematoma required a major intra-abdominal operation. The patients were classified on the basis of histopathology; nodular sclerosis--40, mixed cellularity--44, lymphocyte predominant--24, lymphocyte depleted--13, and undetermined--2. The pathological stage following laparotomy was unchanged from the clinical stage in 62%, reduced in 15%, and advanced in 23%. Subsequent therapy, therefore, was altered in 38% of the patients. Lymphangiography, done in 108 patients, showed lymph node involvement in 46 patients and no involvement in 62 patients. Of those lymphangiographic findings, 79% were confirmed histopathologically, 19% were falsely positive, and 1.8% were falsely negative. There were positive findings of Hodgkin's disease in the spleen in 42% of patients. The staging laparotomy continues to be a valuable tool in the staging and treatment of Hodgkin's disease.

Abscess↗
PubMed1979

Screening for colorectal cancer.

A voluntary colorectal screening program was carried out in North Carolina to evaluate the public's willingness to perform a do-it-yourself bowel test, to educate the public on the importance of routine colorectal screening, and to assess the efficacy of a small-scale screening program in detecting colorectal cancer. A screening kit was requested by 1,204 individuals after hearing or reading about the program; 770 kits were returned. Of 29 (3.7%) positive test results, six were negative after retesting. Adequate follow-up was available for 18 of the remaining 23 positive results. Thirteen were due to anal bleeding, diverticulosis, or heavy ingestion of aspirin; five were considered false-positive results, since no evidence of disease could be found. No cases of polypoid tumors or carcinoma were detected. The main value of such a program in an area with a small population base is to increase the awareness of the public of the importance of routine screening for colorectal cancer.

Adult↗
PubMed1977

Agenesis of the gallbladder--an inherited defect?

Agenesis of the gallbladder is a rare anomaly believed to be an organogenetic failure. This is the third instance of familial agenesis of the gallbladder reported in the literature. The diagnosis of agenesis of the gallbladder can only be made during exploratory celiotomy and must be confirmed by an intraoperative needle cholecystogram. This congenital anomaly should be suspected when oral cholecystography shows a nonvisualizing gallbladder in relatives of any patient with proven agenesis of the gallbladder.

Adult↗
PubMed1976

Critical analysis of treatment of stage II and stage III melanoma patients with immunotherapy.

Over the past 8 years, 244 patients with Stage II or III melanoma have been treated by cutaneous injection of a crude acellular homogenate of allogeneic melanoma cells (V-I) or a more concentrated fraction (V-II), followed in most patients by exchanges of WBC between paired partners. Patients with Stage III disease exhibited an overall response rate of 24% and prolongation of survival compared with control data. Stage II patients also had prolonged survival and reduced rate of recurrence over historic peers' data. Breakdown of subgroup data revealed that V-II plus exchange of WBC is similar to V-I plus exchange or V-II alone. However, recent experience of LTF suggests a higher response rate than in either V-I or V-II groups, particularly when autochthonous tumor is used for cross-immunization. The most meaningful immunologic data resulted from analysis of DNCB and MIF data. Patients negative to DNCB rarely respond to immunotherapy. A positive pretreatment MIF or positive conversion following treatment correlates with response, whereas, conversion of positive to negative predicts poor clinical performance.

Antigens, Neoplasm↗