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Biomedical subjects

J Oldhoff

Publications and source records attributed to J Oldhoff.

At least 73 records · Page 4Linked to original sources
PubMed1986

[Management of the presacral space following colorectal surgery of malignant tumors. Results of 50 consecutive operations].

Septic complications often arise in the presacral space after low anterior resections, abdominoperineal resections and extended Hartmann procedures for a malignant process. In the framework of a prospective study the authors investigated the impact of leaving the pelvic peritoneum open and the use of a presacral irrigation suction system during 24 hours. This article reports about the experience with 50 consecutive patients. Wound infections occurred in 2 patients (4%). The average postoperative hospital stay was 15 days. It appears from this study that the use of an irrigation suction system in the presacral space contributes to avoid septic complications and shortens the hospital stay.

Aged↗
PubMed1985

Viability of tumor cells in the irrigation fluid of the Cavitron Ultrasonic Surgical Aspirator (CUSA) after tumor fragmentation.

The Cavitron Ultrasonic Surgical Aspirator (CUSA) (Cooper Medical, Stamford, CT) is a relatively new surgical modality. The risk of tumor seeding during tumor surgery has not been studied until now. Hanks balanced salt solution, normal saline, distilled water, and Dakin's solution were used as irrigation fluids during CUSA fragmentation of Lewis lung carcinoma in C57B1/10 female mice, using the machine at 40% of its maximal output. All four irrigation fluids contained viable tumor cells--growing in vitro as well as in vivo--after tumor aspiration. Normal saline was also used when the machine was operating at its maximal output. Under these conditions, the irrigation fluid contained viable tumor cells as well.

Animals↗
PubMed1985

Treatment of malignant fibrous histiocytoma of bone. A plea for primary chemotherapy.

Seven patients have been treated for malignant fibrous histiocytoma (MFH) of bone since the end of 1977. One patient received no chemotherapy, and one did not complete attempted chemotherapy. Both died, 7 and 51 months after diagnosis, respectively. The remaining five patients completed chemotherapy. Two first underwent a primary amputation, whereas the other three received primary chemotherapy with histologic evaluation of the effect. These patients showed a complete remission. The five patients who completed chemotherapy are all still alive, without indications of metastases or local recurrence. Although the number of cases is small, a 25- to 58-months (mean, 45) survival, in five patients treated either with chemotherapy alone or chemotherapy and surgery, is surprisingly good in view of previous experience with this tumor. In some of these patients, the authors were able to document an absence of any viable tumor following chemotherapy.

Adolescent↗
PubMed1985

Improved tissue perfusion during pressure regulated hyperthermic regional isolated perfusion. A clinical study.

In previous studies on isolated hindlimb perfusions in dogs, the authors proved that the extracorporeal circuit should be regulated at a delta pressure (systemic mean arterial pressure minus hindlimb mean arterial pressure) of not more than 15 mmHg, to achieve adequate tissue perfusion. To confirm this in patients the authors performed clinical perfusions, divided into three groups. In group I and II the extracorporeal circuit was regulated at a delta pressure of 15 mmHg and 50 mmHg, respectively. In group III perfusions were performed using the common technique of a predetermined fixed flow. Tissue oxygenation, determined by means of a transcutaneous pO2 electrode, was adequate in group I and was severely impaired in group II and III. Although in group I high perfusion flows were needed, leakage was less than 10%. To achieve adequate tissue perfusion during clinical regional perfusions, the extracorporeal circuit must be regulated at a delta pressure of 15 mmHg.

Adult↗
PubMed1985

Dosimetry of cytostatics in hyperthermic regional isolated perfusion.

During the period from February to October 1983, 21 patients with malignant melanoma of the extremities were treated by hyperthermic regional isolated perfusion with L-phenylalanine mustard (melphalan). The melphalan dose for each patient was determined by the tissue volume of the perfused region, using a dose of 10 mg/l perfused tissue. Despite an average increase of melphalan dosage of 18% above the maximum for iliac perfusions recommended in the literature, no increase in toxic tissue reactions was observed after hyperthermic iliac perfusions. The same dose of 10 mg/l perfused tissue was used in hyperthermic axillary perfusions, resulting in an average decrease of melphalan dosage of 14% below the minimum recommended in the literature. By applying a constant dose per unit tissue volume, a standardization of treatment is achieved. This excludes variations like body weight, age, type of complexion, and hair color, which so far have determined dosimetry.

Chemotherapy, Cancer, Regional Perfusion↗
PubMed1985

Palliative and curative electrocoagulation for rectal cancer. Experience and results.

The 18-year experience with electrocoagulation of rectal cancer in 51 patients is reported. The "boiling" technique used in this study is described. Electrocoagulation for palliative purpose was carried out in 18 patients. One patient is alive without evidence of disease after 4 years. The remaining 17 patients died within 2 years. Electrocoagulation for cure was performed in 33 patients. In two patients abdominoperineal resection was needed for residual tumor. All cases were strictly followed, and none of the patients died of cancer. Recurrent tumor was never seen, and the crude 5-year survival was 71%. The authors describe the criteria for selection any patient should meet in order to be eligible for electrocoagulation with curative purpose and advocate caution in making the choice between radical and local surgery.

Adult↗
PubMed1985

Biopsy of bone tumours.

Bone biopsy is not only the most important step in the diagnosis of bone tumours, but since the introduction of chemotherapy, it has also become essential in the evaluation of treatment of highly malignant bone tumours. A total of 206 bone biopsies were performed on 136 patients seen between January 1, 1978 and August 1, 1982 (99 open and 107 drill biopsies). Complications during or after biopsy were relatively rare, and none were of a serious nature. Pathological fractures at sites of biopsies developed exclusively in patients given chemotherapy. In gaining adequate histologic material, the overall result of open bone biopsies (98%) was superior to that of drill biopsies (70%). The choice between both techniques was dependent on individual patient factors. Of the total of 206 bone biopsies, 10% proved not to be representative. It is concluded that, especially in patients given chemotherapy for a malignant tumour of a long bone, the possibility of a spontaneous fracture after a bone biopsy should be borne in mind.

Adolescent↗
PubMed1985

The treatment of primary tumors of the femur with chemotherapy (if indicated), resection and reconstruction with an endoprosthesis.

The treatment protocol of 15 patients with a primary tumor of the femur, including osteosarcoma, malignant fibrous histiocytoma and chondrosarcoma is presented. All patients had been selected for resection and reconstruction with an endoprosthesis. An endoprosthesis was implanted in 12 patients. The results of this type of treatment appear to be satisfactory. In eight osteosarcoma cases resection and reconstruction with an endoprosthesis combined with preoperative and postoperative chemotherapy, according to Rosen, were performed. Follow-up in all 15 patients, varying from 1.4 to 6.0 years, showed no evidence of disease in 12 patients. Three patients had died. Function of the involved leg was satisfactory in most cases. The advantage and disadvantages of the use of an endoprosthesis are discussed as well as complications in this series of patients.

Adolescent↗
PubMed1985

Fertility and hormonal function in patients with a nonseminomatous tumor of the testis.

Semen quality and serum testosterone, LH, and FSH levels were studied in 54 patients with a unilateral nonseminomatous tumor of the testis--14 before and 40 after orchiectomy. Semen analyses before and after orchiectomy gave essentially no different results: a poor semen quality was found in most men. The additional effect of a recent orchiectomy on semen quality was not demonstrable in the patients described here. Before orchiectomy, increased testosterone levels were found in patients with a beta-hCG-producing tumor. After orchiectomy serum testosterone levels were decreased, and LH and FSH levels increased. With beta-hCG-producing tumors FSH was suppressed after orchiectomy, and testosterone levels did not exceed those in patients with a tumor not producing beta-hCG. The results of semen analysis and of hormonal studies after orchiectomy suggest a dysfunction of the remaining "normal" testis. Diminished spermatogenesis and insufficient testosterone production by the Leydig cells clearly indicate anomalies already present before orchiectomy.

Adult↗
PubMed1985

Isolated hindlimb perfusion in dogs: the effect of perfusion pressures on the oxygen supply (ptO2 histogram) to the skeletal muscle.

During regional isolated perfusion, neoplasms in extremities are treated with high doses of chemotherapeutic drugs by means of an extracorporeal circuit. The question is whether optimal tissue perfusion, which is essential for the therapy, is obtained by regulation of the extracorporeal circuit on an adequate perfusion flow or on an adequate perfusion pressure. To determine which perfusion pressure is needed to maintain adequate tissue perfusion, hindlimbs of six dogs were perfused at perfusion pressures 0, 15, 25, and 50 mm Hg below systemic mean arterial pressure. A multiwire polarographic oxygen electrode placed on the sartorius muscle permitted quantitative evaluation of tissue oxygenation by means of ptO2 histograms. Our results indicated that the perfusion pressure must be equal to or within 15 mm Hg below systemic mean arterial pressure to obtain optimal tissue perfusion. To maintain this perfusion pressure, high perfusion flows of about five to 10 times control femoral flows were needed. At a perfusion pressure 50 mm Hg below systemic mean arterial pressure, perfusion flow was normal, but tissue perfusion was severely impaired.

Animals↗
PubMed1984

Epiphyseal fractures in children treated for osteosarcoma of the femur with chemotherapy, tumourresection, and endoprosthesis: report of four fractures in two children.

This paper reports on two patients, who both were under treatment for osteosarcoma of the femur. Treatment consisted of chemotherapy, resection of the tumour, and reconstruction with an endoprosthesis . Both patients sustained an epiphyseal fracture on two occasions after a minor trauma. Careful observations of the x-rays, including tomography, reveals that a metaphyseal anomaly could be the cause of these fractures. It is suggested that these metaphyseal changes are caused by chemotherapeutic agents. All fractures healed well after a conservative treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Improved tissue perfusion during pressure-regulated hyperthermic regional isolated perfusion in dogs.

To achieve adequate tissue perfusion during regional isolated perfusion, hind limbs of dogs were perfused for 60 min, regulating the extracorporeal circuit on pressure. The dogs were divided into three groups. In groups I and II perfusions were performed at a delta pressure (systemic mean arterial pressure minus hind limb mean arterial pressure) of respectively 50 and 15 mm Hg; in group III delta pressure was also 15 mm Hg but the cytostatic drug Melphalan was added. Tissue perfusion was determined by means of a multiwire polarographic oxygen electrode. Adequate tissue perfusion was obtained only at subnormal perfusion pressures (groups II and III), although in all groups perfusion flow was higher than preoperative flow. At low perfusion pressures (group I), tissue perfusion was severely impaired. In all groups leakage remained less than 10%. During regional isolated perfusion the extracorporeal circuit must be regulated at a delta pressure of 15 mm Hg to achieve adequate tissue perfusion.

Animals↗
PubMed1984

The rubber dam as a means to isolate contaminated peritoneal defects after colonic resection.

After colonic resections, peritoneal defects exposed to colonic flora and blood may become the seat of localized peritonitis and cause small-bowel adhesions and obstruction. In the past five years, we have seen 14 patients where one or both of these complications was anticipated for one of the following reasons: presence of an abscess cavity, local infection or accidental tear of the colon. In these patients a rubber sheet was stitched to the edges of the peritoneal defect with absorbable sutures and brought out through the abdominal wall. In all patients the rubber dam functioned as a passive drain and as a barrier between the peritoneal defect and the small bowel. Three weeks later the rubber dam was removed by traction. None of these patients developed small-bowel obstruction and no adverse effects from the rubber sheet were seen. The working mechanism of the rubber dam was investigated in female Wistar rats. After removing the peritoneum between the left kidney and pelvis, the defect was covered with a rubber dam. A capsule with a standard solution of Escherichia coli, Bacteroides fragilis, and autoclaved feces was used to initiate peritonitis under the rubber dam. The rubber proved to act as an efficient drain and barrier. No abscesses or small-bowel adhesions were seen. In the control group, 75 per cent of the animals died from generalized peritonitis or developed an abscess.

Animals↗
PubMed1984

Thoracotomy as a staging procedure after chemotherapy in the treatment of Stage III nonseminomatous carcinoma of the testis.

Of 108 patients with a nonseminomatous testicular carcinoma, 28 with lung metastases were studied. After combination chemotherapy with cisplatin, vinblastine, and bleomycin (PVB), 11 patients underwent exploratory thoracotomy. Viable carcinomatous tissue, along with fibrosis, necrosis, and mature teratoma, was found in 4 patients. Three of these patients were successfully retreated with VP 16-213, cisplatin, and actinomycin D. In patients with residual pulmonary or mediastinal masses after chemotherapy, resection of the lesions is mandatory to demonstrate viable carcinoma so that treatment can be readministered. Thus, in our view, thoracotomy is a diagnostic procedure.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Indications for elective groin dissection in clinical stage I patients with malignant melanoma of the lower extremity treated by hyperthermic regional perfusion.

From 1973 through 1979, inguinal node biopsy was performed to stage the disease process in 179 clinical Stage I patients with malignant melanoma of the lower extremity, who were all treated by hyperthermic regional perfusion as well. Of the 179 tumors, 12% were intermediate risk (0.75-1.44 mm) and 88% were high risk (greater than or equal to 1.5 mm); all had a Clark level of IV or V. The Rosenmüller node at the caudal margin of the saphenous hiatus was elected for inguinal node biopsy. This biopsy supplies a fair amount of information about the entire inguinal node region: a malignant node was found in 16 patients (9%); no other metastatic nodes were found in 11 (73%) of 15 subsequent therapeutic node dissections; the 16th had metastatic parailiac nodes as well. Two patients of the remaining 163 had only metastatic parailiac nodes, without metastatic inguinal nodes. Of the remaining 161 histologic Stage I patients, 23 (14%) developed inguinal node metastases in the course of the follow-up. In 17 (74%) these metastases occurred within 2 years of perfusion. Ten of the 23 showed simultaneous general metastases. The vast majority of the inguinal node metastases developed in patients with a tumor greater than or equal to 5 mm. The 5-year survival was 81%, i.e. 84% in females versus 69% in males, the difference being significant (P less than 0.01). A tumor thickness greater than or equal to 5 mm implied a significantly less favorable prognosis as to development of inguinal node metastases associated with general metastases than a tumor thickness less than 5 mm. The benefit of the inguinal node biopsy was related to the difference in 5-year survival between the group with inguinal node metastases at perfusion (69%) and the group who developed inguinal node metastases during the follow-up (24%). The difference was great (45%) but statistically not significant. The data seem to warrant the conclusion that, after perfusion therapy, inguinal node biopsy is sufficient to stage the disease process at a tumor thickness less than or equal to 5 mm. Given a tumor thickness less than or equal to 5 mm, elective groin dissection might improve the chance of survival.

Biopsy↗