Search PubMed⌕ Search

Biomedical subjects

M Deutsch

Publications and source records attributed to M Deutsch.

At least 217 records · Page 12Linked to original sources
PubMed1987

Metastatic brain tumor following negative second-look operation for ovarian carcinoma.

Three patients with stage III ovarian cancer had brain metastases following aggressive chemotherapy with Platinol and Adriamycin, and negative second-look surgery. The possibility of brain metastasis following complete control of intraperitoneal ovarian disease should be considered in patients with neurological symptoms.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Results of therapy in stage IV-S neuroblastoma with massive hepatomegaly.

To document the incidence and severity of symptomatic hepatomegaly in patients with Stage IV-S neuroblastoma, we reviewed the charts of children with neuroblastoma seen at Children's Hospital of Pittsburgh between 1951 and 1985. Sixteen met the criteria for IV-S disease, and 11 of these (69%) had massive hepatomegaly. Five children had symptoms referable to their liver size including respiratory distress, gastroesophageal reflux, or decreased urine output. Liver function appeared to be normal or only mildly abnormal in the 9 patients where data were available. Because therapy was so variable, it was not possible to correlate treatment regimen with outcome. However, 3 symptomatic patients who received less than or equal to 600 rad without chemotherapy had prompt subjective responses. Follow-up was available on 10 children 6 months-18 years (median 18 years) from diagnosis. Eight were alive with resolved or resolving hepatomegaly. High dose (greater than or equal to 3,300 rad) radiation-related side effects included multiple rib chondromas, chest- and pelvic-wall hypoplasia in one patient, and radiation nephritis with hepatic fibrosis resulting in death of a second patient. Our results support prior recommendations that for symptomatic hepatomegaly, low doses of radiation be considered.

Adrenal Gland Neoplasms↗
PubMed1987

In vitro lining of fibronectin coated PTFE grafts with cryopreserved saphenous vein endothelial cells.

In an attempt to produce instant endothelial cell (EC) monolayers on graft surfaces, cryopreserved cultivated human saphenous vein endothelial cells (HSVEC) were cultivated on reinforced PTFE prostheses. The graft surface was precoated with 40 micrograms/ml human fibronectin (HFN) prior to seeding with 200 x 10(3) EC/cm2. The seeding procedure was performed in a specially designed rotation device. After a cultivation period of 9 days, the seeded endothelial cells on the PTFE prostheses were exposed to shear stresses in a perfusion circuit, containing a bubble oxygenator, a roller pump and a tygon perfusion loop. The applied shear forces were 3 and 6 dyn/cm2, respectively. In control grafts, spontaneous cell detachment occurred from day 11 onwards and only 50% of the graft surface remained endothelialized on day 16. When the grafts were exposed to 3 dyn/cm2 only small cell-free areas less than 1000 micron in diameter were found after 4 hours of perfusion. In contrast, exposure to 6 dyn/cm2 produced discouraging results: as early as 4 hours after the onset of perfusion 50% of the graft surface was cell free. After 16 hours only 20% endothelial cell coverage was seen under the stereo microscope. However, assuming that an ideal precoating substratum can be found, the two stage technique of in vitro endothelialization of vascular grafts with autologous endothelial cells may offer a promising clinical method. Moreover, the fact that our grafts were lined with cryopreserved EC implies the possible prospect of cell banks supplying unlimited numbers of EC for subsequent bypass operations.

Blood Vessel Prosthesis↗
PubMed1987

Endothelial cell seeding of polytetrafluoroethylene vascular grafts in humans: a preliminary report.

The importance of initial human trials with autologous endothelial seeding lies not only in the implementation of a promising idea but also in the fact that canine data are only partially applicable to humans. The surface area of jugular veins in humans is much smaller than in dogs and considerably longer grafts are needed. Moreover, the reproductive capacity of adult human endothelial cells under in vivo conditions, which probably determines the success of seeding more than the seeding density, is also uncertain. Therefore the efficiency of autologous endothelial seeding in humans was investigated in 18 patients undergoing distal femoropopliteal bypass surgery. The average surface area of the jugular veins was 4.9 +/- 1.7 cm2 with an average cell yield of 32.6 +/- 18.0 x 10(4). The mean number of seeded cells per square centimeter of graft surface was 3.1 x 10(3). In a follow-up extending for 14 weeks, plasma levels of platelet factor 4 and beta-thromboglobulin as well as the platelet function in the whole blood aggregometer showed significantly better results in the seeded group. Plasma thromboxane B2, uptake and survival of indium 111-labeled platelets, and Doppler ultrasound investigations also favored the seeded group, but the results were statistically insignificant. No difference at all was found for the platelet dense granule compounds, releasable adenosine triphosphate and platelet serotonin. Thus our findings did not indicate the development of a closed endothelialized surface after 14 weeks, which is a period three times as long as the one required for confluent endothelial cell coverage in dogs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Scanning electron microscopy of circulating platelets reveals new aspects of platelet alteration during cardiopulmonary bypass operations.

Seventeen male patients undergoing cardiopulmonary bypass (CPBP) surgery for aorto-coronary bypass grafting were investigated by scanning electron microscopy (SEM) for alterations of the surface morphology of circulating platelets. An initial decline in the percentage of unactivated smooth discocytes (SD) to 87 +/- 12% was found after thoracotomy. Three minutes after the onset of CPBP, the percentage of SD had dropped drastically to 59 +/- 13%, and by the 8th minute of CPBP it had dropped to its lowest point (49 +/- 19%). On the other hand, the percentage of shape-changed platelets (SC) increased to 17 +/- 9% after 3 minutes, and the percentage of pseudopod discocytes (PD) to 25 +/- 13% after 8 minutes. Surprisingly, a remarkable recovery of platelet morphology could be observed after even 15 minutes of CPBP, and by the end of bypass 78 +/- 15% of the circulating platelets had regained the smooth discoid (SD) appearance of unactivated platelets. We conclude that this recovery of platelet morphology is due to an increasing insensitivity of the platelets to activating stimuli during the course of CPBP. Our study provides evidence that the only major platelet activation occurs during the first minutes of CPBP, and that CPBP-caused platelet activation is much less pronounced than generally believed.

Journal Article↗
PubMed1987

Endothelialization of artificial surfaces: does surface tension determine in vitro growth of human saphenous vein endothelial cells?

To evaluate the possibility of providing, in vitro, an endothelial lining for artificial hearts, we cultivated adult autologous endothelial cells on two polyurethane and two silicone rubber surfaces. Over the ensuing 11-day period, we investigated the resulting cell proliferation and morphology by means of scanning electron and light microscopy. On the silicone rubber surfaces, seeding of 200,000 human saphenous vein endothelial cells per cm(2) produced an ideal cobblestone monolayer within a single day. In contrast, the polyurethane surfaces displayed an uneven, patchy distribution of endothelial cells. Scanning electron microscopy revealed microvilli and marginal overlapping in both groups. After the first day, the cell count on the polyurethane surfaces increased, whereas the count on the silicone rubber surfaces decreased. Morphologic investigations revealed that the ideally shaped cells initially on the silicone rubber had begun to overspread and subsequently to become detached, leaving denuded spheroid areas. Moreover, cultivation for 11 days on the polyurethane surfaces resulted in an unevenness of cell distribution that far exceeded the unevenness seen on the first day. Thus, despite the fact that materials with a high surface tension (such as silicone rubbers) seem to be ideal for initial cell spreading, subsequent cultivation results in cell detachment and death. On materials with a lower surface tension (such as polyurethanes), the less differentiated monolayers do at least proliferate, although their morphology remains unsatisfactory. Even if adult human endothelial cells should prove shear-stress-resistant, a minimum of 6 to 8 weeks would be required to establish autologous endothelial cell monolayers on the inner surface. Therefore, the endothelialization of artificial hearts is not possible when such hearts are used for urgent "bridging" before cardiac transplantation.

Journal Article↗
PubMed1987

Phase II study of carboplatin in previously untreated patients with metastatic small cell lung carcinoma.

Fourteen previously untreated patients with metastatic small cell lung carcinoma (SCLC) were treated with carboplatin, 400 mg/m2, given as a 1-hour infusion every 28 days. Eleven patients had a partial response to therapy [response rate, 79% (95% confidence limits, 57%-100%)]. The median duration of response was 8 weeks (range, 4-41) and the median survival was 29 weeks (range, 11-68+). Hematologic toxicity was limited to one patient who developed World Health Organization (WHO) grade IV thrombocytopenia; no patient developed infection due to granulocytopenia. Nonhematologic toxicity was limited to WHO grade I and II nausea and vomiting. This study demonstrates that carboplatin is a highly active drug in SCLC with minimal toxicity. Future studies should evaluate its use in combination with other chemotherapeutic drugs in SCLC.

Adult↗
PubMed1986

[Diagnosis and therapy of supravalvular aortic dissection (type A)--an interdisciplinary challenge].

Acute dissection of the ascending aorta is a life-threatening disease. Successful management requires close teamwork of internal medical specialist, radiologist and cardiovascular surgeon. The diagnostic and therapeutic approach is reviewed on the basis of 18 of our own cases - 15 men and 3 women aged from 42 to 88 years. Peculiarities of history, pain and ECG give valuable clues to the differentiation of aortic dissection from myocardial infarction and massive pulmonary embolism. As a non-invasive rapidly available diagnostic method echocardiography may yield decisive information about the aortic root and the presence of pericardial effusion. Definite confirmation of diagnosis is accomplished by aortography and/or computed tomography. Blood pressure and aortic flow must be decreased to the lowest level tolerated by the patient to prevent pericardial tamponade or rupture into the mediastinum. The urgency of surgical repair is underlined by a median survival time of 12 hours from onset of symptoms to death with conservative treatment. 7 of our patients were operated on. In 6 cases surgery was performed by means of extracorporeal circulation and the ascending aorta was replaced by a graft. 3 patients survived the operation (2 for over 2 years and three died in the postoperative period due to cerebral and pulmonary complications). In one case with inoperable dissection an axillo-femoral bypass was performed for relief of complete ischaemia of the left lower limb. Postoperatively, maintainance of the patient's blood pressure at the low normal level ist mandatory.

Adult↗
PubMed1986

Neurofibromatosis and childhood tumors.

Although tumors are a known complication of von Recklinghausen's neurofibromatosis (NF), they often develop after the second decade and their characteristics in the pediatric population are unclear. To define the frequency and distribution of tumor types in children with NF, the authors reviewed the experience at Children's Hospital of Pittsburgh between 1953 and 1984. During that time, 121 children younger than 18 years with documented NF were seen. Three patients (2.5%) developed locally extensive, unresectable sarcomas, two of which were clearly neural in origin. Two other children died from complications of highly cellular but not histologically malignant neurofibromas. Seventeen patients (14%) had brain tumors, of which 3 (2.5%) were malignant astrocytomas and 9 were optic gliomas. Two children had acute myelogenous leukemia. Although it has been said that patients with NF are particularly susceptible to the oncogenic effects of radiation, 12 children were treated with a median of 5000 rad to their tumor bed. Follow-up after radiation in that small cohort of patients ranged from 6 months to 12 years (mean, 6 years). Eleven of 12 patients experienced adequate local control. During the follow-up period, none developed a second tumor outside or within the radiation port that could be related to radiation. The authors conclude that clinically significant tumors in children with NF, not all of which are histologically malignant, are not rare. Although more prospective information is needed on response to and sequelae from therapy, the data in this report suggest no contraindication to aggressive therapy.

Adolescent↗
PubMed1986

Radiation-induced accelerated coronary arteriosclerosis.

There is a paucity of information on radiation-induced coronary heart disease. A young patient with myocardial infarction following mediastinal irradiation is described. The role of radiotherapy and chemotherapy on the subsequent development of coronary heart disease is discussed.

Adult↗