Biomedical subjects
Publications and source records attributed to M Walter.
In most cases of metastatic gastric cancer, treatment with cytostatic drugs seems to be justified. Responsiveness to chemotherapy, according to the MAF-schedule (Methotrexate, Adriamycin, 5-Fluorouracil) was reported to be successful in 50% of this cancer type.
Malnutrition must be considered as a factor of risk in surgery and therefore it has to be taken into account in surgical planning. Many authors aggregated several measurements into an index or another mathematical model by stepwise regression or discriminant analysis. Hitherto none of these approaches has been subjected to a critical analysis designed to determine whether the information gained differentiates patients with increased operative risk from those without, to a degree that is clinically relevant. In a prospective study the predictive values of nutritional assessment techniques of various authors were examined in 246 surgical patients undergoing a major surgical procedure. The specificity, sensitivity, and validity of each assessment technique were determined. The statistical analysis showed that none of the assessment techniques separated patients who were at high risk from those who were at low risk in a statistically significant predictive power. Serum albumin level was a quite accurate prognostic indicator of postoperative morbidity and mortality. The mean complication rate in this study was 26.8%. Concerning the specificity, sensitivity, and validity the single measurement of the serum albumin had a predictive value as high as all other determined assessment techniques in this study. We contend that combining measurements into a statistically derived index is time-consuming and expensive and does not produce an assessment technique with sufficient predictive power to identity high risk patients in a clinically relevant fashion.
Report on a patient with a complication of anticoagulant treatment, in whom intramural colon wall bleeding was diagnosed and followed up by ultrasonography.
Single amino acid changes were introduced into normal (non-oncogenic) and activated forms of the human H-ras protein at a position (residue 116) proposed on structural grounds to represent a contact site with guanine nucleotides. Substitutions at this site could significantly reduce the ability of both forms to bind and hydrolyze guanosine 5'-triphosphate; these substitutions, however, did not necessarily diminish the transforming capacity of activated derivatives. One substitution that severely impairs these functions activated the transforming potential of the otherwise normal polypeptide.
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Malnutrition can effect negatively the results of major cancer surgery. Adequate preoperative nutritional therapy helps to overcome the catabolic situation of malnourished cancer patients and leads to a reduction of postoperative morbidity and mortality. The beneficial effect of nutritional therapy after major cancer surgery is generally accepted, despite there is a lack of comparative clinical trials which could support this opinion. Forced feeding stimulated tumor growth in certain animal models. These findings seem to have not any clinical relevance in cancer surgery.
In the choice of a Class I intravenous antiarhythmic medication for the treatment of threatening ventricular extrasystoles, one must take into account the speed of action of the product, its effects on hemodynamics and conduction as well as its efficacy. The rapidity of action implies the ability to reach, without delay, a therapeutic plasma level which will depend upon the distribution volume and the dose injected. An effective plasma level may be quickly reached following the intravenous administration of lidocain, disopyramide, lorcainide, tocainide and flecainide. All antiarhythmic medications have an unfavorable effect on hemodynamics; xylocain and ajmaline seem to depress the least the left ventricular function, followed by lorcainide. Unfavorable effects on the atrio-ventricular conduction are observed with substances of type IC; the duration of QRS may be affected as well by antiarhythmic medications IA and IC, with a lengthening of QT being mostly noted type IA medications. Comparison of the efficacy of antiarhythmic medications requires a strict methodology and the current data from the literature do not permit to assert with certainty the superiority of one antiarhythmic medication over the others.
72 patients with gastro-intestinal carcinomas were involved in a retrospective study in which 97 metabolic parameters were pre-operatively determined from each of them and subsequently tested by stepwise discriminant analysis for their bearings on clinical mortality. A discriminant function of seven parameters was obtained and can be used as a prognostic nutritional index for successful subdivision of patients into differentiated risk groups. Two prospective control studies were conducted into 605 patients consecutively operated on for benign and malignant diseases for the purpose of testing the nutritional index for its prognostic information potential. The discriminant function proved to be applicable to differentiation between patients with high, moderate, and low surgical risk. Findings were unambiguous. The nutritional index can thus be used as an aid for decision-making in cases in which alternatives exist between several surgical approaches. The importance of malnutrition as a possible causative factor of complications is likely to grow along with the invasiveness of the intervention.
A model for parenteral nutrition of unrestrained rats is described. Apparatus and nutrient solutions are very simple, inexpensive, and commonly available. The major survival time is at least 6-8 weeks. During the parenteral nutrition the rats gain weight and are in a excellent general health. The cumulative nitrogen balance is highly positive with a retention of 95%.
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20 male adult Sprague-Dawley rats were fed exclusively parenterally. After achieving metabolic equilibrium they received a duodenoileostomy and subtotal resection leaving only 8-10% of the small gut. On the 1st pop. day the urinary 3-MH excretion rose to 1.5-1.7 of the preoperative level, but on the 12th-14th pop. day it fell again and was equal to the preoperative basal level. A control group of 10 rats undergoing a small gut anastomosis without resection yielded similar results. We conclude that the small gut source does not make a significant contribution to 24 h-urinary 3-MH excretion in the adult rat. The transient postoperative increase in urinary 3-MH excretion is probably due to post-injury metabolism.
During a 8-year period, recurrent swelling of the right knee-joint was observed in a 31-year-old female. Although only minimal pain was present, flexion of the knee-joint was severely limited. Bearing in mind the extent of the swelling, the initial diagnostic procedures were suggestive of a malignant neoplasm. Biopsy of the knee-joint led however to the diagnosis of a pigmented villo-nodular synovitis. The postoperative course after synovectomy of the knee-joint was uneventful. Although benign, this lesion has to be followed-up closely, due to the recurrence-rate of 33%.