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Biomedical subjects

R A Malt

Publications and source records attributed to R A Malt.

At least 19 recordsLinked to original sources
PubMed1992

Survival after hepatic resection for malignant tumours.

A retrospective analysis of 194 patients who underwent hepatic resection for primary or metastatic malignant disease from January 1962 to December 1988 was undertaken to determine variables that might aid the selection of patients for hepatic resection. Hepatic metastases were the indication for resection in 126 patients. The 5-year survival rate was 17 per cent. For patients with resected metastases from colorectal cancer (n = 104), the survival rate at 5 years was 18 per cent. The 5-year survival rate was 27 per cent when the resection margin was > 5 mm compared with 9 per cent when the margin was < or = 5 mm (P < 0.01). No patient with extrahepatic invasion, lymphatic spread, involvement of the resection margin or gross residual disease survived to 5 years, compared with a 23 per cent 5-year survival rate for patients undergoing curative resection (P < 0.02). The survival rate of patients with poorly differentiated primary tumours was nil at 3 years compared with a 20 per cent 5-year survival rate for patients with well or moderately differentiated tumours (P not significant). The site and Dukes' classification of the primary tumour, the sex and preoperative carcinoembryonic antigen level of the patient, and the number and size of hepatic metastases did not affect the prognosis. The 5-year survival rate for patients with hepatocellular carcinoma (n = 42) was 25 per cent. An improved survival rate was found for patients whose alpha-fetoprotein level was normal (37 per cent at 5 years) compared with those having a raised level (nil at 3 years) (P < 0.01). Involvement of the resection margin, extrahepatic spread and spread to regional lymph nodes were associated with an 8 per cent 5-year survival rate versus 44 per cent for curative resection (P < 0.005). The presence of cirrhosis, the presence of symptoms, and the multiplicity and size of the tumour did not affect the prognosis. The 5-year survival rate of 11 patients with hepatic sarcoma was 25 per cent. No patient with peripheral cholangiocarcinoma survived to 1 year in contrast to patients with hilar cholangiocarcinoma, all four of whom survived for more than 14 months.

Adenoma, Bile Duct↗
PubMed1979

Obstructing phytobezoar of an intrahepatic bile duct.

Drainage of a choledochal cyst with a cystogastrostomy allowed food to reflux into the liver, where it obstructed a major right hepatic duct and produced recurrent cholangitis. Partial hepatectomy was necessary for relief. Drainage of choledochal cysts with a long Roux-en-Y loop seems advisable.

Adult↗
PubMed1979

Noncoordinate regulation of cytoplasmic RNA in compensatory renal hypertrophy.

To examine the regulatory role of mRNA in compensatory renal hypertrophy, the accumulation and decay of [3H]orotic acid in poly(A)-containing mRNA in mouse kidney was analyzed after unilateral nephrectomy during the period of maximal rRNA accretion. The distribution of radioactivity between newly synthesized poly(A)-containing and poly(A)-lacing polysomal RNA was altered, but no differences in mRNA half-life were observed in growth compared with effects of sham nephrectomy. Radioactivity in polysomal polyadenylated RNA was diminished by approximately 25% during growth where mice were labeled after nephrectomy, but if mice were labeled 18 h before operation, no difference was noted. Thus, accumulation of newly synthesized poly(A)-containing mRNA relative to RNAs that lack poly(A) is changed early in the course of renal hypertrophy. This noncoordinate regulation may represent a control mechanism effective early in induced cell growth involving mRNAs that lack poly(A).

Animals↗
PubMed1979

Tests and management affecting survival after portacaval and spenorenal shunts.

New data were derived from records of 115 patients undergoing portacaval or spenorenal shunts from 1966 to 1973. The last serum bilirubin level determined before a shunt was the best predictor of operative mortality. The strongest predictor of long term survival was the first serum albumin level measured after admission. Operative mortality was strongly correlated with intraoperative clotting disorders; however, the prothrombin time and the partial thromboplastin time predicated long term survival. Clinical assessment added unique information to conclusion derived from laboratory tests. Results of operation were independent of the skill and experience of the surgeon, except that the best risk patients perhaps may have done better when operated upon by the most experienced surgeons. Once a patient has stabilized after a bleeding episode, he might as well be operated upon at the same admission rather than be discharged to be operated upon at a later arbitrary time.

Ascites↗
PubMed1979

Enhanced colonic carcinogenesis with azoxymethane in rats after pancreaticobiliary diversion to mid small bowel.

Since biliary excretion of metabolites might determine the pattern of intestinal neoplasms induced by azoxymethane, the number and distribution of tumors were studied in rats after pancreaticobiliary diversion to the mid small bowel. Pancreaticobiliary diversion was performed either immediately before the first of 16 weekly injections of azoxymethane or 10 days after the last. Seven months after pancreaticobiliary diversion, persistent ileal hyperplasia was manifested by higher levels of mucosal RNA and DNA compared with controls (34--102%: P less than 0.001), while there was little residual adaptation in the colon. Qualitative and quantitative analysis of fecal bile acids 6--26 wk after pancreaticobiliary diversion showed few differences. Pancreaticobiliary diversion doubled the incidence of colonic tumors, whether operation preceded (P less than 0.005) or followed (P less than 0.02) the course of azoxymethane. Suture-line tumors were common in the small bowel, particularly in the transposed duodenal stump. Despite intense ileal hyperplasia as a consequence of pancreaticobiliary diversion, the ileum remained resistant to chemical carcinogenesis. The potentiation of colonic neoplasms by pancreaticobiliary diversion probably depends on the stimulation of colonic mucosal proliferation.

Adenocarcinoma↗
PubMed1979

Ileal resection potentiates 1,2-dimethylhydrazine-induced colonic carcinogenesis.

The effect of colonic hyperplasia produced by resection of the distal third of the small bowel (DSBR) on the development of chemical carcinogenesis of the colon by dimethylhydrazine (DMH) was tested in rats. For the most part the amounts of RNA and DNA in the small bowel were the same with the combined treatments as with either one alone; quantities of nucleic acids tended to increase only in transverse and distal colon. After 37 weeks the number of neoplasms per rat was increased six-fold by combining DSBR with DMH. Neoplasms were spread throughout the colon after combined treatment as opposed to the ascending colong after DMH alone. Postresectional hyperplasia appears to increase the incidence and distribution of colon tumors.

Animals↗
PubMed1979

Alterations in the relative abundance of specific messenger ribonucleoproteins associated with compensatory renal hypertrophy.

A possible role of messenger RNA (mRNA)-associated proteins during compensatory renal hypertrophy in modulation of mRNA biogenesis has been examined in this investigation. Renal cytoplasmic free messenger ribonucleoprotein (CF mRNP) and polysomal mRNP (PA mRNP) have been isolated from kidney following 48 hours of compensatory renal hypertrophy, and the relative amounts of proteins associated with CF mRNP and PA mRNP in control and hypertrophying mouse kidney are compared. (CF mRNP refers to nonpolysomal messenger ribonucleoprotein found in the subribosomal region of sucrose gradients. PA mRNP or polysome-associated mRNP refers to mRNP released from polysomes.) CF mRNP has a buoyant density of 1.3 to 1.44 gm. per ml., contains RNA that sediments at 5 to 22 Svedberg units, and has a protein moiety comprising at least 15 polypeptides as revealed by sodium dodecyl sulfate polyacrylamide gels. PA mRNP contains three major polypeptides (molecular weights, 77,000, 52,000 and 17,000). Following 48 hours of compensatory renal hypertrophy, the relative amounts of proteins are changed: a 44,000- and 52,000- molecular weight polypeptide in CF mRNP is increased, a 52,000-molecular weight polypeptide in PA mRNP is reduced, and a 17,000-molecular weight polypeptide in PA mRNP is increased.

Animals↗
PubMed1978

Randomized trial of emergency mesocaval and portacaval shunts for bleeding esophageal varices.

A randomized trial of emergency portacaval or mesocaval shunting was conducted in twenty-four cirrhotic patients bleeding from esophageal varices. The group of eleven patients having mesocaval shunts was comparable to the group having portacaval shunts in age distribution, sex, and preoperative physical condition. Postoperative fatality rates were 46% after portacaval shunting and 73% after mesocaval shunting. Results favor portacaval shunts for the emergency control of bleeding varices in the spectrum of patients seen in an urban hospital.

Adult↗
PubMed1978

Side-to-side portacaval shunt versus nonsurgical treatment of Budd-Chiari syndrome.

Although a side-to-side portacaval shunt will relieve some patients with Budd-Chiari syndrome, distinction between relief as a result of operation and spontaneous recovery may be inexact. A nonshunting operation relieved one of two patients as much as a side-to-side portacaval shunt did. In these two patients and one additional patient, streptokinase therapy may have been beneficial.

Adult↗
PubMed1978

Clinical correlates of resectability and survival in gastric carcinoma.

The course of 201 patients with carcinoma of the stomach treated from 1962 through 1966 was followed with 97% determinacy for 10 years. The actual five year survival rate was 11%; the ten year rate was 7%. The mean duration of survival was 5.8 +/- 2.7 (S.D.) months. These results were similar to those reported for the period 1922-1926. Survival was strongly correlated with the surgeon's assessment after exploration. All patients alive after five years had operations thought to be curative, usually partial gastrectomies; the survival rate of this group was 24%. Gastroenterostomy was ineffectual palliation. Better results will require nonsurgical adjuncts, since the correlates of survival are those of minimally invasive cancer.

Aged↗