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Biomedical subjects

R C Doberneck

Publications and source records attributed to R C Doberneck.

At least 37 records · Page 2Linked to original sources
PubMed1982

A remotely programmable insulin delivery system. Successful short-term implantation in man.

A remotely controlled, programmable insulin delivery system was implanted in a diabetic man and the feasibility of the technique was examined. Specific problems included (1) development of an appropriate surgical approach, (2) identification of methods to assess the integrity of the insulin delivery system following implantation, and (3) assessment of plasma glucose and free-insulin profiles obtained with the implanted system. The insulin pump was implanted submuscularly through a midline abdominal incision. The insulin reservoir was placed subcutaneously to allow percutaneous refilling. The insulin delivery catheter terminated in the peritoneal space. No postoperative wound infection occurred and rapid healing of the surgical site ensued. In vivo assessment of the system included (1) dye contrast roentgenography, (2) vasopressin stimulation, and (3) reservoir volume monitoring. Short-acting insulin was then placed in the implanted reservoir and delivered by the system for one month. Mean plasma glucose concentration declined to normal levels, as did glycosylated hemoglobin. Plasma insulin profiles were normalized with appropriate insulin peaks with each meal. We conclude that implantation of a remotely programmable insulin pump is feasible in type I diabetic man. Additional studies are necessary to define which patients will benefit from this type of insulin delivery system.

Blood Glucose↗
PubMed1982

Aspects of breast cancer control: is prophylactic mastectomy a feasible modality?

Even though mammographic techniques have improved and small tumors of 0.5 cm in diameter can be detected, decreased breast cancer mortality has not yet resulted. Because small tumors may cause systemic spread, in many patients breast cancer at the time of diagnosis is a systemic disease which is incurable. A reduction in breast cancer mortality seems possible by prophylactic bilateral mastectomy in women at extraordinary high risk of breast cancer. These are patients with (a) breast cancer in mother and sister, (b) breast cancer in mother or sister and a combination of various risk factors (early menarche - late menopause, nulliparity, late first pregnancy), (c) noninvasive malignant breast disease (carcinoma in situ), (d) therapy-resistant fibrocystic disease with intolerable pain and/or extreme anxiety (carcinophobia, and (e) benign breast neoplasia with malignant potentials (cellular atypia = precancerosis). Also, in breast cancer patients without regional and systemic spread and who are at high risk for developing cancer in the other breast, prophylactic contralateral mastectomy may be indicated. These are patients with (a) unilateral invasive breast cancer in the premenopause and a family history (mother or sister) of breast cancer, (b) unilateral invasive lobular carcinoma or tubular (ductal) carcinoma, and (c) unilateral invasive breast cancer and precancerous lesions in the other breast.

Adult↗
PubMed1982

Subcutaneous peritoneal access device for type I diabetic patients nonresponsive to subcutaneous insulin.

Three type I diabetic patients nonresponsive to subcutaneous insulin were implanted with a subcutaneous peritoneal access device. In these patients, multiple subcutaneous injections had been unable to prevent recurrent hospital admissions for diabetic ketoacidosis. The patients were responsive to intravenous insulin but had limited accessible peripheral veins. Complications of thrombosis and/or septicemia from permanent central venous catheters prevented the long-term use of this route. The peritoneal access device was implanted subcutaneously adjacent to the umbilicus with its insulin delivery catheter terminating in the peritoneal space. Transcutaneous injection of insulin into the subcutaneous access port resulted in the same quantity of insulin entering the peritoneal space. Using a mixture of regular and protamine zinc insulin in a ration of 1:1 resulted in acute increases in plasma free insulin concentration with meals and a declining background level postprandially. All peritoneal access devices have been functioning well for at least 2 mo and in one of the implanted diabetic subjects, it has been in continuous use for 5 mo with no evidence of peritonitis or resistance to peritoneal insulin. These results suggest that a subcutaneous peritoneal access device may provide an alterative insulin delivery route for patients who are nonresponsive to subcutaneous insulin injections.

Adolescent↗
PubMed1982

Pelvic actinomycosis associated with use of intrauterine device: a new challenge for the surgeon.

Pelvic actinomycosis associated with the use of an intrauterine device (IUD) is a recently recognized combination. The usual manifestation of the disease are those of mild pelvic inflammatory disease (PID) in a woman who uses an IUD. The disease is easily recognized on Papanicolaou-stained cervicovaginal smears. Early treatment involves removal of the IUD and administration of penicillin. Rarely, the disease may be serious and may require drainage of intra-abdominal abscesses, hysterectomy with salpingo-oophorectomy, or both. The second known death from pelvic actinomycosis associated with use of an IUD is reported.

Actinomycosis↗
PubMed1982

Reappraisal of the problems of intra-abdominal abscess.

During a ten year period, 69 patients underwent 100 operations for more than 147 intra-abdominal abscesses. The over-all mortality was 24.6 per cent and the redrainage rate, 30.4 per cent. Most often, abscesses were located in the subphrenic space and followed elective gastrointestinal surgical procedures. Most patients harbored two or more different organisms. Mortalities were low in patients less than 20 years of age having a single abscess, a short duration of fever prior to drainage and after operations on the colon and secondary operations on the appendix. Mortalities were high in patients more than 40 years of age having multiple abscesses; a prolonged duration of fever prior to drainage; multiple drainage procedures, and abscesses after gastroduodenal, hepatobiliary and pancreatic procedures. The mortality and redrainage rate were lower in patients given appropriate perioperative prophylactic antibiotics than inappropriate perioperative prophylactic antibiotics at the antecedent operations. The mortality and the redrainage rate were not related to duration of administration of appropriate prophylactic antibiotics or the number of different isolates. The choice of incision for drainage should be based upon clinical findings rather than a matter of personal preference. Prompt defervescence was a sign of successful drainage. In the present study, the prime importance of prompt drainage and the secondary role of antibiotics in the treatment of intra-abdominal abscess are confirmed.

Abdomen, Acute↗
PubMed1982

Drains and antibiotics perioperatively for elective cholecystectomy.

In a review of 512 patients having elective cholecystectomies without choledochotomy, patients having drainage of the gallbladder bed were found to have longer postoperative hospital stays, higher incidences of fever postoperatively and both wound infections and postoperative complications than those patients not having such drainage. The use of antibiotics perioperatively and gallbladder bed closure did not alter these outcomes. We conclude that the routine use of drainage and prophylactic antibiotics in elective cholecystectomy not only is unnecessary but also may be harmful.

Adult↗
PubMed1980

Breast biopsy: a study of cost-effectiveness.

The entry of third party payors into the field of health care has brought about increasing awareness of cost-effectiveness. Since breast biopsy is among the most commonly performed operations and open to criticism, the purpose of this report is to provide data relative to cost-effectiveness of breast biopsies at the University of New Mexico and to compare such data with 1) cost-effectiveness of mammographic screening for breast cancer, and 2) cost-effectiveness of judicious use of mammography in patients with breast complaints. From 1972 through 1978, 1064 patients were seen because of complaints relative to the breasts and 516 breast biopsies were done. Seventy patients were found to have cancer (14% of the breast biopsies). Using the October 1978 through March 1979 cost schedules for hospital and professional fees, the average cost of a breast biopsy was $1,216.00 for general anesthesia, $751.00 for assisted local anesthesia, and $520.00 for local anesthesia. The major differences lay in 1) anesthesia and operating room average charges of $618.00 for general anesthesia, $451.00 for assisted local anesthesia, and $260.00 for local anesthesia; 2) room charge of $174.00 for general anesthesia; and 3) laboratory and x-ray charges of $256.00 for general anesthesia, $120.00 for assisted local anesthesia, and $91.00 for local anesthesia. In 1978 64% of breast biopsies were done under local anesthesia as opposed to 1972 when 22% were done under local anesthesia. For the 516 breast biopsies, 47% were done under local anesthesia, 4% under assisted local anesthesia and 49% under general anesthesia. The calculated overall cost of the 516 breast biopsies was $448,794.00 or $6411.00 per cancer. Comparing our data to those of Lewis at our 1978-79 cost schedules and assuming our anesthetic mix in his patients, his cost per cancer identified was $3973.00 in patients with breast complaints. His cost figure is considerably lower than ours because of a higher yield of cancer (41%). Making the same assumptions for cost and anesthetic mix, the cost per biopsy proved cancer diagnosed in mammographic screening for breast cancer is $11,175.00 (Feig), and $24,482 (Lewis). Thus, 1) use of local anesthesia rather than general anesthesia reduces cost of breast biopsies by $694.00 per breast biopsy, 2) greater precision in selection of patients for breast biopsies is mandatory to reduce cost of diagnosis of cancer, 3) present state of the surgical art is more cost-effective than is screening for breast cancer.

Anesthesia, General↗
PubMed1977

Current status of clinical pion radiotherapy.

An RBE for acute skin reaction to peak pions, for a specific fractionation scheme, has been established at 1.40-1.44. The time of development of acute skin reactions varied in 2 patients with 30 metastatic skin nodules treated with doses varying from 1,175 to 1,951 peak pions and 2,350 to 3,901 rads of 100 kVp x rays. The reactions reached their peak approximately one week apart at all dose levels with both forms of radiation. No untoward effects have been seen in epidermis or subcutaneous tissues as late as 169 days after the start of treatment. All nodules disappeared and have not returned 169 days after treatment. There is a strong suggestion that the response of thick tumors is sensitive to the proportion of high LET radiation deposited at various levels in the tumor.

Dose-Response Relationship, Radiation↗
PubMed1975

Gastrojejunostomy inhibits postshunt siderosis.

Thirteen of fourteen dogs developed marked increases in hepatic hemosiderin (postshunt siderosis) after construction of portacaval shunt, whereas only three of 12 dogs developed such siderosis after construction of a portacaval shunt and end-to-side gastrojejunostomy with duodenal exclusion. Splenic hemosiderin was increased markedly in dogs with portacaval shunt but increased minimally in dogs with portacaval shunt and gastrojejunostomy. Rib marrow fat increased slightly in dogs with portacaval shunt and decreased slightly in dogs with portacaval shunt and gastrojejunostomy. Thus continued iron absorption appears to account for the development of postshunt siderosis and the addition of gastrojejunostomy ameliorates postshunt siderosis by diminishing iron absorption.

Adipose Tissue↗