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R L Koretz

Publications and source records attributed to R L Koretz.

At least 55 records · Page 3Linked to original sources
PubMed1996

Chronic viral hepatitis and use of interferon. Whom are we treating?

When the number of Americans carrying hepatitis B or C virus is compared with the number facing end-stage liver disease, it is obvious that most carriers are spared disease progression. Unfortunately, there is no way to identify the few patients who will not be so fortunate. Dr Koretz contends that subjecting all patients to the risks and expense of interferon therapy with the hope that we may help those few is not justified. Improved short- or long-term symptomatology should be the primary objective of therapy, he states, not normalization of laboratory findings, and he notes that available data do not prove that interferon accomplishes this goal.

Antiviral Agents↗
PubMed1994

Nutrition support in patients with cancer: what do the data really show?

Although more than 70 prospective randomized controlled trials have evaluated the use of nutrition support in patients with cancer, the indications for nutrition therapy in this patient population remain controversial. We reviewed the published prospective randomized controlled trials that evaluated clinically important endpoints (morbidity, mortality, and duration of hospitalization). Many trials had serious shortcomings in study design that limit the ability to draw definitive conclusions from the data. In general, the data failed to demonstrate the clinical efficacy of providing nutrition support to most patients with cancer. Therefore, the indications for using nutrition therapy should be the same as those for patients with benign disease.

Enteral Nutrition↗
PubMed1993

Non-A, non-B post-transfusion hepatitis. Looking back in the second decade.

OBJECTIVE: To determine the long-term course of non-A, non-B post-transfusion hepatitis. DESIGN: Follow-up in 1989 to 1992 of patients prospectively identified as having contracted non-A, non-B post-transfusion hepatitis between 1972 and 1980. SETTING: A university hospital. PATIENTS: Patients who were prospectively followed from receipt of blood products and in whom otherwise unexplained abnormalities in their serum alanine aminotransferase levels developed without serologic evidence of exposure to hepatitis A or B. MEASUREMENTS: The presence or absence of clinical evidence of liver failure or symptoms of chronic hepatitis. RESULTS: Of 90 patients identified in the 1970s, 80 were recontacted and evaluated between 1989 and 1992. Based on the current status of these 80 patients and on the last known status of the remaining patients, the following observations were made: 1) Although about 40% had some symptoms during the early phase of the disease, none subsequently experienced significant clinical problems related to hepatic inflammation; 2) eight patients (seven with chronic hepatitis) developed hepatic failure; and 3) life-table analysis showed that the probabilities of developing clinical evidence of cirrhosis after 16 years of disease in the entire cohort, in the subgroup who developed chronic hepatitis, in the patients who had hepatitis C, and in those with chronic hepatitis C were 18%, 21%, 17%, and 20%, respectively. CONCLUSIONS: For most of the study patients, non-A, non-B post-transfusion hepatitis was a biochemical and histologic disease that had not yet caused hepatic symptoms. If hepatic failure does occur, it is usually seen only after 10 or more years of disease. Before that time, many infected persons die due to other disease processes.

Adult↗
PubMed1993

Malignant polyps: are they sheep in wolves' clothing?

One of the arguments supporting the concept that benign adenomatous polyps of the colon degenerate into cancer is the observation of malignancy in polypoid growths known to have been present for years. Although a latent phase--the duration of time between the initial development of a malignancy and the subsequent occurrence of a clinical problem--must exist, this argument implies that this time span is not many years. If both the prevalence of malignant polyps and the incidence of consequent symptomatic colon cancer were known, the average latent phase could be calculated. In order to estimate this prevalence, I used autopsy data; the estimate was validated using independent data fro three colonoscopic screening studies. The annual incidence of all colon cancer in the United States is approximately 150,000 cases. I estimate that 725,000 people in the United States harbor at least one malignant polyp. Even if all 150,000 cases of colon cancer were associated with symptoms and began as malignant polyps, the average latent phase is 4.8 years. Because some colon cancers are removed while the patient is still asymptomatic (discovered on screening examination) and because at least some colon cancers arise de novo from the mucosa, the average latent phase must be even longer. These estimates suggest that it cannot be assumed that the histologic finding of cancer in a polyp that has been observed for many years represents "malignant degeneration" of a previously benign neoplasm; such a malignancy may have had that histologic characteristic from the start. Further, histologically ominous lesions (malignant polyps) may often have prolonged benign clinical courses.

Adult↗
PubMed1993

Immunonutrition?

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Enteral Nutrition↗
PubMed1993

Immunonutrition.

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Arginine↗
PubMed1993

Non-A, non-B posttransfusion hepatitis: comparing C and non-C hepatitis.

Using assays to detect antibodies against antigens (C-100, 5-1-1, C-22 and C-33) of the hepatitis C virus, we tested stored sera from 40 patients prospectively identified as having non-A, non-B posttransfusion hepatitis. The 28 patients who demonstrated seroconversion ("documented hepatitis C") had more severe initial disease; all 20 cases of chronic hepatitis occurred in this subgroup. Only 2 of the 12 patients who did not demonstrate such seroconversion even had symptoms. In the group of patients with documented hepatitis C, chronic hepatitis was more commonly seen in men (89%) than in women (40%). The patients in whom antibody to the C-100 antigen developed were younger and had received more blood than had those patients who had hepatitis C diagnosed by demonstration of antibodies to the 5-1-1, C-22 or C-33 antigen (or all three). The proportion of cases of posttransfusion hepatitis that could be associated with antibody sero-conversion decreased around the time that blood banks switched to an all-volunteer system. The hepatitis seen in patients who failed to demonstrate serological evidence of hepatitis C virus exposure was usually clinically unimportant; it may or may not have been due to viral infection.

Acute Disease↗