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Biomedical subjects

R R Rozin

Publications and source records attributed to R R Rozin.

At least 37 records · Page 2Linked to original sources
PubMed1987

Nail-bed melanoma.

In our series of 348 patients treated over a 10-year period, six (1.7%) had their primary lesions in the nail bed. Five of the subungual melanomas occurred in the toes and one in the thumb. Four of the lesions were of the acral lentiginous type. The delay in diagnosis was 7 months to 6 years. Four of the patients presented with advanced, neglected tumors. One had distant metastases at diagnosis. The treatment was mainly surgical. Digital amputation was carried out for local control. Five patients underwent lymph node dissection and in three of them regional metastases were found. Of the four patients with regional and distant metastases at the time of diagnosis, three died within 6 to 60 months and the fourth is alive with metastatic spread. Of the two patients with melanoma confined to the nail bed, one is free of disease 50 months following diagnosis and the other suffered from a local recurrence and has been free of disease for 30 months following wide excision and limb perfusion.

Aged↗
PubMed1987

Surgical approach to malignant melanoma in the gastrointestinal tract.

The gastrointestinal (GI) tract is a common site for malignant melanoma. Diagnosis of lesions in the GI tract is usually delayed until complications occur, such as obstruction, bleeding, or perforation of the GI tract. Of 348 patients with malignant melanoma treated during a 10-year period, 11 had GI involvement either in a metastatic form or as a primary melanoma. Three of these patients were treated surgically for metastatic lesions in the small bowel causing intussusception, two for peritonitis secondary to perforation of the small bowel, and one for massive bleeding from metastatic melanoma in the stomach. Another patient had a primary melanoma in the esophagus and underwent esophagectomy. Three patients had primary melanomas of the anal canal and one of the rectum. Three of them underwent abdominoperineal resections, and two had bilateral groin dissection in addition. Six of the patients are alive 6 months to 4 years following diagnosis. The remaining five died of metastatic melanoma from 6 months to 4 years post-surgery.

Adult↗
PubMed1987

Gangrene of the lower limbs in diabetic patients: a malignant complication.

Diabetic foot lesions are a common medical problem with major socioeconomic impact. Gangrene is usually a late and sometimes fatal complication. A series of 118 diabetic patients who underwent amputation of the lower limb at our institution over a 10 year period has been presented. Forty-two patients underwent amputation of the toes or part of the foot, 48 underwent below-knee amputation, and 18 underwent above-knee amputation. In 24 (20.3 percent), the necrotic process advanced postoperatively and necessitated additional amputation. The average hospital stay was 33.6 days. Twenty-eight patients (23.7 percent) died during the postoperative period, and the main cause of death was sepsis. Patients who presented with extensive gangrene had a higher mortality rate. There was no correlation between mortality and the duration of conservative treatment, number of repeated operations, the treatment of diabetes before hospitalization, onset of symptoms, or status of the peripheral pulses. The solution to the problem is early and vigorous preventive treatment. This could be accomplished through highly specialized clinics within the community.

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PubMed1987

Training aids for instruction in the initial management of injury casualties and in resuscitation procedures.

Practical experience in the initial treatment of injured patients is not easily available to the medical student. The small number of injured patients available for observation in a short time, the fact that the patients do not necessarily arrive in regular teaching hours, and the large number of students present in teaching groups compound this difficulty. Specialized instruction in these subjects is therefore important. The acquisition and use of teaching aids facilitate precise and efficient presentation of the material. We present teaching aids specifically prepared for instruction in the initial management of the injured and in resuscitation procedures. These aids include a library of video recordings documenting important emergency procedures, a TV camera used for filming these procedures, a collection of slides on the subject of emergency medicine and recent injuries, mannequins for instruction in cardiopulmonary resuscitation (CPR), utilization of the hospital's animal research laboratory for instruction in critical procedures such as venous cutdown, chest drainage, etc., and simulated computer programs.

Animals↗
PubMed1987

Gastrointestinal anastomotic healing during treatment with perioperative 5-fluorouracil.

This clinical study examines the influence of perioperative administration of 5-fluorouracil (5-FU) on gastrointestinal anastomotic healing. Intravenous 5-FU, 10 mg/kg body weight, was started during surgery and continued for 9 days only when advanced cancer was detected. A total of 32 gastric and enteric anastomoses were performed. All 32 patients with anastomoses recovered without any clinical evidence of leakage. Side effects attributed to 5-FU appeared in five patients, usually in a mild form of diarrhea and vomiting. On the whole, the course of recovery of this group was no different than expected from patients with advanced malignancy undergoing extensive surgery. Based on this, it appears that 5-FU administration during and immediately after surgery has no deleterious effect on the gastrointestinal tract.

Aged↗
PubMed1987

Conventional fractionation radiotherapy combined with 5-fluorouracil for metastatic malignant melanoma.

Clinical and experimental data suggest a synergistic antitumoral effect with the combined treatment of radiotherapy and 5-fluorouracil (5-FU) serving as a radiosensitizer. This combined modality was studied in 30 malignant melanoma patients with advanced locoregional or isolated, bulky, soft-tissue or visceral metastases. All patients were symptomatic, pain being the chief complaint, followed by symptoms related to large tumors. Treatment was given on an ambulatory basis, twice weekly, and consisted of 5-FU, 500 mg/m2 administered in 8-h i.v. drip infusion, followed by radiotherapy 8 h after completion of the 5-FU administration. 60Co teleunit, delivering 400 rad per dose per fraction, was given over 6 1/2 weeks to a total of 5,200 rad. The overall response rate was 70% (21 of 30 patients). Three patients (10%) achieved a complete response lasting from 3 to 11 months, and 18 (60%) achieved a partial response lasting from 3 to 13 months. The response rate was 82% for skin, 75% for lymph node, and 43% for visceral metastases. Symptomatic relief was obtained in 83% (25 of 30) of the patients. This palliative therapy was well-tolerated, and patients were able to maintain their routine lifestyles throughout. Only in one patient was 5-FU abandoned after 3 weeks, due to cardiac ischemia. Similar response rates have only been achieved with radiotherapy alone employing individual fractions of 600 rad or higher. Since the 5-FU we added is known to have a very limited effect on malignant melanoma, this study suggests its potential as a radiosensitizer in malignant melanoma.

Abdominal Neoplasms↗
PubMed1987

Effect of OKY 046, a thromboxane synthase inhibitor, on lung vascular permeability after pulmonary embolism in sheep.

OKY 046, a specific thromboxane synthase inhibitor, was used to investigate whether large pulmonary emboli, like microemboli, cause an increase in thromboxane A2 and an associated increase in vascular permeability in sheep. Nineteen sheep were anaesthetised and had cannulas inserted into the afferent lymphatic of the caudal mediastinal lymph node and pulmonary and carotid arteries. Several days later the animals were pretreated with placebo or OKY 046 0.4 mg/kg one hour before being given clotted blood 0.5 g/kg intravenously. After embolisation in the control animals mean pulmonary artery pressure (MPAP) rose from 12 to 34 mm Hg and pulmonary artery wedge pressure (PAWP) fell from 4.4 to 1.5 mm Hg; the cardiac index did not change but the physiological shunt (QS/QT) rose from 17% to 50%. One hour after embolisation the platelet count fell from 76 to 32 x 10(6)/l whereas at 15 minutes thromboxane B2 rose from 116 to 560 pg/ml in plasma and from 324 to 795 pg/ml in lymph (p less than 0.05). By 2 hours the concentration of thromboxane B2 was higher in lymph than in plasma. Lymph flow rose from 8.7 to a maximum of 27.3 ml/h at 15 minutes but despite the increase in flow the lymph:plasma (L:P) protein ratio did not fall, indicating an increased permeability of the blood vessels to protein. Pretreatment with OKY 046 inhibited the rise in plasma and lymph thromboxane B2, and limited the rise of QS/QT. The changes in MPAP, PAWP, cardiac index, platelet count, lymph flow, and L:P protein ratio, however, were no different from those in untreated sheep. These results indicate that a large pulmonary embolus leads to an increase in plasma and lung lymph thromboxane A2, which moderates the rise in QS/QT in part but not the increase in vascular permeability.

Acrylates↗
PubMed1987

Surgical priorities of abdominal wounded in a combat situation.

It is well established that abdominal wounded should be operated on as soon as possible. Combat conditions or mass casualty situations may dictate a delay in surgery because of higher priorities or lack of surgical facilities. A review of 178 abdominal wounded treated in an evacuation hospital during the 1973 and 1982 Israeli wars evaluates the effects of delay on mortality and complications. Surgery on 141 of the 178 abdominal casualties was delayed from 8 to 17 hours from the time of their injury. They were well supported hemodynamically along the chain of evacuation and none died en route. Mortality for the delay group was 5% and for the entire group 7.9%, which compares favorably with the 8.5% mortality during the latter part of the Vietnam War. Abdominal casualties who can tolerate delay in surgery are those who respond rapidly to vigorous volume replacement and remain stable with the aid of conventional supportive treatment.

Abdominal Injuries↗
PubMed1986

Active immunotherapy of human solid tumor with autologous cells treated with cholesteryl hemisuccinate. A Phase I study.

A marked increase in specific immunogenicity of tumor cells is induced upon incorporation of cholesteryl hemisuccinate (CHS) into the cell membrane, which presumably promotes the expression of latent tumor-associated antigens. Immunotherapy with CHS-treated and irradiated tumor cells as vaccine was found to be very effective in various murine experimental tumors and in eliciting delayed-type hypersensitivity in cancer patients. Based on these findings, we have carried out a Phase I study on 21 patients with solid tumor who had exhausted standard therapeutic options. All participating patients were examined by conventional physical and clinical tests prior and during the study. The immunotherapy regimen for most patients consisted of an intramuscular injection of 2 X 10(7) CHS treated and irradiated autologous tumor cells given at 2-week intervals. Variations on this regimen were mostly due to the lack of sufficient number of cells. None of the patients displayed evidence of toxicity or any other local or systemic adverse effects. In seven patients, regression of tumor mass was observed. In six of nine patients who were tested for delayed-type hypersensitivity against their CHS treated tumor cells, a significant increase in skin reaction was observed after immunotherapy. The lack of any adverse reaction in this treatment, in addition to the observed positive clinical and immunologic response in advanced cancer patients, indicate a safe therapeutic potency which is planned to be investigated in the subsequent clinical studies.

Cholesterol Esters↗
PubMed1986

"Spermatocele" following abdominoperineal resection and radiotherapy.

A 60-year-old man developed repeated spermatic fluid collection in the small pelvis following abdominoperineal resection and radiotherapy for carcinoma of the rectum. The "spermatocele" was due to a fistula originating in the vasoseminal vesicle junction. This complication has not been described previously.

Abdomen↗
PubMed1986

Intramural haematoma of the duodenum following blunt abdominal injury--the place for conservative treatment.

Two patients with intramural haematoma of the duodenum following blunt abdominal injury are presented. They responded well to conservative treatment. Complete resolution of the duodenal obstruction was demonstrated by consecutive radiological studies. Because haematomas usually resolve spontaneously, awareness and diagnosis of this rare condition are important in order to prevent unnecessary operation.

Abdominal Injuries↗
PubMed1986

Endoscopic decompression of acute colonic obstruction. Avoiding staged surgery.

Colostomy is the traditional treatment for acute obstruction of the sigmoid colon. This entails two or three surgical procedures in a high-risk group of patients. Presented is a nonsurgical approach used in three patients with acute colonic obstruction. Decompression of the bowel was achieved with a tube introduced proximal to the obstruction with the aid of a flexible sigmoidoscope. In a fourth patient, in whom the obstruction was next to the splenic flecture, the procedure failed. In all instances where decompression was successful, a one-stage procedure--primary resection and anastomosis--was performed.

Acute Disease↗
PubMed1986

Femoral vein occlusion following Mc-Vay repair.

Three cases of femoral vein occlusion following a Mc-Vay repair for femoral and inguinal hernias are presented. Phlebography demonstrated constriction of the femoral vein at the site of the repair. This complication is due to compression of the femoral vein by too tight a repair.

Aged↗