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Biomedical subjects

R Weiner

Publications and source records attributed to R Weiner.

At least 37 records · Page 2Linked to original sources
PubMed1999

Preparation of extremely obese patients for laparoscopic gastric banding by gastric-balloon therapy.

BACKGROUND: In super, super obese patients (body mass index [BMI] >60), especially those with extreme intra-abdominal fat deposition, the technical difficulties in laparoscopic procedures increase. The purpose of this study was to evaluate whether gastric balloon therapy (GBT) can improve the operative conditions for laparoscopic adjustable gastric banding (LAGB) in extremely obese patients. MATERIALS AND METHODS: From April 1995 to August 1998, 196 LAGBs were performed. In 15 patients (7 female and 8 male), median age 38.8 years (range 17-54), who had been selected as suitable candidates for bariatric surgery, preoperative GBT was studied. Fourteen patients were extremely obese (BMI 60.2 kg/m2 [range 58-72]). One 17-year-old boy with BMI 46.6 kg/m2 was also treated. The Bioenterics Intragastric Balloon (BIB) was used. The placement, the volume modification, and the removal of the BIB were performed endoscopically. Close follow-up was possible in 14 patients. After balloon removal, 13 patients underwent LAGB. RESULTS: In 14 of 15 cases, GBT was successful. There was only one ballon dysfunction. The mean weight loss was 18.1 kg, and the median duration of balloon therapy was 16.8 weeks. After balloon removal, body weight started to increase. CONCLUSIONS: In our experience, the gastric balloon can improve the conditions for laparoscopic surgery in super and in super, super obese patients. There was no conversion to open surgery. The effect of weight loss is much less than immediately after LAGB. However, after failure of all conservative treatments to reduce the preoperative body weight, the GBT seems to be the last possibility.

Adult↗
PubMed1998

Durable remission of locally advanced breast cancer with multimodality management.

We treated 20 women with locally advanced breast cancer between January 1991 and September 1996. The treatment regimen included 4 cycles of intensive doxorubicin (30 mg/m2/d on 3 consecutive days every 2 weeks with G-CSF support), followed by appropriate surgery, followed by high dose therapy with cyclophosphamide, carboplatin and thiotepa (STAMP V, CTCb). Of the 20 patients, seven presented with inflammatory breast cancer, three with Stage IIIB, seven with stage IIIA, one with multifocal Stage IIB and two with Stage IV M1 (ipsilateral supraclavicular lymph node involvement) (including one who had an inflammatory primary) disease. Six patients had not undergone mastectomy at the time of entering the protocol. These six received the doxorubicin in a neoadjuvant fashion and were thus evaluable for tumor response. The remaining 14 received doxorubicin as adjuvant therapy prior to intensification and transplantation. All patients underwent local-regional radiation therapy and were placed on oral tamoxifen. Doxorubicin was well tolerated in this schedule with all but three patients receiving all their cycles on schedule. Both BM and PBPC were easily collected after this regimen and, when reinfused, resulted in the prompt recovery of granulocytes (median 11 days to 500 absolute granulocyte count) and platelets (median 13 days to 20,000 platelets). The six patients who received doxorubicin prior to mastectomy all had major clinical responses, but were found to have microscopic focii of breast cancer in the mastectomy specimens. The overall treatment was well tolerated with the exception of one treatment-related death (5%). The overall and relapse free survival are 70% and 58% respectively with a median follow-up of 40 months (range 12-74 months). When the Stage IV patients are censored, the relapse-free survival rate is 69%. In the bone marrow transplant phase of treatment, the major non-hematologic toxicities were stomatitis (70%) and anorexia requiring parental nutrition (75%).

Adult↗
PubMed1998

[Management and therapy of postoperative complications after "gastric banding" for morbid obesity].

Laparoscopic gastric banding has become a common procedure in bariatric surgery. Early as well as late complications are, in comparison to conventional techniques, rare. Complications arising from the operative technique are: perforation, early pouch dilatation, gastric slippage, infections of the port and the band, erosion and defects of the band tube. Insufficient weight loss and late pouch dilatation arise from unsatisfactory compliance on the part of the patient. In 7.5% of 146 cases, reoperations were necessary. Obstruction of the pouch stoma and a slippage resulted in total food intolerance. After radiologic diagnosis the band system should be deflated first and a naso-gastric tube applied. If this does not result in the pouch collapsing, a revision operation is needed.

Adult↗
PubMed1998

On mathematical modeling of dermal and transdermal drug delivery.

This paper deals with two extensions of diffusion models for the drug delivery process into human skin in order to give a more realistic approach. As one extension several penetrating substances formulated within a vehicle are considered for modeling the case of an applied drug and some penetration modifiers (enhancers and reducers, respectively). A coupling via concentration-dependent diffusivities between the diffusion equations of the involved substances is used to model the dependencies between them. Furthermore, a moving boundary problem for the diffusion equation of the drug delivery process is developed to describe the time-dependent maximum penetration depth of each penetrant marked by a movingboundary. On this basis a model is developed that can predict both the concentration profile and the position of the penetration boundary depending on time. Both concepts are described on a two-dimensional multilayered domain representing a cross section through human skin. The model equations are solved by exploiting a suitable numerical discretization method.

Administration, Cutaneous↗
PubMed1998

[Laparoscopic gastric banding for treatment of morbid obesity].

The laparoscopic implantation of the LAP-BAND is a minimal invasive technique in obese patients. The effectiveness is comparable to that of gastroplasty. In all 186 patients were treated laparoscopically. The conversion rate was 0%. There were no death. In 0.5% there were intraoperative complications; 3% complications were caused by the port system; and 4% of the late postoperative complications were related to the LAP-BAND (pouch dilatation, slippage).

Adult↗
PubMed1997

[Laparoscopic-gastroscopic intragastric stomach surgery].

In three cases, a new technique for intragastric surgery were used. The ports were placed using a step system (blunt trocars) directly into the stomach. In two cases, a benign tumor was resected, and we converted one case of bleeding.

Adenoma↗
PubMed1996

Retrospective multicenter analysis of 3i endosseous dental implants placed over a five-year period.

Osseointegrated dental implants have now become an accepted form of treatment for patients with a fully or partially missing dentition. The purpose of this study was to evaluate the performance of 3i threaded and cylindrical implants. During a 5-year period, a total of 1969 3i endosseous implants were placed at 6 centers in the United States and 2 elsewhere in the edentulous and partially edentulous jaws of 653 consecutive patients ranging in age from 18 to 82 years. Of the total number of implants placed, 1341 were commercially pure titanium threaded implants and 628 were titanium plasma-sprayed implants with a cylindrical configuration. A total of 28 patients with 110 implants were lost to follow-up. Implants in these patients were considered neither a success nor a failure. Success was predicated on the osseointegration of each and every implant followed in this analysis rather than the persistence of prosthetic function. Confirmed bone anchorage was considered essential for success. A total of 625 patients with 1871 implants remain in the study with a follow-up period ranging from 6 to 60 months. A total of 93 implants (5.0% of the total implants followed) were considered as failures. A mean implant survival rate was 95.0% for both the threaded and the cylindrical implant was calculated. The success rate of threaded implants was 97.0% in the mandible and 93.8% in the maxilla. The success rate for the 3.3-mm cylindrical implants was 96.0% in the mandible and 95.5% in the maxilla, and the success rate of 4.0-mm-diameter cylindrical implants was 95% in the mandible and 92.0% in the maxilla. Causes of failure consisted of loss of osseointegration (2.3%), crestal bone loss requiring periodontal therapy after the first year of function (1.7%) had mechanical problems associated with the prosthesis (0.9%). This retrospective analysis of the 3i endosseous implant system is comparable to previous reports on other implant systems in terms of implant survival and prosthesis stability. It is demonstrated that 3i implants are predictable and can provide lasting osseointegration leading to improvement of oral function if the recommended surgical and restorative protocol is followed.

Adolescent↗
PubMed1996

Occupational health monitoring practices of registered mercury-using workplaces within Gauteng.

OBJECTIVES: To assess monitoring practices of workplaces registered as mercury users within the then PWV South region of the Department of Manpower (now Gauteng region of the Department of Labour); to identify the main industrial sectors that use mercury and to estimate the number of workers potentially exposed. DESIGN: A descriptive study design was used. SETTING: Workplaces situated in the former PWV South region, as defined by the Department of Manpower. SUBJECTS: Fifty-eight workplaces were registered as mercury users in this region. Postal questionnaires were sent to 34 workplaces on the Department of Manpower's list of mercury users-24 were excluded because they had closed, moved or claimed, on telephonic contact, no longer to use mercury. MAIN OUTCOME MEASURES: Industry type and form of mercury used, monitoring practices and attitudes to legislation. RESULTS: The response rate to the questionnaire was 73.5% (25). Despite being registered as users, 52% (13) of the respondents claimed not to use mercury. Of the 10 mercury-using workplaces, 5 conducted biological monitoring, while only 2 performed environmental measurements. Six of the 10 workplaces used an inorganic form of mercury, 3 used a combination of inorganic and organic mercury, while 1 used organic mercury only. Sixty per cent of all respondents would support legislation that regulated monitoring of mercury in industry. CONCLUSIONS: The study suggests that biological monitoring of mercury is conducted by a limited number of users in Gauteng, while environmental monitoring appears to be neglected. Recently enacted legislation for industrial mercury monitoring needs to be implemented rigorously. Since more than half of the respondents claimed not to use mercury, even though they were registered as users with the Department of Manpower, the study further demonstrates a need to review the system of registration and record-keeping.

Environmental Monitoring↗
PubMed1995

Improved survival of patients with chronic myelogenous leukemia undergoing allogeneic bone marrow transplantation.

A total of 28 patients with chronic myelogenous leukemia (CML) in chronic phase (CP) received bone marrow allografts from HLA-matched siblings at the University of Florida between August 1984-July 1992. The present study compares the disease-free survival (DFS) for those patients who were transplanted before or after August 1988 using the same conditioning regimen. The analysis shows significant difference in 3-year DFS for those patients transplanted post- vs. pre-August 1988 (69.6% vs. 20%, respectively; P = 0.006). A decrease in pneumonitis due to different etiologies from pre-August 1988 (6/13, 46%) to post-August 1988 (1/15, 7%) was statistically significant (P = 0.029). A decrease, although statistically insignificant, in the overall incidence and severity of acute and chronic graft vs. host disease (GVHD) after August 1988 was also noticed. This study indicates significantly improved outcome for patients with CML in CP who have been treated in the University of Florida after August 1988. Better supportive care and prophylaxis for GVHD most likely contributed to such improvement.

Adult↗
PubMed1995

Structure, function and immunochemistry of bacterial exopolysaccharides.

There has been much written on bacterial exopolysaccharides (EPS) and their role in virulence. Less has been published regarding EPS in free living species. This review focuses on that subject, emphasizing their functions in the environment and the use of antibody probes to study them.

Bacterial Capsules↗
PubMed1995

[Laparoscopic staging of gastrointestinal tumors].

Laparoscopic staging was carried out in 28 cases with carcinomas of the distal esophagus, cardia, stomach or pancreas. The intention was first to rule out peritoneal carcinomatosis and secondly to see, whether RO-resection would be possible, mainly for the reason of therapeutic splitting. The diagnostic accuracy can be raised to 95% using laparoscopic ultrasound, exploration of the lesser sac of the peritoneum and tissue sampling in combination with preoperative endoscopy and radiography. In 39.3% of the investigated patients the staging must be corrected after laparoscopic staging compared with the preoperative findings. 35.7% of the patients did not need explorative laparotomy.

Aged↗
PubMed1995

Ethics rounds.

Explore the source record for details and available documents.

American Nurses' Association↗
PubMed1994

A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis.

PURPOSE: A multi-institutional experience in radiosurgery for solitary brain metastases was combined to identify factors associated with safety, efficacy, tumor control, and survival. MATERIALS AND METHODS: A review of 116 patients with solitary brain metastases who underwent gamma knife stereotactic radiosurgery at five institutions was performed. The median follow-up was 7 months following radiosurgery and 12 months following diagnosis. Minimum tumor doses varied from 8-30 Gy (mean, 17.5 Gy). Forty-five patients failed prior radiotherapy and 71 had no prior brain irradiation. Fifty-one patients had radiosurgery alone and 65 underwent combined radiosurgery with fractionated large-field radiotherapy (mean dose, 33.8 Gy). RESULTS: Median survival was 11 months after radiosurgery and 20 months after diagnosis. Follow-up documented local tumor control in 99 patients (85%), tumor recurrence in 17 (15%), and documented radiation necrosis in one (1%). The 2-year actuarial tumor control rate was 67 +/- 8%. Tumor histology affected survival (better for breast cancer, p = .004) and local control (better for melanoma and renal cell, p = .0003) in multivariate analyses. Combined fractionated radiotherapy and radiosurgery improved local control (p = 0.111), but not survival in multivariate testing. CONCLUSION: Radiosurgery is effective in controlling solitary brain metastases with low morbidity. Further study is needed to better define optimum treatment parameters for radiosurgery.

Adult↗
PubMed1994

Splenic lymphoma with circulating villous lymphocytes: report of seven cases and review of the literature.

Splenic lymphoma with villous lymphocytes (SLVL) is a relatively new entity with only a few reports published. We report seven cases of SLVL with detailed clinicopathologic and comprehensive immunophenotypic studies to further characterize this lymphoma, which is frequently confused with hairy cell leukemia and other low-grade B-cell lymphoid neoplasms. The diagnostic criteria we used include 1) prominent splenomegaly, 2) insignificant or no lymphadenopathy, 3) lymphocytosis without leukopenia, 4) presence of circulating villous lymphocytes, 5) characteristic cytologic and histologic features, and 6) specific phenotypic and cytochemical findings. Our studies show that SLVL does not represent a pure entity but rather a morphologically heterogeneous group of low-grade lymphomas with various cytologic and histologic features. Although immunophenotyping is helpful in differential diagnosis, multiparameter studies are necessary to confirm the diagnosis. In our series, only two patients died of SLVL, who probably developed transformation to a higher-grade lymphoma.

Aged↗
PubMed1994

The need to certify products to CDRH Regulations.

Laser products that are sold in the United States are required to comply with the regulations published by the Center for Devices and Radiological Health (CDRH) within the US Food and Drug Administration [1]. The need to certify products is straightforward in most instances, however, the applicability of the regulations is not as clear for: lasers sold only to Original Equipment Manufacturers (OEMs) as components for incorporation into end-use products, end-use products that contain lasers which have already been certified by their manufacturers, and end-use products that are being imported into the US and that already comply with international laser safety standards. This article will discuss these applications in an attempt to clarify the need for certification by laser product manufacturers and importers. The discussion applies equally for lasers and laser systems.

Certification↗