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Biomedical subjects

R Wolff

Publications and source records attributed to R Wolff.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Preoperative chemoradiation for patients with locally advanced adenocarcinoma of the pancreas.

BACKGROUND: Improved resectability is a major theoretical benefit of preoperative chemoradiation for pancreatic cancer. Since 1994, patients at Duke University Medical Center with locally advanced pancreatic cancer have been treated with multimodality preoperative therapy. The purpose of this study was to review our experience with preoperative therapy for locally advanced pancreatic cancer and determine if an aggressive neoadjuvant regimen would not only downstage these tumors pathologically but also improve the odds of complete surgical resection. METHODS: The charts of 25 patients treated with neoadjuvant chemoradiation at Duke University Medical Center with biopsy-proven, locally advanced adenocarcinoma of the pancreas were reviewed. Tumors were defined as locally advanced based on radiographic or intraoperative evidence of disease that abuts the superior mesenteric artery or vein (n = 22) or involves lymph nodes that are within the proposed radiation field (n = 3). All 25 patients received external beam radiotherapy (median dose 4500 cGy) in daily fractions of 180 cGy over 5 weeks. All patients concurrently received 5-fluorouracil (FU), and many also received mitomycin C or cisplatin, or both. Patients were given a 3- to 4-week break before a restaging computed tomographic (CT) scan was performed. Three patients were not restaged: one died from metastatic disease; one was reclassified as having a neuroendocrine tumor; and one was lost to follow-up. RESULTS: On restaging after neoadjuvant therapy, 64% of patients had stable or decreased primary tumor size. Radiographically, two patients appeared potentially resectable, and seven others developed evidence of metastatic disease. Eight patients underwent exploration, but only five could be resected. Of the five patients resected, only one had negative margins and negative lymph nodes. This patient had significant pancreatitis on initial exploration. After neoadjuvant therapy, he had a complete response radiographically, and there was no residual cancer in his resection specimen. Pathologic examination of the other resection specimens suggested that despite significant tumor fibrosis, malignant cells persist even at the periphery of the lesions. CONCLUSION: Although neoadjuvant chemoradiation has many theoretical advantages in managing pancreatic malignancy, true pathologic downstaging of locally advanced lesions into tumors that can be removed with negative nodes and margins appears to be a rare event with currently used therapeutic regimens.

Adenocarcinoma↗
PubMedDate not supplied

[Fibrin glue and bone regeneration].

The osteoinductive property of fibrin glue with and without admixture of aprotinin was proven in animal model. Aprotinin as an inhibitor of the fibrinolysis is supposed to be an inhibitor of the osteogenesis, too. Three holes of 4 mm diameter and 2 mm depth were placed into the diaphysis of both femura in 12 adults dogs. The defects were filled with either pure fibrin glue or with glue containing aprotinin (3000 KIE), or with nothing (vacant). After 8 weeks the quantity of the new built woven-bone was examined by plane geometry and the "Bone Metabolising Unit (BMU)" (Frost) which are crossing the border of lamellar bone and new woven bone were counted out. There was seen no statistical significantly between the three groups neither in the quantity of new bone nor in the BMU. Therefore the fibrin glue has no osteoinductive property.

Animals↗
PubMedDate not supplied

[Salmonella bacteremia and generalized cryptococcosis, a double indicator of African AIDS].

A male Rwandese adult with proven A.I.D.S. died from generalized cryptococcosis six months after episodes of recurrent fever with isolation of Salmonella enteritidis from the blood culture. The authors discuss the frequent and precocious appearance of Salmonella septicaemia in patients with A.I.D.S. They propose the inclusion of nontyphoidal Salmonella bacteraemia in the provisional W.H.O. case definition of adult A.I.D.S. in countries with limited diagnostic resources.

Acquired Immunodeficiency Syndrome↗