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Biomedical subjects

T O Lipman

Publications and source records attributed to T O Lipman.

At least 19 recordsLinked to original sources
PubMed2001

Evolving management and outcome of esophageal cancer with airway involvement.

BACKGROUND: Esophageal cancer with airway involvement, including patients with esophagorespiratory fistula (ERF), has been associated with a poor prognosis. Multimodality treatment, self-expanding metal stents, and improved supportive therapy may be impacting outcome in these patients. There is concern for the development of ERF during therapy. METHODS: We retrospectively studied 74 consecutive male patients at a single institution presenting between 1/85 to 12/98 with bronchoscopic, endoscopic or radiographic confirmation of airway involvement with esophageal cancer, including 35 patients with ERF. Comparison was made between the first 35 patients (group I) and the last 39 patients (group II) with regard to antineoplastic therapy, stent placement, and survival. RESULTS: Treatment in group I included supportive care in 17 of 35 patients, plastic stent in 7 of 35 patients, and radiation or chemotherapy in 9 of 35 patients. In group II, radiation or chemotherapy was offered to 33 patients, and self-expanding metal stents were placed in 10 of 39 patients. Surgical resection was possible after neoadjuvant therapy in 13 of 39 patients in group II, including 2 initially presenting with ERF. Median survival in group I was 16 weeks and in group II was 37 weeks. Comparison of Kaplan-Meier survival estimates using log rank testing demonstrated improved survival in group II (p = 0.0026). Long-term survival in 4 group II patients initially presenting with ERF and receiving multimodality treatment was observed. Development of ERF during treatment occurred in 3 group II patients. Treatment failure was predominantly local in group I and local and distant in group II. CONCLUSIONS: More aggressive treatment may favorably influence outcome in esophageal cancer with airway invasion. Long-term survival and the development of ERF during therapy occurred at similar rates.

Adenocarcinoma↗
PubMed2001

Nutrition in gastroenterology and hepatology.

Nutritional issues, sometimes obvious and sometimes not so obvious, confront the primary care practitioner on a daily basis. Understanding the multi-disciplinary nature of nutrition science and clinical nutrition and having a basic understanding of gastrointestinal tract digestive and absorptive physiology can only help sort out the many issues involved. The general practitioner needs a core understanding of the principles of nutrition assessment.

Family Practice↗
PubMed2001

AGA technical review on parenteral nutrition.

This literature review and the recommendations therein were prepared for the American Gastroenterological Association Clinical Practice and Practice Economics Committee. The paper was approved by the Committee on September 13, 2001, and by the AGA Governing Board on May 18, 2001.

Gastroenterology↗
PubMed1999

Systematic screening of chromosome 18 for loss of heterozygosity in esophageal squamous cell carcinoma.

Esophageal cancer ranks among the 10 most common cancers in the world, and is almost uniformly fatal. The genetic events leading to the development of esophageal carcinoma are not well established. To identify genomic regions involved in esophageal carcinogenesis, we performed a systematic screening for loss of heterozygosity (LOH) in 24 samples of squamous cell carcinomas, initially focusing the analysis on chromosome 18. Thirteen short tandem repeat markers spanning 18p and 18q were used. We found a broad peak of LOH spanning 18p11.2 and 18q21.1 with the most frequent LOH (72%) at D18S978 on 18q12.2, which coincides with a known fragile site FRA18A. This region is 4 cM proximal to known tumor suppressor genes and therefore suggests the possible existence of a yet undiscovered tumor suppressor gene.

Alleles↗
PubMed1999

Home artificial nutrition.

Home artificial nutrition is a mature technology that has been with us for over a quarter of a century. Its use appears to be more widespread in the USA than in other western countries. Issues of outcome, ethics, and quality of life are increasingly important. Complications continue to be reported, some newly recognized and some that we must continually relearn.

Adult↗
PubMed1997

Group I: choosing the appropriate method of placement of an enteral feeding tube in the high-risk population.

The traditional nasogastric/nasoenteric feeding tube is the preferred access device for short-term feeding (< 30 days), with delivery into the stomach suggested unless aspiration or motility abnormalities are present. Preference for a long-term access device is operator- and facility-dependent. Endoscopic or fluoroscopic placement is preferred as first choices over laparoscopic placement because of considerations of cost, need for general anesthesia, and need for operating room time. Gastrostomy is preferred over intestinal placement for long-term access unless problems with aspiration or motility abnormalities exist.

Critical Illness↗
PubMed1995

Hepatobiliary toxicity of total parenteral nutrition in adults.

The enzymology and clinical manifestations of total parenteral nutrition (TPN)-induced liver abnormalities have been investigated extensively. The cause, pathogenesis, and treatment of TPN-related hepatic and biliary dysfunction in adults still are not well understood, however. The findings of experimental studies in animals has not necessarily correlated with the human data, and there have been few prospective, randomized controlled trials examining the mechanism, cause, or treatment of TPN-induced hepatobiliary toxicity in adults. This article examines the animal models of pathogenesis and treatment of TPN-induced intrahepatic and extrahepatic abnormalities, and provides a discussion of abnormalities seen in humans.

Adult↗
PubMed1991

Clinical trials of nutritional support in cancer. Parenteral and enteral therapy.

Cancer-related malnutrition is associated with poor prognosis. Although logic would dictate that nutritional support should improve malnutrition and thus outcome, when tested by controlled clinical trials, this has not borne out. With the exception of bone marrow transplantation, routine specialized nutritional support, particularly parenteral nutrition, has not demonstrated consistent therapeutic benefit with respect to any outcome measure and may be associated with harm to patients. The clinician must carefully select appropriate indications for specialized nutritional support in cancer patients.

Enteral Nutrition↗
PubMed1987

Esophageal zinc content in human squamous esophageal cancer.

Zinc and vitamin A are known to interact, and deficiencies have been associated with carcinogenesis in experimental animals and humans. Since we previously have demonstrated decreased plasma zinc and vitamin A levels in patients with esophageal cancer, we wished to examine endoscopically obtained epithelial tissue for vitamin A and zinc content. This was not feasible for vitamin A, but using newly developed techniques for zinc analysis of small tissue samples, we measured esophageal epithelial zinc as well as plasma zinc and plasma vitamin A in 21 patients with esophageal cancer, 17 patients with esophagitis, and 12 normals. Mean plasma zinc in the esophageal cancer group (56 +/- 3 micrograms/dl) (mean +/- SEM) was significantly less than in the esophagitis group (72 +/- 5 micrograms/dl) and the normals (78 +/- 5 micrograms/dl). Mean plasma vitamin A in the esophageal cancer group (32 +/- 3 micrograms/dl) was significantly less than the esophagitis group (57 +/- 4 micrograms/dl) or the normals (58 +/- 5 micrograms/dl). There was no significant difference in tissue zinc content (measured as micrograms zinc/g wet weight of tissue, mean +/- SEM) among cancerous tissue (57 +/- 5 micrograms/g) and adjacent normal tissue (61 +/- 4 micrograms/g), esophagitis tissue (66 +/- 6 micrograms/g) and adjacent normal tissue (61 +/- 6 micrograms/g), or normal esophageal tissue (59 +/- 6 micrograms/g). We conclude that deficiencies of zinc or vitamin A may be cofactors in the induction of human esophageal cancer, but a mechanism cannot be accounted for by differences in epithelial zinc content.

Carcinoma, Squamous Cell↗
PubMed1983

Plasma zinc and vitamin A in human squamous carcinoma of the esophagus.

Zinc deficiency enhances experimental esophageal tumor induction. Vitamin A supplementation inhibits carcinogenesis in animals. Plasma zinc and plasma vitamin A levels are reduced in several human squamous cancers, but have not been studied in a US population with esophageal cancer. Therefore, we measured plasma zinc and vitamin A in patients with newly diagnosed esophageal cancer. In addition, we assessed hepatic and nutritional status and attempted to control for other factors known to influence plasma zinc and vitamin A levels. Plasma zinc and vitamin A were both significantly less in esophageal carcinoma than in age-matched healthy controls (plasma zinc 65.7 +/- 3.3 micrograms/dl [mean +/- SEM] in esophageal cancer versus 80.5 +/- 2.4 micrograms/dl in controls, P less than 0.01; plasma vitamin A 32.6 +/- 3.4 micrograms/dl in esophageal cancer versus 60.2 +/- 4.2 in controls, P less than 0.001). Overall, 15 of 17 patients with esophageal cancer had decreased plasma zinc and/or decreased plasma vitamin A. Our findings are compatible with a hypothesis that zinc or vitamin A deficiency may be co-factors in the induction of human esophageal carcinoma.

Aged↗
PubMed1981

Insensitivity of guaiac slide tests for detection of blood in gastric juice.

Two guaiac slide tests (Hemoccult and Fe-Cult) were evaluated for their ability to detect blood in gastric juice and other fluid mixtures relevant to clinical testing in upper gastrointestinal hemorrhage. Blood was added to these fluid mixtures in various amounts sufficient to yield concentrations from 20 microL blood/dL to 4000 microL/dL. With these agents we frequently could not detect blood in unbuffered gastric juice at concentrations as great as 4000 microL/dL. Buffering of gastric juice to pH 4 with either of two antacids only slightly restored sensitivity for blood detection. In contrast, blood in gastric juice obtained from subjects previously given intravenous cimetidine tested positive at concentrations as low as 50 microL/dL. The ability of both test agents to detect blood in gastric juice was considerably enhanced by neutralizing gastric juice with 0.1 N NaOH.

Adult↗
PubMed1977

Chronic active hepatitis. Prolonged survival without treatment.

A case is presented of a patient with established HBsAg-positive chronic active hepatitis and cirrhosis of at least 14 years duration. The disease, although untreated, has caused the patient relatively little disability. The implications of the patient's prolonged illness are discussed with reference to current knowledge of chronic active hepatitis. It is concluded that corticosteroid therapy may not be a mandatory requirement for all patients with this disease.

Adrenal Cortex Hormones↗
PubMed1973

Marine training.

Explore the source record for details and available documents.

Heat Exhaustion↗