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Biomedical subjects

A S Al-Jurf

Publications and source records attributed to A S Al-Jurf.

At least 19 recordsLinked to original sources
PubMed2000

Longterm central venous access in gynecologic cancer patients.

BACKGROUND: To assess the utility and safety of three different longterm indwelling intravenous catheters in patients with gynecologic malignancies. STUDY DESIGN: A retrospective review was performed of the records of all women with gynecologic malignancies who required longterm venous access catheters and ports between 1990 and 1997. RESULTS: Two hundred sixty-eight women underwent placement of 308 indwelling catheters, of which 305 were available for analysis. Of those, 68 (22%) were Hickman catheters, 162 (53%) were infusaports, and 75 (25%) were Peripheral Access System (PAS) ports. Venous access was obtained percutaneously in 152 (50%) patients and by cutdown in 153 (50%). Prophylactic anticoagulation was used with 96 catheters (31%). Catheter placement was associated with 12 (4%) immediate complications and 87 (29%) delayed complications. The average duration of a catheter in place was 5.6 months for the Hickman, 12.5 months for the infusaport, and 16.0 months for the PAS port (p < 0.001). Bacteremia was more likely to develop in patients with Hickman catheters when compared with those with infusaports and PAS ports (19% versus 6% and 5%, respectively, p = 0.002). Thrombosis was significantly less likely to develop in patients receiving prophylactic anticoagulation (11% versus 4%, p = 0.004). Overall, the complication rate was lower with cutdown versus percutaneous access (p = 0.004). There was no statistically significant difference between the frequency of complications when correlated with the stage of disease, patient age, body mass index, or type of malignancy. CONCLUSIONS: Infusaports and PAS ports were associated with a lower risk of infection and have a longer life than Hickman catheters. The cutdown approach was associated with a lower complication rate. Low-dose prophylactic anticoagulation should be given to all patients with longterm central venous catheters.

Adult↗
PubMed1997

Spigelian hernia: diagnosis by high-resolution real-time sonography.

The purpose of this study was to demonstrate the role of high-resolution real-time sonography in the diagnosis of spigelian hernias. The sonographic findings in three patients, two of whom had surgical confirmation, are presented. We also discuss and demonstrate the anatomic and pathologic factors that predispose to these hernias. In all three cases, real-time high-resolution sonography was very helpful in providing detailed images of the abdominal wall defect, the hernial sac and contents, and the relationship of the contents to the spigelian fascia and the rectus, external oblique, and internal oblique muscles. The role of the Valsalva and other provocative maneuvers in demonstrating the "in and out" sliding movement of the contents of the hernia also is discussed. Although the number of cases in our study is small, we think that this modality may be the most effective means for establishing this diagnosis, especially in cases with equivocal clinical findings.

Abdominal Muscles↗
PubMed1989

Sonography of acute appendicitis: a critical review.

In 20% of the cases of acute appendicitis, especially in children, the elderly, and ovulating women, the findings are atypical. The radiographic procedures used to aid in the diagnosis have not been proven reliable. Sonography has often been used to diagnose or rule out appendiceal abscesses, or diseases that can mimic acute appendicitis, such as gynecologic, obstetric, or biliary abnormalities. Recently, high-resolution sonography with graded compression has been shown to be very helpful in the diagnosis of acute appendicitis in several studies. High-resolution 5- to 7.5-MHz transducers are used to compress the bowels, displace the interfering gas in the right lower quadrant, and directly visualize the inflamed appendix with a sensitivity that varies from 80 to 95%, a specificity of 95 to 100%, and an accuracy of 91 to 95%. It is also possible to differentiate acute appendicitis from the gangrenous and perforated appendix. High-resolution sonography is currently the diagnostic method of choice for appendicitis, particularly in patients with equivocal clinical findings. The technique, normal and pathologic anatomy values, and limitations of sonography are discussed.

Acute Disease↗
PubMed1987

Angiosarcoma of the breast following segmental mastectomy complicated by lymphedema.

A patient is discussed who had angiosarcoma of her lymphedematous right breast develop four years after segmental mastectomy for infiltrating ductal carcinoma. The lymphedema developed and persisted after an indolent and recurrent postoperative infection. The possibility that the second malignancy is a consequence of the chronic lymphedema, similar to the angiosarcomas of lymphedematous extremities after radical mastectomy, is cautiously entertained. This hypothesis is worthy of consideration as more breast conservation surgery is being done, with or without adjuvant radiation therapy, and accumulating evidence suggests that lymphedema of the breast is a common complication of surgery followed by radiation.

Aged↗
PubMed1987

Plasma and cerebrospinal fluid nucleosides and oxypurines in acute liver failure.

Concentrations of pyrimidine nucleosides (with the possible exception of uridine) and oxypurines in mammalian plasma and cerebrospinal fluid (CSF) are maintained relatively constant by potent homeostatic mechanisms. To test the importance of the intact liver in maintaining homeostasis of pyrimidine nucleosides and oxypurines in plasma and CSF, we performed a greater than 90% or sham hepatectomy on New Zealand white rabbits. At 1, 6, 12, or 24 hours after real or sham hepatectomy, plasma and CSF nucleosides and oxypurines were measured by high-performance liquid chromatography. At all times after hepatectomy, the concentrations of the pyrimidine deoxyribonucleosides (deoxycytidine, deoxyuridine, and thymidine) were increased approximately threefold in plasma and CSF compared with sham-operated controls. Twenty-four hours after hepatectomy, the concentrations of uridine and cytidine in plasma were decreased by 70% and 50%, respectively, and in CSF by 50% and 40%, respectively, when compared with the concentrations in the sham-operated controls. Hypoxanthine concentrations in CSF were increased approximately twofold at 6, 12, and 24 hours after hepatectomy. These results suggest that liver function is essential for the maintenance of normal concentrations of pyrimidine nucleosides in plasma and CSF. That pyrimidine nucleoside concentrations are disrupted in plasma and CSF in this model of acute liver failure suggests that pools of pyrimidine nucleotides in some tissues (e.g., brain) may be altered by liver failure.

Animals↗
PubMed1986

Malignant melanoma in childhood and adolescence.

A retrospective chart review of 25 patients under the age of 20 years with malignant melanoma, diagnosed between the years 1938 and 1984 at the University of Iowa Hospitals and Clinics, was conducted. Nine of the patients were under the age of 14 years, and 18 patients were females. There appeared to be a frequent delay in diagnosis of the primary lesion, occasionally incorrect initial diagnosis, and under-treatment in these young patients. Primary treatment varied from limited excision of the lesion to wide excision and regional lymph node dissection. Females appeared to have a better prognosis than males, and wide local excision with or without regional lymph node dissection was associated with the most favorable outcome. Overall 10-year survival in this group of patients was 56 per cent, a rate that compares well to the overall survival in adult patients with malignant melanoma.

Adolescent↗
PubMed1985

Magnesium balance and distribution during total parenteral nutrition: effect of calcium additives.

Homeostatic alterations and derangements in magnesium (and phosphate) metabolism may occur during total parenteral nutrition (TPN) and may be influenced by the amounts of calcium supplied daily. We tested these possibilities in previously fasted or nonfasted animals receiving TPN with variable amounts of calcium. Large calcium additives (90 mg/d) produced hypomagnesemia in nonfasted animals and increased the degree of hypomagnesemia observed in some of the fasted groups. Bone and muscle magnesium were occasionally altered, by high-calcium additives. Urine magnesium was increased, metabolism may have been dependent upon the amount of calcium added and magnesium supplied in TPN. Some of the derangements may have been dependent upon the state of fasting (and resultant phosphate-depletion syndrome).

Animals↗
PubMed1985

Effect of nutritional method on adaptation of the intestinal remnant after massive bowel resection.

Adaptation of the intestinal remnant with hypertrophy/hyperplasia and increased absorption occurs, ultimately, after massive bowel resection. During the early postresection period, the rate of the adaptational process may be influenced by the method of nutritional support. Nutrients given by mouth may support a strong stimulus for hypertrophy but may be incompletely absorbed from the short intestinal remnant. Intravenous nutrition, while eliminating the need for intestinal absorption, may not support the hypertrophic process of that remnant. We tested the effect of different nutritional methods on the hypertrophic and functional adaptation of the intestinal remnant after 90% resection in the rat. The methods included oral feeding with regular rat chow, oral feeding with elemental diet, intravenous nutrition, and a combination of intravenous nutrition and oral feedings. Full thickness intestinal wall wet weight and mucosal wet weight, as well as in vivo L-valine absorption, were measured 9 days after operation. Resected subgroups were compared to sham-operated controls receiving similar diets. Increase in the weight of the intestinal remnant and its mucosa was noted in all resected subgroups receiving oral diets. Valine absorption per unit length and/or unit weight was significantly decreased in rats receiving oral diets alone and rats receiving a combination of intravenous and oral elemental diet. Significant increase in intestinal and mucosal weight without decrease in valine absorption was demonstrated in the animals receiving a combination of intravenous nutrition and regular chow diet. The results suggest that a combination of intravenous nutrition and ad libitum oral feedings with regular diet may represent the best method of nutritional support in the early postresectional period.

Adaptation, Physiological↗
PubMed1985

Carcinoid tumors of the gastrointestinal tract.

Carcinoid tumors continue to be of specific clinical interest because of their diverse presentation, hormonal secretion, and malignant potential. One hundred ninety-two patients with carcinoid tumors were treated at the University of Iowa Hospitals and Clinics between 1938 and 1982. The most common location of these tumors was the appendix (30%), followed by the ileum (23%) and rectum (9%). Metastatic disease occurred in 29 per cent of all patients, with colonic and ileal tumors being the most likely to metastasize (40% and 35%, respectively). Surgical excision continues to be the treatment of choice in resectable tumors. Appendectomy alone proved effective in the treatment of appendiceal tumors less than 2 cm in diameter and without lymph node metastases. Local excision was also sufficient for the treatment of rectal tumors less than 2 cm in diameter and without invasion of the muscularis propria. Ileal, colonic, and locally advanced appendiceal and rectal tumors should be treated with radical excision including resection of the regional lymph nodes. The overall 5-year survival rate was 47%. Patients with metastatic disease had a lower survival rate (25%) compared with patients without metastases (64%).

Adolescent↗
PubMed1985

Male breast carcinoma.

Fifty men with primary breast carcinoma were seen between the years 1938 and 1983 at the University of Iowa Hospitals and Clinics. In most patients, there was a significant delay between the onset of symptoms and seeking medical advice (mean, 21 months; range, 1-156). The vast majority of patients were treated by simple, modified radical, or radical mastectomy. Ten patients underwent incisional or excisional biopsy with or without radiation because of locally advanced disease or distant metastases. Survival was comparable in the groups of patients treated with simple mastectomy (mean, 70 months), modified radical mastectomy (mean, 61 months), and radical mastectomy (mean, 78 months). Local recurrence occurred in 25 per cent of all patients, and this rate was not dependent on the operation performed. The data suggest that modified radical mastectomy is adequate therapy for local control and staging of the disease without reducing survival from that observed after radical mastectomy.

Adult↗
PubMed1985

Specimen xeroradiography after needle localization and biopsy of noncalcified, nonpalpable breast lesions.

Xeroradiography was used to detect and aid in needle localization of 63 nonpalpable breast lesions over an 8-year period. In 28 patients (44%), no microcalcifications were present in the lesion biopsied. Xeroradiographs of these noncalcified lesions after their submersion in water carried a clean and close resemblance to their in vivo appearance and aided the pathologist in localizing the abnormality within the biopsy specimen. This simple method improved the accuracy of the needle-guided biopsy while allowing excision of minimal breast tissue. A total of 17 (27%) lesions revealed malignancy. At the time of mastectomy, all carcinomas were at an early stage with no nodal involvement. No recurrence has been detected to date with a mean follow-up period of 24 months. This procedure requires close cooperation between the surgeon, radiologist, and pathologist.

Adult↗
PubMed1984

Hepatic artery ligation and chemotherapeutic infusion in the treatment of hepatic malignancy.

This report reviews the results of treatment of hepatic malignancies by intra-arterial infusional chemotherapy and hepatic artery ligation. Seventy-nine patients with liver metastases or primary hepatomas were treated by this technique between the years 1970 and 1982. The majority of patients had metastatic disease from colon and rectal cancers. The median and mean survivals in the total group was 10 and 14 months, respectively (including operative deaths). Patients with metastatic disease from colon and rectal cancers had better survival than those with metastases from other primaries. Patients with synchronous liver malignancy had better survival than those with metachronous disease. Length of survival correlated positively with the duration of chemotherapeutic infusions, the latter being frequently (in 42% of patients) interrupted because of catheter complications. A new technique utilizing implantable pumps can be expected to further improve the results by reducing catheter malfunction and prolonging treatment courses.

Antineoplastic Agents↗
PubMed1983

Uncommon features of giant colonic diverticula.

Two patients with giant colonic diverticula were operated upon within one week. Uncommon features of this rare condition were observed in both patients: 1) the diverticulum was located outside the sigmoid colon, 2) smooth-muscle fibers and ganglion cells were present in the wall of the diverticulum, and 3) free perforation into the peritoneal cavity was the presenting symptom. Barium enema in one patient showed no communication between the diverticulum and the colonic lumen, despite evidence of such communication on histologic examination. Both patients were successfully treated by simple excision of the diverticulum without colonic resection.

Adult↗
PubMed1983

Elevated intestinal disaccharidase activity in the streptozotocin-diabetic rat is independent of enteral feeding.

Specific and total activities of the disaccharidases, sucrase, maltase, and lactase are increased in mucosa of the small intestine of the streptozotocin diabetic rat. Because disaccharidases are essential for terminal digestion of carbohydrate, and disaccharidase deficiency is a common clinical problem, understanding the mechanisms regulating disaccharidase activity is important. In normal animals, disaccharidase activities are determined by route of feeding and are decreased by parenteral feeding. The indirect exocrine, endocrine, neurocrine, and paracrine functions of the gastrointestinal tract that are dependent on feeding via the gut are greatly decreased in parenteral as compared with enteral feeding. Hormone secretion by the gut and the pattern of response after feeding may be abnormal in diabetes and might be regulatory for disaccharidases. We tested the hypothesis that the elevated intestinal disaccharidases in diabetes are dependent on enteral feeding. Streptozotocin-injected rats (diabetics) and vehicle-injected rats (controls) were fed rat chow ad libitum for 4 days. A subset of control and diabetic animals was then killed to determine disaccharidase activity of the jejunum at the start of pair-feeding the elemental diet. The remaining animals were fed 60 cal/day of glucose, amino acid (Travasol), and electrolyte solution either intragastrically or intravenously for 4 days. Specific and total activities of disaccharidases were greater in diabetics than in controls under all feeding conditions. In controls, the pattern of activity of disaccharidase specific activity was initial greater than intragastric greater than intravenous. In diabetics, disaccharidase specific activities did not differ among groups. In both controls and diabetics, mean mucosal mass was highest initially; intermediate with intragastric feeding; and lowest with intravenous feeding. In both controls and diabetics, total disaccharidases decreased from initial to intragastric to intravenous. We conclude: (1) disaccharidase specific activity in controls is sensitive to feeding route and nature of diet, but is nearly independent of these factors in diabetics; (2) total disaccharidase activities respond to feeding stimuli in parallel with changes in mucosal mass in both controls and diabetics; and (3) the lack of feeding effect on the elevated specific activities of disaccharidases in diabetes suggests that this elevation is a response to the diabetic state and is independent of enteral factors such as luminal nutrition and gastrointestinal hormones.

Animals↗
PubMed1982

Effect of altered thyroid status on lysosomal enzymes and thymidylate synthetase activity in tumors and livers of host animals.

The purpose of this study was to determine whether or not alternations in tumor growth induced by changes in thyroid status were mediated through changes in key enzymes, whose activity is known to be influenced by thyroid hormones. The activities of three lysosomal enzymes (cathepsin B1, cathepsin D, and acid phosphatase) and thymidylate synthetase were measured in implanted mammary tumors as well as in the livers of host animals that were either euthyroid, hypothyroid, or hyperthyroid. Hypothyroidism produced no significant change in enzyme activity in the tumors. Hyperthyroidism, on the other hand, did cause a significant increase in the activity of all lysosomal enzymes in the tumors, but did not affect thymidylate synthetase levels. In the livers of the host animals, hypothyroidism produced a significant decrease in cathepsin B1 and a significant increase in acid phosphatase but did not change cathepsin D or thymidylate synthetase levels. Hyperthyroidism produced a significant increase in all enzymes measured in the livers of the host animals. The significant decrease in tumor weight with hypothyroidism did not correlate with the insignificant changes in the enzymes tested. Similarly, there was no correlation between the significant increase in the enzymes levels found with hyperthyroidism and the insignificant change in tumor weight.

Acid Phosphatase↗