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Biomedical subjects

D Fleischer

Publications and source records attributed to D Fleischer.

At least 19 recordsLinked to original sources
PubMed1997

Rapid assay of plasma brain natriuretic peptide in the assessment of acute dyspnoea.

AIM: Recognition of heart failure may be difficult in patients presenting with acute dyspnoea, particularly in the presence of chronic airways obstruction or obesity. In a previous study of patients with acute dyspnoea, we showed that the measurement of plasma brain natriuretic peptide (BNP)-a hormone secreted in increased amounts by the failing heart-accurately distinguishes heart failure from primary lung disorder. The aim of the present study was to develop a rapid assay for BNP and evaluate its diagnostic use in patients acutely hospitalised for increasing dyspnoea of any cause. METHODS: A rapid assay for plasma BNP, providing results within 24 h of blood collection, was developed without loss of precision. The results of the rapid and previously established BNP assays were highly correlated (r = 0.9). To determine the diagnostic value of the rapid assay, measurements were undertaken on the day of admission in 123 breathless patients (mean age 68.3, range 23 to 90 years) and related to conventional diagnostic assessments and final outcome. RESULTS: In patients diagnosed and treated urgently for clinical heart failure, plasma BNP was significantly higher (115 (SE 13) pmol/L, n = 39) than in those without clinical heart failure (33 (5) pmol/L, n = 84, p < 0.001). Using a cut-off of 50 pmol/L for the presence of heart failure, there was discordance between BNP level and clinical diagnosis in 21 of 123 cases. Reassessment after independent analysis of discordant cases increased the difference in BNP level in the presence (123 (13) pmol/L, n = 43) or absence (24 (1.5) pmol/L, n = 80) of heart failure. Using two way analysis of variance, no further improvement in discrimination was found when chest radiographs were used together with the BNP data. CONCLUSION: Rapid BNP assays are practicable and provide accurate information on cardiac status-superior to chest radiographs in many cases-early in the course of the patient's presentation with acute dyspnoea.

Acute Disease↗
PubMed1997

Use of the 25 mm flanged esophageal Z stent for malignant dysphagia: a prospective multicenter trial.

BACKGROUND: An initial multicenter study using a 21 mm flanged esophageal Z stent demonstrated excellent palliation but an 11% immediate complication rate at placement and a 27% migration rate at 1 month. This North American multicenter trial prospectively studied a 25 mm flanged Z stent to define its palliative ability and whether the increased diameter affected placement or migration problems. METHODS: Fifty patients who had esophageal Z stents at seven university or regional referral hospitals were prospectively studied. Indications for prosthesis placement, previous therapy, patient demographics, incidence of concomitant tracheoesophageal fistula, and degree of dysphagia were defined, as were procedural and subsequent stent-related problems, survival times, the ability to occlude a tracheoesophageal fistula, and subsequent degree of dysphagia. RESULTS: Twenty-four patients had infiltrating malignancy (16 exophytic and 10 extrinsic), 9 of whom had concomitant tracheoesophageal fistulas. Ten patients (20%) had misplaced stents requiring retrieval and replacement, 12 patients (24%) had subsequent stent-related problems including exsanguination (2), aspiration (3), tumor overgrowth (3), and postplacement migration (4) (8%). There was statistically significant improvement in prestent versus poststent dysphagia and two thirds of patients had complete occlusion of their tracheoesophageal fistula. CONCLUSIONS: Redesign of the esophageal Z stent has decreased the migration rate without increasing placement or subsequent erosion problems. Its efficacy appears comparable to the currently marketed Z stent for the palliation of malignant dysphagia and occlusion of tracheoesophageal fistula.

Aged↗
PubMed1995

Esophageal cancer: diagnosis and treatment.

A review of diagnosis and treatment of esophageal cancer is presented. Symptomatic cancer of the esophagus is usually too far advanced for a cure to be offered. Alcohol and tobacco are the common risk factors of this disease. Endoscopy is the diagnostic method of choice. Management of cancer and survival of patients depend on the stage of the disease; therefore, accurate staging is vital in the diagnostic evaluation. Endoscopic ultrasound has become a powerful staging tool, and it must be complemented by conventional imaging. Surgery, chemotherapy, and radiotherapy are used in varying combinations for cure. Palliation of symptoms is important, and it is the only possible form of therapy for some patients. The therapeutic options need to be carefully considered to suit the individual needs of each patient.

Adenocarcinoma↗
PubMed1994

Diffuse hemorrhagic gastroenteropathy: report of a new entity.

An apparently novel entity, diffuse hemorrhagic gastroenteropathy (DHG), in a 70-year-old female who had an unremitting course of chronic gastrointestinal blood loss for 3 years requiring transfusion of more than 200 units of packed red blood cells over this period is reported here. Endoscopy showed diffusely hemorrhagic mucosa in the stomach, duodenum, and small bowel. Full-thickness biopsy of the stomach and small intestine revealed luminal narrowing of capillaries and post-capillary venules within the lamina propria due to swelling and some proliferation of the endothelial cells with margination and emigration by neutrophils as well as partial occlusion of some vessels by fibrin thrombi. DHG may represent a new entity characterized by mucosal hemorrhage due to local mucosal ischemia of the gastrointestinal tract secondary to a small vessel "vasculopathy" apparently restricted to this site.

Aged↗
PubMed1993

The hepatic interleukin-6 receptor. Studies on its structure and regulation by phorbol 12-myristate 13-acetate-dexamethasone.

Recombinant human 125I-interleukin-6 (IL-6) was cross-linked with the homobifunctional reagent disuccinimidyl suberate to human hepatoma cells (HepG2). Three recombinant human 125I-IL-6-containing complexes of apparent molecular masses of 100, 120, and 200 kDa were immunoprecipitated with specific antibodies to human IL-6 or to the 80-kDa IL-6 receptor subunit. We show by immunoprecipitation, peptide mapping, and by the use of a cleavable heterobifunctional cross-linker (Denny-Jaffe reagent) that different polypeptides are involved in the formation of the 100- and 120-kDa IL-6-containing complexes. The molecular compositions of the 100- and 120-kDa cross-linked complexes were identified. The 100-kDa complex consisted of one ligand and one IL-6 receptor subunit, glycoprotein 80 (gp80), whereas the 120-kDa complex was found to be composed of one ligand and a polypeptide which was immunoprecipitable with the monoclonal antibody AM64 directed against gp130. Exposure of HepG2 cells to phorbol 12-myristate 13-acetate (PMA) or PMA-dexamethasone led to an increase in the 80-kDa IL-6 receptor mRNA and functional receptor protein. Whereas treatment of HepG2 cells with PMA led to an increase in the formation of gp80.gp130.IL-6 complexes determined by cross-linking, no corresponding increase in high affinity binding sites was found. The existence of a third IL-6 receptor subunit present in limiting amounts on HepG2 cells is proposed to explain this discrepancy. Evidence is presented that the 80-kDa IL-6 receptor up-regulation by PMA-dexamethasone is caused by the depletion of protein kinase C since the protein kinase C inhibitor staurosporine mimics the effect of PMA-dexamethasone.

Cells, Cultured↗
PubMed1990

Endoscopic lithotripsy of biliary stones.

Historically, gallstone therapy has been surgery. Gastrointestinal endoscopists and radiologists are now becoming increasingly active in the definitive management of both cholelithiasis and choledocholithiasis. Today, for uncomplicated cholelithiasis and for many cases of choledocholithiasis in patients without increased surgical risk, biliary surgery remains the recommended treatment by internists and surgeons alike. However, with an increased battery of available therapeutic modalities, management decisions and strategies are becoming more complex and the treatment of biliary stone disease in the future will be different than it was in the past.

Cholelithiasis↗
PubMed1989

Endoscopic laser therapy for esophageal cancer: present status with emphasis on past and future.

Although the major initial application for endoscopic laser therapy was for the management of gastrointestinal hemorrhage, it is now more common to use the laser endoscopically for the treatment of gastrointestinal neoplasms. A major body of literature surrounds the use of endoscopic laser therapy for esophageal cancer. The initial patient evaluation to determine if laser therapy is indicated includes a contrast radiograph, a screening endoscopy, and an imaging study. After these tests have been performed, it can be determined whether endoscopic laser therapy (ELT) is the best of the many endoscopic options. There is some difference of opinion as to the specifics of the treatment technique, and these are described. There is general agreement from reviewing the clinical data that it is possible to open the obstructed lumen in a large majority of cases and that functional success (the ability to achieve technically good results as well as clinical improvement without complications) is also possible in the majority of patients. Despite the information suggesting the benefits of ELT for esophageal cancer, there are both conceptual and technical limitations to the current approach to therapy. These limitations as well as potential future applications are discussed.

Esophageal Neoplasms↗
PubMed1989

Development of a laser balloon for the treatment of gastrointestinal obstruction.

This work describes the initial results using a laser balloon in a canine model in an attempt to deliver the energy in a circumferential pattern. A balloon catheter, 2 cm long and 3 mm in diameter, was developed. Using a standard cw 100 watt Nd:YAG laser, a 600 micron fiber was tapered to 200 microns and passed through the proximal end of the balloon. Laparotomies were performed on mongrel dogs 14-18 kg in weight. After a gastrotomy, the gastric mucosa was exposed and rugal folds were pulled over the balloon to create a cylinder. Using power settings between 10 and 60 watts, and pulse durations between 10 and 40 seconds, radial energy was delivered and the tissue was examined for both gross and histologic effects. Circumferential zones of coagulation and necrosis were demonstrated.

Animals↗
PubMed1989

[Carpal tunnel syndrome. Late results following surgical treatment].

Of 64 patients, who had undergone operation because of a carpal tunnel syndrome in the years 1982 to 1984, 39 patients could be reinvestigated. The measurement of the distal motor latency was useful as well in the diagnosis as in the course of the CTS. After operation the distal motor latency was normal in about 70.7% of the cases. A subjective improvement showed 69.9% of the patients. Patients with preoperative normal motor latency reached similar postoperative results. The diagnosis cannot made only on the basis of electrophysiologic pathological values, but has to take into account the clinical picture and neurological findings. Phalen's and Tinel's signs are useful helps in the diagnosis of CTS. The results after decompression of the median nerve depend on the length of history.

Adult↗
PubMed1987

Depression and body image following mastectomy and lumpectomy.

A twenty year debate about the appropriate surgery for breast cancer has resulted in two clinical trials comparing radical vs more conservative operations. Despite the favorable results of these trials, the majority of breast cancer patients in North America still undergo mastectomy. We investigated the psychological and social adjustment following total and partial mastectomy in a group of patients randomly assigned to one or the other operation (National Surgical Adjuvant Breast Protocol--B-06). Total mastectomy patients showed higher levels of depression and less satisfaction with body image. Partial mastectomy patients did not display any measurable increase in fear of recurrence. Patients undergoing radiation therapy showed surprising increase in depressive symptoms. Radiation therapy could well be more frightening to breast surgery patients than had been anticipated. These patients may benefit from some anticipatory counselling.

Body Image↗
PubMed1987

Palliative bipolar electrocoagulation therapy of obstructing esophageal cancer.

In a multicenter pilot study, a prototype bipolar electrocoagulation tumor probe was employed for palliation of obstructing circumferential esophageal cancer in 20 patients. Mean number of initial treatment sessions was 1.7. Dysphagia and tumor channel size improved significantly after treatment. Mean treatment interval before repeat treatment was 7.6 weeks. Major complications included delayed hemorrhage (two patients) and esophageal-pulmonary fistula (two patients). This new device may provide a less expensive alternative to laser or surgery for palliation of malignant esophageal obstruction.

Adenocarcinoma↗