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Biomedical subjects

E Steiger

Publications and source records attributed to E Steiger.

At least 19 recordsLinked to original sources
PubMed1995

Current use and clinical outcome of home parenteral and enteral nutrition therapies in the United States.

BACKGROUND & AIMS: Home nutrition support, especially when delivered parenterally, is very costly. The aim of this study is to examine current usage of home parenteral and enteral nutrition (HPEN) in the United States and the quality of therapy outcome. METHODS: Medicare HPEN use from 1989 to 1992 was analyzed to assess use, growth, and costs. National Registry information collected on 9288 patients treated with HPEN from 1985 to 1992 was used to assess disease distribution and therapy outcome. RESULTS: In the United States, there were approximately 40,000 parenteral and 152,000 enteral home patients in 1992. The usage of HPEN doubled between 1989 and 1992, and a large proportion was in patients with short survival. The prevalence of HPEN in the United States was 4-10 times higher than in other Western countries. Outcome data showed both therapies were relatively safe. The primary disease strongly influenced survival and rehabilitation, and age, per se, was not a reason to deny HPEN. CONCLUSIONS: Predicted quality survival at home for several months, rather than a specific diagnosis, seems to be the soundest justification for HPEN. Its role in terminal conditions and patients without primary gastrointestinal diseases needs further evaluations.

Adolescent↗
PubMed1993

Partial mastectomy without radiation is adequate treatment for patients with stages 0 and I carcinoma of the breast.

The treatment of potentially curable carcinoma of the breast has changed from one operation, radical mastectomy, to a flexible approach. At the Cleveland Clinic, we use four types of treatment for primary potentially curable carcinoma of the breast (Stages 0, I and II)--modified radical mastectomy, simple mastectomy, partial mastectomy with postoperative adjuvant radiation therapy and partial mastectomy without radiation therapy. The latter treatment (partial mastectomy without adjuvant radiation) is controversial. We recommend this procedure for patients with T(is) and T1 carcinomas that appear to be localized, without lymph node metastases, Stages 0 and I disease. The overall and disease-free survival rates are similar to those of patients having modified radical or partial mastectomy with radiation. Local recurrence is slightly higher at five years (11.0 percent) as compared with the other procedures, but at ten years, is only 16.1 percent, a figure comparable with patients having partial mastectomy with radiation (14.4 percent). For patients with Stages 0 and I carcinoma of the breast, the addition of postoperative radiation therapy after partial mastectomy seems to be unnecessary.

Breast Neoplasms↗
PubMed1992

Giant duodenal gallstone presenting as gastric outlet obstruction: Bouveret's syndrome.

In a 91 year old woman with nausea and vomiting, the diagnosis of Bouveret's syndrome was considered when a barium meal disclosed a cholecystoduodenal fistula and a giant filling defect in the duodenum. Because of her age and underlying medical illness, operative therapy was initially deferred. Repeated attempts to remove the intermittently obstructing duodenal gallstone endoscopically were unsuccessful using both endoscopic retrograde cholangiopancreatography retrieval baskets and an endoscopic mechanical lithotripter. The patient was referred for definitive operative therapy, and was discharged after a successful and uneventful enterolithotomy.

Aged↗
PubMed1991

Potential use of holmium lasers for angioplasty: evaluation of a new solid-state laser for ablation of atherosclerotic plaque.

Tissue effects of the mid-IR Holmium laser (emitting at a wave-length of 2130 nm) were evaluated. This wavelength is attractive because it combines high water absorption and easy transmission through standard optical fibres. The laser was pulsed with pulse durations in the range of 100 microseconds and repetition rates between 2 and 6 Hertz. For all experiments a repetition rate of 2 Hertz was used. The laser beam was coupled into waterfree quartz fibers with core diameters of 200 and 800 microns with an efficiency of 70 and 80%, respectively. Ablation of atherosclerotic plaque has been performed at an ablation threshold of 10J/cm2 for the 800 microns and 40J/cm2 for the 200 microns fibre. Removal of calcified plaque was possible. Ablation efficiency increased in a non-linear fashion with increasing pulse energies. The ablation rate per pulse was approximately 2 mm at energy fluences of 1000J/cm2 for the 200 microns fibre and 1.25 mm at energy fluences of 70J/cm2 for the 800 microns fibre; a further increase in energy densities did not result in higher ablation rates. On macroscopic examination only very limited thermal injury was found in crater adjacent tissue structures. Crater edges were even and did not reveal signs of crater charring or debris in the crater lumen. However, the histologic specimens revealed zones of thermal damage extending 100 up to 1000 microns lateral into adjacent tissue. Thermal damage increased with increasing radiant exposures and depended on the medium used.

Angioplasty, Laser↗
PubMed1990

A century of home parenteral nutrition for Crohn's disease.

During an 11-year period, 41 patients with Crohn's disease were placed on home parenteral nutrition (HPN) for a mean of 1,083 days (range: 33 to 3,258 days). Data were retrospectively analyzed to determine whether HPN had an effect on the course of their disease, i.e., on the number of operative procedures performed and the intensity of required medical therapy. Data represented information obtained during a total of 121 patient-years of HPN for Crohn's disease. The main indications for HPN were short bowel syndrome (66%) and high stoma output. Twenty-four of 41 patients (59%) underwent surgery for Crohn's disease during the course of HPN. There was no significant difference between the number of procedures performed per patient per year of Crohn's disease during pre-HPN and HPN periods (p greater than 0.25). Although there was no significant change in body weight, both serum albumin and transferrin levels increased during HPN (p less than 0.01 and p less than 0.01, respectively). Twenty-nine percent of patients were taking prednisone while on HPN, compared with 54% of patients during the pre-HPN period (p less than 0.01). HPN appeared to result in a significant improvement in the numerically assessed quality of life. During the HPN period, 24 patients had 1 or more HPN-related complications that required 1 to 13 hospital admissions (mean: 1.8). These complications included catheter sepsis in 19 patients, blocked or damaged catheters in 15 patients, and dehydration and/or electrolyte imbalance in 5 patients. Eight patients died, with 7% of deaths secondary to catheter-related sepsis. Although permanent HPN is associated with an identifiable morbidity and mortality and is not associated with a reduction in the frequency of surgery for Crohn's disease, benefits include a decrease in the intensity of medical therapy, an improvement in patients' nutritional state, and a significant perceived improvement in patients' quality of life. Without HPN, we believe all patients would have died secondary to malnutrition and/or dehydration.

Adult↗
PubMed1990

[Thermal sterilization in the revision of the sterilization section of the East German medical reference].

The G-value estimating sterilization-process is offered and compared with other scales selected from bibliography. Based on the kinetic of destruction of microorganisms the G-value considers every parts of sterilization-processes especially with reference to peak-sterilization. It takes into account the resistance of microorganisms, the safety index and also the influence of germ reducing measures, e.g. cleaning, before the sterilization-processes. Finally a formula is presented to transform G- and F-values each other.

Bacterial Physiological Phenomena↗
PubMed1989

Psychosocial issues of nutritional support. A multidisciplinary interpretation.

In many cases, initiation of specialized nutritional support is a final attempt at medically managing illness for which other treatments have failed. Patients may have suffered for months or even years with their underlying diseases and are usually aware that poor response to nutritional support and concurrent therapies may lead to surgical intervention or more complex treatment. In some cases, there may be few alternatives left to pursue. For such patients, this paints a very stressful picture. If we as caregivers are empathetic to each patient's situation, we are better able to offer the support that these patients need. Health care professionals must keep patients informed of treatment plans and encourage participation in the planning process--during hospitalization, through the discharge phase, and after hospitalization. We need to pay close attention to those needs, whether nutritional support is short-term during hospitalization, prolonged, or permanent. The health care environment is demanding greater proficiency in cost containment and quality assurance in the delivery of care. Complex patient cases are becoming more difficult to manage as time constraints and resources become more restrictive. The ingenuity and imagination of health care providers trying to find ways to continue providing high-quality and safe care to patients are being tested daily. These worthwhile goals can be met only through cooperation, communication, and support among all levels and disciplines involved with the delivery of care. Feelings of helplessness, dependence, and loss of control can be diminished if health care providers maintain optimistic, confident attitudes, offer positive reinforcement for patients successes, and try to restore hope during this stressful period in patients' lives.

Adult↗
PubMed1989

[Effect of laser irradiation on atherosclerosis vascular segments in relation to wave length and pulse width].

The interaction of pulsed Nd:YAG laser radiation and atherosclerotic vessel wall is reported. The effects in the area of radiation were examined at an infrared, green, and ultraviolet wavelength at variable pulsewidths. The laser beam was focused directly on the plane surface of the tissue. The macroscopic and histologic examinations demonstrate that thermal damage of tissue is higher at an infrared wavelength than at a green wavelength and respectively at an ultraviolet wavelength. With increasing pulsewidth an increase of coagulation and necrosis of plaque material and adjacent vessel wall can be noted. The results show that for the precise ablation of plaque without adjacent vessel wall injury short pulsed ultraviolet radiation is preferable.

Angioplasty, Balloon, Coronary↗
PubMed1988

Nitrogen balance in adult hospitalized patients with the use of a pediatric amino acid model.

Normalization of plasma amino acid patterns and that relationship to improved nitrogen balance was studied using a pediatric-specific amino acid solution in 21 adults requiring total parenteral nutrition therapy. There was a significantly positive correlation between improved nitrogen balance and the amino acids cystine, tyrosine, total cysteine/cystine, and ornithine. When additional cysteine was added to the solution of 11 subjects, taurine also correlated with nitrogen balance. Despite higher amounts of histidine in solution, plasma amino acid levels were not normalized. These amino acids, heretofore considered nonessential, may be required in specific molar ratios in stress. The use of a 30% branched-chain pediatric-balanced amino acid solution resulted in near normalization of plasma amino acid levels and group mean positive nitrogen balance.

Adult↗
PubMed1986

Phase I trial of intraperitoneal chemotherapy with 5-fluorouracil and citrovorum factor.

A Phase I trial of intraperitoneally administered 5-FU and citrovorum factor was performed in eight patients with a variety of malignancies. Both drugs were given according to a single weekly dose schedule in a volume estimated to be 2000 cc, including residual ascites. Citrovorum factor 50 mg was given first, immediately followed by 5-FU 1000-3400 mg, according to a dose-escalating schedule. Myelosuppression proved to be the dose-limiting toxicity, though mucositis, diarrhea, nausea, and abdominal pain were also produced. Six patients failed to respond to therapy. One patient with malignant mesothelioma showed a significant decrease in the production of malignant ascites and a transient conversion of peritoneal fluid cytologies from positive to negative, while a second patient with pancreatic cancer showed conversion of peritoneal fluid cytologies from positive to negative and demonstrated an objective partial response of an hepatic metastasis. Dosage adjustment according to body surface area would seem indicated by the toxicity data, with a 5-FU dose of 1200 mg/m2 body surface area and citrovorum factor 50 mg/m2 being recommended for Phase II trials of this combination of drugs given according to this weekly schedule.

Antineoplastic Combined Chemotherapy Protocols↗