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Biomedical subjects

H Boot

Publications and source records attributed to H Boot.

47 records · Page 3Linked to original sources
PubMed1995

Assessment of sucralfate coating by sequential scintigraphic imaging in radiation-induced esophageal lesions.

The value of mucosal protection with sucralfate in cases of gastric ulceration is well documented. Although sucralfate is advocated as treatment of esophageal lesions, we found it to be of limited value in the management of radiation-induced esophagitis; in a pilot study of 10 cases, minor relief of symptoms, with analgetics still required, was noted in 4 patients, and no improvement was seen at endoscopy after 6 weeks of treatment in any patient. To see if this might be the result of inadequate mucosal coating, we administered sucralfate labeled with technetium 99m to 26 patients with endoscopically proven esophagitis secondary to irradiation for esophageal carcinoma. The degree of coating was evaluated according to persistence of the radionuclide in the affected esophageal segment. Scans were performed at regular intervals for 120 minutes after administration of 150 MBq 99mTc-sucralfate. Although scans were positive for radioactivity in 24 of 26 (92%) patients, only 8 (31%) of these represented selective binding of sucralfate to tissue. In the other 16 cases, scans were positive for sucralfate and albumin, indicating nonspecific retention most likely caused by concomitant esophageal stenosis. Residual radioactivity was observed for 30 minutes or more in 11 (42%) patients, but scans were positive for radioactivity after 1 to 2 hours in only 4 (15%). The duration and intensity of tracer accumulation were similar in both acute lesions an chronic radiation damage. These findings suggest that the inability of sucralfate to alleviate irradiation-induced odynophagia may be related to insufficient duration of adherence of this compound to damaged esophageal mucosa.

Aged↗
PubMed1995

Indices from flow-volume curves in relation to cephalometric, ENT- and sleep-O2 saturation variables in snorers with and without obstructive sleep-apnoea.

In a group of 37 heavy snorers with obstructive sleep apnoea (OSA, Group 1) and a group of 23 heavy snorers without OSA (Group 2) cephalometric indices, ENT indices related to upper airway collapsibility, and nocturnal O2 desaturation indices were related to variables from maximal expiratory and inspiratory flow-volume (MEFV and MIFV) curves. The cephalometric indices used were the length and diameter of the soft palate (spl and spd), the shortest distance between the mandibular plane and the hyoid bone (mph) and the posterior airway space (pas). Collapsibility of the upper airways was observed at the level of the tongue base and soft palate by fibroscopy during a Müller manoeuvre (mtb and msp) and ranked on a five point scale. Sleep indices measured were the mean number of oxygen desaturations of more than 3% per hour preceded by an apnoea or hypopnoea of more than 10 s (desaturation index), maximal sleep oxygen desaturation, baseline arterial oxygen saturation (Sa,O2) and, in the OSA group, percentage of sleep time with Sa,O2 < 90%. The variables obtained from the flow-volume curves were the forced vital capacity (FVC), forced expiratory and inspiratory volume in 1 s (FEV1 and FIV1), peak expiratory and peak inspiratory flows (PEF and PIF), and maximal flow after expiring 50% of the FVC (MEF50). The mean of the flow-volume variables, influenced by upper airway aperture (PEF, FIV1) was significantly greater than predicted.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗
PubMed1994

Etoposide, leucovorin, 5-fluorouracil (ELF) combination chemotherapy for advanced gastric cancer: experience with two treatment schedules incorporating intravenous or oral etoposide.

BACKGROUND: Because the ELF regimen (etoposide, leucovorin and 5-FU) in advanced gastric cancer was recently advocated as an active, non-toxic schedule, and drug scheduling of etoposide proved to be important, we performed a pilot study using the original ELF regimen (A), followed by a phase II study of a modified ELF schedule (B) using oral etoposide. PATIENTS AND METHODS: Of the 40 patients entered in the consecutive trials 15 were treated according to the original ELF (A) and 25 according to the modified ELF regimen (B). The primary tumor was originally in the stomach in 22 and the oesophago-cardiac junction in 18. In 6 there was locally advanced and in 34 metastatic disease. RESULTS: Toxicity was mild in ELF (A): grade III leukopenia in 6/63 cycles. The ELF (B) caused slightly more myelosuppression: grade III leukopenia in 4/102 and grade IV in 2/102 cycles, resulting in septicaemia in two patients, and toxic death in one. No severe thrombocytopenia was seen. Hemorrhage (4 cases) was exclusively related to tumor progression. Response rates were 7% (0%-21%) and 28% (10%-46%) for ELF (A) and ELF (B), respectively. Subjective response, however, leading to a clinically significant decrease of dysphagia and pain, was seen in 53% and 56% of the patients. CONCLUSIONS: The modified ELF regimen (B) can be applied safely on an out-patient basis, and shows moderate activity in advanced gastric cancer which leads to an improved quality of life.

Administration, Oral↗
PubMed1989

Pouchitis (pouch ileitis).

Construction of a continent ileostomy or ileo-anal reservoir after (procto)colectomy has provided many patients suffering from inflammatory bowel disease-in particular ulcerative colitis or polyposis coli--with a major improvement in their social wellbeing. However, complications are rather frequent and pouchitis is one of the most important chronic ones, to be defined as the combination of bothersome clinical symptoms (abdominal pain, bloating, increased faecal output, sometimes fever) with evident endoscopic abnormalities of the reservoir ileal mucosa (oedema, reddened mucosa, minor flat up to large irregular ulcerations). The contribution of pouch biopsies is limited, because chronic inflammation is always demonstrable and evidence of acute inflammation is only rarely present. Although backwash ileitis does not promote the occurrence of pouchitis, the immunological mechanism might be highly comparable. Cultures of faecal content for specific pathogens is necessary; bacterial anaerobic or aerobic overgrowth appears to be of no major significance in the development of pouchitis. Nevertheless, a short-term course with metronidazole is nearly always effective, although recurrences are far from rare. In this situation a course of corticosteroid enemas or even maintenance therapy (2-3 wk) should be advised. Experience with mesalazine compounds is limited and should be expanded.

Anastomosis, Surgical↗
PubMed1988

Cardiac tamponade from misplaced central venous line in pericardiophrenic vein.

A patient in whom a left internal jugular vein catheter had first migrated into the left pericardiophrenic vein, and subsequently had perforated into the pericardium leading to a cardiac tamponade is described. Although this malposition has rarely been reported, it does not seem to be so infrequent, as three other similar misplacements have occurred in our institution. This malposition can be prevented by a high degree of suspicion, preferential use of the right internal jugular vein for catheterization, routine use of a J-tipped guidewire, limiting the depth of insertion of the guidewire during cannulation, routine roentgenographic control of radiopaque catheters, and (slow) injection of a small volume of radiopaque dye through the central venous catheter.

Adult↗