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Biomedical subjects

J H Lang

Publications and source records attributed to J H Lang.

At least 37 records · Page 2Linked to original sources
PubMed1991

Treatment of malignant ovarian germ cell tumors with preservation of fertility: a report of 28 cases.

Preservation of fertility was carried out in 28 young patients with malignant germ cell tumors of the ovary from 1962 through 1987. The pathologic diagnosis was immature teratoma in 16, endodermal sinus tumor in 7, dysgerminoma in 2, and germ cell tumor of mixed type in 3. At laparotomy, 16 patients were proved to have stage I disease, 1 had stage II disease, 9 had stage III disease, and 2 had stage IV disease. The tumor was confined to one ovary in all 22 cases treated for the first time, and the preserved ovary and uterus were normal in all 6 referred cases with recurrent diseases. Postoperative chemotherapy was given to all patients except two with stage I immature teratoma. Persistent remission was achieved in 22 patients; 5 patients died and 1 was lost to follow-up. The duration of follow-up was more than 1 year for all surviving patients, more than 3 years in 16 cases (72.7%), and more than 5 years in 13 cases (59.1%). The menstrual periods were normal in all except 3 cases, of whom 2 were below the age of 12 and one failed to menstruate at the age of 21 with a hypoplastic uterus and underdeveloped secondary sex characters. Among 12 married patients, 7 of 10 desirous of child-birth became pregnant during follow-up. Of these, 6 had a normal term delivery and 1 is currently pregnant. The preliminary conclusion is that preservation of fertility for young patients with malignant germ cell tumors of the ovary, regardless of the stage of the disease, is a safe and practicable procedure in the absence of involvement of the contralateral ovary and uterus.

Adolescent↗
PubMed1989

Intestinal metastasis and operation in ovarian cancer: a report on 62 cases.

Among numerous sites of metastasis in ovarian cancer, the most common and serious one is the intestinal tract. However, reports on ovarian malignancy with special reference to intestinal metastasis and its surgical treatment have been few. This paper is a retrospective analysis of cases of ovarian cancer with intestinal metastasis treated at the Peking Union Medical College Hospital. Sixty-two cases of ovarian cancer with intestinal metastatic tumours larger than 2 cm in diameter were treated between January 1982 and October 1987, accounting for 28.2% of a total of 221 cases of ovarian cancer admitted during the same period. Twenty-seven patients were operated on for the first time, 24 were referred from other hospitals where the cancer was considered 'inoperable' during the initial surgery, and 11 were recurrent cases. Of the 62 cases, 51 had epithelial cancer and 11 had germ-cell tumours. Metastasis to the large intestine was observed in all 62 cases, of which the rectosigmoid was involved in 59 (95.2%). Metastasis to the small bowel was observed in 26 cases (41.9%). Superficial or serosal invasion occurred in 40 cases (64.5%), and deep invasion, in which the muscularis or both muscularis and mucosa were involved, occurred in 22 cases. A complete or optimal resection of the intraperitoneal tumours was achieved in 46 cases (74.2%). Resection of metastatic tumours of the intestine was performed in 40 cases, of which a repair of the perforated intestinal wall was required in 19. Resection of the bowel was carried out in 22 cases, and a colostomy was done in 6. Postoperatively, all patients were followed up for at least 6 months. During follow-up, 17 patients (27.4%) survived, 39 died and 6 had recurrent disease. The mean survival time for 17 patients achieving complete remission was 30.3 months. Of these, ten have survived for more than 2 years, and seven for more than 3 years. The survival rate was higher in patients with germ-cell tumours and in those having superficial invasion of the intestinal wall, optimal cytoreduction of tumour and relatively sufficient postoperative chemotherapy. However, only the latter two prognostic factors were found to bear statistical significance. The role and feasibility of bowel surgery in ovarian cancer are discussed.

Adolescent↗
PubMed1989

Lymph node metastasis and retroperitoneal lymphadenectomy in ovarian cancer.

While clinicians are devoting themselves to the study of the behaviour of ovarian cancer as well as to the search for more effective therapeutic modalities, little attention has been paid to an important route of metastasis in this group of diseases: retroperitoneal spread through the lymphatic pathway. The purpose of this report is to present a 5-year experience of a prospective study on lymph node metastasis in patients with ovarian cancer through retroperitoneal lymphadenectomy at the Peking Union Medical College Hospital. From June 1982 through May 1987, retroperitoneal lymph node dissection was performed in 105 cases of ovarian cancer. Seventy-seven (73.3%) were histologically diagnosed as cancer of epithelial origin, and 28 (26.7%) as germ-cell tumours. The overall incidence of retroperitoneal positive nodes was 54.3% (57/105). The incidence of positive pelvic nodes was 46.7% (49/105), and that of positive para-aortic nodes was 37.5% (30/80). In 69 patients who underwent systemic lymphadenectomy, 39 were found to have glandular involvement; in these 39 patients both aortic and pelvic nodes were positive in 19 cases (48.7%), aortic nodes were positive and pelvic nodes negative in 7 cases (18.0%), and pelvic nodes were positive and aortic nodes negative in 13 cases (33.3%). Preoperative lymphography was performed in 30 cases. The positive and negative correspondence rates with the pathological findings were both 83.3%. In 38 cases in which the primary cancer originated in the left ovary, 17 (44.7%) were found to have positive pelvic nodes, whereas in 25 cases with primary cancer arising in the right ovary only 2 (8%) had metastasis of the ipsilateral pelvic nodes. The lymph nodes obtained from 22 patients with positive nodes and sufficient preoperative chemotherapy were carefully examined under the microscope for the effects of the drugs. Some cellular degeneration of the lymph node metastasis was observed in only one of the 15 cases of epithelial cancer, and no response at all was noted in three cases of immature teratoma. Cellular degeneration accompanied by extensive necrosis was demonstrated in the metastatic tumours of the lymph nodes in all four cases of endodermal sinus tumour. Seventy-two patients were followed-up for at least 2 1/2 years. The rate of complete remission was 46.7% (14/30) in patients with negative nodes, but only 33.3% (14/42) in those with positive nodes. However, the difference was not statistically significant.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Conservative surgery in tubal pregnancy].

The results of 10 cases of tubal pregnancy treated by conservative surgery from Jan. 1983 to May 1987 were presented. A linear incision on the pregnant tube was used for evacuation of tubal conceptus in 8 cases, in which the incision were reclosed in 3 and left unapproximated as a "open-window" in 5 cases. In the remaining two cases resection + reanastomosis or resection + implantation of the tube into the cornu was done in each. Hysterosalpingography (HSG) was perl formed after operation in 9 cases. Tubal patency was confirmed in 6. One case with only the diseased tube left became pregnant soon after operation before a HSG could be done. The postoperative pregnancy rate was 77.8% in 9 patients desirous of childbirth. There was no repeat ectopic pregnancy. The liberal use of laparoscopy, ultrasound and serum hCG testing for early diagnosis was emphasized.

Adult↗
PubMed1989

[Lymphangiography in ovarian cancer].

Lymphangiography (LAG) and retroperitoneal lymphadenectomy were performed in 30 patients with ovarian cancer from May 1985 to Oct. 1986. The results showed that preoperative radiologic-postoperative histologic correlation was 83.3%. There was no false negativity in lymphographic diagnosis of the pelvic node metastases but two false negatives in the para-aortic node. The single most reliable criterion for LAG diagnosis of metastases was a filling-defect in the nodes. The value of LAG as an aid in staging and planning therapy was discussed.

Adolescent↗
PubMed1986

Lymph node metastasis of ovarian cancer: a preliminary survey of 74 cases of lymphadenectomy.

Retroperitoneal lymph node dissection was performed in 74 cases of various types of ovarian malignancies. Fifty-three (71.6%) were histologically confirmed as cancer of epithelial origin and 19 (25.7%) as germ cell tumors. The results indicate that lymphatic metastasis is an exceedingly important route of spreading of this group of malignant diseases. The overall incidence of retroperitoneal positive nodes was 56.8% (42/74). In 49 cases undergoing systemic lymphadenectomy 32 were found to have glandular involvement, of which both aortic and pelvic nodes were positive in 17 cases (53.1%), aortic nodes positive but pelvic negative in six (18.8%), and pelvic nodes positive but aortic negative in nine (28.1%). In 32 cases with primary cancer that originated from the left ovary, 17 (53.1%) were found to have positive pelvic nodes, whereas in 19 cases with cancer arising from the right ovary, only one (5.3%) had metastasis of ipsilateral pelvic nodes. The routes of lymphatic spreading and the significance of lymphadenectomy in ovarian cancer are discussed.

Female↗
PubMed1983

The plasma contact system in atopic asthma.

An in vitro test for the rate of appearance of kallikrein in plasma due to contact system activation by dextran sulfate at 0 degree C was applied to plasmas of 19 atopic asthma patients and 19 age- and sex-matched controls without atopy. The average prekallikrein activation rate was markedly higher in the plasmas of the atopic patients. Mean endogenous heparin levels were also elevated.

Adolescent↗
PubMed1981

Prekallikrein-Kallikrein conversion rate as a predictor of contrast material catastrophies.

An in vitro is described that attempts to detect patients with a potential for adverse systemic reactions to contrast material. This test involves measuring the rate of conversion of prekallikrein to kallikrein under certain standard conditions. In a preliminary retrospective study, the test could be used to identify such patients with a sensitivity of 88%, a specificity of 82%, and a predictive value of 79%.

Anaphylaxis↗
PubMed1979

Complement and contrast material reactors.

Patients showing systemic reactions to intravascular contrast media and patients receiving contrast media without reaction have significantly different mean values (p is less than 0.05) for functionally determined serum C1-esterase inhibitor (C1 INH) and total hemolytic complement (CH50). The lower concentration of these components in reactors appears in baseline serum samples (as well as after injection), and suggests that many anaphylactoid reactions to contrast media are conditioned by earlier complement consumption, and result directly from contrast-induced activation of complement, and other activation system components in the presence of inhibitor depression.

Complement C1 Inactivator Proteins↗
PubMed1979

Complement and coagulation: causative considerations in contrast catastrophies.

Earlier studies suggest that adverse reactions to injected radiographic contrast media are idiosyncratic. In an attempt to gain a better understanding of pathophysiologic events underlying these reactions, rabbit models injected with lethal dose ranges of a cholangiographic contrast material were studied. These animals showed activation of both the complement and coagulation systems. Externally applied heat potentiated complement consumption and increased mortality. Depleting complement components C3-C9 by cobra venom factor did not prevent activation of coagulation or diminish mortality. However, depleting fibrinogen diminished complement activation and markedly diminished mortality. Heparin, administered at several hourly intervals after contrast challenge, also diminished mortality. These studies suggest that the adverse effects of contrast media in this model system are mediated chiefly by the coagulation system, and that complement, if it participates deleteriously, must involve components up to, but not including, C3. A logical role for the inhibitor of C1 esterase in adverse contrast reactions is considered.

Ancrod↗