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Biomedical subjects

J Isenberg

Publications and source records attributed to J Isenberg.

32 records · Page 2Linked to original sources
PubMed1993

Cyclosporin A: early or delayed onset by prophylactic immunosuppression?

In a prospective randomized trial, 57 renal transplant patients received sequential immunosuppression consisting of lymphocytoglobulin (ALG), azathioprine, and steroids for 14 days (group A) and another 57 patients for only 2 days (group B). In each case therapy was continued with cyclosporin A and steroids. The purpose of this study was to find the most favourable time to switch over to continuous cyclosporin A therapy with avoidance of its nephrotoxic side-effects during the perioperative phase. As a consequence of ALG intolerance, conventional immunosuppression had to be changed in group A after a mean of 7.8 days, as opposed to 2.1 days in group B. The patients receiving a prophylactic therapy with ALG, azathioprine, and steroids for 14 days (group A) had to be dialysed at a significantly greater frequency than patients with an early start to cyclosporin A (group B) from the second to the fourth week. Patient survival rates 1 and 2 years after transplantation of group A (95 and 92%) and group B (96 and 92%) were not distinct, and there was no significant difference in graft survival rates of group A (79 and 79%) and B (89 and 82%) after the same time. A delayed start of cyclosporin A after 14 days showed no further advantage but rather a significantly greater frequency of dialysis; thus the early onset of cyclosporin A treatment post-transplant is preferable.

Adult↗
PubMed1977

A data retrieval system for the eye clinic. I. Clinical aspects.

The use of a data retrieval system for patients' ophthalmic records is described. Input is by using simple forms and output is in batch. The system is adaptable for on-line use as soon as a terminal is established in the clinic. To date there are over 6000 patients on file, of whom about one half have no other form of ophthalmic medical record.

Humans↗
PubMed1977

A data retrieval system for the eye clinic. II. The programmed system.

The programmed system of a data retrieval system for the eye clinic is described. The system uses an IBM 370/168 computer, involves programmes to minimize the possibility of entering errors and a magnetic tape back-up system to reduce the cost of storing rarely required material and as a safeguard against the accidental erasion of material on disc.

Computers↗
PubMedDate not supplied

Preoperative immunostimulation by Propionibacterium granulosum KP-45 in colorectal cancer.

In order to improve the perioperative resistance to the spread of cancer during operation the effect of preoperative stimulation of the immunesystem by Propionibacterium granulosum KP-45 was investigated in patients with colorectal carcinoma. In a prospective randomized trial 101 patients were allocated to either treatment (n = 51) or control (n = 50). In the treatment 10 mg of Propioni bacteria were administered intravenously between the seventh and third day prior to surgical treatment. At the time of operation 21 tumours were classified as stage I (treatment n = 12, control n = 9), 22 as stage II (treatment n = 10, control n = 2). Postoperatively wound infections requiring treatment were more prevalent in the control group (n = 4) than in the treated group (n = 0). All patients were subsequently followed up for 76 months. For stage I carcinoma the survival rates, excluding perioperative deaths, were 91% in the treated and 63% in the control group respectively. One case of tumour metastasis was seen in the control group. For stage II carcinoma the survival rate was 90% for the treated group with distant spread in 1 case and 45% in the control group where the rate of recurrence was 55%. For stages III and IV there was no statistically significant difference in survival between the treated and the control groups.

Adjuvants, Immunologic↗
PubMedDate not supplied

Immunostimulation by propionibacteria--effects on immune status and antineoplastic treatment.

Experimental studies were performed to investigate further the effects of immunotherapy with Propionibacterium avidum KP-40 on thymocyte proliferation, maturation and emigration in BALB/c-mice. Thymus weight and thymocyte counts, especially cells presenting the immature or cytotoxic/suppressor phenotype were significantly increased. Due to enhanced emigration, peripheral blood lymphocyte and monocyte counts as well as expression of activation markers were significantly upregulated. The antimetastatic effect of Propionibacterium avidum KP-40 was demonstrated in BALB/c-mice, where RAW 117-H10 lymphosarcoma liver colonization was significantly reduced after immunostimulation. Clinical investigations proved that surgical treatment of colorectal carcinoma induced an evident decrease of peripheral blood lymphocytes as compared with preoperative counts. However, single preoperative Propionibacterium avidum KP-40 administration induced a considerable increase of peripheral white blood cell counts, especially lymphocytes. Clinical effects of preoperative immunostimulation by Propionibacterium granulosum KP-45 were investigated in a prospective randomized trial in colorectal carcinoma patients. Positive effects on survival time, local tumor recurrence and distant metastasis could be demonstrated in stages I and II, whereas no advantage of immunotherapy was found in advanced stages III and IV. A recent prospective randomized clinical trial was initiated on the quality of life of colorectal carcinoma patients. Three months after surgical treatment negative effects could not be determined after immunotherapy. Quality of life even proved to be better in patients with abdominoperineal resection as compared to non Propionibacterium avidum KP-40 treated control patients.

Adjuvants, Immunologic↗
PubMedDate not supplied

Gender related survival in colorectal cancer.

The importance of patient characteristics to long term survival in colorectal carcinoma is the subject of much debate. The importance of female gender as an advantagous factor in prognosis is difficult to determine. A retrospective study based on data from 1050 patients resected for colorectal carcinoma was carried out. A complete follow-up and survival data were available. Categorical variables such as age, sex, tumor stage and location, perioperative blood transfusions, and postoperative complications were used. Standard univariate and multivariate descriptive analysis was applied. In addition to tumor staging patients' sex was a strong significant factor on prognosis. When analysed independently of tumor location, blood transfusions, and severe complications, sex was revealed to be a statistically significant independent prognostic factor in longterm survival. The 5-year survival rate for men was 43.5 % and 54.7 % for women. When the observed survival was compared with sex related life expectancy of a representive population, similar differences of survival were seen for both sexes.

Adenocarcinoma↗
PubMedDate not supplied

Treatment of liver metastases from colorectal cancer.

197 cases of distant metastases from colorectal cancer (Dukes A, B, C) were diagnosed in 664 patients after curative resection of the primary tumor. Extrahepatic progress could be excluded in 98 of 142 patients with liver metastases. These 98 patients were allocated to surgical treatment (n = 17), intraarterial chemotherapy (n = 24), transarterial chemoembolization (n = 20), systemic chemotherapy (n = 10) and syptomatic therapy (n = 27) depending on the extent and localization of the disease within the liver and the patients' general condition. Curative success in 12 of 17 patients with a 5-year survival of 47% was achieved by the careful selection of patients for surgical treatment. Prolonged median survival after systemic chemotherapy (13 months), intraarterial chemotherapy (11 months) and transarterial chemoembolization of hepatic metastases (12 months) compared with the survival of patients with a symptomatic treatment only (median 11 months) could not be demonstrated, in spite o local therapeutic effects (intraarterial chemotherapy response rate 42%, transarterial chemoembolization morphologic response 82%). Effective postoperative diagnostic screening determines the percentage of potential curative surgical treatment; nonsurgical approaches failed to demonstrate prolonged survival.

Adenocarcinoma↗
PubMedDate not supplied

Colorectal carcinoma--aspects of surgery in the elderly.

In accordance with the aging of the German population an increasing number of surgical procedures are performed on patients of advanced age. Perioperative data from 441 patients (223 women, 218 men, mean age 64.1 +/- 11.7 years) undergoing colorectal carcinoma resection 133 were aged 70 years and older, 308 were younger than 70 years-were prospectively recorded. Risk factors were found more frequently in the elderly (hypertonus 49% vs. 34%; coronary artery disease 18% vs. 8%; pulmonary disease 39% vs. 31%, gastrointestinal disease 30% vs. 23%). No differences were found in operative (loss of blood, duration of operation, ventilation) and postoperative parameters (intensive care, hospitalization) neither age dependent nor between elective and emergency surgery. Postoperative complications in electively treated patients, such as pneumonia, wound infection, urinary tract infection, pulmonary complications, and anastomotic leakages were not age dependent. Although cardial complications were recorded five times as often in electively treated elderly patients perioperative mortality was unchanged (0.8% vs. 0.9%). After emergency operations the rate of anastomotic leakage after perforating peritonitis was increased in the elderly (5.5%). In particular, cardial complications during emergency surgery in 50% of the elderly had a causal connection with perioperative mortality that was substantially increased by up to 28.6%.

Adult↗
PubMedDate not supplied

Liver lectin blocking with D-galactose to prevent hepatic metastases in colorectal carcinoma patients.

Animal experiments in BALB/c-mice and in DBA/2-mice confirmed that lectin blockade with D-galactose containing receptor analogues can inhibit metastatic spread into the liver. The number of liver colonies of inoculated tumor cells was significantly reduced after D-galactose treatment as compared to animals of control group. Based on experimental investigations 193 colorectal carcinoma patients (UICC stages I-III) were enrolled in a prospectively randomized clinical trial. 93 patients were treated perioperatively with D-galactose- (treatment group: 1.5 g/kg body weight and per day) or D-glucose containing electrolyte infusions (control group: n = 100). Significant side effects were not observed. There were no cases of perioperative mortality. The overall complication rate was 7.3%. Since tumor stages were unequally distributed, analysis was performed in strata. Patients were observed for a total of 6237 months. Differences in overall survival and survival free of recurrence and hepatic metastases were negligible for stages I and II. For stage III carcinoma patients (n = 75) analysis of survival free of hepatic metastases revealed a shift to delayed events (i.e. hepatic metastases or death) after D-galactose treatment within 24 months following surgery. In patients with stage III carcinoma there was an indication for an overall benefit in survival after D-galactose treatment (p = 0.102).

Adult↗