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Biomedical subjects

J M Sterchi

Publications and source records attributed to J M Sterchi.

At least 19 recordsLinked to original sources
PubMed1992

Human peripheral lymph lipoproteins are enriched in sphingomyelin.

The concentrations of total choline-containing phospholipids and of sphingomyelin have been determined in peripheral lymph from six volunteers. The concentration in lymph of total phospholipids was 14.6 +/- 6.0 mg/dl and of sphingomyelin 6.1 +/- 2.7 mg/dl; the estimated concentration of phosphatidylcholine (by subtracting the concentration of sphingomyelin from that of total choline-containing lipoproteins) was 8.5 +/- 5.1 mg/dl. The concentration of free choline in lymph was less than 1 mg/dl. The ratio of the concentration in lymph to that in the subject's own plasma of sphingomyelin was 0.18 +/- 0.07 and that of (estimated) phosphatidylcholine 0.05 + 0.04; the difference between these two ratios was significant at P less than 0.002. The present data are compatible with the hypothesis that some of lipoprotein phosphatidylcholine is lost while crossing from plasma to lymph.

Adult↗
PubMed1991

Lipoproteins of human peripheral lymph. Apolipoprotein AI-containing lipoprotein with alpha-2 electrophoretic mobility.

Evidence from diverse sources has implicated a central role of apolipoprotein AI (apo AI), the most abundant protein of plasma high-density lipoproteins, in the transport of cholesterol from peripheral tissues to the liver (reverse cholesterol transport). Particles containing only apo AI appear to be more effective as cholesterol acceptors in tissue culture than do particles which also contain apo AII. The apo AI-containing lipoproteins of plasma have been extensively studied, but there is less information on those in tissue fluids, to which most peripheral cells are exposed. In the present study the heterogeneity of apo AI-containing particles in human peripheral lymph, collected from the dorsum of the foot, has been examined by starch block electrophoresis, exclusion chromatography and immunoelectrophoresis. The apo AI-containing particles of lymph were found to be more variable in both electrophoretic mobility and size than those of plasma from the same subjects. Of particular interest was a subpopulation which migrated on electrophoresis with the same mobility as alpha-2-macroglobulin. This fraction accounted for approximately 7% (range: 4-12%; n = 5) of lymph apo AI, contained no immunodetectable apo AII, and by exclusion chromatography was composed of particles the size of, or smaller than, albumin. Such physicochemical properties suggest that these alpha-2 migrating particles may function as the principal primary acceptors of cell cholesterol in the extracellular matrix of human peripheral tissues. By isoelectric focusing, lymph apo AI was found to contain a higher proportion of more negatively charged isoforms than the apo AI of plasma.

Adult↗
PubMed1990

A new injection portal for brachially inserted central venous catheter. A multicenter study.

Totally implantable portal systems are widely used for long-term central venous access. A new venous portal system inserted via the brachial veins (P.A.S. Port system, Pharmacia Deltec Inc, U.S.A.) was studied in five centres. From January 1988 through May 1989 61 systems were implanted. Fifty-two patients had malignant diseases. Nine cases had non-malignant disorders. The portals were implanted subcutaneously in the fore-arm and catheterization was done percutaneously (46) or by cutdown-technique (15) under local anesthesia. Catheter tip position was controlled by fluoroscopy or x-ray. The basilic vein (49) and the cephalic vein (12) were used. The total follow-up time for all systems was 323 months. Forty-five systems were still in use at the end of the observation period, six were explanted electively at the end of infusion therapy and six systems were still functioning at the time of the patient's death (at a maximum of 14 months after implantation). Temporary armphlebitis was noticed on the first postoperative week in five patients. Two P.A.S. Port systems were explanted due to infection and one because of skin rupture at the wound. One intact system was removed as it was thought to be leaking because of needle displacement. The P.A.S. Port system is easy and safe to implant with a high success rate and a low complication rate. It is well accepted by patients and nurses. The device should be advantageous in patients unsuitable for standard venous portal systems and offers an excellent alternative system for venous access.

Adolescent↗
PubMed1989

Chemoinfusion of the hepatic artery for metastases to the liver.

During a five year period, 69 patients were treated for carcinoma of the liver (seven primary tumors and 62 metastatic tumors) with 5-fluorodeoxyuridine (5-FUDR) administered through a hepatic artery (n = 62) or portal vein (n = 3) implantable infusion pump. Ten patients proved to have previously unsuspected extrahepatic nodal metastases at laparotomy for pump insertion. 5-FUDR was given in 14 day cycles for three months. At the end of that period and at three month intervals thereafter (mean follow-up time of 18 months, a range of one to 60 months), patients were evaluated with roentgenograms of the chest, liver function tests, carcinoembryonic antigen levels, radionuclide scans and computed tomography. Thirty-five patients had a partial response, nine had stabilization of the disease and 25 had progression of the disease (five during therapy, who were given mitomycin C). Median regression was 6.8 months (a range of three to 18 months). Six of the 35 partial responders, three of the nine patients with stabilization and ten of the 25 patients with progression had extrahepatic visceral disease. Survival time averaged 18.4 months (a range of five to 60 months) for the partial responders, 12.6 months (a range of two to 40 months) for patients with stabilization and seven months (a range of one to 17 months) for those with progression of the disease.

Adult↗
PubMed1988

Detection of liver involvement in Hodgkin's disease.

Liver involvement with Hodgkin's disease is determined at our institution by a combination of wedge biopsy and needle biopsy at the time of staging laparotomy. This retrospective study was undertaken to determine whether the wedge or the needle biopsy method is the more accurate. All staging laparotomies (n = 116) during the period 1972-1986 were reviewed. Twelve patients were found to have liver involvement with Hodgkin's disease; 2 had had wedge biopsies only and ten had had both wedge and needle biopsies. In all ten with both wedge and needle biopsies, the wedge biopsies were positive for liver involvement, but in only five were the needle biopsies positive. This study indicates that wedge biopsy is the more accurate method for detecting liver involvement in these patients, and we believe it should always be a part of the staging laparotomy for Hodgkin's disease.

Biopsy↗
PubMed1987

Primary leiomyosarcoma of the inferior vena cava: a case report and review of the literature.

Sixty-six cases of leiomyosarcoma of the inferior vena cava (IVC) have been reported. We present another case and review the characteristics and treatment of this rare tumor. IVC leiomyosarcomas spread by extension into adjacent tissue planes. Direct extension into the heart is known, but not into the kidneys, adrenals, or bowel. IVC leiomyosarcomas arising below the renal vein cause pain in the right-lower quadrant, back, and flank, and varying degrees of lower extremity edema; those arising in the middle caval segment cause right-upper-quadrant pain and sometimes renovascular hypertension; those arising above the hepatic vein cause varying manifestations of the Budd-Chiari syndrome. A reasonable approach to early diagnosis involves oral and intravenous contrast studies followed by computed tomography, angiography, and vena cavography. Aggressive surgical treatment is optimal in light of the tumor's slow growth pattern and relatively low malignant potential. (Metastases have been reported in fewer than 50% of cases). Tumors involving the lower IVC are most amenable to surgery; extensive collateral venous drainage of the left kidney preserves renal function during resection of middle caval tumors. Upper caval leiomyosarcomas are the least amenable to complete removal. Postoperative survival of all patients has ranged from a few weeks to eight years.

Humans↗
PubMed1987

Cellular blue nevus simulating metastatic melanoma: report of an unusually large lesion associated with nevus-cell aggregates in regional lymph nodes.

A young Caucasian woman had a large area of blue-gray discoloration on the flank and palpable axillary lymph nodes. The discolored area had enlarged during a recent pregnancy, contained multiple subcutaneous nodules, demonstrated increased cellularity and mitotic activity, and was associated with an axillary lymph node containing black streaks within the capsule. Although the lesion was initially considered to be a metastatic malignant melanoma, re-evaluation showed it to be a benign cellular blue nevus with benign nevus-cell aggregates within a regional lymph node. We report this case to emphasize how cellular blue nevus can simulate malignant melanoma and to increase physician awareness of this benign variant of melanocytic nevus so that inappropriate surgery and chemotherapy can be avoided.

Adult↗
PubMed1987

Colon and rectal carcinoma. Forty years and 1400 cases.

One thousand four hundred cases of colorectal carcinoma were treated primarily at the Wake Forest University Medical Center between 1945 and 1985. The surgical approach was constant in all patients without obvious stage IV disease: wide resection, including at least the primary-level and intermediate-level lymph nodes. There were 812 women and 588 men in the series. Sixty-eight per cent of the 1400 cancers occurred in the rectosigmoid, but only 53 per cent of the last 300 cases were in this region. Initial staging showed 560 cases (40%) of local disease, 504 cases (36%) of regional disease, and 336 cases (24%) of distant disease. Cecal, ascending, hepatic, and transverse lesions were most often associated with stage IV disease. Among the 1115 patients with long-term follow-up, 44 per cent with stage I disease, 37 per cent with stage II disease, 24 per cent with stage III disease, and 6 per cent with stage IV disease had survived for 5 years or longer. There were no differences when 5-year survival was correlated with site. This review provided no evidence that wide resection leads to increased long-term survival.

Adult↗
PubMed1986

Occult lesions of the breast.

The biopsy of 148 clinically occult lesions of the breast found at mammographic examination yielded 21 instances of carcinoma (14.2 per cent). Five malignant lesions were lobular or in situ carcinoma, 16 were infiltrating ductal carcinomas and 11 were minimal carcinoma of the breast. Carcinomas found by mammographic examination were smaller and less likely to be associated with metastases to the axillary nodes than carcinomas of the breast diagnosed by palpation during the same time period. Biopsy of the breast was performed by several methods: 1, quandrantectomy with the patient under general anesthesia (the results of 29 biopsies yielded five instances of carcinoma, 17.2 per cent); 2, generous excision of breast tissue with the patient under general anesthesia and the lesion being localized by geometric co-ordinates based upon the mammograms (the results of 35 excisions yielded four instances of carcinoma, 11.4 per cent), and 3, mammogram-directed needle localization (the results of 84 procedures yielded 12 instances of carcinoma, 14.3 per cent). Because needle-directed biopsy causes less distortion of the breast, we prefer it to other biopsy techniques in the evaluation of occult lesions of the breast.

Adenofibroma↗
PubMed1986

Operative technique for insertion of a totally implantable system for venous access.

A totally implantable venous access device is described and a step by step technique for implanting the device is given. Among 203 patients in whom the technique has been used, thrombosis of the subclavian or jugular vein has occurred in only three. There have been no pulmonary complications, and only three devices have been removed because of infection.

Adult↗
PubMed1986

Pseudocalculus sign. A pitfall of static cholangiography.

The pseudocalculus formation was first noted by Caroli in 1960, and was first called a sign by Beneventano and Schein in 1968. It is a cholangiographic illusion that appears as a filling defect in the distal common bile duct when static or "spot" films are exposed during the contractile phase of choledochal sphincter activity. Although first noted and most frequently seen in T-tube cholangiography, it is seen also during intravenous and intraoperative cholangiography. Because it mimics radiographically an impacted stone in the distal common bile duct, its delineation is critical to avoid unnecessary instrumentation of the common bile duct or even reoperation. In this review the authors discuss briefly the anatomy and physiology of the distal common bile duct and the etiology, differential diagnosis, and recognition of the pseudocalculus sign.

Ampulla of Vater↗
PubMed1985

A randomized trial of adjuvant chemotherapy and immunotherapy in Stage I and Stage II cutaneous melanoma. An interim report.

Seventy patients with Stage I and II malignant melanoma were randomized to treatment with either intravenous dacarbazine alone or intravenous dacarbazine plus intradermal injection of the methanol-extracted residue of bacillus Calmette-Guerin (BCG). Analysis of treatment failed to reveal a statistically significant difference between these two forms of treatment in Stage I and II patients. It is possible that chemoimmunotherapy may increase survival in Stage II patients, but this possibility should be interpreted with caution.

Adult↗
PubMed1985

Hepatic artery infusion for metastatic neoplastic disease.

Specific conclusions can be drawn concerning HAI in the treatment of neoplastic hepatic disease. Over-all, a rate of response of 50 per cent is noted, with the results of more recent studies showing improved response rates as measured by a CEA marker. There are extremely few, if any, complete responders. Nonresponders have one-half the survival time of responders. The median time of survival in patients who have received HAI is about one year. There have been series in which the mean survival rate is greater than that in historical control patients, but no one has demonstrated this fact with a matched group of patients in a prospective controlled trial; many such controlled trials are now underway. The duration of survival in patients receiving treatment is strongly influenced by the development and progression of extrahepatic lesions. Placing HAI catheters by laparotomy is more dangerous to life, but the morbidity is higher with percutaneous HAI. On the other hand, patients treated percutaneously have a much higher incidence of thrombosis of the hepatic artery and of other problems related to the catheter, including migration and dislodgment, so that treatment is compromised. The high numbers of patients treated by percutaneous therapy in the past who had an increased incidence of thrombosis of the hepatic artery perhaps have had some influence on the response rate. The technology of HAI has improved rapidly and markedly during the last several years with the development of such pumps with advanced design as the totally implantable, refillable and rechargeable infusion pump. What is needed now are studies designed to determine the best agent or combination of agents that can be administered through these advanced systems. Long term, controlled clinical trials of HAI in the ambulatory patient are underway, but the results are not yet available.

Animals↗
PubMed1984

Hepatic intra-arterial infusion of vincristine.

Currently the chemotherapeutic agents available for intra-arterial infusion in metastatic liver cancer are limited to only a few. The recent demonstration of the feasibility of prolonged IV infusion of vincristine led to exploration of hepatic intra-arterial infusion of this agent. A continuous infusion of 0.4 mg total dose was administered daily for 5 days via a hepatic artery catheter to each of six patients with metastatic liver cancer. Transient but life-threatening toxicity principally involving the nervous and gastrointestinal systems occurred in five of them. Future investigation of hepatic intra-arterial infusion of vincristine should be based on dose-schedules other than that employed in the current trial.

Adult↗
PubMed1984

Postmastectomy angiosarcoma.

Six cases of postmastectomy angiosarcoma of the upper extremity have been treated at the North Carolina Baptist Hospital/Wake Forest University Medical Center over the past 25 years. Five patients had typical ductal carcinoma; one patient had mammary Paget's disease. Two patients, including the patient with Paget's disease, had bilateral mastectomies. The five patients with ductal carcinoma had received postoperative radiation therapy. The mean interval between mastectomy and the appearance of angiosarcoma was 17.5 years. Significant lymphedema of the upper extremity preceded the appearance of angiosarcoma in all six patients, and it appears important that special care be taken during mastectomy to preserve the integrity of the lymphatic system. The patient treated with interscapulothoracic amputation is alive at 2 years postamputation; the five patients whose angiosarcomas were treated with wide excision or radiotherapy died an average of 4.5 years later. Interscapulothoracic amputation is recommended as the initial treatment of postmastectomy angiosarcoma of the upper extremity.

Adult↗
PubMed1984

The risk of improperly staging Hodgkin's disease with partial splenectomy.

Partial splenectomy has been proposed for staging Hodgkin's disease, but the risk of thereby missing limited splenic involvement is unknown. To assess that risk, we reviewed all spleens removed during staging laparotomies for Hodgkin's disease at our institution, assessing splenic weight, the characteristics of all nodules, and grossly visible subcapsular disease. Among 180 spleens, 65 had splenic disease. Fifty-three had six or more nodules; for 49 of those, other abdominal involvement had been present or the disease was so diffuse that staging by partial splenectomy would have been correct. The remaining 12 spleens (18%) contained five or fewer nodules. Eleven had no grossly visible subcapsular nodules, and five of the 11 were associated with no other abdominal involvement. In four of those five, the disease was localized to one area in such a way that it could have been missed by partial splenectomy. All positive spleens averaged 415 g; the four spleens with localized involvement averaged 287 g. Thus, in four of 65 patients, a few splenic nodules in a localized distribution not visible grossly were the only evidence of abdominal Hodgkin's disease, and if partial splenectomy had been done there would have been a 6.2 per cent risk of understaging their Hodgkin's disease.

Hodgkin Disease↗
PubMed1983

Continuous intravenous infusion of vinca alkaloid using a subcutaneously implanted pump in a canine model.

A major drawback of infusions of the vinca alkaloids is the lengthy period of hospitalization which is often required for this novel technique of cancer therapy. A potentially useful system to deliver outpatient therapy has been investigated in a preclinical study. A self-contained infusion pump powered by a self-charging fluorocarbon system has been implanted SC in three dogs. The performance of two pumps which had been factory-calibrated to deliver 2.5 and 4.5 ml/day, respectively, was evaluated during 22 infusions of the vinca alkaloids (vincristine, 7; vinblastine, 7; and vindesine, 8). Infusions were given over a 5- to 7-day period and were repeated at 3-week intervals. No malfunctioning of the pumps occurred in over 500 cumulative days of use. The flow rates of the pumps were quite stable except in one animal whose increased flow rate was probably a consequence of fever due to self-induced inflammation about the pump pocket. No local or distant tissue reactions to the pump were observed. Decomposition of vincristine and vinblastine in the infusate at the end of 5- or 7-day infusions was minimal as determined by high-pressure liquid chromatography. The amount of decomposition of vindesine in the infusate was variable. Steady-state concentrations of vincristine during infusion were always greater than 10(-9) M, and were similar to those previously determined in our clinical infusion trials using a dosage of 0.5 mg/m2/day. Clinical evaluation of this system for prolonged infusions of vincristine and other vinca alkaloids appears to be warranted.

Animals↗