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Biomedical subjects

L H Barr

Publications and source records attributed to L H Barr.

11 recordsLinked to original sources
PubMed1985

Diagnosing breast cancer using frozen sections from Tru-cut needle biopsies. Six-year experience with 162 biopsies, with emphasis on outpatient diagnosis of breast carcinoma.

Experience in a 6-year period with 162 frozen sections from needle biopsies of the breast is reported. The technique was used mainly to diagnose breast cancer in outpatients. The results of frozen section on needle biopsies are compared with frozen sections of excisional biopsies. The sensitivity of detection in breasts containing carcinoma using frozen section of breast needle biopsies was 77%. The sensitivity of detection of carcinoma in needle biopsies subsequently shown to contain carcinoma by paraffin section was 92.8%. The specificity of frozen sections of breast needle biopsies was 86.4% and was devoid of false-positive results. Interpretation of frozen sections of needle biopsies of breast lesions is reliable when performed by experienced surgeons and handled and interpreted by experienced pathologists.

Biopsy↗
PubMed1984

Minimal deviation melanoma.

Minimal deviation melanoma is a recent concept of uncertain biologic significance. Minimally deviant melanocytes are not seen in metastases, suggesting they do not have the same biologic behavior as clearly malignant cells. Therefore, the Breslow and Clark prognostic criteria may not be applicable. Eight patients with MDM are presented. All were treated by scar re-excision and primary closure. Lesions ranged from 0.31 to 1.65 millimeters thick and four were Clark's level IV. Median follow-up study has been 19 months without evidence of local recurrence or distant metastasis. We concluded that MDM has a low likelihood for aggressive behavior in spite of tumor penetration which might suggest otherwise and that radical surgical therapy appears unnecessary.

Adult↗
PubMed1984

Carcinoma of the gallbladder.

Carcinoma of the gallbladder does not present with any specific signs or symptoms, frequently mimicking benign gallbladder disease. Thus the diagnosis often is not made pre- or intraoperatively. A retrospective review of the Louisiana State University Medical Center-Shreveport experience was done to evaluate stage at diagnosis, therapy, and outcome. Thirty cases of gallbladder carcinoma were diagnosed between 1952 and 1982. The mean age of the patients was 67.4 years with 23 women and seven men. Six patients had the diagnosis made only after final pathologic examination of the specimen and had a mean survival of 7.4 months. Only three patients had the diagnosis made at operation with the tumor localized and the procedure thought to be curable with a mean survival 13.0 months. A biopsy alone or autopsy diagnosis was performed in 11 patients and a palliative procedure done in ten patients, with mean survival 0.9 months and 3.6 months, respectively. Successful surgical therapy is usually more fortuitous than planned. Surgeons must maintain a high index of suspicion and obtain frozen section diagnosis of any suspected tumor.

Adenocarcinoma↗
PubMed1983

Marjolin's ulcer. The LSU experience.

Skin cancers originating in areas of chronic injury (Marjolin's ulcers) are thought to behave in a more aggressive fashion than those due to other causes. The initial surgical treatment, especially the management of the regional lymph nodes, remains controversial. This review of 37 patients with Marjolin's ulcer evaluated the effectiveness of local surgical treatment at our center. Three of 18 patients treated with amputation developed recurrences and died of metastatic disease. Five of 16 patients treated by wide excision developed recurrences, two dying with metastatic disease, the remaining three apparently cured by additional surgery. Only six (17.6%) of the patients treated by "local" modalities, i.e., wide excision or amputation, developed subsequent regional node metastases. Recurrences following local excision tend to be local and can usually be managed by re-excision or amputation. It can be inferred from this study that prophylactic node dissections are not required in most patients with Marjolin's ulcers.

Adult↗
PubMed1983

Spontaneous biliary enteric fistulas.

Biliary enteric fistulas usually occur as a complication of chronic cholelithiasis, may be difficult to document preoperatively, and often pose problems in surgical management. We reviewed 13 cases of spontaneous biliary enteric fistulas to identify methods of diagnosis, management, and complications. There was no specific set of clinical symptoms or signs that led to the diagnosis of a fistula. In six cases the diagnosis was made preoperatively by x-ray films showing pneumobilia, gallstone in the small bowel, or fistula. Initial surgical treatment included cholecystectomy in six cases, small bowel enterotomy and removal of gallstones in four, and vagotomy and antrectomy in one case. Two patients initially treated without operation were lost to follow-up. Eight complications occurred in six patients, and there were three deaths due to underlying cardiac disease. The morbidity and mortality of biliary enteric fistulas associated with chronic cholecystitis may be avoided by performing elective cholecystectomy when the patient is in optimal condition.

Aged↗
PubMed1982

Prospective randomized study of the role of N-acetyl cysteine in reversing doxorubicin-induced cardiomyopathy.

We conducted a randomized prospective trial in 19 disease-free soft tissue sarcoma patients with doxorubicin-induced cardiomyopathy identified by ECG radionuclide angiography at rest and during exercise to determine the efficacy of the free radical scavenger, N-Acetyl Cysteine (NAC), in reversing the drug's cardiotoxic effect. Of the 19 patients, 11 received oral NAC (5.5 gm/m2 daily for 30 days) and eight patients served as controls. Patients were stratified for age less than greater than 45 years, time from final dose of doxorubicin to randomization less than greater than 8 months, and history of treatment with mediastinal irradiation. The two groups were well-matched for all parameters. Cumulative mean doxorubicin dose (523 mg/m2 and 532 mg/m2) and range 500-600 mg/m2 was comparable. Left ventricular (LV) ejection fraction before randomization was not significantly different between the two groups either at rest (39 +/- 10% control, 38 +/- 13% NAC) or during exercise (38 +/- 12% control, 35 +/- 11% NAC). Neither rest nor exercise ejection fraction values changed significantly in either group between prerandomization and 1-month postrandomization studies. Late studies performed in seven NAC patients 3-5 months after randomization revealed no difference in LV ejection fraction compared to 1-month postrandomization values. Clinical course in patients with overt congestive heart failure was similar in both groups. LV function did not return to normal in any patient in either group. We conclude that N-Acetyl Cysteine has no effect in reversing long standing doxorubicin-induced cardiomyopathy.

Acetylcysteine↗
PubMed1981

Essential fatty acid deficiency during total parenteral nutrition.

Essential fatty acid (EFA) deficiency has become a clinical problem since the advent of fat-free total parenteral nutrition (TPN). The following study was done to determine the minimum fat requirements for patients receiving continuous TPN solution. Seventy-seven patients who had 97 courses of TPN of at least 14 days duration were prospectively studied. The following fat supplementation was given: a) none, b) 10% soybean oil emulsion intravenously at fixed dosage, c) fat from an oral diet, or d) intravenous and oral fat. No patient was EFA deficient before the onset of TPN. EFA deficiency was prevented when at least 3.2% of total calories were given as intravenous fat or at least 15% as oral fat. Lesser amounts of fat decreased the rate of EFA deficiency development but did not prevent it from occurring. The 7.7 g/day of linoleic acid provided in 1000 ml per week of 10% soybean oil emulsion provides adequate fat to prevent EFA deficiency.

8,11,14-Eicosatrienoic Acid↗
PubMed1981

Doxorubicin cardiotoxicity: assessment of late left ventricular dysfunction by radionuclide cineangiography.

Radionuclide cineangiography was used to evaluate 32 patients who sustained long-term remission of soft tissue sarcoma after adjuvant therapy with a cumulative doxorubicin dose from 480 to 550 mg/m body surface area. Left ventricular ejection fraction at rest was below normal (less than 45%) in eight of 32 patients. The abnormal response of ejection fraction to exercise identified an additional 12 patients with diminished left ventricular functional reserve. Ejection fraction determined at rest or during exercise did not differ 1 to 9 months) and those studied 30 months (range, 21 to 43 months) after completing doxorubicin treatment. Sequential studies in 13 patients, done 6 to 15 months after initial post-doxorubicin evaluation also showed persistent depression of average ejection fraction at rest and with exercise, with the continued deterioration of left ventricular function in six patients. Left ventricular dysfunction, evident in over half of asymptomatic patients even long after "acceptable" cumulative doses of doxorubicin, may persist for years.

Adolescent↗
PubMed1979

The biology of human malignant melanoma. Preliminary findings in the nude mouse.

The nude mouse model was explored as a means of predicting the behavior of human cutaneous malignant melanoma. Subcutaneous implants from 20 patients were observed for external growth, microscopic appearance, and autoradiographic analyses following tritiated thymidine labeling. Normal epithelial and dermal components were maintained in the six low-risk primary implants, but none had any external growth or tumor cell preservation. Four of the five metastatic implants grew throughout the observation periods, with 30% of the counted tumor cells taking up the radioisotope. There was a slower growth rate in four of nine high-risk primary implants, with tumor cell preservation in eight. Only 6% of the counted tumor cells incorporated tritiated thymidine. This model appears to be capable of discriminating among the behavior of various forms of human malignant melanoma.

Animals↗
PubMedDate not supplied

The value of nutritional assessment in the surgical patient.

The prevalence of malnutrition in Veterans Administration Hospitals has been well documented. Several methods have been proposed to assess nutritional status including prognostic nutritional index (PNI) and instant nutritional assessment (INA). A prospective study was done to evaluate the currently used nutritional assessments and determine their efficacy based on sensitivity and specificity in predicting surgical morbidity and mortality. Data on 46 patients were evaluated for the multiparameter index of PNI, total lymphocyte count and serum albumin for INA, and weight loss alone. In this analysis, intermediate and high risk PNI were combined as positive predictor of complications. Any abnormal value in INA was considered positive as was weight loss of greater than 6% of usual body weight. Sensitivity and specificity of each assessment method were determined by 2 X 2 contingency table, and significance of observed differences between methods was determined by chi 2 analysis. There were no complications or deaths in patients with less than 6% weight loss. All three patients with abnormal albumin and total lymphocyte count had complications as compared to only three of 32 patients when both of these parameters were normal. The PNI was also able to predict complications with an increasing incidence as the PNI increased. Only the difference between specificity of weight loss alone vs INA was statistically significant, p less than 0.05. Thus, weight loss alone can be used as a rapid, inexpensive assessment of nutritional status for predicting postoperative complications.

Body Weight↗