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Biomedical subjects

M Adloff

Publications and source records attributed to M Adloff.

At least 19 recordsLinked to original sources
PubMed1992

[Pancreatojejunostomy or pancreatogastrostomy after cephalic pancreatoduodenectomy].

The propensity for leakage at the site of pancreatojejunostomy continues to be a major reason for morbidity and death after pancreaticoduodenectomy. Pancreatogastrostomy has been introduced as a possible alternative to pancreatojejunostomy and although this procedure was developed experimentally more than 50 years ago its use has not gained widespread clinical use. The purpose of this study was to evaluate the role of pancreatogastrostomy. Pancreatogastrostomy was performed in 15 patients with pancreatic resection for carcinoma and compared with 57 pancreatojejunostomy. Our experience confirms that pancreatogastrostomy is a safe and easy method and suggest that it may be used more frequently.

Adult↗
PubMed1991

Colorectal cancer in patients over 80 years of age.

Between January 1, 1973, and December 31, 1986, 1,734 patients underwent colorectal resections for carcinoma. Patients were divided into two groups: Group I included 163 patients aged greater than or equal to 80 years on first presentation; Group II comprised 1,571 patients aged less than 80 years. The total perioperative mortality rates for the elderly and young group were 15.3 percent and 5 percent, respectively (P less than 0.001). The surgical mortality rates after elective operations in Groups I and II were 7.4 and 4.5 percent, respectively, and were not statistically different. Emergency surgery was associated with a significantly higher incidence of perioperative deaths at any age (P less than 0.001). In the elderly group, most deaths (88 percent) resulted from complications of coexisting medical disorders or thromboembolic complications. The 5-year survival for the young and elderly group were 46.2 percent and 35 percent, respectively (P less than 0.05). However, excluding patients dying from nonmalignant disease, the 5-year survival rate did not differ significantly between the two groups of patients (49.5 percent vs. 41.2 percent).

Adenocarcinoma↗
PubMed1991

[Role of pancreaticojejunostomy in the treatment of chronic pancreatitis. A study of 105 operated patients].

105 patients with intractable pain due to chronic pancreatitis were selected for treatment by lateral pancreatico-jejunostomy (according to the procedure of Partington Rochelle) after pre operative endoscopy had revealed a dilatation of the main pancreatic duct (mean : 6 mm). Pancreatico-jejunostomy was the unique procedure in 59 patients; it was associated with a biliary or duodenal diversion in 46 others patients. 2 patients died post-operatively and 12 required a second operation some years subsequent to the pancreatic drainage, for biliary stenosis due to the progress of the sclerosis. 8 of the 22 late death were in direct relation with the persistence of alcohol intake and 4 others died from an extra pancreatic cancer. Peptic ulcer complicating pancreatico-jejunostomy appeared in three patients and two of them died from hemorrhage. Mean observation time was 65 years. Long term results were excellent or improved in 93.4% what pain relief concern, but the progression of exocrine or endocrine pancreatic insufficiency indicates that decompression of the dilated pancreatic duct does not prevent continuing destruction of pancreatic glandular tissue. In spite of these good results, the rational for duct drainage as a mean to decrease the intraductal pressure secondary to stricture is unclear. Neither the patency of the anastomosis, nor the presence or not of pancreatic lithiasis or the size of the dilated pancreatic duct seem to be crucial for pain relief after pancreatico-jejunostomy. Notwithstanding of the dubiousness of the mechanism of action of the drainage procedure, pancreato-jejunostomy remains the most effective procedure for relief of pain in chronic pancreatitis with dilated duct.

Adolescent↗
PubMed1990

[Coloproctectomy with ileo-anal pouch. A simplified technique].

Coloproctectomy with pelvic ileal pouch allows normal transit while preserving and sphincter function. Using stapplers facilitates the construction of the ileal reservoir. Avoiding distal mucosectomy makes the anastomosis with the rectal stump easier and eliminates the need for a protective ileostomy as well as the morbidity associated with its closure.

Anastomosis, Surgical↗
PubMed1990

Progress in the assessment of lymphatic spread in rectal cancer. Rectal endoscopic lymphoscintigraphy.

Rectal endoscopic lymphoscintigraphy was performed in 10 control subjects and in a series of 85 patients with adenocarcinoma of the rectum as a prospective study to evaluate lymphatic drainage of the rectum and lymphatic spread in rectal cancer. Complete cranial drainage was demonstrated in all control subjects, and internal iliac nodes were also visible in 50 percent of cases. Results were correlated with histologic node examination in all patients operated upon for rectal cancer. Rectal endoscopic lymphoscintigraphy was assessed for sensitivity (85 percent), specificity (68 percent), overall accuracy (76 percent), positive predictive value (71 percent), and negative predictive value (83 percent). False-negative and false-positive results are discussed. Rectal endoscopic lymphoscintigraphy represents the only method currently available for evaluation of lymphatic spread in rectal cancer.

Adenocarcinoma↗
PubMed1990

[Colonic cancers. A retrospective study of 1122 surgically-treated patients].

A retrospective study of 1122 cancers of the colon operated by the same surgical team from 1973 to 1989 makes a number of statements possible: In spite of the improved diagnostic means, 66 (5.8%) only of the cancers were of Dukes' type A. 116 patients had complications, ie. perforation in 9 cases and obstruction in 107, among which 59 were operated within 24 hours. The rate of resection is very high: 93.8%. In 8.1% of all cases the excision was extended because of invasion of neighboring tissues. Curative resection was performed in 844 patients, while surgery was palliative in 278, including 205 excisions. The total operative mortality was 5.8%, sinking to 3.9% for curative surgery. It is as high as 22% in emergent surgery. Since 1981, it has been lower than 1% and only caused by general factors. The survival rate of 557 patients after more than 5 years is 46.6%. This rate was studied according to various parameters (sex, location, features of excision, Dukes' stage, involvement of lymph nodes). Lymph node involvement and Dukes' stage are the only factors having a significant influence on survival. In 90.0% of cases, the long-term death of patients followed up for more than 5 years is caused by hepatic metastases (66.6%), local recurrence (13.3%) or both (20%). The occurrence of local recurrence or hepatic metastases can sometimes be treated by second surgery, which has been performed in 20 patients: 11 hepatic resections with a 26.8% survival at 5 years, and 9 excisions for local recurrence with 12.4% survival at 5 years.

Adult↗
PubMed1990

[Progress in the evaluation of lymphatic involvement in cancer of the rectum: endoscopic rectal lymphoscintigraphy].

The preoperative evaluation of lymphatic spread in rectal cancer constitutes a considerable problem. A prospective study including 45 patients operated for rectal cancer, was carried out in order to assess the diagnostic value of a new technique: endoscopic rectal lymphoscintigraphy. The results of the preoperative assessment were compared with histological data according to Dukes' classification (Dukes A/B: 22 cases, Dukes C: 23 cases). Analysis of these results revealed the sensitivity (80%), specificity (73%) and accuracy (80%) of this new technique. If, combined with endorectal ultrasonography, rectal lymphoscintigraphy might play highly significant role in identifying the indications for local excisions of small tumours; similarly, the effect of preoperative radiotherapy might be more thoroughly assessed.

Adenocarcinoma, Mucinous↗
PubMed1990

[Superficial gastric cancer. Report of a series of 57 cases].

We have studied a total of 395 patients with gastric cancer during the past 16 years 57 of whom presented with superficial gastric cancer. The most frequent symptom was gastric pain in 47 patients. Barium weal was not helpful in the diagnosis and failed to define the nature of this disease in 43 patients. Endoscopy enabled visualization of an abnormality in 55 patients, the lesion seen was considered to be compatible with a diagnosis of superficial gastric cancer in 42 cases. The combined results of endoscopy and biopsy diagnosed malignancy in all cases, but a sufficient number of endoscopic biopsy specimens must be taken (5 to 7). Cases of superficial gastric cancer had an 24% incidence of other non gastric malignancies in our series. All patients were treated by surgical resection. The tumor was confined to the mucosa in 38 patients and had infiltrated the submucosa in 19 patients. Four patients had lymph node metastases. The five year actuarial survival was 75% for all the patients and 85% when the lesion was confined to the mucosa. In contrast, the five year survival for the 283 patients with resected gastric cancer was only 23%. Although the prognosis of superficial gastric cancer is remarkably good, patients should be carefully followed over a long period for late recurrent (one patient in our series) of the primary cancer and possible metachronous cancer of other organs.

Actuarial Analysis↗
PubMed1990

[Hepatic metastasis of colorectal cancer. Should it be surgically treated? Report of 55 cases].

Surgical resection currently represents the best chance of improving survival for some patients with hepatic metastases (H.M.) of colorectal origin. Out of a total of 288 patients with H.M. from colorectal cancer, 55 only had a surgical exeresis (hepatectomy or removal of the metastasis). These were 36 cases of synchronous H.M. and 19 of metachronous H.M. The operative mortality is as high as 2%. The overall actuarial survival rate at 5 years is 19.6%. The single-factor analysis of the factors connected with survival reveals 2 deciding factors: the margin of normal peritumoral hepatic parenchyma resected (p less than 0.01) and the degree of tumoral differentiation (p less than 0.05). A preoperative CEA level higher than 30 ng/l may be a pejorative factor (p less than 0.05). The results of this series are likely to be improved: 1 degree by a better selection of the patients scheduled for resection, especially as it is necessary to extend resection into the normal parenchyma more than 1 cm from the tumor, and 2 degrees by the addition of an adjunctive regional chemotherapy.

Adult↗
PubMed1989

Synchronous carcinoma of the colon and rectum: prognostic and therapeutic implications.

In a series of 1,037 patients with colorectal carcinoma diagnosed at one hospital during a 9-year period, synchronous cancers of the colon and rectum occurred in 2 percent. Patient characteristics and presenting symptoms were similar in single and synchronous carcinomas. The frequency of patients with associated benign neoplasms was significantly higher than that in the parent series. An examination of the modified Dukes' classification stage of the lesion in each patient revealed a higher incidence of lymph node involvement and a greater frequency of mucinous adenocarcinoma in patients with synchronous carcinomas. The 5-year survival of patients with synchronous growths did not differ from that of patients with single lesions, even when classified by Dukes' stage. Preoperative diagnosis was difficult, being achieved in no more than 30 percent of patients. Because of the poor accuracy of barium studies, total colonoscopy is the method of choice for this evaluation. We adopted a conservative surgical policy backed by life-long follow-up.

Adenocarcinoma↗
PubMed1989

Biliary elimination of ticarcillin plus clavulanic acid (Claventin): experimental and clinical study.

The aim of the present study was to assess the biliary elimination and disposition of Claventin, a combination of clavulanic acid (CA), a beta-lactamase inhibitor, with ticarcillin (TIC), resulting in an enhancement of the activity of the antibiotic and broadening of its antibacterial spectrum. This work was done experimentally and in humans. Assays of both molecules were performed by HPLC. During a 3 h perfusion of five isolated rabbit liver preparations, 1.3 +/- 0.2% and 0.4 +/- 0.1% of TIC and CA added to the circulating blood were eliminated in the bile. At the same time, 31.8% of TIC and 50.5% of CA were submitted to a hepatic biotransformation. In healthy subjects (n = 5), after a single i.v. injection of 3.2 g of Claventin (TIC: 3 g + CA: 0.2 g) mean peak concentrations of 66.8 +/- 31.9 micrograms/ml (TIC 4th h) and 0.3 +/- 0.1 microgram/ml (CA, 2nd h) were observed in the aspirated duodenal fluid where 0.07% and 0.01%, respectively, of the administered dose were recovered during the 4 h investigation period. In cholecystectomized patients (n = 10) provided with a T-tube, i.v. administration of Claventin, 3.2 g, resulted in biliary maximal levels of 177 +/- 49 micrograms/ml (TIC: 2nd h) and 2.7 +/- 0.5 microgram/ml (CA 1st h). Total amount of each derivative eliminated in bile over 12 h averaged 0.28% (TIC) and 0.05% (CA) of the given dose. Hepatobiliary clearance was 20.5 ml/h (TIC) and 4.4 ml/h (CA). In intra-operative simultaneously sampled specimens of serum, choledochal bile, gallbladder bile and gallbladder wall, the following concentrations were measured 1 h after i.v. administration of Claventin: TIC: 105 +/- 10; 386 +/- 66; 72 +/- 20 micrograms/ml and 36 +/- 11 micrograms/g, CA: 3.5 +/- 0.7; 5.9 +/- 1.5; 0.3 +/- 0.3 microgram/ml and 0.1 +/- 0.1 microgram/g. The biliary pharmacokinetics determined in humans makes it possible to consider favourably the prophylactic use of Claventin in surgery of the biliary tree and constitute a good prerequisite for a possible beneficial treatment of biliary tract infections.

Adult↗
PubMed1989

[Progress in evaluating lymphatic spread in cancer of rectum: endoscopic rectal lymphoscintigraphy].

The preoperative evaluation of lymphatic spread in rectal cancer constitutes a problem of difficult solution. A prospective study including 45 patients operated for rectal cancer, has been carried out in order to evaluate the diagnostic value of a new technique: The endoscopic rectal lymphoscintigraphy. The results of preoperative assessment were compared with histological date according to Dukes' classification (Dukes A/B: 22 cases, Dukes C: 23 cases). Analysis of these results allowed to accurate sensitivity (80%), specificity (73%) and accuracy (80%) of this new technique. Combined to endorectal ultrasonography, rectal lymphoscintigraphy might play an overwhelming role in characterising the indications for local excisions of small tumors; similarly, the effect of preoperative radiotherapy might be further evaluated.

Adenocarcinoma↗
PubMed1989

[Cefpiramide, a new cephalosporin with high hepatic elimination; experimental evaluation of its biliary passage and disposition in the liver].

The biliary elimination and hepatic disposition of cefpiramide were studied using an isolated and perfused rabbit liver model. Five experiments were performed, each lasting 3 hours. After addition of 10 mg of cefpiramide to the circulating blood, the biliary concentration reached a mean peak of 741 +/- 15 micrograms/ml between the 30th and 60th minute; the cumulated biliary elimination of the drug amounted 4042 +/- 1099 micrograms, corresponding to 40.4% of the injected dose. The hepato-biliary clearance was 54.5 ml/hr and the biliary elimination rate constant 0.2019(hr-1). At the end of the perfusion, 21.7% of the dose was still present in the circulating blood and 1.4% is found in the liver. Control experiments showed that 36.2% of the cefpiramide added into the experimental device was submitted to degradation. Thus, it was possible to calculate the rate of liver biotransformation of cefpiramide, which accounted for 0.3%. These experimental results confirm the major role of the liver in the elimination of cefpiramide and prove that the drug is not submitted to hepatic metabolisation.

Animals↗
PubMed1989

[Can the prognosis of patients treated surgically in cancer of the rectum or colon be improved by follow-up? Prospective study of 909 patients].

Outpatient follow up may be performed to detect early recurrence or metastasis in the hope to be cured by further surgery. 909 patients have been prospectively followed after resection for cure of colorectal carcinoma. The mean duration of this follow up was 48 months. 1. Only 322 (35.4%) patients agreed to be submitted to an strict regiment of frequent check up. 2. Only 92 recurrences were diagnosed at times of follow up, the 308 others were discovered between regular follow up examination. 3. Only 32 recurrences out of 92 detected by the follow up schedule were totally without symptoms. 4. In the follow up group 30 patients (32.6%) benefited from second surgery versus 7 for the others (7.8%) p less than 0.001. 5. The comparison about the five years actuarial survival rates between the follow up group and the others is statistically significant: p less than 0.01.

Adult↗
PubMed1989

[Usefulness of a colonic reservoir after resection of the rectum].

Resection of the rectum followed by low colo-rectal anastomosis or colo-anal anastomosis may result in functional modifications. A brief retrospective study of 210 cases showed that the considerable alterations (urgency, frequent stools) are essentially due to very low colo-rectal, supra-anal anastomoses. It would therefore be interesting to evaluate the result of colo-anal anastomoses with colonic reservoir in this group of patients.

Anal Canal↗
PubMed1988

High hepatic excretion in humans of cefpiramide, a new cephalosporin.

After intravenous administration of 1 g of cefpiramide, the biliary elimination of the drug was studied by using high-performance liquid chromatography. In five healthy volunteers, a mean peak concentration of 339 +/- 107 (standard error of the mean) micrograms/ml was measured in aspirated duodenal fluid during h 2 after administration, and 1.2% of the dose given was recovered over a 4-h period. A maximal concentration of 1,161 +/- 392 micrograms/ml was reached during h 2 in T-tube bile from 10 recently cholecystectomized patients, with a 24-h biliary recovery of 23.1%; urinary recovery over the same period averaged 49.4%. In 10 patients undergoing cholecystectomy, the concentrations in serum, choledochal bile, gallbladder bile, and gallbladder wall 1 h after cefpiramide administration were 157 +/- 21, 1,726 +/- 501, and 84 +/- 33 micrograms/ml and 23 +/- 4 micrograms/g, respectively. These figures represent the highest biliary concentrations attained so far with a beta-lactam antibiotic and are therefore a good prerequisite for treatment of biliary tract infections with cefpiramide.

Anti-Bacterial Agents↗