Biomedical subjects

M B Popp

Publications and source records attributed to M B Popp.

At least 19 recordsLinked to original sources

PubMed1999

Laparoscopic diagnosis and management of malignant ascites.

Malignancy is the second most common cause of ascites. Tissue diagnosis is often difficult because the cytology of ascitic fluid is positive in only 57% of cases. Peritoneovenous shunting is often used as palliation in such patients and has proven superior to nonoperative management for some patients. We present three cases of malignant ascites with negative cytologies managed by using laparoscopic biopsies to confirm intraperitoneal cancer and assist in the placement of a peritoneovenous shunt. Results suggest that exploratory laparoscopy and shunt placement is a valuable procedure in these patients with a limited life expectancy and is preferable to open laparotomy.

Adenocarcinoma↗

PubMed1995

Preoperative regional therapy for extremity sarcoma. A tricenter update.

BACKGROUND: Preoperative radiation with sensitizing doxorubicin has been popularized in the treatment of high grade sarcoma of the extremity. A multiinstitutional experience with this protocol that was initiated by the Southeastern Cancer Study Group in 1984 and maintained in three institutions was updated by the authors. METHODS: Patients with biopsied sarcoma had intraarterial infusion with doxorubicin hydrochloride (Adriamycin) 30 mg/24 hrs x 3 days and were allocated by the institution to receive radiation 30-35 Gy in 10 fractions or 46 Gy in 23-25 fractions followed by resection. Surgery was performed within 10 days or 30 days depending on the radiation dose. Postoperative chemotherapy was administered to 31 patients. RESULTS: Of 66 patients, 32 were female and 34 were male. The median age was 46 years (range, 14-77 years); 73% had lower and 27% had upper extremity tumors. There were 55 soft-tissue and 9 malignant bone tumors. Common types were malignant fibrous histiocytoma 20%; liposarcoma, 17%; synovial sarcoma 18%; and 14% were osteosarcoma. American Joint Committee on Cancer stages were: I, IIB (17%), IIIA/B (59%), and IIIC/4A (24%). Limb salvage surgery was performed on 60 patients including radical resection in 21 with extensive tumors, wide local excision in 30, and limited excision in 2 patients. Primary amputation was performed on four patients and delayed amputation in two because of wound complications. Three patients had pulmonary metastasectomy in conjunction with primary surgery (2 are long term survivors > 5 years). There were no postoperative deaths, but wound complications occurred in 41% of the patients. Overall survival and disease free survival at 5 years was 59 and 49%. One patient (1.5%) had local recurrence 9 years after resection of an extensive synovial sarcoma of the shoulder. This was resected with limb salvage techniques. Among 23 patients who failed primarily in the lung, the median survival was 7 months with 4 surviving more than 5 years, after demonstration of the pulmonary metastases. Multivariant analysis of prognostic factors showed that extent of disease and stage correlated with disease free survival, whereas only extent of surgical resection correlated with overall surgical survival. CONCLUSION: Combined therapy for extremity sarcoma in a multicenter setting using preoperative radiation with sensitizing chemotherapy and adequate resection was associated with an excellent local control rate (98.5%) and reasonable long term tumor control, although distant metastases continued to be a major challenge.

Adolescent↗

PubMed1990

Combination regional therapy for extremity sarcoma. A tricenter study.

Patients with extremity sarcomas were treated with a neoadjuvant therapy protocol that had originated within the Southeastern Cancer Study Group. Major objectives were to determine tolerance of therapy and its effects on tumor control and survival. After undergoing biopsy, patients received intra-arterial infusion with doxorubicin hydrochloride (Adriamycin) (30 mg every 24 hours) for 3 days and were allocated by institution to receive irradiation of 30 or 35 Gy in 10 fractions or 46 Gy in 23 to 25 fractions. Surgery was done within 7 to 10 days or 30 days pending irradiation dose. Postoperative chemotherapy was given to 31 patients. There were 60 patients, 29 women and 31 men with a median age of 48 years, with 53 soft-tissue tumors and 7 malignant bone tumors. Stages (American Joint Committee on Cancer) included stage IB, 2 patients; stages IIA and IIB, 9 patients; stage IIIA, IIIB, or IIIC, 39 patients; and stages IVA or IVB, 10 patients. Limb salvage surgery was done in 57 patients, including radical resection in 23 with large extensive tumors, wide local excision in 30, excision with narrow margins in 7, primary amputation in 3, and delayed amputation in 2 because of wound complications. There was one local recurrence in the 57 patients who had limb salvage surgery. Disease-free and overall survival at 48 months were 47% and 56%, respectively. We conclude that combined therapy for extremity sarcomas in a multicenter setting resulted in excellent local control, good function, and reasonable long-term survival in patients having limb salvage surgery.

Adolescent↗

PubMed1989

The effect of perioperative blood transfusions on long-term survival of colon cancer patients.

Blood transfusions have repeatedly been shown to decrease the rejection rate of transplanted organs by inducing an as yet undetermined form of immunosuppression. To evaluate whether these transfusions also decrease resistance to tumor metastases, records of patients who underwent colon cancer surgery were reviewed. A comparison was made between those who received perioperative transfusions and those who did not receive blood with regard to long-term survival. Patients receiving transfusions were found to have a significantly lower long-term survival rate than those who did not receive perioperative transfusions. This finding was most pronounced in those patients who had grossly localized disease at the time of surgery. The use of transfusions at the time of colon cancer surgery may therefore be detrimental to the patient's long-term prognosis.

Blood Transfusion↗

PubMed1988

Host and tumor responses to varying rates of nitrogen infusion in the tumor-bearing rat.

The influence of variations in nitrogen content of nutritional substrate available to the tumor-bearing (TB) host on tumor growth and host have not yet been completely defined. One hundred fifty-two growing Fischer 344 rats were either transplanted with a sarcoma (TB) or injected with saline (NTB, day 0), had aseptic placement of superior vena cava catheter (day 14), and were infused with total parenteral nutrition solutions (days 18-28). Isocaloric solutions (approximately 50 kcal/d) contained either 0%, 5%, 16%, 33%, 67%, 100%, 133%, or 167% of normal intake of an adequate amino acid mixture. Final tumor weight in the 5% group (23.4 +/- 3.0 g) was significantly less than tumor weights of all other groups (range: 33.3 +/- 3.3 to 42.6 +/- 11.3) (p less than 0.05). The carcasses of TB animals were slightly smaller than NTB animals but showed no major alterations in protein, fat, or water composition. This study suggests that the tumor can be starved selectively by strictly nutritional means with complex accompanying host carcass and organ changes.

Amino Acids↗

PubMed1988

Influence of total nitrogen, asparagine, and glutamine on MCA tumor growth in the Fischer 344 rat.

Previous studies from this laboratory have demonstrated that growth of the methylcholanthrene (MCA) sarcoma is dependent on total nitrogen substrate availability in vivo and on the specific amino acids asparagine and glutamine in vitro. This experiment determines whether these two phenomena can be used to selectively depress tumor growth and maintain host carcass. Sixty-two rats were inoculated with sarcoma and were infused for 10 days with isocaloric (60 kcal/day) TPN solutions at 100%, 16%, 10%, and 5% of normal nitrogen levels, either with (W) or isonitrogenously without (WO) the amino acids asparagine, glutamine, aspartic acid, and glutamic acid. W solutions contained 33% of these amino acids. Mean weights of 100 W tumors were significantly greater (p = 0.002) than all other groups. Total body weights minus tumor weights were similar in W versus WO animals at each rate of nitrogen infusion. Mean venous plasma concentrations of asparagine, aspartic acid, glutamine, and glutamic acid were similar in all eight groups. These data indicate that the same degree of tumor depression produced by nitrogen deprivation can also be produced by removal of asparagine, glutamine, and their precursors from nutrient solutions without adverse effects on carcass mass. The mechanisms involved are not readily explained by analysis of venous plasma amino acid concentrations.

Amino Acids↗

PubMed1987

Evaluation of serum proteins in relation to body nitrogen in tumor-bearing rats.

Assessment of visceral and somatic protein stores by serum proteins in surgical oncology patients has been difficult to interpret. Tumor-bearing (methylcholanthrene sarcoma) (TB) and nontumor-bearing (NTB) Fischer 344 rats were infused with a total parenteral nutrition solution at either 25, 100, or 175% of an infusion rate that provided sufficient nutrients for normal rat growth: On the fifth day after diet initiation, the rats were exsanguinated, decapitated, eviscerated, and skinned. Serum was analyzed for transferrin (TF), complement C3, albumin (ALB), retinol-binding protein (RBP), and transthyretin (TTR). Carcass (CAR) and organ (VIS) nitrogens were determined by the Kjeldahl method. TTR, TF, and RBP correlated significantly with TB and NTB VIS nitrogen and TB CAR nitrogen. The correlation of NTB VIS nitrogen with TTR, TF, and RBP (r range = 0.70-0.85, P less than 0.001) was higher than for TB rats (r range = 0.53-0.57, P less than 0.005). The correlation of TB carcass nitrogen (r range = 0.47-0.51, P less than 0.01) with TTR, TF, and RBP was higher than for NTB carcass nitrogen which was not significant (r range = 0.25-0.37, P less than 0.57). These data indicate that TTR, TF, and RBP do correlate with components of body nitrogen mass, but factors other than nutrition may influence their metabolism in the TB host.

Animals↗

PubMed1987

Regression of melanoma nodules in a patient treated with ranitidine.

Human malignant melanoma may regress spontaneously or with immunotherapy, such as Calmette-Guerin bacillus, interferon alfa, interleukin-2, and interleukin-2 plus lymphokine-activated killer cells. Histamine type 2 receptor antagonists can modulate immune function by inhibiting suppressor T-cell induction and activity, and melanoma regressions have been reported after the use of cimetidine with coumarin or interferon alfa. This article describes the complete regression of melanoma nodules in a patient treated with ranitidine hydrochloride, another histamine type 2-receptor antagonist. Ranitidine and cimetidine should be considered to be possibly active immunotherapeutic agents in the design and evaluation of clinical trials.

Female↗

PubMed1986

Combined chemotherapy, radiation, and surgery for epithelial cancer of the anal canal.

Combined chemotherapy and radiation therapy have been reported to produce a high incidence of complete regression of epithelial cancer of the anal canal, resulting in prolonged disease-free survival. This modality has been advocated as an alternative to abdominoperineal resection as a primary treatment for this disease. Our group treated 19 patients between 1979 and 1985. Treatment included two infusions of 5-fluorouracil (1000 mg/m2/24 hours), one dose of mitomycin C (15 mg/m2), and simultaneous whole-pelvis radiation (3000 rad). The complete response rate was 88%. Three patients had anal cancer incompletely controlled by that therapy. They underwent abdominoperineal resections and are alive without disease at 10, 39, and 43 months, respectively. Actuarial disease-free survival at 40 months was 87.5 +/- 8.8 (% +/- standard error of the mean [SEM]). Complications included gastrointestinal, hematologic, and cutaneous toxicity. These results confirmed a high complete response rate to this therapy. Local treatment failures may occur, but these may be salvaged with abdominoperineal resection.

Antineoplastic Agents↗

PubMed1986

Improved survival in squamous esophageal cancer. Preoperative chemotherapy and irradiation.

Initial trials of irradiation and chemotherapy followed by operation for squamous carcinoma of the esophagus have produced encouraging results. Over the past three years, with palliative and curative intent, we have treated 27 unselected patients initially with two courses of chemotherapy (fluorouracil and either cisplatin, mitomycin, or cisplatin and vincristine sulfate) given 29 days apart and 3000 rad (30 Gy) of radiation. Ten patients have then undergone esophageal resection and two patients have undergone esophageal bypass. Results are compared with those of 70 unselected historical control patients treated since 1979. Survival at 30 months was significantly improved for multimodality-treated patients (21.4% +/- 10.1%, mean +/- SEM) when compared with historical control patients (4.8% +/- 2.7%). Twenty-four percent of multimodality-treated patients had complete remission of all tumor. These data indicate that overall therapy for carcinoma of the esophagus has been improved in our institutions.

Carcinoma, Squamous Cell↗

PubMed1986

The effects of rate and route of nutrient intake on protein metabolism.

Isotopic measurements of protein kinetics are useful for the investigation of metabolic protein disorders during surgical illness. The effects of rate and route (oral vs parenteral) of nutritional substrate intake have not been well defined. Fischer 344 rats were infused with a total parenteral nutrition (TPN) solution at either 25, 100, or 175% of their normal substrate intake or were fed an oral diet ad libitum. After 4 days, [15N]glycine was infused at 0.138 mg 15N/hr for 24 hr. Whole-body protein turnover (WPT), synthesis, and catabolism were determined by 15N urea enrichment. Fractional synthesis rates (FSR) of liver and muscle protein were calculated by analyzing 15N tissue enrichment. WPT (r = 0.93, P less than 0.001) and liver FSR (r = 0.57, P less than 0.01) increased linearly with TPN infusion rates. All rats had protein synthesis rates greater than catabolism rates except for the rats infused with 25% TPN. Although caloric intake was the same in rats fed orally and those infused with 100% TPN, the orally fed rats had faster WPT (P less than 0.001), synthesis (P less than 0.05), catabolism (P less than 0.001), and liver FSR (P less than 0.05) than the TPN rats. Muscle FSR was not significantly affected by either the route of feeding or the TPN infusion rate. In this study, rate and route of substrate intake affected protein kinetics in the whole animal and liver, but not in muscle. Rate and route of nutrient intake need to be carefully specified and controlled during isotopic studies of protein kinetics.

Animal Nutritional Physiological Phenomena↗

PubMed1986

Elimination of mechanical failure of the Hickman right atrial catheter.

The double lumen Hickman right atrial catheter (Evermed Co., Palo Alto, Calif.) is usually inserted through an open venous cutdown into the internal jugular or cephalic vein. It is difficult to mechanically secure. Tight ligatures around the vein opening and catheter occlude the lumen of the Silastic rubber catheter while loose ligatures allow slippage. Migration of the tip into the vena cava or innominate vein causes fibrin sleeve formation and occlusion. Because of problems during the initial use of this catheter, we modified a subsequent series by placing a Silastic rubber bead on the catheter. The catheter is carefully trimmed so that the tip will lie in the right atrium and the bead is placed into the vein proximal to the securing ligature. Comparison of the two series of primarily leukemic patients revealed complete elimination of mechanical problems in patients with beaded catheters (0/18), and significant mechanical failure in unbeaded catheters (7/23). These data indicate that adequate fixation of the Hickman catheter at the level of the venotomy and placement of the tip in the right atrium eliminates mechanical failure and markedly improves catheter function.

Adult↗

PubMed1985

A possible beneficial effect of metronidazole in reducing TPN-associated liver function derangements.

Cholestasis and fatty infiltration of the liver are common complications of total parenteral nutrition (TPN). Following a recent suggestion that TPN-associated liver function derangements may be related to intestinal overgrowth of anaerobic bacteria, the effect of metronidazole on hepatic dysfunction during TPN in rats was investigated. After 5 days of TPN with either amino acids and glucose or amino acids with glucose and fat, all groups exhibited a mild weight gain, positive nitrogen balance, increased liver weight, increased liver:body weight ratio, increased levels of liver enzymes, and increased hepatic lipid content. The administration of metronidazole at 15 mg/kg/day significantly decreased the hepatic lipid content from 0.077 g fat/g liver for controls to 0.053 g fat/g liver. The efficacy of metronidazole in reducing hepatic fat accumulation during nutritionally effective and adequate TPN in rats suggests the possible involvement of anaerobic bacterial flora of the intestinal tract, at least in part, in the pathogenesis of TPN-associated liver function derangements. However, the various biochemical and morphological expressions of these changes and the discrepancy between unchanged liver weight, liver:body weight ratio, liver enzymes, and the improved hepatic fat content suggest multifactorial mechanisms for TPN-related liver damage.

Amino Acids↗

PubMed1984

Nearly identical oral and intravenous nutritional support in the rat: effects on growth and body composition.

The physiological effects of administration of identical oral (amino acid diet) and intravenous (total parenteral nutrition) diets in the rat have not been examined. We designed a complete solid synthetic diet which is dissolved in water to produce nearly-identical liquid intravenous and solid oral diets. Minor differences in lipid and vitamin content were probably of little biological significance. The amino acid diet and total parenteral nutrition solution were compared in a 21-day trial with growing rats. Both groups of rats had similar weight gains. Total parenteral nutrition rats compared to the amino acid diet rats had significantly increased spleen and kidney weights; decreased stomach, small bowel, and testes weights; and unchanged heart, lung, liver, adrenal, and colon weights. Body composition studies suggested similar water and protein and increased fat accumulation by rats supported with the total parenteral nutrition solution when compared to rats fed the amino acid diet. These data indicate that the route of nutrient administration is an important determinant of nutritional result.

Administration, Oral↗

PubMed1984

Tumor and host carcass changes during total parenteral nutrition in an anorectic rat-tumor system.

The independent effects of total parenteral nutrition (TPN) on tumor growth and host carcass are important in designing effective nutritional support. In this study, a TPN regimen was used to keep substrate intake at normal levels during a 10-day period of tumor-induced anorexia and cachexia in rats transplanted with a sarcoma. Tumor mass was increased in TPN-supported animals compared to orally-fed controls. Tumor composition (water, fat, nitrogen) was similar in all tumors. Host carcass mass in tumor-bearing (TB) animals was increased by TPN as compared to orally-fed TB controls, but not to the same extent as in orally-fed or TPN-supported nontumor-bearing controls. Host carcass composition determinations demonstrated significantly increased fat content but no significant change in protein or water content in TB-TPN animals compared to orally-fed TB animals. This study demonstrates increased tumor growth and increased host carcass fat stores secondary to TPN.

Animals↗

PubMed1983

Host and tumor responses to increasing levels of intravenous nutritional support.

Responses of tumor and host to increasing rates Of intravenous infusion of nutritional substrate remain undefined. Growing Fischer 344 rats underwent sarcoma transplant (day 0), aseptic placement of a superior vena cava catheter (day 14), and infusion with a nutritionally adequate solution (days 18 to 28). Rates of infusion (percentage of normal caloric intake) were 33%, 67%, 100%, 133%, and 167%. Controls included a tumor-bearing (T) group fed an identical solid oral diet and non-tumor-bearing rats treated identically to T rats. At least five of six rats survived the 10-day experiment from each group except the T-167% group, none of which survived. The mean tumor weight, carcass weight, ratio of tumor weight: carcass weight, and ratio of tumor weight: lean body mass increased linearly with the rate of substrate infusion. Composition studies of tumor revealed similar content of protein, fat, and water for all tumors. Studies of carcass composition revealed an increase in rate of fat accumulation and a constant rate of protein accumulation with increase in substrate infusion. These data indicate that tumor growth increases to a greater extent than the lean host carcass with increasing rate of substrate infusion and that high levels of substrate infusion are not tolerated.

Animals↗

PubMed1982

Resting and activity energy expenditure during total parenteral nutrition in rats with methylcholanthrene-induced sarcoma.

Tumor weight, carcass weight, nitrogen balance, energy balance, resting energy expenditure (REE), and activity energy expenditure (AEE) were measured in normal Fischer 344 rats, free-feeding Fischer 344 rats with methylcholanthrene-induced sarcoma (TB-FF), and similar tumor-bearing rats supported with total parenteral nutrition (TB-TPN). TB-FF rats became hypophagic and demonstrated weight loss, negative nitrogen balance, and negative energy balance as the tumor enlarged. TB-FF rats had a normal FEE and AEE when tumors were small and a decreased REE and AEE when tumors were large. TB-TPN rats were maintained in positive nitrogen and energy balance. TB-TPN rats had significantly increased REE throughout the study and a decreased AEE at the end of the study. Both the host carcass and the tumor responded to increased nutritional substrate with increased growth. The decline in motor activity which characterizes cancer cachexia may not be totally dependent on malnutrition.

Animals↗

PubMed1982

Growth and body composition during long-term total parenteral nutrition in the rat.

Detailed metabolic data indicating the adequacy of long-term total parenteral nutrition in the rat are not available. In this study an aseptic catheterization technique and a presumed adequate intravenous diet were used to support the nutrition of growing male Fischer 344 rats for a 21-day period. These animals were compared with sham-operated rats after 21 days of ad libitum access to one of two adequate oral diets. Total parenteral nutrition rats demonstrated weight gains that were similar to those in the rats consuming the oral diets. Body composition and nitrogen storage studies indicated fat and protein accumulation in total parenteral nutrition rats that were similar to those in the orally fed animals, but with a tendency toward increased fat and decreased nitrogen retention. These data indicate that apparently normal growth and development can be achieved with total parenteral nutrition in rats by meticulous attention to detail.

Adipose Tissue↗