Biomedical subjects

M H Max

Publications and source records attributed to M H Max.

At least 37 records · Page 2Linked to original sources

PubMed1983

Pregnancy and breast cancer.

To examine the relationship of pregnancy to survival in patients with breast cancer, we reviewed the records of 120 women under 36 years of age over a ten-year period and found 15 who were pregnant or lactating when breast cancer was diagnosed or who became pregnant after treatment. All 15 had mastectomy for therapy. Four of the ten patients who were pregnant or lactating had positive lymph nodes, as did three of the five who became pregnant later. Mean survival is 40 months in the six living patients who were pregnant or lactating, and 35 months in the four living patients who became pregnant later. Four of the seven patients with positive nodes (57%) are alive at a mean of 55 months after diagnosis. There was no significant relationship between chemotherapy, irradiation, immunotherapy, or ovarian ablation and subsequent survival. Pregnancy did not appear to influence the outcome. Survival in patients with positive nodes slightly exceeded expectation.

Adult↗

PubMed1983

The relationship of cimetidine to 5-hydroxytryptamine tissue levels in stress ulceration in the rat.

We studied the effect of cimetidine on 5-hydroxytryptamine (5-HT) levels in various tissues in restrained rats. Sixty male Sprague-Dawley rats, divided into four groups, received four intraperitoneal injections at 6-hour intervals in doses determined by body weight. Group I (control) was injected with saline (1 ml/300 gm) and was not restrained. Group II was injected with saline (1 ml/300 gm) and restrained for 18 hours beginning 1 hour after the first injection. Group III was injected with cimetidine (100 mg/kg) and was not restrained, whereas Group IV was injected with cimetidine (100 mg/kg) and restrained according to the schedule for Group II. The rats were killed and their stomachs were collected and graded for ulceration. 5-Hydroxytryptamine levels in the antrum and fundus of the stomach, the colon, the liver, and rectus abdominis muscle were determined by spectrophotofluorometry. Cimetidine prevented an increase in 5-HT in the antrum and protected against ulceration. As 5-HT levels in other tissues were not altered by restraint-induced stress, the phenomenon may be specific to the antrum. The protection against ulceration and elevated 5-HT levels conferred by cimetidine was comparable to that of vagotomy in similar models.

Abdominal Muscles↗

PubMed1983

Carcinoma of the gallbladder.

Results of a retrospective review of 20 consecutive patients with histologically proved carcinoma of the gallbladder encountered during a 15 year period confirm the historically established poor prognosis of the disease. One patient in whom the disease was discovered incidentally and early in its course is alive nine years after diagnosis. The other 19 patients died within eight months of diagnosis, regardless of the extent of the disease or method of treatment. By identifying patients who are at an increased risk, by virtue of such factors as cholelithiasis and advanced age, and scrutinizing all exposed or removed gallbladders for signs of abnormality, carcinoma of the gallbladder may be identified earlier. Then, since carcinoma of the gallbladder develops slowly and spreads along predictable pathways, radical cholecystectomy, including en bloc wedge resection of the gallbladder bed and adjacent nonvital tissue, performed upon patients with localized disease, probably offers the best chance for prolonged survival.

Aged↗

PubMed1982

Perceived needs for gastrointestinal endoscopic training in surgical residencies.

Questionnaires sent to directors of 126 university surgical residency programs analyzed the availability and quality of fiberoptic gastrointestinal endoscopic training. Seventy percent responded: 59 percent of their programs included some endoscopy training. Only half of the respondents believed their residents were adequately trained in endoscopic techniques. Although 67 percent of institutions had at least one surgeon performing endoscopy, many did not involve surgical residents in their cases. Insufficient caseloads were the rule, with fewer than 30 patients available to each resident for gastroscopy in 63 percent of the programs and for colonoscopy in 89 percent. Only half of all directors were satisfied with their relation with gastroenterology with respect to endoscopy. Gastroenterology service monopolized the performance of endoscopy at 41 percent of the universities. Since endoscopy is helpful in the management of many gastrointestinal disorders treated by surgeons, training surgical residents in such techniques is advisable. To do so properly, program directors must recruit skilled faculty and provide more concentrated endoscopic rotations with adequate caseloads or develop truly sharp educational experiences with their colleagues in gastroenterology.

Colonoscopy↗

PubMed1982

Pancreatic carcinoma.

This retrospective review of 33 consecutive patients with cancer of the pancreas was undertaken to investigate epidemiologic factors, presenting symptoms, diagnostic methods, site and extent of cancer, treatment approaches, and survival data. The most frequent presenting complaint, reported by 23 patients (70%), was abdominal pain. Diagnosis was established by radiography or radionuclide scanning in 11 patients (33%). Nine patients (27%) were inoperable. One patient (3%) received resection in attempt for cure, 15 (46%) had palliative bypass procedures, and eight (25%) had laparotomy only. Eighteen patients (55%) received chemotherapy, with or without operation, and two (6%) had irradiation. The mean survival was 5.1 months. One third of the patients were dead a month after diagnosis. All patients died within 16 months of diagnosis, regardless of treatment method or extent of disease.

Adult↗

PubMed1981

Familial papillary carcinoma of the thyroid.

Although the number of reported cases of papillary carcinoma of the thyroid in families is few, a review of the literature and the three cases presented here strongly suggest the characteristics of hereditary cancer. Further study and reportage of similar cases is indicated to confirm whether this is indeed a familial cancer.

Adult↗

PubMed1981

Association of squamous carcinoma of the esophagus with a synchronous primary hepatocellular carcinoma.

We have seen a patient with a squamous carcinoma of the esophagus along with hepatocellular carcinoma. Though the simultaneous occurrence of these tumors is rare, we propose that their development may be more than a chance occurrence. Since many chemical carcinogens which promote esophageal cancers in experimental animals also promote hepatic malignancies, it is possible that dietary nitrosamines in man, causally implicated in esophageal carcinoma, may also sometimes induce hepatic carcinoma in the same patient.

Aged↗

PubMed1981

Manometric evaluation of esophageal disease.

Esophageal manometry has been helpful in delineating several aspects of the pathophysiology of esophageal disease. Its immediate contribution to patient care, however, is not clear. We reviewed our experience with 59 consecutive patients who had been referred to our laboratory specifically for this study. Manometry provided new information resulting in better patient management in only eight patients (14%). Manometric abnormalities are uncommon when radiographs and endoscopy are normal; thus, manometry should rarely be used alone to evaluate subjective complaints. It is useful preoperatively in patients with reflux esophagitis if a motility disorder is suspected and in patients with cricopharyngeal abnormality. After hiatal hernia repair performed with an adequate preoperative radiologic and endoscopic evaluation for reflux esophagitis, esophageal manometry contributes little additional information to the evaluation of postoperative dysphagia.

Esophageal Achalasia↗

PubMed1981

Use of blood products during elective cholecystectomy.

To determine the value of preoperative blood typing and crossmatching, we reviewed the transfusion needs of 100 consecutive patients who had elective cholecystectomy in a city-county teaching hospital. One hundred forty-eight units of blood were typed and crossmatched for 76 patients (1.48 units/patient). Blood was typed and screened for seven patients. Six units were transfused into four patients (two patients postoperatively). None required intraoperative transfusion for hemorrhage or shock. Total blood use was 4%, with a mean of 0.06 units per patient. Substituting the type and screen for a type and crossmatch would have saved approximately $2,108 and 16.6 technician hours in this group and, if applied nationally, $9 million and 72,000 technician hours each year. In addition to sizeable savings, more efficient blood use would result from use of the type and screen in elective cholecystectomy, with no increase in patient risk.

Adolescent↗

PubMed1981

Colonoscopic diagnosis of angiodysplasias of the gastrointestinal tract.

We have reviewed our experience with colonoscopy in the diagnosis of angiodysplastic lesions of the colon. In 14 of the patients in our series, the lesions in the colon were diagnosed colonoscopically, confirming arteriographic findings in many but being the only diagnostic modality facilitating the diagnosis in three of the patients. Results of our experience indicate that colonoscopy is an effective means of diagnosing or confirming the diagnosis of angiodysplastic lesions of the right colon. It should be part of the evaluation along with superior and inferior mesenteric angiography of every patient with occult gastrointestinal tract bleeding or iron deficiency anemia, or both, for whom no diagnosis can be made with standard barium contrast techniques.

Adolescent↗

PubMed1981

Total parathyroidectomy and parathyroid autotransplantation in patients with chronic renal failure.

Sixteen patients with chronic renal failure underwent total parathyroidectomy and parathyroid autotransplantation into the muscle of the forearm. Pertinent preoperative medical history of these patients included renal osteodystrophy, metastatic vascular calcifications, intractable itching and uncontrollable hyperphosphatemia. Efforts to control preoperative serum calcium and elevated serum parathormone levels were unsuccessful. The mass of parathyroid tissue implanted, in most instances, was approximately half that used in other series. Postoperatively, all patients received vitamin D and calcium orally, which were gradually decreased. Fourteen of the 16 patients had relief of symptoms, and all had restoration of parathormone levels to normal or slightly above normal, although in two patients, partial excision of hyperfunctioning tissue from the forearm was subsequently required because of recurring symptoms of secondary hyperparathyroidism. All patients had evidence of functioning grafts six to 40 months postoperatively or until death, attributable to intercurrent causes. The success of total parathyroidectomy and parathyroid autotransplantation in patients with chronic renal failure and symptomatic secondary hyperparathyroidism makes this a viable approach to the disease in such patients.

Female↗

PubMed1980

Emergency laparotomy immediately after coronary bypass.

Eight patients required emergency laparotomy in the immediate postoperative period after coronary artery bypass (CAB). Cardiac complications were few and minor. Sepsis was the major cause of mortality. In the two patients who died, delay in operative management contributed to their deaths. The lack of cardiac causes of morbidity and mortality in our series and others suggests that a stable postoperative coronary bypass patient represents a better surgical risk than the same patient preoperatively. Therefore, aggressive management, including early laparotomy, for suspected intra-abdominal pathology after CAB is recommended to avoid uncontrollable sepsis and death.

Abdomen, Acute↗

PubMed1980

Diversion of duodenal contents: its effect on the production of experimental gastric cancer.

Diversion of duodenal contents after gastroenterostomy and vagotomy did not protect 240 laboratory rats from increased risk of gastric carcinoma. They were divided into three groups of 80: group 1 received 0.9 mg of 3-methylcholanthrene injected submucosally into the gastric antrum; groups 2 and 3 had bilateral truncal vagotomy and gastroenterostomy, with carcinogen injected into the gastric submucosa near the anastomosis; group 3 also had total duodenoenteric diversion. Blind histopathologic examination of surviving rats during necropsy eight months later disclosed that cancer had developed in six of 60 (10%) group 1 rats, in 23 of 71 (33%) group 2 rats, and in seven of 27 (22%) group 3 rats. Compared with group 1, groups 2 and 3 had an increased incidence of gastric cancer but did not differ from one another in this regard.

Adenocarcinoma↗

PubMed1980

Hepatic arterial infusion chemotherapy for cancer of the liver.

Hepatic artery infusion chemotherapy (HAIC) provides objective palliation for unresectable primary and secondary liver neoplasms. By utilizing HAIC rather than systemic chemotherapy, a greater concentration of the chemotherapeutic agent(s) within the liver is achieved with a comparative decrease in toxic side effects. A review of pertinent literature disclosed response rates of 50-71% associated with the administration of 5-fluorouracil (5-FU) and 5-fluoro-2-deoxyuridine (5-FUDR) via the hepatic artery, whereas response rates of 0-25% have been tabulated for systemic chemotherapy.

Floxuridine↗

PubMed1980

Value of colonoscopy in patients with rectal blood loss unexplained by rigid proctosigmoidoscopy and barium contrast enema examinations.

Total colonoscopy is the procedure of choice for patients with any amount of rectal blood loss unexplained by proctosigmoidoscopy and barium contrast enema examinations. In 168 endoscopic examinations, 46 unsuspected lesions in 39 patients (23 percent) were detected, 50 percent of which were 1 cm or greater in diameter. Considering that 30 percent of all unsuspected lesions, 100 percent of angiodysplastic abnormalities and 40 percent of unsuspected carcinomas were located proximal to the splenic flexure, emphasis is placed on the importance of examining the entire colon to the cecum.

Adenoma↗

PubMed1980

Small bowel tumors: a continuing challenge.

Small bowel tumors are difficult to diagnose and are frequently not identified at initial evaluation. We retrospectively reviewed 25 consecutive cases to assess the efficacy of procedures currently used in diagnosis. Barium contrast studies were diagnostic in 14 (56%) of the cases. Enteroclysis provided one diagnosis after the initial barium study was negative. Of the 11 patients for whom barium studies were negative, angiography provided the diagnosis in six (three benign, three malignant). Endoscopy was never helpful. Laparotomy was required in five cases (three benign, two malignant) after repeated negative work-ups. An evaluation protocol which calls for each method as needed seems to provide the most reliable means of diagnosing small bowel tumors.

Adult↗

PubMed1980

Failure of gastric pH control by antacids or cimetidine in the critically ill: a valid sign of sepsis.

To compare the ability of antacids and cimetidine to control gastric pH and potential hemorrhage, 77 critically ill patients were randomized into two groups initially receiving either antacids (37 patients) or cimetidine (40 patients). Gastric pH was monitored hourly and the dosage of medication adjusted as required to maintain gastric pH above 4. Forty-nine patients maintained a pH above 4 while receiving a standard dose of antacids (29 patients) or cimetidine (20 patients). Only 8 of these 49 patients proved to be septic, compared to 20 of the 28 patients who required additional medication to maintain pH above 4 (P less than 0.001). There were five episodes of gastrointestinal hemorrhage occurring in septic patients who had a gastric pH consistently below 4 despite treatment. Excluding septic patients, 8 of 23 failed to maintain a gastric pH of 4 on cimetidine compared to 0 of 26 receiving antacids (P less than 0.005). The data suggest that (1) persistent failure of antacids and/or cimetidine to maintain gastric pH above 4 is yet another indicator of often unappreciated infection, (2) maintaining gastric pH above 4 largely prevents gastrointestinal hemorrhage, and (3) cimetidine is not as consistently effective as antacids in maintaining gastric pH above 4.

Adolescent↗

PubMed1980

Ectopic secretion of parathyroid hormone.

Ectopic parathormone production has become a well described entity. The availability of an assay for parathormone has enabled the tumors responsible for this syndrome to be more readily identified. The differential diagnosis must include primary hyperparathyroidism and, if this cannot be ruled out, neck exploration should be undertaken. If possible, the treatment for the ectopic parathormone syndrome should be the excision of the tumor. This is usually unsuccessful and treatment should be directed at the hypercalcemia. Temporary control is usually successful but recurrent hypercalcemia with its complications is ultimately fatal for the patient. Newer methods of treatment of these often slow-growing tumors may result in longer survival in many of these patients.

Bone Neoplasms↗