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Biomedical subjects

M Krispin

Publications and source records attributed to M Krispin.

At least 19 recordsLinked to original sources
PubMed1992

Primary neoplasms of the small bowel.

Primary neoplasms of the small bowel are unusual and constitute 1-5% of all gastrointestinal tract neoplasms. Preoperative diagnostic difficulties, frequent dissemination at the time of the diagnosis, and poor prognosis are characteristic of this pathology. During a period of 26 years we treated 61 patients with tumors of the small bowel, 44 malignant and 18 benign (1 patient had both). The most common symptoms were abdominal pain (62%), weight loss (41%), and gastro-intestinal bleeding (31%). More than half of the patients were treated as emergencies and among the remaining, the most useful diagnostic test was the small intestinal barium study. Seventeen patients were operated on for intestinal obstruction, 6 of them due to intussusception of the tumor, while 8 other patients presented with perforation and 7 with massive gastrointestinal bleeding. Leiomyoma was the most frequent benign lesion. Among malignancies lymphoma was encountered in 38.6%, followed by adenocarcinoma (29.6%) and leiomyosarcoma (22.8%). Lymphoma was predominant among Sephardic Jews. Curative procedures were attempted in all but one of the benign cases and in 21 of the malignant cases. At the time of surgery metastases were present in 23 patients. The postoperative mortality was high (20% and 14% in the benign and malignant groups, respectively) most probably due to the high incidence of emergency surgery in a high risk population. The prognosis of the malignant tumors was poor with a 5-year survival of 18%. Their disappointing course seems to be related to late diagnosis because of nonspecific symptoms and difficulty in bringing the tumor to the fore. Hopefully, a greater awareness will lead to an earlier diagnosis and improve the prognosis.

Adolescent↗
PubMed1992

Benign cystic mesothelioma of the peritoneum: the occurrence of an adult entity in a child.

Benign cystic mesothelioma of the peritoneum is considered a disease of adulthood occurring predominantly in women. We report a case of benign cystic mesothelioma of the peritoneum in an 11-year-old boy. The innumerable cystic lesions that varied in size occupied the entire peritoneal cavity. He underwent two laparotomies in a period of 15 months during which a partial removal of the tumor was performed. Four years after the second operation the child is well and active, despite significant tumor tissue left behind after the first two operations. The management of this disease is discussed, and the importance of a conservative approach minimizing the number of laparotomies and avoiding radical surgical intervention especially in childhood is emphasized.

Child↗
PubMed1992

Secretory breast cancer in childhood and adolescence: report of a case and review of the literature.

A 17-year-old boy underwent a wide partial mastectomy with axillary dissection for secretory breast cancer, followed by low grade irradiation (30 Gy). There were no axillary lymph node metastases. Hormone receptor assay of the tumor was positive for progesterone and negative for estrogen. There was no local recurrence or sign of dissemination after nearly 5 years. Literature search revealed 21 cases of secretory breast cancer in childhood and adolescence; in only 2 cases was the hormonal status studied. We report an additional case and review the literature.

Adolescent↗
PubMed1990

Penetration of aminoglycosides into human peritoneal tissue.

Each of 30 patients underwent elective laparotomy following administration of a single intravenous dose of amikacin, netilmicin or tobramycin. Therapeutic concentrations of amikacin were achieved in peritoneal tissue in 10/10 patients. Only 13/20 samples from patients receiving the other two antibiotics showed antibacterial activity. Our data suggest that the penetrability of tobramycin (53%) and amikacin (39%) into the uninflamed peritoneal tissue is superior to that of netilmicin (16%).

Amikacin↗
PubMed1989

Penetration of third-generation cephalosporins into human peritoneal tissue.

Each of 40 patients underwent elective laparotomy following administration of a single 1.0-gram intravenous dose of ceftizoxime, ceftriaxone, cefoperazone or cefotaxime. Therapeutic concentrations of cefoperazone and ceftriaxone were achieved in peritoneal tissue in 20/20 patients. Only 9/20 samples from patients receiving the other two antibiotics had detectable antibiotic activity. The antibiotic concentration in peritoneal fluid (7 samples) was 2.36-11.15 times higher than that of concurrently obtained peritoneal tissue. When adjusted for the in vitro susceptibility (MIC) of potential peritoneal pathogens, our data suggest that ceftriaxone and cefoperazone may be preferable to other third-generation cephalosporins for the prophylaxis and therapy of intraabdominal infection.

Ascitic Fluid↗
PubMed1989

The incidence and significance of serum hCG and CEA in patients with gastrointestinal malignant tumors.

Beta-human chorionic gonadotropin (hCG) is normally produced and secreted by trophoblastic cells in pregnancy, by tumors arising from those cells and by a wide variety of tumors of nonendocrine origin. Gonadotropin is produced and secreted by various tissues (stomach, pancreas, ovary, etc.) and the incidence of ectopic secretion varies between 0 and 43%. Our report is an attempt to evaluate the incidence of high plasma beta hCG levels in 101 patients with gastrointestinal malignant tumors. The results revealed negative beta hCG in the control samples, while in the studied patients 41 were positive for beta hCG (44.4%). Three samples from oesophagus squamous cell carcinoma were positive. Twenty-five out of 69 with colorectal carcinoma had raised serum beta hCG (36.8%). Gastric carcinoma showed positive beta hCG in 52% of the patients. Among all the patients high beta hCG levels were far more common in those with positive lymphnodes (P less than 0.05). The beta hCG levels decreased with colorectal carcinoma tumor size and with smaller tumors there was the probability of increasing positive serum measurements (P less than 0.05). The patients with adenocarcinoma of the stomach showed good statistical correlation between stages of the disease at the operation time to beta hCG levels. In our opinion this serological assay will become one of the markers to be added to our armamentarium in the evaluation of patients with gastrointestinal malignant tumors.

Adenocarcinoma↗
PubMed1988

Paget's disease of the male breast.

Histologically proved Paget's disease of the breast with negative hormonal receptor assay in a 73-year-old man induced a review of the 27 valuable cases of the literature. Our patient is disease-free, eight years after treatment by modified radical mastectomy and adjuvant irradiation. Peak incidence of the disease is between 50 and 70 years of age. The most frequent presenting signs reported are ulcerations and eczematous lesions of the nipple (71.4%) with discharge and bleeding in 39.3% of the cases. Other findings are a palpable mass (42.8%) and involved axillary lymph nodes (53.5%). The treatment of choice is shown to be radical or modified radical mastectomy with adjuvant radiotherapy. To date, no proof exists of the value of hormone receptors assays and routine adjuvant hormone therapy is not practiced.

Aged↗
PubMed1988

Choledochoduodenostomy for benign and malignant biliary tract diseases.

Although nonsurgical alternative treatments for primary or retained common bile duct stones--such as dissolution of gallstones with deoxycholic acids and, especially endoscopic papillotomy--have become available, choledochoduodenostomy (CDS) has been used with increasing frequency over the past decade, with extension of the indications for its use. We report our experience with side-to-side CDS in 116 patients with benign (65 patients) and malignant (46 patients) biliary diseases. Even though the mean age of our patients with benign disease--patients who underwent urgent operations because of obstructive jaundice (74%), liver damage (approximately 60%), and other biliary complications--was 66.8 years, the perioperative mortality was 3.07% and the long-term follow-up results were excellent with no biliary complications. In regard to the controversy about the use of CDS in malignant biliary obstructions, our experience shows that none of the 42 patients had any complication due to malignant invasion of the stoma, and only one patient had ascending cholangitis; the perioperative mortality in this group was 8.6%. In our opinion, CDS is a relatively safe, definitive procedure for treatment of benign and malignant biliary diseases, with good long-term results in high-risk, aged patients.

Adult↗
PubMed1987

Surgery for carcinoma of the breast in women over 70 years of age.

A review of 100 women over 70 years of age treated for breast carcinoma is reported. The short- and long-term results of treatment were evaluated with a median follow up of 4.7 years. Due to our aggressive approach, only 11% of this group died from breast cancer, and the 5-year survival rate was 51%, including all stages of the disease. The result of this study indicates that elderly women with breast cancer should be treated by surgical methods that offer the best chance of cure, regardless of patient's age.

Aged↗
PubMed1987

Antitumor effects of inhibitors of arachidonic acid cascade on experimentally induced intestinal tumors.

The antitumor action of inhibitors of cyclooxygenase (indomethacin) and lipoxygenase activity (nordihydroguaiaretic acid) of arachidonic acid cascade was investigated in the chemically induced large bowel tumors in Sprague-Dawley rats. Indomethacin treatment completely prevented the carcinogenic effect of methylazoxymethanol. Thus, no tumors were found in the 14 rat test group, compared with 13 of 14 tumor-bearing rats in the untreated control group. Although nordihydroguaiaretic acid treatment does not abolish prostaglandin synthesis, it does reduce the effect of the carcinogen and tumors were found in only five of 14 treated rats. From this study it can be postulated that not only is reduction in prostaglandin formation responsible for the inhibition of tumor growth, but also leukotrienes may play some role.

Animals↗
PubMed1987

Cancer family syndrome of Lynch.

This report describes a family in whom eight cancers (six colonic and two endometrial) occurred in seven relatives. The colonic cancer was diagnosed in five of the six affected patients at an unusually young age, had a predilection for the proximal colon, and was of the mucinous type in four patients. Polyposis was not found in any colon. The occurrence of cancer in this kindred is characteristic of the "cancer family syndrome" of Lynch.

Adenocarcinoma, Mucinous↗
PubMed1987

Concentration of norfloxacin in human gallbladder tissue and bile after single-dose oral administration.

Concomitant concentrations of norfloxacin in serum and in gallbladder tissue and bile were determined in 10 patients after a single oral dose of 400 mg given before cholecystectomy. Concentrations in gallbladder bile ranged from 0.6 to 15.6 micrograms/ml, with a mean bile/serum ratio of 7.0. The mean concentration in gallbladder tissue was 1.8 +/- 0.8 (standard error) micrograms/g.

Adult↗
PubMed1987

Choledochoduodenostomy for benign biliary tract disease in the elderly.

Endoscopic sphincterotomy is an available nonoperative alternative treatment for recurrent or residual common bile duct stones. Nevertheless, immediate, intraoperative and definitive treatment is needed in patients with common duct stones and other pathologies that are prone to develop into such complications, which is important especially in aged high-risk patients during recurrent operations and nonoperative instrumental interventions. To evaluate the safety of choledochoduodenostomy in elderly patients, we reviewed our experience with 55 patients over the age of 70 years with benign biliary tract diseases. Even though the majority of patients (69%) had obstructive jaundice and were operated on urgently, there was one death (1.8%) due to cardiac failure, and nine (16.3%) early postoperative complications including subphrenic abscess, disruption of wound and pneumonia (one case of each), wound infection (three cases) and urinary tract infections (three cases). There were no complications related to the procedure itself. In a follow-up period of one to 12 years, neither cholangitis nor sump syndrome were documented.

Aged↗
PubMed1986

Prophylactic oophorectomy in premenopausal women with stage II breast carcinoma.

Prophylactic oophorectomy, as an additional treatment for stage II breast cancer, is controversial. In a retrospective study, a group of 37 premenopausal women with stage II infiltrating duct carcinoma and one to three positive axillary lymph node involvement after modified radical mastectomy and bilateral oophorectomy were compared to a matched group of 34 women treated by modified radical mastectomy only. Prophylactic oophorectomy prolonged the disease free interval significantly as compared to the control group. However, it did not prolong survival. This raises the question whether the prolongation of survival achieved by late oophorectomy in women with advanced breast cancer is preferable to an improvement in quality of life resulting from longer disease free intervals.

Actuarial Analysis↗
PubMed1985

Primary resection with colocolostomy for obstructive carcinoma of the left side of the colon.

Between 1970 and 1982, 147 patients were operated on for obstructing carcinoma of the colon at our institution. Of these, 25 patients with obstructing carcinoma of the left side of the colon were treated by emergency primary resection with colocolostomy. Three patients who had primary resection died postoperatively, two of them from myocardial infarction and one, a 66 year old patient with liver metastasis, from sepsis. One patient had an anastomotic leak and underwent a proximal diverting colostomy. Results of this form of treatment have been good, and we advocate the procedure for selected groups of patients.

Aged↗