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Biomedical subjects

R Adam

Publications and source records attributed to R Adam.

At least 37 records · Page 2Linked to original sources
PubMed1990

Phase I trial of 5-day continuous venous infusion of oxaliplatin at circadian rhythm-modulated rate compared with constant rate.

The toxic effects and tissue uptake of both cisplatin and oxaliplatin--[(1R, 2R)-1,2-cyclohexanediamine-N,N'] [oxalato(2-)-O,O']platinum--were previously shown to vary similarly according to dosing time in mice. A 4-hour infusion of cisplatin resulted in fewer side effects and allowed administration of higher doses at 16 hours than at 4 hours in patients with cancer. We hypothesized that the continuous venous infusion of oxaliplatin for 5 days would be less toxic and would deliver a higher dose to the patient if the drug were infused at a circadian rhythm-modulated rate (peak at 16 hr; schedule B) rather than at a constant rate (schedule A). We tested this hypothesis in a randomized phase I trial. We escalated the dose of oxaliplatin to the patient by 25 mg/m2 per course. Courses were repeated every 3 weeks. An external, multichannel, programmable-in-time pump was used for the infusions. Toxicity was assessable for 94 courses in 23 patients (12 patients with breast carcinoma, nine with hepatocellular carcinoma, and two with cholangiocarcinoma). The incidence of neutropenia of World Health Organization grades II-IV and the incidence of distal paresthesias were 10 or more times higher (P less than .05) with schedule A than with schedule B. In addition, vomiting was 55% higher (P = .15) with schedule A than with schedule B. Furthermore, with schedule B, the mean dose of oxaliplatin (P less than .001) and its maximum tolerated dose (P = .06) could be increased by 15% over those doses with schedule A. An objective response was achieved in two of the 12 patients with previously treated breast cancer. We recommend that the dose of oxaliplatin for phase II trials be 175 mg/m2, delivered according to the circadian rhythm-modulated rate.

Adult↗
PubMed1990

Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era.

We review herein our experience in the management of bleeding esophageal varices in cirrhotic patients and consider our findings in light of the dramatic changes in the treatment of cirrhosis resulting from the more widespread use of orthotopic liver transplantation (OLT). It does not seem realistic, at present, to propose OLT as the only effective treatment of variceal bleeding for a variety of reasons, and there remains a large group of patients who are noncompliant or unsuitable for liver transplantation. We propose that initial bleeding be controlled by endoscopic sclerotherapy, thereby allowing careful evaluation to be made electively. Grade A patients appear to be managed best by a reduced-size portacaval shunt (RPS) with prospects of good survival and few complications. Grade B patients can be managed by either sclerotherapy, RPS, or OLT, depending upon individual circumstances. Grade C patients are best managed by liver transplantation, again with excellent survival. In those grade C patients not deemed suitable for OLT (especially alcoholic patients), long-term endoscopic sclerotherapy is the best option. Changes in patient status may sometimes require revision of the treatment decision.

Adolescent↗
PubMed1990

[Value of scalene lymph node biopsy in the treatment plan of advanced cervix cancer].

112 patients with carcinoma of the cervix had a scalene lymph nodes biopsy. In 22 cases (20%) metastases to the scalene lymph nodes were detected. In these cases, systemic spread of the disease beyond curative surgical or radiation therapy possibilities had to be considered. In our findings, patients with positive scalene lymph nodes had a mean survival time of 10 months after detection of the metastases in the scalene lymph nodes. Considering the systemic dissemination of the disease, patients with positive scalene lymph nodes may be treated only by palliative methods and can be spared further high-risk noncurative treatment.

Biopsy↗
PubMed1990

Orthotopic liver transplantation with hepatic artery anastomoses. Hemodynamics and response to hemorrhage in conscious rats.

Orthotopic liver isotransplantation was performed in one group of Lewis rats using cuffs for the portal vein and the infrahepatic vena cava, stents for the hepatic artery and the bile duct. Three other groups were also investigated: group A, normal rats; group B, sham-transplanted rats (clamping of the vessels, washing of the liver, placing cuffs around the portal vein); and group C, sham-transplanted rats with ligature section of the hepatic artery. Blood-flow measurements were performed, 1 week after the surgical procedure, with the radioactive microsphere method in conscious animals. Transplanted rats exhibited significant (ANOVA, P less than 0.05) increase in cardiac index and decrease in mean arterial pressure and systemic vascular resistance. Blood flows of the portal territory and to the kidneys were not significantly modified. Arterial liver blood flow and arterial liver vascular resistance in rats with liver transplantation were not significantly different between normal and sham-transplanted rats but were significantly different from rats with ligature of the hepatic artery. These results confirm the validity of the method used for vascular anastomoses. Hypotensive hemorrhage (2 ml/100 g bw) induced marked hemodynamic changes, but rats with liver transplantation when compared with normal and sham-transplanted rats exhibited the following: (a) significantly lower percentage of decrease in cardiac index and in mean arterial pressure; and (b) significantly higher renal and portal tributary blood flows. Plasma catecholamine concentrations and plasma volume were higher in rats with liver transplantation than in normal rats but were not significantly different from sham-operated rats. Histologic examination of the liver revealed slight portal edema in sham-operated rats and small necrotic areas in the liver, probably corresponding to the reperfusion injury, in rats with liver transplantation. In conclusion, the method described for the four vascular anastomoses allows functional perfusion of the transplanted liver. Rats with liver transplantation exhibited a hyperkinetic circulatory syndrome and an improved tolerance to hemorrhage. Changes in plasma catecholamine concentrations and in plasma volume did not account for the hemodynamic changes.

Anastomosis, Surgical↗
PubMed1989

[Long-term studies of patients with borderline tumors of the ovaries].

This retrospective investigation comprises a follow-up observation of 51 patients with borderline tumours of the ovaries, who had been treated at the Department of Gynaecology of the University of Erlangen between January 1st 1966 and December 31st 1986. The average age was approx. ten years younger that of patients with invasive carcinomas and 65% of the patients were in stage I. For women in stage Ia desiring children, unilateral adnexectomy is sufficient in the context of meticulous staging laparotomy. The remaining ovary should be further exposed by wedge excision. Once the family is complete, hysterectomy and adnexectomy should then be carried out retrospectively in view of the high risk of bilaterality. In ovarian tumours of borderline malignancy stages II and III, the surgical therapy should correspond to the procedure for invasive carcinomas, with the objective of postoperative freedom from tumour. Lymphonodectomy is not obligatory in view of the very rare involvement of lymph nodes. The question as to the necessity of adjuvant therapy is still open. Our observations indicate, that combination chemotherapy, containing cisplatinum is effective as adjuvant therapy in advanced stages as well as in recurrences, which cannot be completely resected surgically. 18% of our patients with borderline tumours suffered a recurrence or tumour progression, in consequence of which five died (10%). The recurrences were manifested clinically after 33 months at the earliest, and after 164 months at the latest, so that the follow-up in these patients should extend over a period of more than ten years.

Adenocarcinoma, Mucinous↗
PubMed1989

[Experiences with drill biopsy in the diagnosis of breast tumors].

We report on our experiences of 598 drill biopsies in 581 female patients. The method is suitable for clarification of dubious palpatory findings in the breast, for verification of relapse, and for receptor analysis in individual cases. It is simple to carry out, almost free of complications and provides sufficient tissue for rapid-section diagnostics. It has a high precision (90% to 92%): no false positive results were noted. The advantage, compared to excision biopsy, consists of the shortening of the duration of operation and anesthesia and better diagnostic clarification. The problem of the excision cavity is avoided. In case of a mastectomy or quadrantectomy, the primary tumor and remains connected with the tissue surrounding the tumor is available in toto for histological examination. The risk of tumor cell dissemination from drillbiopsy did not appear to be increased. The limitations of the method apply to small (less than 1 cm) not definitely palpable tumors near to the thorax wall in large, voluminous breasts. The diagnosis of specific histological types requires a high degree of experience in ultrastructural appraisal of breast tissue. A negative drill biopsy should be followed by an excision biopsy, where a carcinoma is suspected.

Biopsy↗
PubMed1989

[Comparison concentrations of serum CA-72.4 with CA-125 during a clinical course in patients with ovarian cancer].

The course of CA-72.4 serum concentrations was compared with the course of CA-125 in 17 patients with ovarian cancer. The serum levels of CA-72.4 were usually just above the detection range of the assay (3 units/ml). The comparison of the courses of the serum levels of both markers exhibited parallelism. However, no additional information could be obtained by determination of CA-72.4 in those patients who did not demonstrate elevated CA-125 levels at primary diagnosis or during recurrent disease.

Antibodies, Monoclonal↗
PubMed1989

Hematobilia resulting from heterotopic stomach in the gallbladder neck.

Hemorrhage has never been described as a complication of gastric heterotopia of the gallbladder. A case of a heterotopic stomach perforated into the Calot's area and causing hematobilia by arteriobiliary fistula in a young man is described. The clinical presentation, radiologic features, operative and histologic findings are presented, as well as the mechanism of hematobilia and the probable embryologic cause. Extensive review of the literature indicates that this case is unique both in its presentation of hematobilia and by the pathologic configuration of the heterotopic gastric tissue.

Adult↗