Biomedical subjects
Publications and source records attributed to R F Schaefer.
In this report we have described three patients with upper GI bleeding who were found to have acute gastric necrosis. We have demonstrated the usefulness of esophago-gastroduodenoscopy and CT scan in further evaluation of such cases.
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Presented is the fifth case of a cystic islet cell tumor of the pancreas. The diagnosis is usually made postoperatively but should be considered in a patient with "recurrent pseudocyst" or a history incompatible with pseudocyst in combination with a cystic area in the pancreas. Computed tomography is preferred for diagnosis, and resection is the preferred therapy.
Presented is the ninth reported case of teratocarcinoma arising from the parenchyma of the lung. Treatment should include wide surgical resection and adjuvant chemotherapy. Postoperative radiation therapy should be utilized if there is residual disease or nodal metastasis. Preoperative radiation therapy should be considered if there is evidence of chest wall involvement.
Segmental pulmonary resection was employed in 61 patients with cancer whose ages ranged from 44 to 82 years (average 62 years). There were 39 patients in the curative group with disease staged T1N0M0, 9 patients in the limited group with residual thoracic disease, 8 patients in the palliative group with severe chronic obstructive pulmonary disease, and 5 patients in the metastatic group. Two patients died within 30 days after operation. Significant palliation was obtained in the limited and metastatic groups. Most patients in the palliative group died from emphysema within 1 to 2 years after resection. Early survival rates (64 percent after an average of 16 months) in the curative group were not as good as had been anticipated because small peripheral, asymptomatic, and predominantly scar adenocarcinoma spread systemically more than similar bronchogenic cancer. Furthermore, about half the deaths were related to the many other diseases of smoking. However, the local recurrence rate of 5 percent was low. Segmentectomy was well tolerated, even in patients with compromised pulmonary function.
A papillary adenomatous polyp of the verumontanum was studied morphologically and immunochemically. This rare polypoid neoplasm displayed rather typical prostatic acinar epithelium, and by immunoperoxidase method differentiation products of prostatic origin could be demonstrated easily. Findings support the concept that this type of lesion is prostatic in origin and probably arising from ectopic prostatic tissue in the prostatic urethra. The clinical symptoms of this lesion usually are hematospermia or hematuria, and this lesion can be effectively treated by transurethral excision.
Leiomyosarcoma is a malignant tumor which rarely occurs in the rectum. Three patients with leiomyosarcoma of the rectum are presented. Treatment should include wide surgical excision followed by adjuvant chemotherapy. Emphasis is placed upon computerized tomography as the method of choice for the diagnosis of recurrent disease. Recurrent tumor should be resected whenever possible.
The diagnosis of mycotic aneurysm is often elusive, since the patient frequently has signs and symptoms of sepsis only. A patient with a clinically occult mycotic aneurysm was assessed by the combined use of indium-111 leukocyte scintigraphy and computed tomography. While neither study was diagnostic by itself, the combined information obtained from the two noninvasive modalities facilitated the correct diagnosis preoperatively.
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BACKGROUND: This study stems from an encounter with a phrenic nerve paralysis in a patient following doxycycline sclerotherapy for treatment of chylous fistula. The purpose of this study is to identify possible histologic evidence of doxycycline-induced nerve injury. METHODS: The femoral nerves of CD rats were used as the in vivo animal model. The nerves were exposed to varying concentrations doxycycline and normal saline was the control. The nerves were studied at several time intervals using two different staining techniques. RESULTS: The results suggest that topical doxycycline induces tissue reactions which are different from normal saline. These reactions include stimulation of a local giant cell inflammatory reaction and disruption of the myelin sheath. CONCLUSIONS: Despite the fact that this study does not give physiologic evidence of neurotoxicity, the histologic results suggest that topical doxycycline may cause nerve damage directly or indirectly. We conclude that doxycycline should not be used for sclerotherapy where unprotected nerves are exposed to the agent until further physiologic tests are performed to prove its safety.
A diagnosis of herpetic esophagitis was made in a patient with alcoholic liver disease by means of endoscopy and brush cytology. Herpetic esophagitis is a common cause of esophageal ulceration in severely debilitated or immunosuppressed patients especially when the esophagus is traumatized by nasogastric intubation. Dysphagia or odynophagia may occur in some but not all patients. Radiographic picture may resemble Candida esophagitis. Endoscopy, biopsy, cytology, culture and serological studies will help in making a diagnosis. Specific antiviral agents may be used for treatment but spontaneous resolution without any sequelae was documented in our patient.
The antitumor effects produced by combinations of cisplatin (Pt), substituted dithiocarbamates (dimethyldithiocarbamate [DmDTC] and sodium N-methyl-D-glucamine dithiocarbamate [NMGDTC]) and hyperthermia (H) were measured and compared to those produced by single agents alone in C3H/HeN mice bearing the transplantable radiation-induced fibrosarcoma, RIF-1, in one or both hind feet. The average tumor volumes of control and treatment groups were compared periodically after treatment with H. Combinations of H and Pt completely resolved established foot tumors in 10/13 mice. However, evidence of long-term nephrotoxicity and gastrointestinal (GI) toxicity became evident causing death of these mice within 120 to 122 days after tumor inoculation. Hyperthermia plus DmDTC resolved tumors in heated and non-heated feet in 3/8 mice, thus demonstrating both ipsilateral and contralateral anti-tumor activity. Furthermore, H-Pt-NMGDTC produced complete tumor resolution in 7/13 mice; these mice survived and were tumor-free 180 days post inoculation and autopsies revealed no appreciable nephro- or GI toxicity. In addition, 4/8 mice underwent complete tumor resolution in heated left feet plus dramatic retarding of tumor growth in unheated right feet (ipsilateral and contralateral anti-tumor effects). Five heat-treated left foot tumors resolved in the H-Pt-DmDTC group with one mouse demonstrating resolution of tumor in both feet. Advanced foot tumors were treated with H-DmDTC and H-Pt-DmDTC. Hyperthermia and Pt were administered on day 0 of the experiment and DmDTC on days 0 through 3; dramatic tumor shrinkage continued through day 6 for a total of 75 to 80 percent reduction of tumor volume in both groups. The concurrent administration of DmDTC or NMGDTC with H and Pt prevented or greatly reduced nephrotoxicity and GI toxicity in all experiments without retarding anti-tumor efficacy.
In a study in the laboratories of the Chicago Board of Health, the results from determination of lead in paint films by X-ray fluorescence were compared with results from determination by atomic absorption. Portable instruments of three suppliers were used for X-ray fluorescence measurements. An improved version of one of these instruments was also tested. The results of X-ray fluorescence readings on painted card stock panels with one of these instruments compared satisfactorily with the results as determined by the atomic absorption method at levels below 10 mg of lead per square centimeter. Readings on multiple layers of these panels were additive and independent of the order of these panels. All four instruments were tested in the laboratory on painted surfaces from the walls of condemned buildings. The most recent version of each instrument gave a correlation coefficient of 0.96 or better for the linear regression of lead values in milligrams per square centimeter by atomic absorption against instrument readings. It was calculated that a reading of 3.2 or greater on any of the instruments would indicate with greater than 95 percent confidence that 1 mg or more of lead per square centimeter would be found when a sample of the paint was analyzed by atomic absorption. When the readings of one of the instruments showed lead to be absent, that result would inidcate with better than 95 percent confidence that less than 1 mg of lead per square centimeter would be found by the atomic absorption method. Portable X-ray fluorescence instruments can be used in situ to determine whether the walls of a building give readings for lead above the range of 0 to 3.2. Walls with readings above this range can be considered to have 1 mg or more of lead per square centimeter and would not be in conformance with the code of the City of Chicago. Samples would need to be taken for analysis in the laboratory by atomic absorption only from those walls with readings within the range of 0 to 3.2.