Biomedical subjects

R J Barth

Publications and source records attributed to R J Barth.

27 records · Page 2Linked to original sources

PubMed1991

Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan.

For 4 days before surgical repair of a diverticulitic colovesical fistula and for 6 days after, a 63-year-old man was treated with 2 g of intravenous cefotetan disodium every 12 hours for associated urosepsis with bacteremia. Postoperatively, the patient followed a diet of intravenous nutrition only. Uneventful convalescence was interrupted by signs of sudden major blood loss, accompanied by prolonged prothrombin time. After stabilization with packed red blood cells, fresh plasma, crystalloids, and parenteral vitamin K, laparotomy revealed a huge intra-abdominal clot, which was evacuated. This case illustrates the risk of unexpected hypoprothrombinemia and hemorrhage in a cefotetan-treated surgical patient who demonstrated none of the usual comorbid conditions generally described in patients with antibiotic-induced hypoprothrombinemia. Like cefamandole nafate, cefoperazone sodium, moxalactam disodium, and other cephalosporins containing the methylthiotetrazole side chain, cefotetan appears to pose an unusual risk of major bleeding.

Cefotetan↗

PubMed1991

Level of axillary involvement by lymph node metastases from breast cancer is not an independent predictor of survival.

We examined the relationship of axillary level of lymph node metastases from clinical stage I and II breast cancer to overall survival and disease-free survival rates in 135 patients who underwent complete axillary lymph node dissection to determine if anatomic level of axillary involvement (I vs II vs III) is an independent prognostic factor. All patients underwent either modified radical mastectomy or lumpectomy with axillary dissection and whole breast radiotherapy for breast cancer. Median follow-up was 6.9 years. We found no difference in overall survival or disease-free survival between patients whose highest or only level of axillary involvement was level I compared with patients whose highest or only level was II. Although patients whose highest level of nodal involvement was III had significantly worse overall survival and disease-free survival rates than patients whose highest nodal involvement was I or II, when patients were stratified by the total number of positive nodes (one to three vs four or more), there was no difference in overall survival or disease-free survival rates between levels I, II, and III. These findings indicate that the level of axillary involvement for stage II breast cancer is not of independent prognostic significance.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

The prognosis of melanoma patients with metastases to two or more lymph node areas.

The prognosis of melanoma patients who present with metastatic involvement of two or more noncontiguous lymph node regions before the detection of extranodal metastases has not been previously reported. We identified 21 patients with metastatic melanoma in at least two nodal basins in a review of 175 patients with melanoma undergoing lymphadenectomy at the National Cancer Institute. The median survival time of these patients was 46 months, with 55%, 27%, and 17% of the patients alive 2, 5, and 10 years, respectively, after the second lymphadenectomy. Because the prognosis of melanoma patients with metastases to two or more regional nodal areas appears equivalent to that of patients with metastatic involvement of only one regional node site, lymphadenectomy of the involved groups should be performed with therapeutically curative intent.

Adolescent↗

PubMed1991

Preoperative diagnosis of acromegaly by growth hormone-releasing factor radioimmunoassay.

Acromegaly was diagnosed in a 37-year-old woman with classical physical and biochemical findings; an enlarged sella on computed tomography suggested the presence of a pituitary macroadenoma. Radiologic evidence of a lung mass prompted radioimmunoassay of plasma growth hormone-releasing factor (7,500 pg/ml; normal less than 100 pg/ml). After resection of a bronchial carcinoid, which stained positive for growth hormone-releasing factor, circulating growth hormone-releasing factor levels normalized. Subsequently, her clinical, biochemical, and radiologic evidence for acromegaly resolved. This case represents the first reported use of the human pancreatic growth hormone-releasing factor 1-40 radioimmunoassay to preoperatively diagnose this rare etiology of acromegaly.

Acromegaly↗

PubMed1990

Unique murine tumor-associated antigens identified by tumor infiltrating lymphocytes.

Tumor infiltrating lymphocytes (TIL) were cultured from multiple methylcholanthrene-induced sarcomas under four different conditions: either low-dose (10 U/ml) or high-dose (1000 U/ml) rIL-2 was used with Ag stimulation by irradiated autologous tumor and splenocytes starting either at day 1 or day 10 of culture. TIL grown from four antigenically distinct sarcomas in low-dose rIL-2 were specifically lytic in vitro to their tumor of origin in 13 of 15 (87%) lytic cultures whereas only 8 of 28 (29%) lytic TIL cultures grown in high-dose rIL-2 showed specificity. TIL cultured in low-dose rIL-2 with Ag stimulation on day 1 of culture proliferated at a rate equal to TIL grown in high-dose rIL-2 and maintained their specificity for over 3 mo in culture. Cytolysis by specific TIL was MHC-restricted. TIL with in vitro specificity were therapeutically effective in eliminating established micrometastases in murine models. These investigations demonstrate that CTL derived from tumor-bearing mice can be used to define unique tumor-associated Ag on at least four different sarcomas and may be valuable in studies of the biologic nature of these Ag and in the adoptive immunotherapy of tumors.

Animals↗

PubMed1987

The mislabeling of sexual impulsivity.

Several authors have discussed a pattern of behavior that has been called Compulsive Sexual Behavior, Sexual Addiction, or Hypersexuality. The literature concerning this disorder is reviewed. It is suggested that the various labels applied to this disorder are inaccurate descriptions that are not reflective of the true nature of the condition. It is further suggested that this behavioral pattern is best viewed as a manifestation of an Atypical Impulse Control Disorder.

Diagnosis, Differential↗

PubMed1985

The use of art therapy in marital and sex therapy.

The literature pertaining to the use of art therapy in marital and sex counseling of couples is reviewed. All articles in this area are based on case study reports; therefore, their conclusions must be considered with caution. Art therapy techniques which have been developed for use in marriage counseling are identified, and several advantages to the use of these procedures are cited. Suggestions for research to validate these procedures are discussed.

Art Therapy↗

PubMedDate not supplied

Dendritic cell infiltration in colon cancer.

We quantitatively evaluated dendritic cell (DC) infiltration in primary colorectal cancers from 44 patients and metastatic colorectal tumors from 13 patients using immunohistochemistry for the DC marker CD83, HLA-DR, and the DC activation molecules CD40 and CD86. Nearly all CD83+ cells were also HLA-DR+, CD40+, and CD86+, indicating that the DCs that infiltrate colon cancer in vivo express the activation and costimulatory molecules associated with a mature DC phenotype. The density of DCs in colorectal cancer primaries was three times lower than that seen in normal colonic mucosa (0.29 versus 0.84 CD83+ cells/ high-power field (hpf), p < 0.001). Dendritic cells were rarely observed in metastatic tumors: DC density in metastases was sixfold lower than in colorectal primary tumors (0.05 versus 0.29 CD83+ cells/hpf, p < 0.001). Because cytokines have been shown, in vitro, to exert potent effects on DCs, we also evaluated the relationship between intratumor DC density and the expression of cytokines by tumor-infiltrating lymphocytes (TILs) and tumor cells. Expression of interleukin-10 and transforming growth factor beta by either TIL or tumor cells was not associated with decreased DC density or decreased expression of CD40 or CD86 on DCs. Tumor expression of vascular endothelial growth factor was associated with a more than twofold increase in DC density (p = 0.01). Patients who had a high proportion of TILs expressing tumor necrosis factor (TNF) had a greater intratumor mature DC density than patients with a low proportion of TNF + TIL (0.54 versus 0.21 CD83+ cells/hpf, p < 0.01).

Adult↗

PubMedDate not supplied

Equipotent generation of protective antitumor immunity by various methods of dendritic cell loading with whole cell tumor antigens.

Multiple clinically applicable methods have been used to induce dendritic cells (DCs) to express whole cell tumor antigens, including pulsing DCs with tumor lysate, and mixing DCs with apoptotic or live tumor cells. Herein we demonstrate, using two different tumor systems, that these methods are equipotent inducers of systemic antitumor immunity. Furthermore, tumor lysate pulsed DC vaccines generate more potent antitumor immunity than immunization with irradiated tumor cells plus the classic adjuvant, Corynebacterium parvum.

Animals↗