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Biomedical subjects

U Laffer

Publications and source records attributed to U Laffer.

At least 55 records · Page 3Linked to original sources

Intraperitoneal chemotherapy in peritoneal malignancy: impact of intensive system care on practicability.

In a group of 31 patients a port-a-cath-system for intraperitoneal chemotherapy was installed. From 23 evaluable patients 9 showed a tumor remission, but only 1 was a patient with gastrointestinal carcinoma. All others were patients with ovarial carcinoma. The median survival rate of all patients was 9 months after implantation of the intraperitoneal catheter. 50% of all patients with gastrointestinal carcinoma died within the first 6 months, only 1 of 11 patients with ovarial carcinoma died in this period.

Adult↗

[Blood transfusion, short perioperative intraportal chemotherapy and recurrence of colorectal cancer].

Carcinomatous tumors usually have a rather slow proliferation rate. However, this process is sensibly accelerated as soon as immunodepressive phenomena occur. Blood transfusions may result in the appearance of a considerable mass of alloantigens and in simultaneous immunomodulation. On the basis of a series of 469 patients, we are able to realize that the intra-and postoperative administration of blood during the curative resection of colorectal cancers produced a poor prognosis. We also followed up subjects who had had chemotherapy via the portal system for one week but no blood transfusion. The prognosis was definitely better in these patients, and proved to be 2 to 3 times as favorable as for patients receiving blood transfusions without chemotherapy. The various results are thoroughly analyzed, the primary aim being the study of the effects of intraoperative portal chemotherapy. This leads to advocating the restriction of blood transfusions, and the use of autotransfusion or hemodilution if required.

Animals↗

[Indications-related and technical errors and their consequences in breast saving treatment].

Conservative treatment becomes an established procedure for small breast cancer worldwide. Randomized and non-randomized studies have shown equal prognostic results compared with the more radical operative treatment. This large-scale therapy only can be worthwhile, if the cosmetic results are better than breast reconstruction after mastectomy. Therefore a rigorous indication, a standardized technical procedure and a well-functioning team of interdisciplinary cooperation is required. Out of 500 conservatively treated patients we controlled a random sample of 134 relative to the cosmetic result. The results were related to our standard technique.

Breast↗

[Breast saving therapy: diagnostic problems in after care].

From 1.1.1977 through 31.12.1985 two hundred seventy-five patients with stages pTis, pT1-2, pN0-1, cM0 breast cancer were treated by breast-conserving therapy. Six patients (2%) were lost to follow-up. Fifty-four patients developed significant subcutaneous or parenchymal induration in the treated breast. The induration was considered clinically suspicious for recurrence in 30/54 and non-suspicious in 24/54. Of the 30 suspicious indurations mammography was diagnostic or suggestive of recurrence in 12 (40%), and the diagnosis of recurrence could be confirmed microscopically in 16 (53%). Mammography showed no pathologic findings in 14/30 (42%) patients with suspicious indurations, and in 12/30 (40%) the impression of benignity was also confirmed microscopically. In patients whose mammograms were diagnostic or suggestive of tumor, malignancy was demonstrated by pathologic examination in all cases. In 21/24 (87.5%) clinically benign indurations no tumor could be found on microscopic examination. Twenty of these patients had a normal mammogram, and in only 1 of these was a recurrence discovered incidentally during a cosmetic operation. Four of the 24 patients with clinically benign indurations had pathologic mammograms, and in 2 of these the diagnosis of recurrence was established histologically. - The rate of agreement between suspicious clinical and mammographic or microscopic findings was about 50%, whereas the correlation for clinically benign indurations was greater than 80%.

Biopsy, Needle↗

[Implantable catheter system for ambulatory parenteral antibiotic chemotherapy. A prospective study].

17 patients with infectious diseases needed a long-term parenteral antibiotic therapy. Therefore a subcutaneous catheter system (Port-a-Cath) was implanted for intravenous application of the antibiotic drugs. With a total dwelling-time of 952 patient/days no catheter super-infection was observed. Due to postoperative hematoma in an anticoagulated patient one catheter system was not functioning temporarily. One had to be removed on suspicion of a fungous colonization which could not be verified after bacterial examination. Quality of life for all patients was unaltered so that ambulant therapy was possible in almost 20%.

Adult↗

[Suspected appendicitis: immediate surgery or observation?].

Ruptured appendicitis involves a morbidity rate greater than that of negative exploration, and estimations of morbidity as high as 15% for negative laparotomy have been accepted by various investigators. We undertook a prospective analysis of 450 patients admitted to our hospital with suspected acute appendicitis, to identify those aspects in differentiating diseases that required surgery from those permitting observation. A prompt appendectomy was performed in 265 patients (59%). The appendix was normal in 4% of them. 185 patients were observed clinically and by laboratory investigations. None of them had to be operated on during the following 12 months of out-patient observation. We may conclude that clinical observation by an experienced physician may decrease the rate of negative laparotomies.

Adolescent↗

[A total subcutaneously implantable venous catheter system. 4 years' experience in cancer patients].

A totally implantable venous access system (Port-a-Cath) was inserted in 48 cancer patients. The devices were utilized for the administration of chemotherapy, antibiotics and blood products, as well as for blood drawing. Implantation was possible on an outpatient basis. The system provided full physical activity and good quality of life for the patient. Complications related to the Port-a-Cath were one subclavian vein thrombosis, one catheter thrombosis, two catheter dislocations, one dislocation of the "port" and reduced blood aspiration in two cases. It is stressed that no catheter related infections were seen. With increasing experience of the team the complication rate was significantly reduced.

Anti-Bacterial Agents↗

[Value of subtotal stomach resection in stomach cancer].

The controversy about the extent of resection of gastric cancer has been lasting for decennies. The extreme viewpoints may have become less divergent recently although controlled data are still lacking. As gastrectomy has generally become safer, a somewhat broader indication for it is justified. Subtotal resection is still justified for cancer of the antrum of the intestinal type (Laurén-classification) without evidently involved distant nodes and as long as a clear margin can be expected, furthermore in some advanced disease situations and finally in high risk patients, especially with severe cardiopulmonary handicaps.

Gastrectomy↗

[Do pathologico-anatomic parameters modify the incidence of recurrence following conservative breast surgery and radiotherapy?].

201 breast cancer patients (pT1-2, pN0-1) were treated with conservative breast surgery and radiation therapy. 28 (13.9%) treatment failures, -13 (6.5%) local recurrences, 4 (2.0%) axillary - and 11 (5.5%) distant metastases -, were found overall after a mean follow-up of 47 months. The differences between pT2 and pT1-tumors (20.6% vs 10.5%) and nodal positive versus nodal negative patients (28.1% vs 6.8%) are statistically significant. No differences were seen regarding histological features.

Breast↗

Prevention of deep vein thrombosis in patients with hip fractures: low molecular weight heparin versus dextran.

A randomized open trial was undertaken to compare the antithrombotic efficacy of a low molecular weight heparin (LMWH; Sandoparin) with that of dextran 70 in patients undergoing surgery for hip fracture. One hundred thirteen patients received LMWH once daily subcutaneously at a fixed dosage while 103 patients received intravenous dextran 70. Postoperative deep vein thrombosis (DVT) was assessed by a diagnostic algorithm using the 125Iodine fibrinogen uptake test as screening and Duplex ultrasonography and/or ascending venography as confirming techniques for suspected DVT. The frequency of DVT was significantly lower in the LMWH group than in the dextran group (15.5 versus 32.6%, p less than 0.005). Proximal DVT was rare in both groups (LMWH: 2%, Dextran: 1%). Only one case of fatal fat pulmonary embolism was observed during the 10 day prophylaxis period in a patient receiving Dextran. Three cases of pulmonary embolism occurred later; one fatal event in the dextran group on day 14, and two cases in the LMWH group (one fatal and one non-fatal event) on day 14 and 17, respectively. There was no major bleeding complication in either group. We conclude that the LMWH we used is safe, was well tolerated, and has a significantly better thromboprophylactic effect than dextran 70.

Adult↗

Hematological toxicity of adjuvant portal liver infusion with fluorouracil, mitomycin and heparin.

Adjuvant perioperative liver infusion chemotherapy with fluorouracil, mitomycin and heparin caused mild but significant myelosuppression in the first two postoperative weeks. This was associated with a slightly increased bleeding tendency. Mortality was not increased. Future trials might combine chemotherapy with hematopoietic growth factors in order to minimize myelosuppression.

Antineoplastic Agents↗