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PubMed1978

Pleural effusion from malignancy.

Pleural effusion from metastatic malignancy can cause major impairment of respiratory function and eventual death. Although cure is not possible, successful palliative treatment allows months to years of productive life, obviating the need for continuous hospitalization and repeated thoracenteses. Successful palliative treatment requires obliteration of the pleural space. Literature survey indicates that a wide variety of medical agents and surgical methods have been used with variable success. Medical methods include instillation of antineoplastic agents, antimicrobial agents, or colloidal radioisotopes into the pleural space; quinacrine and tetracycline are moderately to highly effective agents, but the toxicity of the former is substantial. Bedside talc poudrage with thoracostomy-tube drainage is a safe and highly effective alternative. Pleurectomy is the definitive method of preventing reaccumulation of pleural fluid that results from metastatic malignancy, even when other methods have failed, but thehigh morbidity and mortality of the procedures mandate careful patient selection.

Anti-Bacterial Agents↗
PubMed1975

Operator-promoter functions in the threonine operon of Escherichia coli.

The prophage curing properties of secondary-site lysogens of coliphage lambda have been studied. The site of integration in the original lysogen (L79) is within the ooerator-promoter region of the thr operon. As a result, expression of the thr enzymes is reduced, and the strain is a leaky threonine auxotroph. Heat pulse curing of strain L79 and a thr+ lysogenic revertant (L79-20) showed that heat pulse curing of both lysogens was int and xis dependent and occurred by correct excisions of the prophage. The heat pulse curing restored strain L79 to prototrophy whereas strain L79-20 synthesized the thr enzymes constitutively and at high levels. This indicates that the reversion mutation in strain L79-20 occurred outside of the prophage and within the operator-promoter region of the thr operon. In contrast, spontaneous curing of both lysogens occurred by both correct and incorrect excisions. Spontaneously cured derivatives of strain L79-20 gave rise to three classes of regulatory mutants affecting operator and promoter functions to the thr operon.

Cell-Free System↗
PubMed1978

Dimensional and occlusal changes in fluid resin dentures.

This study evaluated complete dentures processed with fluid acrylic resins. The dentures were constructed with the aid of a new flask and modified spruing procedures, with the teeth immobilized in the hydrocolloid mold, and with slight mechanical vibration provided during the pouring of the resin. The fluid resin dentures were compared with the dentures constructed by the compression-molding technique and processed with heat-curing acrylic resin. The results indicate that the fluid resin dentures underwent more processing shrinkage (0.617%) than the conventionally processed dentures (0.377%). However, the fluid resin dentures seemed to function as well as the heat-cured dentures. The excessive reduction in the vertical dimension of the occlusion usually observed with fluid resin dentures was minimized; the average cusp height reduction was -0.089 mm. Individual tooth movement, voids, visible porosity, and other surface deficiencies were eliminated.

Acrylic Resins↗
PubMed1978

Tobramycin in patients with various infections: a clinical evaluation.

22 patients with various gram-negative infections were treated with tobramycin at a dose of approximately 3 mh/kg body weight/24 h for 7 to 53 (mean 16) days. Therapy was monitored with determinations of drug serum concentrations and renal and audio-vestibular function tests. In 16 patients either cure of clinical improvement were achieved. Two patients did not improve. In another 4 patients the effect of tobramycin therapy could nto be evaluated. One patient exhibited a subclinical vestibular dysfunction and one patient experienced transient tinnitus. In one patient, slight but clinically significant renal impairment occurred.

Adolescent↗
PubMed1976

Application of contemporary reconstructive techniques in head and neck surgery for anterior oral-facial cancers.

One hundred and seventy-eight patients underwent surgical therapy for oral and cervical cancers from 1964 to 1975. About 25 percent of the patients underwent neck dissection and/or "pull-through" procedures. However, majority of patients required a spectrum of reconstructive techniques extending from marginal mandibulectomy with or without skin flaps (39), partial mandibulectomy with immediate prosthetic mandible reconstruction (36), to extended resections with skin flaps or staged reconstructive procedures (48). The advantages and disadvantages of each reconstructive procedure have been observed and a scheme of graded management has been developed. The therapeutic goal is to maximize functional oral reconstruction without compromising tumor cure. There were two operative deaths--one from myocardial infarction after operation and one from halothane hepatitis. The tumors were grouped according to TNM classification. In the follow-up of the 178 patients, 47 per cent are known to be alive and free of tumor. The better results (greater than 70% free of tumor) are in the group with smaller tumors (less than 2 cm.) and no node involvement, and there are less favorable rates for those patients with larger tumors and nodal metastasis or invasion of adjacent structures. There was a 49 percent 2 year survival rate and 12 of the deaths were from nontumor causes. Ninety percent of these patients smoked more than one pack of cigarettes per day, accounting for the high rate of synchronous or subsequent oroairway cancers (7 percent). Seventy-five percent were considered to be "heavy alcoholics" with evidence of cirrhotic liver disease. These two factors significantly decreased the survival from rate 54 to 47 percent. The series shows that planned primary reconstructive surgery can be done at a low risk, that it can enhance resectability of head and neck cancers, and that it does improve oral function after operation.

Adenocarcinoma↗
PubMed1977

The submandibular triangle in radical neck dissection.

Various modifications of the standard radical neck dissection operation have been advocated since its original description. An ideal operation would offer maximum cure rates with minimal cosmetic and functional disturbance. The validity of removing the submandibular triangle contents as part of radical neck dissection was studied by analyzing the involvement of this region by metastatic squamous cell carcinomas of the head and neck. Only three of the 51 neck-dissection specimens that were examined contained metastases to submandibular triangle lymph nodes. The primary sites were nose, floor of mouth, and retromolar trigone. None of the 26 laryngeal tumors in this series had spread to the submandibular triangle. In the absence of palpable submandibular or upper, deep cervical lymph nodes, the contents of the submandibular triangle can probably be left undisturbed in radical neck dissections for laryngeal cancer.

Carcinoma, Squamous Cell↗
PubMed1977

Management of ruptured posterior urethra in childhood.

Seven boys with fracture(s) of the bony pelvis and associated partial or complete rupture of the posterior urethra were managed by the time-honored technique of early suprapubic cystostomy and concomitant primary realignment of the urethra over a catheter. Of the 4 children who had a functionally significant urethral stricture 3 were cured within a few months by 1 or 2 simple urethral dilatations and 1 by subsequent transperineal lysis of the angulated urethra from its surrounding fibrous tissue. Followup data for 8 to 22 years (mean 14 years) indicate that all 7 patients void with an excellent stream and are continent, free of infection and potent. In fact, 3 of the 4 married boys have fathered children.

Adolescent↗
PubMed1975

Chemical studies on tobacco smoke. XXXIII. N' -nitrosonornicotine in tobacco: analysis of possible contributing factors and biologic implications.

A chemical analytic method to determine N'-nitrosonornicotine (NNN) and N' -nitrosoanabasine (NAB) in tobacco was developed. NNN was found in the unburned tobacco of commercial products at concentrations betweeen 0.3 and 88.6 mug/g. The highest levels were observed in highly fermented snuff (29.1 mug/g) and fine-cut chewing tobacco (88.6 mug/g). NAB was not detected (smaller than 0.5 ng/g) in any tobacco examined. Two new tobacco components, N' -carbomethoxynornicotine and N' -carbomethoxyanabasine,were found. Possible origins of NNN in tobacco were discussed, especially in relation to concentrations of nitrite, nitate, and alkaloids, and in relation to pH and curing. Biologic implications, including the possible function of NNN (the first organic carcinogen isolated from unburned tobacco) as a causative factor in cancer of the oral cavity in tobacco chewers and betel quid chewers, were also discussed.

Alkaloids↗
PubMed1978

Surgical treatment of urinary fistulae.

A survey is presented, based upon a personal material of 225 cases of urinary fistulae. 173 of them were postoperative or obstetric fistulae, whereas 52 had appeared after a radiological or combined radiological and surgical treatment for cancer of the uterus. --The author's method for preparing the fistula region from a transverse incision under the external urethral orifice is described as well as his grafting techniques. Vessels are brought to the fistula region by using flaps from one or both pubococcygeus muscles, the rectus abdominis muscle or the gracilis muscle. --For vesico-vaginal fistulae situated high up in the fundus a graft from the omentum majus or an appendix epiploica is sometimes used. They can usually be grasped from below after the peritoneum has been opened. --In cases where the ureters were also damaged by irradiation a special technique was used. After the damaged part of the ureter had been resected the ureters were implanted into an ileum segment which was anastomosed to the bladder fistula. --In one of the 173 non-irradiated cases, a Bricker-bladder had finally to be made because of the failure to achieve a functioning urethra. The others were all cured after one or in a few cases two operations. --Among the 52 cases, which had been irradiated, 46 coud to be made, one got a fast growing local recurrence of the carcinoma and one had too bad general condition to allow a diversion operation. Two patients have rest fistulae but may be possible to cure conservatively.

Diagnosis, Differential↗
PubMed1978

[The change of pulmonary function and working capacity of patients with healed pulmonary tuberculosis in the course of 15 years (author's transl)].

Pulmonary function (VC, FEV1, RV) and physical ability with the same methods and even apparature were assessed in patients with pulmonary tuberculosis dismissed in 1958/59 as cured or markedly improved. The values of pulmonary function gained at dismission and 15 years later were compared with the trend of the data on physical ability and disablement in the course of the years. In patients invalidated from this disease a 3 times greater reduction of VC, a 9 times higher decrease of FEV1 and nearly a 2 times greater increase of RV was found than in patients with previous tuberculosis but still on the job.

Follow-Up Studies↗
PubMed1977

[Endocurietherapy for carcinoma of the penis (author's transl)].

46 cases of epithelioma of the penis treated by endocurietherapy (Iridium 192) are analysed, with a minimum follow up to of 5 years. The local results appear to be excellent for small lesions, of the order of 20 mm, with only 2 recurrences out of 14 cases. With a slight potential of lymphatic spread, 12 of the patients are apparently cured. The organ has been preserved in perfect functional state. More extensive lesions, but less than 40 mm in size, have a less satisfactory prognosis by virtue of more frequent lymph node spread, difficult to control, and their general course. However local results remain quite respectable, despite 5 recurrences out of 25 cases, 3 of which were easily "salvaged" by surgery. 12 of these patients are apparently cured and in 9 the organ has been preserved in satisfactory functional condition. By contrast, massive forms, larger than 40 mm, recur or necrose and thus represent a poor indication for curietherapy. In conclusion it may be said that endocurietherapy for carcinoma of the penis, by virtue of a technique rendered opitmal by accurate prior dosimetry, is certainly an excellent therapeutic option for all small or moderately extensive lesions, avoiding mutilation. The presence of lymph node involvement has an unfavourable influence on prognosis.

Humans↗
PubMed1975

[Mechanical-dynamic properties of prosthesis plastics].

Comparative studies on the mechanic and molecular properties of heat- and self-curing polymers (PMMA) showed the following results: 1. The glass-transition temperature of heat- and self-curing polymers clearly shows measurable differences also as a function of their storage conditions. However, this is hardly of any clinical or practical significance. 2. The modulus of elasticity values of heat and self-curing polymers are not significantly different in the range of the usually applied temperatures. However, water-uptake considerably reduces the rigidity. 3. Overloading or fatigue failures do not show any clear differences in morphological characteristics. The practical influence of smaller long-term inflation strength of self-curing polymers has not yet been sufficiently proven. 4. Heat and self-curing polymers are identical as basic materials for dentures from the point of view of material technology.

Cold Temperature↗
PubMed1976

Diagnosis and surgical treatment of page kidney: Selected aspects.

The Page kidney is a well-recognized cause of correctable hypertension. The case described herein illustrates certain select diagnostic features including the method of radiographic visualization of the capsule and subcapsular fluid-which appears to be related to both the volume of contrast material injected and the proper timing sequence of the radiographic examination. The chosen therapeutic approach was aimed at curing the hypertension while preserving maximal renal function. Aspiration therapy was used as an initial conservative procedure. Removal of the entire pseudocapsule followed in preference to nephrectomy.

Adolescent↗
PubMed1976

Review of erythroplasia of Queyrat and its treatment.

EQ (erythroplasia of Queyrat) manifests itself by single or multiple asymptomatic papules or plaques on the glans penis, or periurethrally, predominantly in uncircumcised men, age range from twenty to eighty years of age. The bright red lesions may be ulcerated. The disease progresses slowly, and the interval between onset and diagnosis may be years. The cause is unknown. Diagnosis is confirmed only by histologic examination. A therapeutic regimen of 5 per cent 5-fluorouracil cream applied to lesion(s) twice daily for four to five weeks has produced a high cure rate and maintained penile integrity and function.

Adult↗
PubMed1978

Failures after irradiation in early vocal cord cancer.

Radiation therapy for early laryngeal cancer offers an excellent probability of cure as well as preservation of vocal function. Reported failure rates range from 9 to 21% in patients with T1 lesions, and from 28 to 44% in those with T2 lesions, the majority of whom are subsequently salvaged by surgery. Results obtained at the Radiotherapy Center of the University of Wisconsin Hospitals in 44 patients during the period from 1960 to 1972 yielded failure rates of 21% in patients with T1 tumors and 38% in patients with T2 tumors at 5 years. Five of the eight recurrences were salvaged with surgery yielding an overall tumor control rate of 93%. The larynx was preserved in 82% of the cases. Determinate 5-year survival was 91% in T1 cases and 86% in T2 cases. Failure rates at 3 years were 18% for T1 tumors and 30% for T2 lesions. These results are in conflict with those reported by Brandenburg and Rutter as being 46% and 60% respectively. Ultimate success in the treatment of laryngeal cancer rests in the full cooperation between surgeons and radiotherapists.

Carcinoma, Squamous Cell↗
PubMed1977

[Supplement on the treatment of acute pancreatitis].

The authors describe their perceptions in pathogenesis, clinic and healing of acute pancreatitis. The importance of food fat and albumen metabolism, and alcohol effect are described. Authors prefere conservative cure. Removing the pain and shock, better function of pancreas drain channel, and parenteral feed with enough calories and vitamins are very important in the treatment of acute pancreatitis. Special care is dedicated to take infection away and to the orderly function of cardiorespiratoral circulation. Operative treatment is strictly indicated in special cases. Holding on these lines of directions in treating medically acute pancreatitis we deduced mortality on hardly 2,14%.

Acute Disease↗
PubMed1976

[Revascularization of arteries of the leg by bypass in chronic arteriopathies of the lower limbs. Apropos of 50 cases].

The authors report 50 by-pass operations followed up for from 6 months to 4 years, which were designed to restore the blood supply via the leg arteries in peripheral arterial disease of the lower limbs. 40 patients were at stages III and IV; acute ischemia required emergency operation in 6 cases. 2 Patients died immediately after operation. 30 by-passes remained permeable. A cure of the trophic disorder and a functional improvement were obtained in 39 patients with only 8 subsequent amputations. In the light of the world literature and their personal experience they discuss the main pronostic factors and the indications for this method which has proved to be a remarkable progress in the treatment of severe arterial disease of the lower limbs.

Adult↗