Showing papers by "LAC+USC Medical Center published in 1984"

Hepatocellular carcinoma. Diagnostic and prognostic features in North American patients.

Abstract: Diagnostic and prognostic characteristics of 121 North American patients with hepatocellular carcinoma seen in one metropolitan area over a 6-year period were assessed using multivariate analysis. Presenting symptoms commonly included abdominal pain (53%) or mass (34%), anorexia (31%), and ascites (20%); however, the ability to make an early diagnosis was complicated by a variety of unusual symptoms accounting for 25% of presentations. While cirrhosis (63%) and hepatitis B surface antigen (HBsAg) positivity (52%) were common associated findings, the majority of patients (67%) had no prior diagnosis of liver disease. Despite the vascular nature of these malignancies, percutaneous biopsy procedures performed in 66 patients provided diagnostic material in over 85% of cases with little morbidity. Histologic diagnosis was made by blind percutaneous biopsy (41 done, 83% positive), peritoneoscopy with directed percutaneous biopsy (25 done, 88% positive), laparotomy (42 done, 98% positive), or autopsy (19). Percutaneous hepatic biopsy procedures were associated with no mortality and rare bleeding (three cases). Overall median survival was only 18 weeks; multivariate analysis indicated increased bilirubin or presence of pulmonary metastases adversely influenced outcome. Unexpectedly, patients younger than 45 years of age had a significantly (P less than 0.01) greater survival (median, 40 versus 9 weeks) than did older patients with this disease. We conclude: (1) hepatocellular carcinoma can be rapidly and safely diagnosed using percutaneous biopsy procedures; (2) North American patients with hepatocellular carcinoma younger than 45 years of age have a more favorable prognosis.

Improved control of bulky prostate carcinoma with sequential estrogen and radiation therapy

Abstract: Patients with bulky prostate cancer have usually been treated by palliative measures because the likelihood of tumor control with definitive irradiation has been low and the development of distant metastases high. The addition of estrogen to irradiation has not been shown to be of value. However, we believe the method of estrogen administration may have been the cause for the apparent lack of benefit. Estrogen had been started either concurrent with irradiation or had been used for palliation and was given for long and unscheduled time periods prior to irradiation. We have used estrogen for two months prior to and concurrent with irradiation. We postulated that in those patients with estrogen responsive cancer, the reduced tumor burden prior to irradiation could enhance tumor control and survival. Between 1975 and 1980, 25 patients with bulky prostate cancer received sequential estrogen and irradiation, 12 patients irradiation alone and six patients irradiation after having become refractory to longterm estrogen use. One patient was lost to follow-up. Eighteen of 25 (72%) treated by sequential estrogen and irradiation, 14/17 (82%) with estrogen responsive cancer and 4/8 (50%) with estrogen resistant cancer had a complete tumor response. Six of 11 (55%) patients treated by irradiation alone and 2/6 (33%) treated by irradiation for estrogen refractory cancer had a complete tumor response. Disease-free survival was observed in 13/25 (52%) treated by sequential estrogen and irradiation, and 8/17 patients (47%) with irradiation. It is also possible the improved survival in the estrogen responsive group was a direct result of improved local control. Persistent local disease can act as a source for distant metastases. Distant metastases was observed in 15% of patients when the primary tumor was controlled and 30% when there was persistent or recurrent local disease. Also, progressive local disease can be an important cause of death. This was most evident in our patients with estrogen refractory cancer. Almost all patients in this group had progressive local disease that caused serious urinary bleeding and urinary infection that were considered the major cause of death. Our results suggest bulky prostate cancer should be aggressively treated when first diagnosed. The value of adjunct estrogen is unproven. Our results with the use of estrogen prior to and concurrent with irradiation is encouraging. Estrogen may shrink the cancer and allow for a more favorable geometry for external irradiation. Tumor control and survival may be thereby improved. The lower frequency of tumor control and survival of patients with estrogen resistant cancer indicates the need to explore other therapeutic approaches for this group of patients. A higher dose of external irradiation or the addition of chemotherapy prior to irradiation may be of value.

Calcemic responses to photic and pharmacologic manipulation of serum melatonin.

Abstract: We have reported decreased serum calcium(CaS) in human infants(HI) and in newborn rats(NBR) during exposure to white light(Photo). In NBR, bone Ca uptake increased. At wavelengths below 600nM (orange to blue), cranial light penetration fell sharply and CaS was unaffected. Occipital shields prevented hypocalcemia in both HI and NBR. Pineal melatonin synthesis is increased by isoproterenol and decreased by propanolol and by light (PNAS 69: 2547, 1972). In NBR we found serum melatonin to be 27±8 pg/ml during Photo and 122±32 pg/ml in shaded littermates (n=24, p<.01). Exogenous melatonin (20ng/Gm IP) gave serum concentrations of 383 pg/ml at 1 hr and 83 pg/ml at 2 hrs and prevented the hypocalcemic response to Photo. Propanolol reduced CaS in shaded NBR from 9.5±.1 mg/dl to 7.9±.2 mg/dl; after propanolol + melatonin, CaS was 8.8±.2 mg/dl. Isoproterenol ameliorated hypocalcemia during Photo (Shade 9.7±.1 mg/dl, Photo 8.8±.1 mg/dl, Photo + isoproterenol 9.4±.1 mg/dl). These findings support the hypothesis that hypocalcemia during phototherapy results from transcranial photic inhibition of melatonin synthesis.

Mandibular lingual releasing approach to oral and oropharyngeal carcinomas

Abstract: Resection of a carcinoma of the oral cavity or oropharynx requires adequate exposure for direct visual and bimanual examination. Transoral resection of tumors of the oral cavity using the "pull-through" procedure can be difficult due to interference by the circumoral tissue and mandibular arch. Exposure of carcinomas involving the base of tongue may require mandibulotomy or lateral mandibulectomy even when margin control does not mandate removal of the jaw. Alternatively, surgical techniques routinely used for exodontia and periodontal surgery can be applied to the creation of a mandibular lingual mucoperiosteal flap that allows for the entire tongue and floor of mouth to be delivered into the neck. Oral cavity and base of tongue lesions can then be resected with excellent direct visual and palpable control of margins, but without lip splitting, mandibulotomy or mandibulectomy.

Acute traumatic vertebral arteriovenous fistula: balloon occlusion with the use of a contralateral approach.

Abstract: A traumatic fistula of the left vertebral artery to vertebral and epidural veins with an expanding suboccipital false aneurysm was trapped by endovascular occlusion with detachable balloons. The lesion was not amenable to treatment using the left vertebral artery alone for access. Distal trapping was accomplished by catheterizing the (contralateral) right vertebral artery and placing the balloon retrograde into the distal segment of the left vertebral artery. This maneuver extends the range of vertebral artery lesions for which detachable balloons, either alone or as an adjunct to operation, can be used.

Behaviour of protein C inhibitor in intravascular coagulation and liver disease.

Abstract: We measured levels of protein C inhibitor in patients with disseminated intravascular coagulation (DIC) and liver disease using a functional assay. Levels in 24 normal subjects averaged 93% of the amount in normal pooled plasma, giving a normal range of 65 to 121%. Levels were below normal in 8 of 17 patients with DIC, in 4 of 19 patients with liver cirrhosis, and in 3 patients with acute hepatic necrosis. Levels were normal or elevated in 9 of 10 patients with cirrhosis and accelerated fibrinolysis, and in 6 patients receiving warfarin. We conclude that protein C inhibitor may be involved in regulation of protein C activity during pathologic activation of the hemostatic system (DIC). Decreased protein C inhibitor does not appear to contribute to the pathogenesis of accelerated fibrinolysis in liver disease. The liver may be the site of synthesis of protein C inhibitor.

Differences in the Ratio of Bioactive to Immunoreactive Serum Luteinizing Hormone during Vasomotor Flushes and Hormonal Therapy in Postmenopausal Women

Abstract: With the recognition of differences between serum bioactive (bio) and immunoreactive (i) LH concentrations in various clinical situations, we measured changes in the bio:i LH ratio in postmenopausal (PM) women in response to iv GnRH, during the vasomotor flush, and in response to both estrogen and progestin treatment. Bio LH was measured using the mouse interstitial cell assay and LER 907 as standard, with conversion to milliinternational units per ml (Second International Reference Preparation of human menopausal gonadotropin). In 22 PM women, aged 42–56 yr, serum bio LH [455 ± 73 (±SE) mIU/ml] and the bio:i LH ratio (8.3 ± 0.7) were significantly higher than in premenopausal women (25.5 ± 5 mIU/ml and 1.5 ± 0.2, respectively; P < 0.002). In response to 150 µg iv GnRH, there was a greater rise in levels of iLH and bioLH in PM women than in premenopausal women, but there were no changes in the bio:i LH ratio after GnRH. During nine flushing episodes in three women, documented by digital temperature and iL...

Granular cell tumor of the intrapancreatic common bile duct.

Abstract: A case of granular cell tumor involving the intrapancreatic portion of the common bile duct is reported. The tumor was misdiagnosed as a bile duct carcinoma clinically and at surgery. Intraoperative needle biopsy failed to provide a specific diagnosis and led to a pancreatico-duodenectomy. The importance of making a specific frozen section diagnosis and the difficulties associated with this in this setting are presented.

A 26-year radiographic follow-up of workers in a diatomite mine and mill.

Abstract: Chest roentgenograms of 473 employees of a California diatomite plant were reviewed as part of periodic reevaluation of the efficacy of the dust control program. The plant's processing of diatomite included flux-calcination, which provided opportunities for exposure to cristobalite. The films examined were those of workers with at least five years of service. Only 11 films were interpreted as showing changes consistent with pneumoconiosis, i.e., small opacities of profusion categorized as 1/1 or greater. Only six were classified as 1/2 or more. All who developed categories 1/1 or higher during their employment had more than 25 years of service. No large opacities were reported. The low prevalence of abnormalities and the absence of definite pneumoconiosis in employees with fewer than 25 years of service was in striking contrast with findings in 1953. At that time more than 25% of those with five or more years of employment had roentgenographic evidence of pneumoconiosis and over 10% had confluent changes producing large opacities.

Surgical treatment of carcinoma of the breast: II. Prognostic factors influencing relapse rate.

Abstract: This is a study of 408 patients who had mastectomy for clinical stages I, II, and early III carcinoma of the breast during 1971-1980. Analysis of disease-free probabilities up to 5 yr showed that the number of positive axillary nodes was the most important prognostic factor. Size of primary tumor was the second most useful factor, with best separation of disease-free rates using 4 cm as a dividing line. Patients with colloid carcinoma and other less common lesions had much better prognosis than those with infiltrating ductal, lobular, or medullary carcinomas. Discriminating analysis also showed that information about the number of positive axillary node alone gave the best prediction of possibility of developing recurrence (overall accuracy, 75%).

Comprehensive pharmaceutical services in a medical intensive-care unit.

Abstract: The clinical and distributive services that have been provided by clinical pharmacists for the past 14 years in the medical intensive care unit (MICU) of a 1600-bed urban teaching hospital are described. The MICU pharmacy staff consists of 4.3 full-time equivalent pharmacists who provide daily 24-hour services. The pharmacists are actively involved in all pharmacological decisions with hands-on control of drug distribution from preparation through delivery and administration. They maintain up-to-date patient medication records and monitoring flow sheets for each patients. The pharmacists identify adverse reactions, formulate contingency plans, and promptly intervene to prevent crises. They provide comprehensive pharmacokinetic services, select drug administration times and routes, and prepare and deliver all medications. All i.v. medications are custom-made to meet the patients' fluid, sodium, or potassium restrictions. The pharmacists set up infusion pumps and select the proper infusion rates for i.v. and intra-arterial drugs. They also recommend and monitor the patients' nutritional support therapy. The program has been well accepted by nurses and physicians; however, only 20% of the inpatient clinical pharmacists desire to work in the MICU. The skills and educational requirements for managing patients in an MICU are discussed. Pharmacists have become an integral part of this MICU by optimal drug therapy, increasing productivity and efficiency, providing prompt and accurate services, and participating in research.

Effects of oral and parenteral quinine on rats with ventromedial hypothalamic knife-cut obesity

Abstract: The addition of quinine to the food reversed the obesity in rats with hypothalamic hyperphagia induced by knife cuts. Similarly, the injection of quinine into rats with hypothalamic knife cuts reduced food intake and body weight but the effects were smaller than those observed when quinine was added to the diet. Urinary quinine excretion was similar by the oral and parenteral routes. The food intake of the knife-cut animals receiving quinine gradually fell to the same level as in the sham-operated animals receiving quinine by either route. The weights of retroperitoneal fat pads were related to the weights of the animals and were reduced in the quinine-treated groups. Plasma insulin concentrations were significantly higher in the knife-cut animals and were reduced toward control levels by quinine treatment. Gluconeogenesis, measured by incorporation of radioactivity from labeled bicarbonate into glucose, was unaffected by treatment with quinine or by knife cuts. Lipogenesis from tritiated water in vivo was not different between treatment groups in the liver or retroperitoneal fat pads. However, in vivo lipogenesis was reduced in knife-cut rats fed ad libitum compared with quinine-treated rats. The response of lipogenesis to insulin in vitro was also not different between treatment groups. These data suggest that a major part of the reduction in food intake in hyperphagic rats eating a quinine-adulterated diet is due to postingestional events.

Proteases in hormone production and metabolism.

Abstract: The physiologic effect of a hormone is governed by its bioavailability to receptors on the target organ. Chertow (1) has suggested that proteases can potentially regulate hormone availability by 1) intracellular conversion of precursor hormones to active hormones, 2) degradation of hormone in the cell prior to secretion, 3) facilitation of release of hormone from the cell, 4) activation or inactivation of the hormone in the circulation, and 5) degradation of hormone in target tissue. These regulatory mechanisms particularly apply to polypeptide hormones and enzymes, which are produced as larger molecular weight precursors and subsequently converted by limited proteolysis to their secreted forms.