Longterm central venous access in gynecologic cancer patients.

Background: To assess the utility and safety of three different longterm indwelling intravenous catheters in patients with gynecologic malignancies.

Study Design: A retrospective review was performed of the records of all women with gynecologic malignancies who required longterm venous access catheters and ports between 1990 and 1997.

Results: Two hundred sixty-eight women underwent placement of 308 indwelling catheters, of which 305 were available for analysis.

Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters.

Background And Aims: Total parenteral nutrition (TPN) is typically delivered through catheters inserted into the superior vena cava (SVC) via a subclavian or internal jugular vein approach. A peripherally-inserted central venous catheter (PICC), utilizing a cephalic or basilic venous approach, may provide a safe alternative to the standard catheter approach and, because non-physician providers can insert the PICC, may introduce a potential cost-savings to health care institutions. We sought to determine if PICC lines are safer and more cost-effective than the standard central venous catheter approach for hospitalized patients who require TPN.

Spigelian hernia: diagnosis by high-resolution real-time sonography.

The purpose of this study was to demonstrate the role of high-resolution real-time sonography in the diagnosis of spigelian hernias. The sonographic findings in three patients, two of whom had surgical confirmation, are presented. We also discuss and demonstrate the anatomic and pathologic factors that predispose to these hernias.

Collagenous colitis associated with chronic constipation.

We present a case in which the classical histopathologic features associated with collagenous colitis were present throughout the colectomy specimen of a 69-year-old woman operated on for life-long intractable idiopathic constipation. This patient had never suffered from episodes of watery diarrhea. The reasons for this paradox are unclear, but suggest that a thickened collagen table and damaged surface epithelium may not be entirely specific pathologic findings marking the clinicopathological syndrome of collagenous colitis.

Sonography of acute appendicitis: a critical review.

In 20% of the cases of acute appendicitis, especially in children, the elderly, and ovulating women, the findings are atypical. The radiographic procedures used to aid in the diagnosis have not been proven reliable. Sonography has often been used to diagnose or rule out appendiceal abscesses, or diseases that can mimic acute appendicitis, such as gynecologic, obstetric, or biliary abnormalities.

Plasma and cerebrospinal fluid nucleosides and oxypurines in acute liver failure.

Concentrations of pyrimidine nucleosides (with the possible exception of uridine) and oxypurines in mammalian plasma and cerebrospinal fluid (CSF) are maintained relatively constant by potent homeostatic mechanisms. To test the importance of the intact liver in maintaining homeostasis of pyrimidine nucleosides and oxypurines in plasma and CSF, we performed a greater than 90% or sham hepatectomy on New Zealand white rabbits. At 1, 6, 12, or 24 hours after real or sham hepatectomy, plasma and CSF nucleosides and oxypurines were measured by high-performance liquid chromatography.

Angiosarcoma of the breast following segmental mastectomy complicated by lymphedema.

A patient is discussed who had angiosarcoma of her lymphedematous right breast develop four years after segmental mastectomy for infiltrating ductal carcinoma. The lymphedema developed and persisted after an indolent and recurrent postoperative infection. The possibility that the second malignancy is a consequence of the chronic lymphedema, similar to the angiosarcomas of lymphedematous extremities after radical mastectomy, is cautiously entertained.

Phosphate balance and distribution during total parenteral nutrition: effect of calcium and phosphate additives.

Hypophosphatemia is occasionally observed during total parenteral nutrition (TPN). The phenomenon was recognized since the introduction of TPN and was attributed to preexisting phosphate deficits and inadequate phosphate supplements. Because of the close relationship between phosphate and calcium metabolisms, we speculated that calcium additives may also influence phosphate balance and distribution during TPN.

Malignant melanoma in childhood and adolescence.

A retrospective chart review of 25 patients under the age of 20 years with malignant melanoma, diagnosed between the years 1938 and 1984 at the University of Iowa Hospitals and Clinics, was conducted. Nine of the patients were under the age of 14 years, and 18 patients were females. There appeared to be a frequent delay in diagnosis of the primary lesion, occasionally incorrect initial diagnosis, and under-treatment in these young patients.

Magnesium balance and distribution during total parenteral nutrition: effect of calcium additives.

Homeostatic alterations and derangements in magnesium (and phosphate) metabolism may occur during total parenteral nutrition (TPN) and may be influenced by the amounts of calcium supplied daily. We tested these possibilities in previously fasted or nonfasted animals receiving TPN with variable amounts of calcium. Large calcium additives (90 mg/d) produced hypomagnesemia in nonfasted animals and increased the degree of hypomagnesemia observed in some of the fasted groups.

Effect of nutritional method on adaptation of the intestinal remnant after massive bowel resection.

Adaptation of the intestinal remnant with hypertrophy/hyperplasia and increased absorption occurs, ultimately, after massive bowel resection. During the early postresection period, the rate of the adaptational process may be influenced by the method of nutritional support. Nutrients given by mouth may support a strong stimulus for hypertrophy but may be incompletely absorbed from the short intestinal remnant.

Specimen xeroradiography after needle localization and biopsy of noncalcified, nonpalpable breast lesions.

Xeroradiography was used to detect and aid in needle localization of 63 nonpalpable breast lesions over an 8-year period. In 28 patients (44%), no microcalcifications were present in the lesion biopsied. Xeroradiographs of these noncalcified lesions after their submersion in water carried a clean and close resemblance to their in vivo appearance and aided the pathologist in localizing the abnormality within the biopsy specimen.

Male breast carcinoma.

Fifty men with primary breast carcinoma were seen between the years 1938 and 1983 at the University of Iowa Hospitals and Clinics. In most patients, there was a significant delay between the onset of symptoms and seeking medical advice (mean, 21 months; range, 1-156). The vast majority of patients were treated by simple, modified radical, or radical mastectomy.

Carcinoid tumors of the gastrointestinal tract.

Carcinoid tumors continue to be of specific clinical interest because of their diverse presentation, hormonal secretion, and malignant potential. One hundred ninety-two patients with carcinoid tumors were treated at the University of Iowa Hospitals and Clinics between 1938 and 1982. The most common location of these tumors was the appendix (30%), followed by the ileum (23%) and rectum (9%).

Hepatic artery ligation and chemotherapeutic infusion in the treatment of hepatic malignancy.

This report reviews the results of treatment of hepatic malignancies by intra-arterial infusional chemotherapy and hepatic artery ligation. Seventy-nine patients with liver metastases or primary hepatomas were treated by this technique between the years 1970 and 1982. The majority of patients had metastatic disease from colon and rectal cancers.

Uncommon features of giant colonic diverticula.

Two patients with giant colonic diverticula were operated upon within one week. Uncommon features of this rare condition were observed in both patients: 1) the diverticulum was located outside the sigmoid colon, 2) smooth-muscle fibers and ganglion cells were present in the wall of the diverticulum, and 3) free perforation into the peritoneal cavity was the presenting symptom. Barium enema in one patient showed no communication between the diverticulum and the colonic lumen, despite evidence of such communication on histologic examination.

Elevated intestinal disaccharidase activity in the streptozotocin-diabetic rat is independent of enteral feeding.

Specific and total activities of the disaccharidases, sucrase, maltase, and lactase are increased in mucosa of the small intestine of the streptozotocin diabetic rat. Because disaccharidases are essential for terminal digestion of carbohydrate, and disaccharidase deficiency is a common clinical problem, understanding the mechanisms regulating disaccharidase activity is important. In normal animals, disaccharidase activities are determined by route of feeding and are decreased by parenteral feeding.

Plasma hormone responses to tamoxifen therapy and oophorectomy.

The effect of tamoxifen therapy on plasma hormones in the pre- and postmenopausal state was studied in a young patient with breast cancer. Tamoxifen therapy was carried out for metastatic disease prior to (premenopausal) and after oophorectomy (surgical menopause). Changes in luteinizing hormone, follicle-stimulating hormone, prolactin, and estrogen were noted and were corroborated with the therapy or oophorectomy.

Partial protection of the gastric toxicity of regional 5-fluorouracil infusion by thymidine and cimetidine.

Gastric ulceration resulted from regional (infusion) chemotherapy when high doses of 5-fluorouracil were accidently infused into the stomach during hepatic artery infusions. A method for reproduction of those ulcers was established by gastric artery infusions. A trial to protect against such development with thymidine produced only partial protection.