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Biomedical subjects

A Hirsch

Publications and source records attributed to A Hirsch.

At least 73 records · Page 4Linked to original sources
PubMed1998

Monitoring of p53 autoantibodies in lung cancer during therapy: relationship to response to treatment.

Alteration of the p53 gene is the most frequent genetic alteration in human cancer, and it leads to the accumulation of mutant p53 in the nucleus of tumor cells. In addition, it has been shown that patients with various types of neoplasias have p53 antibodies in their sera. ELISA was used to detect anti-p53 antibodies in their sera of 167 patients with lung cancer. Among these, 32 individuals (16 positive for p53 antibodies and 16 negative) were monitored over a period of 30 months for p53 antibodies. Twelve of 16 antibody positive patients had reduced titers during chemotherapy that led to partial or complete remissions of disease. The specificity of these antibodies was confirmed by two different ELISA procedures and by immunoprecipitation. The very rapid, specific decrease in these antibodies during therapy suggests that a constant level of tumoral cells with nuclear accumulating p53 protein is necessary for a detectable humoral anti-p53 response. The good correlation found between the specific evolution of the p53 antibody titer and the response to therapy suggests that p53 antibodies could represent a useful tool for checking the response to therapy and for monitoring some relapses before they are clinically detectable.

Antibody Formation↗
PubMed1998

Root coverage: combined surgical procedures.

A number of surgical procedures have therapeutic goals to restore the gingival tissue to the level of the cementoenamel junction with attachment of soft tissue to the previously exposed root surfaces. These procedures are indicated where esthetic needs, root sensitivity, or shallow carious lesions involve the root surfaces. Surgical innovations over the past decade have enabled the periodontist to correct these problems. Case reports of root coverage by combined surgical procedures are described and presented. These reports illustrate greater predictability and improved esthetics compared to other surgical possibilities.

Connective Tissue↗
PubMed1998

[Evaluation and comparison of tobacco control legislation in member states of the European Union].

BACKGROUND: Nowadays, tobacco use represents the main cause of avoidable deaths in Europe. Public health authorities have several means at their disposal to fight against this epidemic. For instance, legislative action can operate on the supply side as well as on the demand side, with the aim of reducing tobacco consumption in the targetted populations. METHODS: A systematic data collection of all legislative texts dealing with tobacco control was carried out within the framework of the EuroLego project. This was done, either through direct contact with the countries or through a systematic computer and manual search of data bases concerning the 15 member states of the European Union. RESULTS: At present, the legislative context varies widely from one country to another, whether regarding the number of texts adopted or the subject that is covered. Since the 1950s, a marked increase in the number of legislative texts has been noted as well as a trend towards harmonization of the texts among the different member states. CONCLUSIONS: Several health recommendations can be put forward in the context of public health activities with priority to be given to the protection of the children and the young and to the defense of the rights of non-smokers.

Europe↗
PubMed1997

Tobacco smoking and gastric cancer: review and meta-analysis.

Although declining, gastric cancer (GC) is estimated to be second in frequency worldwide. Major causes appear to be environmental rather than genetic. A relationship has been suggested between tobacco smoking and GC. A number of epidemiological studies have been performed dealing with this question. All the cohort studies showed a significantly increased risk of GC of the order of 1.5-2.5 for cigarette smokers. Evidence from case-control studies is less consistent. We have carried out a meta-analysis on the 40 studies providing a quantitative estimate of the association between GC risk and tobacco smoking. Results suggest a risk of stomach cancer among smokers of the order of 1.5-1.6 as compared to non-smokers. The summary relative risk was higher in men (1.59) than in women (1.11). Several studies examined the dose-response relationship which existed in 4 cohort studies and 6 case-control studies. We estimated the number of GC cases attributable to tobacco smoking occurring worldwide: in total, over 80,000 cases of GC (11% of all estimated cases) may be attributed to tobacco smoking each year. This figure is larger than that estimated for other cancers for which association with tobacco smoking is clearly established, such as pancreatic and renal cancers.

Aged↗
PubMed1997

The structure of porin from Paracoccus denitrificans at 3.1 A resolution.

The crystal structure of a non-specific porin from Paracoccus denitrificans at 3.1 A resolution has been solved by molecular replacement using the porin from Rhodopseudomonas blastica as the search model. Paracoccus porin is very similar to other non-specific porins of known structure: a trimer of 16 stranded beta-barrels each with a central pore constricted by a long extracellular loop folding back against the barrel wall. The distinctive distribution of charged residues of this non-specific porin contributes to understanding the relation between structure and ion selectivity.

Amino Acid Sequence↗
PubMed1997

[Concomitant radiochemotherapy in inoperable non-small cell lung cancer].

PURPOSE: As locally advanced and inoperable non-small cell lung cancers still have a poor prognosis, the present phase II study focused on the administration of concomitant chemotherapy and radiotherapy and was aimed at increasing both local and metastatic controls. MATERIALS AND METHODS: Thirty-nine patients (36 male and three female patients, mean age, 56 years) were included into the study. Ninety five percent of them had a good performance status (OMS status 0 or 1). The histopathological analysis showed the existence of squamous cell in 64% of the cases. There was one stage I tumor, nine stage IIIA tumors and 24 stage IIIB tumors. In two cases, the tumor stage was unknown. The duration of each cycle of the protocol was 3 weeks and included the administration of cisplatin (50 mg/m2 at d1 and d2) and fluorouracil (5-FU) (1 gr/m2 in continuous infusion at d1, d2, and d3), and external beam irradiation (20 Gy subdivided into 2 Gy-fractions that were administered from d1 to d12); the 3rd week was a resting period. RESULTS: The tolerance to the treatment was good. Fifteen per cent grade 3-4 leucopenia, 3% grade 3-4 thrombopenia and 15% grade 3-4 nausea with vomiting were observed. No serious esophagitis was recorded. Chemotherapy was completed in more than 90% of the cycles. An objective response was described in 56% of the cases, with only 3% of complete responses. However, evaluation was done on average 6 weeks after radiotherapy, at a time where post-irradiation fibrosis could hamper radiological assessment. Median survival and 2- and 3-year survivals were 11.4 months, 27% and 14%, respectively. The only significant prognostic factor was the OMS performance status index, while the radiological response was particularly non-predictive of survival. Failure patterns were analyzed in 20 patients and consisted of the following: local relapse only, six cases; metastatic relapse only, 13 cases; both local and metastatic relapse, one case. CONCLUSION: The concomitant administration of 5-FU, cisplatin and external irradiation seems feasible in current clinical practice. Survival but not radiological response should be the only criteria to evaluate this type of association. Improvement in local control is not unlikely with this type of association.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Endobronchial brachytherapy: the Saint-Louis Hospital experience].

PURPOSE: During the evolution of lung cancer, bronchial obstruction is often noticed and is sometimes responsible for serious symptoms. Several methods of desobstruction can be proposed, including brachytherapy. MATERIALS AND METHODS: One hundred forty-nine patients presenting with endobronchial brachytherapy were included into the study. Seventy-three were treated with curative intent, 47 with palliative intent and 29 with a combination of external irradiation and brachytherapy. We usually delivered a series of two 7-Gy fractions (1 cm from the catheter), the treatment being repeated one, two or three times. RESULTS: When all symptoms were taken into account, respiratory function improvement was present in 79% of the patients. Among the 132 tumors that could be evaluated via a new endoscopy 2 months after treatment, 64 (48.5%) were in complete histological remission. The median survival was 14.4 months for the patients treated with curative intent. Eleven massive hemoptysies and 13 radiation bronchitis were observed. CONCLUSION: These results confirm the feasibility and good results related to endobronchial brachytherapy, though controlled studies are needed to better define its place in the therapeutic strategy of bronchial carcinomas.

Aged↗
PubMed1997

Non-smoker lung cancer deaths attributable to exposure to spouse's environmental tobacco smoke.

BACKGROUND: The causal relationship between environmental tobacco smoke (ETS) and lung cancer is established; however, the magnitude of the risk is not known. Therefore, it is conceivable that ETS is responsible for a number of lung cancer deaths because of the large number of smokers and the widespread presence of ETS. We estimated the number of lung cancer deaths occurring in 1990 in the European Union (EU), attributable to ETS generated by a spouse. METHODS: In each country and for each sex, we used the proportion of smokers and of married people in 1970 to estimate the number of lung cancer deaths not attributable to tobacco smoking occurring in married people, assuming a relative risk (RR) for active smoking equal to 10. We then assumed a prevalence of smoking among these deaths equal to the population at large, and estimated the number of deaths attributable to ETS based on an RR for ETS of 1.3. Additional analyses were carried out assuming different values of RR for smoking and exposure to spouse's ETS. RESULTS: Based on our best assumptions, we calculated that 1146 (839 females, 307 males) lung cancer deaths were attributable to exposure to spouse's ETS in the EU in 1990. All the hypotheses tested resulted in not less than several hundred deaths. CONCLUSION: Regardless of the limitations of this exercise, our results suggest that exposure to spouse's ETS represents a relatively important public health problem in the EU.

Adult↗
PubMed1997

Results of a radiology performance report for a health maintenance organization.

PURPOSE: To present results with a radiology performance report to help evaluate utilization of radiologic examinations by primary-care practices (family practice, internal medicine, or pediatrics) in an independent practice association health maintenance organization (HMO). MATERIALS AND METHODS: Utilization reports for primary-care-physician practices (n = 5,000) over a 12-month period (July 1, 1993 through June 30, 1994) were derived from administrative data collected from claim and encounter forms submitted by radiologic practices. Data were divided into 22 measures to help define practice utilization. five overall measures helped evaluate procedures performed by HMO member or nonmember practices per 1,000 members. Twelve specific measures helped evaluate patterns of use of frequently ordered imaging procedures (eg, computed tomography, magnetic resonance imaging, bone scanning, cardiovascular nuclear imaging, nonobstetric ultrasound, and plain radiography). Five quality measures helped evaluate utilization of screening mammography in women aged 50-64 years (as a percentage of all women in the HMO aged 50-64 years) and of low-yield examinations (ie, sinus, rib, and skull radiography per 1,000 adult members). RESULTS: Individual practice utilisation mean results were compared with overall HMO mean results adjusted for practice type and age and sex of members. CONCLUSION: Utilization data are an integral part of evaluation of HMOs and their providers, and these results helped establish a baseline level of performance.

Adult↗
PubMed1997

[Intrabronchial curietherapy. Experiences at Hôpital Saint-Louis after the treatment of 149 patients].

Endobronchial tumour obstruction threatens to occur in cases of carcinoma of the bronchus throughout the course of the disease. Such patients can benefit from relief of the bronchial obstruction by several techniques which are currently available. We have treated 149 patients with endobronchial radiotherapy. Seventy three patients were treated with a view to cure, 47 with a palliative dose and 29 received endobronchial radiation in complement with external irradiation. The treatment was carried out in series repeated every 15 days until a maximum of three treatments, consisting of two sessions at 24 hour intervals delivering at each session and irradiating of 7 Gy with a 1 cm catheter. All the clinical signs were relieved and in 79% of patients there was a symptomatic benefit. One hundred and thirty two patients were evaluated by control endoscopy two months after the treatment and 64 had a complete histological remission. The median survival was 14.4 months for patients treated with intent to cure. Obtaining a histological remission was a gauge for prolonged survival (median survival 26.5 months), 11 (7.4%) had massive hemoptysis and 13 (8%) irradiation pneumonitis, all of which occurred some time after the therapeutic procedure. The results confirm the feasibility and the good results of endobronchial irradiation in this field and encourage the idea of controlled multi-centre trials in order to assess a placed of endobronchial radiotherapy in the therapeutic strategy of bronchial cancer.

Adenocarcinoma↗
PubMed1996

Differences between porin isolated from Rhodobacter capsulatus B10 and 37b4.

Porin was isolated from Rhodobacter (Rb.) capsulatus wild type B10, as well as from Rb. capsulatus 37b4 as a control. The porin from Rb. capsulatus B10 shows significant differences to that of Rb. capsulatus 37b4 in N-terminal sequence, amino acid composition and molecular mass. The apparent molecular mass of the purified porin from Rb. capsulatus B10 is about 28 kDa by SDS-PAGE, whereas the native porin trimer migrates at 75 kDa. For Rb. capsulatus 37b4 the molecular mass of the momomer is about 30 kDa and for the trimer about 76 kDa. These differences may be related to the morphological differences between the two wild type strains. Rb. capsulatus B10 has an extracellular capsule whereas Rb. capsulatus 37b4 is capsuleless. The native proteins from both wild types showed similar single channel conductance measurements in black lipid membranes. The B10 porin has been crystallised using the detergent beta-d-octyl-gluco-pyranoside. The crystals diffracted to 3 A and belong to the orthorhombic space-group P212121. The crystal packing could be elucidated by molecular replacement.

Amino Acids↗
PubMed1996

Fluoxetin-induced pulmonary granulomatosis.

A patient treated with fluoxetin for a manic depressive disorder developed pulmonary inflammatory nodules with noncaseating giant cell granulomas, interstitial pneumonia and non-necrotizing vasculitis, whilst remaining asymptomatic. A progressive resolution of pulmonary nodules occurred after withdrawal of the offending agent, and the chest radiograph returned to normal in 9 months. The diagnosis was assessed by an open lung biopsy.

Antidepressive Agents, Second-Generation↗
PubMed1996

Effect of ABVD chemotherapy with and without mantle or mediastinal irradiation on pulmonary function and symptoms in early-stage Hodgkin's disease.

PURPOSE: To evaluate the effect of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy alone and of ABVD with mantle or mediastinal irradiation (RT) on the pulmonary function of patients with early-stage Hodgkin's disease. PATIENTS AND METHODS: Between 1989 and 1993, 60 patients with clinical stage I to IIIA HD enrolled onto randomized trials at Memorial Sloan-Kettering Cancer Center (MSKCC) underwent prospective evaluation of pulmonary function. All patients received six cycles of ABVD, and 30 patients received mantle or mediastinal RT. Pulmonary function tests (PFTs) and symptom evaluation were conducted before, during, and after completion of chemotherapy and RT, and at various intervals thereafter. The median follow-up time was 30 months. RESULTS: During chemotherapy, symptoms of cough and dyspnea on exertion developed in 32 of 60 patients (53%) and declines in pulmonary function occurred in 22 of 60 patients (37%). Discontinuation of bleomycin was necessary in 14 of 60 patients (23%). Following chemotherapy, there was a significant decline in median forced vital capacity (FVC) and diffusing capacity of carbon monoxide (DLCO). In patients who received mantle or mediastinal RT, there was a further decline in FVC following radiation therapy. At the most recent follow-up evaluation, five of 29 patients (18%) who received ABVD alone and nine of 30 (30%) who received ABVD and RT reported persistent mild pulmonary symptoms (P = .36), which did not significantly affect normal daily activity. CONCLUSION: ABVD chemotherapy induced acute pulmonary toxicity that required bleomycin dose modification in a substantial number of patients. The addition of RT resulted in a further decrease in FVC; however, this did not significantly affect the functional status of patients.

Adolescent↗
PubMed1996

Medicare managed care and the need for quality measurement.

With the increasing penetration of managed care as health insurance coverage for Medicare beneficiaries, accountability for quality of care is being demanded. While HEDIS 2.5 has become the standard for assessing the performance of health plans in caring for their commercial members, no such standard exists for Medicare enrollees. U.S. Quality Algorithms, the performance measurement subsidiary of U.S. Healthcare, has developed the Medicare Quality Report Card as a tool for performance assessment and quality improvement. This article describes how the measures of quality important to the Medicare population were chosen, how the measures were calculated, and how they have been used in programs designed to improve the quality of care for U.S. Healthcare Medicare members.

Aged↗
PubMed1996

USQA Health Profile Database as a tool for health plan quality improvement.

Managed care organizations are in a unique position to evaluate and improve the quality of care delivered to their defined memberships. Traditionally, health services delivery has been claims-focused. We describe a potentially richer, patient-centered approach, whereby patients with certain chronic diseases are first identified and then used as the unit of analysis. U.S. Quality Algorithms (USQA), a subsidiary of U.S. Healthcare (USHC) based in Blue Bell, Pennsylvania, has developed selection criteria for 36 different chronic diseases and a new database, the USQA Health Profile Database (HPD), to identify and archive patients with those diseases. Examples of how this approach and database can be used as a quality tool are demonstrated.

Chronic Disease↗