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Biomedical subjects

A Roche

Publications and source records attributed to A Roche.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Long-term oncological results of hepatectomy performed after selective portal embolization].

BACKGROUND: Preoperative selective portal vein embolization (PSPVE), usually of the right portal branch, allows some patients to undergo an hepatectomy which was initially impossible as it would have left an insufficient amount of liver parenchyma. PSPVE induces relative atrophy of the embolized part of the liver, inducing compensatory hypertrophy of the nonembolized part (future remaining liver). Its technical aspects, its tolerance, its immediate results and indications are currently well-known, but long-term results of PSPVE followed by hepatectomy are unknown. The objective of this retrospective study was to assess the long-term survival of this unusual therapeutic approach. PATIENTS AND METHODS: Forty-one patients with initially unresectable (for volumetric reasons) malignant lesions of the liver, underwent PSPVE followed by hepatectomy between September 1987 and September 1998. In two-thirds of cases, the primary tumor was a colorectal adenocarcinoma. The mean number of resected lesions was 4.6 per patient, the mean size of the free margin was 4.3 mm, and 26.8% of the patients presented a (resectable) extrahepatic tumor. RESULTS: Overall 5-year survival (including the two postoperative deaths) was 31.3%, and 5-year survival without recurrence was 24%. For the 27 patients with colorectal metastases (the only homogenous subgroup of the series), overall 5-year survival was 28.6%. Although this result was lower than those obtained with classical hepatectomy (34.4%), it can be considered to be satisfactory, due to the number and size of the lesions. CONCLUSION: In conclusion, it is justified to use PSPVE to make initially unresectable very large liver tumors resectable, in view of the good survival results.

Adenocarcinoma↗
PubMed1999

[Percutaneous radiofrequency ablation of hepatic metastases. Preliminary experience].

AIM: To evaluate the efficiency of percutaneous radiofrequency ablation in the treatment of liver metastases. METHODS: Eighteen patients with 31 liver metastases, mainly from colorectal cancer, 10 - 35 mm in diameter (m = 23), underwent 26 courses of percutaneous radiofrequency ablation. Fifteen patients had previously undergone hepatectomy, and 3 patients had contra-indications to surgery. Imaging guidance was ultrasound in 21 patients, CT in 4 (tumors not seen with ultrasound), and both in 1. A generator working at 450 KHz with a maximum output power of 150 W was used to treat each lesion for 18 - 20 min. Treatment was monitored with real time ultrasound. RESULTS: Among the 12 patients followed more than 3 months, only one of the 24 treated lesions recurred after a mean follow up of 259 ¿ 109 days. Liver disease was controlled in 8 of the 12 patients after 90 - 509 days (m = 306). Among these 8 patients, 3 were tumor free after 559, 378 and 90 days, respectively; 2 died tumor free of non-tumoral disease (pulmonary embolism, digestive bleeding); 3 developed lung metastases treated with chemotherapy (n = 2) or surgery (n = 1). Three of the 12 patients had widespread hepatic tumor occurrence, and one patient died of these metastases. Six patients experienced mild skin burns, but no major complication was observed. CONCLUSION: Radiofrequency ablation of hepatic metastases appears safe and promising in this preliminary experience. Further investigation is needed.

Adult↗
PubMed1998

[Preoperative portal embolization: an effective means for inducing hypertrophy of the healthy liver and increasing indications for hepatic resection].

AIM OF THE STUDY: The aim of the preoperative portal embolization is a redistribution of the portal venous blood flow in an attempt to induce hypertrophy of the future remnant liver in order to perform a curative liver resection. MATERIAL AND METHODS: Preoperative portal embolization was performed in a group of 43 patients. The volumetric ratio (future remnant liver/total liver-tumor) was 20%. Liver metastases were present in 40 patients and primary liver tumor in three. Twenty-four patients had received chemotherapy prior to the preoperative portal embolization. Required operative procedures were right hepatectomy (n = 15), right hepatectomy extended to the segment IV (n = 24) or atypical resection (n = 4). Preoperative portal embolization was performed under percutaneous transhepatic approach with a Blue Histoacryl and Lipiodol Ultra Fluide mixture. Liver volumetric measurements were obtained with 3D color encoded computed tomography, before portal embolization and before surgery. RESULTS: Hypertrophy of the future remnant liver was 83 +/- 58% after a mean 32-day interval between portal embolization and surgery. The tolerance of portal embolization was excellent. Thirty-six hepatectomies were performed as initially planned; seven were cancelled for emergence of metastases (distant in six patients and intrahepatic in one). CONCLUSION: Pre-operative portal embolization is a safe and effective procedure which increases the possibilities of curative resection in the liver tumors.

Embolization, Therapeutic↗
PubMed1998

Treatment of unresectable hepatocellular carcinoma with lipiodol chemoembolization: a multicenter randomized trial. Groupe CHC.

BACKGROUND/AIMS: Lipiodol chemoembolization is a widely used method of treatment in patients with unresectable hepatocellular carcinoma, but its efficacy is still debated. The aim of our study was to assess the efficacy of lipiodol chemoembolization in patients with unresectable hepatocellular carcinoma. METHODS: Seventy-three patients with unresectable hepatocellular carcinoma, but without severe liver disease or portal vein occlusion, were randomly assigned to receive either repeated lipiodol chemoembolization (lipiodol, cisplatin (2 mg/kg), lecithin, and gelatin sponge injected into the hepatic artery) plus tamoxifen (40 mg) or tamoxifen alone. The main end-point was survival. RESULTS: The 37 patients in the lipiodol chemoembolization group received 104 courses (median 3 per patient). By 1 September 1996, 58 patients had died: 30 in the lipiodol chemoembolization group and 28 in the tamoxifen group. There was no difference in survival between the two groups (p=0.77). The relative risk of death in the lipiodol chemoembolization plus tamoxifen group as compared to the tamoxifen group was 0.92 (95% confidence interval 0.55 to 1.56). At 1 year, survival was 51% and 55%, respectively. An objective tumoral response was more frequently observed in the lipiodol chemoembolization group than in the tamoxifen group (24 versus 5.5%, respectively, p=0.046). Lipiodol chemoembolization caused two deaths and induced signs of liver failure in 51% of the patients assigned to this treatment. CONCLUSION: In our randomized study, lipiodol chemoembolization did not improve the survival of patients with unresectable hepatocellular carcinoma treated with tamoxifen.

Adult↗
PubMed1998

Endovascular management of bleeding iliac artery pseudoaneurysms complicating radiation therapy for pelvic malignancies.

OBJECTIVE: We evaluated arteriographic findings and endovascular treatments of eight patients who had bleeding iliac artery pseudoaneurysms and who had undergone radiation therapy (3000-6500 rad [30-65 Gy]) and surgery for pelvic malignancies. CONCLUSION: Angiography revealed contrast media extravasation in 75% of patients who had bleeding iliac artery pseudoaneurysms and failed to show the source of bleeding in 25%. The patients who had positive findings at angiography were all successfully treated percutaneously, although two patients required additional bypass surgery. Among embolic materials, coils and balloons were safe and efficient, whereas cyanoacrylate was unsafe and led to complications in two of three patients. A covered stent, which was not available for most of our patients, was used in one patient and may be an effective means of treating pseudoaneurysms.

Aneurysm, False↗
PubMed1997

Hepatic veno-occlusive disease after myeloablative treatment and bone marrow transplantation: value of gray-scale and Doppler US in 100 patients.

PURPOSE: To determine the value of gray-scale ultrasonography (US) and Doppler US in the prediction, diagnosis, and prognostic assessment of hepatic veno-occlusive disease (HVOD). MATERIALS AND METHODS: One hundred patients (median age, 22 years; range, 18 months to 59 years) receiving total body irradiation or busulfan therapy as intensive treatment before hematopoietic stem cell transplantation were studied prospectively. Each patient underwent gray-scale and Doppler US examination before transplantation and weekly thereafter while hospitalized (about four examinations per patient). Seven gray-scale morphologic criteria and seven Doppler criteria were studied, yielding three individual scores: gray-scale score, Doppler score, and total score. RESULTS: Twenty-five patients developed HVOD; nine of these patients died. Positive predictive values of the 14 criteria were 31%-95%, and negative predictive values were 85%-96%. The three scores correlated with the clinical diagnosis of HVOD. Depending on the cutoff value, the positive predictive value of the total score was 44%-89% and the negative predictive value was 91%-98%. The gray-scale and Doppler criteria differed significantly between patients with HVOD and those with graft-versus-host disease of the liver (P = 10(-4)). CONCLUSION: Even if there is overlap in findings between patients with and those without HVOD, gray-scale and Doppler US are valid for positive and differential diagnosis and have predictive and prognostic relevance.

Adult↗
PubMed1997

Somatostatin and growth hormone-releasing hormone in normal and tumoral human breast tissue: endogenous content, in vitro pulsatile release, and regulation.

Endogenous production of SRIH and GHRH was analyzed in human breast tissue. SRIH precursor (pro-SRIH) was identified after Sephadex G-50 filtration of acetic acid extracts of normal and tumoral human breast samples. SRIH-(1-14) or -(1-28) could not be detected in breast tissue, whereas the immunoreactive SRIH released in vitro was characterized as SRIH-(1-28). Endogenous production of GHRH was assessed by identification of GHRH messenger ribonucleic acid by PCR followed by sequencing of the amplified complementary DNA and by high performance liquid chromatographic characterization of immunoreactive GHRH contained in the tissue and released in vitro. There were no differences in pro-SRIH or GHRH-(1-44) tissue contents between normal and tumoral samples. The release of both peptides was evidenced in perifusion and static incubation. Perifusion of normal breast tissue (n = 3) showed pulsatile release of SRIH and GHRH. Perifusion of tumors (n = 4) showed SRIH release in 50% of the cases. SRIH release was pulsatile in one case. GHRH release was observed in the four tumoral samples analyzed, but was pulsatile in only one case. In static incubation, tumors (n = 6) secreted 13 times more GHRH than did normal samples (n = 3; 383 +/- 92 vs. 29.6 +/- 4.6 fmol/mg protein; P < 0.05). Stimulation of GHRH release by exogenous SRIH was observed only with the normal tissue. Together these data provide evidence for the existence of local production of SRIH and GHRH by human breast. Hypersecretion of GHRH by breast tumors indicates that this peptide could play a role in maintaining epithelial cell proliferation as is the case for other peptides produced locally.

Breast↗
PubMed1997

Self-expanding metallic stents as palliative treatment of malignant gastroduodenal stenosis.

OBJECTIVE: Our objective was to evaluate the efficacy of self-expanding metallic stents as palliative treatment in 10 patients with malignant stenosis of the stomach (n = 2) or the duodenum (n = 8). CONCLUSION: Metallic stents appeared valuable for the treatment of malignant gastroduodenal stenosis in this preliminary study because they provided durable relief of symptoms in eight of 10 patients for a mean of 93 days, until death. Particular attention should be paid to evaluating the digestive tract meticulously downstream because this zone was the cause of failure in two patients. Further studies are needed using a larger series.

Abdominal Neoplasms↗
PubMed1996

Liver abscess formation after local treatment of liver tumors.

Our goal was to determine a subset of patients at high risk of developing liver abscesses after local treatment of liver tumors (LTLT) and establish guidelines for the conduct of LTLT in the safest conditions in such patients. Five hundred sixty-one LTLT, 489 transhepatic arterial chemoembolizations (TAC, 10 hepatic embolizations, and 62 percutaneous intratumor injections (PIT), were retrospectively reviewed for liver parenchyma necrosis and abscess formation. Four patients developed abscesses, three after TAC and one after PIT. Despite broad-spectrum antibiotherapy, percutaneous drainage, and surgery, two patients died. A left hepatectomy was required in the other two patients for cure. All four patients had a carcinoid or a neuroendocrine pancreatic tumor. Three out of four patients had bilioenteric anastomoses, and the fourth had recently undergone cholecystectomy and papillotomy. A Lipiodol/doxorubicin mixture without any particulate embolization was injected in the three patients who developed abscesses after TAC. LTLT in patients with bilio enteric anastomosis or papillotomy and/or neuroendocrine or carcinoid tumor should be performed with strict precautions during the procedure and for peri-procedural care.

Antineoplastic Agents↗
PubMed1996

Decrease of ciliary beat frequency by platelet activating factor: protective effect of ketotifen.

The ciliary beat frequency (CBF) of the tracheal epithelial cells controls in part the respiratory tract mucociliary transport efficiency. We investigated the effects on CBF of PAF-acether (PAF) and its metabolite/precursor lyso-PAF. Guinea-pig tracheal rings were incubated for 3 to 6h with 1 microM PAF (C16, C18, C16/C18: 80/20%), lyso-PAF C16 or lyso-phosphatidylcholine (LPC). CBF changes were assessed by microphotooscillography (mean number of measures per ring = 14). We also examined the effect on PAF-induced CBF changes of the PAF receptor-antagonist WEB 2086, the anti-asthmatic/anti-anaphylactic drug ketotifen and the anti-histamine H1 pyribenzamine. CBF of control rings exposed to vehicle only from 0 to 6h showed no significant statistical variations (hertz, mean +/- SEM): 10.8 +/- 0.1 (n of measures = 890). By contrast, 1 microM C16, C18, and C16/C18 PAF significantly inhibited CBF after 3 to 6h incubation. C16 and C16/C18 PAF were more potent than C18 PAF (8.8 +/- 0.2, n = 112, 8.7 +/- 0.2, n = 64, and 9.6 +/- 0.1, n = 537 respectively; ANOVA analysis, p < 0.001 from control). At the same concentration, lyso-PAF also inhibited CBF, 9.5 +/- 0.1 (n = 197, p < 0.001) but not LPC, 10.5 +/- 0.2 (n = 127). WEB 2086 inhibited lyso-PAF and C16/18 PAF-induced CBF decrease. Preincubation (20 min) with ketotifen but not with pyribenzamine (1 microM) also suppressed the CBF inhibitory effect of PAF and lyso-PAF. Incubation of [3H]PAF with tracheal rings from 10 min to 6h resulted in its partial metabolism (25%) into [3H]lyso-PAF and a compound with a short retention time (10 min). [3H]lyso-PAF incubated for 3h with tracheal rings was partially metabolized (10%) into [3H]PAF and a compound with a short retention time. The PAF-induced decrease of CBF is congruent with its influence on pulmonary clearance, possibly via a specific receptor, since WEB 2086 abolished the effect of PAF. The inhibition of the PAF-induced CBF decrease by ketotifen may contribute to the therapeutic properties of this antiallergic drug.

Animals↗
PubMed1996

Preoperative portal vein embolization for extension of hepatectomy indications.

To render hepatectomy feasible in patients with an initially deficient volume of the future remnant liver (FRL), we redistributed portal blood flow rich in hepatotrophic substances toward the FRL. Redistribution was achieved with preoperative portal vein embolization (POPE) feeding the future resected liver. POPE was performed in 31 patients, under fluoroscopic guidance, via a percutaneous access. POPE was well tolerated and surgery was practicable in 24 patients without severe postoperative liver failure. Seven operations were cancelled, but only one due to insufficient hypertrophy of the FRL. FRL volume values were 90 to 560 mL (mean 260 mL) before POPE and 160-783 mL (mean 443 mL) after POPE, which represents a median increase of 79% +/- 50%. Hypertrophy of the FRL was 90% +/- 52% after 30 days with cyanoacrylate, 53% +/- 6% after 43 days with Gelfoam, and 44% +/- 30% after 35 days with coils. Slight shrinkage was obtained in the volume of the embolized liver, for which resection was planned. Overall survival was 2-62 months (mean 26 months), disease-free survival was 0-60 months (mean 19 months), and 7 patients are disease-free and alive 14 to 60 months (mean 43 months) after surgery. Although exclusively applicable in a limited subset of patients, POPE widens the possibilities of curative hepatectomies, because it induces sound hypertrophy of unembolized liver segments. Cyanoacrylate seems to ensure better and faster hypertrophy.

Adolescent↗
PubMed1996

Quantification of tumor uptake of iodized oils and emulsions of iodized oils: experimental study.

PURPOSE: To optimize use of iodized oil for diagnostic computed tomography (CT) enhanced with iodized oil and for interstitial radiation therapy with iodine-131-labeled iodized oil, the authors quantified the distribution of iodized oil after injection of different formulations of iodized oil into the hepatic artery. MATERIALS AND METHODS: I-125-labeled iodinated ethyl ester of poppyseed oil in two viscosities (iodized oil ultrafluid [viscosity, 0.04 Pa/sec] and iodized oil fluid [viscosity, 0.17 Pa/sec]) was injected (pure forms and three different emulsions of each) into the hepatic artery of rabbits bearing VX2 tumors in the liver. All rabbits received a radiation dose of 4 MBq per kilogram of body weight in 0.1 mL/kg iodized oil. Animals were killed 4 days later, and iodized oil uptake was evaluated in the tumor, nontumorous liver, and lung. RESULTS: There were no statistically significant differences in uptake between pure iodized oil ultrafluid or fluid or between the same type of emulsions made with each type of iodized oil. Lung uptake was significantly higher with pure iodized oil ultrafluid and fluid (19.75 kBq/g +/- 3.25 [standard error of the mean] vs 19.48 kBq/g +/- 6.15, respectively) than with any emulsions (range, 3.72-8.14 kBq/g; mean, 5.68 kBq/g) except the small-droplet oil-in-water emulsion (10.51 kBq/g +/- 1.18). The ratio of tumor to nontumorous liver uptake of iodized oil was significantly higher with large-droplet water-in-oil emulsions made of iodized oil ultrafluid or fluid (10.26 +/- 2.88 and 9.53 +/- 0.64, respectively) than with any other product (range, 4.07-5.38; mean, 4.49). CONCLUSION: Use of large-droplet water-in-oil emulsions limited lung uptake and increased tumor uptake of iodized oil after intraarterial hepatic injection in rabbits bearing VX2 tumors in the liver.

Animals↗