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Biomedical subjects

B Epstein

Publications and source records attributed to B Epstein.

At least 19 recordsLinked to original sources
PubMed1991

Multimodality cisplatin treatment in nonresectable alpha-fetoprotein-positive hepatoma.

Twenty-eight patients with alpha-fetoprotein-positive (AFP+) nonresectable hepatoma have been enrolled in a new multimodality Phase I, II program. Induction therapy consisted of 50 mg/m2 intravenous cisplatin followed by 2100 cGy irradiation to the tumor volume in seven fractions over 10 days. Hepatic arterial infusion of 50 mg/m2 cisplatin (IA-CDDP) was then administered at monthly intervals. Twenty-one patients have completed induction and at least two cycles of IA-CDDP. Twelve-month cumulative survival was 52% for all 28 patients and 69% for the 21 patients completing induction and IA-CDDP. Median survival has not yet been reached. Response rate (complete and partial) was 36% overall and 48% among the 21 patients who completed treatment. The improved survival of the present series of patients as well as the minimal hematologic toxicity suggests possible further integration of new modalities for therapy.

Adult↗
PubMed1991

Second neoplasms in patients with carcinomas of the vocal cord: incidence and implications for survival.

A retrospective analysis was performed for 218 patients who were managed for carcinomas of the glottic larynx from 1975 to 1988. With a median follow-up of 51 months (range: 24 to 120 months), 41 patients developed a second malignant neoplasm. Six patients had synchronous and 35 had metachronous second malignant neoplasms. The median interval between the diagnosis of glottic carcinoma and a second malignant neoplasm was 31 months. This median interval increased to 43 months when only the metachronous tumors were analyzed. The average annual risk of developing a second malignant neoplasm (SMN) in a 10-year period was 3.1%. Seventy-one percent of them occurred in the upper aerodigestive tract or lungs. When analyzed according to the initial stage of the glottic carcinoma, 23 of 145 (16%) patients with T1 or T2 glottic carcinomas developed a second malignant neoplasm, whereas 18 of 73 (25%) patients T3 or T4 lesions did so. For the T1/T2 group, the average annual risk was 2.5%, as compared to 4.8% for the T3/T4 group (p = 0.023). The development of a second malignant neoplasm adversely affected survival. The 10-year actuarial survival for these patients who did not develop a second malignant neoplasm was 45%, as compared to 19% for those who did develop a second malignant neoplasm (p = 0.008). Although second malignant neoplasms occurred in only 19% of the total patient population, their impact on the survival rate of the overall population was equal to that of glottic carcinomas. The median survival after the diagnosis of a SMN was 6 months. The high incidence of second malignant neoplasms in patients with glottic carcinomas warrants careful follow-up and clinical investigation of the use of chemopreventive agents.

Adult↗
PubMed1988

The use of radionuclide venography in the differential diagnosis of inferior vena caval obstruction.

In using radionuclide imaging of the inferior vena cava (RIVC) to investigate the prevalence of membranous obstruction of the inferior vena cava (IVC) in patients with hepatocellular carcinoma, it was necessary first to determine if this technique would distinguish membranous obstruction of the IVC both from other causes of IVC obstruction likely to be encountered in these patients and from the picture obtained with severe ascites. RIVC readily distinguished an obstructed from a normally patent IVC. However, membranous obstruction of the IVC could not in most instances be differentiated from extrinsic compression of the IVC by an enlarged tumourous liver, occlusion of the lumen of the IVC by tumour, or the effect of severe ascites. In a proportion of the patients with membranous obstruction of the IVC, flow of the radionuclide through large superficial collateral vessels was seen, enabling this diagnosis to be made with confidence. Thus, if RIVC shows the IVC to be obstructed or if severe ascites is present, contrast venography will usually be necessary to determine the nature of the obstructing lesion.

Ascites↗
PubMed1986

Small and asymptomatic hepatocellular carcinoma detected by alpha-fetoprotein screening in black hepatitis B carriers. A report of 2 cases.

Two patients in whom asymptomatic and small hepatocellular carcinomas (HCC) were detected by alpha-fetoprotein (AFP) screening are reported. Both patients were hepatitis B surface antigen-positive. In the first patient, the tumour grew slowly and was resected more than 2 years after a significant elevation in serum AFP levels had been first detected and 13 months after hepatic angiography confirmed the presence of a vascular tumour. In the second patient, a small encapsulated HCC was diagnosed by AFP screening and hepatic imaging. The clinical course in these 2 patients illustrates that small, asymptomatic and encapsulated HCCs do occur in southern African black hepatitis B carriers. Regular screening of patients at risk may be justified.

Adult↗
PubMed1978

Damage to hyphal forms of fungi by human leukocytes in vitro. A possible host defense mechanism in aspergillosis and mucormycosis.

Evidence suggests that neutrophils are important in host defenses against invasive aspergillosis and mucormycosis, although hyphae in these lesions are too large to be phagocytized. Interactions of neutrophils with hyphae of Aspergillus fumigatus and Rhizopus oryzae were studed in vitro. Light and electron microscopic observations indicated that neutrophils attached to and spread over the surfaces of hyphae, even in the absence of serum. This was followed by dramatic morphologic changes which suggested severe damage and probably death of hyphae. An assay of neutrophil-induced reduction of uptake of radioisotopes was used to quantitate damage to the fungi by neutrophils from normal subjects. Damage to hyphae was inhibited by a variety of compounds which are known to affect neutrophil surface functions, motility, and metabolism. Use of inhibitors of oxidative microbicidal mechanisms of neutrophils indicated the central importance of these mechanisms in damage to hyphae. Inhibitors of neutrophil cationic proteins altered damage only to Rhizopus. Damage to hyphae by lysozyme suggested that it may play a secondary role in the neutrophil, primarily against Aspergillus. This new nonphagocytic mechanism may play an important role in host defenses against these and other hyphal forms of fungi.

Aspergillosis↗
PubMed1977

Reactions and serologic responses after administration of inactivated monovalent influenza A/swine virus vaccines. I. Immunization of children and adults with influenza A/Shope virus vaccines.

Reactivity and immunogenicity of three inactivated, zonally purified, monovalent influenza A/swine virus vaccines were studied in children and adults. Each dose of vaccine contained either 400 chick cell-agglutinating (CCA) units/0.5 ml or 200 CCA units/0.25 ml. The vaccines contained either whole virus or ether-extracted, subunit virus with or without 1.5 mg of A1PO4/0.5 ml. Children younger than 10 years of age received a half dose. Substantial system reactions, including temperature increases of 2.2 F-4.9 F, were observed in all children who received whole-virus vaccines. In contrast, ether-extracted, subunit vaccines (with or without A1PO4) were minimally pyrogenic in 185 subjects. Two doses of subunit vaccine in subjects younger than 25 years of age were immunologically equivalent to a single dose in older subjects. We concluded that two doses of ether-extracted, subunit virus vaccine with Hsw1N1 antigen, administered at least four weeks apart, are serologically effective for immunization of seronegative subjects of any age and that this dosage regimen should be used in young children in whom whole-virus vaccines are unacceptably reactive.

Adolescent↗
PubMed1977

Reactions and serologic responses after administration of inactivated monovalent influenza A/swine virus vaccines. II. Immunization of children with influenza A/New Jersey/X-53 virus vaccines.

Reactivity and immunogenicity of two inactivated, zonally purified, ether-extracted, influenza A/New Jersey/X-53 subunit virus vaccines were studied in 103 children three to 18 years of age. Children aged nine years of younger received doses of 100 or 200 chick cell-agglutinating (CCA) units, and those older than nine years received doses of 200 or 400 CCA units. Vaccines were given intramuscularly. Two doses were given at intervals of four weeks. The vaccines were minimally pyrogenic, causing only two instances of temperatures of greater than 100.0 F. Other systemic reactions were observed infrequently. Tenderness at the site of injection occurred relatively frequently but was of no medical consequence. The geometric mean titers of homologous antibody, which ranged from 1:52 to 1:75 after administration of two doses, were statistically equivalent in all treatment groups. Titers of antibody of greater than or equal to 1:40 to the influenza A/New Jersey/8/76 virus strain were achieved by 88% of the vaccinees. We concluded that two doses of ether-extracted, subunit influenza A/New Jersey/X-53 virus vaccine were well tolerated and, when given at least four weeks apart, were serologically effective for immunization of children aged three to 18 years.

Adolescent↗