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D Elias

Publications and source records attributed to D Elias.

At least 199 records · Page 11Linked to original sources
PubMed1991

Prolonged intermittent clamping of the portal triad during hepatectomy.

From 112 consecutive hepatectomies for malignant tumours performed with intermittent portal triad clamping, we have retrospectively selected the 20 cases in which clamping exceeded 90 min. Intermittent portal clamping of prolonged duration was used because of abnormal liver texture in 13 cases (mainly patients who had received intra-arterial chemotherapy) and/or because of technically difficult hepatectomy. The mean(s.d.) duration of intermittent portal clamping was 109(18) min and in two cases it exceeded 140 min (148 and 150 min). There was no postoperative mortality and the rate of postoperative morbidity was 35 per cent. Postoperative changes in biochemical liver tests were not major and transient hepatic failure occurred in only one patient following subtotal resection of the liver. We conclude that intermittent portal clamping is a useful manoeuvre in partial hepatectomy when resection is difficult or prolonged, or when the liver parenchyma is abnormal. Such clamping may be used for longer than 120 min without major complications.

Adult↗
PubMed1991

Prognostic factors in patients with liver metastases from colorectal carcinoma treated with discontinuous intra-arterial hepatic chemotherapy.

48 patients with colorectal cancer metastatic to the liver were implanted with a subcutaneous access system allowing hepatic intra-arterial perfusion. Regional chemotherapy used 5-fluorouracil, while 17 patients also received low-dose mitomycin at the beginning of the study. Responses to the treatment occurred in 29 patients (60%) and median survival was 14.4 months. Toxicity included gastroduodenal erosions in 12.5% of the patients, leucopenia in 20.8%, catheter thrombosis in 42% and arterial thrombosis in 50%. 2 patients died of digestive haemorrhage probably related to treatment. When individually analysed, four factors were found to significantly affect survival: presence of hepatomegaly (defined as palpable liver edge exceeding the right costal margin by more than 5 cm) (P = 0.006), percentage of hepatic replacement superior to 50% (P = 0.003), more than four metastases (P = 0.025) and hypovascularised metastases at radionuclide liver scan with 99m technetium-labelled macroaggregate albumin (MAA) (P = 0.04). The effect of the four variables on the observed survival time was analysed using a Cox regression model. Two variables were found to have simultaneously influenced survival. Presence of hepatomegaly emerged as the more significant (P = 0.0001), the other being hypovascularised metastases at 99mTc-MAA.

Adenocarcinoma↗
PubMed1991

Preoperative segmental localization of hepatic metastases: utility of three-dimensional CT during arterial portography.

To evaluate the accuracy of a fast three-dimensional (3D) reconstruction technique in determining the segmental location of hepatic metastases, 14 patients (40 metastases) were prospectively investigated before surgery with dynamic two-dimensional (2D) computed tomography during sequential arterial portography (CTAP). All patients underwent subsequent hepatic tumor resection within 4 days. After computer-generated mapping of hepatic venous structures with high attenuation and metastases with low attenuation, 3D reconstruction was performed. Thirty-six of the 40 lesions (90%) were detected with 2D and 3D CTAP. The accuracy in determining the segmental location of hepatic metastases was 78% (28 of the 36 metastases) for 2D CTAP and 94% (34 of the 36 metastases) for 3D CTAP. The difference in localization rates between 2D CTAP and 3D CTAP was statistically significant. The 3D CTAP technique provides vital data unattainable with other imaging modalities that improve the preoperative assessment of the resectability of hepatic metastases and allows planning a safer surgical approach.

Adult↗
PubMed1991

[Biodistribution of murine XF-8 monoclonal antibody in patients with colonic cancer].

We describe a biodistribution study using a radiolabelled anti-tumor murine monoclonal antibody F(ab')2 in XF-8 in 6 patients with colorectal carcinoma. One patient had an isolated rectal carcinoma. Five patients had hepatic metastasis of colorectal carcinoma. Among them three had also the primary colorectal carcinoma. Double-label method using simultaneous injection of 131-Iodine monoclonal antibody XF-8 F(ab')2 and 125-Iodine control monoclonal antibody was performed to evaluate the specificity of monoclonal antibody localization in the tumor. Each patient received 4-8 mCi of 131-I XF-8 F(ab')2 infused at doses 0.5-5 mg. Simultaneously 200 microCi of 125-I non relevant antibody were infused. Before each administration, immunoreactivity of antibodies preparations was checked before labelling by immunohistological methods and, after labelling, by cell-binding tests. In biodistribution studies, patients were scanned with a scintillation camera each day since the infusing day to the surgery day (3-6 days). To study specificity of XF-8 F(ab')2 antibody localization we measured by means of scintillation counting in tumors and normal tissues recovered after surgery. In vitro immunoreactivity of monoclonal antibody batches was safe. All our data in vivo are negative but correlated. We concluded that criteria for screening the monoclonal antibodies considered for detection of human tumors are not really known.

Adult↗
PubMed1991

[Is the aggressive treatment of locoregional recurrences of colorectal cancers justified?].

Fifty-two local recurrences (LR) of colonic (n = 31) or rectal (n = 21) cancers, with synchronous metastases in 19 cases, were treated aggressively between 1981 and 1989. Treatment consisted of extended surgical resection combined with transcutaneous radiation therapy. Intravenous chemotherapy (5 fluorouracil and folinic acid) was delivered to the last 42 patients. The synchronous metastases were resected in all cases, except one. A sufficient high-dose radiation therapy (45 Gy after complete excision and 60 Gy after incomplete excision) was performed in 23 cases only. The majority (29 cases) of the patients underwent a second operation, and some 3, 4, or 5 operations. Global survival and survival without recurrence were 60 percent and 42 percent at 3 years. These good results were not stable and decreased progressively with time. The excision required usually surgery of large magnitude. Postoperative mortality was null but morbidity and functional disorders were important. After complete excision of the LR, radiation therapy doubled the rate of local control when it was greater than 45 Gy. The benefit of radiation therapy was doubtful after incomplete excision, even with high-dose irradiation. The role of systemic chemotherapy could not be analyzed in this study. Study of prognostic factors showed that resectable synchronous metastases and rectal or colonic location of primary tumors were not correlated with survival, Survival was correlated with the local control of LR (P = 0.012) and the presence of invaded neighbouring organs (P = 0.006) which reflected the tumor volume. In conclusion, it was difficult to conclude if aggressive treatment of LR should be mandatory or not.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Surgical and chemotherapeutic treatment of hepatic metastases from carcinoma of the breast.

To date, no five year survival rates have been reported for patients with hepatic metastases (HM) from breast origin treated by chemotherapy or hormone therapy. This study was done to evaluate whether or not surgical excision of such metastatic disease associated with chemotherapy has any effect on such a poor prognosis. Between May 1985 and September 1988, 22 patients with a diagnosis of isolated (solitary or multiple) HM have been surgically treated. The therapeutic approach also included systemic preoperative and postoperative chemotherapy. Laparotomy findings for those 22 patients are presented. There were benign hepatic lesions in four patients (four different histologic types) and hepatectomy was done in two patients. Diffuse metastatic disease contraindicated any attempt at hepatic resection in six patients. Hepatectomy was possible in 12 patients. There was no postoperative mortality and minimal morbidity. One-half of the patients with metastases had one or more positive lymph nodes at the hepatic pedicule. Median survival time for 12 patients treated by hepatectomy was 37 +/- 9 months after hepatectomy and 42 +/- 3 months after the discovery of HM. Eleven patients had other metastases after an average period of 11.8 months after hepatectomy, and the liver was the first site of recurrence in eight. One patient underwent a hepatectomy twice. Two patients were free of disease 29 to 46 months postoperatively in spite of poor prognostic features on the excised specimen. Although the median survival time was two times better than with usual treatment, we believe this procedure is of doubtful benefit. In this situation, hepatectomy acts as cytoreductive surgical treatment, with the main limiting factor being the relatively low effectiveness of chemotherapy. This type of therapy can be applied only to a restricted number of patients, and if we decide to proceed with this study, we will have to modify the protocol of chemotherapy radically.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Synchronous cancers of the esophagus and of the ORL area: results of combined treatments with esophagectomy (28 cases)].

Twenty-eight patients with synchronous esophageal and head and neck epidermoid cancers have been treated by a combined protocol including esophagectomy. Seventy-nine percent received pre-operative chemotherapy, 50% had resection of the head and neck lesion at the same time as the esophagectomy and 79% received post-operative irradiation. Two patients died during the post-operative period (7%), and 1, 2 and 3-yr survival rate (Kaplan-Meier) was respectively 64, 32 and 27%. Contrary to our initial assumption, there was no significant decrease in survival compared to patients operated on for an isolated esophageal cancer. The patients were divided into 4 very simple prognostic groups based on the T and N stages of the clinical pre-therapeutic TNM classification: T1 or T2 for esophageal lesions and different T or N stages according to the prognosis for head and neck lesions. A study of each group tended to show that esophagectomy was beneficial except in cases of synchronous T2 esophageal cancer and locally advanced head and neck cancer (there was 2-yr survival in this group). The 28 patients studied represent a particular population which presented 91 cancerous localisations during the duration of the study (mean: 3.25 localisations per patient).

Carcinoma, Squamous Cell↗
PubMed1990

Induction and therapy of autoimmune diabetes in the non-obese diabetic (NOD/Lt) mouse by a 65-kDa heat shock protein.

Insulin-dependent diabetes mellitus is caused by autoimmune destruction of the insulin-producing beta cells of the pancreas. The results described here indicate that a beta-cell target antigen in non-obese diabetic (NOD/Lt) mice is a molecule cross-reactive with the 65-kDa heat shock protein (hsp65) of Mycobacterium tuberculosis. The onset of beta-cell destruction is associated with the spontaneous development of anti-hsp65 T lymphocytes. Subsequently hsp65 cross-reactive antigen becomes detectable in the sera of the prediabetic mice and some weeks later anti-hsp65 antibodies, anti-insulin antibodies, and anti-idiotypic antibodies to insulin antibodies become detectable. The hsp65-cross-reactive antigen, the autoantibodies, and the T-cell reactivity then decline with the development of overt insulin-dependent diabetes. The importance of hsp65 in the pathogenesis of insulin-dependent diabetes was confirmed by the ability of clones of anti-hsp65 T cells to cause insulitis and hyperglycemia in young NOD/Lt mice. Moreover, hsp65 antigen could be used either to induce diabetes or to vaccinate against diabetes, depending on the form of its administration to prediabetic NOD/Lt mice. Other antigens such as the 70-kDa heat shock protein (hsp70) had no effect on the development of diabetes.

Animals↗
PubMed1990

Human immunodeficiency virus infection in tuberculosis patients.

Human immunodeficiency virus (HIV) serology was performed in non-Asian-born patients 18-65 years old with newly diagnosed tuberculosis at a county tuberculosis clinic, and demographic and clinical features of HIV-seropositive and HIV-seronegative patients were compared. Sixty of 128 eligible patients agreed to participate, of whom 17 (28%) were seropositive. Risk of HIV was associated with homosexual contact, intravenous drug use, or both; however, 4 (24%) of the 17 seropositives denied risk behaviors. Significantly more blacks (48%) than whites (10%) or Latinos (20%) were HIV-seropositive (P less than .01). Site of disease, tuberculin reactivity, response to therapy, drug toxicity, and relapse did not differ significantly between groups. HIV-seropositive patients had significantly lower median CD4+ cell counts (326/mm3, range 23-742/mm3, vs. 929/mm3, range 145-2962/mm3, P less than .0005) and median CD4+:CD8+ ratios (0.50, range 0.14-1.07 vs. 1.54, range 0.35-4.36, P less than .0001). HIV infection is associated with clinically typical tuberculosis and HIV screening of tuberculosis patients is recommended in areas where HIV is endemic.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Intra-arterial hepatic chemotherapy with pirarubicin. Preclinical and clinical studies.

Intra-arterial hepatic chemotherapy (IAHC) with adriamycin (ADM) has not increased its therapeutic index. For our preclinical studies, we selected pirarubicin (THP), an ADM derivative with faster cellular uptake. In rabbits with VX2 tumor in the liver we compared plasmatic and cellular pharmacokinetics of ADM and THP after i.v. and IAH therapy. For ADM, there were no differences in plasma and heart concentrations, with only a slight increase in tumoral levels after IAH compared to i.v. administration; on the other hand, with IAH THP, there was important reduction in systemic exposure with a major increase in tumoral drug distribution. In the phase I study, involving nine patients with implanted catheters, the starting dose of THP was 30 mg/m2 with a 10 mg/m2 intrapatient escalation every 3 weeks in the absence of toxicity. Pharmacokinetics were compared for i.v. and IAH administration in seven patients. The limiting toxicity was neutropenia and the maximal tolerated dose (MTD) ranged from 50 to 110 mg/m2. Moderate nausea-vomiting (grade 1-2) and alopecia (grade 1) occurred at the MTD. No arterial occlusion, gastroduodenal ulcer, hepatitis, or sclerosing cholangitis were seen. In the phase II study, in colorectal cancer patients (CRC) with metastasis confined to the liver, patients were enrolled until June 1990. THP (40 min infusion every 3 weeks) was initiated at 60 mg/m2 with 10 mg/m2 increment until grade 2 hematotoxicity. The median MTD was 85 mg/m2 (range of 60-120 mg/m2), and the median number of cycles was 7 (range of 2-11) with cumulated doses from 180 to 1,030 mg/m2. Grade 2-4 neutropenia was reached in 15 patients. Other toxicities included two arterial occlusions, one episode of gastritis, but no hepatic toxicity and no heart failure. Antitumor effect (in 18 patients) included 1 CR, 5 PR, 3 MR, 6 NC, and 3 PD. The median survival was 18+ months and 1-year survival was 73% +/- 12%. Seven patients had extrahepatic progression at this time. In conclusion, besides 5-FU or Fudr, THP is active in IAHC (probably in relation with high local extraction) on CRC liver metastases usually unresponsive to ADM. It can be given in an outpatient setting with minimal toxicity.

Animals↗
PubMed1990

Insulin-mimicking anti-idiotypic antibodies in development of spontaneous autoimmune diabetes in BB/E rats.

BB/E rats spontaneously develop a form of autoimmune diabetes resembling insulin-dependent diabetes mellitus (IDDM) in humans. IDDM results from central destruction of the insulin-producing beta-cells of the pancreatic islets. Herein, we report that the outbreak of IDDM in BB/E rats is preceded by the spontaneous development of an anti-idiotypic antibody to a particular antibody to insulin made by the rats. This anti-idiotype, designated anti-DM-id, behaves as an antibody to the insulin-hormone receptor. Thus, a spontaneous anti-idiotypic antibody network whose products can affect the peripheral utilization of insulin seems to accompany the central destruction of beta-cells in developing IDDM.

Animals↗
PubMed1990

[150 hepatic resections of malignant tumors. Technical aspects].

One hundred and fifty hepatic resections for liver tumors have been performed in 130 patients during the last six years. The origin of the tumors was miscellaneous, but 76 resections were made for liver metastases from colo-rectal cancers, and all the types of hepatic resections were performed. The post-operative mortality and morbidity were respectively 2% and 26%. After such an experience, we think that hepatic resections for tumors are currently safe surgical operations. This security comes from two technical ameliorations: the practice of intraoperative ultrasonography and the systematic use of repetitive pedicular clampings. A detailed account is done about the different operative technics concerning intraoperative ultrasonography, pedicle clamping and different types of systematized or atypical hepatectomies.

Colorectal Neoplasms↗
PubMed1989

Intra-arterial hepatic chemotherapy for metastatic liver from colo-rectal carcinoma origin.

Loco-regional intra-arterial chemotherapy of hepatic metastases from colo-rectal cancer is one of the most effective non-surgical treatments in this clinical situation. In our experience of 58 cases treated during 3 years, in a non randomized study by either: 1) discontinuous perfusion of 5FU (using a subcutaneous access) or 2) by continuous infusion of FUDR (using an implantable pump), we observed an objective response rate of 52% and 53% with a 1 year survival of 73% and 90%, respectively. This technique, however, is limited in its application by loco-regional complications and in its long term efficacy by the development of extrahepatic metastases. The proof of its efficacy in terms of survival prolongation, is being studied within the framework of a prospective randomized trial with a control group.

Adenocarcinoma↗
PubMed1989

[Neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma. Preliminary results].

Gastric adenocarcinoma locally advanced or located at the cardia, or of large size or with local lymphadenopathies are of bad prognosis. To improve the surgical results we have tested the feasibility and tumoral efficacity of pre-operative (neoadjuvant) chemotherapy. Twenty patients have been included between 6/87 and 12/88. Median age was 63 years (36-74); all patients were in good general condition (OMS 0-1). The tumors were located at the cardia in 50%. The tumor median size was 10 cm (6-19), pathological lymph nodes were seem at CAT. Scan in 10/20. The neoadjuvant chemotherapy was continuous IV, 5 FU 1 g/m2/day for 5 days + CDDP 100 mg/m2, day 1. The cycles were repeated every 4 weeks. The median number of cycles prior surgery was 2 (1-4) and depended of tolerance and efficacy. We have observed (WHO criteria). 1 CR, 12 PR (Responsible rate: 65%). 6 MR or S. One patient was non evaluable because coronary insufficiency complicating the first cycle. The neoadjuvant chemotherapy toxicity was mainly hematological. The surgical procedure was curative in 15/20 patients; palliative 4 and non feasible for progression 1. Normal rate of post-operative complications was encountered: 2 subphrenic abscess, 1 pneumopathy, 1 stercoral peritonitis. At this date 3/20 patients died (17 patients are still alive, among them 14 are NED (the overall median survival is more than 10 months). This study demonstrated the feasibility and high response rate of neoadjuvant chemotherapy in patients with locally advanced gastric carcinomas. A randomized trial is warranted to demonstrate the survival benefit.

Adenocarcinoma↗