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Biomedical subjects

D Elias

Publications and source records attributed to D Elias.

At least 217 records · Page 12Linked to original sources
PubMed1989

[Anatomo-pathologic study of hepatic toxicity in intra-arterial hepatic chemotherapy].

Intra-arterial hepatic chemotherapy is effective in the treatment of colorectal or endocrine carcinomas liver metastasis. However it is potentially toxic for the healthy liver. To check this, we studied non tumoral liver specimens in 14 patients treated by intra-arterial chemotherapy with 5 fluorouracil, 5 fluoro-2 deoxyuridine and an association of 5 fluorouracil and streptozotocin. The main hepatic lesions observed were: sclerosing cholangitis, central vein (dilatation and fibrosis) and moderate hepatocellular necrosis or cholestasis in the centrolobular area. Thus intra-arterial hepatic chemotherapy has important toxic effects on healthy liver, even if clinical and biological liver disturbances are minimal in most cases. Caution must be exercised in using this method.

Adult↗
PubMed1989

[Gastroduodenal complications of hepatic intra-arterial chemotherapy of hepatic metastases of colorectal origin].

Fifty-eight patients with colorectal liver metastases were treated by intra-arterial hepatic chemotherapy (IAHC) containing 5 FU (n = 42) or FUDR (n = 16). Twenty-three patients (39.6 p. 100) complained of abdominal pain. In three of these patients, the course was complicated by digestive hemorrhage. Endoscopic explorations and angioscintigraphy were normal in 4, showed oesophagitis in 3, superficial gastritis or duodenitis in 8 (34.7 p. 100) and gastric (2) or duodenal ulceration (6) in 8 (34.7 p. 100). The duodenal ulceration was extensive and considered to be cause of hemorrhage in two cases. Duodenal perforation due to the catheter was discovered in two other cases, one of which was secondary to tumoral extension revealed by forceps biopsy. This patient died 3 months later. Surgical treatment was mandatory in the other case due to digestive hemorrhage but did not prevent death. Angioscintigraphy performed in 15 patients with gastroduodenal inflammation or ulceration was normal in 7 patients, revealed arterial thrombosis in 5 and an extra-hepatic perfusion in the gastroduodenal area in 3 : this was related to a small pyloric artery which was occluded secondarily. IAHC was continued there after. This experience underlines the importance of exploring patients with digestive symptoms during IAHC so that it may be temporarily discontinued while an inadequately positioned infusion catheter may be corrected should gastroduodenal ulceration occur.

Antineoplastic Agents↗
PubMed1989

[Epidermoid cancer of the esophagus. Does the efficacy of chemoradiotherapy justify surgical abstention?].

Nine inoperable patients with squamous esophageal cancer were selected from 112 patients treated with combination chemo-radiotherapy. The criteria of selection were: 1) localized cancer (T1 or T2 of the TNM classification), 2) complete response after neoadjuvant chemotherapy suggesting the possibility of a good survival, 3) and 65 Gy-irradiation in the previous tumor bed. Eight of these 9 carcinomas recurred locally after a median delay of 12.6 months after the end of the treatment (extremes: 2 and 30 months). Only one patient is free of disease 24 months after the end of the treatment. These results point out that this chemo-radiotherapeutic association is disappointing in the long term in terms of loco-regional tumoral control and survival, but appeared to be good palliative treatment. This is an argument against the attitude of physicians who currently recommended a non-surgical strategy and deny the value of surgery. The carcinologic surgical excision of esophageal cancers is still the best treatment today. It must be performed whenever it is feasible, possibly associated with complementary treatments (evaluated in prospective studies).

Carcinoma, Squamous Cell↗
PubMed1989

[Epidermoid cancer of the esophagus: is the combination of chemotherapy then surgery beneficial?].

Ninety-two patients with carcinoma of the esophagus were treated with pre-operative chemotherapy (2 courses) before undergoing surgery. Chemotherapy and/or radiation were carried out after surgery depending on the tumor response to chemotherapy and extent of the tumor found at surgery. Tumor response before surgery (according to OMS criteria) was determined in 84 patients. Forty-four percent of patients showed a tumor regression of over 50%. Curative surgery was more frequently performed in patients with good tumor regression (greater than 50%) than in patients with less satisfactory tumor regression (less than 50%) (76 versus 57.5% respectively) (P = 0.08). Patients who underwent curative surgery had a lower pathologic staging when tumor regression was over 50%. However, the number of patients is too limited for any definite conclusions to be made. Survival rate at 3 years was similar in both groups of patients with curative surgery. Survival was not influenced by the extent of tumor regression before surgery. This study also suggests that the pre-operative chemotherapy did not increase the survival rate of patients who underwent curative surgery. Therefore it does not seem advisable to undertake a phase III randomized study on pre-operative chemotherapy patients.

Antineoplastic Agents↗
PubMed1989

[Technics of extensive lymph node curettage in cancer of the esophagus].

During esophagectomy for cancer traditional lymph node curettage is performed extensively in the lower region but is practically nonexistent towards the upper zone, which fails to correspond to a satisfactory anatomic and oncologic exeresis. An operative technique has been adopted to extend lymph gland curettage, particularly in the anterior and superior mediastinum in the region of the recurrent and cervical chains. An analysis is performed of the advantages (increased survival) and inconveniences (increased postoperative morbidity) inherent in these extensive lymph node curettages.

Abdomen↗
PubMed1988

Postinfarction seizures. A clinical study.

We retrospectively studied 90 patients with postinfarction seizures to determine the clinical features (onset, number, type), prognosis, and electroencephalographic and computed tomographic findings; we included infarctions of all etiologies. Thirty-three percent of the 90 seizures appeared early (within 2 weeks after the infarction), and 90% of the 30 early seizures appeared within 24 hours after the infarction. Seventy-three percent of the 90 seizures occurred within the first year, and only 2% occurred greater than 2 years after the infarction. Fifty-six percent of the 90 seizures were single, and status epilepticus was seen in only 8%. Early-onset seizures were more likely to be partial (57% of 30); late-onset seizures were more likely to be generalized (65% of 60). Thirty-nine percent of the 90 initial seizures recurred, and there was no significant difference in recurrence rate between early- or late-onset initial seizures. Twenty-two percent of the 90 initial seizures became multiple recurrent seizures, and we could identify a precipitating factor in 86% of the 35 recurrent seizures. The most common electroencephalographic abnormality in the 61 patients so examined was focal slowing (61%), but recurrent seizures occurred in 100% of the four patients with periodic lateralized epileptiform discharges and in 75% of the eight patients with diffuse slowing. Computed tomography in 61 patients showed that large infarctions were associated with early (p less than 0.021) and multiple (p less than 0.05) seizures. Deep infarctions on computed tomograms (cortical infarctions extending to subcortical structures) tended to cause recurrent seizures (p less than 0.057). Seizures in 88% of the 90 patients could be managed with monotherapy.

Adult↗
PubMed1988

Desensitization of the insulin receptor by antireceptor antibodies in vivo is blocked by treatment of mice with beta-adrenergic agonists.

In previous studies we reported that immunization of mice with ungulate insulins induced the development of antiinsulin antibodies, which include an idiotype that appeared to recognize the part of the insulin molecule recognized by the hormone receptor. The antiinsulin antibodies of this idiotype were replaced spontaneously by antiidiotypic antibodies. The antiidiotypic antibodies, which persisted for about 14 d, mimicked insulin and functioned as antibodies to the insulin receptor. They induced down regulation, desensitization and refractoriness of the insulin receptor and disturbances in glucose homeostasis in vivo (Shechter, Y., D. Elias, R. Maron, and I.R. Cohen., 1984; Elias, D., R. Maron, I.R. Cohen, and Y. Shechter. 1984, J. Biol. Chem. 259: 6411-6419). We now report that effects of the antiidiotypic antibodies on the insulin receptor effector system can be modified pharmacologically. Administration of the beta-adrenergic agonist isoproterenol during the period of insulin resistance (days 26-40 after primary immunization), largely restored fat cell responsiveness to insulin, and eliminated the appearance of fasting hyperglycemia. This restoration appeared to be caused by inhibition of both insulin receptor desensitization and refractoriness. In contrast, down regulation of insulin receptors was not reversed by isoproterenol treatment in vivo. The effects of treatment with isoproterenol persisted for 2-4 d after termination of treatment. The beta-antagonist, propranolol and more so, the beta 1a-antagonist metoprolol, specifically blocked the effect of isoproterenol at a molar ratio of 3-10:1. Oral administration of the cAMP phosphodiesterase inhibitor, aminophylline, was also effective in inhibiting the development of desensitization in fat cells. These results indicate that treatment with beta 1-adrenergic agonists in vivo, or other agents that elevate cellular cAMP levels, can inhibit the development of the "postbinding" defects induced by insulin-mimicking, antireceptor antibodies. These observations have both basic and clinical implications.

Adipose Tissue↗
PubMed1988

[Gastric adenocarcinoma surgically treated. A multivariate analysis of prognostic factors].

One hundred and twelve curatively resected gastric adenocarcinomas were studied retrospectively to appreciate the survival factors. Twenty different criteria (clinic, histologic and therapeutic parameters) were assessed using univariate and then multivariate analysis (semi parametric regression (COX's) model). Only three criteria were very important according to the multivariate analysis: 1) invasion of neighboring organs (p less than 0.006) with a relative risk score (RRS) of 4.26; 2) intravascular or intralymphatic tumor embols outside the tumor (p less than 0.004; RRS = 2.11); 3) invaded distal nodes (located at the origin of the vessels (p less than 0.04; RRS = 1.88). A prognosis index was described according to these results. A repartition of the patients in three prognostic groups according to these 3 criteria was proposed. Future, trials should consider these three different prognostic groups.

Adenocarcinoma↗
PubMed1988

[Epidermoid cancers of the esophagus: combined chemotherapy, surgery and radiotherapy. Preliminary results in 50 cases].

Fifty operable epidermoid esophageal carcinomas were treated by combined chemotherapy, surgery and radiotherapy. The post-operative mortality was 5.4% and the severe post-operative morbidity was 29%. The vindesine-5FU-platinum association and the vindesine-endoxan-platinum association gave respectively 55% and 35% objective responses (OR) after two preoperative courses without increasing the operative mortality. The patients who showed an OR had a less important tumoral extension. Thus, an objective response to the pre-operative chemotherapy is in fact a new prognostic factor. Survival without recurrence seems to be increased when chemotherapy is efficient in the curative resection group. These findings incite to promote prospective randomized studies with this kind of combined therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Antibodies to insulin receptor followed by anti-idiotype. Antibodies to insulin in child with hypoglycemia.

A child presenting severe hypoglycemia despite low or normal secretion of insulin was found to have IgM antibodies to the insulin receptor. These antibodies stimulated lipogenesis in fat cells in vitro and competed with insulin for binding to insulin receptors. After treatment with glucocorticoids, the anti-receptor antibodies and the hypoglycemia both disappeared, and antibodies to insulin appeared in the patient's serum. The anti-insulin antibodies were isolated by affinity chromatography and were found to inhibit the anti-insulin-receptor antibodies that were present earlier. The interaction between the patient's anti-insulin antibodies and his anti-receptor antibodies suggests that these two species of antibodies are related as idiotypes and anti-idiotypes. We also studied the interaction of the hypoglycemic patient's anti-receptor antibodies with anti-insulin antibodies of a diabetic patient and with anti-insulin antibodies of mice immunized to insulin. The hypoglycemic patient's anti-receptor antibodies were neutralized by the diabetic patient's anti-insulin antibodies, indicating that anti-insulin antibodies with a common idiotype may arise in both diabetes and hypoglycemia. Moreover, mouse anti-insulin antibodies that interacted with mouse anti-receptor antibodies neutralized the hypoglycemic patient's anti-receptor antibodies. In contrast, mouse anti-insulin antibodies that did not interact with the mouse anti-receptor antibodies did not neutralize the hypoglycemic patient's anti-receptor antibodies. Thus, the human anti-insulin antibodies share an idiotype with a specific class of mouse anti-insulin antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

[Locoregional chemotherapy of hepatic metastases of colorectal cancer].

Locoregional, intra-arterial chemotherapy of liver metastases secondary to colo-rectal cancers is the least damaging among non-surgical treatments. In our experience of 58 cases treated during three years either with intermittent perfusions of 5 FU, or with continuous perfusion of FUDR (by pump), we observed 52% and 53% of objective responses with a survival rate at one year, of 73% and 90% respectively. However, this technique is limited because of locoregional complications and less effective, due to the development of extra-hepatic metastases. The proof of its effectiveness, in terms of survival, is currently being studied in the scope of a prospective and randomized trial with control group.

Adenocarcinoma↗
PubMed1987

Early adjuvant intraportal chemotherapy after curative hepatectomy for colorectal liver metastases--a pilot study.

A preliminary study was conducted with early and continuous intraportal adjuvant chemotherapy (IPAC) after a curative hepatectomy for colorectal metastases. The IPAC consisted of 14 days of 5-FU infusion at the rate of 600 mg/m2/d. The ultimate aim of this study was to reduce the frequency of recurrences in the remaining liver after curative hepatectomy. Twelve patients were included. IPAC was initiated in nine of them, while three technical failures occurred. The 14-day course with continuous 5-FU was given five times. The treatment had to be ceased prematurely because one medical and three mechanical complications occurred during the infusion. Pains and vomiting were frequent, but were usually the result of mechanical complications. No important hepatotoxicity or haematological toxicity was observed. This study shows that a full course of chemotherapy could be administered in only 40% of the patients. Further pilot studies with the aim of improving feasibility should be undertaken. If the mechanical problems are improved and IPAC duration is reduced, then feasibility should be dramatically increased. Subsequently, only a prospective randomized study would confirm the efficiency of the method in minimizing liver recurrence.

Adenocarcinoma↗