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Biomedical subjects

D Elias

Publications and source records attributed to D Elias.

At least 235 records · Page 13Linked to original sources
PubMed1987

A simplified surgical technical procedure for intra-arterial chemotherapy in secondary liver cancer. Experience in 50 patients.

The purpose of this study was to prove that only one intra-arterial catheter for hepatic chemotherapy can perfuse the whole liver in all anatomic cases, including cases with aberrant or accessory hepatic arteries. The ligations of various hepatic arteries induce the immediate aperture of intra hepatic arterial shunts and a total revascularization of the whole liver by the only remaining hepatic artery. Based on the experience from 50 consecutive cases of surgical implantation of intra-arterial catheters for local chemotherapy, the simplified technique is analysed principally as a function of anatomical variations of the hepatic artery. The usual procedure (catheter implanted into the gastro-duodenal artery) was performed in 58% of the cases, while in 28% of the cases this was possible only after section of a right and/or a left aberrant or accessory hepatic artery. Unusual implantations were necessary in 14% of the cases to ensure complete perfusion of liver. The evaluation was based on three criteria: intra-operative perfusion of fluorescein, post-operative scan with 99mTc macro-aggregated albumin and objective clinical responses after intra-arterial chemotherapy. The perfusion of the whole liver was good in all cases except one. Unusual procedures gave the same clinical objective responses after intra-arterial chemotherapy (61%) as usual procedures (48%) (chi-square: P = 0.40).

Adult↗
PubMed1986

[Isolated hepatic metastases. Treatment by intra-arterial chemotherapy using a subcutaneous access chamber].

Twenty eight patients with isolated liver metastases of colorectal origin have been treated with discontinuous intra-arterial chemotherapy. This treatment was performed weekly with a surgically implanted subcutaneous access chamber. In all the patients the metastases were non-resectable and involved less than 75% of the liver. The first six patients were investigated in a phase I study which demonstrated that the method was well tolerated and provided a normal life at a lower price than the totally implanted pump. A subsequent phase II study included 22 patients. After implantation, they received an 8-hour infusion of 5 Fu 1 g/m2 each day for 8 consecutive days and after discharge, a weekly 8-hour infusion of 5 Fu 1 g/m2 and mitomycin C 1.5 mg/m2 as out-patients. Twenty-one patients have now been followed up for more than 3 months and are assessable in terms of response: we observed 4/21 complete responses, 6/21 partial responses, 3/21 minor responses, 7/21 stable disease and 1/21 progression. The objective response rate was 48%. The complication rate was low (2 leukopenias and 2 duodenal ulcerations) and comfort excellent with normal life between courses. In conclusion, with discontinuous intra-arterial chemotherapy we obtained the same response rate as with the totally implanted pump, with good tolerance and quality of life and perhaps a lower rate of complication. The two methods should now be compared in a randomized trial.

Ambulatory Care↗
PubMed1986

A human monoclonal antibody to insulin.

To elucidate the immune aspects of insulin-dependent diabetes mellitus (IDDM), we attempted to generate human monoclonal anti-insulin antibodies by fusing peripheral blood lymphocytes obtained from 10 insulin-treated IDDM patients with cells from a human lymphoblastoid cell line. Hybridomas that secreted immunoglobulins appeared in 9 of 400 wells. One of these hybridomas secreted anti-insulin antibody of the IgM class. The lymphocytic partner of this hybridoma was obtained from an IDDM patient who had undetectable levels of antibodies to insulin in his serum. Thus, by employing the hybridoma technique, it was possible to reveal the presence of insulin-sensitized B-lymphocytes in a patient who was serologically negative for anti-insulin antibodies. The monoclonal antibody recognized intact human insulin and insulins of other species, but not isolated A- and B-chains. This indicates that the antibody was functionally an autoantibody directed to an epitope formed by the native conformation of a highly conserved portion of the insulin molecule. This is the first report of a human hybridoma antibody to insulin.

Animals↗
PubMed1986

[Early adjuvant intraportal chemotherapy after hepatectomy for metastases of colorectal origin].

EAIPC was tested in a preliminary study, with continuous 600 mg/m2/day 5 FU with twelve consecutive patients after curative hepatectomies for colo-rectal metastases. The aim of this study is to reduce the frequency of recurrences inside the remaining liver. The numerous reasons explaining this kind of treatment are detailed. Results about technic problems and tolerance are analysed. This work should be initiate a prospective randomized study to evaluate the efficiency of the EAIPC.

Colonic Neoplasms↗
PubMed1986

[Pelvic cancers: radioprotection of the small intestine by using a mammary prosthesis for postoperative irradiation. Apropos of 12 cases].

A preventive technique of radiation injuries to small intestines with intrapelvic mammary prosthesis is described. It has been used for twelve cases in which 9 concerned rectal adenocarcinomas (local recurrences 7 and fixated tumors 2). After this short experience, we can recommend this reliable technique without important local complication and describe the irradiation technique. The indications of this method are precised because it is finally an unfrequent therapeutic.

Adenocarcinoma↗
PubMed1985

[Prevention of radiolesions of the small intestine by intrapelvic silicone breast prosthesis].

In a patient with non resectable pelvi-perineal recurrence of epidermoid carcinoma of the anus, a silicone breast prosthesis inserted into the lower pelvis made it possible to irradiate the malignant lesion without risk of radiation-induced damage to the small intestine displaced upward by the prosthesis. This unusual technique, indicated when epiplooplasty cannot be performed, has several advantages over other techniques of radioprotection of the small intestine.

Anus Neoplasms↗
PubMed1985

[Surgical treatment of severe radiation injuries of the small intestine and colon-rectum. Apropos of 85 patients surgically-treated at the Gustave-Roussy Institute].

Radiation lesions of the small intestine, colon and rectum were treated surgically in 85 patients between 1970 and 1983. These were serious complications in all cases involving the short-term vital prognosis in patients lacking signs of recurrence of cancer for which they had received radiotherapy. Immediate operative mortality was 26%. Anastomotic digestive fistulae complicated 31% of resection-anastomosis and 29% of internal bypass operations. During the next 2 years the progression of the chronic radiation lesions themselves required repeat operations due to further complications in 19% of patients, with an operative mortality of 33%. Rather than comparing efficacy of resection-anastomosis with that of internal bypass procedures they should be considered as complementary, since they have different indications. Based on the analysis of results and acquired experience, a surgical strategy is proposed for treating complicated radiation lesions of the intestines.

Adolescent↗
PubMed1985

[Surgical technics for implantation of hepatic intra-arterial catheters for local chemotherapy. Experience with 42 cases].

Based on the experience of 42 cases of surgical implantation of hepatic intra-arterial catheters (HIAC) for local chemotherapy, the techniques used are analyzed principally as a function of anatomical variations of the hepatic artery. A conventional procedure (HIAC implanted into gastroduodenal artery) was performed in 60% of cases, while in 26% of patients this was possible only after section of a right and/or left hepatic artery. Atypical implantation was necessary in 14% of cases to ensure complete perfusion of liver. The different methods employed and the reasons for their choice are discussed.

Adult↗
PubMed1985

[Combination vindesine, cyclophosphamide, cis-platinum and CCNU in esophageal epidermoid cancer. Preliminary analysis of 64 cases].

We have treated 64 patients with esophageal squamous cell carcinoma using a combination of Vindesine 1.4 mg/m2 on day 1-2, Cyclophosphamide 200 mg/m2 on day 2-3-4, Cis-Platin 100 mg/m2 on day 3 and CCNU. 28 of the 37 patients considered to be inoperable were evaluable. We observed three complete responses and three partial responses in this group (overall response rate 21,5%). Twenty seven patients considered to be operable received the same chemotherapy without CCNU, owing to the risk of thrombopenia. 23 of these patients were evaluable in whom we observed 35% partial responses and no complete responses. No severe toxicity related to the chemotherapy protocol was observed. The mediocre results among the group of inoperable patients suggest that other chemotherapy protocols need to be tested. On the other hand, in the group of operable patients, the preliminary results encourage us to continue this study.

Adult↗
PubMed1985

[Cancers of the rectum: predictive factors in locoregional recurrence. Multifactorial study].

Local recurrences (LR) after curative surgery have been analyzed in series of 173 rectal adenocarcinomas treated between 1973 and 1983. LR predictive factors were analyzed by univariate and multivariate (Cox model) studies. Five factors had no predictive value on LR: age, sex, tumor differentiation, tumor size, and number of metastatic nodes. Five factors had a predictive value on LR: severe clinical symptoms (fixation, obstruction and perforation) (p = 0.03), tumors localized within five cm of the anal verge (p less than 0.001), intramural infiltration (p = 0.09), localization of positive nodes (p = 0.02), and tumor emboli inside the vessels (p less than 0.01). The multivariate study underlined the two main predictive factors: the tumor site within 5 cm of the anal verge (p less than 0.001) and involvement of the serosa (p = 0.05). An equation of LR risk is presented and four subgroups of different LR risk patients are defined. This study might provide guidelines for indications and evaluation of major adjuvant treatments in the highest LR risk patients.

Adenocarcinoma↗
PubMed1984

Mouse antibodies to the insulin receptor developing spontaneously as anti-idiotypes. I. Characterization of the antibodies.

Mice immunized to ungulate insulins were found to develop antibodies of two specificities: insulin antibodies that were mostly IgG1 and IgG2 antibodies that acted both as anti-idiotypes to specific mouse insulin antibodies and as antibodies to the insulin receptor. There was a negative association between the presence of anti-idiotypic receptor antibodies and insulin antibodies bearing the specific idiotype; the specific idiotypic antibodies were confined to the early phase of the primary response while the anti-idiotypic receptor antibodies were detected only after the idiotypic antibodies had disappeared. To map the insulin epitope that triggered the specific idiotypic response, we chemically altered the insulin molecule so as to inhibit its interaction with the insulin receptor. The altered insulins triggered high titers of antibodies binding to antigenic determinants on native insulin, but no anti-idiotypic receptor antibodies. Thus, the epitope responsible for the specific idiotypic-anti-idiotypic network was probably the part of the insulin molecule whose conformation is recognized by the insulin receptor.

Adipose Tissue↗
PubMed1984

Mouse antibodies to the insulin receptor developing spontaneously as anti-idiotypes. II. Effects on glucose homeostasis and the insulin receptor.

Mice immunized to bovine insulin were observed to develop anti-idiotypic antibodies which behaved in in vitro assays as antibodies to the insulin receptor. The studies described here were undertaken to investigate the effects of these antibodies in vivo on the physiology of glucose homeostasis and the state of insulin receptors. Mice developing anti-idiotypic receptor antibodies manifested abnormal fasting blood glucose concentrations: a period of hypoglycemia followed by a period of hyperglycemia. Moreover, the mice were deficient in their ability to respond to a glucose load. Changes in the number and activity of insulin receptors were associated with these physiological aberrations. In an insulin binding assay, adipocytes obtained from immunized mice had only 40% of the number of insulin receptors demonstrable on the adipocytes of control mice. The lipogenic response of the affected adipocytes was also relatively insensitive to insulin, and in addition, they manifested only 70% of the maximal response to high concentrations of insulin. Thus, development of anti-idiotypic receptor antibodies appeared to be associated with insulin resistance of adipocytes and abnormal glucose homeostasis.

Adipose Tissue↗
PubMed1983

Autoantibodies to the insulin receptor in juvenile onset insulin-dependent diabetes.

Insulin-dependent diabetes mellitus (IDDM) usually begins in childhood or early adulthood, and its aetiology is thought to involve autoimmune damage to the islet cells that secrete insulin. To investigate an additional target of autoimmunity in IDDM we examined sera for antibodies to insulin receptors. Such antibodies were defined by their ability to compete with insulin for binding to insulin receptors and by their capacity to behave like insulin in activating lipogenesis in adipocytes. We now report the occurrence of anti-insulin receptor antibodies of the IgM class in the sera of 10 of 22 IDDM patients obtained before their treatment with exogenous insulin. Furthermore, two of five IDDM patients who were initially negative developed anti-insulin receptor antibodies during treatment with human or pork insulin. These findings suggest that autoimmunity to the insulin receptor may contribute to the pathophysiology of IDDM.

Autoantibodies↗