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Biomedical subjects

D Elias

Publications and source records attributed to D Elias.

At least 253 records · Page 14Linked to original sources
PubMed1983

[Locating parathyroid glands by methylene blue during thyroid surgery].

Identification of parathyroid tissue during surgery of the thyroid gland usually reduces the risk of post-operative hypoparathyroidism. The reliability of methylene blue by intravenous infusion as a means of recognizing the parathyroid glands was tested in 59 consecutive patients (including 23 with carcinoma) undergoing thyroid gland surgery. Precise localization of the glands was possible in 87%. The side-effects being mild, the authors suggest that this method should be used systematically in all cases of bilateral thyroid surgery, in cancers of the thyroid glands and in reoperations.

Humans↗
PubMed1983

Mice immunized to insulin develop antibody to the insulin receptor.

We immunized mice with insulin and found that those strains that develop insulin antibodies subsequently produce insulin-like activity in amount equivalent to 300-400 ng insulin per ml serum. The activity was due exclusively to IgG2 antibodies. Bioactivity could be blocked efficiently by insulin antibodies from guinea pigs and from mice. The active IgG2 also displaced labeled insulin from fat cells. Preliminary in vivo studies have indicated that the appearance of insulin-like antibodies in the mouse resulted in abnormal glucose homeostasis and "down regulation" of insulin receptors. These results indicate that immunization to insulin can initiate an idiotype-anti-idiotype network resulting in antibodies to the hormone receptor.

Animals↗
PubMed1983

[Cancer of the cervical esophagus. 64 cases treated by radiotherapy. Evaluation and considerations].

Radiotherapy was applied in 64 of 88 cases of cervical esophagus cancer during the period 1968 to 1980. The lesions treated were 49 epitheliomas of the esophageal opening, excluding hypopharyngeal tumors extending into the esophagus, and 15 epitheliomas of the remaining cervical segment of the esophagus. Survival did not exceed 2 years in any patient, and the reasons for these poor results are investigated. These included the particular selection of patients, the choice of radiotherapy as basic treatment, and the dosage administered. A new therapeutic approach is proposed based on pathologic findings and the various therapeutic measures available. Preoperative chemotherapy is followed by a total laryngopharyngectomy, with a total esophagectomy without opening the thorax and under certain well defined conditions. Continuity is re-established by a gastropharyngostomy, and postoperative radiotherapy is given routinely. This very heavy therapeutic approach, is appropriate for selected patients only, other cases having, unfortunately, to make do with an association of radio and chemotherapy.

Carcinoma, Squamous Cell↗
PubMed1983

[Modified duodenal diversion in the treatment of esophagitis from bile reflux complicating an upper-pole gastrectomy].

A surgical technique is described which has been adapted from the operation known as "total duodenal diversion", but which is suitable for the anatomical conditions resulting from an upper pole gastrectomy. The method was used successfully in two patients with severe esophagitis from bile reflux resistant to all medical treatment and resulting from upper pole gastrectomies.

Bile Reflux↗
PubMed1983

[Retrospective study of 88 cases of cancer of the cervical esophagus and definition of a new therapeutic approach].

Eighty-eight cases of cancers of the cervical esophagus were treated at the Institut Gustave-Roussy (France) between 1968 and 1980. They included 67 epitheliomas of the esophageal opening excluding those of the hypopharynx extending into the esophagus, and 21 epitheliomas of the actual cervical portion of the esophagus. Whenever possible, basic therapy was by radiotherapy (64 cases). There were no survivors after 2 years, possible explanations for this poor result being the selection criteria for treatment, the choice of radiotherapy as basic treatment, and the doses employed. A new therapeutic approach is suggested following a pathological study and an analysis of the different therapeutic possibilities available. Pre-operative chemotherapy is followed by total laryngopharyngectomy with total esophagectomy without opening of the thorax, performed under certain well defined conditions. Continuity is reestablished by gastropharyngostomy and postoperative radiotherapy is applied systematically. This therapeutic approach involving major surgery is applicable only for selected patients, others having to be treated by combined radiotherapy and chemotherapy alone.

Carcinoma, Squamous Cell↗
PubMed1982

Autoantibodies to insulin receptor spontaneously develop as anti-idiotypes in mice immunized with insulin.

Mice immunized with insulin developed antibodies to both insulin and the insulin receptor. The antibodies to insulin receptor displaced labeled insulin from insulin receptors and mimicked the actions of insulin in stimulating the oxidation of glucose and its incorporation into lipids, and in inhibiting lipolysis. The antibodies to insulin receptor could be blocked by or bound to the antibodies to insulin, and therefore were identified as anti-idiotypes. Thus, immunization against a hormone may activate spontaneously an idiotype-anti-idiotype network resulting in antibodies to the hormone receptor.

Animals↗
PubMedDate not supplied

[Rationale for oncological surgery in multimodal cancer treatments].

The permanent dissemination of circulating cancer cells from infiltrative cancers renders the notion of localized cancer obsolete. This raises the question of the role of treatments such as surgery which are localized in time and space. Moreover, it is now proven that surgery increases the number of circulating cancers cells and produces transient immunodepression which promotes cancer cell implantation. In addition, the healing process stimulates growth factors, which also act on tumor growth. In spite of these deleterious effects, oncological surgery remains an important tool in the anti-cancer armamentarium. Optimal cytoreductive surgery facilitates the effect of adjuvant treatments by eliminating the vascular sanctuaries present in the center of any large tumor and by its effect as a striking-force very localized in time and space. Oncological surgery must evolve as an integrative part of our improving understanding of tumor biology, taking into account recent developments in functional imaging, genomics and proteomics. Modalities and timing must be reconsidered for oncological surgery to play its proper role as one of the many components contributing to multimodal cancer treatments. New modalities will undoubtedly be necessary with the development of future technologies.

Animals↗
PubMedDate not supplied

Hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis of digestive and peritoneal origin: rationale.

Up to a few years ago peritoneal carcinomatosis was considered as an "incurable" disease. The aim of this paper is to review the surgical approach with curative intent to carcinomatosis: it consists of complete resection of macroscopic disease (R1), associated with hyperthermic intraperitoneal chemotherapy (HIPEC) to treat residual microscopic disease, and to evaluate its indications. Overall 5-year survival of patients with peritoneal carcinomatosis treated by HIPEC is similar to that of patients with hepatic metastases treated with curative intent. Those patients should no longer be considered as patients with a terminal disease but as patients with a potentially treatable localized disease.

Antineoplastic Agents↗
PubMedDate not supplied

MRI of liver metastases from colorectal cancer vs. CT during arterial portography.

A prospective study was performed to compare, with a lesion-by-lesion analysis, the sensitivities of high field strength MRI and CT during arterial portography (CTAP) in detecting hepatic metastases from colorectal cancer. Twenty-one patients with liver metastases from colorectal cancer were prospectively investigated by high field strength MRI (1.5 or 2 T) and CTAP. High field strength MRI was performed with pre and post gadopentetate dimeglumine enhanced T1-weighted SE sequences and T2-weighted SE sequences. All patients underwent partial hepatectomy and 37 metastases were surgically and pathologically proved. The metastasis detection rate (sensitivity) was 94% (35 of 37) for CTAP and 78% (29 of 37) for high field strength MRI. The 16% (95% confidence interval: 1-31%) difference in sensitivity between CTAP and high field strength MRI was statistically significant (p < 0.05, McNemar test). The use of gadopentetate dimeglumine did not improve the sensitivity of T1-weighted SE sequences. Since our study demonstrated significant difference in sensitivities between high field strength MRI and CTAP in our group of patients, we can conclude that high field strength MRI cannot replace CTAP in the preoperative evaluation of patients with liver metastases from colorectal cancer. Computed tomography during arterial portography must be considered as the preoperative gold standard.

Colonic Neoplasms↗
PubMedDate not supplied

Biliary lesions during radiofrequency ablation in liver. Study on the pig.

BACKGROUND: Radiofrequency (RF) is a method of in situ destruction of liver tumor. Biliary complications are bile ducts stenosis or biliary abcess. The aim of this work was to study consequences of liver RF on bile ducts. METHODS: A porcine model of biliary lesions was created using radiofrequency ablation liver. Twenty-two pigs were used for the study. The RF RITA 1500 generator (RITA Medical Systems, Mountain View, Calif., USA) was used for all experiments. The needle was positioned under sonographic control in liver parenchyma beside bile ducts. Two lesions were performed in left liver. Four groups of 5 pigs were treated. The pigs were sacrificed 1 or 3 weeks after the procedure. Pringle maneuver was utilized in half of the RF procedures. An ex vivo cholangiogram was obtained by direct injection into the main bile duct. Samples of RF lesions of liver parenchyma near and at a distance from the RF lesions were taken for pathological studies. RESULTS: Radiological lesions were biliary stenosis, with or without upstream bile duct dilatation, or complete interruption of the bile duct, or extravasation of the radiological contrast agent. Histological lesions of bile ducts were observed near RF lesions and at distance of the RF lesions when a Pringle maneuver was used or when the liver was removed after 3 weeks. CONCLUSIONS: RF ablation in contact of the intrahepatic bile duct induced biliary lesions. Therefore, it is required to stay away from the bile duct or to protect it when performing RF ablation.

Animals↗
PubMedDate not supplied

Treatment of liver metastases with moderate peritoneal carcinomatosis by hepatectomy and cytoreductive surgery followed by immediate post-operative intraperitoneal chemotherapy: feasibility and preliminary results.

BACKGROUND/AIMS: Peritoneal carcinomatosis (PC) discovered during hepatectomy is usually a contraindication to resection. A potentially efficient treatment of PC is the resection of the macroscopic disease and the treatment of the residual microscopic disease with immediate post-operative intraperitoneal chemotherapy (IPIC) (before the entrapment of cancer cells inside the fibrin deposit which rapidly cover the injured tissues). Feasibility and survival results of this treatment, combined with major hepatectomy, have never been evaluated. The purpose of this study is to report tolerance and preliminary results in patients with liver metastases synchronous to moderate PC, treated with hepatectomy, complete cytoreductive surgery, and IPIC. METHODOLOGY: Twelve patients with liver metastases and moderate PC from miscellaneous origins, underwent: 1) hepatectomy (9 of them were major hepatectomies); 2) complete cytoreductive surgery of the PC resecting between 20 and 150 nodules; and, 3) IPIC, for 5 days, according to histology. RESULTS: There was no mortality. Morbidity was mainly due to four transient biliary leakages (33%) and there was no systemic complication due to the chemotherapy. After a median follow-up of 14.4 months, there was no detectable recurrence of the PC. Preliminary results concerning survival are promising with 7 patients without recurrent disease. CONCLUSIONS: When a minimal or moderate PC is discovered during laparotomy for liver resection of metastases, the combination of hepatectomy with complete cytoreductive surgery of the peritoneal disease, followed with IPIC is logical and feasible. This aggressive treatment is well tolerated although the frequency of biliary leakage seems to be higher than that after standard hepatectomy. No recurrence of the peritoneal disease was detected and survival results are very promising.

Adult↗
PubMedDate not supplied

Results of lymphadenectomy for obvious lateroaortic lymph node metastases from colorectal primaries.

BACKGROUND/AIMS: To analyze the results of surgery for macroscopically or radiologically obvious (i.e., easily detectable by computed tomography scan or by palpation) synchronous or metachronous lateroaortic lymph node metastases from colorectal primaries. METHODOLOGY: Thirty-one highly selected patients who underwent a lateroaortic lymphadenectomy for obvious lateroaortic lymph node metastases from January 1989 to January 1999 were analyzed retrospectively. An associated metastatic lesion was present in 68% of the cases before or concomitantly with the lateroaortic lymph node metastases. Ten lateroaortic lymph node metastases were synchronous with the primary, and 21 were metachronous. Decision for lymphadenectomy was taken after a multidisciplinary meeting and a period of observation. Median follow-up after lymphadenectomy was 24.2 months (range: 6-120). All the patients received at least two systemic lines of chemotherapy before or after the lateroaortic lymphadenectomy. RESULTS: There was no postoperative mortality. Resection was macroscopically complete (R0-1 of UICC) in 26 cases (84%). Twenty-six (83.8%) patients developed recurrent lesions or had progressive residual disease. The most frequent first site of recurrence was intrathoracic (54.8%) for the entire series, except for the subgroup of isolated lateroaortic lymph node metastases in which recurrent lesions were mainly lateroaortic. Three-year global and disease-free survival rates were, respectively, 39% and 9.6%. No significant difference was noted in survival between lateroaortic lymph node metastases that were synchronous or metachronous with the primary. However, the most important prognostic factor was the presence of associated metastases. Indeed 3-year survival attained 30% when lateroaortic lymph node metastases were isolated but 0% when lateroaortic lymph node metastases were associated with another metastatic site (P = 0.006). CONCLUSIONS: Obvious lateroaortic lymph node metastasis is rarely isolated. However, when it is isolated, in selected cases (objective response to systemic chemotherapy, good general status), resection can be beneficial whatever its synchronous or metachronous appearance.

Adenocarcinoma↗
PubMedDate not supplied

Prognostic factors for chemoembolization in liver metastasis from endocrine tumors.

BACKGROUND/AIMS: The aims of this study were to assess response rates, evaluate side effects and determine prognostic factors for both response and toxicity in patients with liver metastasis from endocrine tumors treated with chemoembolization. METHODOLOGY: Data concerning 64 patients who underwent a total of 186 sessions of chemoembolization were retrospectively evaluated and correlated with response and toxicity after chemoembolization. RESULTS: Overall clinical, morphological and biological response rates were 93%, 74% and 52% respectively. Complete control of hormone-related symptoms was obtained in 59% of patients with a mean duration of response of 15 months. Transient major complications occurred after 5.9% of sessions and 3 patients died. In the univariate and multivariate analyses, a non-pancreatic primary and chemoembolization as first-line non-surgical treatment were prognostic factors for clinical response, and <30% of liver involvement for morphological response. A significant increase in morbidity was noted in patients with more than 70% of liver involvement. CONCLUSIONS: Hormone-related symptoms were controlled in the majority of patients with a non-pancreatic primary and in those treated with chemoembolization as first-line therapy. Morphological response and toxicity were respectively correlated with liver involvement of less than 30% and greater than 70%.

Adult↗
PubMedDate not supplied

[Control of perfusion by angioscintigraphy during hepatic intra-arterial chemotherapy].

Intra-arterial hepatic chemotherapy is effective in the treatment of liver metastases, and it has been used at the Gustave Roussy Institute since 1983. During laparotomy, arterial catheters are introduced usually into the gastroduodenal artery, and they are connected either to a subcutaneous access or to an implantable pump. Seventy-one patients with liver metastases from colorectal adenocarcinoma were examined by angioscintigraphy to evaluate the quality of liver perfusion. Our technique uses three radioactive compounds and makes it possible to obtain a standard liver scintigram with technetium 99-colloidal rhenium sulphur, a dynamic view of liver arterial perfusion by injection of pure technetium 99 pernechtate, and a static mapping of well-perfused territories after injection of technetium 99-labelled macroaggregated albumin. This technique is reliable to explain most of the problems encountered during intra-arterial hepatic chemotherapy. In our experience, the quality of perfusion was highly variable and had a prognostic value. Objective responses were more frequent in well-vascularized metastases (64 percent) than in metastases with hypoperfusion (36 percent). Survival was also better in the former case, with a median survival of 18 months as against 12 months (p = 0.028).

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Hepatectomy for hepatocarcinoma on a cirrhotic liver: decision plans and principles of perioperative resuscitation. Experience with 204 cases].

Among more than 450 hepatectomies performed in the National Cancer Center Hospital of Tokyo from the beginning of 1977 to the end of 1986, 204 were performed for excision of an hepatocarcinoma on cirrhotic liver. The post-operative mortality (determined until the exit of the patient out of the hospital) was 7.8%. It was rather high at the beginning (20% of the first 30 cases) and progressively decreased with experience, to be only 2.8% of the last 70 cases. According to this experience the authors recommend a decisional diagram which appreciate the quantity of functional liver parenchyma which must be resected (depending on the tumor's characteristics) and the quantity of functional liver parenchyma which can be resected without major operative risk (depending on the gravity of the cirrhosis). They expose their attitude with oesophageal varix, the operative techniques and the peri-operative cares they have trained to decrease dramatically the post-operative complications.

Adult↗