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Biomedical subjects

M George

Publications and source records attributed to M George.

At least 163 records · Page 9Linked to original sources
PubMed1990

[Randomized trial of initial chemotherapy in 151 locally advanced carcinoma of the cervix (T2b-N1, T3b, MO)].

From 1982 to 1987, a randomized phase III trial was performed in order to determine the long-term effect of induction chemotherapy before standard pelvic irradiation in stage IIb-N1, III squamous cell carcinomas of the cervix. Patients were randomized to either chemotherapy and radiotherapy (C + R group) vs radiotherapy alone (R group). Radiotherapy for all patients consisted of 50 Gy in the pelvis with a boost by external irradiation or by brachytherapy (cumulative dose of 68 Gy). The chemotherapy regimen was an association of methotrexate (10 mg/m2, D2-4), chlorambucil (4 mg/m2, D1-5), vincristine (0,7 mg/m2, D1), cisplatin (80 mg/m2, D5), given every 3 wks; at least 2 courses were to be given before assessing efficacy and 2 more courses were given to patients who responded. One hundred and fifty-one patients were fully evaluable, after a mean follow-up of 38 mths (range 2-7 years), 76 in the R arm and 75 in the C + R arm. The response rate (greater than 50%) to chemotherapy was 42.5%. After completion of treatment, the complete response rate was 86.8% in the R arm and 86.3% in the C + R arm. The 3 year disease-free survival was 58.7% in the C + R group and 54.5% in the R group, and the median survival was 39.5% and 47 months respectively (NS). The survival of patients with a complete response at the end of radiotherapy was significantly better in the C + R group (when chemotherapy had been active) than in the R group (p = 0.04). Although radiotherapy was not modified whether patients had initial chemotherapy or not, tolerance was not significantly different between the 2 groups. The data collected in this study indicate that: 1) efficacy of induction chemotherapy is the only available predictive test for long-term results, 2) tolerance to treatment is crucial for optimal chemotherapy delivery, 3) higher dose intensity of chemotherapy in cervical carcinoma is associated with a better tumor reduction, and probably a better survival.

Actuarial Analysis↗
PubMed1990

[Effects of coronary insufficiency on the early and late results in patients surgically treated for aneurysm of the sub-renal abdominal aorta].

UNLABELLED: Between 1973 and 1988, 200 patients underwent repair of unruptured aortic aneurysm located distal to the renal arteries. There were 181 men (90%) and the mean age was 68.8 years. The most serious associated disease was arteriosclerotic heart disease which was present in 102 patients (51%): 48 patients had angina pectoris; 59 patients had previous myocardial infarct; 8 patients had ischemic myocardiopathy. Associated cerebrovascular disease was found in 29 patients (15%). Of these 200 patients, 36% had no symptoms relating to the aneurysm. The aneurysm was associated with iliac aneurysm (19%), iliac occlusion (14%), distant femoral occlusion (14%). In patients with history of coronary arteries disease (102), 39 (18%) had a coronary angiography prior the elective resection, 18 (9%) coronary artery bypass surgery underwent elective myocardial revascularisation prior to elective resection of their aneurysm. The treatment was by graft replacement and exclusively by graft inclusion. RESULTS: Death occurred within 30 days of treatment in 5 patients (2.5%). The first cause of early death was myocardial infarct (3). Early peripheral vascular complication occurred within 30 days in these 200 patients and were thromboembolism in 12 patients and colic ischemia in 8 patients. Of the 83 patients (1975-1983) who survived operation, follow up information regarding survival was obtained in 79 patients. The overall 5 and 8 years survival rates in percentage in the series were 69% and 50%. The survival rate was greatest in patients free of associated disease and worse in patients with myocardial infarctus. Subsequently 24 vascular operations were performed in these patients: 7 iliac aneurysms, 16 occlusive lesions and 2 false aneurysms. DISCUSSION: Young (15) and associates reported an operative mortality rate of 6.3% for elective aneurysm resection but found that 20% of the patients with pre-operative evidence of coronary artery disease had post-operative myocardial infarct of which 58% were fatal. Hertzer and colleagues (6), using routine coronary angiography prior to elective aortic reconstruction, have documented a 59% incidence of significant anatomic coronary artery disease. This incidence increased to 95% in patients with abdominal aortic aneurysm and suspected coronary artery disease. Only one patient of the 68 patients with an abdominal aortic aneurysm had normal coronary arteries in their series. Thus, considering the omnious implications of coronary artery disease in patients with abdominal aortic aneurysms, routine preoperative coronary angiography has been recommended. For Brown and coll. (1), it would appear that the risk of prophylactic coronary artery revascularisation may be greater than that for elective abdominal aortic aneurysm resection alone in the older age group. For the authors, only patients which instable angina pectoris or angina pectoris with a myocardial infarct had a coronary angiography. The coronary artery bypass is recommended for left maintrunk obstruction or diffuse multivessel coronary artery disease.

Aged↗
PubMed1989

Treatment of high-risk gestational trophoblastic disease with chemotherapy combinations containing cisplatin and etoposide.

The authors have treated 22 patients with high-risk gestational trophoblastic disease (GTD) by cisplatin-etoposide-containing combinations. Sixteen patients were treated with dactinomycin, platinum, and etoposide combination (APE regimen) and six patients had platinum and etoposide combination (PE regimen). Fourteen patients were treated for resistant or relapsing GTD after first-line therapy, and eight patients initially. All 22 patients were high risk according to the World Health Organization prognostic score values. Sustained complete remission was achieved in 19 patients (86%). All eight patients who received treatment as initial therapy were cured (100%) whereas only 11 patients were cured among the 14 patients who failed prior chemotherapy (78%). Hematologic and renal toxicities were limited and no treatment-related deaths occurred in this group of patients. Cisplatin and etoposide could be more widely used in chemotherapeutic combinations for high-risk gestational trophoblastic disease.

Adult↗
PubMed1989

Whole abdominal irradiation following chemotherapy in patients with minimal residual disease after second look surgery in ovarian carcinoma.

From January 1981 through December 1985, 65 patients with epithelial carcinoma of the ovary were treated with the following protocol: surgery, combination chemotherapy, second-look surgery documenting tumor less than or equal to 2 cm, and whole abdominal irradiation. Chemotherapy consisted of a combination of cyclophosphamide, adriamycin, and cisplatinum in 89% of the patients. The median number of cycles was eleven. Second-look surgery documented no residual tumor in 23 patients, microscopic disease in three patients, and macroscopic disease less than or equal to 2 cm in 39 patients. Whole abdominal irradiation was given with an open field technique up to 20 Gy without renal or hepatic shield. A pelvic boost of 15-30 Gy was subsequently added in 17 patients with macroscopic disease in the pelvis at the time of second-look surgery. Fifteen patients received complementary chemotherapy mostly hexamethylmelamine. All but two patients completed whole abdominal irradiation: one refused further radiotherapy after 3 Gy and one developed disease progression with bowel obstruction after 1 Gy. The median follow-up was 69 months. The 3-year and 6-year no evidence of disease survival rates were 60% (95% CI: 48-71) and 33% (95% CI: 21-46), respectively. The 3-year and 6-year recurrence rates were 33% (95% CI: 22-45) and 54% (95% CI: 40-67), respectively. The 3-year and 6-year metastasis rates were 22% (95% CI: 13-34) and 43% (95% CI: 30-58), respectively. A multivariate analysis showed that residual disease after second-look surgery was the only significant prognostic factor with a relative risk of death or local or distant failure of 4.2 (95% CI: 1.9-9.5, p less than 10(-4)). Two patients developed mean-term gastrointestinal complications (small bowel obstructions requiring surgery). Survival remains poor with high level of failure even with aggressive multimodal treatment.

Adult↗
PubMed1989

DNA repair mechanisms affecting cytotoxicity by streptozotocin in E. coli.

Mechanisms underlying cytotoxicity by the monofunctional nitrosourea streptozotocin (STZ) were evaluated in DNA repair-deficient E. coli mutants. Strains not proficient in recombinational repair which lack either RecA protein or RecBC gene products were highly sensitive to STZ. In contrast, cells that constitutively synthesize RecA protein and cannot initiate SOS repair mechanisms because of uncleavable LexA repressor (recAo98 lexA3) were resistant to this drug compared to a lexA3 strain. Further, E. coli cells lacking both 3-methyladenine DNA glycosylases I (tag) and II (alkA) also were highly sensitive to STZ. DNA synthesis was most inhibited by STZ in recA and alkA tag E. coli mutants, but was suppressed less markedly in wild-type and recBC cells. DNA degradation was most extensive in recA E. coli after STZ treatment, while comparable in recBC, alkA tag, and wild-type cells. Although increased single-stranded DNA breaks were present after STZ treatment in recA and recBC mutants compared to the wild type, no significant increase in DNA single-stranded breaks was noted in alkA tag E. coli. Further, DNA breaks in recBC cells were repaired, while those present in recA cells were not. These findings establish the critical importance of both recombinational repair and 3-methyladenine DNA glycosylase in ameliorating cytotoxic effects and DNA damage caused by STZ in E. coli.

Bacterial Proteins↗
PubMed1989

Changing trends in drug use: the second follow-up of a local heroin using community.

The first Seadown study documented the way in which police action in closing down the cohort's central point for meeting and drug distribution had effectively destroyed the long established heroin distribution network. Throughout the period of low heroin availability the social network of the cohort was preserved as members developed a whole range of alternative coping styles (displacement activities) in compensation for the enforced abstinence caused by the heroin drought. During the period of observation heroin returned to Seadown initially through a small, unstable and informal distribution co-operative and stayed in this phase until a new central meeting place had been established. Thereafter once a pyramidal distribution network developed, most cohort members were able to modify or stop their displacement activities to accommodate the re-availability of heroin.

Cohort Studies↗
PubMed1989

Open-heart surgery in a patient with a high oxygen affinity haemoglobin variant.

A man in heart failure with a high oxygen affinity haemoglobin variant (Hb Rainier) underwent a mitral commissurotomy with the aid of cardiopulmonary bypass. Pre-operatively, a total blood exchange transfusion was carried out to prevent potential hypoxic and thrombo-embolic complications. No complications occurred in the postoperative period.

Adult↗
PubMed1989

Phase II trial of mitozolomide in patients with advanced ovarian cancer. A study of the EORTC Gynecological Cancer Cooperative Group.

Twenty-seven fully evaluable patients with advanced ovarian cancer and documented disease progression despite cytotoxic treatment were treated with mitozolomide (NCS-353451) 90 mg/m2 as a 1-h infusion once every 6 weeks. None of the patients responded, one had stabilization of disease for 4 months. Haematologic toxicity was the major side effect with a nadir or white blood cell counts around day 40. Two patients died with severe leukopenia and septic shock. We conclude that mitozolomide is not active in this poor-risk group of patients.

Adult↗
PubMed1989

[Dobutamine during anesthesia of patients at risk for heart failure. A controlled prospective multicenter study of 93 surgical patients over 64 years of age].

Most anaesthetic agents cause cardiac depression possibly hazardous in the elderly, especially in presence of a poor cardiac reserve. Ninety-three patients undergoing non cardiac surgery lasting more than 90 min. were entered in a double-blind multicentre randomized trial. They were 65 year old or more and unaffected by evolutive angina pectoris. After insertion of a Swan Ganz catheter and an arterial cannula, anaesthesia was induced by thiopentone, fentanyl and 02/nitrous oxide (50%). Forty-five patients were infused dobutamine 7 micrograms.kg-1.min-1 (group D) from 10 min. after induction till the completion of surgery. Forty-eight patients received a placebo (group P). Haemodynamic parameters were recorded throughout anaesthesia and at its emergence. After induction, heart rate, pulmonary capillary wedge pressure and mean pulmonary artery pressure did not change significantly; mean arterial pressure, cardiac index, stroke index and left ventricular stroke work index decreased by 21, 33, 28 and 42% respectively (p less than 0.001); systemic and pulmonary arterial resistances increased by 12 and 37% respectively (p less than 0.001). In group P, these changes persisted throughout the procedure but, 30 min after extubation, cardiac index returned to control levels due to a 25% increase in heart rate; in this group 4 patients presented with both perioperative low cardiac output and persistent postoperative confusion. With dobutamine, haemodynamic parameters returned to preoperative values and heart rate increased by 12 b.min-1. More arrhythmias and hypertensive episodes but less hypotensions occurred in group D. Substantial haemodynamic changes occur during anaesthesia and surgery in elderly patients. Dobutamine corrects the peroperative decrease in cardiac output and blood pressure, and might prevent postoperative neurological disorders.

Aged↗
PubMed1989

The effect of hyaluronidase on akinesia during cataract surgery.

The ability of hyaluronidase to improve akinesis in retrobulbar anesthesia was evaluated in a double-masked study. Forty consecutive patients undergoing cataract surgery were anesthetized with 3 ml of a 1:1 mixture of 4.0% lidocaine and 0.75% bupivacaine solution. In a predetermined randomized fashion, 2 ml of hyaluronidase (300 USP units) were added to half of the syringes, and 2 ml of saline to the remaining half. The level of akinesia was graded in six different positions of gaze. Seventy percent of the hyaluronidase group exhibited complete akinesis, while only 40% of the control group did. The mean scores for four out of six positions of gaze were significantly higher in the hyaluronidase patients than in the control group. Similarly, the hyaluronidase subjects showed a significantly higher sum score for the six sectors than did the control subjects (p = .0001). These results show that hyaluronidase significantly enhances akinesia. It is therefore recommended that it be included in the anesthetic regimen for such surgeries.

Anesthesia, Local↗
PubMed1988

Prognostic factors in gestational trophoblastic tumors. A multivariate analysis.

One hundred sixty-two gestational trophoblastic tumors (GTT) were treated at the Institute Gustave-Roussy, Villejuif, France, from 1975 to 1985. Sustained complete remission (CR) was obtained in 146 patients (90%). All 97 patients with no histologic diagnosis of choriocarcinoma were cured, including 19 patients considered at high risk initially. Among 65 histologic chariocarcinoma patients, 16 died (CR, 75.5%) including seven initially nonmetastatic patients. Using a univariate analysis, all factors tested in the whole group of patients were more or less significant except for age and parity. However, when the same variables were tested in patients considered at high risk initially, only three factors were statistically significant. Those three factors were the only ones associated with a statistically significant higher relative death risk (RR) on multivariate analysis and are as follows: an antecedent nonmolar pregnancy (RR = 4.3; P less than 0.01); initial presentation with more than one metastatic organ (RR = 7.4; P less than 0.01); and primary resistance to single agent (RR = 18.8; P less than 0.0001) or multi-agent chemotherapy (RR = 26.1; P less than 0.0001). It seems that those three factors, together with a histologic diagnosis of choriocarcinoma, are the prognostic factors that discriminate patients with unfavorable outcomes among the high-risk group.

Choriocarcinoma↗
PubMed1988

Nutritionally variant streptococcal serotype I antigen. Characterization as a lipid-substituted poly(ribitol phosphate).

Initial characterization of the nutritionally variant streptococcal serotype I amphipathic polymer indicated an estimated m.w. of 360,000 for the aggregated form of the molecule, whereas the dissociated form had an estimated m.w. of 38,000 based on dextran m.w. standards. In addition, SDS-PAGE indicated an amphiphile with a stepladder appearance made up of several components with m.w. larger than the major electrophoresis components of LPS or lipoteichoic acid. Chemically, the serotype I amphiphile appeared to be a lipid-substituted poly(ribitol phosphate) with galactose and alanine substitution on the ribitol phosphate backbone. This report represents the first characterization of a bacterial amphiphile with a chemical composition and structure as proposed here. As is the case with other bacterial amphiphiles, the nutritionally variant streptococcal serotype I amphiphile was found both intra- and extracellularly. Finally, immunofluorescence studies demonstrated that the amphiphile was expressed on the cell surface.

Alanine↗
PubMed1988

Evolution of right ventricular performance after CABG.

34 patients scheduled for coronary artery bypass graft (CABG) surgery were studied during postoperative period. Right ventricular performance was specially performed with use of cardiac output computer REF-1 Edwards Lab., before Anaesthesia (T1) and at 6 investigation times after surgery during and after mechanical ventilation. The sixth first postoperative hours were marked by a decrease of cardiac index (2.56 +/- 0.4 to 2.41 +/- 0.41.mn-1.m2) and right Ventricular Ejection Fraction (RVEF) (0.48 +/- 0.07 to 0.37 +/- 0.09). The second period was the weaning period with a further drop of RVEF (0.43 +/- 0.1 to 0.36 +/- 0.07) without change in cardiac index (2.80 +/- 0.51.mn-1.m2, suggesting a ventricular post-operative and weaning depression, as previously described for the left ventricle. In addition, postoperative tachycardia (Heart rate = 59 +/- 9 at T1 to 95 +/- 14 at T7) may contribute to myocardial ischemia.

Aged↗
PubMed1988

Feasibility study of an alternating schedule of radiotherapy and chemotherapy in advanced uterine cervical carcinoma.

From July 1981 to April 1982, 36 patients with advanced cervical carcinoma stage III (24 patients) and stage IV (12 patients) entered a feasibility study of a radiotherapy and chemotherapy combination. The first three chemotherapy courses consisted of cis-platinum alone (50 mg/m2) and were interdigitated with radiotherapy. Six more courses composed of an association of cis-platinum (50 mg/m2) and cyclophosphamide (400 mg/m2) were given after the completion of radiotherapy. Radiotherapy was delivered in two courses of 25 Gy separated by a gap of 2 weeks. The overall 4-year survival rate was 35% (95% CI: 22%). The 4-year survival rate, cumulative loco-regional failure rate, and cumulative metastasis rate were respectively 44% (95% CI: 20%), 56% (95% CI: 21%), and 30% (95% CI: 21%) in stage III and 28% (95% CI: 27%), 83% (95% CI: 21%) and 74% (95% CI: 30%) in stage IV. The incidence of immediate and late complications was low: no patient had her radiotherapy stopped because of an intolerance and two patients had their chemotherapy stopped because of an haematological intolerance. Only one patient presented a severe late clinical complication (small bowel injury).

Adult↗