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Biomedical subjects

B Epstein

Publications and source records attributed to B Epstein.

At least 19 recordsLinked to original sources
PubMed1991

Multimodality cisplatin treatment in nonresectable alpha-fetoprotein-positive hepatoma.

Twenty-eight patients with alpha-fetoprotein-positive (AFP+) nonresectable hepatoma have been enrolled in a new multimodality Phase I, II program. Induction therapy consisted of 50 mg/m2 intravenous cisplatin followed by 2100 cGy irradiation to the tumor volume in seven fractions over 10 days. Hepatic arterial infusion of 50 mg/m2 cisplatin (IA-CDDP) was then administered at monthly intervals. Twenty-one patients have completed induction and at least two cycles of IA-CDDP. Twelve-month cumulative survival was 52% for all 28 patients and 69% for the 21 patients completing induction and IA-CDDP. Median survival has not yet been reached. Response rate (complete and partial) was 36% overall and 48% among the 21 patients who completed treatment. The improved survival of the present series of patients as well as the minimal hematologic toxicity suggests possible further integration of new modalities for therapy.

Adult↗
PubMed1991

Second neoplasms in patients with carcinomas of the vocal cord: incidence and implications for survival.

A retrospective analysis was performed for 218 patients who were managed for carcinomas of the glottic larynx from 1975 to 1988. With a median follow-up of 51 months (range: 24 to 120 months), 41 patients developed a second malignant neoplasm. Six patients had synchronous and 35 had metachronous second malignant neoplasms. The median interval between the diagnosis of glottic carcinoma and a second malignant neoplasm was 31 months. This median interval increased to 43 months when only the metachronous tumors were analyzed. The average annual risk of developing a second malignant neoplasm (SMN) in a 10-year period was 3.1%. Seventy-one percent of them occurred in the upper aerodigestive tract or lungs. When analyzed according to the initial stage of the glottic carcinoma, 23 of 145 (16%) patients with T1 or T2 glottic carcinomas developed a second malignant neoplasm, whereas 18 of 73 (25%) patients T3 or T4 lesions did so. For the T1/T2 group, the average annual risk was 2.5%, as compared to 4.8% for the T3/T4 group (p = 0.023). The development of a second malignant neoplasm adversely affected survival. The 10-year actuarial survival for these patients who did not develop a second malignant neoplasm was 45%, as compared to 19% for those who did develop a second malignant neoplasm (p = 0.008). Although second malignant neoplasms occurred in only 19% of the total patient population, their impact on the survival rate of the overall population was equal to that of glottic carcinomas. The median survival after the diagnosis of a SMN was 6 months. The high incidence of second malignant neoplasms in patients with glottic carcinomas warrants careful follow-up and clinical investigation of the use of chemopreventive agents.

Adult↗
PubMed1988

The use of radionuclide venography in the differential diagnosis of inferior vena caval obstruction.

In using radionuclide imaging of the inferior vena cava (RIVC) to investigate the prevalence of membranous obstruction of the inferior vena cava (IVC) in patients with hepatocellular carcinoma, it was necessary first to determine if this technique would distinguish membranous obstruction of the IVC both from other causes of IVC obstruction likely to be encountered in these patients and from the picture obtained with severe ascites. RIVC readily distinguished an obstructed from a normally patent IVC. However, membranous obstruction of the IVC could not in most instances be differentiated from extrinsic compression of the IVC by an enlarged tumourous liver, occlusion of the lumen of the IVC by tumour, or the effect of severe ascites. In a proportion of the patients with membranous obstruction of the IVC, flow of the radionuclide through large superficial collateral vessels was seen, enabling this diagnosis to be made with confidence. Thus, if RIVC shows the IVC to be obstructed or if severe ascites is present, contrast venography will usually be necessary to determine the nature of the obstructing lesion.

Ascites↗
PubMed1986

Small and asymptomatic hepatocellular carcinoma detected by alpha-fetoprotein screening in black hepatitis B carriers. A report of 2 cases.

Two patients in whom asymptomatic and small hepatocellular carcinomas (HCC) were detected by alpha-fetoprotein (AFP) screening are reported. Both patients were hepatitis B surface antigen-positive. In the first patient, the tumour grew slowly and was resected more than 2 years after a significant elevation in serum AFP levels had been first detected and 13 months after hepatic angiography confirmed the presence of a vascular tumour. In the second patient, a small encapsulated HCC was diagnosed by AFP screening and hepatic imaging. The clinical course in these 2 patients illustrates that small, asymptomatic and encapsulated HCCs do occur in southern African black hepatitis B carriers. Regular screening of patients at risk may be justified.

Adult↗
PubMed1984

Exclusion of the oesophagus: is this a dangerous manoeuvre?

If oesophagectomy is contra-indicated or dangerous, oesophageal bypass can restore the ability to swallow. It is not known if excluding the bypassed oesophagus by closing both ends will lead to serious complications. In this study we report on 89 patients who underwent bypass surgery for benign and malignant strictures of the oesophagus. The thoracic oesophagus was completely excluded in 51 patients and in 30 cases the bypass procedure was combined with distal oesophageal drainage. Gastro-oesophageal continuity was preserved in eight patients undergoing an extra-oesophageal colon bypass. The operative mortality was similar in the three groups. Neck abscesses, probably due to leakage from the upper end of the bypassed oesophagus, occurred in 17 per cent of patients with oesophageal exclusion and in 9 per cent of the remainder. Changes occurring in the bypassed oesophagus of 38 patients were monitored with computed axial tomography. Segmental, mucus-filled dilatations ( mucocoeles ) of the oesophagus were identified in 20 patients. In 19 patients these mucocoeles remained small and asymptomatic. One patient with achalasia developed an oesophago-airway fistula two years after operation. Provided both ends of the oesophagus are securely closed, oesophageal exclusion is not a dangerous manoeuvre in patients undergoing bypass surgery for locally invasive tumours or corrosive injuries of the oesophagus.

Adolescent↗
PubMed1984

The syndromes of pancreatic pseudocysts and fluid collections.

The clinical and radiologic spectrum of pseudocysts associated with alcohol-induced pancreatitis is wide and variable. Several illustrative cases which delineate the diversity of syndromes that occur with pseudocysts are presented. A classification is proposed to facilitate a more coherent approach to the concept of pseudocysts and is based on the clinical presentation. Thus, in acute pancreatitis duct disruption and enzyme activation may result in intrapancreatic or extrapancreatic fluid collections. In calcifying chronic pancreatitis duct obstruction may result in pseudocysts of the head, body, or tail of the pancreas, which can enlarge and penetrate into extrapancreatic sites. This subdivision will assist in elucidating the natural history of pseudocysts and pancreatic fluid collections. Furthermore, it may establish new guidelines for diagnosis and therapy.

Adult↗
PubMed1984

The spread of oesophageal cancer: an evaluation of clinical, barium and computed tomography assessments.

One hundred and three patients with proven oesophageal cancer were evaluated prospectively by clinical examination, upper gastro-intestinal barium studies and computed tomography (CT). The accuracy of each method in assessing the extent of disease was determined by correlation with findings at bronchoscopy (100 patients), thoracotomy (26 patients) and laparotomy (63 patients). The results indicated that CT will accurately demonstrate mass invasion of cancer into mediastinal structures. But the absence of fat-planes on CT is the least reliable indication of spread into peri-oesophageal soft tissues. Early mediastinal infiltration is best assessed by analysis of the oesophageal axis on barium swallow and the patient's symptoms. Computed tomography is not helpful in the diagnosis of mediastinal node metastases. Barium studies of the proximal stomach will accurately identify (and CT reliably exclude) local tumour extension into the stomach. CT can frequently fail to detect malignant abdominal lymphadenopathy in cachexic patients.

Abdominal Neoplasms↗
PubMed1984

Hypoxanthine and oxygen induced lung injury: a possible basic mechanism of tissue damage?

Lung injury was induced in young rats by a continuous infusion of hypoxanthine intravenously and breathing 100% oxygen for 48 h (group 1). Control animals were rats infused glucose and breathing 100% oxygen (group 2), rats infused hypoxanthine in room air (group 3), and untreated rats (group 4). In group 1 rats interstitial and alveolar edema was found with a tendency toward marked margination of polymorphonuclear neutrophils in small vessels (P less than 0.025 compared with group 2). The main elastase inhibitor alpha 1-antitrypsin (alpha-1-PI) was significantly elevated in group 1; 2-, 3- and 5-fold, respectively, when compared with groups 2, 3, and 4. The surfactant phospholipids from alveolar lavage were normal in all groups. The protein-rich fraction of the lavage fluid from group 1 rats inactivated, however, the surface properties of lung surfactant. Minimum surface tension in group 1 rats was 14.5 dyn/cm compared with 7.0 dyn/cm in group 2, 2.9 dyn/cm in group 3 and 3.5 dyn/cm in group 4 (P less than 0.05, group 1 and 2 versus 4). We conclude that the combination of hypoxanthine and high levels of oxygen causes lung injury, possibly via free oxygen radicals. We discuss the possibility that these findings demonstrate a basic pathogenetic mechanism for the hypoxic-hyperoxic insult and can contribute to the understanding of pathogenesis of a variety of diseases both in pediatrics and adult medicine.

Animals↗
PubMed1984

Decontamination of urinary bags for rehabilitation patients.

Patients with neurologic injuries frequently have permanent indwelling or external catheters connected to disposable urinary bags. These patients routinely disconnect the bed bag during the day and apply a leg bag which can be concealed under their clothes. In our rehabilitation unit, both bags are discarded daily. This study investigated the possibility of safely reusing bed and leg bags. The procedure involved decontamination of the bags using 180 ml of a 1% solution of sodium hypochlorite. Initially, discarded bed and leg bags were decontaminated in the lab to ensure effectiveness of the procedure. Next, 22 patients reused their bed and leg bags with daily decontamination by the rehabilitation nursing staff. These bags were reused for two to eight days. Cultures of 137 bags were obtained to evaluate the technique. All cultures were negative. Baseline urine cultures for both time periods showed no significant difference in rates of bacteriuria. The potential savings for one year on our rehabilitation unit, with an average of 12 catheterized patients, would be approximately $39,000. Although this methodology conflicts with thoughts about not reusing disposable products, we have shown that the procedure can be done safely in rehabilitation patients and it is easy and inexpensive.

Bacteriuria↗
PubMed1983

Autoradiographic study of colchicine inhibition of DNA synthesis and cell migration in hairless mouse epidermis in vivo.

In vivo effects of colchicine on mitotic counts, DNA synthesis, and cell migration time were investigated in hairless mouse epidermis. [H3]TdR was used to examine DNA synthesis and measure the transit time. We found that colchicine (at a dose of 50 micrograms/25 g body weight) caused mitotic arrest, but had no effect on the number of cells in S phase during the first 4 hr after injection. Colchicine reduced the number of cells in S phase in normal epidermis during the 16-30 hr after injection, but the effect was no longer seen at 42 hr post injection. A similar depression in S-phase cell counts appeared in UVR-stimulated hyperplastic epidermis by 48 hr after injection of colchicine. In addition, migration of [H3]TdR-labelled cells from the basal layer to the superficial layers in UVR-stimulated hyperplastic epidermis was disturbed by colchicine injection. The delay in movement was not seen during the first 24 hr, but appeared by 48 hr after injection.

Animals↗
PubMed1982

Pancreatic abscess and computed tomographic scanning.

A 42-year-old man presented with acute haemorrhagic pancreatitis. He developed all the major complications of acute pancreatitis including a pancreatic abscess which was shown to progress on serial computed tomography (CT) scans. The diagnostic value of CT in acute pancreatitis is emphasized.

Abscess↗
PubMed1978

Damage to hyphal forms of fungi by human leukocytes in vitro. A possible host defense mechanism in aspergillosis and mucormycosis.

Evidence suggests that neutrophils are important in host defenses against invasive aspergillosis and mucormycosis, although hyphae in these lesions are too large to be phagocytized. Interactions of neutrophils with hyphae of Aspergillus fumigatus and Rhizopus oryzae were studed in vitro. Light and electron microscopic observations indicated that neutrophils attached to and spread over the surfaces of hyphae, even in the absence of serum. This was followed by dramatic morphologic changes which suggested severe damage and probably death of hyphae. An assay of neutrophil-induced reduction of uptake of radioisotopes was used to quantitate damage to the fungi by neutrophils from normal subjects. Damage to hyphae was inhibited by a variety of compounds which are known to affect neutrophil surface functions, motility, and metabolism. Use of inhibitors of oxidative microbicidal mechanisms of neutrophils indicated the central importance of these mechanisms in damage to hyphae. Inhibitors of neutrophil cationic proteins altered damage only to Rhizopus. Damage to hyphae by lysozyme suggested that it may play a secondary role in the neutrophil, primarily against Aspergillus. This new nonphagocytic mechanism may play an important role in host defenses against these and other hyphal forms of fungi.

Aspergillosis↗
PubMed1977

Reactions and serologic responses after administration of inactivated monovalent influenza A/swine virus vaccines. I. Immunization of children and adults with influenza A/Shope virus vaccines.

Reactivity and immunogenicity of three inactivated, zonally purified, monovalent influenza A/swine virus vaccines were studied in children and adults. Each dose of vaccine contained either 400 chick cell-agglutinating (CCA) units/0.5 ml or 200 CCA units/0.25 ml. The vaccines contained either whole virus or ether-extracted, subunit virus with or without 1.5 mg of A1PO4/0.5 ml. Children younger than 10 years of age received a half dose. Substantial system reactions, including temperature increases of 2.2 F-4.9 F, were observed in all children who received whole-virus vaccines. In contrast, ether-extracted, subunit vaccines (with or without A1PO4) were minimally pyrogenic in 185 subjects. Two doses of subunit vaccine in subjects younger than 25 years of age were immunologically equivalent to a single dose in older subjects. We concluded that two doses of ether-extracted, subunit virus vaccine with Hsw1N1 antigen, administered at least four weeks apart, are serologically effective for immunization of seronegative subjects of any age and that this dosage regimen should be used in young children in whom whole-virus vaccines are unacceptably reactive.

Adolescent↗
PubMed1977

Reactions and serologic responses after administration of inactivated monovalent influenza A/swine virus vaccines. II. Immunization of children with influenza A/New Jersey/X-53 virus vaccines.

Reactivity and immunogenicity of two inactivated, zonally purified, ether-extracted, influenza A/New Jersey/X-53 subunit virus vaccines were studied in 103 children three to 18 years of age. Children aged nine years of younger received doses of 100 or 200 chick cell-agglutinating (CCA) units, and those older than nine years received doses of 200 or 400 CCA units. Vaccines were given intramuscularly. Two doses were given at intervals of four weeks. The vaccines were minimally pyrogenic, causing only two instances of temperatures of greater than 100.0 F. Other systemic reactions were observed infrequently. Tenderness at the site of injection occurred relatively frequently but was of no medical consequence. The geometric mean titers of homologous antibody, which ranged from 1:52 to 1:75 after administration of two doses, were statistically equivalent in all treatment groups. Titers of antibody of greater than or equal to 1:40 to the influenza A/New Jersey/8/76 virus strain were achieved by 88% of the vaccinees. We concluded that two doses of ether-extracted, subunit influenza A/New Jersey/X-53 virus vaccine were well tolerated and, when given at least four weeks apart, were serologically effective for immunization of children aged three to 18 years.

Adolescent↗