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Biomedical subjects

C Partensky

Publications and source records attributed to C Partensky.

At least 73 records · Page 4Linked to original sources

Altered homologous and heterologous gap-junctional intercellular communication in primary human liver tumors associated with aberrant protein localization but not gene mutation of connexin 32.

Gap-junctional intercellular communication (GJIC) in 20 primary human liver tumors with different degrees of malignancy has been studied at the functional and molecular levels. When GJIC capacity was determined by dye-transfer assay performed directly with freshly removed tumor tissue, significant reduction was found in all samples, regardless of their morphology. In addition, a selective lack of GJIC between tumor and surrounding non-tumorous cells was observed in some cases, probably due to the physical separation between them resulting from encapsulation of tumors. There was, however, no essential change in the level of expression of the major liver gap-junction protein, connexin (cx) 32, in liver tumors as measured by Northern and Western blot analyses. Immunohistochemical study revealed aberrant localization of cx 32 in the majority of malignant liver tumors. Instead of cytoplasmic membrane localization at intercellular contacts, cx 32 was detected mainly either intracytoplasmically or in plasma membrane free from contact with other cells. We did not detect any mutation in the coding sequence of the cx 32 gene from any of the human liver tumors we tested. Thus it is likely that the aberrant localization of cx 32 in tumor cells is due to disruption of the mechanisms for establishment of this protein into gap-junction plaques, rather than to structural abnormality of the cx 32 protein itself. Another member of the connexin family, cx 43, not detectable in non-tumorigenic hepatocytes, was expressed in several tumors, especially in invasive areas, but was detected in only a few tumor cells and was localized intracytoplasmically, suggesting that cx 43 protein is not involved in GJIC in the tumors.

Adult↗

Five-year survival after transhiatal resection of esophageal carcinoid tumor with a lymph node metastasis.

BACKGROUND: Carcinoid tumors of the esophagus are rare. Most reported cases have had a poor prognosis. The authors report the case of a 64-year-old man with a 4-cm carcinoid tumor of the lower esophagus. METHODS: Following endoscopic resection of an argyrophilic, nonargentaffin, carcinoid tumor of the lower esophagus, endosonography showed residual tumor, suggestive of a metastatic lymph node. The findings were confirmed at transhiatal esophagectomy. RESULTS: No recurrence has been observed along the current 5-year follow-up. CONCLUSIONS: Lymph node metastasis does not rule out the possibility of prolonged survival in esophageal carcinoids. Endosonography is strongly advisable for preoperative evaluation.

Carcinoid Tumor↗

Repeated hepatic resections for colorectal metastases.

Repeated hepatic resection (RHR) for recurrent colorectal metastases remains uncommon and controversial. We report our experience in order to assess the feasibility and the potential oncologic benefit of such an aggressive management. From 1981 to 1991, 13 patients underwent a RHR. The first hepatic resection had been an anatomic hepatectomy removing between two and six segments in 10 patients and a wedge resection in three. The RHR was performed after a mean delay of 16 +/- 10 months (5-35) from the first liver procedure. The RHR was an anatomic hepatectomy in eight patients (including a right hepatectomy in three) and a minor resection (tumorectomy or segmentectomy) in five. Three patients underwent a third liver resection for recurrence. There was no post-operative mortality. Eleven patients died from recurrence after a mean survival of 17 +/- 13 months from the second hepatic procedure (range: 6-47). One patient died from unrelated disease after 12 months and one was alive free of recurrence 22, 53 and 84 months after third, second and first hepatectomy respectively. The median survivals from the second and first hepatic resections were 17 and 31 months, respectively. It is concluded that in the well-trained team, RHR is feasible and safe even after major primary hepatectomy. However the oncologic benefit remains questionable.

Adult↗

[Indications for classical surgery and celiosurgery. Evaluation].

Laparoscopic cholecystectomy is a novel technique resulting from the advances achieved in video-endoscopy. In the field of uncomplicated gallstones it has in a few years thoroughly altered the surgical indications, taking preference over conventional surgery and ousting extracorporeal lithotripsy. However, the risk of complications must be kept in mind, and the utmost care must be taken in training operators and in recording all cases and their complications. Nowadays, conventional cholecystectomy remains indicated when laparoscopy is contra-indicated, notably in cases with tight peritoneal adhesions precluding laparoscopy.

Cholecystectomy↗

[Esophagectomy without thoracotomy for adenocarcinoma in Barrett's esophagus].

From April 1985 to November 1990, 12 patients with adenocarcinoma in a Barrett's esophagus, all of them men, with a median age of 62 years (range, 46 to 79 years), were operated by transhiatal esophagectomy and were submitted to a periodic follow-up. Dysphagia was the main symptom. Preoperative investigations included esogastroscopy and CT-scan of the abdomen and thorax in all patients. Esophageal endosonography was performed in the last 4 cases and MRI in one case. All patients recovered postoperatively and were discharged from hospital. The resected specimens were staged according to Rosenberg et al.'s classification: stage 1, 3 patients, stage 2, 2 patients, stage 3, 6 patients, stage 4, 1 patient. An anastomotic stricture occurred in 4 patients and was treated successfully by endoscopic dilatation. Five patients died during the follow-up period. Seven patients are alive without evidence of recurrence. Transhiatal esophagectomy appears to be the procedure of choice for adenocarcinoma arising from Barrett's esophagus.

Adenocarcinoma↗

Cancer risks related to electricity production.

The International Agency for Research on Cancer has previously evaluated the cancer risks associated with fossil fuel-based industrial processes such as coal gastification and coke production, substances and mixtures such as coal tars, coal tar pitch and mineral oils, and a number of substances emitted from fossil-fuelled plants such as benzo[a]pyrene and other polycyclic aromatic hydrocarbons, arsenic, beryllium, cadmium, chromium, nickel, lead and formaldehyde. Based on these evaluations and other evidence from the literature, the carcinogenic risks to the general population and occupational groups from the fossil fuel cycle, the nuclear fuel cycle and renewable cycles are reviewed. Cancer risks from waste disposal, accidents and misuses, and electricity distribution are also considered. No cycle appears to be totally free from cancer risk, but the quantification of the effects of such exposures (in particular of those involving potential exposure to large amounts of carcinogens, such as coal, oil and nuclear) requires the application of methods which are subject to considerable margins of error. Uncertainties due to inadequate data and unconfirmed assumptions are discussed. Cancer risks related to the operation of renewable energy sources are negligible, although there may be some risks from construction of such installations. The elements of knowledge at our disposal do not encourage any attempt toward a quantitative comparative risk assessment. However, even in the absence of an accurate quantification of risk, qualitative indication of carcinogenic hazards should lead to preventive measures.

Accidents, Occupational↗

[Hepatic resection for alveolar echinococcosis].

The authors report their experience with 20 patients who underwent liver resection for alveolar echinococcosis of the liver from June 1982 to March 1991. Resection was radical in 9 patients and non radical in 11 patients. The 9 patients treated by radical resection are alive. 8 patients are symptom-free and disease-free when one patient with a parasitic recurrence underwent another radical resection. Among the 11 patients treated by non radical resection, 4 of them died during the follow-up period, the cause of the death being related to the disease in 3 cases and non related in one case. When feasible, radical liver resection is the best form of therapy. When massive parasitic invasion precludes radical hepatectomy, non radical resection associated if necessary with percutaneous procedures should be considered before embarking on orthotopic liver transplantation.

Adult↗

[Peliosis hepatis of late onset in a patient exposed to vinyl chloride and treated for hepatic angiosarcoma].

We report the case of a 45 year old man with asymptomatic hepatic angiosarcoma after professional exposure to vinyl chloride. Diagnosis was made with annual ultrasound examination during a medical surveillance program. Two years after surgical resection and adjuvant chemotherapy, hepatic recurrence was treated with radiation therapy and chemoembolization. A complete response was observed. Peliosis hepatis, confirmed by liver biopsy, occurred secondarily. Eight years after initial diagnosis, the patient was asymptomatic without recurrence of angiosarcoma. The difficulty of diagnosis of angiosarcoma at an early stage, therapy modalities, and the relation between peliosis, fibrosis, and angiosarcoma are discussed.

Antineoplastic Combined Chemotherapy Protocols↗

Aberrant expression of gap junction gene in primary human hepatocellular carcinomas: increased expression of cardiac-type gap junction gene connexin 43.

The expression of connexin 32 (the major liver gap junction protein) and connexin 43 (the major cardiac gap junction protein) was examined in six surgically removed human hepatocellular carcinoma tissues and the surrounding nontumorous livers using specific rat connexin probes. No decrease in connexin 32 mRNA expression was found in carcinomas compared with the surrounding nontumorous tissue. Morphometrical analysis also showed that in most of the carcinomas the number of gap junction spots stained with connexin 32 antibody was not less than that in the surrounding livers. These results are in striking contrast to the significant reductions in connexin 32 mRNA and protein expression observed in rat primary liver tumors induced by chemicals. On the other hand, all of the six human hepatocellular carcinomas exhibited elevated levels of connexin 43 mRNA, which was expressed at a very low level in the surrounding nontumorous livers. These carcinomas exhibited no detectable amplification of the connexin 43 gene. The present study suggests that gap junctional intercellular communication is altered in human hepatocellular carcinomas by molecular mechanisms different from those in rat hepatocarcinogenesis.

Blotting, Northern↗

[Resection of carcinoid tumors of the small intestine is still indicated in the presence of disseminated hepatic metastases].

The authors report their experience with resection of small bowel carcinoid tumors associated with diffuse hepatic metastases. Nine patients were operated during the last ten years. A carcinoid syndrome was present biologically in every case and clinically in 8 cases. The tumor was removed in every case, either by right hemicolectomy (n = 6), or by small bowel resection (n = 3). Postoperative mortality and morbidity were nil. Adjuvant therapy included hepatic chemo-embolization and long-term therapy by a long-acting somatostatin analog. Five patients died during the period of follow-up and 4 patients were alive at the end of the study. Resection of small bowel carcinoid tumor is indicated even when the liver is involved by diffuse metastases to prevent the risk of small bowel occlusion, and to promote hepatic chemoembolization as subsequent therapy against the carcinoid syndrome and metastatic spread. Moreover, the procedure can participate in the selection of cases for orthotopic liver transplantation, when conservative therapy fails to control the carcinoid syndrome.

Aged↗

[Metastatic pancreatic endocrine tumor with elevation of alpha-fetoprotein].

Hepatoma was diagnosed in a 47 year old man presenting with multiple liver tumors and elevated alpha-fetoprotein concentration (460 micrograms/l). Liver biopsy showed a poorly differentiated carcinoma. The discovery of 2 hypervascular tumors in the splenic area at celiac arteriography led to challenge the diagnosis: ultrasound guided-aspiration biopsy showed endocrine cells at the level of the hepatic and pancreatic tumors. The diagnosis of pancreatic islet cell tumor with liver secondaries was confirmed by the pathology of the operative specimen. During the following months, alpha-fetoprotein concentration steadily increased. The patient died 5 months later from widespread metastases. At necropsy, no evidence of hepatoma was found. Immunocytochemical study with antibody raised against alpha-fetoprotein was negative both at the level of the tumoral cells and of the liver cells around the tumor. This case adds a new cause to abnormally high plasma alpha-fetoprotein. As hepatoma and endocrine tumor metastatic to the liver could be difficult to differentiate, this new cause could be clinically relevant.

Humans↗

Esophageal squamous cell carcinoma associated with gastric adenocarcinoma.

Adenocarcinoma of the stomach occurred in six of 425 consecutive patients with esophageal squamous cell cancer. In two cases, the gastric cancer, which was recognized at 17 and 29 months, respectively, after the nonsurgical treatment of the esophageal tumor, was treated by surgical resection. In three cases, the tumors which were diagnosed simultaneously, were treated by surgery (one case) resection of the gastric tumor and nonsurgical therapy for the esophageal tumor (one case), and nonsurgical therapy for both tumors (one case). In one case, a gastric cancer was resected 6 years before diagnosis of an esophageal tumor and a second cancer in the gastric stump. A nonsurgical protocol was then adopted for both tumors. The association of these two cancers raises questions concerning their epidemiology, diagnosis, prognosis, and management. There is room for nonsurgical multimodality protocols and, in association with surgery, survival was prolonged for more than 1 year in five of six patients.

Adenocarcinoma↗

Surgical treatment of endocrine tumors of the pancreas.

Surgeons have a key role in the management of most endocrine tumors of the pancreas. The objective of surgery is either curative or palliative, according to the resectability of the tumor. The preoperative management includes the assertion of the tumoral syndrome, the localization of the tumor by imaging techniques and the preparation of the patient to surgery. Emergency indications to operate have become exceptional since the temporary control of inappropriate secretions by pharmacologic agents is available. Intraoperative ultrasonography is useful both for detection of the tumors and selection of the best procedure for resection. A careful postoperative follow-up is advocated for patients with malignant tumors and MEN-1, since iterative resections can be undertaken in case of limited tumoral recurrence or liver metastases. The place of hepatic transplantation for diffuse metastases is still under evaluation.

Anesthesia↗

[Late results of Warren's distal splenorenal shunt].

To assess the long term results of the Warren distal splenorenal shunt, 53 patients suffering from chronic liver disease and managed with such a procedure from 1975 to 1981 for bleeding esophageal varices were evaluated. No rebleeding occurred after the immediate postoperative period. Five-year survival was 62 +/- 13 p. 100. No difference in survival was found between alcoholic cirrhotics and patients without any history of alcohol abuse. Of the 28 six-year survivors, 24 accepted endoscopy, which confirmed the absence of esophageal varices. Thirteen patients accepted mesenteric angiography; all had a patent shunt and significant hepatofugal collateral flow. Although reduced portal perfusion was maintained in 10 patients. Severe chronic encephalopathy occurred in 3 patients who had important hepatofugal collateral flow. At 5 years, operation resulted in a significant increase of the mean leucocyte and platelet counts in patients who had preoperative hypersplenism (p less than 0.001). In conclusion our data confirm the long term efficiency of the Warren distal splenorenal shunt in decompression of esophageal varices. Despite the development of hepatofugal collateral veins, portal perfusion is preserved in most cases, and disabling encephalopathy is rare.

Adult↗