PubMed Health⌕ Search

Biomedical subjects

E Raymond

Publications and source records attributed to E Raymond.

108 records · Page 6Linked to original sources
PubMed1995

Epstein-Barr virus-related localized hepatic lymphoproliferative disorders after liver transplantation.

BACKGROUND: Localized hepatic post-transplant lymphoproliferative disease is uncommon. In such cases, lymphocyte Epstein-Barr virus (EBV) infection may promote an intrahepatic B-lymphocyte monoclonal expansion. METHODS: From 1990 to 1991, 149 patients underwent liver transplantation for various liver failures. Immunosuppressive therapy was azathioprine, cyclosporine-A, and methylprednisolone. Rejection episodes were treated by methylprednisolone bolus injection with or without OKT3 therapy. Three patients (2%), aged 38, 50, and 47 years, developed lymphoproliferative disease localized in the transplanted livers within 5 months of liver transplantation (a patient had been immunosuppressed for 3 years before the lymphoproliferative disease occurred within the third allografted liver). Diagnoses were obtained by fine needle aspiration. In situ hybridizations were performed with the kappa/lambda mRNA-kit FITC DAKO (DAKO Corporation, Carpenteria, CA) and the early mRNA-EBER oligonucleotide FITC DAKO: RESULTS: Lymphoproliferative diseases were all classified as diffuse polymorphic large cell lymphomas in the working formulation and considered as lymphoproliferative disorders with polymorphic large cells in the Frizzera classification. All large cells were CD20-positive, CD45-positive and CD45RO-negative. In situ mRNA light chain hybridization demonstrated monoclonality in two cases. In all three cases, EBV mRNA was detected in large cells by early mRNA-EBV (EBER) in situ hybridization. Patients were treated with doxorubicin, cyclophosphamide, vincristine, and VM26. Two patients maintained a complete remission 3 years after six cycles of chemotherapy, whereas one died of an early opportunistic infection. CONCLUSION: Epstein-Barr virus may play a special role in the pathogenesis of lymphoproliferative disorders that develop in patients who have undergone liver transplantation.

Adult↗
PubMed1995

[Extravasation of paclitaxel (Taxol)].

Paclitaxel is a new antimitotic derived from yew-tree, used for the treatment of ovarian and breast cancers. The local toxicity of paclitaxel is still poorly known. We report one of the first observations of accidental subcutaneous extravastion of paclitaxel. Local epidermic necrosis was observed and evolution was good with local treatment only. Treatments of such extravasation are discussed.

Aged↗
PubMed1994

[Adamantinoma of the proximal end of the tibia. A case].

Adamantinoma is a rare primary tumour of long bones containing mesenchymatous and epithelial cells. There has been some controversy over the pathogenesis. We observed a localization in the right tibia. A 22-year-old patient from Algeria was seen for spontaneous progressively increasing pain in the upper part of the right tibia. The patient's general health had deteriorated somewhat, with fever. On examination there was ulceration of the skin, costal and pelvic pain and inflammatory right inguinal lymph nodes. Radiography revealed lateral metaphyseal lytic image with interruption of the cortex also seen on magnetic resonance imaging which revealed invasion of the soft tissue and multiple bilateral pulmonary nodules. Bone scintigraphy showed several zones of hyperfixation. The diagnosis of adamantinoma was confirmed by pathology examination of the biopsy specimen. On surgical exeresis, the capsule of the knee joint was found to be involved without invasion of the knee joint. Node dissection showed inguinal and popliteal invasion. Macroscopically, the surgical specimen was a red-whitish osteolytic tumour. Microscopically, the tumour was composed of hyperchromatic epithelial cells in an abondant fibrous stroma. Immunohistochemical studies were negative for vimentine, cytokeratin and factor VIII. Adjuvant chemotherapy was based on a sarcoma protocol. Unfortunately, after two cycles, white cell counts fell sharply and multiple skin nodules appeared together with progression of the bone metastases. The chemotherapy was modified without any therapeutic effect and the patient died in February 1993. An epithelial origin would appear most probable, but at least two groups of adamantinoma can be described: one with typical epithelial differenciation and one overlapping to the differential diagnosis of osteofibrous dysplasia. Although considered as a low grade malignant tumour, we emphasize the aggressive forms with local relapse or metastatic resistance to chemotherapy. Treatment relies on wide surgery and prognosis is generally good. Neither chemotherapy nor radiotherapy has stood the test of time in cases with metastasis.

Adult↗
PubMed1994

[Metastatic eye neoplasms. Review of the literature apropos of 4 cases].

Malignant disease metastatic to the eye is a common entity afflicting hundred patients each year. Breast carcinoma is the most common carcinoma responsible for ocular metastases with an estimated range probably closer to 30% and prevalence of 11.000 women by year in United-States. Breast carcinoma is followed by lung cancer and adenocarcinoma of an unknown primary. The diagnosis should be suspected in patient with history of carcinoma and a decreased visual acuity or any other visual symptom. The most useful diagnostic techniques include direct ophthalmoscopy, ultrasonography, computed tomography and magnetic resonance imaging. The cornerstone of treatment of ocular metastases remains radiation therapy. The overall response rates of earlier diagnosis, according to measurement of visual acuity, may be ranged from 72 to 94%. Early diagnosis and treatment of those lesions are a primary concern to maximize the quality of life until death of patients with metastatic disease. We report four cases of women with breast cancer metastatic to the eye.

Breast Neoplasms↗
PubMed1993

Germinal center analysis with the tools of mathematical morphology on graphs.

Only few studies devoted to quantitative analysis of tissue architecture have been performed. The analysis of neighborhood relationships between cells, using graphs and mathematical morphology (MM), constitutes one approach. We propose to analyse quantitatively the architecture of a tissue with the tools of MM on graphs. The use of graphs seems best suited to take into account the neighborhood relationships between cells, independently from their mutual distances: two cells are considered as neighbors if no interfering cell is placed in a given sense between them. Such neighboring cells are linked by an arc in a graph. On such a graph, all tools of MM may be applied. We investigate two of them in the present work: (1) the distance transforms permits to analyse the repartition of a cellular population A relative to population B, (2) the size distribution permits to analyse the tendancy of a cell population to form clusters. We have applied this method using Gabriel's graph, derived from the Voronoï diagram, to determine the "zone of influence" of a cell. We have analysed the neighborhood relationships between cells in germinal centers (GC) from lymph nodes. Twelve hyperplastic GCs from follicular hyperplasia (FH) and 5 neoplastic GCs from small cleaved cell follicular lymphoma (++SCCFL) have been studied; 2 microns hematoxylin-eosin plastic embedded sections have been analysed. Cell nuclei have been identified manually by the observer by giving a numerical and image color code. Gabriel's graphs have been constructed with all centrofollicular cells. Subgraphs with only lymphoid cells, large cells or small cleaved cells have also been studied. The application of MM transformations on the graphs using software package Morphograph has allowed a quantitative description of cell distribution in the tissue. The distances of centrofollicular lymphoid cells from the periphery of the GCs (mantle zone), from nonlymphoid cells as macrophages located within the GCs and between large lymphoid cells and small lymphoid cells have been determined in FH and SCCFL. Using iterative closings and openings, we have detected aggregates of small and large cells and characterized their size and distribution in the GCs. The application of this method on lymph node biopsy has allowed a quantitative description and comparison of GCs in different pathological conditions.

Biopsy↗
PubMed1993

[Cancer of the kidney: changes in blood lymphocyte subsets induced by treatment with interferon alpha-2b and interleukin-2r].

Twenty patients (6 females and 14 males), age range 36-70 years-old, with metastatic renal cell carcinoma (MRCC), received interferon alpha-2b (IFN-A) 10 x 10(6) units/day IM for 5 days followed by continuous i.v. infusion of interleukin-2 (IL-2) 18 x 10(6) units/day for 5 days. The median follow-up was 10 months. We observed four partial responses (20%), 13 stable (65%) and three progressive diseases (15%). The mean CD4/CD8 ratio, obtained before therapy in patients with MRCC, was compared with CD4/CD8 ratio in 51 patients with different advanced malignancy and in patients with no cancer. The CD4/CD8 ratio was higher in patients with MRCC (2.55) than in other cancers (1.474) and than in populations with no cancer (1.66 x chi 2 = 17,378). The surface phenotypes of peripheral lymphocytes were analysed by cytofluorometry in patients with MRCC during and after treatment with IFN-A and IL-2. Immune modulatory effects of therapy immediately induced a decrease of different sub-populations of lymphocytes except CD25+. Far from the first course, a rise in lymphocyte count was observed. The proliferation effect was as follows: CD4+, CD8+, CD4+ CD45RA- and CD16+ CD8- cells. Far from the second and 3rd course, the sub-populations of lymphocytes decreased, except the CD4+ and CD4- CD45RA+ cells. The CD4/CD8 ratio increased progressively during treatment. Before each course, the CD4/CD8 ratio of patients with response to treatment was higher than the CD4/CD8 ratio of patients with no response. Results were non-significant due to the small number of subjects with responses in this study.

Adult↗
PubMed1991

[Interferon and interleukin 2 in metastatic cancer of the kidney. Apropos of 18 cases].

Eighteen patients with advanced renal cancer received a combination of IFN alpha 10 x 10(6) U/m2/Day (D) x 5D followed by Interleukin 2 (IL2) 18 x 10(6) UI/m2/D x 5 D. The median follow-up is 10 months. Four partial responses were observed lasting 7 to 13 months (22.2%). The clinical safety was satisfactory. The survival for responding patients is 12 months (median). The safety of treatment is an argument in favour of future trials in an attempt to demonstrate the benefit of combinations of biomodulators.

Adenocarcinoma↗
PubMed1990

Efficacy of the metastatic survey in the staging of gestational trophoblastic disease.

Between 1965 and 1987, 190 patients with nonmetastatic and 134 patients with metastatic gestational trophoblastic disease (GTD) underwent initial metastatic survey at the Southeastern Regional Trophoblastic Disease Center (Durham, NC). These patients were evaluated for characteristics which might predict the presence of high-risk metastases before a full radiographic survey was obtained. Minimal staging evaluation of all patients included history and examination, quantitative HCG level by beta-subunit radioimmunoassay, chest radiograph, and evaluation for brain and liver metastases with radionuclide or computed tomography (CT) scans. Seventeen patients had high-risk sites of metastases (i.e., those outside lungs, vagina, or pelvis). Characteristics were identified which might predict high-risk metastases: (1) all had metastases in lungs or vagina; (2) 13 of 17 (76%) had at least one other high risk factor (i.e., beta-HCG titer greater than 40,000 mIU/ml, greater than 4 months since onset of symptoms or antecedent term pregnancy; and (3) 15 of 17 (88%) had obvious symptoms or signs related to high-risk metastasis. The authors then evaluated these criteria to identify high-risk metastasis: (1) asymptomatic patients with GTD are screened for therapy with history and physical examination, HCG level, and chest radiograph or CT of the lungs; and (2) further radiographic imaging is used only for patients with signs or symptoms of high-risk metastases, identifiable lung or pelvic metastases, or other high-risk clinical factors. Using this criteria, patients with high-risk metastases were identified with sensitivity of 100% and specificity of 63%. Approximately 60% of patients did not require further radiographic evaluation.

Angiography↗
PubMedDate not supplied

Endoscopy teaching in Canada: a survey of obstetrics and gynecology program directors and graduating residents.

OBJECTIVE: To examine the current state of basic and advanced gynecologic endoscopy teaching in Canadian Obstetrics and Gynecology (Ob/Gyn) residency programs. METHODS: On Institutional Research Board approval, 2 pretested anonymous questionnaires were developed: one distributed to all Canadian Ob/Gyn program directors and a second to graduating residents (Canadian Task Force classification III). Two mailings were sent to maximize response, and some department chairs received personal telephone calls by the senior author to encourage participation. Residents on maternity leave were excluded from the study. RESULTS: Fifteen of 16 (94%) program directors, and 47 of 62 (76%) residents participated. Directors expect all residents to be knowledgeable and competent performing basic endoscopic procedures on graduation. However, considerable variation exists among programs that teach advanced endoscopy. Some of the more important factors limiting integration of advanced endoscopic teaching include paucity of trained faculty, lack of attending interest, scarcity of operating time, and financial constraints. Most graduating residents consider undertaking additional gynecologic endoscopy fellowships. CONCLUSION: Most Ob/Gyn program directors and graduating residents consider endoscopic surgery essential to contemporary practice. There is consensus to improve resident teaching in gynecologic endoscopy and commitment to better prepare future practitioners to ensure patient safety. Paucity of trained faculty and fiscal constraints appear to be important limiting factors.

Canada↗
PubMedDate not supplied

To whom do inner-city minors talk about their pregnancies? Adolescents' communication with parents and parent surrogates.

A study of 334 black, urban teenagers who sought pregnancy tests in two Baltimore clinics in 1985-1986 explored communication between the teenagers and their parents or parent surrogates before the pregnancy test visit and, among those whose test results were positive, before the final pregnancy outcome decision. Of these young women, 66% had discussed the possibility that they were pregnant with a parent (usually the mother) or parent surrogate before the test; an additional 6% had turned to another adult. At a follow-up interview a year later, 91% of those whose test results had been positive reported that they had consulted a parent or parent surrogate before deciding what to do about the pregnancy, and 4% had confided in another adult. The probability that an adolescent would consult a parent before deciding what to do about her pregnancy was higher if she was younger, if she lived with the parent and if she found the parent easy to talk to. A year after the pregnancy test, 88% of the adolescents who had given birth or had had an abortion were satisfied with their pregnancy outcome. Satisfaction was not related to whether the young woman had discussed her decision with a parent. Dissatisfaction was most likely if the parent did not support the final outcome, if someone other than the young woman had made the final decision, or if the final outcome was different from the adolescent's preference at the time of the pregnancy test.

Abortion, Legal↗
PubMedDate not supplied

[Tumor angiogenesis inhibitors: media and scientific aspects].

Work begun more than 30 years ago at Children's Hospital in Boston led to the publication of an article on the antiangiogenic properties of two compounds, endostatin and angiostatin (J. Folkman, Nature 1997; 390:404-7). It only took weeks for the medias in the US and then in France and the rest of Europe to stimulate the fervor of patients for this new 'cure' for cancer. Insight into the fundamental role of angiogenesis in locoregional and metastatic development of cancer has been accumulated over the last decades. Factors stimulating tumoral angiogenesis include aFGF, bFGF, VEGF, angiogenin, and other more recently discovered substances. Likewise, factors inhibiting tumoral angiogenesis, including angiostatin, have been identified. Angiostatin is a specific inhibitor of endothelial cell growth that migh appear rapidly in the serum of patients with a primary tumor. Angiostatin could have both local and systemic effects and possibly protect against metastatic dissemination in vivo. The importance of angiogenesis inhibitors was emphasized at the recent meeting of the American Association for Cancer Research (New Orleans March 28-April 1, 1998). To date, at least eleven compounds are being tested. Currently, most are in phase 1 or 2; for the few in phase 3, marketing approval will undoubtedly require several years. It is interesting to note that neither endostatin nor angiostatin are among the list of drugs under clinical assessment, first because these small human proteins are not available in sufficient quantity for therapeutic trials and secondly, because the processes necessary to produce pure and safe compounds remain to be developed. Even after these steps have been accomplished, preclinical evaluations will have to be performed before the first clinical trials could be envisaged. For the time being, antiangiogenesis remains a promising avenue of anti-cancer research but neither endostatin nor angiostatin will be available for human research for several months at least.

Angiostatins↗