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Biomedical subjects

E Shiloni

Publications and source records attributed to E Shiloni.

At least 55 records · Page 3Linked to original sources
PubMed1993

Subtotal colectomy with primary ileocolonic anastomosis for obstructing carcinoma of the left colon: valid option for elderly high risk patients.

During a period of 4 years, 20 patients with obstructing carcinoma of the left colon were treated by subtotal colectomy with primary ileocolonic anastomosis. Thirteen patients (65%) were 65 years of age or older. All patients presented to the emergency room with large bowel obstruction. Twelve patients (age > 65) suffered other systemic diseases (chronic obstructive pulmonary disease, ischemic heart disease, morbid obesity), placing them in a high risk category. The mortality rate was 5% (1/20), 7.6% if only high risk patients are considered. The one-stage procedure in the treatment of obstructing carcinoma of the left colon offers the patient a number of advantages over stage intervention elimination of colostomy, namely removal of occult lesions in the resected colon, shorter hospitalization and low morbidity and mortality. We found this procedure to be a valid option also in the elderly (> 65) high risk patient. Metastatic disease in our view is not a contraindication, since the elimination of colostomy will improve the quality of life of these patients.

Adult↗
PubMed1992

[CA15-3 tumor marker in early detection of breast cancer].

CA15-3 is a tumor marker associated with mammary tumors. Increased levels have been observed in patients with breast cancer, while normal low levels are usually found in women with no evidence of disease. The potential clinical uses of this marker include monitoring of patients with breast cancer, prognosis, and early detection of recurrence. Tumor markers are not usually used for diagnosis, as only in a few patients are elevated levels found. But when high levels of tumor markers are detected at an early stage, it may be of diagnostic value. In this study we describe a patient we believe to be the first in whom the CA15-3 tumor marker indicated breast cancer, while physical examination and the initial mammography were without suspicious findings. We also show sections of formalin-fixed, paraffin-embedded tissue stained by the CA15-3 indirect immunoperoxidase method.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1992

Oral changes in interleukin-2 treated patients: a preliminary report.

Immunotherapy with high doses of interleukin-2 (IL-2) in patients with metastatic cancer is accompanied by multiorgan side effects. To determine the effect of this treatment on oral tissues, 5 cancer patients receiving a course of recombinant IL-2 (rIL-2) were followed. Oral pathology and subjective oral complaints were noted. Whole saliva parameters and routine blood and urine values were recorded daily before, during and after treatment. Mucositis and diminution of salivary flow occurred in all patients. Concomitantly, salivary sodium and protein were elevated.

Adult↗
PubMed1991

Effect of TNF on triacylglycerol in cultured vascular smooth muscle cells.

Smooth muscle cells (SMC) isolated from bovine aorta or human saphenous vein were cultured and used to study the putative effect of recombinant human tumor necrosis factor (TNF) on lipid metabolism in vascular cells. Addition of TNF to the culture medium for 24-48 h resulted in an increase of [3H]oleic acid uptake and esterification into lipids. The effect could be seen already with 0.3 ng/ml and was maximal with 30 ng/ml. The effect of TNF was mainly on the incorporation of [3H]oleic acid into triacylglycerol which increased by 140% in the bovine cells. There was also a significant increase in [3H]cholesteryl ester. In the human SMC there was a 40% increase in [3H]oleic acid into total lipids, while the rise in [3H]triacylglycerol ranged between 60-90%. TNF did not modulate cellular triacyglycerol synthesis in cultured mouse peritoneal macrophages. Since TNF was shown to be synthesized and secreted not only by macrophages but also by smooth muscle cells, it could play an autocrine role in lipid metabolism during development of atherosclerotic lesions. The cellular population of the lesions, i.e., predominance of macrophages or smooth muscle cells, could determine the relative proportion of triacylglycerol accumulation.

Animals↗
PubMed1991

Sequential administration of recombinant human interleukin-2 and dacarbazine in metastatic melanoma: a multicenter phase II study.

Twenty-five assessable patients with metastatic melanoma have been entered in a multicenter phase II study of two induction cycles of human recombinant interleukin-2(IL2), 18 x 10(6) IU/m2/d continuous intravenous (IV) infusion on days 1 to 5 and days 12 to 17. Dacarbazine (DTIC), 850 mg/m2 IV bolus was given on day 26. The cycle was repeated at 5 weeks. Maintenance therapy was scheduled 3 weeks after the completion of induction treatment, consisting of IL2, 18 x 10(6) IU/m2/d for 5 days alternating with DTIC, 850 mg/m2 IV every 3 weeks, for a total of 18 weeks. Six patients responded (24%); two complete and four partial. Stable disease was seen in five patients. None of the six patients with more than two sites of metastases responded. Maximum response was observed in the first 3 months of treatment. Progression-free periods of 6 months and longer were seen in the two complete responders (8 and 17+ months), in two of the four partial responders (7 and 12+ months), and in three of the five patients with stable disease (9+, 15, and 17+ months). Toxicity included fever, skin rash, fatigue, anorexia, and diarrhea in most patients. Two patients had a weight gain of more than 10%. Eight patients needed intensive care for the observation and treatment of a myocardial injury (one patient), ventricular tachycardia (one), hypotension and oliguria (four), and sepsis (two). Sequential treatment with IL2 and DTIC appears to be effective but not clearly better than could be expected of IL2 alone.

Adult↗
PubMed1990

Lethal hypoglycemia and hypothermia induced by administration of low doses of tumor necrosis factor to adrenalectomized rats.

An increased sensitivity of adrenalectomized (Adex) rats to intravenous (IV) injection of recombinant human tumor necrosis factor (rHuTNF) was manifested by a marked increase in the rate of mortality. The rats that died exhibited severe hypoglycemia and hypothermia. Administration of 2.5 or 10 micrograms/100 g body weight (3% or 12%) of the lethal dose in sham-operated rats (90 micrograms/100 g body weight) rHuTNF caused a mortality rate of 50% or 100%, respectively, within 4 hours of its injection. Pre-administration of dexamethasone or intermittent glucose infusion protected the animals from the lethal effect of rHuTNF. Indomethacin did not change the mortality rate in rHuTNF-treated Adex rats, but prevented it in sham-operated rats. The rats that died exhibited a marked decrease in body temperature, but only Adex rats developed hypoglycemia after low doses of TNF. Pretreatment with dexamethasone prevented the hypothermia in both Adex and sham-operated rats, while indomethacin was effective only in sham-operated rats and did not prevent the hypothermia or the hypoglycemia in Adex rats. In the surviving rHuTNF-treated Adex rats, a rapid increase in body temperature occurred, blood glucose decreased to 30 mg/dL, serum insulin concentration decreased to 6 microU/mL, liver glycogen content was reduced by 98%, and a significant reduction in liver phosphoeonolpyruvate carboxykinase (PEPCK) and liver microsomal glucose-6-phosphatase activities was observed. Repeated administration of glucose IV to rHuTNF-treated Adex rats caused an increase in blood glucose and insulin concentrations, and some repletion in liver glycogen content. Injection of rHuTNF, 2.5 to 10 micrograms/100 g body weight, to sham-operated rats caused a significant but slower increase in body temperature.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Medulla↗
PubMed1990

Sequential treatment of melanoma patients who progressed on interleukin-2 and dacarbazine by alpha-interferon and dacarbazine--a preliminary report.

alpha-Interferon, 3 x 10(6) U/m2 every other day, and dacarbazine, up to 800 mg/m2 every 3 weeks, were given to nine patients with metastatic malignant melanoma who had progressed on a combination of interleukin-2 and dacarbazine. Partial response was documented in two patients for 9 and 4 months. Responsive sites were the lungs, lymph nodes, liver, and skin. Failure to respond to one biologic response modifier does not predict the response to another modifier.

Adult↗
PubMed1990

Treatment of fistulas of the biliary tract by endoscopic insertion of endoprostheses.

Five patients with fistulas of the biliary tract are reported; three had fistulas caused by operative injury and two, by accidental blunt abdominal trauma. All patients were treated successfully by endoscopic transpapillary insertion of biliary endoprostheses. The endoprostheses were removed after four to 17 weeks in all patients, and no evidence of biliary leakage was revealed by repeat cholangiograms and other clinical follow-up study. This effective, simple and safe method allows the fistula to heal and is a good alternative to surgical treatment.

Adolescent↗
PubMed1989

[Routine omentectomy during Tenckhoff catheter insertion for peritoneal dialysis].

Peritoneal dialysis is now one of the main methods of treating acute and chronic renal failure, and the number of patients treated by continuous ambulatory peritoneal dialysis (CAPD), instead of hemodialysis, is increasing. The most commonly used device for CAPD is the Tenkhoff catheter. The major complications after its insertion are infection and catheter obstruction. To reduce the incidence of obstruction and related complications, usually the result of omental occlusion of catheter ports, we performed routine omentectomy on insertion of the catheter. During 1984-1987 we inserted 56 Tenckhoff catheters for CAPD in 32 males and 20 females ranging in age from 2.5 to 83 years (mean 50.1 +/- 19.7). 32 suffered from end-stage renal disease and 20 from acute temporary renal failure. In 87% local anesthesia was used, and in the others general anesthesia. Omentectomy was performed in 81%. In only 8 patients (15%) omentectomy could not be performed, as the omentum was either too short or was adherent to the abdominal wall as a result of previous abdominal surgery. In an additional 2 patients the omentum was not resected, in 1 because of previous surgery for a perforated duodenal ulcer and in the other because the procedure was performed at the bedside. Peritonitis followed in 14 cases, but in 12 of them it completely resolved after administration of antibiotics. Over a follow-up period of 32 months there was only 1 case of catheter obstruction, significantly fewer than reported in other series. We conclude that routine omentectomy during insertion of the Tenckhoff catheter for CAPD under local anesthesia is safe and reduces the incidence of catheter obstruction during short and long term use.

Acute Kidney Injury↗
PubMed1989

Mechanism of the hypertriglyceridemia induced by tumor necrosis factor administration to rats.

4 h after intravenous injection of recombinant HuTNF-alpha to fed rats, an increase in heart, diaphragm, and plasma lipoprotein lipase activity was observed. At the same time, a 40-60% decrease in enzymic activity in epididymal fat pad and kidney and 40% decrease in hepatic lipase activity in liver had occurred. Similar results were obtained 20 h after injection of recombinant HuTNF-alpha into fasted rats. Pretreatment with Indomethacin did not affect the changes in tissue lipoprotein lipase activity observed following recombinant HuTNF-alpha administration. Serum triacylglycerol concentration increased by 2- and 6-fold; 4 and 20 h after recombinant HuTNF-alpha administration. Disappearance of 14C-labeled triacylglycerol from the circulation after injection of small chylomicrons, biosynthetically labeled in their triacylglycerol and cholesterol moieties, was lower in TNF-treated than in control rats. However, the clearance rate of triacylglycerol was the same or even higher in recombinant HuTNF-alpha treated rats (assuming that 14C-labeled chylomicron triacylglycerol represents the serum triacylglycerol pool). The livers of recombinant HuTNF-alpha-treated rats and controls contained similar amounts of 14C-labeled lipids, but less [3H]cholesterol, suggesting that in recombinant HuTNF-alpha-treated rats, the liver took up chylomicron remnant particles enriched with triacylglycerol. Separation of the d less than 1.04 g/ml fraction of serum obtained from control and recombinant HuTNF-alpha treated rats by zonal ultracentrifugation revealed that in recombinant HuTNF-alpha-treated rats the lipoprotein particles were less lipolyzed than in controls. The secretion rate of [3H]triacylglycerol into the serum was determined 90 min after injection of [3H]palmitate albumin complex and Triton WR 1339. In recombinant HuTNF-alpha-treated rats, the secretion of [3H]triacylglycerol into plasma was 48% higher than in controls. It is suggested that the increase in lipoprotein lipase activity of heart and diaphragm resulted from an indirect effect of TNF. It is concluded that the increase in serum triacylglycerol in the recombinant HuTNF-alpha-treated rats is due mainly to an increased secretion of triacylglycerol by the liver. Impaired lipolysis, probably due to a fall in hepatic lipase could also contribute to the rise in plasma triacylglycerol.

Animals↗
PubMed1989

Intra-abdominal lymphangioma.

The historical background, aetiology, clinical features, radiographic findings and treatment of abdominal lymphangiomas are reviewed. The condition may give rise to the acute surgical abdomen.

Humans↗
PubMed1989

Role of total parenteral nutrition in the treatment of Crohn's disease.

We studied 49 patients with severe nonresponsive Crohn's disease receiving 73 courses of total parenteral nutrition (TPN) for a total of 2,153 days (30 +/- 18 days/admission). Forty-five percent of all courses of TPN resulted in patients not being operated on, whereas 55 percent resulted in surgical intervention. Fifty percent of patients who did not undergo operation initially as a result of a successful course of bowel rest and TPN had surgery within 15.4 +/- 13.9 months, whereas 75 percent of patients operated on immediately after a course of TPN did not need additional surgery during a follow-up of 36.1 +/- 31.2 months. Thus, a total of 80 percent of patients underwent gastrointestinal surgery sometime during the study and follow-up periods. TPN has an important role in replenishment of nutritional deficits and perioperative nutritional support; however, from the results of the present study, it is difficult to advocate it as the sole primary therapy for Crohn's disease.

Adolescent↗
PubMed1989

Surgical morbidity in patients with systemic lupus erythematosus.

Thirty-six surgical procedures were performed on 29 patients with systemic lupus erythematosus (SLE). Nineteen cases involved active lupus at the time of surgery and 11 were performed on an emergent basis. Most patients had multiple organ involvement and were on some form of systemic therapy at the time of surgery. Thirty-seven postoperative complications were confined to 20 of these cases. Comparing this complicated group with the remaining 16 uncomplicated cases, the patients in the former group had a higher mean dose of steroid preoperatively, more organ involvement by SLE, and more frequent renal involvement; a higher percentage of the cases in this group were emergent rather than elective. The majority of factors examined failed to show predictive value in the outcome of surgery in lupus patients. We conclude that surgical complications are frequent in SLE patients and have identified four factors predictive of increased morbidity.

Adolescent↗
PubMed1989

Sequential administration of recombinant human interleukin-2 and dacarbazine in metastatic melanoma. A multicentre phase II study.

Twenty-four evaluable patients with metastatic melanoma have been entered in a multicentre Phase II study of two induction cycles of human recombinant interleukin-2 (rIL-2) 18 x 10(6) IU/m2/day continuous i.v. bolus on days 1-5 and days 12-17. Dacarbazine (DTIC) 850 mg/m2 i.v. bolus was given on day 26. The cycle was repeated at five weeks. Maintenance therapy was scheduled three weeks after the completion of the induction treatment, consisting of rIL-2 18 x 10(6) IU/m2/day for five days alternating with DTIC 850 mg/m2 i.v., every three weeks, for a total of 18 weeks. Median age was 44 years (range 23-80), and Karnofsky index was 100 (range 80-100). One patient had received prior chemotherapy with hydroxyurea and one patient had prior radiotherapy. Six patients responded (25%): two had complete responses (CR) and four had partial responses (PR). Stable disease (SD) was seen in five patients. Responses occurred in the following sites: liver 2/9 (22%), lung 3/14 (21%), skin 2/11 (18%), and lymph nodes 3/12 (25%). Duration of CR was 11+ and 13 months. PRs lasted 2, 5, 7, and 11+ months. Of note, time to progression in patients with SD was similar to that of responders: 4, 4, 11+, 11+, and 14+ months. Toxicity included fever, skin rash, fatigue, anorexia, and diarrhoea in most patients. Two patients had a weight gain of more than 10%. Hypotension requiring vasoactive agents or interruption of rIL-2 occurred in four patients, creatinine elevations WHO grade 1-2 in seven patients, and bilirubin elevations WHO grade 1-3 in six patients. One patient developed transient ventricular tachycardia. It appears that rIL-2 and DTIC in this schedule is feasible and effective, but not clearly superior to rIL-2 alone.

Adult↗