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Biomedical subjects

G Lucas

Publications and source records attributed to G Lucas.

At least 55 records · Page 3Linked to original sources
PubMed1996

Major surgery in haemophilic patients with inhibitors using recombinant factor VIIa.

In the haemophilic patient, development of antibodies that inhibit the function of the missing coagulation factor causes several delicate problems. Most importantly, antibodies will block the function of the specific coagulation factor, and often the antibody activity is so fierce that effective substitution therapy is outruled. In consequence, alternative measures must be adopted to control bleeding. Amongst those most commonly employed, like factor IX concentrates, activated prothrombin complex concentrates, and factor VIII of porcine origin, a new recombinant activated factor VII molecule has been evaluated clinically for some years with promising results. The aim of the present paper was to present a series of patients suffering from haemophilia A or B in whom inhibitors have complicated the clinical picture, and in whom a surgical procedure was indicated. As part of a compassionate use program devised by the producer of this genetically engineered factor VIIa, 12 patients underwent life-saving or essential surgery where the recombinant factor VIIa product was used to promote haemostasis in 13 surgical procedures. Due to a short in vivo half-life of activated factor VIIa, frequent administration was scheduled, injecting factor VIIa every 2-3 h for up to 2 days after which dosage intervals were prolonged. In one case, a global evaluation of the end treatment result was not reported, but in all of the other 12 cases the end result were considered excellent (n = 11) or efficient (n = 1). In none of the cases was other types of coagulation factor treatment modalities necessary. In conclusion, recombinant factor VIIa seems a tempting alternative to traditional treatment of the haemophilic patient with inhibitors, in whom surgery is called for. With other types of haemostatic agents, surgery in haemophilic inhibitor patients has only been studied rarely, and operations have generally been restricted to life-threatening situations.

Adolescent↗
PubMed1996

Testicular neoplasm presenting as a major pulmonary embolism.

OBJECTIVE: To report an unusual and life-threatening presentation of a nonseminomatous germ cell tumor of the testis. METHODS: A 35-year-old male presented with pulmonary embolism secondary to a neoplastic thrombus from a nonseminomatous germ cell tumor. Prompt management involved surgical thrombectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest, followed by orchiectomy and adjuvant chemotherapy. RESULTS: Three years later, the patient remains disease free according to physical examination, radiographic workup and serum markers. CONCLUSION: The excellent long-term outcome of this patient supports an aggressive multidisciplinary management of nonseminomatous germ cell tumors in young adults.

Adult↗
PubMed1995

Initial brachytherapy in the breast conservation approach to breast cancer.

The outcome of 100 consecutive newly diagnosed breast cancer patients treated between 1975 and 1985 within a protocol of planned segmental mastectomy and radiation therapy that included an initial brachytherapy boost is reported. Margins were not routinely inked in this study and the tumor bed was determined with the operating surgeon at the time of brachytherapy. There were 30 T1 tumors, 61 T2, and 9 T3. Segmental mastectomy was followed 2 weeks later by an interstitial implant with iridium-192 sources given as initial boost dose to the tumor bed, at the time of axillary dissection. All patients received at least 20 Gy as boost dose followed by external beam radiation to a total dose of 45-50 Gy to the breast and regional nodes delivered over a period of 4-5 weeks. With a median follow-up of 7 years a total of 3 (3%) breast recurrences were detected (1/30 in T1 tumors, 2/61 in T2 tumors). Only one of the three recurrences was at the initial tumor bed. None of the nine T3 patients included in this series recurred locally. There were 4 severe complications (2 soft tissue necroses and 2 osteonecroses) occurring in 2/30 T1 and in 2/61 T2. Cosmetic results were good to excellent in 77% of the cases and fair to poor in 23%. The actuarial local control and survival probability rate were, respectively, 95% and 85% at 5 years and 93% and 73% at 10 years. Initial brachytherapy boost to a target volume accurately determined with the operating surgeon followed by subsequent external beam radiotherapy achieved excellent local control in the breast even for lesions larger than 2 cm (70% of the reported cases).

Adult↗
PubMed1995

Laparoscopic diagnosis and treatment of Morgagni hernia.

The application of new minimally invasive techniques in the diagnosis and treatment of surgically correctable diseases continues to produce impressive results. Herniae of the Foramen of Morgagni are unusual abdominal wall defects which have historically been difficult to diagnose. Interestingly, laparoscopy was utilized for the diagnosis and repair of three such herniae during a 5-month period. All of these repairs were performed by one primary author in conjunction with co-authors. In this report we will review this rare hernia and report our technique of repair. We believe that an aggressive approach to diagnostic laparoscopy may produce cost-effective solutions to old and new intraabdominal problems.

Adult↗
PubMed1994

Auditing drug metabolism protocols, data, and reports.

A critical component of the drug discovery process is to assess the safety and metabolic disposition of a drug. This can be accomplished by evaluating drug concentration levels as part of safety assessment studies (toxicokinetics) and identifying the drug's presence in and throughout the body by conducting ADME (adsorption, distribution, metabolism, and excretion) studies. From a regulatory perspective, the major difference between these two types of evaluations is that toxicokinetic studies are under the purview of the Good Laboratory Practice (GLP) regulations (21 CFR 58) and ADME studies are not. International debate continues to resolve around the need to consider the applicability of the GLPs to ADME studies. While it is recognized that the current regulatory intent between ADME and toxicokinetic studies differs, this inspecting/auditing approach treats them generally the same. It assures management and external reviewers that data integrity measures are in place for all drug metabolism studies conducted by the facility.

Animals↗
PubMed1994

Occupational risk factors in patients with alcoholic or non-alcoholic liver disease.

The present study examines the presence of specific occupational risk factors in a group of patients suffering from alcoholic liver disease compared with a group of patients with non-alcoholic liver disease. The first group was more dependent on alcohol, with fewer social or psychological alcohol-related problems. The majority of them were employed, although more likely to be employed in traditional 'high risk' occupations. They showed lower job satisfaction, and the total sum of all previously reported occupational risk factors was highly significant. This was the first empirical evidence in support of the importance of the specific occupational risk factors previously postulated.

Adolescent↗
PubMed1993

Reduction of HIV transmission during laparoscopic procedures.

Laparoscopic surgery has recently been encouraged as an alternative to open procedures in patients infected with the human immunodeficiency virus (HIV). The laparoscopic technique reduces exposure to blood products and sharp instruments; however, it exposes the surgical team to the HIV-infected patient in a manner not encountered during open procedures. The evacuation of the pneumoperitoneum during laparoscopic procedures releases aerosolized HIV-infected blood and peritoneal fluid into the operative suite. Evacuation of the penumoperitoneum into a closed system and appropriate precautions during instrument changes will diminish the exposure of the surgical team to aerosolized HIV-infected blood and peritoneal fluid.

HIV Infections↗
PubMed1992

Alternative management of choledocholithiasis.

This paper is presented to clarify the role of ERCP in conjunction with laparoscopic cholecystectomy. As the field of surgery moves more toward less invasive procedures, our management schemata may also need revision. With the popularity of laparoscopic cholecystectomy came a large increase in the number of patients treated with cholelithiasis, and therefore an increase in patients with choledocholithiasis. The authors believe that treatment options exist to avoid open common bile duct procedure in most cases.

Adult↗
PubMed1992

[Lipomas of the mesentery in young children].

Lipomas of the small bowel and mesentery are exceedingly rare in young pediatric patients. This article reports a case which underlines the difficulty of establishing this diagnosis before exploratory laparotomy.

Child, Preschool↗
PubMed1990

Tamm Horsfall protein expression by a small renal cell carcinoma presenting with metastases.

The clinical presentation of cervical metastases in a young woman presenting with cervical lymphadenopathy is described. The clinical, histological, ultrastructural and immunological findings establishing the diagnosis of a renal primary tumour are seen. The significance of mixed tumour cell expression of antigens specific for the proximal tubule (CD10, DPP4 and aminopeptidase N) and of Tamm Horsfall protein, normally expressed on the thick ascending limb of loop of Henle and distal tubule, is discussed.

Adult↗
PubMed1989

Alcoholic housewives and role satisfaction.

Three groups of housewives adhering to strict inclusion criteria were compared along several variables. The groups were patients with non-alcoholic liver disease (N = 19), alcoholic liver disease (N = 15) and alcoholics attending a community treatment centre (N = 13). The study confirms the differences between alcoholics who develop liver disease from those who do not. There was a strong relationship between dissatisfaction with the role of housewife and severity of alcoholism.

Adolescent↗
PubMed1989

Rapid diagnosis of cytomegalovirus by indirect immunofluorescence assay with monoclonal antibody F6b in a commercially available kit.

Anti-human cytomegalovirus (CMV) monoclonal antibody (MAb) F6b produced by clone 95/12 was used for the rapid diagnosis (16 to 24 h) of CMV isolates in 308 clinical specimens and compared with classic isolation. MAb F6b gave 100% correlation with isolation. When this MAb was used for direct diagnosis with 212 urine and bronchoalveolar specimens, detection of CMV varied from 50 to 75% compared with viral isolation.

Antibodies, Monoclonal↗