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Biomedical subjects

M Shafir

Publications and source records attributed to M Shafir.

At least 19 recordsLinked to original sources
PubMed1996

Cryoablation of unresectable malignant liver tumors.

BACKGROUND: Unresectable malignant liver tumors, particularly metastases of gastrointestinal origin, are rapidly lethal in a vast majority of patients, regardless of treatment. PATIENTS AND METHODS: We evaluated 58 patients by laparoscopy and/or laparotomy. Thirty-nine were treated with cryoablation of liver tumors using a liquid-nitrogen cryoprobe delivering a tumoricidal temperature of -196 degrees C with intraoperative ultrasound monitoring. Histologic evaluation showed that 25 patients had colorectal metastases, 3 had gastric tumors, 4 hepatocellular carcinomas, 6 carcinoids, and 1 gastrinoma. RESULTS: All patients who received complete cryoablation are alive with a mean follow-up of 14 months. Five whose treatment could not be completed died between 3 and 9 months postoperatively. Thirteen patients (28%) have recurrent disease and 20 (51%) have no evidence of disease. There were no operative mortalities. Postoperative transient elevation of liver function tests and thrombocytopenia were noted. All patients received postoperative chemotherapy. CONCLUSION: Cryoablation is an active and safe treatment for advanced liver malignancies.

Adult↗
PubMed1992

Malignant melanoma in inflammatory bowel disease.

Malignant melanoma occurred in 11 patients with inflammatory bowel disease (IBD). Six cases occurred in patients with ileocolitis, two in regional enteritis, one in granulomatous colitis, and two in patients with ulcerative colitis. The mean age at development of IBD was 24 yr, and at development of melanoma was 40 yr: the mean duration from onset of IBD to development of melanoma was thus 16 yr. All patients for whom complete information was available, except two, had received steroids and azulfidine for approximately a decade, as well as blood transfusions, usually multiple, and on repeated occasions. Six of the 11 patients had undergone one to seven prior operations (mean 3.5). All patients had wide radical excision of the melanoma, with or without concomitant or subsequent nodal dissection. Two patients (ages 25 and 36 yr) died rapidly from widely disseminated malignant melanoma. These cases may be coincidental, or else there may be an association between IBD and melanoma, related to immunosuppression either from the disease itself, from the medical and surgical therapy, and/or from x-ray exposure.

Adolescent↗
PubMed1987

Exclusion of small bowel from pelvis for postoperative radiotherapy for rectal cancer.

The pelvis is the preferential site of disease when recurrence occurs after curative resection of rectal cancer. Postoperative adjuvant radiotherapy decreases local recurrence rates for Dukes stages B and C; however, after abdominoperineal or anterior resections, the small bowel descends into the lower pelvis, and, due to its low tolerance to radiation, optimal doses cannot be safely delivered unless the small bowel can be excluded from the pelvis. This can be achieved by cystopexy and/or by creating a pelvic sling with a knitted polypropylene mesh. Three cases are presented in which radiotherapy was satisfactorily delivered with these techniques.

Aged↗
PubMed1987

Circulating immune complexes in cancer patients.

Circulating Immune Complexes (CIC) have been described in malignant diseases. To elucidate their potential clinical significance, CIC of seventy-eight patients with cancer and of seventy-one normal individuals were studied. Total protein and immunoglobulin composition of CIC were quantitatively measured. Patients sera had consistently higher titers of CIC than normal individuals. Sodium Dodecyl Sulfate/Polyacrylamide Gel Electrophoresis (SDS/PAGE) showed subtle differences in the CIC protein composition between patients and normal individuals.

Adult↗
PubMed1986

Immunoglobulins (Ig) in circulating immune complexes (CIC) in cancer and inflammatory bowel disease (IBD).

Chronically inflamed tissues and most malignancies have antigenic properties. Patients with long-standing inflammatory bowel disease (IBD) are prone to development of colorectal cancer, which is known to shed antigens in the bloodstream. In an effort to study immunological aspects of these diseases, sera from patients with IBD and colorectal cancer were evaluated for presence of circulating antigen-antibody immune complexes (CIC), and compared to normal controls. CIC were precipitated by polyethylene glycol (PEG) and found to be elevated in all diseased groups. Dissociation of CIC and quantification of their antibody component revealed significant elevation of each immunoglobulin in IBD and in patients with colorectal cancer versus control: IgG = 1.776 +/- 1.573 vs 0.734 +/- 0.618 (P less than 0.001); IgA = 0.368 +/- 0.452 vs 0.090 +/- 0.198 (P less than 0.001); IgM = 0.434 +/- 0.235 vs 0.080 +/- 0.285 (P less than 0.001) serum total Ig levels were consistently much higher than CIC Ig. No correlation was found between the individual serum Ig components and the precipitable complexes-bound Ig, suggesting a selective recognition of antigenic components in the CIC, rather than non-specific association and subsequent precipitation of serum Ig. CIC may represent an easily accessible source of immunological determinants for the study of malignant and chronic inflammatory diseases.

Adolescent↗
PubMed1985

Radical retroperitoneal tumor surgery with resection of the psoas major muscle.

Three patients with extensive retroperitoneal cancer are presented, in whom the psoas muscle was resected as part of a radical tumor excision. The resection of the psoas muscle, including the femoral nerve, which travels in its substance, and the genitofemoral and ilioinguinal nerves, caused little morbidity (denervation weakness of the quadriceps and anterior high numbness) and improved the quality of the excision. Ablation of the psoas muscle is technically possible; it may improve the patient's outlook both for palliation and for curative intent.

Adult↗
PubMed1985

Pharmacology and toxicology of a seven-day infusion of 1-beta-D-arabinofuranosylcytosine plus uridine in dogs.

In vitro studies of certain lymphoid tumor cells show potentiation of 1-beta-D-arabinofuranosylcytosine (ara-C) effects by uridine because it elevates intracellular uridine triphosphate, resulting in increased ara-C triphosphate levels. Seven-day continuous i.v. infusions of uridine at 123 mg/kg/h (2.5 g/sq m/h) were studied in 5 male beagles. Steady state levels of uridine were reached within 4 to 6 h and ranged from 2 to 5 X 10(-4) M over the course of the infusion. Steady state uracil levels ranged from 4 to 10 X 10(-4) M. After the end of infusion, uridine and uracil levels fell with a half-life of approximately 15 and 18 min, respectively. Toxicity in 2 dogs treated at this dose was limited to minimal diarrhea and a transient rise of alkaline phosphatase to 2 to 3 times normal. No drug toxicity was evident at sacrifice on Days 7 or 72. Three dogs received a 7-day infusion of ara-C plus uridine followed approximately 4 weeks later by an infusion of ara-C alone (or the same drugs in the reverse sequence). Coinfusion of 2.5 or 5.0 mg/kg/day (50 or 100 mg/sq m/day) of ara-C had no significant effects on uridine plasma levels or postinfusion half-lives. Similarly, no consistent effect was seen of uridine on ara-C plasma levels. Uridine coinfusion with ara-C resulted in a definite potentiation of myelosuppression; at 5.0 mg/kg/day X 7 of ara-C white blood cell and platelet nadirs (X 10(3)/microliters) were 0.8 and 15 as compared to 3.6 and 66, respectively, with ara-C alone. One-third of the dogs developed reversibly elevated transaminases with the combination treatment. The results show that a minimally toxic dose of uridine enhances bone marrow and probably hepatic toxicity of coadministered ara-C.

Adenosine Triphosphate↗
PubMed1984

Hemicorporectomy--perioperative management: a case presentation and review of literature.

Hemicorporectomy , or translumbar amputation, is a dramatically drastic surgical salvage procedure for patients with uncontrolled locally extensive pelvic-perineal malignancies. Several successful cases have been reported in the world literature [3-6] and careful perioperative management has been crucial. The case presented is that of a massive recurrent chondrosarcoma of the pelvis with special emphasis on close monitoring and finely tuned supportive care; unusual manifestations of neuroleptic malignant syndrome and of narcotic withdrawal are discussed.

Amputation, Surgical↗
PubMed1982

Mallory-Weiss syndrome secondary to cis-platinum chemotherapy: an unusual complication.

The Mallory-Weiss syndrome is a relatively infrequent cause of digestive tract bleeding and most cases have been described in alcoholics. Nonoperative management is frequently successful. We present here a case of sudden onset of wretching and vomiting after IV infusion of cis-platinum for recurrent carcinoma of the uterine cervix in which the patient had profuse hematemesis secondary to three posterior gastroesophageal tears requiring operative intervention after failure of nonsurgical management. This is an unusual complication of antineoplastic chemotherapy and its prevention is emphasize in this paper.

Carcinoma, Squamous Cell↗