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Biomedical subjects

N Joseph Espat

Publications and source records attributed to N Joseph Espat.

At least 19 recordsLinked to original sources
PubMed2006

Yttrium-90 internal radiation therapy for hepatic malignancy.

Surgical resection is the only potentially curative strategy in the treatment of patients with hepatic malignancy. Unfortunately, due to advanced stage, underlying liver disease, or medical comorbidities, most patients are inoperable at the time of presentation. As a result, various locoregional therapies have emerged for otherwise unresectable hepatic tumors. One such modality is Yttrium-90 (Y(90)) internal radiation therapy. Numerous studies demonstrate the safety and potential survival benefit of intra-arterial Y(90) for primary and metastatic liver tumors. However, more data is needed in order to understand the exact role of Y(90) in the algorithm of hepatic tumor management. This review presents the available literature on Y(90) with the aim of defining the current status of Y(90) in the armamentarium of therapeutic strategies for hepatic malignancy.

Antineoplastic Agents↗
PubMed2006

Intraductal papillary mucinous neoplasms of the pancreas.

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are rare tumors with different characteristics than conventional ductal pancreatic adenocarcinomas. Although they are commonly classified as cystic neoplasms of the pancreas, within their own subgroup of pancreatic cystic tumors, they are unique in their presentation, histologic characteristics, treatment, and survival rates. Currently, strategies are being implemented to better characterize these tumors preoperatively. Once IPMN is diagnosed, treatment strategies are based upon multiple factors, including patient condition, symptoms, and type and extent of disease. Although these factors may determine different treatment strategies, surgery remains the mainstay of therapy due to the favorable survival rate if the disease is diagnosed and treated prior to the development of invasive carcinoma. The goal of treatment is to alleviate symptoms and to extirpate disease prior to its transition to malignancy, invasion, and metastases. Although some experts advocate a nonoperative approach to patients with suspected benign disease, the risk of progression to malignancy can present a dilemma for the treating physician and patient. Unfortunately, differentiation of benign from malignant disease can only be determined conclusively following complete review of the entire surgical specimen. To further complicate treatment strategies, IPMN is a multifocal disease, and additional lesions can develop in the remnant pancreas. This fact has compelled most physicians familiar with the disease to institute lifelong surveillance for patients with the disease. Although our understanding of IPMN has increased greatly since its initial description in 1982, the natural history of the disease is poorly defined, and there is no consensus among experts on standards of practice. Although additional long-term follow-up of greater numbers of patients and their response to various interventions are necessary to develop consensus-based practice guidelines, this review will discuss our treatment recommendations based upon a review of the literature.

Journal Article↗
PubMed2006

Does the literature support an indication for hepatic metastasectomy other than for colorectal primary?

Hepatic resection for colorectal hepatic metastatic disease has been demonstrated to have a significant outcome benefit for selected patients. Advances in anesthetic and surgical technique have resulted in a significantly reduced morbidity and mortality for this procedure, and this management approach has become widely practiced. This hepatic resection paradigm is also being applied to hepatic metastatic disease of noncolorectal origin. The purpose of this report is to review and summarize the reported literature in order to define if the current data support an indication for hepatic metastasectomy. The specific cancer primaries that this analysis evaluated include breast, melanoma, gynecologic, neuroendocrine, sarcoma, and gastric cancer. Based on the data examined, we propose that although hepatic metastasectomy for noncolorectal cancer may be a promising component of overall oncologic treatment, the role of surgical resection cannot be generalized and at present should be individualized based on the patient's clinical course and by the biologic behaviors of specific malignancies.

Breast Neoplasms↗
PubMed2006

SURGISIS-assisted surgical site control in the delayed repair of a complex bile duct injury after laparoscopic cholecystectomy.

Although laparoscopic cholecystectomy has revolutionized the surgical approach to patients with gallbladder disease, it has also brought a marked increase in the incidence of complex and serious bile duct injuries. Many of these major injuries represent a major technical challenge for even the most seasoned hepatobiliary-trained surgeon. Herein, we present a case outlining the algorithmic treatment approach for delayed-presentation complex biliary injury and report on the novel use of small intestinal submucosal biomaterial for surgical site control in the staged repair of a complex biliary injury (Strasberg E4) after laparoscopic cholecystectomy.

Aged↗
PubMed2005

Experimental studies defining omega-3 fatty acid antiinflammatory mechanisms and abrogation of tumor-related syndromes.

Clinical and experimental evidence has supported a benefit for the inclusion of fish oils (a primary source of omega-3 fatty acids) as a component of a normal healthy diet. Polyunsaturated omega-3 fatty acids have been demonstrated to be of benefit in a number of inflammation-associated disease states, including atherosclerosis, autoimmune disorders, malignancy, and sepsis. The beneficial effects of omega-3 fatty acids are thought to occur through the postulated antiinflammatory actions of omega-3 fats; however, the specific mechanism(s) of action has not been completely defined. In this review, we discuss the recent progress made in our laboratory on defining the mechanisms of omega-3 fatty acids activity.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Understanding clinical issues in postoperative nutrition after pancreaticoduodenectomy.

Postoperative nutrition support for patients undergoing pancreaticoduodenectomy (Whipple's procedure) may be complicated due to gastrointestinal tract dysfunction (gastroparesis, dumping, and malabsorption) subsequent to the procedure. Clinical management of these patients may be adversely affected by procedure-specific knowledge deficits (method of gastrointestinal [GI] reconstruction), common and expected surgical complications, and the available route for alimentation. It is the aim of this report to provide the reader with an overview of the procedure, common postoperative nutrition issues, and available interventions.

Humans↗
PubMed2004

Ciliary neurotrophic factor upregulates ubiquitin-proteasome components in a rat model of neuronal injury.

Neuronal injury triggers the release of ciliary neurotrophic factor (CNTF), promoting local neuronal repair but producing systemic effects of anorexia and lean body weight loss. Due to the rapid rate of systemic protein loss stimulated by CNTF, we hypothesized involvement of the hepatic ubiquitin-proteasome proteolytic (UPP) pathway in CNTF-induced proteolysis. To assess the role of central CNTF in systemic UPP regulation, we measured hepatic UPP mRNA and proteasome activity in a rat model of neuronal injury and determined alterations induced by intracerebroventricular (ICV) administration of CNTF-neutralizing antibody or additional exogenous CNTF. We also assessed proteolytic parameters and nutritional status by measuring caloric intake, body weight, and protein levels. We produced neuronal injury by implanting a lateral ventricle cannula and giving daily ICV saline bolus injections, which increased hepatic 20S proteasome mRNA and enzymatic activity while reducing caloric intake, body weight, and protein levels compared to controls. Administration of ICV anti-CNTF antibodies (but not control antibodies) prevented these effects. Addition of exogenous CNTF augmented the weight loss along with the increases in 20S proteasome mRNA and proteolytic activity induced by neuronal injury. We conclude that CNTF decreases lean body weight through a combination of appetite inhibition and UPP pathway activation.

Animals↗
PubMed2004

Role of omega-3 fatty acid supplementation in inflammation and malignancy.

Omega-3 fatty acids (FAs), which include eicosapentaenoic acid (EPA) and docosahexaenoic acid, are found in fish oils and have long been investigated as components of therapy for various disease states. Population studies initially revealed the cardioprotective and anti-inflammatory effects of omega-3 FAs and EPA, with subsequent clinical studies supporting the therapeutic role of omega-3 FAs in cardiovascular and chronic inflammatory conditions. Prospective randomized placebo-controlled trials have also demonstrated the utility of omega-3 FA supplementation in malignancy and cancer cachexia. In recent years, in vitro and animal studies have elucidated some of the mechanistic explanations underlying the wide range of biological effects produced by omega-3 FAs and EPA, including their antiproliferative and anticachectic actions in malignancy. In this review, the authors discuss the recent progress made with omega-3 FAs, focusing on the advances in mechanistic understanding and the results of clinical trials.

Animals↗
PubMed2003

Evaluation of preoperative and postoperative radiotherapy on long-term functional results of straight coloanal anastomosis.

PURPOSE: Preoperative radiotherapy for rectal cancer avoids radiation to the reconstructed rectum and may circumvent the detrimental effects on bowel function associated with postoperative radiotherapy. We compared the long-term functional results of patients who received preoperative radiotherapy, postoperative radiotherapy, or no radiotherapy in conjunction with low anterior resection and coloanal anastomosis to assess the impact of pelvic radiation on anorectal function. METHODS: One hundred nine patients treated by low anterior resection and straight coloanal anastomosis for rectal cancer between 1986 and 1997 were assessed with a standardized questionnaire at two to eight years after resection. All radiotherapy was given to a total dose of 4,500 to 5,400 cGy with conventional doses and techniques. Most patients received concurrent 5-fluorouracil-based chemotherapy. RESULTS: There were 39 patients in the preoperative radiotherapy group, 11 patients in the postoperative radiotherapy group, and 59 patients in the no radiotherapy group. The postoperative radiotherapy group reported a significantly greater number of bowel movements per 24-hour period (P < 0.01) and significantly more episodes of clustered bowel movements (P < 0.02) than either the preoperative radiotherapy group or the no radiotherapy group. No significant difference in anal continence or satisfaction with bowel function was found among the three groups. CONCLUSION: In this study of straight (nonreservoir) coloanal anastomoses, postoperative pelvic radiotherapy had significant adverse effects on anorectal function, with higher rates of clustering and frequency of defecation than with preoperative radiotherapy. No differences in continence rates were demonstrated, perhaps because of the sample size of the compared groups. We attribute the adverse effects of postoperative radiotherapy to irradiation of the neorectum, which is spared when treatment is given preoperatively. The deleterious effects of adjuvant radiation on long-term anorectal function can be reduced by preoperative treatment.

Adult↗
PubMed2003

Early experience employing a linear hepatic parenchyma coagulation device.

BACKGROUND: In recent years, hepatic resection for primary and metastatic disease has been facilitated by improved anesthetic and surgical techniques, as well as by the application of new technologies. Historically, the major complications associated with hepatic resection have been postoperative bleeding, bile leak, and liver failure. Resection techniques and devices that minimize hemorrhage and bile leak, and enable the preservation of functional hepatic parenchyma, have been useful in the surgical management of liver tumors. METHODS: Herein, the use of a radiofrequency powered device for the pretransection coagulation of hepatic tissue that simultaneously seals blood vessels and bile ducts 3 mm in diameter or smaller is described. RESULTS: Early results from our single-center experience with the use of this linear radiofrequency device are reported. Seven patients underwent liver resection for either hepatocellular carcinoma or colorectal cancer metastases. There were no postoperative bile leaks, hemorrhage, or hepatic insufficiency. No transfusions were required, and the mean estimated blood loss for the parenchymal transection phase was less than 165 cc. CONCLUSIONS: The linear radiofrequency device is expedient for the pretransection coagulation of hepatic tissue and, thus, facilitates liver resection.

Aged↗
PubMed2003

Gastrointestinal stromal tumors: a spectrum of disease.

The majority of gastrointestinal stromal tumors (GIST) express c-kit, a growth factor receptor with tyrosine kinase activity. Mutations in the c-kit proto-oncogene may lead to constitutive ligand-independent activation of c-kit and subsequent neoplastic transformation. Selective tyrosine kinase inhibitors target this property of GIST and have become the standard chemotherapy for metastatic or unresectable tumors. The mainstay of treatment, however, continues to be complete surgical resection. Tyrosine kinase inhibitors may prove expedient for adjuvant therapy, and are currently the focus of clinical trials conducted by the ACOSOG, RTOG, and ACRIN. It is important to distinguish GISTs from other mesenchymal tumors of the GI tract because of differences in natural history, as well as the efficacy of treatments targeting the GIST tyrosine kinase.

Aged↗
PubMed2003

Total gastrectomy: options for the restoration of gastrointestinal continuity.

Total gastric resection and the subsequent selection of the optimum procedure for reconstruction of the oesophageal-intestinal tract is a highly debated topic. Many different types of reconstruction have been proposed, but attempts to objectively validate the potential advantages of these techniques of have not produced any definitive conclusions. The main aim of reconstruction should be to maintain the nutritional status and quality of life of the patient, with the additional goal of achieving similar function to normal gut. In this review, we discuss the prospectively randomised studies of gastrointestinal reconstruction that were done between 1987 and 2002.

Anastomosis, Roux-en-Y↗
PubMed2003

Simplified surgical placement and stabilization methods for intracerebroventricular cannulas in rat lateral ventricles.

Intracerebroventricular cannulation in rat models is an efficient tool for exploring the effects of substances directly injected into the CNS, bypassing the blood-brain barrier. Techniques for surgically securing the ICV cannula require a balance between ease of application and adequate stability. The authors tested several methods of lateral ventricle cannula stabilization, especially focusing on a comparison of cyanoacrylate gel to cranioplastic cement with an anchoring bone screw.

Animals↗
PubMed2003

Omega-3 fatty acids: implications for the treatment of tumor-associated inflammation.

Our in vivo and in vitro studies using omega-3 fatty acids (FA) have provided insight into the biological effects and mechanisms of their anti-inflammatory action(s). The implications for this research are profound because there are few nutritional therapies available that have the potential to be clinically effective in malignancies and other chronic inflammatory conditions as omega-3 FA. In this summary of experiments the biological effects of omega-3 FA are discussed and the potential mechanisms of action presented.

Angiogenesis Inducing Agents↗