2024-03-29T08:57:23Zhttps://laur.lau.edu.lb:8443/oai/requestoai:laur.lau.edu.lb:10725/22532021-03-19T09:59:47Zcom_10725_2056col_10725_2077
Cryomyolysis, a new procedure for the conservative treatment of uterine fibroids
Zreik, Tony
Rutherford, Thomas
Patler, Steven
Troiano, Robert
Williams, Ena
Brown, Janis
Olive, David
Conservative surgical options for uterine myomata traditionally were abdominal myomectomy, laparoscopic myomectomy, and, more recently, myolysis. Each of these procedures has distinct advantages, but also apparent disadvantages. We attempted to introduce an additional option for conservative surgical treatment of fibroids by freezing the structures, a procedure termed cryomyolysis. In this pilot study, 14 women were pretreated with a gonadotropin-releasing hormone (GnRH) agonist for a minimum of 2 months preoperatively to minimize uterine and myoma size. Cryomyolysis was performed and the GnRH agonist was discontinued. Magnetic resonance imaging scans were performed in 10 of the 14 women after GnRH agonist treatment but before surgery, and 4 months postoperatively. Total uterine volume ranged from 41.3 to 1134.8 ml preoperatively, and 49.5 to 1320 ml postoperatively (mean increase 22% after discontinuation of GnRH agonist). Normal uterine volume ranged from 35.6 to 548.7 ml preoperatively and 45.1 to 729.6 ml postoperatively (mean increase 40%); however, myoma volume showed a mean decrease of 6% (range-87-28%). Analysis of only frozen myomata revealed a mean volume decrease of 10%. Cryomyolysis maintains at or slightly reduces these lesions to post-GnRH agonist size, and all other uterine tissue returns to pretreatment size. We believe cryomyolysis may be an effective conservative surgical approach to uterine fibroids.
Published
N/A
2015-10-06T06:44:46Z
2015-10-06T06:44:46Z
1998
2016-05-17
Article
1074-3804
http://hdl.handle.net/10725/2253
http://dx.doi.org/10.1016/S1074-3804(98)80008-X
Zreik, T. G., Rutherford, T. J., Palter, S. F., Troiano, R. N., Williams, E., Brown, J. M., & Olive, D. L. (1998). Cryomyolysis, a new procedure for the conservative treatment of uterine fibroids. The Journal of the American Association of Gynecologic Laparoscopists, 5(1), 33-38.
http://www.sciencedirect.com/science/article/pii/S107438049880008X
en
The Journal of the American Association of Gynecologic Laparoscopists
oai:laur.lau.edu.lb:10725/22542019-02-28T09:59:06Zcom_10725_2056col_10725_2077
Patients with early onset of type 1 diabetes have significantly higher GG genotype at position 49 of the CTLA4 gene
Zalloua, Pierre
Abchee, Antoine
Shbaklo, Hadia
Zreik, Tony
Terwedow, Henry
Halaby, Georges
Azar, Sami
Type 1 diabetes (T1D) is a complex autoimmune disease. Several genetic loci have been implicated in the susceptibility to this illness. Evaluated was the role of the CTLA4 exon 1 A49G polymorphism and its role as a risk factor for T1D in our population. DNA from 190 patients with T1D and their families and 96 control individuals were genotyped for CTLA4 exon 1 polymorphism and human leukocyte antigen (HLA)–DQB1*0201 and *0302 haplotypes by polymerase chain reaction (PCR) amplification–restriction enzyme analysis and PCR amplification that used sequence-specific primers, respectively. Patients were nonobese and <26 years old. The CTLA4 G allele was found to be more frequently present in patients with T1D (32.4%) as compared with its frequency in control individuals (24.5%). The GG genotype was also significantly higher among patients (12.6%) than in controls (4.2%). χ2 analysis and family-based association studies were performed and suggested the association of CTLA4 exon 1 G polymorphism with T1D (p = 0.0229). Furthermore, in HLA-DQB1*0201–positive patients with T1D, the GG and AA genotypes were higher and lower, respectively, than those found in control individuals. This study suggests that CTLA4 is a candidate susceptibility gene for T1D.
Published
N/A
2015-10-06T07:58:46Z
2015-10-06T07:58:46Z
2004
2015-10-06
Article
0198-8859
http://hdl.handle.net/10725/2254
http://dx.doi.org/10.1016/j.humimm.2004.04.007
Zalloua, P. A., Abchee, A., Shbaklo, H., Zreik, T. G., Terwedow, H., Halaby, G., & Azar, S. T. (2004). Patients with early onset of type 1 diabetes have significantly higher GG genotype at position 49 of the CTLA4 gene. Human immunology, 65(7), 719-724.
http://www.sciencedirect.com/science/article/pii/S0198885904001132
en
Human immunology
oai:laur.lau.edu.lb:10725/22552016-08-26T07:05:52Zcom_10725_2056col_10725_2077
Prospective, randomized, crossover study to evaluate the benefit of human chorionic gonadotropin-timed versus urinary luteinizing hormone-timed intrauterine inseminations in clomiphene citrate-stimulated treatment cycles
Zreik, Tony
Valesco, Juan A Garcia
Habboosh, May
Olive, David
Arici, Aydin
Objective: To compare two methods of timing IUI, urinary LH monitoring and transvaginal ultrasonography/hCG timing of ovulation, in patients receiving clomiphene citrate.
Design: Prospective, randomized, crossover study.
Setting: Yale University Reproductive Medicine Center.
Patient(s): Infertile couples undergoing IUI because of unexplained infertility, anovulation, or male factor infertility.
Intervention(s): Patients received clomiphene citrate on days 3–7 of the menstrual cycle and were randomized initially to one of two monitoring protocols. In protocol A, urinary LH monitoring was used to time IUI. Urinary LH levels were determined daily with the use of commercial kits, starting on day 10 of the cycle. When urinary LH was detected, IUIs were performed daily for the next 2 days. In protocol B, ultrasound monitoring of folliculogenesis was performed until a leading follicle of ≥18 mm was noted, at which time hCG (10,000 IU) was given intramuscularly and IUIs were performed daily for the next 2 days. If no pregnancy occurred, the couple crossed over to the alternate protocol for the next cycle and continued this alternating therapy for a total of four cycles.
Main Outcome Measure(s): Pregnancy rate per cycle.
Result(s): One hundred forty-one cycles were completed. In these cycles, six pregnancies occurred, for an overall pregnancy rate of 4.26% per cycle. The pregnancy rate with LH-timed IUI was 4.29% (3/70) and that with hCG-induced ovulation was 4.23% (3/71); the difference was not statistically significant.
Conclusion(s): Timing IUI with the use of a relatively expensive and time-consuming method such as ultrasound monitoring of folliculogenesis and hCG induction of ovulation does not appear to produce an increased pregnancy rate over urinary LH monitoring of ovulation.
Published
N/A
2015-10-06T08:21:28Z
2015-10-06T08:21:28Z
1999
2015-10-06
Article
0015-0282
http://hdl.handle.net/10725/2255
http://dx.doi.org/10.1016/S0015-0282(99)00116-8
Zreik, T. G., Garcı́a-Velasco, J. A., Habboosh, M. S., Olive, D. L., & Arici, A. (1999). Prospective, randomized, crossover study to evaluate the benefit of human chorionic gonadotropin–timed versus urinary luteinizing hormone–timed intrauterine inseminations in clomiphene citrate–stimulated treatment cycles. Fertility and sterility, 71(6), 1070-1074.
http://www.sciencedirect.com/science/article/pii/S0015028299001168
en
Fertility and sterility
oai:laur.lau.edu.lb:10725/22562016-08-25T08:58:25Zcom_10725_2056col_10725_2077
Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy
Zreik, Tony
Purpose The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The role of consolidative radiation therapy (RT) in the setting of R-CHOP chemotherapy is not well reported. This retrospective analysis is an attempt to clarify this role.
Patients and Methods Subjects were 469 patients with histologically confirmed DLBCL treated between January 2001 and December 2007. Variables including age, sex, Ann Arbor disease stage, bulky disease status, standardized uptake values (SUVs) on positron emission tomography (PET), International Prognostic Index (IPI), and Ki67 staining (proliferation).
Results Of 469 patients, 190 (40.5%) had stage I or II disease and 279 (59.5%) had stage III or IV disease, 327 (70%) had at least six cycles of R-CHOP, and 142 (30.2%) had involved-field RT (dose, 30 to 39.6 Gy) after complete response to chemotherapy. Median follow-up was 36 months (range, 8 to 85 months). Multivariate analysis showed that RT (P < .0001), IPI score (P = .001), response to therapy (P = .001), use of six to eight cycles of R-CHOP (P < .001), and combined presence (P = .006) or absence (P = .025) of high Ki67, high PET SUV, and bulky disease influenced overall survival (OS) and progression-free survival (PFS). Matched-pair analyses of patients who received six to eight cycles of R-CHOP with stage I or II disease (44 pairs) and all stages (74 pairs) indicated that RT improved OS (hazard ratio [HR], 0.52 and 0.29, respectively) and PFS (HR, 0.45 and 0.24, respectively) compared with no RT.
Conclusion This study showed significant improvements in OS and PFS among patients who received consolidation RT after R-CHOP chemotherapy for DLBCL.
Published
N/A
2015-10-06T08:45:51Z
2015-10-06T08:45:51Z
2010
2015-10-06
Article
0732-183X
http://hdl.handle.net/10725/2256
http://dx.doi.org/10.1200/JCO.2009.27.3441
Phan, J., Mazloom, A., Medeiros, L. J., Zreik, T. G., Wogan, C., Shihadeh, F., ... & Dabaja, B. S. (2010). Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy. Journal of Clinical Oncology, 28(27), 4170-4176.
en
Journal of Clinical Oncology
oai:laur.lau.edu.lb:10725/22582019-02-28T09:59:29Zcom_10725_2056col_10725_2077
Psammoma bodies in cervicovaginal smears
Zreik, Tony
Rutherford, Thomas
Objective: To estimate the prevalence of psammoma bodies in routine cervical cytology specimens and describe clinical diagnoses associated with them in pre- and postmenopausal women.
Methods: We identified all reports that contained psammoma bodies from a retrospective review of 34,816 cytology reports over 4 consecutive years from the computerized pathology database at Yale New-Haven Medical Center. Slides were reviewed to confirm and qualify psammoma bodies. Medical records of women with psammoma bodies were reviewed and information on follow-up was collected.
Results: We identified 18 women with psammoma bodies on their Papanicolaou smears. The median age was 49.5 years (range 17–78 years). Seven of eight postmenopausal women had gynecologic malignancies. Five presented with postmenopausal bleeding and had uterine serous or clear-cell carcinomas. One presented with a pelvic mass that was ovarian serous carcinoma. Another had a serous carcinoma of the fallopian tube with only psammoma bodies on Papanicolaou smears. Only one of the remaining 11 nonmalignant cases was a postmenopausal woman.
Conclusion: The prevalence of psammoma bodies in consecutively screened Papanicolaou smears was 18 of 34,816. Psammoma bodies on Papanicolaou smears are ominous in postmenopausal women. Their presence in asymptomatic premenopausal women warrants further evaluation, but not necessarily surgical exploration
Published
N/A
2015-10-06T09:04:39Z
2015-10-06T09:04:39Z
2001
2015-10-06
Article
0029-7844
http://hdl.handle.net/10725/2258
Zreik, T. G., & Rutherford, T. J. (2001). Psammoma bodies in cervicovaginal smears. Obstetrics & Gynecology, 97(5), 693-695.
http://journals.lww.com/greenjournal/Abstract/2001/05000/Psammoma_Bodies_in_Cervicovaginal_Smears.9.aspx
en
Obstetrics & Gynecology
oai:laur.lau.edu.lb:10725/22602019-02-28T09:56:08Zcom_10725_2056col_10725_2077
Follicular fluid of women with endometriosis stimulates the proliferation of endometrial stromal cells
Zreik, Tony
Bahtiyar, M.O.
Seli, E.
Oral, E.
Arici, A.
The peritoneal environment in endometriosis is known to have growth-promoting effects on endometrial cells. To investigate whether follicular fluid, a contributor to the peritoneal fluid, stimulates endometrial cell proliferation, we incubated endometrial stromal cells in culture with various dilutions of follicular fluid obtained from women with or without endometriosis undergoing oocyte retrieval for in-vitro fertilization. Cell proliferation assays were performed using follicular fluid from 28 women (without endometriosis, n = 13; with endometriosis, n = 15) in eight different endometrial stromal cell culture set-ups. Cell proliferation was assessed by a colorimetric method. Maximum cell proliferation was detected when endometrial cells were incubated with 50% dilution of follicular fluid for 48 h. Follicular fluid from women with endometriosis induced significantly higher cell proliferation than follicular fluid from women without endometriosis (P < 0.05). Our findings indicate that follicular fluid contents may contribute to the growth-promoting factors in the peritoneal fluid of women with endometriosis.
Published
N/A
2015-10-06T10:53:28Z
2015-10-06T10:53:28Z
2001
2015-10-06
Article
0268-1161
http://hdl.handle.net/10725/2260
http://dx.doi.org/10.1093/humrep/13.12.3492
Bahtiyar, M. O., Seli, E., Oral, E., Senturk, L. M., Zreik, T. G., & Arici, A. (1998). Follicular fluid of women with endometriosis stimulates the proliferation of endometrial stromal cells. Human Reproduction, 13(12), 3492-3495.
http://humrep.oxfordjournals.org/content/13/12/3492.short
en
Human Reproduction
oai:laur.lau.edu.lb:10725/22612016-08-25T10:42:33Zcom_10725_2056col_10725_2077
Myometrial tissue in uterine septa
Zreik, Tony
Troiano, Robert
Ghoussoub, Rola
Olive, David
Arici, Aydin
McCarthy, Shirley
Study Objective. To assess the frequency of myometrial tissue in the septa of septate uteri.
Design. Retrospective review (Canadian Task Force classification II-2).
Setting. University-affiliated tertiary referral center.
Patients. Twenty-nine consecutive women with uterine septa diagnosed by magnetic resonance imaging (MRI).
Interventions. The MRI examination was performed with a 1.5 Tesla scanner using high-resolution phased array coils with multiplanar fast-spin echo and T1-weighted sequences. Of resected septa, tissue was available in four for histologic evaluation for the presence of myometrial tissue.
Measurements and Main Results. In 17 women MRI showed a partial septum, all containing myometrium. The 12 patients with complete septum had evidence of myometrium in the upper part of the septum, with fibrous tissue constituting the lower part. Histology reviewed from four resected septa (2 partial, 2 complete) reported myometrial tissue.
Conclusion. Uterine septa are frequently composed of myometrial tissue
Published
N/A
2015-10-06T11:19:15Z
2015-10-06T11:19:15Z
1998
2015-10-06
Article
1074-3804
http://hdl.handle.net/10725/2261
http://dx.doi.org/10.1016/S1074-3804(98)80082-0
Zreik, T. G., Troiano, R. N., Ghoussoub, R. A., Olive, D. L., Arici, A., & McCarthy, S. M. (1998). Myometrial tissue in uterine septa. The Journal of the American Association of Gynecologic Laparoscopists, 5(2), 155-160.
en
The Journal of the American Association of Gynecologic Laparoscopists
oai:laur.lau.edu.lb:10725/22622019-02-28T09:54:54Zcom_10725_2056col_10725_2077
Effect of war on the menstrual cycle
Hannoun, Antoine
Nassar, Anwar H.
Usta, Ihab M.
Zreik, Tony
Musa, A.A.
OBJECTIVE: To study the effect of a short period of war on the menstrual cycles of exposed women.
METHODS: Six months after a 16-day war, women in exposed villages aged 15–45 years were asked to complete a questionnaire relating to their menstrual history at the beginning, 3 months after, and 6 months after the war. A control group, not exposed to war, was also interviewed. The data collected were analyzed to estimate the effect of war on three groups of women: those who stayed in the war zone for 3–16 days (Group A), those who were displaced within 2 days to safer areas (Group B), and women not exposed to war or displacement (Group C-control).
RESULTS: More than 35% of women in Group A and 10.5% in Group B had menstrual aberrations 3 months after the cessation of the war. These percentages were significantly different from each other and from that in Group C (2.6%). Six months after the war most women regained their regular menstrual cycles with the exception of 18.6% in Group A.
CONCLUSION: We found a short period of war, acting like an acute stressful condition, resulted in menstrual abnormalities in 10–35% of women and is probably related to the duration of exposure to war. This might last beyond the war time and for more than one or two cycles. In most women the irregular cycles reversed without any medical intervention.
Published
N/A
2015-10-06T11:58:44Z
2015-10-06T11:58:44Z
2007
2015-10-06
Article
0029-7844
http://hdl.handle.net/10725/2262
http://dx.doi.org/10.1097/01.AOG.0000257170.83920.de
Hannoun, A. B., Nassar, A. H., Usta, I. M., Zreik, T. G., & Musa, A. A. A. (2007). Effect of war on the menstrual cycle. Obstetrics & Gynecology, 109(4), 929-932.
http://journals.lww.com/greenjournal/Abstract/2007/04000/Effect_of_War_on_the_Menstrual_Cycle.21.aspx
en
Obstetrics & Gynecology
oai:laur.lau.edu.lb:10725/22632016-08-25T10:29:50Zcom_10725_2056col_10725_2077
Laparoscopic hernias
Two case reports and a review of the literature
Bemporad, Joshua
Zreik, Tony
Brink, James
Laparoscopic operations are becoming more common and replacing more traditional surgical procedures. As a result, radiologists should be aware of some of the unique complications that may occur from these types of procedures. We report two cases of incarcerated bowel hernias in lateral trocar sites.
Published
N/A
2015-10-06T12:09:16Z
2015-10-06T12:09:16Z
1999
2015-10-06
Article
0363-8715
http://hdl.handle.net/10725/2263
http://dx.doi.org/10.1016/j.amjmed.2005.01.051
Bemporad, J. A., Zreik, T. G., & Brink, J. A. (1999). Laparoscopic hernias: two case reports and a review of the literature. Journal of computer assisted tomography, 23(1), 86-89.
http://journals.lww.com/jcat/Abstract/1999/01000/Laparoscopic_Hernias__Two_Case_Reports_and_a.18.aspx
en
Journal of computer assisted tomography,
oai:laur.lau.edu.lb:10725/22642019-02-28T10:00:55Zcom_10725_2056col_10725_2077
Vocal Changes in Patients With Polycystic Ovary Syndrome
Hannoun, Antoine
Zreik, Tony
Husseini, Samer
Mahfoud, Lorice
Sibai, Abla
Hamdan, Abdul-latif
Purpose
The purpose of this study is to look at the prevalence of vocal symptoms and acoustic changes in patients with polycystic ovary syndrome (PCOS).
Materials and Method
A total of 17 patients with PCOS diagnosed on the basis of three criteria: the presence of irregular menstrual cycles, hirsutism, and polycystic ovaries were included in the study. Twenty-one normal females' frequencies matched on age with the cases were used as controls. The following vocal symptoms were investigated: throat clearing, deepening of the voice, loss of voice, lump in the throat, and difficulty being heard. Acoustic analysis and laryngeal videostroboscopy were performed.
Results
The age range was between 19 and 38 years with a mean age of 26 years. The most common prevailing symptom was throat clearing present in 76.5% versus 4.8% in the controls, followed by loss of voice (47.6%), lump in the throat (41.2%), and deepening of voice (35.3%). The differences in the prevalence of throat clearing, deepening of voice, lump in the throat, and difficulty being heard were statistically significant compared with controls (P value < 0.05). There was no statistically significant difference in the acoustic parameters except for an increase in the relative average perturbation (P value = 0.035) and a decrease in maximum phonation time (P value = 0.001) in patients with PCOS. In the PCOS group, three patients had evidence of mild vocal fold edema and one patient had vocal fold nodules. In the control group, one subject had vocal fold edema and one subject had vocal fold nodules.
Conclusion
Patients with PCOS seem to have more vocal symptoms compared with controls. Physicians should be aware of vocal changes in hirsute subjects with PCOS.
Published
N/A
2015-10-06T13:02:03Z
2015-10-06T13:02:03Z
2011
2015-10-06
Article
0892-1997
http://hdl.handle.net/10725/2264
http://dx.doi.org/10.1016/j.jvoice.2009.12.005
Hannoun, A., Zreik, T., Husseini, S. T., Mahfoud, L., Sibai, A., & Hamdan, A. L. (2011). Vocal changes in patients with polycystic ovary syndrome. Journal of Voice, 25(4), 501-504.
http://www.sciencedirect.com/science/article/pii/S0892199709002501
en
Journal of Voice
oai:laur.lau.edu.lb:10725/22652019-02-28T09:55:31Zcom_10725_2056col_10725_2077
Fertility drugs and risk of ovarian cancer
Dispelling the myth
Zreik, Tony
Ayoub, Chakib
Hannoun, Antoine
Karam, Cynthia
Munkarah, Adnan
Purpose of review: Worldwide 50–80 million people suffer from infertility. Assisted reproductive technology has provided a way of overcoming infertility and childlessness.
The current article will focus on data linking infertility and its treatment to ovarian cancer.
Recent findings: Ovarian cancer risks associated with fertility drug treatment are encouraging, but not decisive. In view of the limited ability to evaluate drug effects on borderline tumors, given their rare occurrence, studies involving patient reports of prior drug exposures have noted an elevated risk of borderline tumors associated with fertility drugs. Nevertheless, the risk of invasive ovarian cancer appears to be restricted to those women who remain childless despite the infertility treatment.
Summary: As long as doubt persists, it might be advisable to reflect on a few clinical recommendations: identify high-risk infertile patients for ovarian cancer, investigate preexisting cancer before fertility treatment, inform patients regarding potential risks, obtain an informed consent, avoid exposure to long periods of ovulation induction cycles that are given before patients are referred for in-vitro fertilization and embryo transfer for women at greater risk and monitor women who have been treated with these drugs, especially those who failed to conceive, regularly and thoroughly.
Published
N/A
2015-10-07T05:58:31Z
2015-10-07T05:58:31Z
2008
2015-10-07
Article
1040-872X
http://hdl.handle.net/10725/2265
http://dx.doi.org/10.1097/GCO.0b013e3282fdc6c3
Zreik, T. G., Ayoub, C. M., Hannoun, A., Karam, C. J., & Munkarah, A. R. (2008). Fertility drugs and risk of ovarian cancer: dispelling the myth. Current Opinion in Obstetrics and Gynecology, 20(3), 313-319.
http://journals.lww.com/co-obgyn/Abstract/2008/06000/Fertility_drugs_and_risk_of_ovarian_cancer_.19.aspx
en
Current Opinion in Obstetrics and Gynecology
oai:laur.lau.edu.lb:10725/22662019-02-28T09:56:42Zcom_10725_2056col_10725_2077
Identification and characterization of an ascorbic acid transporter in human granulosa–lutein cells
Zreik, Tony
Kodaman, Pinar
Jones, Ervin
Olive, David
Behrman, Harold
Ascorbic acid serves a vital role as a pre-eminent antioxidant. In animals, it has been shown to be concentrated in granulosa and theca cells of the follicle, in luteal cells of the corpus luteum, and in the peripheral cytoplasm of the oocyte. We have previously identified hormonally-regulated ascorbic acid transporters in rat granulosa and luteal cells, and herein present preliminary evidence for the presence of a transporter for ascorbic acid in human granulosa–lutein cells. Granulosa–lutein cells were obtained from the follicular fluid of patients undergoing in-vitro fertilization. Following an overnight incubation, the cells were incubated with [14C]-ascorbic acid (0.15 μCi; 150 μMM) and ascorbic acid uptake was determined. The uptake of ascorbic acid was saturable with a Michaeli's constant (Km) and maximum velocity (Vmax) of 21 μM and 3 pmol/106 cells/min respectively. Ouabain, low Na+ medium, and dinitrophenol significantly inhibited ascorbic acid uptake (P < 0.05). Neither the presence of insulin, human chorionic gonadotrophin (HCG), insulin-like growth factor (IGF)-I, nor IGF-II affected the uptake of ascorbic acid in a statistically significant fashion. Following saturation of cellular uptake, the ascorbic acid level was estimated to be 1.04 pmoles/106 cells or ~1 mM, a high concentration similar to that seen in rat luteal cells. Active ascorbic acid transport in human granulosa–lutein cells appears to occur via a Na+- and energy-dependent transporter, with high levels of ascorbic acid being accumulated in these cells.
Published
N/A
2015-10-07T06:07:42Z
2015-10-07T06:07:42Z
1999
2015-10-07
Article
1360-9947
http://hdl.handle.net/10725/2266
http://dx.doi.org/10.1093/molehr/5.4.29
Zreik, T. G., Kodaman, P. H., Jones, E. E., Olive, D. L., & Behrman, H. (1999). Identification and characterization of an ascorbic acid transporter in human granulosa–lutein cells. Molecular human reproduction, 5(4), 299-302.
http://molehr.oxfordjournals.org/content/5/4/299.short
en
Molecular human reproduction,
oai:laur.lau.edu.lb:10725/22672019-02-28T09:53:46Zcom_10725_2056col_10725_2077
The consanguinity effect on QF‐PCR diagnosis of autosomal anomalies
Choueiri, Michel
Makhoul, Nadine
Zreik, Tony
Mattar, Farid
Eid, Raymond
Mroueh, Adnan
Zalloua, Pierre
Objectives
Quantitative Fluorescent PCR (QF-PCR) is a simpler and faster method of detecting common chromosomal abnormalities when compared to cytogenetic analysis. The aim of our study is to investigate the applicability of this methodology in a population where consanguineous marriages are common and to estimate the heterozygous frequency of the PCR markers used.
Methods
Four hundred and twenty-three DNA samples were extracted from uncultured amniocytes and amplified with 18 short tandem repeats (STR) markers specific to chromosomes 13, 18 and 21. Amplification products were analyzed using the GeneScan software.
Results
QF-PCR correctly identified all the numerical abnormalities related to chromosomes 13, 18 and 21. A total of 24 autosomal trisomies (5.7%) were detected. The markers D21S1432 and D21S11 were the most consistent in providing unequivocal positive results for chromosome 21 and the heterozygosity percentages of the markers used were lower than the values reported in Western populations.
Conclusion
QF-PCR is reliable for the prenatal diagnosis of numerical anomalies of the chromosomes 13, 18 and 21 in our study population. The absence of STR heterozygosity data from Lebanon and surrounding countries makes our study very useful for the development of a reliable QF-PCR trisomy detection test. Copyright © 2006 John Wiley & Sons, Ltd.
Published
N/A
2015-10-07T08:01:45Z
2015-10-07T08:01:45Z
2006
2015-10-07
Article
0197-3851
http://hdl.handle.net/10725/2267
http://dx.doi.org/10.1002/pd.1424
Choueiri, M. B., Makhoul, N. J., Zreik, T. G., Mattar, F., Adra, A. M., Eid, R., ... & Zalloua, P. A. (2006). The consanguinity effect on QF‐PCR diagnosis of autosomal anomalies. Prenatal diagnosis, 26(5), 409-414.
http://onlinelibrary.wiley.com/doi/10.1002/pd.1424/full
en
Prenatal diagnosis
oai:laur.lau.edu.lb:10725/22682016-08-26T08:33:45Zcom_10725_2056col_10725_2077
Transvaginal uterine cervical dilation with fluoroscopic guidance
Preliminary results in patients with infertility
Dickey, K.W.
Zreik, Tony
Hsia, H.C.
Eschelman, D.J.
Keefe, D.L.
Olive, D.L.
Glickman, M.G.
PURPOSE: To assess efficacy of uterine cervical dilation performed with fluoroscopic guidance to treat patients with infertility who have cervical stenosis, false channels within the endocervical canal, or both. MATERIALS AND METHODS: Fifteen patients in whom infertility was diagnosed were referred because the uterine lumen could not be accessed. Three of the patients had endometriosis. With fluoroscopic guidance, the cervix was cannulated and the endocervical canal was dilated with an angioplasty balloon or with dilators. Five patients underwent simultaneous fallopian tube recanalization. Five of 15 patients who underwent dilation subsequently underwent in vitro fertilization for embryo transfer (IVF-ET) or intrauterine insemination. RESULTS: Four patients became pregnant. Of those four, one underwent IVF-ET and one underwent intrauterine insemination. Two patients became pregnant spontaneously. In the five patients who underwent IVF-ET or intrauterine insemination and in the remaining eight patients, the cervix could be easily cannulated up to 7 months after dilation. CONCLUSION: Dilation of the uterine cervix may provide options for treatment in selected patients with infertility. The effect of dilation on patients with other sequelae of cervical obstruction such as endometriosis remains uncertain.
Published
N/A
2015-10-07T08:15:42Z
2015-10-07T08:15:42Z
2015-10-07
Article
0033-8419
http://hdl.handle.net/10725/2268
Dickey, K. W., Zreik, T. G., Hsia, H. C., Eschelman, D. J., Keefe, D. L., Olive, D. L., ... & Glickman, M. G. (1996). Transvaginal uterine cervical dilation with fluoroscopic guidance: preliminary results in patients with infertility. Radiology, 200(2), 497-503.
http://pubs.rsna.org/doi/abs/10.1148/radiology.200.2.8685347
en
Radiology
oai:laur.lau.edu.lb:10725/22692019-02-28T09:59:54Zcom_10725_2056col_10725_2077
Role of angiotensin II in the processes leading to ovulation
Andrade-Gordon, Patricia
Zreik, Tony
Apa, Rosanna
Naftolin, Frederick
N/A
N/A
2015-10-07T08:27:45Z
2015-10-07T08:27:45Z
1991
2015-10-07
Article
0006-2952
http://hdl.handle.net/10725/2269
http://dx.doi.org/10.1016/0006-2952(91)90027-3
Andrade-Gordon, P., Zreik, T., Apa, R., & Naftolin, F. (1991). Role of angiotensin II in the processes leading to ovulation. Biochemical pharmacology, 42(4), 715-719.
en
Biochemical pharmacology
oai:laur.lau.edu.lb:10725/22702019-02-28T10:00:17Zcom_10725_2056col_10725_2077
Sibutramine in pregnancy
Finan, Ramzi
Dahdouh, Elias
Sabra, Mona
Zreik, Tony
Sibutramine hydrochloride monohydrate is an orally administered agent for the treatment of obesity. Chemically, the active ingredient is a racemic mixture of (+) and (−) enantiomers of cyclobutanemethanamine [1]. It produces its therapeutic effect by norepinephrine, serotonin, and dopamine reuptake inhibition, and it exerts its pharmacologic actions via two active metabolites M1 and M2 [1,2]. Menstrual irregularities along with elevation in blood pressure and heart rate have been reported with the use of sibutramine.
Published
N/A
2015-10-07T08:40:07Z
2015-10-07T08:40:07Z
2005
2015-10-07
Article
0301-2115
http://hdl.handle.net/10725/2270
http://dx.doi.org/10.1016/j.ejogrb.2005.02.016
Ramzi, F., Elias, D., Mona, S., & Zreik, T. G. (2005). Sibutramine in pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 122(2), 243-244.
en
European journal of obstetrics, gynecology, and reproductive biology
oai:laur.lau.edu.lb:10725/22712019-02-28T09:53:04Zcom_10725_2056col_10725_2077
Amniotic fluid embolus
Can we affect the outcome?
Ayoub, Chakib
Zreik, Tony
Dabbous, Aliya
Baraka, Anis
Purpose of review: Amniotic fluid embolism is a rare catastrophe unique to pregnancy. Its mortality rate remains high despite efforts at prompt and aggressive management protocols, highlighting the need to maintain a high index of suspicion.
Recent findings: The intrusion of amniotic fluid into the maternal bloodstream may lead in certain women to a complex series of physiological reactions mimicking those seen in human anaphylaxis or sepsis, negating the purely embolic phenomenon theory as previously understood. The clinical picture is the sudden onset of cardiovascular collapse, cyanosis, haemorrhage or disseminated intravascular coagulopathy, during or soon after delivery.
Summary: The mainstay of a successful outcome remains the identification of high-risk patients, as well as early clinical diagnosis and management.
Published
N/A
2015-10-07T09:20:35Z
2015-10-07T09:20:35Z
2003
2015-10-07
Article
1804-204X
http://hdl.handle.net/10725/2271
http://dx.doi.org/10.1097/01.aco.0000073223.10825.f3
Ayoub, C. M., Zreik, T. G., Dabbous, A. S., & Baraka, A. S. (2003). Amniotic fluid embolus: can we affect the outcome?. Current Opinion in Anesthesiology, 16(3), 257-261.
en
Current Opinion in Anesthesiology,
oai:laur.lau.edu.lb:10725/22722016-08-25T09:55:37Zcom_10725_2056col_10725_2077
Filariasis infection is a probable cause of implantation failure in in vitro fertilization cycles
Bazi, Tony
Finan, Ramzi
Zourob, Dani
Sabbagh, Amira
Nasnas, Roy
Zreik, Tony
Objective
To describe a parasitic infection that probably affected the implantation of good-quality embryos in an in vitro fertilization (IVF) cycle.
Design
Case report.
Setting
Tertiary care center in a university hospital.
Patient(s)
A 36-year-old Caucasian female with primary unexplained infertility. The patient underwent two cycles of IVF with good-quality embryos transferred; however, no pregnancy ensued despite adequate luteal support.
Intervention(s)
In vitro fertilization cycles, CBC, blood smear, evaluation for eosinophilia including serological evaluation for parasitic infections.
Main Outcome Measure(s)
Pregnancy.
Result(s)
Following treatment for filariasis, a repeat IVF cycle using the same stimulation protocol yielded a full-term pregnancy.
Conclusion(s)
This case is of particular importance because, to our knowledge, it is the first to describe a parasitic infection that probably affected the implantation of good-quality embryos in IVF cycles.
Published
N/A
2015-10-07T09:42:46Z
2015-10-07T09:42:46Z
2006
2015-10-07
Article
0015-0282
http://hdl.handle.net/10725/2272
http://dx.doi.org/10.1016/j.fertnstert.2005.11.067
Bazi, T., Finan, R., Zourob, D., Sabbagh, A. S., Nasnas, R., & Zreik, T. G. (2006). Filariasis infection is a probable cause of implantation failure in in vitro fertilization cycles. Fertility and sterility, 85(6), 1822-e13.
http://www.sciencedirect.com/science/article/pii/S0015028206005000
en
Fertility and sterility
oai:laur.lau.edu.lb:10725/22732016-08-25T09:06:50Zcom_10725_2056col_10725_2077
A case of fatal pulmonary thromboembolism associated with the use of intravenous estrogen therapy
Zreik, Tony
Odunsi, Kunle
Cass, Ilna
Olive, David
Sarrel, Philip
Objective: To report a case of fatal pulmonary embolism associated with the use of IV estrogen therapy for menometrorrhagia.
Design: Case report.
Setting: University hospital.
Patient(s): A 52-year-old woman with fibroid uterus treated with GnRH analogues with add-back therapy who presented with excessive vaginal bleeding.
Intervention(s): Intravenous conjugated estrogens were administered for a total of six doses.
Main Outcome Measure(s): Fatal thromboembolic event.
Result(s): The day after IV conjugated estrogens were administered, the patient had only scant vaginal bleeding, but she experienced the sudden onset of respiratory distress, became comatose, and subsequently had ventricular fibrillation leading to asystole. All resuscitative efforts failed. Postmortem examination revealed bilateral pulmonary artery thromboembolism (saddle embolus).
Conclusion(s): Intravenous conjugated estrogen therapy may be complicated by fatal thromboembolic events. This potential adverse effect must be considered in the use of such therapy for severe menometrorrhagia, especially when treating a patient at increased risk.
Published
N/A
2015-10-07T11:06:13Z
2015-10-07T11:06:13Z
1999
2015-10-07
Article
0015-0282
http://hdl.handle.net/10725/2273
http://dx.doi.org/10.1016/S0015-0282(98)00446-4
Zreik, T. G., Odunsi, K., Cass, I., Olive, D. L., & Sarrel, P. (1999). A case of fatal pulmonary thromboembolism associated with the use of intravenous estrogen therapy. Fertility and sterility, 71(2), 373-375.
http://www.sciencedirect.com/science/article/pii/S0015028298004464
en
Fertility and sterility
oai:laur.lau.edu.lb:10725/22742019-07-22T06:10:36Zcom_10725_2056col_10725_2077
Fertility drugs and the risk of breast cancer
A meta-analysis and review
Zreik, Tony
Mazloom, Ali
Vannucci, Marina
Pinnix, Chilsea
Fulton, Stephanie
Hadziahmetovic, Mersiha
Asmar, Nadia
Munkarah, Adnan
Ayoub, Chakib M.
Shihadeh, Ferial
Berjawi, Ghina
Hannoun, Antoine
Zalloua, Pierre
Wogan, Christine
Dabaja, Bouthaina
The risk of breast cancer has been associated with reproductive history. The purpose of this study was to determine the relationship between fertility drugs used in assisted reproductive procedures and the risk of breast cancer. We performed a literature search using the MEDLINE, the COCHRANE Library, and Scopus to identify studies linking breast cancer to fertility drugs. We excluded case series, case reports, and review articles from our analysis. The study populations included women who were treated for infertility with clomiphene, gonadotropins, gonadotropin-releasing hormones, or other unspecified fertility agents. We extracted information on study design, sample size, type of fertility drugs and number of treatment cycles, breast cancer incidence, and follow-up time from these studies. Eight case–control studies and fifteen cohort studies were included in the quantitative analyses. The Newcastle–Ottawa Quality Assessment Scales were used. Two investigators independently extracted study methods, sources of bias, and outcomes. We found that the risk of breast cancer was not significantly associated with fertility drug treatment. The follow-up periods were short in some of the studies analyzed in our study; however, we proceeded to test the trend in risk estimates across different durations of follow-up and found a trend for association using the nonparametric test; this was interpreted with caution in view of the lack of adjustment with other confounding factors. The current published data do not suggest higher risk of breast cancer in women who receive fertility treatment, but the lack of long-term follow up and the inherent weaknesses in some of the published studies have to be cautiously taken into account.
Published
N/A
2015-10-07T11:15:46Z
2015-10-07T11:15:46Z
2010
2015-10-07
Article
0167-6806
http://hdl.handle.net/10725/2274
http://dx.doi.org/10.1007/s10549-010-1140-4
Zreik, T. G., Mazloom, A., Chen, Y., Vannucci, M., Pinnix, C. C., Fulton, S., ... & Dabaja, B. (2010). Fertility drugs and the risk of breast cancer: a meta-analysis and review. Breast cancer research and treatment, 124(1), 13-26.
http://link.springer.com/article/10.1007/s10549-010-1140-4
en
Breast cancer research and treatment
oai:laur.lau.edu.lb:10725/22752016-08-25T10:31:29Zcom_10725_2056col_10725_2077
Lateral distribution of endometriomas as a function of age
Bazi, Tony
Abi Nader, Khalil
Seoud, Muhieddine
Charafeddine, Maya
Rechdan, Johnny
Zreik, Tony
Published
N/A
2015-10-07T11:27:17Z
2015-10-07T11:27:17Z
2007
2015-10-07
Article
0015-0282
http://hdl.handle.net/10725/2275
http://dx.doi.org/10.1016/j.fertnstert.2006.06.028
Bazi, T., Nader, K. A., Seoud, M. A., Charafeddine, M., Rechdan, J. B., & Zreik, T. G. (2007). Lateral distribution of endometriomas as a function of age. Fertility and sterility, 87(2), 419-421.
http://www.sciencedirect.com/science/article/pii/S0015028206031943
en
Fertility and sterility
oai:laur.lau.edu.lb:10725/22762016-08-26T07:17:16Zcom_10725_2056col_10725_2077
Response Angiotensin II
Does It Have a Direct Obligate Role in Ovulation?
Naftolin, Frederick
Andrade-Gordon, Patricia
Pellicer, Antonio
Palumbo, Angela
Apa, Rosanna
Zreik, Tony
Ki Yoon, Tae
DeCherney, Alan
Published
N/A
2015-10-07T12:02:27Z
2015-10-07T12:02:27Z
1989
2015-10-07
Article
0036-8075
http://hdl.handle.net/10725/2276
http://dx.doi.org/10.1126/science.245.4920.871
Naftolin, F., Andrade-Gordon, P., Pellicer, A., Palumbo, A., Apa, R., Zreik, T., ... & DeCherney, A. (1989). Response: Angiotensin II: Does It Have a Direct Obligate Role in Ovulation?. Science (New York, NY), 245(4920), 871-871.
en
Science
oai:laur.lau.edu.lb:10725/22772016-08-25T10:08:29Zcom_10725_2056col_10725_2077
Human osteoblast-like cells express aromatase immunoreactivity
Roa-Pena, Lucia
Zreik, Tony
Harada, Nobuhiro
Spelsberg, Thomas
Riggs, Lawrence
Naftolin, Frederick
The main source of estrogen after menopause is the peripheral aromatization of adrenal androgens. Estrogen synthetase (aromatase) has been described in several tissues including placenta, ovary, testis, brain, and adipose tissue. The possibility that bone cells themselves could be a local source of estrogen production has been raised in previous studies that reported the presence of aromatase activity in crushed rat mandible and human bone cells. To determine the presence of aromatase in bone cells, cultured male and female human osteoblast-like cells were immunostained with a specific antiserum generated against human aromatase. Aromatase-immunopositive granules were found throughout the entire cytoplasm in all cultures. The morphological demonstration of immunoreactive aromatase in bone cells indicates that bone may be a site of extragonadal aromatization in both sexes. These findings open new possibilities for understanding the mechanisms of bone metabolism, the development of peak bone mass, sex differences in bone mass, and issues regarding the role of sex steroids in bone maintenance and repair.
Published
N/A
2015-10-07T12:08:20Z
2015-10-07T12:08:20Z
1994
2015-10-07
Article
1072-3714
http://hdl.handle.net/10725/2277
Roa-Peña, L., Zreik, T., Harada, N., Spelsberg, T. C., Riggs, B. L., & Naftolin, F. (1994). Human Osteoblast-Like Cells Express Aromatase Immunoreactivity. Menopause, 1(2), 73-78.
http://journals.lww.com/menopausejournal/Abstract/1994/00120/Human_Osteoblast_Like_Cells_Express_Aromatase.3.aspx
en
Menopause
oai:laur.lau.edu.lb:10725/22932019-02-28T09:55:11Zcom_10725_2056col_10725_2077
Endogenous LH surge detection versus administration of HCG to correctly time intrauterine insemination
which provides a better pregnancy rate?
Zreik, Tony
Gracia-Velasco, Juan A
Arici, Aydin
Published
N/A
2015-10-20T12:44:49Z
2015-10-20T12:44:49Z
2000
2015-10-20
Article
0268-1161
http://hdl.handle.net/10725/2293
http://dx.doi.org/ 10.1093/humrep/15.4.975
Garcia-Velasco, J. A., Arici, A., & Zreik, T. G. (2000). Endogenous LH surge detection versus administration of HCG to correctly time intrauterine insemination: which provides a better pregnancy rate?. Human Reproduction, 15(4), 975-976.
http://humrep.oxfordjournals.org/content/15/4/975.short
en
Human Reproduction
oai:laur.lau.edu.lb:10725/22982021-03-19T09:59:48Zcom_10725_2056col_10725_2077
Addition of sphingosine-1-phosphate to human oocyte culture medium decreases embryo fragmentation
Zreik, Tony
Hannoun, Antoine
Abu-Musa, Antoine
Hajameh, Fatiha
Awwad, Johnny
Apoptosis is implicated in the fragmentation of preimplantation mammalian embryos, yet the extent of this association remains controversial. The aim of this study was to assess the ability of sphingosine-1-phosphate (S1P), a known anti-apoptotic substance, to reduce the fragmentation rate of human preimplantation embryos when added to their culture microenvironment. Mature human oocytes were inseminated using intracytoplasmic sperm injection, incubated for 3 days and evaluated for embryo quality and fragmentation by the same embryologist. Oocytes in the study group were manipulated and cultured in culture medium supplemented with S1P to a 20 μmol/l concentration. A total of 46 patients donated 177 mature oocytes for the study group and 546 oocytes for the control group. The fertilization rate was significantly lower in the S1P-supplemented group (52.4% versus 67.3%; P = 0.002) and the proportion of grade I embryos with less than 15% fragmentation was significantly higher in the same group (79.5% versus 53.9%; P < 0.0001). Sphingosine-1-phosphate added to the culture medium of human preimplantation embryos is associated with a significantly lower fragmentation rate and hence better quality embryos. The clinical significance of these findings on reproductive outcome remains highly speculative awaiting further studies to translate this improvement in embryo quality into better pregnancy rates.
Published
N/A
2015-10-22T06:39:18Z
2015-10-22T06:39:18Z
2010
2016-02-16
Article
1472-6483
http://hdl.handle.net/10725/2298
http://dx.doi.org/10.1016/j.rbmo.2009.11.020
Hannoun, A., Ghaziri, G., Musa, A. A., Zreik, T. G., Hajameh, F., & Awwad, J. (2010). Addition of sphingosine-1-phosphate to human oocyte culture medium decreases embryo fragmentation. Reproductive biomedicine online, 20(3), 328-334.
http://www.sciencedirect.com/science/article/pii/S1472648309002715
en
Reproductive biomedicine online
oai:laur.lau.edu.lb:10725/23052021-03-19T09:59:48Zcom_10725_2056col_10725_2077
Significance and cost-effectiveness of somatosensory evoked potential monitoring in cervical spine surgery
Zreik, Tony
Ayoub, Chakib
Sawaya, Raja
Domloj, Nathalie
Sabbagh, Amira
Skaff, Ghassan
Background : Intraoperative somatosensory evoked potential (SSEP) monitoring during cervical spine surgery is not a universally accepted standard of care. Our retrospective study evaluated the efficacy and cost-effectiveness of intraoperative SSEP in a single surgeon's practice. Materials and Methods : Intraoperative SSEP monitoring was performed on 210 consecutive patients who had cervical spine surgery: anterior cervical approach 140 and posterior approach 70. They were screened for degradation or loss of SSEP data. A cost analysis included annual medical costs for health and human services, durable goods and expendable commodities. Results : Temporary loss of the electrical wave during cauterization resolved upon discontinuation of the cautery. We had no loss of cortical wave with preservation of the popliteal potential. A drop in the amplitude of the cortical wave was observed in three patients. This drop was resolved after hemodynamic stabilization in the first patient, readjusting the bone graft in the second patient, and interrupting the surgery in the third patient. The additional cost for SSEP monitoring was $835 per case and the total cost of the surgery was $13,835 per case. By spending $31,546 per year on SSEP, our institution is saving a total cost ranging from $64,074 to $102,192 per patient injured per year. Conclusion : Intraoperative SSEP monitoring is a reliable and cost-effective method for preventing postoperative neurological deficit by the early detection of vascular or mechanical compromise, and the immediate alteration of the anesthetic or surgical technique.
Published
N/A
2015-10-22T08:24:03Z
2015-10-22T08:24:03Z
2010
2016-05-06
Article
0028-3886
http://hdl.handle.net/10725/2305
http://dx.doi.org/10.4103/0028-3886.66454
Ayoub, C., Zreik, T., Sawaya, R., Domloj, N., Sabbagh, A., & Skaf, G. (2010). Significance and cost-effectiveness of somatosensory evoked potential monitoring in cervical spine surgery. Neurology India, 58(3), 424.
http://neurologyindia.com/article.asp?issn=0028-3886;year=2010;volume=58;issue=3;spage=424;epage=428;aulast=Ayoub
en
Neurology India
oai:laur.lau.edu.lb:10725/23022016-08-25T09:16:41Zcom_10725_2056col_10725_2077
Contraceptive options during perimenopause
Zreik, Tony
Bazi, Tony
During the transition years leading to menopause, the possibility of conception persists, although at a lower rate. Contraceptive choices available to perimenopausal women are as varied as those for their younger counterparts, albeit with some limitations related predominantly to coexisting medical conditions rather than the advancing age itself. In this review, different contraceptive choices pertaining to this age group will be discussed, with a focus on evidence-based data.
Published
N/A
2015-10-22T08:10:38Z
2015-10-22T08:10:38Z
2006
2015-10-22
Article
1745-5057
http://hdl.handle.net/10725/2302
http://dx.doi.org/10.2217/17455057.2.6.899
Bazi, T., & Zreik, T. G. (2006). Contraceptive options during perimenopause.
http://www.futuremedicine.com/doi/abs/10.2217/17455057.2.6.899?journalCode=whe
en
Women's Health
oai:laur.lau.edu.lb:10725/23032016-08-11T08:31:37Zcom_10725_2056col_10725_2077
Unicornuate uterus with a rudimentary horn and ovarian dysgerminoma
A case report
Zreik, Tony
Pustilink, TB
Gracia-Velasco, JA
Rutherford, TJ
Troiano, RN
Olive, DL
BACKGROUND: Several documented cases of endometrial and cervical carcinoma arising in unicornuate uteri have been described; however, ovarian malignancy occurring in conjunction with this müllerian anomaly has not been reported.
CASE: An 18-year-old woman had a unicornuate uterus, noncommunicating rudimentary horn and homogeneous, solid, right ovarian mass found to be a dysgerminoma at surgery.
CONCLUSION: Müllerian anomalies are unlikely to predispose women to ovarian malignancies. However, it is essential to keep in mind that women with such anomalies, though presenting at a young age, could still have cervical, uterine or even ovarian malignancies.
Published
N/A
2015-10-22T08:19:15Z
2015-10-22T08:19:15Z
1999
2015-10-22
Article
0024-7758
http://hdl.handle.net/10725/2303
Zreik, T. G., Pustilnik, T. B., Garcia-Velasco, J. A., Rutherford, T. J., Troiano, R. N., & Olive, D. L. (1999). Unicornuate uterus with a rudimentary horn and ovarian dysgerminoma. A case report. The Journal of reproductive medicine, 44(12), 1025-1028.
http://europepmc.org/abstract/med/10649813
en
The Journal of Reproductive Medicine
oai:laur.lau.edu.lb:10725/23082021-03-19T09:59:48Zcom_10725_2056col_10725_2077
Effect of powdered gloves, worn at the time of embryo transfer, on the pregnancy outcome of IVF cycles
Zreik, Tony
Hannoun, Antoine
Ghaziri, Ghina
Abu-Musa, Antoine
Awwad, Johnny
Purpose
To assess the effect of wearing powdered gloves during embryo transfer as compared to un-powdered gloves on the pregnancy outcome of IVF cycles.
Methods
Patients, undergoing embryo transfer procedures, were prospectively randomized into two groups: In the first (group A, n=356) group embryo transfer was performed while wearing powdered gloves; in the second (group B, n=356) group embryo transfer was performed while wearing un-powdered gloves. The primary end point of the study was the clinical pregnancy rate.
Results
The two groups were comparable with respect to the mean age, mean number of grade one embryos obtained, and the mean number of embryos transferred. The clinical pregnancy rates of the two groups were not different.
Conclusions
Powdered gloves, worn during embryo transfer, have no adverse effect on the pregnancy outcome of IVF cycles.
N/A
N/A
2015-10-22T10:11:44Z
2015-10-22T10:11:44Z
2009
2016-05-11
Article
1058-0468
http://hdl.handle.net/10725/2308
http://dx.doi.org/10.1007/s10815-008-9285-3
Hannoun, A., Zreik, T. G., Ghaziri, G., Musa, A. A., & Awwad, J. (2009). Effect of powdered gloves, worn at the time of embryo transfer, on the pregnancy outcome of IVF cycles. Journal of assisted reproduction and genetics, 26(1), 25-27.
en
Journal of assisted reproduction and genetics
oai:laur.lau.edu.lb:10725/23092019-02-28T09:54:16Zcom_10725_2056col_10725_2077
Effect of Betadine Vaginal Preparation during Oocyte Aspiration in in vitro Fertilization Cycles on Pregnancy Outcome
Zreik, Tony
Hannoun, A.
Awwad, J.
Ghaziri, G.
Abu-Musa, A.
Objective: The objective of this study is to assess the effect of two methods of vaginal scrubbing before egg retrieval on the outcome of in vitro fertilization-embryo transfer (IVF-ET) cycles. Method: 721 consecutive cycles of IVF-ET, at the American University Hospital of Beirut, were randomized prospectively into one of two groups. In the study group the betadine used to scrub the vagina, prior to egg retrieval, was not washed out, whereas in the control group this betadine was cleansed by saline irrigation. The two groups were compared as to the outcome of their IVF-ET cycles. Result: Both groups were similar in age, mean dose of FSH received, the number of oocytes and embryos obtained, the number of grade 1 embryos obtained, and the fertilization rate. There was no difference in the total pregnancy, clinical pregnancy, missed abortion, and multiple pregnancy rates between the two groups. However, the chemical pregnancy rate was higher in the study group as compared to controls. Conclusion: Vaginal preparation by betadine does not seem to affect the results of IVF. However, because it is associated with an increase in the rate of chemical pregnancy, it is advisable to cleanse before oocyte aspiration.
Published
N/A
2015-10-22T12:07:10Z
2015-10-22T12:07:10Z
2008
2015-10-22
Article
0378-7346
http://hdl.handle.net/10725/2309
http://dx.doi.org/10.1159/000156378
Hannoun, A., Awwad, J., Zreik, T., Ghaziri, G., & Abu-Musa, A. (2008). Effect of betadine vaginal preparation during oocyte aspiration in in vitro fertilization cycles on pregnancy outcome. Gynecologic and obstetric investigation, 66(4), 274-278.
http://www.karger.com/Article/Abstract/156378
en
Gynecologic and obstetric investigation
oai:laur.lau.edu.lb:10725/23182019-02-28T10:12:23Zcom_10725_2056col_10725_2077
PGE2 induces COX-2 expression in podocytes via the EP4 receptor through a PKA-independent mechanism
Faour, Wissam
Gomi, Kaede
Kennedy, Christopher
Cyclooxygenase-2 (COX-2)-dependent prostaglandin E2 (PGE2) synthesis correlates with the onset of proteinuria and increased glomerular capillary pressure (Pgc) glomerular disease models. We previously showed that an in vitro surrogate for Pgc (cyclical mechanical stretch) upregulates the expression of both COX-2 and the PGE2 responsive E-Prostanoid receptor, EP4 in cultured mouse podocytes. In the present study we further delineate the signaling pathways regulating podocyte COX-2 induction. Time course experiments carried out in conditionally-immortalized mouse podocytes revealed that PGE2 transiently increased phosphorylated p38 MAPK levels at 10 min, and induced COX-2 protein expression at 4 h. siRNA-mediated knockdown of EP4 receptor expression, unlike treatment with the EP1 receptor antagonist SC 19220, completely abrogated PGE2-induced p38 phosphorylation and COX-2 upregulation suggesting the involvement of the EP4 receptor subtype. PGE2-induced COX-2 induction was abrogated by inhibition of either p38 MAPK or AMP activated protein kinase (AMPK), and was mimicked by AICAR, a selective AMPK activator, and by the cAMP-elevating agents, forskolin (FSK) and IBMX. Surprisingly, neither PGE2 nor FSK/IBMX-dependent p38 activation and COX-2 expression were blocked by PKA inhibitors or mimicked by 8-cPT-cAMP a selective EPAC activator, but were instead abrogated by Compound C, suggesting the involvement of AMPK. These results indicate that in addition to mechanical stretch, PGE2 initiates a positive feedback loop in podocytes that drives p38 MAPK activity and COX-2 expression through a cAMP/AMPK-dependent, but PKA-independent signaling cascade. This PGE2-induced signaling network activated by increased Pgc could be detrimental to podocyte health and glomerular filtration barrier integrity.
Published
N/A
2015-10-23T08:03:27Z
2015-10-23T08:03:27Z
2008
2015-10-23
Article
0898-6568
http://hdl.handle.net/10725/2318
http://dx.doi.org/10.1016/j.cellsig.2008.08.007
Faour, W. H., Gomi, K., & Kennedy, C. R. (2008). PGE 2 induces COX-2 expression in podocytes via the EP 4 receptor through a PKA-independent mechanism. Cellular signalling, 20(11), 2156-2164.
http://www.sciencedirect.com/science/article/pii/S0898656808002350
en
Cellular signalling
oai:laur.lau.edu.lb:10725/23102016-08-25T09:15:11Zcom_10725_2056col_10725_2077
Consolidative Radiation Therapy for Stage III Hodgkin Lymphoma in Patients Who Achieve Complete Response After ABVD Chemotherapy
Zreik, Tony
Phan, Jack
Mazloom, Ali
Abboud, Mirna
Salehpour, Mohamad
Reed, Valerie
Shihadeh, Ferial
Fisher, Christine
Wogan, Christine
Dabaja, Bouthaina
Objectives: To examine the role of consolidation radiation therapy (RT) for patients with stage III Hodgkin lymphoma.
Methods: We retrospectively reviewed 118 patients with stage III Hodgkin lymphoma who were diagnosed and treated at the University of Texas M.D. Anderson Cancer Center from 1993 through 2006. We evaluated the influence of site and size of initial involvement and use of consolidative RT on survival and patterns of failure after complete response (CR) to ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine).
Results: After chemotherapy, 104 patients (88%) achieved CR; median follow-up time was 68 months (range, 8 to 190). Seventy-one patients (68%) received ≥6 cycles of ABVD, and 40 patients (38.5%) received consolidative RT. Comparing patients who received RT with those who did not, the 5-year, 10-year, and 15-year overall survival (OS) rates were 98%, 80%, and 80% versus 91%, 72%, and 29%, respectively (P=0.08). Disease-free survival (DFS) rates were 94%, 81%, 65% versus 78%, 45%, and 15%, respectively (P=0.04). On multivariate analysis, the presence of initial mediastinal involvement (P=0.001) and bulky head and neck disease (P=0.001) was associated with worse DFS; mediastinal RT was associated with improved DFS (P=0.003) and OS (P=0.029). Use of ≥6 cycles of ABVD was associated with improved OS (P=0.001). The pattern of failure analysis showed that most failures (23 of 28) occurred above the diaphragm.
Conclusions: Consolidative RT after CR may benefit patients with initial disease above the diaphragm, whereas below-the-diaphragm disease seems to be well managed by chemotherapy alone.
Published
N/A
2015-10-22T12:18:24Z
2015-10-22T12:18:24Z
2011
2015-10-22
Article
0277-3732
http://hdl.handle.net/10725/2310
http://dx.doi.org/10.1097/COC.0b013e3181f477a8
Phan, J., Mazloom, A., Abboud, M., Salehpour, M., Reed, V., Zreik, T., ... & Dabaja, B. (2011). Consolidative Radiation Therapy for Stage III Hodgkin Lymphoma in Patients Who Achieve Complete Response After ABVD Chemotherapy. American journal of clinical oncology, 34(5), 499-505.
http://journals.lww.com/amjclinicaloncology/Abstract/2011/10000/Consolidative_Radiation_Therapy_for_Stage_III.11.aspx
en
American journal of clinical oncology
oai:laur.lau.edu.lb:10725/23112016-08-26T07:06:43Zcom_10725_2056col_10725_2077
Prostaglandin E2 regulates the level and stability of cyclooxygenase-2 mRNA through activation of p38 mitogen-activated protein kinase in interleukin-1β-treated human synovial fibroblasts
Faour, Wissam
He, Yulan
He, Qing Wen
De ladurantaye, Manon
Quintero, Maritza
Mancini, Arturo
Di Battista, John
The p38 MAPK mediates transcriptional and post-transcriptional control of cyclooxygenase-2 (COX-2) mRNA following interleukin-1(IL-1)/lipopolysaccharide cellular activation. We explored a positive feedback, prostaglandin E2 (PGE2)-dependent stabilization of COX-2 mRNA mediated by the p38 MAPK cascade in IL-1β-stimulated human synovial fibroblasts. We observed a rapid (5 min), massive (>30-fold), and sustained (>48 h) increase in COX-2 mRNA, protein, and PGE2 release following a recombinant human (rh) IL-1β signal that was inhibited by NS-398, a COX-2 inhibitor, and SB202190, a selective, cell-permeable p38 MAPK inhibitor. PGE2 completely reversed NS-398-mediated inhibition but not SB202190-dependent inhibition. The eicosanoid didn't potentiate IL-1β-induced COX-2 expression nor did it activate COX-2 gene expression in quiescent cells. Transfection experiments with a human COX-2 promoter construct revealed a minor element of p38 MAPK-dependent transcriptional control after IL-1β stimulation. p38 MAPK synergized with the cAMP/cAMP-dependent protein kinase cascade to transactivate the COX-2 promoter. When human synovial fibroblasts were activated with rhIL-1β for 3–4 h (steady state) followed by washout, the elevated levels of COX-2 mRNA declined rapidly (<2 h) to control levels. If PGE2, unlike EP2/3 agonists butaprost and sulprostone, was added to fresh medium, COX-2 mRNA levels remained elevated for up to 16 h. SB202190 or anti-PGE2 monoclonal antibody compromised the stabilization of COX-2 mRNA by PGE2. Deletion analysis using transfected chimeric luciferase-COX-2 mRNA 3′-untranslated region reporter constructs revealed that IL-1β increased reporter gene mRNA stability and translation via AU-containing distal regions of the untranslated region. This response was mediated entirely by a PGE2/p38 MAPK-dependent process. We conclude that the magnitude and duration of the induction of COX-2 mRNA, protein, and PGE2 release by rhIL-1β is primarily the result of PGE2-dependent stabilization of COX-2 mRNA and stimulation of translation, a process involving a positive feedback loop mediated by the EP4 receptor and the downstream kinases p38 MAPK and, perhaps, cAMP-dependent protein kinase.
Published
N/A
2015-10-23T05:52:42Z
2015-10-23T05:52:42Z
2001
2015-10-23
Article
0021-9258
http://hdl.handle.net/10725/2311
http://dx.doi.org/10.1074/jbc.M104036200
Faour, W. H., He, Y., He, Q. W., de Ladurantaye, M., Quintero, M., Mancini, A., & Di Battista, J. A. (2001). Prostaglandin E2 regulates the level and stability of cyclooxygenase-2 mRNA through activation of p38 mitogen-activated protein kinase in interleukin-1β-treated human synovial fibroblasts. Journal of Biological Chemistry, 276(34), 31720-31731.
http://www.jbc.org/content/276/34/31720.short
en
Journal of Biological Chemistry
oai:laur.lau.edu.lb:10725/23122019-02-28T10:29:14Zcom_10725_2056col_10725_2077
T-cell-derived interleukin-17 regulates the level and stability of cyclooxygenase-2 (COX-2) mRNA through restricted activation of the p38 mitogen-activated protein kinase cascade
Faour, Wissam
Mancini, Arturo
He, Qing Wen
Di Battista, John
Although interleukin-17 (IL-17) is the pre-eminent T-cell-derived pro-inflammatory cytokine, its cellular mechanism of action remains poorly understood. We explored novel signaling pathways mediating IL-17 induction of the cyclooxygenase-2 (COX-2) gene in human chondrocytes, synovial fibroblasts, and macrophages. In preliminary work, recombinant human (rh) IL-17 stimulated a rapid (5–15 min), substantial (>8-fold), and sustained (>24 h) increase in COX-2 mRNA, protein, and prostaglandin E2 release. Screening experiments with cell-permeable kinase inhibitors (e.g. SB202190 and p38 inhibitor), Western analysis using specific anti-phospho-antibodies to a variety of mitogen-activated protein kinase cascade intermediates, co-transfection studies using chimeric cytomegalovirus-driven constructs of GAL4 DNA-binding domains fused to the transactivation domains of transcription factors together with Gal-4 binding element-luciferase reporters, ectopic overexpression of activated protein kinase expression plasmids (e.g. MKK3/6), or transfection experiments with wild-type and mutant COX-2 promoter constructs revealed that rhIL-17 induction of the COX-2 gene was mediated exclusively by the stress-activated protein kinase 2/p38 cascade. A rhIL-17-dependent transcriptional pulse (1.76 ± 0.11-fold induction) was initiated by ATF-2/CREB-1 transactivation through the ATF/CRE enhancer site in the proximal promoter. However, steady-state levels of rhIL-17-induced COX-2 mRNA declined rapidly (<2 h) to control levels under wash-out conditions. Adding rhIL-17 to transcriptionally arrested cells stabilized COX-2 mRNA for up to 6 h, a process compromised by SB202190. Deletion analysis using transfected chimeric luciferase-COX-2 mRNA 3′-untranslated region reporter constructs revealed that rhIL-17 increased reporter gene mRNA stability and protein synthesis via distal regions (–545 to –1414 bases) of the 3′-untranslated region. This response was mediated entirely by the stress-activated protein kinase 2/p38 cascade. As such, IL-17 can exert direct transcriptional and post-transcriptional control over target proinflammatory cytokines and oncogenes.
Published
N/A
2015-10-23T06:07:23Z
2015-10-23T06:07:23Z
2003
2015-10-23
Article
0021-9258
http://hdl.handle.net/10725/2312
http://dx.doi.org/10.1074/jbc.M212790200
Faour, W. H., Mancini, A., He, Q. W., & Di Battista, J. A. (2003). T-cell-derived Interleukin-17 Regulates the Level and Stability of Cyclooxygenase-2 (COX-2) mRNA through Restricted Activation of the p38 Mitogen-activated Protein Kinase Cascade ROLE OF DISTAL SEQUENCES IN THE 3′-UNTRANSLATED REGION OF COX-2 mRNA. Journal of Biological Chemistry, 278(29), 26897-26907.
http://www.jbc.org/content/278/29/26897.short
en
Journal of Biological Chemistry
oai:laur.lau.edu.lb:10725/23142016-08-25T09:39:22Zcom_10725_2056col_10725_2077
Early growth response factor-1 mediates prostaglandin E2-dependent transcriptional suppression of cytokine-induced tumor necrosis factor-α gene expression in human macrophages and rheumatoid arthritis-affected synovial fibroblasts
Faour, Wissam
Alaaeddine, Nada
Mancini, Arturo
He, Qing Wen
Jovanovic, Dragan
Di Battista, John
Tumor necrosis factor-α (TNF-α) is a pleiotropic proinflammatory cytokine that modulates a broad range of inflammatory and immunological processes. We have investigated the potential immunomodulatory properties of prostaglandin E2 (PGE2) by examining the molecular mechanism by which the eicosanoid suppresses T-cell-derived interleukin-17 (IL-17)-induced TNF-α mRNA expression and protein synthesis in human macrophages and rheumatoid arthritis-affected synovial fibroblasts. Initial studies confirmed that PGE2 induces egr-1 mRNA expression and protein synthesis by restricted SAPK2/p38 MAPK-dependent activating transcription factor-2 (ATF-2) dimer transactivation of the egr-1 promoter as judged by studies using wild-type (WT) and deletion mutant egr-1 promoter constructs, Northern and Western blotting, and standard and supershift electrophoretic mobility shift analyses. Using human leukemic monocytic THP-1 cells stably transfected with WT and dominant-negative mutant expression constructs of Egr-1, cotransfected or not with a WT pTNF-615SVOCAT construct, we observed that PGE2 inhibition of IL-17-stimulated TNF-α mRNA expression and promoter activity was dependent on Egr-1 expression, as mutants of Egr-1, alone or in combination, markedly abrogated any inhibitory effect of PGE2. Standard and supershift electrophoretic mobility shift analysis, signaling “decoy” overexpression studies, and pTNF-615SVOCAT promoter assays using WT and mutant promoter constructs revealed that IL-17-up-regulated promoter activity was largely dependent on ATF-2/c-Jun transactivation. PGE2 suppression of IL-17-induced ATF-2/c-Jun transactivation and DNA binding was dependent on Egr-1-mediated inhibition of induced c-Jun expression. We suggest that egr-1 is an immediate-early PGE2 target gene that may be a key regulatory factor in mediating eicosanoid control of genes involved in the immune and inflammatory responses.
Published
N/A
2015-10-23T06:32:57Z
2015-10-23T06:32:57Z
2005
2015-10-23
Article
0021-9258
http://hdl.handle.net/10725/2314
http://dx.doi.org/10.1074/jbc.M414067200
Faour, W. H., Alaaeddine, N., Mancini, A., He, Q. W., Jovanovic, D., & Di Battista, J. A. (2005). Early growth response factor-1 mediates prostaglandin E2-dependent transcriptional suppression of cytokine-induced tumor necrosis factor-α gene expression in human macrophages and rheumatoid arthritis-affected synovial fibroblasts. Journal of Biological Chemistry, 280(10), 9536-9546.
http://www.jbc.org/content/280/10/9536.short
en
Journal of Biological Chemistry
oai:laur.lau.edu.lb:10725/23152021-03-19T09:59:48Zcom_10725_2056col_10725_2077
Nimesulide, a preferential cyclooxygenase 2 inhibitor, suppresses peroxisome proliferator‐activated receptor induction of cyclooxygenase 2 gene expression in human synovial fibroblasts: Evidence for receptor antagonism
Faour, Wissam
Kalajdzic, Tanja
He, Qing Wen
Fahmi, Hassan
Martel-Pelletier, Johanne
Pelletier, Jean-Pierre
Di Battista, John
Objective
To characterize the inhibitory effects of therapeutic concentrations of the nonsteroidal antiinflammatory drug nimesulide (NIM) on peroxisome proliferator-activated receptor (PPAR)-induced cyclooxygenase 2 (COX-2) gene expression in human synovial fibroblasts (HSFs) from patients with osteoarthritis (OA) and to define the intracellular mechanisms mediating the response.
Methods
PPARα and PPARγ messenger RNA (mRNA) expression and protein synthesis in OA HSFs were measured by reverse transcription-polymerase chain reaction and electrophoretic mobility shift assay, respectively. Experiments investigating endogenous and overexpressed PPARα and PPARγ activation of COX-2 mRNA and protein were conducted by incubating nontransfected and transfected cells with increasing concentrations of cognate ligands WY-14,643 (α agonist), ciglitasone (γ agonist), and 15-deoxy-Δ12,14-prostaglandin J2 (15d-PGJ2) in the absence or presence of NIM and NS-398 (1 μM). COX-2 mRNA and protein were measured by Northern and Western blotting procedures, respectively. Receptor activation studies were evaluated by cotransfecting pSG5-Gal 4 DNA binding domain (DBD)-PPARα ligand binding domain (LBD) or pSG5-Gal 4 DBD-PPARγ LBD chimeric constructs with a 5× Gal 4 enhancer site tk-tataa-luciferase reporter under ligand stimulation in the presence or absence of increasing concentrations of NIM. Gene transactivation analyses were conducted by treating cells overexpressing cytomegalovirus (CMV)-PPARα or CMV-PPARγ expression constructs with either a PPAR response element (PPRE)-luciferase construct containing 3 DR1 acyl-coenzyme A (acyl-CoA) oxidase gene response elements or human COX-2 promoter constructs with WY-14,643, ciglitasone, and 15d-PGJ2 in the presence or absence of increasing concentrations of NIM.
Results
Human synovial cells expressed functional PPAR isoforms, PPARα and PPARγ. Neither receptor agonists nor antagonists modulated the intracellular protein levels of PPAR. PPARα and, especially, PPARγ mediated the induction of COX-2 gene expression by receptor agonists. Stimulation of COX-2 mRNA expression and protein synthesis by 15d-PGJ2 appeared to occur through a receptor-independent process. NIM inhibited PPAR agonist stimulation of COX-2 expression and synthesis in a dose-dependent manner in both nontransfected cells and cells overexpressing both receptor isoforms. NIM potently abrogated basal and ligand-stimulated PPRE3X DR1 acyl-CoA oxidase-driven luciferase activity and also human PPRE-containing COX-2 promoter activity.
Conclusion
PPAR-mediated induction of COX-2 expression and synthesis in human OA synovial fibroblasts is inhibited by therapeutic concentrations of NIM through the functional antagonism of ligand-dependent receptor activation, with the resultant suppression of PPAR-dependent transactivation of target genes (e.g., COX-2).
Published
N/A
2015-10-23T07:13:01Z
2015-10-23T07:13:01Z
2002
2016-05-17
Article
0004-3591
http://hdl.handle.net/10725/2315
http://dx.doi.org/10.1002/art.10055
Kalajdzic, T., Faour, W. H., He, Q. W., Fahmi, H., Martel‐Pelletier, J., Pelletier, J. P., & Di Battista, J. A. (2002). Nimesulide, a preferential cyclooxygenase 2 inhibitor, suppresses peroxisome proliferator‐activated receptor induction of cyclooxygenase 2 gene expression in human synovial fibroblasts: Evidence for receptor antagonism. Arthritis & Rheumatism, 46(2), 494-506.
http://onlinelibrary.wiley.com/doi/10.1002/art.10055/full
en
Arthritis & Rheumatism
oai:laur.lau.edu.lb:10725/23162021-03-19T09:59:48Zcom_10725_2056col_10725_2077
Prostaglandin E2 stimulates p53 transactivational activity through specific serine 15 phosphorylation in human synovial fibroblasts ROLE IN SUPPRESSION OF c/EBP/NF-κB-MEDIATED MEKK1-INDUCED MMP-1 EXPRESSION
Faour, Wissam
He, Qing Wen
Mancini, Arturo
Jovanovic, Dragan
Antoniou, John
Di Battista, John
Cyclooxygenase-2 (COX-2) overexpression has been linked to cell survival, transformation, and hyperproliferation. We examined the regulation of the tumor suppressor gene p53 and p53 target genes by prostaglandin E2 (PGE2) in human synovial fibroblasts (HSF). PGE2 induced a time-dependent increase in p53 Ser15 phosphorylation, with no discernible change in overall p53 levels. PGE2-dependent Ser15 phosphorylation was apparently mediated by activated p38 MAP kinase as SB202190, a p38 kinase inhibitor, blocked the response. Overexpression of a MKK3 construct, but not MKK1, stimulated SB202190-sensitive p53 Ser15 phosphorylation. PGE2-stimulated [phospho-Ser15]p53 transactivated a p53 response element (GADD45)-luciferase reporter in transiently transfected HSF (SN7); the effect was compromised by overexpression of a dominant-negative mutant (dnm) of p53 or excess p53S15A expression plasmid but mimicked by a constitutively active p53S15E expression construct. PGE2, wtp53 expression in the presence of PGE2, and p53S15E suppressed steady-state levels of MEKK1-induced MMP-1 mRNA, effects nullified with co-transfection of p53 dnm or p53S15A. MEKK1-induced MMP-1 promoter-driven luciferase activity was largely dependent on a c/EBPβ-NF-κB-like enhancer site at –2008 to –1972 bp, as judged by deletion and point mutation analyses. PGE2, overexpression of p53wt with PGE2, or p53S15E abolished the MEKK1-induced MMP-1 promoter luciferase activity. Gel-shift/super gel-shift analyses identified c/EBPβ dimers and c/EBPβ/NF-κB p65 heterodimers as binding species at the apparent site of MEKK1-dependent transactivation. PGE2-stimulated [phospho-Ser15]p53 abrogated the DNA binding of c/EBPβ dimers and c/EBPβ/NF-κB p65 heterodimers. Our data suggest that COX-2 prostaglandins may be implicated in p53 function and p53 target gene expression
Published
N/A
2015-10-23T07:56:31Z
2015-10-23T07:56:31Z
2006
2016-05-09
Article
0021-9258
http://hdl.handle.net/10725/2316
http://dx.doi.org/10.1074/jbc.M601293200
Faour, W. H., He, Q., Mancini, A., Jovanovic, D., Antoniou, J., & Di Battista, J. A. (2006). Prostaglandin E2 Stimulates p53 Transactivational Activity through Specific Serine 15 Phosphorylation in Human Synovial Fibroblasts ROLE IN SUPPRESSION OF c/EBP/NF-κB-MEDIATED MEKK1-INDUCED MMP-1 EXPRESSION. Journal of Biological Chemistry, 281(29), 19849-19860.
http://www.jbc.org/content/281/29/19849.short
en
Journal of Biological Chemistry
oai:laur.lau.edu.lb:10725/23192019-02-28T10:25:02Zcom_10725_2056col_10725_2077
A maladaptive role for EP4 receptors in podocytes
Faour, Wissam
Stitt-Cavanagh, Erin
Takami, Kaede
Carter, Anthony
Vaderhyden, Barbara
Ghan, Youfei
Schendeir, Andre
Breyer, Mathieu
Kennedy, Christopher
Inhibition of p38 mitogen-activated protein kinase and cyclooxygenase-2 reduces albuminuria in models of chronic kidney disease marked by podocyte injury. Previously, we identified a feedback loop in podocytes whereby an in vitro surrogate for glomerular capillary pressure (i.e., mechanical stretch) along with prostaglandin E2 stimulation of its EP4 receptor induced cyclooxygenase-2 in a p38-dependent manner. Here we asked whether stimulation of EP4 receptors would exacerbate glomerulopathies associated with enhanced glomerular capillary pressure. We generated mice with either podocyte-specific overexpression or depletion of the EP4 receptor (EP4pod+ and EP4pod−/−, respectively). Glomerular prostaglandin E2-stimulated cAMP levels were eightfold greater for EP4pod+ mice compared with nontransgenic (non-TG) mice. In contrast, EP4 mRNA levels were >50% lower, and prostaglandin E2-induced cAMP synthesis was absent in podocytes isolated from EP4pod−/− mice. Non-TG and EP4pod+ mice underwent 5/6 nephrectomy and exhibited similar increases in systolic BP (+25 mmHg) by 4 weeks compared with sham-operated controls. Two weeks after nephrectomy, the albumin-creatinine ratio of EP4pod+ mice (3438 μg/mg) was significantly higher than that of non-TG mice (773 μg/mg; P < 0.0001). Consistent with more severe renal injury, the survival rate for nephrectomized EP4pod+ mice was significantly lower than that for non-TG mice (14 versus 67%). In contrast, 6 weeks after nephrectomy, the albumin-creatinine ratio of EP4pod−/− mice (753 μg/mg) was significantly lower than that of non-TG mice (2516 μg/mg; P < 0.05). These findings suggest that prostaglandin E2, acting via EP4 receptors contributes to podocyte injury and compromises the glomerular filtration barrier.
N/A
2015-10-23T08:16:58Z
2015-10-23T08:16:58Z
2010
2015-10-23
Stitt-Cavanagh, E. M., Faour, W. H., Takami, K., Carter, A., Vanderhyden, B., Guan, Y., ... & Kennedy, C. R. (2010). A maladaptive role for EP4 receptors in podocytes. Journal of the American Society of Nephrology, 21(10), 1678-1690.
http://jasn.asnjournals.org/content/21/10/1678.short
Journal of the American Society of Nephrology
oai:laur.lau.edu.lb:10725/23212021-03-19T09:59:48Zcom_10725_2056col_10725_2077
Mechanical stretch and prostaglandin E2 modulate critical signaling pathways in mouse podocytes
Faour, Wissam
Thibodeau, Jean-Francois
Kennedy, Christopher
Elevated glomerular capillary pressure (Pgc) and hyperglycemia contribute to glomerular filtration barrier injury observed in diabetic nephropathy (DN). Previous studies showed that hypertensive conditions alone or in combination with a diabetic milieu impact podocyte cellular function which results in podocyte death, detachment or hypertrophy. The present study was aimed at uncovering the initial signaling profile activated by Pgc (mimicked by in vitro mechanical stretch), hyperglycemia (high glucose (HG), 25 mM d-glucose) and prostaglandin E2 (PGE2) in conditionally-immortalized mouse podocytes. PGE2 significantly reduced the active form of AKT by selectively blunting its phosphorylation on S473, but not on T308. AKT inhibition by PGE2 was reversed following either siRNA-mediated EP4 knockdown, PKA inhibition (H89), or phosphatase inhibition (orthovanadate). Podocytes treated for 20 min with H2O2 (10−4 M), which mimics reactive oxygen species generation by cells challenged by hyperglycemic or enhanced Pgc conditions, significantly increased the levels of active p38 MAPK, AKT, JNK and ERK1/2. Interestingly, stretch and PGE2 each significantly reduced H2O2-mediated AKT phosphorylation and was reversed by pretreatment with orthovanadate while stretch alone reduced GSK-3β inhibitory phosphorylation at ser-9. Finally, mechanical stretch alone or in combination with HG, induced ERK1/2 and JNK activation, via the EGF receptor since AG1478, a specific EGF receptor kinase inhibitor, blocked this activation. These results show that cellular signaling in podocytes is significantly altered under diabetic conditions (i.e., hyperglycemia and increased Pgc). These changes in MAPKs and AKT activities might impact cellular integrity required for a functional glomerular filtration barrier thereby contributing to the onset of proteinuria in DN.
Published
N/A
2015-10-23T08:30:40Z
2015-10-23T08:30:40Z
2010
2016-05-09
Article
0898-6568
http://hdl.handle.net/10725/2321
http://dx.doi.org/10.1016/j.cellsig.2010.03.014
Faour, W. H., Thibodeau, J. F., & Kennedy, C. R. (2010). Mechanical stretch and prostaglandin E 2 modulate critical signaling pathways in mouse podocytes. Cellular signalling, 22(8), 1222-1230.
http://www.sciencedirect.com/science/article/pii/S0898656810000884
en
Cellular signalling
oai:laur.lau.edu.lb:10725/23222021-03-19T09:59:48Zcom_10725_2056col_10725_2077
Biological and anti-inflammatory evaluation of two thiazole compounds in RAW cell line
potential cyclooxygenase-2 specific inhibitors
Faour, Wissam
Hamade, Eva
Habib, Aida
Hachem, Ali
Hussein, Alaa
Abbas, Malak
Hirz, Taghreed
The anti-inflammatory effect of two new thiazoles derivatives CX-32 (N-[4-(4-hydroxy-3-methoxyphenyl)-1,3-thiazol-2-yl]acetamide ) and CX-35 (4-(2-amino-1,3-thiazol-4-yl)-2-methoxyphenol), was investigated in LPS-stimulated RAW 264.7 cell line. Synthesis, structure analysis and purity of these compounds were evaluated by high performance liquid chromatography, H1 NMR, and C13 NMR. Assessment of CX-32 and CX-35 inhibitory effect on cyclooxygenase-2 (COX-2) activity was achieved by incubating LPS-activated RAW cells with 25 μM, 50μM or 100μM of CX-32 or CX-35 respectively. Levels of secreted PGE2 were evaluated by enzyme immunoassay (EIA) and levels of COX-2 protein were measured by western blot. Finally, cell viability experiments were undertaken to assess the toxicity of each compound. Treatment of LPS-activated RAW cells with 25 μM, 50 μM, or 100 μM of CX-35 or CX-32 respectively, prevented the production of prostaglandins, but was without effect on COX-2 protein levels. Moreover, CX-35 and CX-32 reduced PGE2 production to levels comparable to those obtained in LPS-activated RAW cells incubated with the selective COX-2 inhibitor NS 398. Furthermore, both CX-32 and CX-35 showed no toxic effects, since viability of non-treated Hela cells was similar to Hela cells incubated with either CX-35 or CX-32. Our data demonstrated that CX-32 and CX-35 significantly blocked prostaglandin production induced during inflammatory cellular stress, possibly acting through specific COX-2 inhibition; confirmation of this hypothesis requires further investigation.
Published
N/A
2015-10-23T08:53:51Z
2015-10-23T08:53:51Z
2012
2016-05-09
Article
0076-6054
http://hdl.handle.net/10725/2322
Hamade, E., Habib, A., Hachem, A., H Hussein, A., Abbas, M., Hirz, T., ... & H Faour, W. (2012). Biological and anti-inflammatory evaluation of two thiazole compounds in RAW cell line: potential cyclooxygenase-2 specific inhibitors. Medicinal Chemistry, 8(3), 401-408.
http://www.ingentaconnect.com/content/ben/mc/2012/00000008/00000003/art00010
en
Medicinal Chemistry
oai:laur.lau.edu.lb:10725/23232024-01-31T15:13:50Zcom_10725_2056com_10725_2058com_10725_2053col_10725_2077col_10725_2073col_10725_2071
Growth hormone treatment modulates active ghrelin levels in rats
Haddad, Haytham
Mroueh, Mohamad
Faour, Wissam H.
Daher, Costantine
Introduction: Impairments in neuroendocrine regulation of food intake and postprandial satiety are leading causes to obesity. Ghrelin peptide is a GI hormone known to increase food intake partly through induction of growth hormone. The regulation of ghrelin production is still unknown. Objective: The aim of the current study is to investigate the influence of growth hormone (Genotropin) treatment on active ghrelin levels in plasma, stomach, pancreas and kidney in rats. Material/methods: Male Sprague-Dawley rats, randomly allocated into control and three treatment groups, received daily subcutaneous injections of Genotropin at 2, 20 and 100 µg/rat/day for 5 consecutive days. Active ghrelin levels were quantified per tissue mass or tissue protein. Results: In control groups, the highest active ghrelin concentration in pmol/g tissue was found in the stomach (15.5 ± 0.21) followed by the pancreas (1.96 ± 0.066) and the kidney (1.36 ± 0.037). Genotropin treatment caused a dose dependent decrease in active ghrelin concentration in stomach, kidney and pancreas with a concomitant increase in plasma, and reaching significance at 20 and 100 µg/rat/day doses. However, the treatment caused variable effect on total protein concentrations, with a decrease in pancreas and an increase in stomach and kidney supernatants. Consequently, under such treatment, determination of active ghrelin concentration per tissue mass rather than per tissue protein is favored. Conclusions: The present study suggests a direct correlation between Genotropin treatment and active ghrelin secretion into the rat plasma via modulating its stores in stomach, kidney and pancreas.
Published
N/A
2015-10-23T09:07:18Z
2015-10-23T09:07:18Z
2014
2015-10-23
Article
0743-5800
http://hdl.handle.net/10725/2323
http://dx.doi.org/10.3109/07435800.2013.799484
Haddad, H., Mroueh, M., Faour, W. H., & Daher, C. (2014). Growth hormone treatment modulates active ghrelin levels in rats. Endocrine research, 39(1), 39-43.
http://www.tandfonline.com/doi/abs/10.3109/07435800.2013.799484
en
Endocrine Research
oai:laur.lau.edu.lb:10725/23242019-02-27T11:25:21Zcom_10725_2056col_10725_2077
Influence of standardized patient body habitus on undergraduate student performance in an Objective Structured Clinical Examination
Bahous, Sola Aoun
Faour, Wissam
Asmar, Nadia
Yazbeck-Karam, Vanda
Khairallah, Maya
Purpose: Previous studies have shown that the standardized patient's (SP) gender may affect student performance in an Objective Structured Clinical Examination (OSCE). The aim of this study is to investigate the influence of the SPs’ body habitus on students’ performance in an OSCE counseling station.
Methods: Four equally trained female SPs, with either a normal or an obese BMI participated in an OSCE counseling station for cardiovascular risk factors. Ninety-two, second year medical students were randomly assigned to one of the SPs. Station scores were compared and student behavior and opinion regarding the influence of their SP's body habitus on their performance was assessed.
Results: There was no difference in mean exam scores for students interacting with SPs with a normal BMI versus increased BMI (14.9 ± 2.2 versus 14.01 ± 2.2/20 respectively, p = 0.06). Additionally, almost all students gave advice about healthy diets (93.5% versus 95.7%) with no specificity regarding the BMI of the SP.
Conclusions: The body habitus of the SP did not significantly affect students’ performance in an undergraduate OSCE about cardiovascular risk factors, suggesting that students at that level may primarily focus on gaining points the diagnostic checklist without considering SPs as real patients.
Published
N/A
2015-10-23T09:14:55Z
2015-10-23T09:14:55Z
2014
2015-10-23
Article
0142-159X
http://hdl.handle.net/10725/2324
http://dx.doi.org/10.3109/0142159X.2013.856511
Yazbeck-Karam, V., Aoun Bahous, S., Faour, W., Khairallah, M., & Asmar, N. (2014). Influence of standardized patient body habitus on undergraduate student performance in an Objective Structured Clinical Examination. Medical teacher, 36(3), 240-244.
https://www.tandfonline.com/doi/pdf/10.3109/0142159X.2013.856511?needAccess=true
en
Medical Teacher
oai:laur.lau.edu.lb:10725/23532019-05-30T09:29:33Zcom_10725_2056col_10725_2077
A novel xylene-free deparaffinization method for the extraction of proteins from human derived formalin-fixed paraffin embedded (FFPE) archival tissue blocks
Mansour, Anthony
Chatila, Rajaa
Bejjani, Noha
Faour, Wissam H.
Dagher, Carole
Protein detection methods in formalin-fixed paraffin embedded (FFPE) tissue blocks are widely used in research and clinical setting in order to diagnose or to confirm a diagnosis of various types of diseases. Therefore, multiple protein extraction methods from FFPE tissue sections have been developed in this regard. However, the yield and the quality of proteins extracted from FFPE tissues are significantly reduced in blocks stored for longer periods of time. Regardless the protein extraction method used, tissue sections must be first deparaffinized with xylene, and then washed in serial dilutions of ethanol in order to remove the toxic organic solvent “xylene” and rehydrate the tissue. The objective of this study was first to develop a method to deparaffinize FFPE blocks that excludes the use of toxic solvent “xylene”. Second minimize the time required to perform the extraction. Here we describe a method where:
•
The entire paraffin embedded blocks are deparaffinized and rehydrated using only hot distilled water as a substitute for both xylene and ethanol
•
The entire procedure takes about 15 min
•
Deparaffinized blocks are immediately homogenized in lysis buffer, and the obtained lysate analyzed by Western blot.
With this new modified technique, we were able to successfully detect actin and AKT proteins in lysates from blocks embedded in paraffin for up to 9 years.
Published
N/A
2015-10-27T09:19:12Z
2015-10-27T09:19:12Z
2014
2015-10-27
Article
2215-0161
http://hdl.handle.net/10725/2353
http://dx.doi.org/10.1016/j.mex.2014.07.006
Mansour, A., Chatila, R., Bejjani, N., Dagher, C., & Faour, W. H. (2014). A novel xylene-free deparaffinization method for the extraction of proteins from human derived formalin-fixed paraffin embedded (FFPE) archival tissue blocks. MethodsX, 1, 90-95.
http://www.sciencedirect.com/science/article/pii/S2215016114200355
en
MethodsX
oai:laur.lau.edu.lb:10725/23542021-03-19T09:59:48Zcom_10725_2056col_10725_2077
Proliferation and differentiation of human adipose-derived mesenchymal stem cells (ASCs) into osteoblastic lineage are passage dependent
Faour, Wissam
Abdalla, Eddie
Di Battista, Jiovanni
Shehaby, Wassim
Kizilay, Ozge
Hamade, Eva
Abou Merhi, Raghida
Mebarek, Saida
Abdallah, Dina
Badran, Bassam
Saad, Fady
Objective
The effect of in vitro expansion of human adipose-derived stem cells (ASCs) on stem cell properties is controversial. We examined serial subcultivation with expansion on the ability of ASCs to grow and differentiate into osteoblastic lineages.
Design
Flow cytometric analysis, growth kinetics, cell population doubling time, light microscopy and confocal analysis, and osteogenesis induction were performed to assess growth and osteogenic potential of subcultivated ASCs at passages 2 (P2), P4 and P6.
Results
Flow cytometric analysis revealed that ASCs at P2 express classical mesenchymal stem cell markers including CD44, CD73, and CD105, but not CD14, CD19, CD34, CD45, or HLA-DR. Calcium deposition and alkaline phosphatase activity were the highest at P2 but completely abrogated at P4. Increased passage number impaired cell growth; P2 cultures exhibited exponential growth, while cells at P4 and P6 showed near linear growth with cell population doubling times increased from 3.2 at P2 to 4.8 d at P6. Morphologically, cells in various subcultivation stages showed flattened shape at low density but spindle-like structures at confluency as judged by phalloidin staining.
Conclusions
Osteogenic potential of ASCs is impaired by successive passaging and may not serve as a useful clinical source of osteogenic ASCs past P2.
Published
N/A
2015-10-27T09:32:40Z
2015-10-27T09:32:40Z
2014
2016-05-10
Article
1023-3830
http://hdl.handle.net/10725/2354
http://dx.doi.org/10.1007/s00011-014-0764-y
Di Battista, J. A., Shebaby, W., Kizilay, O., Hamade, E., Merhi, R. A., Mebarek, S., ... & Faour, W. H. (2014). Proliferation and differentiation of human adipose-derived mesenchymal stem cells (ASCs) into osteoblastic lineage are passage dependent. Inflammation Research, 63(11), 907-917.
en
Inflammation Research
oai:laur.lau.edu.lb:10725/24962019-02-26T08:05:51Zcom_10725_2056col_10725_2077
Arterial levels of oxidized glutathione (GSSG) reflect oxidant stress in vivo
Abdalla, Eddie
Mickeal, Caty
Guice, Karen
Hinshaw, Daniel
Oldham, Keith
Neutrophil-related, oxidant-mediated injury to the pulmonary microvasculature appears to follow endotoxemia, cutaneous thermal injury, and ischemia—reperfusion injury to the liver or intestine. Glutathione is an important endogenous intracellular oxygen radical scavenger. Plasma concentrations of oxidized glutathione (GSSG) reflect oxidant injury resulting from an overdose of certain oxidatively metabolized drugs. The purpose of this investigation was to evaluate plasma GSSG as an indicator of oxidant stress resulting from activation of the endogenous inflammatory response. An established model of neutrophil- and oxidant-related acute lung injury following intestinal ischemia and reperfusion in rats was used. Intestinal ischemia was induced by clip occlusion of the superior mesenteric artery (SMA) for 120 min. Reperfusion resulted from SMA clip removal. Following reperfusion for 0, 15, or 120 min, plasma GSSG levels in portal vein, inferior vena cava (IVC), and aorta were obtained. Plasma GSSG was undetectable in sham animals and those with intestinal ischemia alone. Following reperfusion, all plasma samples had significant elevations in GSSG. Aortic plasma GSSG after 15 min of reperfusion was significantly elevated compared to both portal vein and IVC plasma GSSG. These data suggest that oxidant stress after intestinal reperfusion is reflected by elevations in plasma GSSG. The step up in plasma GSSG across the pulmonary vascular bed, a site of known oxidant injury, suggests that plasma GSSG may be a useful marker of oxidant stress in vivo, particularly with regard to the pulmonary microvasculature. This simple in vivo approach to assessing oxidant stress related to inflammatory tissue injury may have the potential to be of significant use in the clinical setting.
Published
N/A
2015-11-09T12:48:00Z
2015-11-09T12:48:00Z
1990
2015-11-09
Article
0022-4804
http://hdl.handle.net/10725/2496
http://dx.doi.org/10.1016/0022-4804(90)90061-6
Abdalla, E. K., Caty, M. G., Guice, K. S., Hinshaw, D. B., & Oldham, K. T. (1990). Arterial levels of oxidized glutathione (GSSG) reflect oxidant stress in vivo. Journal of Surgical Research, 48(4), 291-296.
http://www.sciencedirect.com/science/article/pii/0022480490900616
en
Journal of Surgical Research
oai:laur.lau.edu.lb:10725/24982019-02-26T09:38:19Zcom_10725_2056col_10725_2077
Increased leptin expression in mice with bacterial peritonitis is partially regulated by tumor necrosis factor alpha
Abdalla, Eddie
Moshyedi, Armin
Joseph, Michael
Mackay, Sally
Edwards III, Carl
Copeland III, Edward
Moldawer, Lyle
Plasma leptin and ob gene mRNA levels were increased in mice following bacterial peritonitis, and blocking an endogenous tumor necrosis factor alpha (TNF-α) response blunted the increase. However, plasma leptin concentrations did not correlate with the associated anorexia. We conclude that leptin expression is under partial regulatory control of TNF-α in peritonitis, but the anorexia is not dependent on increased leptin production.
Published
N/A
2015-11-09T13:29:53Z
2015-11-09T13:29:53Z
1998
2015-11-09
Article
0019-9567
http://hdl.handle.net/10725/2498
Moshyedi, A. K., Josephs, M. D., Abdalla, E. K., MacKay, S. L., Edwards, C. K., Copeland, E. M., & Moldawer, L. L. (1998). Increased leptin expression in mice with bacterial peritonitis is partially regulated by tumor necrosis factor alpha. Infection and immunity, 66(4), 1800-1802.
http://iai.asm.org/content/66/4/1800.short
en
Infection and Immunity
oai:laur.lau.edu.lb:10725/25002016-08-26T06:40:48Zcom_10725_2056col_10725_2077
Paraplegia following intraoperative celiac plexus injection
Abdalla, Eddie
Schell, Scott
The technique for percutaneous and open neurolytic celiac plexus injection, using ethanol or phenol, for relief of intractable pancreatic cancer pain has been well described. Prospective randomized studies, demonstrating safety and efficacy with few complications, have led to widespread acceptance and use of this palliative procedure. The complications of neurolytic celiac plexus injection are rare, and are usually minor. However, transient or permanent paraplegia has been reported previously in 10 cases. The case described herein represents the third reported case of permanent paraplegia following open intraoperative neurolytic celiac plexus injection using 50% ethanol. The literature surveying the indications for this procedure, routes of administration, known complications, and their pathophysiology are reviewed.
Published
N/A
2015-11-09T13:43:49Z
2015-11-09T13:43:49Z
1999
2015-11-09
Article
1091-255X
http://hdl.handle.net/10725/2500
http://dx.doi.org/10.1016/S1091-255X(99)80091-2
Abdalla, E. K., & Schell, S. R. (1999). Paraplegia following intraoperative celiac plexus injection. Journal of Gastrointestinal Surgery, 3(6), 668-671.
http://www.sciencedirect.com/science/article/pii/S1091255X99800912
en
oai:laur.lau.edu.lb:10725/25022016-08-11T05:44:00Zcom_10725_2056col_10725_2077
Monolobar Caroli's Disease and cholangiocarcinoma
Abdalla, Eddie
Forsmark, Christopher
Lauwers, Gregory
Vauthey, Nicolas
Caroli's Disease (CD) is a rare congenital disorder characterized by cystic dilatation of the intrahepatic bile ducts. This report describes a patient with cholangiocarcinoma arising in the setting of monolobar CD. In spite of detailed investigations including biliary enteric bypass and endoscopic retrograde cholangiography, the diagnosis of mucinous cholangiocarcinoma (CCA) was not made for almost one year. The presentation, diagnosis and treatment of monolobar CD and the association between monolobar CD and biliary tract cancer are discussed. Hepatic resection is the treatment of choice for monolobar CD.
Published
N/A
2015-11-09T13:55:00Z
2015-11-09T13:55:00Z
1999
2015-11-09
Article
0894-8569
http://hdl.handle.net/10725/2502
http://dx.doi.org/10.1155/1999/70985
Abdalla, E. K., Forsmark, C. E., Lauwers, G. Y., & Vauthey, J. N. (1999). Monolobar Caroli's disease and cholangiocarcinoma. HPB Surgery, 11(4), 271-277.
http://www.hindawi.com/journals/hpb/1999/070985/abs/
en
HPB surgery
oai:laur.lau.edu.lb:10725/25032019-02-26T10:49:53Zcom_10725_2056col_10725_2077
Recent advances in the treatment and outcome of locally advanced rectal cancer
Abdalla, Eddie
Vauthey, Nicolas
Marsh, Robert
Zlotecki, Robert
Solorzano, Carmen
Bray, Elizabeth
Freeman, Mark
Lauwers, Gregory
Kubilis, Paul
Mendenhall, William
Copeland III, Edward
Objective
To compare the outcomes of treatment of locally advanced rectal cancer of the early era (1975–1990) with those of the late era (1991–1997).
Background
Preoperative therapy has been used in locally advanced rectal cancer to preserve sphincter function, decrease local recurrence, and improve survival. At the University of Florida, preoperative radiation has been used since 1975, and it was combined with chemotherapy beginning in 1991.
Methods
The records of 328 patients who underwent preoperative radiation or chemoradiation followed by complete resection for locally advanced rectal cancer defined as tethered, annular, or fixed tumors were reviewed. The clinicopathologic characteristics, adjuvant treatment administered, surgical procedures performed, and local recurrence-free and overall survival rates were analyzed.
Results
There were 219 patients in the early era and 109 in the late era. No significant differences were seen in patients (age, gender, race) or tumor characteristics (mean distance from the anal verge, annularity, fixation). Preoperative radiation regimens were radiobiologically comparable. No patient in the early era received preoperative chemotherapy, compared with 64 in the late era. Of those receiving any pre- or postoperative chemotherapy, three patients received chemotherapy in the early era, compared with 76 in the late era. Sphincter-preserving procedures increased from 13% in the early era to 52% in the late era. Pathologic downstaging for depth of invasion increased from 42% to 58%, but lymph node negativity remained similar. The 1-, 3-, and 5-year local recurrence-free survival rates were comparable. However, in the late era, 1-, 3-, and 5-year overall survival rates improved significantly compared with those of the early era, and also compared with each of the preceding 5-year intervals.
Published
N/A
2015-11-09T14:10:01Z
2015-11-09T14:10:01Z
1999
2015-11-09
Article
0003-4932
http://hdl.handle.net/10725/2503
Vauthey, J. N., Marsh, R. D. W., Zlotecki, R. A., Abdalla, E. K., Solorzano, C. C., Bray, E. J., ... & Copeland III, E. M. (1999). Recent advances in the treatment and outcome of locally advanced rectal cancer. Annals of surgery, 229(5), 745.
http://journals.lww.com/annalsofsurgery/Abstract/1999/05000/Recent_Advances_in_the_Treatment_and_Outcome_of.18.aspx
en
Recent advances in the treatment and outcome of locally advanced rectal cancer
oai:laur.lau.edu.lb:10725/25042016-08-25T09:04:52Zcom_10725_2056col_10725_2077
Breast Disease-Related Educational Outcomes at the University of Florida
Abdalla, Eddie
Lind, Scott
Flynn, Timothy
Tepas, Joseph
Copeland III, Edward
The purpose of this study was to assess resident knowledge related to breast disease at the University of Florida. In addition, we surveyed graduates of our surgery program regarding the importance of breast disease in their surgical practice and we determined if the completion of postgraduate courses on breast disease influenced patient outcome measures. In the decade of the 1990s, we compared the American Board of Surgery In-Service Training Examination (ABSITE) scores of residents rotating on the breast service in the 6 months immediately prior to examination (June–January) with those residents who had not rotated on the breast service within the 6 months leading up to the ABSITE examination. We also compared ABSITE scores of surgery residents at the University of Florida at Gainesville (breast service) to surgery residents at the University of Florida at Jacksonville (no breast service). Finally, we surveyed graduates of the general surgery program at the University of Florida at Gainesville (1980–1998) to determine the importance of breast disease in their practices and if the completion of postgraduate courses on breast disease influenced rates of breast conservation and immediate breast reconstruction. Residents who rotated on the breast service in the 6 months prior to the ABSITE had significantly fewer incorrect breast-related ABSITE questions than residents who had not rotated on the breast service. Those graduates who had taken postgraduate courses in breast disease responded that they were more likely to perform breast–conserving surgery. There was also a trend for graduates who had completed postgraduate courses on breast disease to respond that they were more likely to perform immediate breast reconstruction following mastectomy. Limiting breast surgery to a single service does not appear to improve resident accumulation and retention of breast disease-related knowledge. Graduates who complete postgraduate courses related to breast disease are more likely to perform breast-conserving surgery and immediate reconstruction following mastectomy. Since the management of breast disease comprises a significant part of general surgical practice, surgical educators must ensure adequate resident education and evaluation with respect to breast disease.
Published
N/A
2015-11-10T08:29:55Z
2015-11-10T08:29:55Z
2000
2015-11-10
Article
1075-122X
http://hdl.handle.net/10725/2504
http://dx.doi.org/10.1046/j.1524-4741.2000.99035.x
Lind, D. S., Abdalla, E. K., Flynn, T. C., Tepas, J. J., & Copeland, E. M. (2000). Breast Disease‐Related Educational Outcomes at the University of Florida. The breast journal, 6(3), 157-160.
http://onlinelibrary.wiley.com/doi/10.1046/j.1524-4741.2000.99035.x/full
en
Breast journal
oai:laur.lau.edu.lb:10725/25052019-02-26T10:46:32Zcom_10725_2056col_10725_2077
Portal vein embolization
Rationale, technique and future prospects
Abdalla, Eddie
Hicks, M.E.
Vauthey, Nicolas
Background:
Advances in surgery have reduced the mortality rate after major liver resection, but complications resulting from inadequate postresection hepatic size and function remain. Portal vein embolization (PVE) was proposed to induce hypertrophy of the anticipated liver remnant in order to reduce such complications. The techniques, measurement methods and indications for this treatment remain controversial.
Methods:
A Medline search was performed to identify papers reporting the use of PVE before hepatic resection. Techniques, complications and results are reviewed.
Results:
Complications of PVE typically occur in less than 5 per cent of patients. No specific substance (cyanoacrylate, thrombin, coils or absolute alcohol) emerged as superior. The increase in remnant liver volume averages 12 per cent of the total liver. The morbidity rate of resection after treatment is less than 15 per cent and the mortality rate is 6–7 per cent with cirrhosis and 0–6·5 per cent without cirrhosis. Embolization is currently used for patients with a normal liver when the anticipated liver remnant volume is 25 per cent or less of the total liver volume, and for patients with compromised liver function when the liver remnant volume is 40 per cent or less.
Conclusion:
This treatment does not increase the risks associated with major liver resection. It may be indicated in selected patients before major resection. Future prospective studies are needed to define more clearly the indications for this evolving technique. © 2001 British Journal of Surgery Society Ltd
Published
N/A
2015-11-10T08:40:35Z
2015-11-10T08:40:35Z
2001
2015-11-10
Article
0007-1323
http://hdl.handle.net/10725/2505
http://dx.doi.org/10.1046/j.1365-2168.2001.01658.x
Abdalla, E. K., Hicks, M. E., & Vauthey, J. N. (2001). Portal vein embolization: rationale, technique and future prospects. British journal of surgery, 88(2), 165-175.
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2168.2001.01658.x/full
en
British Journal of Surgery
oai:laur.lau.edu.lb:10725/25062016-08-25T09:20:22Zcom_10725_2056col_10725_2077
Cytosolic Phospholipase A2-Mediated ICAM-1 Expression Is Calcium Dependent
Abdalla, Eddie
Carlton, Barnett
Moore, Ernest
Silliman, Christopher
David, Patrick
Curley, Steven
Background. Some human malignancies such as virus-related hepatocellular cancer arise in a setting of chronic inflammation. Upregulation of ICAM-1 is a seminal late event in malignant transformation following chronic inflammation. Cytosolic phospholipase A2 (cPLA2) is a lipid-mediator activated by inflammatory stimuli, which has been shown to mediate ICAM-1 upregulation. As lipid mediators are known to work via calcium-dependent mechanisms in nearly all mammalian cells, we hypothesize that inflammatory-mediated ICAM-1 upregulation is dependent on both cPLA2 and intracellular calcium.
Materials and methods. HUVEC were chosen as a representative cell line as they emulate hepatic sinusoids and are a well-established cell model. These were grown to confluence in T-25 flasks and stimulated with TNF-α or LPS for 6 h. Additional groups were preincubated with AACOCF3 (a specific cPLA2 inhibitor) or BAPTA A.M. (a specific inhibitor of intracellular Ca2+) prior to being exposed to inflammatory stimuli. ICAM-1 expression was determined by mean fluorescent intensity (MFI) as measured by FITC-labeled moAb to ICAM-1 via FACS. The role of intracellular Ca2+ on cPLA2 activity was determined by thin-layer chromatography. Groups were compared using ANOVA with Scheffe's post hoc analysis; *P < 0.05 vs control, †P < 0.05 vs LPS and TNF-α was considered significant; N ≥ 4 all experimental groups.
Results. Both cPLA2 and Ca2+ inhibition significantly inhibited inflammatory upregulation of ICAM-1. Pretreatment with BAPTA A.M. attenuated HUVEC cPLA2 activity in response to LPS. These findings suggest that appropriate molecular target suppression may prevent malignant degeneration in the presence of chronic inflammation.
Published
N/A
2015-11-10T08:58:08Z
2015-11-10T08:58:08Z
2001
2015-11-10
Article
0022-4804
http://hdl.handle.net/10725/2506
http://dx.doi.org/10.1006/jsre.2001.6188
Barnett, C. C., Moore, E. E., Silliman, C. C., Abdalla, E. K., Partrick, D. A., & Curley, S. A. (2001). Cytosolic phospholipase A 2-mediated ICAM-1 expression is calcium dependent. Journal of Surgical Research, 99(2), 307-310.
http://www.sciencedirect.com/science/article/pii/S0022480401961888
en
Journal of Surgical Research
oai:laur.lau.edu.lb:10725/25072019-02-26T08:08:16Zcom_10725_2056col_10725_2077
Biallelic inactivation of the APC gene is associated with hepatocellular carcinoma in familial adenomatous polyposis coli
Abdalla, Eddie
Su, Li-Kuo
Law, Calvin
Kohlmann, Wendy
Rashid, Asif
Vauthey, Nicolas
BACKGROUND
Certain primary hepatic tumors have been associated with familial adenomatous polyposis (FAP), a condition caused by germline mutations of the adenomatous polyposis coli (APC) gene. However, a genetic association between FAP and hepatocellular carcinoma (HCC) has not been shown. This study tested the hypothesis that biallelic inactivation of the APC gene contributed to the development of HCC in a patient with FAP and a known germline mutation of the APC gene at codon 208, but no other risk factors for HCC.
METHODS
Total RNA and genomic DNA were isolated from the tumor, and in vitro synthesized protein assay and DNA sequencing analysis were used to screen for a somatic mutation in the APC gene.
RESULTS
A somatic one–base pair deletion at codon 568 was identified in the wild-type allele of the APC gene.
CONCLUSIONS
To the authors' knowledge, this study provides the first evidence that biallelic inactivation of the APC gene may contribute to the development of HCC in patients with FAP. Cancer 2001;92:332–9. © 2001 American Cancer Society.
Published
N/A
2015-11-10T09:10:33Z
2015-11-10T09:10:33Z
2001
2015-11-10
Article
0008-543X
http://hdl.handle.net/10725/2507
http://dx.doi.org/10.1002/1097-0142(20010715)92:2<332::AID-CNCR1327>3.0.CO;2-3
Su, L. K., Abdalla, E. K., Law, C. H., Kohlmann, W., Rashid, A., & Vauthey, J. N. (2001). Biallelic inactivation of the APC gene is associated with hepatocellular carcinoma in familial adenomatous polyposis coli. Cancer, 92(2), 332-339.
http://onlinelibrary.wiley.com/doi/10.1002/1097-0142(20010715)92:2%3C332::AID-CNCR1327%3E3.0.CO;2-3/full
en
Cancer
oai:laur.lau.edu.lb:10725/25082016-08-25T09:46:38Zcom_10725_2056col_10725_2077
Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization
Abdalla, Eddie
Barnett, Carlton
Doherty, Dorota
Curley, Steven
Vauthey, Nicolas
Hypothesis Preoperative portal vein embolization (PVE) allows potentially curative hepatic resection without additional morbidity or mortality in patients with hepatobiliary malignancies who are marginal candidates for resection based on small liver remnant size.
Design A retrospective review of a consecutive series of patients in a multi-institutional database who underwent extended hepatectomy.
Setting University-based referral centers.
Patients Forty-two patients underwent preoperative determination of the future liver remnant (FLR) volume before extended hepatectomy (≥5 segments) for hepatobiliary malignancy without chronic underlying liver disease. Patients were stratified by treatment with or without preoperative PVE.
Intervention Preoperative percutaneous PVE.
Main Outcome Measures Clinical characteristics, FLR volume, operative morbidity, and survival.
Results There was no difference between the groups that did and did not undergo PVE for the number of tumors, tumor size, estimated blood loss, duration of the operation, complexity of resection, or surgical margins. The FLR at presentation was significantly smaller in patients who underwent PVE than in patients who did not undergo PVE (18% vs 23%; P<.001). After PVE, FLR volumes increased significantly (P = .003); preoperative FLR volumes were similar in both groups (patients who underwent PVE, 25%; and patients who did not undergo PVE, 23%). There was no perioperative mortality and no statistical difference in the incidence of perioperative complications between those who did and those who did not undergo PVE (5 [28%] of 18 patients vs 5 [21%] of 24 patients). The overall 3-year survival was 65% and the median survival duration was equivalent in the 2 groups (40 vs 52 months for those who did vs those who did not undergo PVE).
Conclusion Portal vein embolization enables safe and potentially curative extended hepatectomy in a subset of patients who would otherwise be marginal candidates for resection based on a small liver remnant size.
N/A
N/A
2015-11-10T09:27:08Z
2015-11-10T09:27:08Z
2002
2015-11-10
Article
http://hdl.handle.net/10725/2508
http://dx.doi.org/10.1001/archsurg.137.6.675
Abdalla, E. K., Barnett, C. C., Doherty, D., Curley, S. A., & Vauthey, J. N. (2002). Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Archives of Surgery, 137(6), 675-681.
http://archsurg.jamanetwork.com/article.aspx?articleid=212568
en
JAMA Surgery
oai:laur.lau.edu.lb:10725/25092019-02-26T10:18:47Zcom_10725_2056col_10725_2077
Metastasectomy for limited metastases from soft tissue sarcoma
Pisters, Peter
Abdalla, Eddie
The development of metastatic soft tissue sarcoma (American Joint Committee on Cancer stage IV) is associated with a poor prognosis. Surgical resection of isolated solitary or multiple metastases is the only curative treatment; all other forms of treatment are considered palliative. As with all surgical procedures, patient selection is important to maximize the clinical benefit of metastasectomy and to minimize the risk for treatment-related morbidity. Over the past decade, nonresectional ablative approaches have been developed to manage visceral metastatic disease. These ablative procedures include cryosurgery, radiofrequency tumor ablation, and alcohol injection. All such procedures are considered investigational; outcome should be compared to that achievable with traditional surgical metastasectomy. The optimal sequence of treatments and role for perioperative (combined with metastasectomy) chemotherapy are unknown. Given the potential curative nature of metastasectomy, all patients with metastatic soft tissue sarcoma should be evaluated for the possibility of surgical resection. Patients with good performance status who have radiographically resectable disease should be considered for metastasectomy.
Published
N/A
2015-11-10T09:35:02Z
2015-11-10T09:35:02Z
2002
2015-11-10
Article
1527-2729
http://hdl.handle.net/10725/2509
http://dx.doi.org/10.1007/s11864-002-0069-1
Abdalla, E. K., & Pisters, P. W. (2002). Metastasectomy for limited metastases from soft tissue sarcoma. Current treatment options in oncology, 3(6), 497-505.
http://link.springer.com/article/10.1007/s11864-002-0069-1
en
Current Treatment Options in Oncology
oai:laur.lau.edu.lb:10725/25102016-08-25T08:49:34Zcom_10725_2056col_10725_2077
Activation of Src Kinase in Primary Colorectal Carcinoma
Abdalla, Eddie
Allgayer, Heike
Boyd, Douglas
Heiss, Markus
Curley, Steven
Gallick, Gary
BACKGROUND. The specific activity of the non-receptor protein tyrosine kinase, Src,
is increased in the majority of colon and rectal adenocarcinomas compared to
normal mucosa. However, the prognostic significance of this difference is unknown.
The objective of the current study was to determine if Src activity is a
marker for poor clinical prognosis in colon carcinoma patients. As Src activation
leads to expression of urokinase/plasminogen activator receptor (u-PAR), expression
of Src and u-PAR were correlated with patient survival.
METHODS. Tumors and adjacent normal colonic mucosae from 45 patients with
colorectal carcinoma were screened for Src activity by the immune complex kinase
assay. Expression of u-PAR was determined by enzyme linked immunoabsorbent
assay. The primary tumor-to-normal mucosa ratios of activity were compared
following classification and regression tree (CART) analysis to determine the prognostic
significance of elevated specific Src activity. Expression of u-PAR was correlated
with Src activity.
RESULTS. By CART analysis, Src activity in tumors elevated more than twofold over
normal mucosa was significant. Increased Src activity significantly correlated with
Dukes stage, pT and pN classification, and increased u-PAR levels (P 0.001).
Kaplan Meier analysis showed a significant association between elevated Src
activity and shorter overall survival of all patients (P 0.0004) and of Dukes Stage
A-C patients (P 0.0037). In patients who underwent curative resection, a significant
correlation with a decreased disease-free survival rate was found (P
0.0001). Multivariate analysis revealed that elevated Src activity was a prognostic
parameter independent of M classification (P 0.0125, relative risk 3.54, 95%
confidence interval 1.31 – 9.76).
CONCLUSIONS. Src activity is an independent indicator of poor clinical prognosis in
all stages of human colon carcinoma. These data suggest that Src-specific inhibitors
may have a therapeutic role in inhibiting tumor progression and metastasis,
and that measurement of Src activity may aid in selection of early stage patients for
adjuvant therapy. C
Published
N/A
2015-11-10T09:43:41Z
2015-11-10T09:43:41Z
2002
2015-11-10
Article
0008-543X
http://hdl.handle.net/10725/2510
http://dx.doi.org/10.1002/cncr.10221
Allgayer, H., Boyd, D. D., Heiss, M. M., Abdalla, E. K., Curley, S. A., & Gallick, G. E. (2002). Activation of Src kinase in primary colorectal carcinoma. Cancer, 94(2), 344-351.
http://onlinelibrary.wiley.com/doi/10.1002/cncr.10221/full
en
Cancer
oai:laur.lau.edu.lb:10725/25112019-02-26T08:08:55Zcom_10725_2056col_10725_2077
Body surface area and body weight predict total liver volume in Western adults
Abdalla, Eddie
Vauthey, Nicolas
Doherty, Dorota
Gertsch, Philippe
Fenstermacher, Marc
Loyer, Evelyne
Leurt, Jan
Materne, Roland
Wang, Xuemei
Encarnacion, Arthur
Herron, Delise
Mathey, Christian
Ferrari, Giovanni
Charnsangavej, Chusilp
Do, Kim-Anh
Denys, Alban
Computed tomography (CT) is used increasingly to measure liver volume in patients undergoing evaluation for transplantation or resection. This study is designed to determine a formula predicting total liver volume (TLV) based on body surface area (BSA) or body weight in Western adults. TLV was measured in 292 patients from four Western centers. Liver volumes were calculated from helical computed tomographic scans obtained for conditions unrelated to the hepatobiliary system. BSA was calculated based on height and weight. Each center used a different established method of three-dimensional volume reconstruction. Using regression analysis, measurements were compared, and formulas correlating BSA or body weight to TLV were established. A linear regression formula to estimate TLV based on BSA was obtained: TLV = −794.41 + 1,267.28 × BSA (square meters; r2 = 0.46; P < .0001). A formula based on patient weight also was derived: TLV = 191.80 + 18.51 × weight (kilograms; r2 = 0.49; P < .0001). The newly derived TLV formula based on BSA was compared with previously reported formulas. The application of a formula obtained from healthy Japanese individuals underestimated TLV. Two formulas derived from autopsy data for Western populations were similar to the newly derived BSA formula, with a slight overestimation of TLV. In conclusion, hepatic three-dimensional volume reconstruction based on helical CT predicts TLV based on BSA or body weight. The new formulas derived from this correlation should contribute to the estimation of TLV before liver transplantation or major hepatic resection.
Published
N/A
2015-11-10T09:58:25Z
2015-11-10T09:58:25Z
2002
2015-11-10
Article
1527-6465
http://hdl.handle.net/10725/2511
http://dx.doi.org/10.1053/jlts.2002.31654
Vauthey, J. N., Abdalla, E. K., Doherty, D. A., Gertsch, P., Fenstermacher, M. J., Loyer, E. M., ... & Denys, A. (2002). Body surface area and body weight predict total liver volume in Western adults. Liver transplantation, 8(3), 233-240.
http://onlinelibrary.wiley.com/doi/10.1053/jlts.2002.31654/full
en
Liver Transplantation
oai:laur.lau.edu.lb:10725/25122019-02-26T09:56:33Zcom_10725_2056col_10725_2077
Localized adenocarcinoma of the pancreas: the rationale for preoperative chemoradiation
Abdalla, Eddie
Wayne, Jeffrey
Wolff, Edward
Crane, Christopher
Pisters, Peter
Evans, Douglas
Pancreatic adenocarcinoma is the fifth leading cause of cancer-related death in the U.S. In spite of advancements in surgical treatment, nearly 80% of patients thought to have localized pancreatic cancer die of recurrent or metastatic disease when treated with surgery alone. Therefore, efforts to alter the patterns of recurrence and improve survival for patients with pancreatic cancer currently focus on the delivery of systemic therapy and irradiation before or after surgery. Postoperative adjuvant therapy appears to improve median survival. However, more than one-fourth of patients do not complete planned adjuvant therapy due to surgical complications or a delay in postoperative recovery of performance status. Utilizing a preoperative (neoadjuvant) approach, overall treatment time is reduced, a greater proportion of patients receive all components of therapy, and patients with rapidly progressive disease are spared the side effects of surgery as metastatic disease may be found at restaging following chemoradiation (prior to surgery).
This paper examines the factors pertinent to clinical trial design for resectable pancreatic cancer, and carefully reviews the existing data supporting adjuvant and neoadjuvant therapy for potentially resectable disease.
Published
N/A
2015-11-10T10:07:39Z
2015-11-10T10:07:39Z
2002
2015-11-10
Article
1083-7159
http://hdl.handle.net/10725/2512
http://dx.doi.org/10.1634/theoncologist.7-1-34
Wayne, J. D., Abdalla, E. K., Wolff, R. A., Crane, C. H., Pisters, P. W., & Evans, D. B. (2002). Localized adenocarcinoma of the pancreas: the rationale for preoperative chemoradiation. The Oncologist, 7(1), 34-45.
en
The Oncologist
oai:laur.lau.edu.lb:10725/25132016-08-26T08:23:13Zcom_10725_2056col_10725_2077
Subaquatic laparoscopy for staging of intraabdominal malignancy
Abdalla, Eddie
Barnett, Carlton
Pisters, Peter
Cleary, Karen
Evans, Douglas
Feig, Barry
Mansfield, Paul
Published
N/A
2015-11-10T10:18:35Z
2015-11-10T10:18:35Z
2003
2015-11-10
Article
Abdalla, E. K., Barnett, C. C., Pisters, P. W., Cleary, K. R., Evans, D. B., Feig, B. W., & Mansfield, P. F. (2003). Subaquatic laparoscopy for staging of intraabdominal malignancy. Journal of the American College of Surgeons, 196(1), 155-158.
1072-7515
http://hdl.handle.net/10725/2513
http://dx.doi.org/10.1016/S1072-7515(02)01614-9
en
Journal of the American College of Surgeons
oai:laur.lau.edu.lb:10725/25142019-02-26T10:55:40Zcom_10725_2056col_10725_2077
Resection Prior to Liver Transplantation for Hepatocellular Carcinoma
Belghiti, Jacques
Cortes, Alexandre
Abdalla, Eddie
Regimbeau, Jean-Marc
Prakash, Kurumboor
Durand, Francois
Sommacale, Daniele
Dondero, Federica
Lesurtel, Mickeal
Sauvanet, Alain
Farges, Olivier
Kianmanesh, Reza
Objective:
To evaluate the feasibility and postoperative course of liver transplantation (LT) in cirrhotic patients who underwent liver resection prior to LT for HCC.
Summary Background Data:
Although LT provides longer survival than liver resection for treatment of small HCCs, donor shortage and long LT wait time may argue against LT. The feasibility and survival following LT after hepatic resection have not been previously examined.
Methods:
Between 1991 and 2001, among 107 patients who underwent LT for HCC, 88 met Mazzafero’s criteria upon pathologic analysis of the explant. Of these, 70 underwent primary liver transplantation (PLT) and 18 liver resection prior to secondary liver transplantation (SLT) for recurrence (n = 11), deterioration of liver function (n = 4), or high risk for recurrence (n = 3). Perioperative and postoperative factors and long-term survival were compared.
Results:
Comparison of PLT and SLT groups at the time of LT revealed similar median age (53 vs. 55 years), sex, and etiology of liver disease (alcohol/viral B/C/other). In the SLT group, the mean time between liver resection and listing for LT was 20 months (range 1–84 months). Overall time on LT waiting list of the two groups was similar (3 vs. 5 months). Pathologic analysis after LT revealed similar tumor size (2.2 vs. 2.3 cm) and number (1.6 vs. 1.7). Perioperative and postoperative courses were not different in terms of operative time (551 vs. 530 minutes), blood loss (1191 vs. 1282 mL), transfusion (3 vs. 2 units), ICU (9 vs. 10 days) or hospital stay (32 vs. 31 days), morbidity (51% vs. 56%) or 30-day mortality (5.7% vs. 5.6%). During a median follow-up of 32 months (3 to 158 months), 3 patients recurred after PLT and one after SLT. After transplantation, 3- and 5-year overall survivals were not different between groups (82 vs. 82% and 59 vs. 61%).
Conclusions:
In selected patients, liver resection prior to transplantation does not increase the morbidity or impair long-term survival following LT. Therefore, liver resection prior to transplantation can be integrated in the treatment strategy for HCC.
Published
N/A
2015-11-10T12:43:55Z
2015-11-10T12:43:55Z
2003
2015-11-10
Article
0003-4932
http://hdl.handle.net/10725/2514
http://dx.doi.org/10.1097/01.sla.0000098621.74851.65
Belghiti, J., Cortes, A., Abdalla, E. K., Régimbeau, J. M., Prakash, K., Durand, F., ... & Kianmanesh, R. (2003). Resection prior to liver transplantation for hepatocellular carcinoma. Annals of surgery, 238(6), 885.
http://journals.lww.com/annalsofsurgery/Abstract/2003/12000/Resection_Prior_to_Liver_Transplantation_for.12.aspx
en
oai:laur.lau.edu.lb:10725/25152016-08-26T07:20:05Zcom_10725_2056col_10725_2077
Right portal vein ligation: a new planned two-step all-surgical approach for complete resection of primary gastrointestinal tumors with multiple bilateral liver metastases
Abdalla, Eddie
Kianmanesh, Reza
Farges, Olivier
Sauvanet, Alain
Ruszniewski, Philippe
Belghiti, Jacques
Published
N/A
2015-11-10T12:53:55Z
2015-11-10T12:53:55Z
2003
2015-11-10
Article
0001-0790
http://hdl.handle.net/10725/2515
http://dx.doi.org/10.1016/S1072-7515(03)00334-X
en
Journal of the American College of Surgeons
oai:laur.lau.edu.lb:10725/25162019-02-26T08:09:54Zcom_10725_2056col_10725_2077
Carotid artery revascularization through a radiated field
Abdalla, Eddie
Lesèche, Guy
Castier, Yves
Chataigner, Olivier
Francis, Fady
Besnard, Mathieu
Thabut, Gabriel
Cerceau, Olivier
Objective
Extracranial carotid stenosis is a complication of external head and neck irradiation. The safety and durability of carotid artery revascularization through a radiated field has been debated. We describe the immediate and long-term results in a series of 27 consecutive patients who received treatment over 12 years.
Methods
From May 1990 to May 2002, 27 consecutive patients underwent 30 primary carotid artery revascularization procedures. All patients had received previous radiation therapy within a mean interval of 10 years (range, 1-26 years), with average radiation dose of 62 Gy (range, 50-70 Gy). Moderate to severe scarring of the skin or radiation fibrosis was present in three fourths of patients. Thirteen patients (48%) had undergone radical neck dissection, and 2 patients had a permanent tracheotomy. The indications for carotid surgery included high-grade (>70%) symptomatic stenosis in 18 patients (60%) and high-grade asymptomatic stenosis in 12 patients (40%). General anesthesia with systematic shunting was used in 18 patients (60%), and regional anesthesia with selective shunting was used in 12 patients (40%). Operations included standard carotid endarterectomy (n = 20), with patch angioplasty (n = 12) or direct closure (n = 8); carotid interposition bypass grafting (n = 7); and subclavian to carotid bypass grafting (n = 3). Primary closure of the surgical wound was performed in all procedures without any special muscular or skin flaps. All patients were followed up for a mean of 40 months (range, 3-99 months).
Results
There was one (3.3%) perioperative death, from massive intracerebral hemorrhage; and 1 patient had a transient ischemic attack. In-hospital complications included neck hematoma in 2 patients, which required surgical drainage in 1 patient. There was neither delayed wound healing nor infection. Twelve patients died during follow-up, of causes not related to treatment. None of the surviving patients had further stroke, and all remained asymptomatic. Follow-up duplex scans showed asymptomatic recurrent stenosis greater than 60% in 3 patients, 2 of whom with stenosis greater than 80% underwent repeat operation. Risk for recurrent stenosis greater than 60% at 18 months was 16.6%. Recurrent stenosis occurred in 2 of these patients after saphenous vein bypass, and in 1 patient after endarterectomy with vein patch angioplasty.
Conclusion
The clinical results and sustained freedom from symptoms and stroke over 40-month follow-up suggests that carotid revascularization through a radiated field is a safe and durable procedure in patients at high surgical risk, despite a marked incidence of recurrent stenosis.
Radiation-induced accelerated atherosclerosis has been recognized for some time.1, 2, 3 and 4 Because of the prolonged survival of patients treated with radiation,5 the frequency of this long-term side effect is expected to increase. In a prospective study, late (>70%) carotid artery stenosis was found in 11.7% of 240 patients who had undergone cervical irradiation.6 The chronic effects of radiation therapy lead to decreased vascularity and increased fibrosis, which in turn lead to risk for tissue necrosis, infection, and ulceration. In addition, many stenoses involve extensive segments of the carotid artery and other supra-aortic vessels, which renders surgical management more demanding.7 and 8 No prospective randomized study exists to guide optimal therapy in patients with radiation-induced accelerated high-grade carotid stenosis who do not fit eligibility criteria set forth in the major clinical trials.9 and 10 Furthermore, the potential additional morbidity incurred from treatment in patients who have undergone radiation therapy may invalidate the documented benefit of surgical carotid revascularization. Thus, to elucidate factors important in the management of these cases and to assess safety and durability of the procedure, we reviewed our experience over 12 years.
Published
N/A
2015-11-10T13:04:53Z
2015-11-10T13:04:53Z
2003
2015-11-10
Article
0741-5214
http://hdl.handle.net/10725/2516
http://dx.doi.org/10.1016/S0741-5214(03)00320-3
Lesèche, G., Castier, Y., Chataigner, O., Francis, F., Besnard, M., Thabut, G., ... & Cerceau, O. (2003). Carotid artery revascularization through a radiated field. Journal of vascular surgery, 38(2), 244-250.
http://www.sciencedirect.com/science/article/pii/S0741521403003203
en
Journal of Vascular Surgery
oai:laur.lau.edu.lb:10725/25172019-02-26T11:09:36Zcom_10725_2056col_10725_2077
The small remnant liver after major liver resection
How common and how relevant?
Yigitler, Cengizhan
Farges, Olivier
Kianmanesh, Reza
Regimbeau, Jean-Marc
Abdalla, Eddie
Belghiti, Jacques
The maximum extent of hepatic resection compatible with a safe postoperative outcome is unknown. The study goal was to determine the incidence and impact of a small remnant liver volume after major liver resection in patients with normal liver parenchyma. Among 265 major hepatectomies performed at our institution (1998 to 2000), 138 patients with normal liver and a remnant liver volume (RLV) systematically calculated from the ratio of RLV to functional liver volume (FLV) were studied. Patients were divided into five groups based on RLV-FLV ratio from ≤30% to ≥60%. Kinetics of postoperative liver function tests were correlated with RLV. Postoperative complications were stratified by RLV-FLV ratios. Ninety patients (65%) underwent resection of up to four Couinaud segments. The RLV-FLV ratio was ≤60% in 94 patients (68%) including only 13 (9%) with RLV-FLV ≤30%. There was no linear correlation between the number of resected segments and the RLV-FLV. Postoperative serum bilirubin but not prothrombin time correlated with extent of resection. The incidence of complications including liver failure was not different among groups. Analysis of the four groups with a RLV-FLV ratio <60% showed a trend toward more complications and a longer intensive care unit stay in patients with the smallest RLVs. After major hepatectomy in patients with normal livers, the proportion of patients with a small remnant liver is low and not directly related to the number of segments resected. Although the rate of postoperative complications, including liver failure, did not directly correlate with the volume of remaining liver, the postoperative course was more difficult for patients with smaller remnants. Therefore preoperative portal vein embolization should be considered in patients who will undergo extended liver resection who have (1) injured liver or (2) normal liver when the planned procedure will be complex or when the anticipated RLV-FLV will be <30%. (Liver Transpl 2003;9:S18-S25.)
Published
N/A
2015-11-10T13:28:03Z
2015-11-10T13:28:03Z
2003
2015-11-10
Article
1527-6465
http://hdl.handle.net/10725/2517
http://dx.doi.org/10.1053/jlts.2003.50194
Yigitler, C., Farges, O., Kianmanesh, R., Regimbeau, J. M., Abdalla, E. K., & Belghiti, J. (2003). The small remnant liver after major liver resection: how common and how relevant?. Liver Transplantation, 9(9), S18-S25.
http://onlinelibrary.wiley.com/doi/10.1053/jlts.2003.50194/full
en
Liver Transplantation
oai:laur.lau.edu.lb:10725/25182019-02-26T11:15:15Zcom_10725_2056col_10725_2077
Total and segmental liver volume variations
Implications for liver surgery
Abdalla, Eddie
Denys, Alban
Chevalier, Patrick
Nemr, Rabih
Vauthey, Nicolas
Background
Liver remnant volumes after major hepatic resection and graft volumes for liver transplantation correlate with surgical outcome. The relative contributions of the hepatic segments to total liver volume (TLV) are not well established.
Methods
TLV and hepatic segment volumes were measured with computed tomography (CT) in 102 patients without liver disease who underwent CT for conditions unrelated to the liver or biliary tree.
Results
TLV ranged from 911 to 2729 cm3. On average, the right liver (segments V, VI, VII, and VIII) contributed approximately two thirds of TLV (997±279 cm3), and the left liver (segments II, III and IV) contributed approximately one third of TLV (493±127 cm3). Bisegment II+III (left lateral section) contributed about half the volume of the left liver (242±79 cm3), or 16% of TLV. Liver volumes varied significantly between patients—the right liver varied from 49% to 82% of TLV, the left liver, 17% to 49% of TLV, and bisegment II+III (left lateral section) 5% to 27% of TLV. Bisegment II+III contributed less than 20% of TLV in more than 75% of patients and the left liver contributed 25% or less of TLV in more than 10% of patients.
Discussion
There is clinically significant interpatient variation in hepatic volumes. Therefore, in the absence of appreciable hypertrophy, we recommend routine measurement of the future liver remnant before extended right hepatectomy (right trisectionectomy) and in selected patients before right hepatectomy if a small left liver is anticipated.
High-quality spiral computed tomography (CT) permits accurate preoperative determination of liver volume.1. and 2. Liver volume is measured with CT before living-donor liver transplantation or major hepatic resection in patients with and without chronic liver disease.3., 4., 5., 6., 7., 8., 9. and 10. This reproducible, noninvasive procedure is necessary because significant interpatient variation is believed to exist in the relative contributions of the hepatic segments to TLV.11 CT volumetry accurately predicts TLV on the basis of body surface area or body weight,12 which may achieve the true goal of preoperative CT volumetry of the liver, that is to estimate the individual patient's hepatic metabolic demands after resection or transplantation.7
Complications associated with technical aspects of liver surgery are decreasing, and focus has concurrently shifted to analysis of postoperative complications after major hepatic resection and liver transplantation on the basis of liver remnant volume and graft volume.3., 4., 6., 7., 8. and 13. Acceptable outcomes have been reported with living donor liver and partial-liver transplantation by use of graft-volume–to–standard-liver-volume ratios of 30% to 32%.6., 7. and 14. Similarly, extended resections of up to 80% of the functional hepatic parenchyma can be performed with acceptable complication rates in patients with primary and metastatic hepatobiliary malignancies in the absence of chronic liver disease.4., 13., 14., 15. and 16. Indeed, improvement in outcome and decrease in complications after extended hepatic resections of increasing complexity have been linked to preservation of adequate functional parenchyma.17
There are few studies in the literature describing the relative contributions of the anatomic hepatic segments to the TLV. Some data have been reported for Eastern patients;7., 10. and 11. however, there is evidence that TLV differ between Eastern and Western patients,12 and volume distribution data in Western patients are lacking. Knowledge of the normal variations in the contributions of the hepatic segments to TLV may improve the systematic preoperative evaluation of patients scheduled to undergo extended hepatic resection or living donor transplantation. In this study, we measured hepatic segment volumes in 102 Western patients without liver disease who underwent CT for conditions unrelated to the liver or biliary tree. Variations in the volumes of each segment and of the whole liver were analyzed.
Methods
TLV and segmental liver volumes were measured in 102 individuals who underwent helical CT for conditions unrelated to the hepatobiliary system and who had no known liver disease (cirrhosis, fibrosis, or steatosis). Patients with conditions potentially affecting the biliary tree (eg, pancreatic cancer) or associated with diffuse liver disease (eg, lymphoma) were excluded. The 102 patients reported in this study represent a subset of 292 patients from a recent study reporting the association between TLV and body surface area (BSA).12 As indicated in this study, these patients belonged to a homogeneous white population.
CT images were acquired using a multidetector spiral CT scanner (Lightspeed, General Electric, Milwaukee, WI) at a single center (Lausanne, Switzerland). The data were collected by 2 radiologists (AD and PC). Images were obtained by use of a 5-mm slice thickness 60 seconds after injection of 100 mL of contrast medium (iopentol; Imagopaque 300). Liver volumes were calculated with an Advantage Windows workstation (Advantage Windows software version 3.1, GE Medical Systems, Waukesha, Wis). The contours of the liver were delineated consecutively on the screen; the gallbladder and vena cava were excluded. Volumes were calculated by summation of slice volumes (determined by multiplying the surface area by the slice thickness plus space between slices). The Brisbane 2000 Terminology recommended for liver resection was used (Fig 1).18
Published
N/A
2015-11-10T13:37:36Z
2015-11-10T13:37:36Z
2015-11-10
Article
0039-6060
http://hdl.handle.net/10725/2518
http://dx.doi.org/10.1016/j.surg.2003.08.024
Abdalla, E. K., Denys, A., Chevalier, P., Nemr, R. A., & Vauthey, J. N. (2004). Total and segmental liver volume variations: implications for liver surgery. Surgery, 135(4), 404-410.
http://www.sciencedirect.com/science/article/pii/S0039606003005531
en
Surgery
oai:laur.lau.edu.lb:10725/25192015-11-10T13:54:33Zcom_10725_2056col_10725_2077
Hepatic vascular occlusion
Which technique?
Abdalla, Eddie
Noun, Roger
Belghiti, Jacques
N/A
N/A
2015-11-10T13:54:33Z
2015-11-10T13:54:33Z
2004
2015-11-10
Article
0039-6109
http://hdl.handle.net/10725/2519
http://dx.doi.org/10.1016/S0039-6109(03)00231-7
en
Surgical clinic of North America
oai:laur.lau.edu.lb:10725/25202016-08-26T08:22:27Zcom_10725_2056col_10725_2077
Staging and preoperative evaluation of upper gastrointestinal malignancies
Abdalla, Eddie
Pisters, Peter
Esophageal and gastric cancers are distinct carcinomas of the upper gastrointestinal tract, although the distinction between them becomes less clear at the gastroesophageal junction (GEJ). Increasingly accurate staging is possible based on newer radiographic and surgical techniques such as positron emission tomography (PET), laparoscopy and thoracoscopy, laparoscopic ultrasound, and endoscopic ultrasound (EUS). For both cancer types, tumor classification is determined by depth of penetration of the primary tumor into the gastric or esophageal wall. For esophageal cancer, primary tumor anatomic position-upper, mid, and lower esophagus-is used to define the local nodal basin. Metastases in nodes outside the local basin are considered to be distant (M) rather than regional (N). In gastric cancer, the region of nodal metastasis has been abandoned in favor of the number of lymph nodes containing metastasis, which predicts outcome more accurately—patients with more than 15 positive lymph nodes have an outcome comparable to those with M disease. Increasing consideration is being given to the subclassification of tumors near the GEJ into types based on anatomical position, although this staging scheme (“Full-size image (<1 K)denocarcinoma of the Full-size image (<1 K)sophagoFull-size image (<1 K)astric junction” or AEG type) has not yet been universally adopted. We review the current pathologic staging systems for esophageal and gastric cancers, the clinical staging approaches for these diseases, and the controversy surrounding classification of tumors of the GEJ.
Published
N/A
2015-11-10T14:50:37Z
2015-11-10T14:50:37Z
2004
2015-11-10
Article
0093-7754
http://hdl.handle.net/10725/2520
http://dx.doi.org/10.1053/j.seminoncol.2004.04.014
Abdalla, E. K., & Pisters, P. W. (2004, August). Staging and preoperative evaluation of upper gastrointestinal malignancies. In Seminars in oncology (Vol. 31, No. 4, pp. 513-529). WB Saunders.
http://www.sciencedirect.com/science/article/pii/S0093775404002350
en
Seminars in Oncology
oai:laur.lau.edu.lb:10725/25212019-02-26T10:50:05Zcom_10725_2056col_10725_2077
Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases
Abdalla, Eddie
Vauthey, Nicolas
Ellis, Lee
Ellis, Vicky
Pollock, Raphael
Hess, Kenneth
Curley, Steven
Broglio, Kristine
Objective:
To examine recurrence and survival rates for patients treated with hepatic resection only, radiofrequency ablation (RFA) plus resection or RFA only for colorectal liver metastases.
Summary Background Data:
Thermal destruction techniques, particularly RFA, have been rapidly accepted into surgical practice in the last 5 years. Long-term survival data following treatment of colorectal liver metastasis using RFA with or without hepatic resection are lacking.
Methods:
Data from 358 consecutive patients with colorectal liver metastases treated for cure with hepatic resection ± RFA and 70 patients found at laparotomy to have liver-only disease but not to be candidates for potentially curative treatment were compared (1992–2002).
Results:
Of 418 patients treated, 190 (45%) underwent resection only, 101 RFA + resection (24%), 57 RFA only (14%), and 70 laparotomy with biopsy only or arterial infusion pump placement (“chemotherapy only,” 17%). RFA was used in operative candidates who could not undergo complete resection of disease. Overall recurrence was most common after RFA (84% vs. 64% RFA + resection vs. 52% resection only, P < 0.001). Liver-only recurrence after RFA was fourfold the rate after resection (44% vs. 11% of patients, P < 0.001), and true local recurrence was most common after RFA (9% of patients vs. 5% RFA + resection vs. 2% resection only, P = 0.02). Overall survival rate was highest after resection (58% at 5 years); 4-year survival after resection, RFA + resection and RFA only were 65%, 36%, and 22%, respectively (P < 0.0001). Survival for “unresectable” patients treated with RFA + resection or RFA only was greater than chemotherapy only (P = 0.0017).
Conclusions:
Hepatic resection is the treatment of choice for colorectal liver metastases. RFA alone or in combination with resection for unresectable patients does not provide survival comparable to resection, and provides survival only slightly superior to nonsurgical treatment.
Published
N/A
2015-11-10T14:59:38Z
2015-11-10T14:59:38Z
2004
2015-11-10
Article
0003-4932
http://hdl.handle.net/10725/2521
http://dx.doi.org/ 10.1097/01.sla.0000128305.90650.71
Abdalla, E. K., Vauthey, J. N., Ellis, L. M., Ellis, V., Pollock, R., Broglio, K. R., ... & Curley, S. A. (2004). Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Annals of surgery, 239(6), 818.
http://journals.lww.com/annalsofsurgery/Abstract/2004/06000/Recurrence_and_Outcomes_Following_Hepatic.9.aspx
en
Annals of surgery
oai:laur.lau.edu.lb:10725/25222019-02-26T11:11:51Zcom_10725_2056col_10725_2077
Surgical treatment of colorectal cancer metastasis
Abdalla, Eddie
Izzo, Francesco
Curley, Steven
Vauthey, Nicolas
Colorectal cancer is one of the most common solid tumors affecting people around the world. A significant proportion of patients with colorectal cancer will develop or will present with liver metastases. In some of these patients, the liver is the only site of metastatic disease. Thus, surgical treatment approaches are an appropriate and important treatment option in patients with liver-only colorectal cancer metastases. Resection of colorectal cancer liver metastases can produce long-term survival in selected patients, but the efficacy of liver resection as a solitary treatment is limited by two factors. First, a minority of patients with liver metastases have resectable disease. Second, the majority of patients who undergo successful liver resection for colorectal cancer metastases develop recurrent disease in the liver, extrahepatic sites, or both. In this paper, in addition to the results of liver resection for colorectal cancer metastases, we will review the results of thermal ablation. Each of these surgical treatment modalities can produce long-term survival in a subset of patients with liver-only colorectal cancer metastases, whereas administration of systemic or regional chemotherapy rarely results in long-term survival in these patients. While surgical treatments provide the best chance for long-term survival or, in some cases, the best palliation in patients with colorectal cancer liver metastases, it is clear that further improvements in patient outcome will require multimodality therapy regimens. Modern surgical treatment of colorectal liver metastases can be performed safely with low mortality and transfusion rates, and surgical treatment should be considered in patients with disease confined to their liver.
Published
N/A
2015-11-10T15:06:58Z
2015-11-10T15:06:58Z
2004
2015-11-10
Article
0167-7659
http://hdl.handle.net/10725/2522
http://dx.doi.org/10.1023/A:1025875332255
Curley, S. A., Izzo, F., Abdalla, E., & Vauthey, J. N. (2004). Surgical treatment of colorectal cancer metastasis. Cancer and metastasis reviews, 23(1-2), 165-182.
http://link.springer.com/article/10.1023/A:1025875332255
en
Cancer and Metastasis Reviews
oai:laur.lau.edu.lb:10725/25232019-02-26T08:23:58Zcom_10725_2056col_10725_2077
Early and Late Complications After Radiofrequency Ablation of Malignant Liver Tumors in 608 Patients
Curley, Steven
Marra, Paolo
Beaty, Karen
Vauthey, Nicolas
Abdalla, Eddie
Scaife, Courtney
Raut, Chan
Wolff, Robert
Choi, Haesun
Loyer, Evelyne
Vallone, Paolo
Fiore, Francesco
Scordino, Fabrizio
Di Rosa, Vincenzo
Orlando, Raffaele
Pignata, Sandro
Daniele, Bruno
Izzo, Francesco
Background:
Radiofrequency ablation (RFA) has become a common treatment of patients with unresectable primary and secondary hepatic malignancies. We performed this prospective analysis to determine early (within 30 days) and late (more than 30 days after) complication rates associated with hepatic tumor RFA.
Methods:
All patients treated between January 1, 1996 and June 30, 2002 with RFA for hepatic malignancies were entered into a prospective database. Patients were evaluated during RFA treatment, throughout the immediate post RFA course, and then every 3 months after RFA to assess for the development of treatment-related complications.
Results:
A total of 608 patients, 345 men (56.7%) and 263 women (43.3%), with a median age of 58 years (range 18–85 years) underwent RFA of 1225 malignant liver tumors. Open intraoperative RFA was performed in 382 patients (62.8%), while percutaneous RFA was performed in 226 (37.2%). The treatment-related mortality rate was 0.5%. Early complications developed in 43 patients (7.1%). Early complications were more likely to occur in patients treated with open RFA (33 [8.6%] of 382 patients) compared with percutaneous RFA (10 [4.4%] 226 patients, P < 0.01), and in patients with cirrhosis (25 [12.9%] complications in 194 patients) compared with noncirrhotic patients (31 [7.5%] complications in 414 patients, P < 0.05). Late complications arose in 15 patients (2.4%) with no difference in incidence between open and percutaneous RFA treatment. The combined overall early and late complication rate was 9.5%.
Conclusions:
Hepatic tumor RFA can be performed with low mortality and morbidity rates. Though relatively rare, late complications can develop and physicians performing hepatic RFA must be cognizant of these delayed treatment-related problems.
Published
N/A
2015-11-10T15:20:40Z
2015-11-10T15:20:40Z
2004
2015-11-10
Article
0003-4932
http://hdl.handle.net/10725/2523
http://dx.doi.org/10.1097/01.sla.0000118373.31781.f2
Curley, S. A., Marra, P., Beaty, K., Ellis, L. M., Vauthey, J. N., Abdalla, E. K., ... & Izzo, F. (2004). Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Annals of surgery, 239(4), 450.
http://link.springer.com/article/10.1007%2FBF02524164?LI=true
en
Annals of surgery
oai:laur.lau.edu.lb:10725/25242016-08-26T08:32:08Zcom_10725_2056col_10725_2077
Transdiaphragmatic radiofrequency ablation of liver tumors
Abdalla, Eddie
Mullen, John
Walsh, Garett
Loyer, Evelyne
Curley, Steven
Vauthey, Nicolas
Published
N/A
2015-11-10T15:37:30Z
2015-11-10T15:37:30Z
2004
2015-11-10
Article
0001-0790
http://hdl.handle.net/10725/2524
http://dx.doi.org/10.1016/j.jamcollsurg.2004.07.010
en
Journal of the American College of Surgeons
oai:laur.lau.edu.lb:10725/25252019-02-26T09:34:42Zcom_10725_2056col_10725_2077
Hepatitis serology predicts tumor and liver-disease characteristics but not prognosis after resection of hepatocellular carcinoma
Abdalla, Eddie
Pawlik, Timothy
Poon, Ronnie
Sarmiento, Juan
Lkai, Iwao
Curley, Steven
Nagorney, David
Belghiti, Jacques
Oi-Lin Ng, Irene
Yamaoka, Yoshio
Lauwers, Gregory
Vauthey, Nicolas
The impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection on survival rates after resection of hepatocellular carcinoma (HCC) is controversial. The objective of this study was to determine whether serologic evidence of HBV or HCV infection ("hepatitis serology") can predict underlying liver disease, tumor factors, and survival rates in patients with HCC. Using a multicenter international database, we identified 446 patients with complete HBV and HCV serology. One hundred twenty-six patients were negative for HBV and HCV, 163 patients had HBV infection only, 79 patients had HCV infection only, and 78 patients had coinfection with HBV and HCV. Patients with hepatitis were more likely to have tumors smaller than 5 cm and bilateral HCC involvement. Hepatitis status (negative vs. HBV vs. HCV vs. coinfection with HBV and HCV) did not predict tumor grade or the presence of multiple tumor nodules. Patients with HCV or coinfection with HBV and HCV exhibited a lower incidence of vascular invasion, but worse fibrosis than patients with negative serology or HBV. The median survival rate was 47.9 months. The presence of hepatitis did not significantly affect the survival rate, but hepatic fibrosis and vascular invasion predicted a decreased survival rate. The prognosis after resection of HCC is influenced by tumor factors and liver disease, but not by HBV or HCV infection. The treatment for HCC should be dictated by the extent of underlying liver disease rather than by hepatitis serology.
Published
N/A
2015-11-10T15:46:16Z
2015-11-10T15:46:16Z
2004
2015-11-10
Article
1091-255X
http://hdl.handle.net/10725/2525
http://dx.doi.org/10.1016/j.gassur.2004.06.013
Pawlik, T. M., Poon, R. T., Abdalla, E. K., Sarmiento, J. M., Ikai, I., Curley, S. A., ... & Vauthey, J. N. (2004). Hepatitis serology predicts tumor and liver-disease characteristics but not prognosis after resection of hepatocellular carcinoma. Journal of gastrointestinal surgery, 8(7), 794-805.
http://link.springer.com/article/10.1016/j.gassur.2004.06.013
en
Journal of Gastrointestinal Surgery
oai:laur.lau.edu.lb:10725/25262019-02-26T10:56:25Zcom_10725_2056col_10725_2077
Risk factors for early death due to recurrence after liver resection for hepatocellular carcinoma: Results of a multicenter study
Abdalla, Eddie
Regimbeau, Jean-Marc
Vauthey, Nicolas
Lauwers, Gregory
Durand, Francois
Nagorney, David
Lkai, Iwao
Yamaoka, Yoshio
Belghiti, Jacques
Background and Objectives: Recurrence after partial liver resection for hepatocel-lular carcinoma (HCC) is a major cause of death from this disease. To identify riskfactors for early death from recurrence after liver resection for HCC.Methods: All 547 patients in this study had greater than 1 year of follow-up aftercomplete resection of HCC (1980–1999) at one of the four hepatobiliary centers inJapan, France, and the United States. Patients who died of recurrence 1 year post-resection and all of those alive at least 1 year were compared. Survival and clinico-pathological factors associated with death from recurrence within 1 year of resectionwere analyzed.Results: Overall postoperative mortality rate was 5%. In the first postoperative year,123 (22%) patients died. Of these, 53 (43%) died of recurrence, 30 (24%) of post-operative complications, and 40 (33%) of liver failure/hemorrhage. On multivariateanalysis, tumor size greater than 5 cm (P < 0.02; odds ratio, 3.0), multiple tumors(P < 0.01; odds ratio, 3.3), and greater than 5 mitoses per 10 high-power fields(P < 0.03; odds ratio, 3) were associated with increased risk of early death due torecurrence.Conclusions: These findings enable identification of patients with HCC who are athigh risk for early death due to recurrence following potentially curative resection whomight be candidates for adjuvant therapy trials.
Published
N/A
2015-11-10T15:57:42Z
2015-11-10T15:57:42Z
2004
2015-11-10
Article
0022-4790
http://hdl.handle.net/10725/2526
http://dx.doi.org/10.1002/jso.10284
Regimbeau, J. M., Abdalla, E. K., Vauthey, J. N., Lauwers, G. Y., Durand, F., Nagorney, D. M., ... & Belghiti, J. (2004). Risk factors for early death due to recurrence after liver resection for hepatocellular carcinoma: results of a multicenter study. Journal of surgical oncology, 85(1), 36-41.
http://onlinelibrary.wiley.com/doi/10.1002/jso.10284/abstract
en
Journal of Surgical Oncology
oai:laur.lau.edu.lb:10725/25272019-02-26T10:42:09Zcom_10725_2056col_10725_2077
Obesity and diabetes as a risk factor for hepatocellular carcinoma
Abdalla, Eddie
Regimbeau, Jean-Marc
Colombat, Magali
Mognol, Philippe
Degott, Claude
Degos, Francoise
Farges, Olivier
Belghiti, Jacques
Ten percent of patients who undergo resection for hepatocellular carcinoma (HCC) associated with chronic liver disease have no detectable cause for this underlying liver disease. Recent studies have shown that patients with cryptogenic chronic liver disease frequently have risk factors for nonalcoholic fatty liver disease (NAFLD). This study examines the incidence of risk factors for NAFLD in patients with chronic liver disease who underwent resection for HCC. Among 210 patients with chronic liver disease who underwent resection for HCC, 18 (8.6%) had no identifiable cause for the underlying liver disease. These patients were assessed for obesity, diabetes mellitus, and histological features of the tumor and the adjacent liver parenchyma. Comparisons were made with matched patients with alcohol- and chronic-viral-hepatitis-related HCC. The prevalence of obesity (50% vs. 17% vs. 14%), diabetes (56% vs. 17% vs. 11%), aspartate aminotransferase / alanine aminotransferase ratio < 1 (50% vs. 19% vs. 17%), and steatosis > 20% (61% vs. 17% vs. 19%) was significantly higher in patients with cryptogenic liver disease than in patients with alcohol abuse and chronic viral hepatitis (P < 0.0001 for each). Well-differentiated tumors were significantly more common in patients with cryptogenic liver disease (89% vs. 64% in patients with alcohol-related HCC vs. 55% in patients with chronic viral hepatitis-related HCC, P < 0.0001).
In conclusion, the hypothesis that obesity and diabetes mellitus may be important risk factors for cryptogenic chronic liver disease in patients with HCC is supported by the analysis of surgically treated patients. Whether HCC is primarily related to obesity and diabetes mellitus or secondarily to a NAFLD-like parenchymal lesions remains to be clarified. (Liver Transpl 2004;10:S69–S73.)
Published
N/A
2015-11-10T16:14:03Z
2015-11-10T16:14:03Z
2004
2015-11-10
Article
1527-6465
http://hdl.handle.net/10725/2527
http://dx.doi.org/10.1002/lt.20033
Regimbeau, J. M., Colombat, M., Mognol, P., Durand, F., Abdalla, E., Degott, C., ... & Belghiti, J. (2004). Obesity and diabetes as a risk factor for hepatocellular carcinoma. Liver transplantation, 10(S2), S69-S73.
http://onlinelibrary.wiley.com/doi/10.1002/lt.20033/full
en
Liver Transplantation
oai:laur.lau.edu.lb:10725/25282016-08-26T06:39:35Zcom_10725_2056col_10725_2077
Pancreaticoduodenectomy with vascular resection
Margin status and survival duration
Abdalla, Eddie
Tseng, Jennifer
Raut, Chandrajit
Lee, Jeffrey
Pisters, Peter
Vauthey, Nicolas
Gomez, Henry
Sun, Charlotte
Crane, Christopher
Wolff, Robert
Evans, Douglas
Major vascular resection performed at the time of pancreaticoduodenectomy (PD) for adenocarcinoma remains controversial. We analyzed all patients who underwent vascular resection (VR) at the time of PD for any histology at a single institution between 1990 and 2002. Preoperative imaging criteria for PD included the absence of tumor extension to the celiac axis or superior mesenteric artery (SMA). Tangential or segmental resection of the superior mesenteric or portal veins was performed when the tumor could not be separated from the vein. As a separate analysis, all patients who underwent PD with VR for pancreatic adenocarcinoma were compared to all patients who underwent standard PD for pancreatic adenocarcinoma. A total of 141 patients underwent VR with PD. Superior mesenteric-portal vein resections included tangential resection with vein patch (n = 36), segmental resection with primary anastomosis (n = 35), and segmental resection with autologous interposition graft (n = 55). Hepatic arterial resections were performed in 10 patients, and resections of the anterior surface of the inferior vena cava were performed in 5 patients. PD was performed for pancreatic adenocarcinoma in 291 patients; standard PD was performed in 181 and VR in 110. Median survival was 23.4 months in the group that required VR and 26.5 months in the group that underwent standard PD (P = 0.177). A Cox proportional hazards model was constructed to analyze the effects of potential prognostic factors (VR, tumor size, T stage, N status, margin status) on survival. The need for VR had no impact on survival duration. In conclusion, properly selected patients with adenocarcinoma of the pancreatic head who require VR have a median survival of approximately 2 years, which does not differ from those who undergo standard PD and is superior to historical patients believed to have locally advanced disease treated nonoperatively.
Published
N/A
2015-11-11T07:31:10Z
2015-11-11T07:31:10Z
2015-11-11
Article
1091-255X
http://hdl.handle.net/10725/2528
http://dx.doi.org/10.1016/j.gassur.2004.09.046
Tseng, J. F., Raut, C. P., Lee, J. E., Pisters, P. W., Vauthey, J. N., Abdalla, E. K., ... & Evans, D. B. (2004). Pancreaticoduodenectomy with vascular resection: margin status and survival duration. Journal of Gastrointestinal Surgery, 8(8), 935-950.
http://link.springer.com/article/10.1016/j.gassur.2004.09.046
en
Journal of Gastrointestinal Surgery
oai:laur.lau.edu.lb:10725/25292019-02-26T09:39:13Zcom_10725_2056col_10725_2077
Is extended hepatectomy for hepatobiliary malignancy justified?
Abdalla, Eddie
Vauthey, Nicolas
Pawlik, Timothy
Arens, James
Nemr, Rabih
Wei, Steven
Kennamer, Debra
Ellis, Lee
Curley, Steven
Background:
Extended hepatectomy may be required to provide the best chance for cure of hepatobiliary malignancies. However, the procedure may be associated with significant morbidity and mortality.
Methods:
We analyzed the outcome of 127 consecutive patients who underwent extended hepatectomy (resection of ≥ 5 liver segments) for hepatobiliary malignancies.
Results:
The patients underwent extended hepatectomy for colorectal metastases (n = 86; 67.7%), hepatocellular carcinoma (n =12; 9.4%), cholangiocarcinoma (n =14; 11.0%), and other malignant diseases (n =15; 11.5%). Thirty-two left and ninety-five right extended hepatectomies were performed. Eight patients also underwent caudate lobe resection, and 40 patients underwent a synchronous intraabdominal procedure. Twenty patients underwent radiofrequency ablation, and 31 underwent preoperative portal vein embolization. The median blood loss was 300 mL for right hepatectomy and 600 mL for left hepatectomy (P = 0.02). Thirty-six patients (28.3%) received a blood transfusion. The overall complication rate was 30.7% (n = 39), and the operative mortality rate was 0.8% (n = 1). Significant liver insufficiency (total bilirubin level > 10 mg/dL or international normalized ratio > 2) occurred in 6 patients (4.7%). Multivariate analysis showed that a synchronous intraabdominal procedure was the only factor associated with an increased risk of morbidity (hazard ratio [HR], 4.9; P = 0.02). The median survival was 41.9 months. The overall 5-year survival rate was 25.5%.
Conclusions:
Extended hepatectomy can be performed with a near-zero operative mortality rate and is associated with long-term survival in a subset of patients with malignant hepatobiliary disease. Combining extended hepatectomy with another intraabdominal procedure increases the risk of postoperative morbidity.
Published
N/A
2015-11-11T07:43:37Z
2015-11-11T07:43:37Z
2004
2015-11-11
Article
0003-4932
http://hdl.handle.net/10725/2529
http://dx.doi.org/10.1097/01.sla.0000124385.83887.d5
Vauthey, J. N., Pawlik, T. M., Abdalla, E. K., Arens, J. F., Nemr, R. A., Wei, S. H., ... & Curley, S. A. (2004). Is extended hepatectomy for hepatobiliary malignancy justified?. Annals of surgery, 239(5), 722.
http://journals.lww.com/annalsofsurgery/Abstract/2004/05000/Is_Extended_Hepatectomy_for_Hepatobiliary.17.aspx
en
Annals of surgery
oai:laur.lau.edu.lb:10725/25302019-02-26T09:39:55Zcom_10725_2056col_10725_2077
Laparoscopy for diagnosis and staging of hepatobiliary malignancies
Abdalla, Eddie
Aloia, Thomas
Vauthey, Nicolas
Objective: To review the role of diagnostic laparoscopy (DL) for staging of malignant diseases of the liver and biliary tract.
Methodology: Critical review of the current literature.
Results: Analysis of the utility of DL in hepatobiliary cancers depends on several criteria, particularly in the era of high quality prelaparotomy and pre-DL imaging. Selection criteria for DL, selection criteria for resection, definition of resectability, patterns of intra- and extrahepatic spread, association with underlying liver disease and frequency of indications for palliative laparotomy impact the utility of DL depending on the disease studied.
Conclusions: DL has a very limited role for staging patients with colorectal liver metastases as a result of expanding definitions of resectability, multistage approaches to bilateral metastases, and methods to increase resectability such as portal vein embolization and preoperative chemotherapy. For hepatocellular carcinoma, DL can be useful for staging patients with advanced tumours and cirrhosis, and might have an emerging role for the evaluation of transplant candidates with equivocal imaging findings. For biliary cancers, DL is indicated for patients with advanced stage hilar cholangiocarcinoma and gall bladder carcinoma.
Published
N/A
2015-11-11T10:34:39Z
2015-11-11T10:34:39Z
2005
2015-11-11
Article
1744-1625
http://hdl.handle.net/10725/2530
http://dx.doi.org/10.1111/j.1744-1633.2005.00263.x
Abdalla, E. K., Aloia, T. A., & Vauthey, J. N. (2005). Laparoscopy for diagnosis and staging of hepatobiliary malignancies. Surgical Practice, 9(3), 78-89.
http://onlinelibrary.wiley.com/doi/10.1111/j.1744-1633.2005.00263.x/full
en
Surgical Practice
oai:laur.lau.edu.lb:10725/25312019-02-26T11:17:22Zcom_10725_2056col_10725_2077
Two-Surgeon Technique for Hepatic Parenchymal Transection of the Noncirrhotic Liver Using Saline-Linked Cautery and Ultrasonic Dissection
Aloia, Thomas
Zorzi, Daria
Abdalla, Eddie
Vauthey, Nicolas
Objective:
The purpose of this study was to analyze our experience with saline-linked cautery in hepatic surgery.
Summary Background Data:
Safe and efficient hepatic parenchymal transection is predicated on the ability to simultaneously address 2 tasks: parenchymal dissection and hemostasis. To date, no single instrument has been designed that addresses both of these tasks. Saline-linked cautery is now widely used in liver surgery and is reported to decrease blood loss during liver transection, but data on its exact benefits are lacking.
Methods:
From a single institution, prospective liver surgery database, we identified 32 consecutive patients with noncirrhotic livers who underwent resection for primary or metastatic disease using a 2-surgeon technique with saline-linked cautery and ultrasonic dissection (SLC+UD) from December 2002 to January 2004. From the same database, we identified a contemporary and matched set of 32 patients who underwent liver resection with similar indications using ultrasonic dissection alone (UD alone). Operative and anesthetic variables were retrospectively analyzed to identify differences between the 2 groups.
Results:
The 2 groups were equivalent in terms of age, gender, tumor histology, tumor number, and tumor size. The UD+SLC group had a decreased duration of inflow occlusion (20 minutes versus 30 minutes, P = 0.01), blood loss (150 mL versus 250 mL, P = 0.034), and operative time (187 minutes versus 211 minutes, P = 0.027). Postoperative liver function and complication rates were similar in each group.
Conclusions:
The 2-surgeon technique for liver parenchymal transection using SLC and UD in noncirrhotic livers is safe and may provide advantages over other techniques.
Published
N/A
2015-11-11T10:40:15Z
2015-11-11T10:40:15Z
2005
2015-11-11
Article
0003-4932
http://hdl.handle.net/10725/2531
http://dx.doi.org/ 10.1097/01.sla.0000171300.62318.f4
Aloia, T. A., Zorzi, D., Abdalla, E. K., & Vauthey, J. N. (2005). Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection. Annals of surgery, 242(2), 172.
http://journals.lww.com/annalsofsurgery/Abstract/2005/08000/Two_Surgeon_Technique_for_Hepatic_Parenchymal.4.aspx
en
Annals of surgery
oai:laur.lau.edu.lb:10725/25322016-08-26T08:32:49Zcom_10725_2056col_10725_2077
Transhepatic Ipsilateral Right Portal Vein Embolization Extended to Segment IV
Improving Hypertrophy and Resection Outcomes with Spherical Particles and Coils
Madoff, David
Abdalla, Eddie
Gupta, Sanjay
Morris, Jeffrey
Denys, Alban
Wallace, Micheal
Morello, Frank
Ahrar, Kamran
Murthy, Ravi
Hicks, Marshall
Vauthey, Nicolas
PURPOSE
To analyze outcomes after right portal vein embolization extended to segment IV (right PVE + IV) before extended right hepatectomy, including liver hypertrophy, resection rates, and complications after embolization and resection, and to assess differences in outcomes with two different particulate embolic agents.
MATERIALS AND METHODS
Between 1998 and 2004, transhepatic ipsilateral right PVE + IV with particles and coils was performed in 44 patients with malignant hepatobiliary disease, including metastases (n = 24), biliary cancer (n = 14), and hepatocellular carcinoma (n = 6). Right PVE + IV was considered if the future liver remnant (FLR; segments II/III with or without I) was less than 25% of the total estimated liver volume (TELV). Tris-acryl microspheres (100–700 μm; n = 21) or polyvinyl alcohol (PVA) particles (355–1,000 μm; n = 23) were administered in a stepwise fashion. Smaller particles were used to occlude distal branches, followed by larger particles to occlude proximal branches until near-complete stasis. Coils were then placed in secondary portal branches. Computed tomographic volumetry was performed before and 3–4 weeks after right PVE + IV to assess FLR hypertrophy. Liver volumes and postembolization and postoperative outcomes were measured.
RESULTS
After right PVE + IV with PVA particles, FLR volume increased 45.5% ± 40.9% and FLR/TELV ratio increased 6.9% ± 5.6%. After right PVE + IV with tris-acryl microspheres, FLR volume increased 69.0% ± 30.7% and FLR/TELV ratio increased 9.7% ± 3.3%. Differences in FLR volume (P = .0011), FLR/TELV ratio (P = .027), and resection rates (P = .02) were statistically significant. Seventy-one percent of patients underwent extended right hepatectomy (86% after receiving tris-acryl microspheres, 57% after receiving PVA). Thirteen patients (29%) did not undergo resection (extrahepatic spread [n = 9], inadequate hypertrophy [n = 3], other reasons [n = 1]). No patient developed postembolization syndrome or progressive liver insufficiency after embolization or resection. One death after resection occurred as a result of sepsis and hemorrhage. Median hospital stays were 1 day after right PVE + IV and 7 days after resection.
CONCLUSION
Transhepatic ipsilateral right PVE + IV with use of particles and coils is a safe, effective method for inducing contralateral hypertrophy before extended right hepatectomy. Embolization with small spherical particles provides improved hypertrophy and resection rates compared with larger, nonspherical particles.
Published
N/A
2015-11-11T11:29:51Z
2015-11-11T11:29:51Z
2005
2015-11-11
Article
1051-0443
http://hdl.handle.net/10725/2532
http://dx.doi.org/10.1097/01.RVI.0000147067.79223.85
Madoff, D. C., Abdalla, E. K., Gupta, S., Wu, T. T., Morris, J. S., Denys, A., ... & Vauthey, J. N. (2005). Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. Journal of vascular and interventional radiology, 16(2), 215-225.
http://www.sciencedirect.com/science/article/pii/S1051044307605508
en
Journal of vascular and interventional radiology
oai:laur.lau.edu.lb:10725/25332016-08-11T06:24:11Zcom_10725_2056col_10725_2077
Portal vein embolization in preparation for major hepatic resection
Evolution of a new standard of care
Madoff, David
Abdalla, Eddie
Vauthey, Nicolas
Portal vein (PV) embolization (PVE) is gaining acceptance in the preoperative management of patients selected for major hepatic resection. PVE redirects portal blood flow to the intended liver remnant to induce hypertrophy of the nondiseased portion of the liver and thereby reduce complications and shorten hospital stays after resection. This article reviews the rationale and existing literature on PVE, including the mechanisms of liver regeneration, the pathophysiology of PVE, the imaging techniques used to measure liver volumes and estimate functional hepatic reserve, and the technical aspects of PVE, including approaches and embolic agents used. In addition, the indications and contraindications for performing PVE in patients with and without chronic liver disease and the multidisciplinary approach required for the treatment of these complex cases are emphasized.
Published
N/A
2015-11-11T12:16:14Z
2015-11-11T12:16:14Z
2005
2015-11-11
Article
1051-0443
http://hdl.handle.net/10725/2533
http://dx.doi.org/10.1097/01.RVI.0000159543.28222.73
Madoff, D. C., Abdalla, E. K., & Vauthey, J. N. (2005). Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care. Journal of vascular and interventional radiology, 16(6), 779-790.
http://www.sciencedirect.com/science/article/pii/S1051044307606824
en
Journal of vascular and interventional radiology
oai:laur.lau.edu.lb:10725/25342019-02-26T10:42:31Zcom_10725_2056col_10725_2077
Operative considerations in resection of hilar cholangiocarcinoma
Abdalla, Eddie
Parikh, Alexandre
Vauthey, Nicolas
This article reviews the preoperative evaluation and operative considerations in patients with hilar cholangiocarcinoma. The preoperative evaluation is based on the imaging evaluation of the longitudinal and radial extent of the tumour along and around the hepatic duct confluence. The use of portal vein embolization to increase the safety of extended hepatectomy and the extent of surgical resection (caudate lobe and portal vein) are discussed within the context of recently published series.
Published
N/A
2015-11-11T12:26:26Z
2015-11-11T12:26:26Z
2005
2015-11-11
Article
1365-182X
http://hdl.handle.net/10725/2534
http://dx.doi.org/10.1080/13651820500373093
Parikh, A., Abdalla, E., & Vauthey, J. N. (2005). Operative considerations in resection of hilar cholangiocarcinoma. HPB, 7(4), 254-258.
http://onlinelibrary.wiley.com/doi/10.1080/13651820500373093/full
en
HBP
oai:laur.lau.edu.lb:10725/25352019-02-26T11:16:27Zcom_10725_2056col_10725_2077
Tumor size predicts vascular invasion and histologic grade
Implications for selection of surgical treatment for hepatocellular carcinoma
Abdalla, Eddie
Pawlik, Timothy
Delman, Keith
Vauthey, Nicolas
Nagorney, David
Oi-Lin Ng, Irene
Yamaoka, Yoshio
Ikai, Iwao
Belghiti, Jacques
Lauwers, Gregory
Poon, Ronnie
Vascular invasion and high histologic grade predict poor outcome after surgical resection or liver transplantation for hepatocellular carcinoma (HCC). Despite the known association between tumor size and vascular invasion, a proportion of patients with large tumors can be treated surgically with excellent outcomes. Clarification of the association between tumor size, histologic grade, and vascular invasion has implications for patient selection for resection and transplantation. The objective of this study was to examine the relationship between HCC tumor size and microscopic (occult) vascular invasion and histologic grade in a multicenter international database of 1,073 patients who underwent resection of HCC. The incidence of microscopic vascular invasion increased with tumor size (≤3 cm, 25%; 3.1-5 cm, 40%; 5.1-6.5 cm, 55%; >6.5 cm, 63%) (P < 0.005). Both size and number of tumors were important factors predicting vascular invasion. Among all patients with tumors 5.1 to 6.5 cm, microscopic vascular invasion was present in 55% compared with 31% for all patients with tumors 5 cm or smaller (P < 0.001). Among patients with solitary tumors only, microscopic vascular invasion was significantly more common in tumors measuring 5.1 to 6.5 cm (41%) compared with 27% of tumors 5 cm or smaller (P < 0.003). Tumor size also predicted histologic grade: 36% of tumors 5 cm or smaller were high grade, compared with 54% of lesions 5.1 to 6.5 cm (P = 0.01). High histologic grade, an alpha-fetoprotein level of at least 1000 ng/mL, and multiple tumor nodules each predicted occult vascular invasion in tumors larger than 5 cm. The high incidence of occult vascular invasion and advanced histologic grade in HCC tumors larger than 5 cm, as well as biologic predictors of poor prognosis, should be considered before criteria for transplantation are expanded to include these patients. (Liver Transpl 2005;11:1086–1092.)
Published
N/A
2015-11-11T12:44:15Z
2015-11-11T12:44:15Z
2005
2015-11-11
Article
1527-6465
http://hdl.handle.net/10725/2535
http://dx.doi.org/10.1002/lt.20472
Pawlik, T. M., Delman, K. A., Vauthey, J. N., Nagorney, D. M., Ng, I. O. L., Ikai, I., ... & Abdalla, E. K. (2005). Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transplantation, 11(9), 1086-1092.
http://onlinelibrary.wiley.com/doi/10.1002/lt.20472/full
en
Liver Transplantation
oai:laur.lau.edu.lb:10725/25362016-08-25T09:18:01Zcom_10725_2056col_10725_2077
Critical Appraisal of the Clinical and Pathologic Predictors of Survival After Resection of Large Hepatocellular Carcinoma
Abdalla, Eddie
Pawlik, Timothy
Poon, Ronnie
Zorzi, Daria
Ikai, Iwao
Curley, Steven
Nagorney, David
Belghiti, Jacques
Oi-Lin Ng, Irene
Yamaoka, Yoshio
Lauwers, Gregory
Vauthey, Nicolas
Hypothesis A subset of patients with hepatocellular carcinoma (HCC) with a diameter of 10 cm or larger may benefit from hepatic resection.
Design Retrospective study of a multi-institutional database.
Setting Five major hepatobiliary centers.
Patients We identified 300 patients who underwent hepatic resection for HCC 10 cm or larger.
Main Outcome Measures Clinical and pathologic data were collected, and prognostic factors were evaluated by univariate and multivariate analyses. Patient survival was stratified according to a clinical scoring system and pathologic T classification.
Results The perioperative mortality rate was 5%. At a median follow-up of 32 months, the median survival was 20.3 months, and the 5-year actuarial survival rate was 27%. Four clinical factors—α-fetoprotein of 1000 ng/mL or higher, multiple tumor nodules, the presence of major vascular invasion, and the presence of severe fibrosis—were significant predictors of poor survival (all P<.05). Patients were assigned a clinical score according to the following risk factors: 1, no factor; 2, one or two factors; or 3, three or four factors. On the basis of the clinical score, patients could be stratified into only 2 distinct prognostic groups: no factor (score of 1) vs 1 or more factors (score of 2 or 3) (P<.001). In contrast, when patients were stratified according to pathologic T classification, 3 distinct groups were identified: T1 vs T2 vs T3 and T4 combined (P<.001). Fifty-six percent of the patients with a clinical score of 2 and 20% of patients with a clinical score of 3 actually had T1 or T2 disease on pathologic examination.
Conclusions Patients with large HCCs should be considered for liver resection as this treatment is associated with a 5-year survival rate exceeding 25%. Clinical predictors should not be used to exclude patients from surgical resection because these factors do not reliably predict outcome.
Published
N/A
2015-11-11T13:41:25Z
2015-11-11T13:41:25Z
2005
2015-11-11
Article
2168-6254
http://hdl.handle.net/10725/2536
http://dx.doi.org/doi:10.1001/archsurg.140.5.450.
Pawlik, T. M., Poon, R. T., Abdalla, E. K., Zorzi, D., Ikai, I., Curley, S. A., ... & Vauthey, J. N. (2005). Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Archives of surgery, 140(5), 450-458.
http://archsurg.jamanetwork.com/article.aspx?articleid=508591
en
JAMA Surgery
oai:laur.lau.edu.lb:10725/25372019-02-26T08:26:22Zcom_10725_2056col_10725_2077
Effect of Surgical Margin Status on Survival and Site of Recurrence After Hepatic Resection for Colorectal Metastases
Pawlik, Timothy
Scoggins, Charles
Zorzi, Daria
Abdalla, Eddie
Andres, Axel
Eng, Cathy
Curley, Steven
Loyer, Evelyne
Muratore, Andrea
Mentha, Gilles
Capussotti, Lorenzo
Vauthey, Nicolas
Objective:
To evaluate the influence of surgical margin status on survival and site of recurrence in patients treated with hepatic resection for colorectal metastases.
Methods:
Using a multicenter database, 557 patients who underwent hepatic resection for colorectal metastases were identified. Demographics, operative data, pathologic margin status, site of recurrence (margin, other intrahepatic site, extrahepatic), and long-term survival data were collected and analyzed.
Results:
On final pathologic analysis, margin status was positive in 45 patients, and negative by 1 to 4 mm in 129, 5 to 9 mm in 85, and ≥1 cm in 298. At a median follow-up of 29 months, the 1-, 3-, and 5-year actuarial survival rates were 97%, 74%, and 58%; median survival was 74 months. Tumor size ≥5 cm, >3 tumor nodules, and carcinoembryonic antigen level >200 ng/mL predicted poor survival (all P < 0.05). Median survival was 49 months in patients with positive margins and not yet reached in patients with negative margins (P = 0.01). After hepatic resection, 225 (40.4%) patients had recurrence: 21 at the surgical margin, 56 at another intrahepatic site, 82 at an extrahepatic site, and 66 at both intrahepatic and extrahepatic sites. Patients with negative margins of 1 to 4 mm, 5 to 9 mm, and ≥1 cm had similar overall recurrence rates (P > 0.05). Patients with positive margins were more likely to have surgical margin recurrence (P = 0.003). Adverse preoperative biologic factors including tumor number greater than 3 (P = 0.01) and a preoperative CEA level greater than 200 ng/mL (P = 0.04) were associated with an increased risk of positive surgical margin.
Conclusions:
A positive margin after resection of hepatic colorectal metastases is associated with adverse biologic factors and increased risk of surgical-margin recurrence. The width of a negative surgical margin does not affect survival, recurrence risk, or site of recurrence. A predicted margin of <1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection.
Published
N/A
2015-11-11T13:50:32Z
2015-11-11T13:50:32Z
2005
2015-11-11
Article
0003-4932
http://hdl.handle.net/10725/2537
http://dx.doi.org/ 10.1097/01.sla.0000160703.75808.7d
Pawlik, T. M., Scoggins, C. R., Zorzi, D., Abdalla, E. K., Andres, A., Eng, C., ... & Vauthey, J. N. (2005). Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Annals of Surgery, 241(5), 715.
http://journals.lww.com/annalsofsurgery/Abstract/2005/05000/Effect_of_Surgical_Margin_Status_on_Survival_and.5.aspx
en
Annals of surgery
oai:laur.lau.edu.lb:10725/25382016-08-26T08:22:45Zcom_10725_2056col_10725_2077
Staging classifications for hepatocellular carcinoma
Van Deusen, Mathew
Abdalla, Eddie
Vauthey, Nicolas
Evaluation and treatment of patients with hepatocellular carcinoma is dependent on accurate staging. Tumor-specific factors and the degree of underlying liver disease must be considered when evaluating patients with hepatocellular carcinoma. Clinical staging classification systems based on preinterventional data are predictive of survival and influence patient selection for various therapeutic modalities. Pathologic staging systems accurately assess prognosis and influence additional treatment post resection. The various staging systems for hepatocellular carcinoma are reviewed in detail. The benefits and limitations of these classification systems are discussed in this review. Considerable controversy remains over which classification system provides the optimum staging of hepatocellular carcinoma. The revised American Joint Committee on Cancer/International Union Against Cancer emphasizes the importance of major vascular and microvascular invasion as independent predictors of death and the negative impact of severe fibrosis/cirrhosis on survival following resection of hepatocellular carcinoma. As such, it is currently the most accurate staging system in this group of patients. Its applicability in those patients who are not candidates for resection is uncertain.
Published
N/A
2015-11-11T14:00:49Z
2015-11-11T14:00:49Z
2014
2015-11-11
Article
1473-7159
http://hdl.handle.net/10725/2538
http://dx.doi.org/10.1586/14737159.5.3.377
Van Deusen, M. A., Abdalla, E. K., Vauthey, J. N., & Roh, M. S. (2005). Staging classifications for hepatocellular carcinoma.
en
Expert Review of Molecular Diagnostics
oai:laur.lau.edu.lb:10725/25402019-02-26T11:10:19Zcom_10725_2056col_10725_2077
Southwest Oncology Group 0408
Phase II Trial of Neoadjuvant Capecitabine/Oxaliplatin/Bevacizumab for Resectable Colorectal Metastases in the Liver
Abdalla, Eddie
Eng, Cathy
Madary, Alice
Vauthey, Nicolas
Published
N/A
2015-11-12T07:52:25Z
2015-11-12T07:52:25Z
2015-11-12
Article
1533-0028
http://hdl.handle.net/10725/2540
http://dx.doi.org/10.3816/CCC.2006.n.015
Abdalla, E. K., Eng, C., Madary, A., & Vauthey, J. N. (2006). Southwest Oncology Group 0408: Phase II trial of neoadjuvant capecitabine/oxaliplatin/bevacizumab for resectable colorectal metastases in the liver. Clinical colorectal cancer, 5(6), 436-438.
en
Clinical Colorectal Cancer
oai:laur.lau.edu.lb:10725/25412016-08-26T08:21:21Zcom_10725_2056col_10725_2077
Solitary colorectal liver metastasis
Resection determines outcome
Abdalla, Eddie
Vauthey, Nicolas
Loyer, Evelyne
Ribero, Dario
Pawlik, Timothy
Wei, Steven
Zorzi, Daria
Background Hepatic resection (HR) and radiofrequency ablation (RFA) have been proposed as equivalent treatments for colorectal liver metastasis.
Hypothesis Recurrence patterns after HR and RFA for solitary liver metastasis are similar.
Design Analysis of a prospective database at a tertiary care center with systematic review of follow-up imaging in all of the patients.
Patients and Methods Patients with solitary liver metastasis as the first site of metastasis treated for cure by HR or RFA were studied (patients received no prior liver-directed therapy). Prognostic factors, recurrence patterns, and survival rates were analyzed.
Results Of the 180 patients who were studied, 150 underwent HR and 30 underwent RFA. Radiofrequency ablation was used when resection would leave an inadequate liver remnant (20 patients) or comorbidity precluded safe HR (10 patients). Tumor size and treatment determined recurrence and survival. The local recurrence (LR) rate was markedly lower after HR (5%) than after RFA (37%) (P<.001). Treatment by HR was associated with longer 5-year survival rates than RFA, including LR-free (92% vs 60%, respectively; P<.001), disease-free (50% vs 0%, respectively; P = .001), and overall (71% vs 27%, respectively; P<.001) survival rates. In the subset with tumors 3 cm or larger (n = 79), LR occurred more frequently following RFA (31%) than after HR (3%) (P = .001), with a 5-year LR-free survival rate of 66% after RFA vs 97% after HR (P<.001). Patients with small tumors experienced longer 5-year overall survival rates after HR (72%) as compared with RFA (18%) (P = .006).
Conclusions The survival rate following HR of solitary colorectal liver metastasis exceeds 70% at 5 years. Radiofrequency ablation for solitary metastasis is associated with a markedly higher LR rate and shorter recurrence-free and overall survival rates compared with HR, even when small lesions (≤3 cm) are considered. Every method should be considered to achieve resection of solitary colorectal liver metastasis, including referral to a specialty center, extended hepatectomy, and chemotherapy.
Published
N/A
2015-11-12T08:03:46Z
2015-11-12T08:03:46Z
2006
2015-11-12
Article
2168-6254
http://hdl.handle.net/10725/2541
http://dx.doi.org/10.1001/archsurg.141.5.460
Aloia, T. A., Vauthey, J. N., Loyer, E. M., Ribero, D., Pawlik, T. M., Wei, S. H., ... & Abdalla, E. K. (2006). Solitary colorectal liver metastasis: resection determines outcome. Archives of surgery, 141(5), 460-467.
http://archsurg.jamanetwork.com/article.aspx?articleid=398409
en
JAMA Surgery
oai:laur.lau.edu.lb:10725/25422016-08-26T06:53:02Zcom_10725_2056col_10725_2077
Portal thrombosis and steatosis after preoperativechemotherapy with FOLFIRI-bevacizumab for colorectal liver metastases
Abdalla, Eddie
Donadon, Matteo
Loyer, Evelyne
Charnsangavej, Chusilp
In order to discuss the role of preoperative chemo-therapy for colorectal liver metastases, which is used frequently before hepatic resection, even in patients with resectable disease at presentation, we herein report the development of two complications, partial portal vein thrombosis and hepatic steatosis with lobular inflammation, during the course of preoperative chemotherapy with FOLFIRI plus bevacizumab for colorectal liver metastases, which recognition led to timely discontinuation of chemotherapy as well as a change in the surgical strategy to resect the tumors and the damaged liver through advanced techniques. We conclude that duration of treatment and drug doses and combinations may impact the development of chemotherapy-induced liver injury. Surgeons and medical oncologists must work together to devise safe, rational, and oncologically appropriate treatments for patients with multiple colorectal liver metastases, and to improve the understanding of the pathogenesis of chemotherapy-induced liver injury.
Published
N/A
2015-11-12T09:18:34Z
2015-11-12T09:18:34Z
2006
2015-11-12
Article
1007-9327
http://hdl.handle.net/10725/2542
http://dx.doi.org/10.3748/wjg.v12.i40.6556
Donadon, M., Vauthey, J. N., Loyer, E. M., Charnsangavej, C., & Abdalla, E. K. (2006). Portal thrombosis and steatosis after preoperativechemotherapy with FOLFIRI-bevacizumab for colorectal liver metastases. World journal of gastroenterology: WJG, 12(40), 6556.
en
World J Gastroenterol
oai:laur.lau.edu.lb:10725/25432015-11-12T09:29:50Zcom_10725_2056col_10725_2077
Portal Vein Embolization
A Preoperative Approach to Improve the Safety of Major Hepatic Resection
Abdalla, Eddie
Madoff, David
Wallace, Micheal
Chaan, Ribero
Portal vein embolization (PVE) has become an important tool in the preoperative management of select patients prior to major hepatic resection. PVE redirects portal flow to the intended remnant liver to induce hypertrophy of the nondiseased portion of the liver and thereby may reduce complications and shorten hospital stays after surgery. This article reviews the rationale and existing literature on PVE, including the mechanisms and rates of liver regeneration, the pathophysiology of PVE, the importance of liver volumetric measurements to best estimate functional hepatic reserve, and the technical aspects of PVE including the use of state-of-the-art imaging techniques to guide the procedure. Also, the indications and contraindications for performing PVE in patients with and without chronic liver disease and the multidisciplinary approach required for the treatment of these complex cases are emphasized.
Published
N/A
2015-11-12T09:29:50Z
2015-11-12T09:29:50Z
2006
2015-11-12
Article
1573-4056
http://hdl.handle.net/10725/2543
http://dx.doi.org/10.2174/157340506778777150
Madoff, D. C., Abdalla, E. K., Wallace, M. J., Ng, C. S., Ribero, D., & Vauthey, J. N. (2006). Portal vein embolization: a preoperative approach to improve the safety of major hepatic resection. Current Medical Imaging Reviews, 2(4), 385-404.
en
Current Medical Imaging Reviews
oai:laur.lau.edu.lb:10725/25442016-08-25T09:35:58Zcom_10725_2056col_10725_2077
Debunking dogma
Surgery for four or more colorectal liver metastases is justified
Abdalla, Eddie
Pawlik, Timothy
Vauthey, Nicolas
Curley, Steven
Treatment of four or more colorectal liver metastases (CRLMs) is controversial and remains a relative contraindication to surgery at some institutions. We sought to assess the outcome of patients with four or more CRLMs treated with surgery. Patients (159) with four or more CRLMs were treated surgically at a single institution. The median number of treated lesions was 5 (range, 4–14). The majority of patients received neoadjuvant chemotherapy (89.9%). Forty-six (29.0%) patients underwent resection only, 12 (7.5%) underwent radiofrequency ablation (RFA) only, and 101 (63.5%) underwent resection plus RFA. The 5-year actuarial disease-free and overall survival rates were 21.5% and 50.9%, respectively. Patients who underwent RFA as part of their surgical procedure (hazard ratio [HR] =1.81, P =0.03) and those with a positive surgical resection margin (HR=1.52, P =0.01) were more likely to have a shorter time to recurrence. Patients who did not have a reduction in tumor size following neoadjuvant chemotherapy had a higher likelihood of death following surgical treatment (HR=2.53, P =0.01). Patients with four or more CRLMs should be considered for aggressive surgical treatment, including liver resection with or without RFA, in order to improve the chance of long-term survival. Certain clinicopathologic factors, including lack of response to neoadjuvant chemotherapy, were associated with a worse prognosis.
Published
N/A
2015-11-12T09:37:58Z
2015-11-12T09:37:58Z
2006
2015-11-12
Article
1091-255X
http://hdl.handle.net/10725/2544
http://dx.doi.org/10.1016/j.gassur.2005.07.027
Pawlik, T. M., Abdalla, E. K., Ellis, L. M., Vauthey, J. N., & Curley, S. A. (2006). Debunking dogma: surgery for four or more colorectal liver metastases is justified. Journal of gastrointestinal surgery, 10(2), 240-248.
http://link.springer.com/article/10.1016/j.gassur.2005.07.027
en
Journal of Gastrointestinal Surgery
oai:laur.lau.edu.lb:10725/25452016-08-26T07:18:46Zcom_10725_2056col_10725_2077
Results of a Single-Center Experience With Resection and Ablation for Sarcoma Metastatic to the Liver
Abdalla, Eddie
Pawlik, Timothy
Vauthey, Nicolas
Pollock, Raphael
Ellis, Lee
Curley, Steven
Hypothesis A subset of patients with sarcoma liver metastasis may benefit from hepatic resection and/or ablation.
Design Retrospective review of prospectively collected cancer center database records.
Patients and Methods Sixty-six patients who underwent hepatic resection and/or open radiofrequency ablation of metastatic sarcoma between July 1, 1996, and April 30, 2005, were identified from the database. Clinicopathologic, operative, recurrence, and long-term survival data were analyzed.
Results The primary sarcoma site was the abdomen or retroperitoneum (n = 22), stomach (n = 18), small or large bowel (n = 17), pelvis (n = 4), uterus (n = 3), or other (n = 2). Tumor pathologic types included gastrointestinal stromal tumor (n = 36), leiomyosarcoma (n = 18), and sarcoma not otherwise classified (n = 12). Thirty-five patients underwent resection, 18 underwent resection plus radiofrequency ablation, and 13 underwent radiofrequency ablation only. With a median follow-up of 35.8 months, 44 patients (66.7%) had recurrence (intrahepatic only, n = 16; extrahepatic only, n = 11; both, n = 17). Treatment with radiofrequency ablation (either alone or combined with resection) (P = .002) and lack of adjuvant chemotherapy (P = .01) predicted shorter disease-free survival. The 1-, 3-, and 5-year overall survival rates were 91.2%, 65.4%, and 27.1%, respectively. Patients with gastrointestinal stromal tumor who were treated with adjuvant imatinib mesylate had the longest median survival (not reached) (P = .003).
Conclusions Long-term survival can be achieved following surgical treatment of sarcoma liver metastasis, especially in patients with gastrointestinal stromal tumor. Patients with sarcoma liver metastasis should be evaluated by a multidisciplinary team, as recurrence is common and adjuvant therapy may prolong survival.
Published
N/A
2015-11-12T09:51:19Z
2015-11-12T09:51:19Z
2006
2015-11-12
Article
2168-6254
http://hdl.handle.net/10725/2545
http://dx.doi.org/10.1001/archsurg.141.6.537
Pawlik, T. M., Vauthey, J. N., Abdalla, E. K., Pollock, R. E., Ellis, L. M., & Curley, S. A. (2006). Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Archives of surgery, 141(6), 537-544.
http://archsurg.jamanetwork.com/article.aspx?articleid=398557
en
JAMA Surgery
oai:laur.lau.edu.lb:10725/25462019-02-26T09:34:12Zcom_10725_2056col_10725_2077
Hepatic Resection for Metastatic Melanoma
Distinct Patterns of Recurrence and Prognosis for Ocular Versus Cutaneous Disease
Abdalla, Eddie
Pawlik, Timothy
Zorzi, Daria
Clary, Bryan
Gershenwald, Jeffrey
Ross, Merrick
Aloia, Thomas
Curley, Steven
Camacho, Luis
Capussotti, Lorenzo
Elias, Dominique
Vauthey, Nicolas
Background
Resection of melanoma metastatic to the liver remains controversial. We evaluated the efficacy of hepatic resection in patients with metastatic ocular and cutaneous melanoma and assessed factors that could affect survival after resection.
Methods
Forty patients with hepatic melanoma metastasis underwent resection at four major hepatobiliary centers. Clinicopathologic factors were evaluated with regard to recurrence and survival by using χ2 and log-rank tests.
Results
The primary tumor was ocular in 16 patients and cutaneous in 24. The median disease-free interval from the time of primary tumor treatment to hepatic metastasis was the same for both groups (ocular, 62.9 months; cutaneous, 63.1 months; P = .94). Most patients underwent either an extended hepatic resection (37.5%) or hemihepatectomy (22.5%). Twenty-six patients (65%) received perioperative systemic therapy. Thirty (75.0%) of 40 patients developed tumor recurrence. The median time to recurrence after hepatic resection was 8.3 months (ocular, 8.8 months; cutaneous, 4.7 months; P = .3). Patients with primary ocular melanoma were more likely to experience recurrence within the liver (53.3% vs. 17.4%; P = .015), whereas patients with a cutaneous primary tumor more often developed extrahepatic involvement. The 5-year survival rate for patients with a primary ocular melanoma was 20.5%, whereas there were no 5-year survivors for patients with cutaneous melanoma (P = .03).
Conclusions
Patterns of recurrence and prognosis after resection of hepatic melanoma metastasis differ depending on whether the primary melanoma is ocular or cutaneous. Resection should be performed as part of a multidisciplinary approach, because recurrence is common.
Published
N/A
2015-11-12T09:59:08Z
2015-11-12T09:59:08Z
2006
2015-11-12
Article
1068-9265
http://hdl.handle.net/10725/2546
http://dx.doi.org/10.1245/ASO.2006.01.016
Pawlik, T. M., Zorzi, D., Abdalla, E. K., Clary, B. M., Gershenwald, J. E., Ross, M. I., ... & Vauthey, J. N. (2006). Hepatic resection for metastatic melanoma: distinct patterns of recurrence and prognosis for ocular versus cutaneous disease. Annals of surgical oncology, 13(5), 712-720.
http://link.springer.com/article/10.1245/ASO.2006.01.016
en
Annals of Surgical Oncology
oai:laur.lau.edu.lb:10725/25472019-02-26T09:55:54Zcom_10725_2056col_10725_2077
Liver resection in the treatment of hepatocellular carcinoma
Abdalla, Eddie
Ribero, Dario
Thomas, Melanie
Vauthey, Nicolas
Hepatocellular carcinoma is a leading cause of cancer death worldwide. Liver resection and liver transplantation remain the only options for cure. Since the indications for orthotopic liver transplantation are limited, partial liver resection is the more common treatment. Recently, indications for liver resection have been expanded and there have been advances in the associated surgical techniques. This review describes the state-of-the-art of liver resection for hepatocellular carcinoma. Topics covered include: new indications, such as treatment of large tumors, bilobar tumors and those associated with vascular invasion; preoperative assessment of liver function; and surgical strategies. An overview of the most common staging systems, which are useful in predicting prognosis after liver resection for hepatocellular carcinoma, is given.
Published
N/A
2015-11-12T10:42:28Z
2015-11-12T10:42:28Z
2006
2015-11-12
Article
1473-7140
http://hdl.handle.net/10725/2547
http://dx.doi.org/10.1586/14737140.6.4.567
Ribero, D., Abdalla, E. K., Thomas, M. B., & Vauthey, J. N. (2006). Liver resection in the treatment of hepatocellular carcinoma. Expert review of anticancer therapy, 6(4), 567-579.
en
Expert Review of Anticancer Therapy
oai:laur.lau.edu.lb:10725/25482016-08-25T09:08:14Zcom_10725_2056col_10725_2077
Chemotherapy Regimen Predicts Steatohepatitis and an Increase in 90-Day Mortality After Surgery for Hepatic Colorectal Metastases
Vauthey, Nicolas
Pawlik, Timothy
Ribero, Dario
Wu, Tsung-Teh
Zorzi, Daria
Hoff, Paulo
Xiong, Henry
Eng, Cathy
Lauwers, Gregory
Mino-Kenudson, Mari
Risio, Mauro
Muratore, Andrea
Capussotti, Lorenzo
Curley, Steven
Abdalla, Eddie
Purpose Chemotherapy before resection of hepatic colorectal metastases (CRM) may cause hepatic injury and affect postoperative outcome.
Patients and Methods Four hundred six patients underwent hepatic resection of CRM between 1992 and 2005. Pathologic review of the nontumorous liver was performed using established criteria for steatosis, steatohepatitis, and sinusoidal injury. The effect of chemotherapy and liver injury on perioperative outcome was analyzed.
Results One hundred fifty-eight patients (38.9%) received no preoperative chemotherapy, whereas 248 patients (61.1%) did. The median duration of chemotherapy was 16 weeks (range, 2 to 70 weeks). Chemotherapy consisted of fluoropyrimidine-based regimens (fluorouracil [FU] alone, 15.5%; irinotecan plus FU, 23.1%; and oxaliplatin plus FU, 19.5%) and other therapy (3.0%). On pathologic analysis, 36 patients (8.9%) had steatosis, 34 (8.4%) had steatohepatitis, and 22 (5.4%) had sinusoidal dilation. Oxaliplatin was associated with sinusoidal dilation compared with no chemotherapy (18.9% v 1.9%, respectively; P < .001; odds ratio [OR] = 8.3; 95% CI, 2.9 to 23.6). In contrast, irinotecan was associated with steatohepatitis compared with no chemotherapy (20.2% v 4.4%, respectively; P < .001; OR = 5.4; 95% CI, 2.2 to 13.5). Patients with steatohepatitis had an increased 90-day mortality compared with patients who did not have steatohepatitis (14.7% v 1.6%, respectively; P = .001; OR = 10.5; 95% CI, 2.0 to 36.4).
Conclusion Steatohepatitis is associated with an increased 90-day mortality after hepatic surgery. In patients with hepatic CRM, the chemotherapy regimen should be carefully considered because the risk of hepatotoxicity is significant.
Published
N/A
2015-11-12T11:35:12Z
2015-11-12T11:35:12Z
2006
2015-11-12
Article
0732-183X
http://hdl.handle.net/10725/2548
http://dx.doi.org/10.1200/JCO.2005.05.3074
Vauthey, J. N., Pawlik, T. M., Ribero, D., Wu, T. T., Zorzi, D., Hoff, P. M., ... & Abdalla, E. K. (2006). Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. Journal of Clinical Oncology, 24(13), 2065-2072.
en
Journal of Clinical Oncology
oai:laur.lau.edu.lb:10725/25492019-02-26T11:11:12Zcom_10725_2056col_10725_2077
Subtotal hepatectomy following neoadjuvant chemotherapy for a previously unresectable hepatocellular carcinoma
Abdalla, Eddie
Zorzi, Daria
Pawlik, Timothy
Brown, Thomas
Vauthey, Nicolas
An awareness of variant hepatic vascular anatomy provides vital information in the preoperative evaluation of patients with hepatocellular carcinoma. The authors present a patient with unresectable hepatocellular carcinoma who responded to combination systemic and regional chemotherapy. Because of the presence of an enlarged inferior right hepatic vein, the patient subsequently underwent successful subtotal hepatectomy with resection of all three main hepatic veins. This case illustrates that the combination of innovative neoadjuvant chemotherapy and well-planned surgical approaches may benefit a small number of patients previously deemed unresectable.
Published
N/A
2015-11-12T11:47:14Z
2015-11-12T11:47:14Z
2006
2015-11-12
Article
0944-1166
http://hdl.handle.net/10725/2549
http://dx.doi.org/10.1007/s00534-005-1087-8
Zorzi, D., Abdalla, E. K., Pawlik, T. M., Brown, T. D., & Vauthey, J. N. (2006). Subtotal hepatectomy following neoadjuvant chemotherapy for a previously unresectable hepatocellular carcinoma. Journal of hepato-biliary-pancreatic surgery, 13(4), 347-350.
http://onlinelibrary.wiley.com/doi/10.1007/s00534-005-1087-8/full
en
Journal of Hepato-Biliary-Pancreatic Surgery
oai:laur.lau.edu.lb:10725/25502019-02-26T08:18:10Zcom_10725_2056col_10725_2077
Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases
Abdalla, Eddie
Zorzi, Daria
Mullen, John
Pawlik, Timothy
Andres, Axel
Muratore, Andrea
Curley, Steven
Mentha, Gilles
Capussotti, Lorenzo
Vauthey, Nicolas
Some investigators have suggested that wedge resection (WR) confers a higher incidence of positive margins and an inferior survival compared with anatomic resection (AR) of colorectal liver metastases (CLM). We sought to investigate the margin status, pattern of recurrence, and overall survival of patients with CLM treated with WR or AR. We identified 253 consecutive patients, in a multi-institutional database from 1991 to 2004, who underwent either WR or AR. WR was defined as a nonanatomic resection of the CLM, and AR was defined as single or multiple resections of one or two contiguous Couinaud segments. Clinicopathologic factors were analyzed with regard to pattern of recurrence and survival. One hundred six WRs were performed in 72 patients and 194 ARs in 181 patients. There was no difference in the rate of positive surgical margin (8.3%), overall recurrence rates, or patterns of recurrence between patients treated with WR vs. AR. Patients who had a positive surgical resection margin were more likely to recur at the surgical margin regardless of whether they underwent WR or AR. The median survival was 76.6 months for WR and 80.8 months for AR, with 5-year actuarial survival rates of 61% and 60%, respectively. AR is not superior to WR in terms of tumor clearance, pattern of recurrence, or survival. WR should remain an integral component of the surgical treatment of CLM.
Published
N/A
2015-11-12T12:08:04Z
2015-11-12T12:08:04Z
2006
2015-11-12
Article
1091-255X
http://hdl.handle.net/10725/2550
http://dx.doi.org/10.1016/j.gassur.2005.07.022
Zorzi, D., Mullen, J. T., Abdalla, E. K., Pawlik, T. M., Andres, A., Muratore, A., ... & Vauthey, J. N. (2006). Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. Journal of Gastrointestinal Surgery, 10(1), 86-94.
http://link.springer.com/article/10.1016/j.gassur.2005.07.022
en
Journal of Gastrointestinal Surgery
oai:laur.lau.edu.lb:10725/25512019-02-26T10:52:24Zcom_10725_2056col_10725_2077
Resection of Hepatic Colorectal Metastases Involving the Caudate Lobe
Perioperative Outcome and Survival
Abdalla, Eddie
Ribero, Dario
Pawlik, Timothy
Zorzi, Daria
Curley, Steven
Muratore, Andrea
Andres, Axel
Mentha, Gilles
Capussotti, Lorenzo
Vauthey, Nicolas
Purpose:
To examine clinical features and outcome of patients who underwent hepatic resection for colorectal liver metastases (LM) involving the caudate lobe.
Patients and Methods:
Consecutive patients who underwent hepatic resection for LM from May 1990 to September 2004 were analyzed from a multicenter database. Demographics, operative data, pathologic margin status, recurrence, and survival were analyzed.
Results:
Of 580 patients, 40 (7%) had LM involving the caudate. Six had isolated caudate LM and 34 had LM involving the caudate plus one or more other hepatic segments. Patients with caudate LM were more likely to have synchronous primary colorectal cancer (63% vs. 36%; P = 0.01), multiple LM (70% vs. 51%; P = 0.02) and required extended hepatic resection more often than patients with non-caudate LM (60% vs. 18%; P < 0.001). Only four patients with caudate LM underwent a vascular resection; three at first operation, one after recurrence of a resected caudate tumor. All had primary repair (vena cava, n = 3; portal vein, n = 1). Perioperative complications (43% vs. 28%) and 60-day operative mortality (0% vs. 1%) were similar (caudate vs. non-caudate LM, both P > 0.05). Pathological margins were positive in 15 (38%) patients with caudate LM and in 43 (8%) with non-caudate LM (P < 0.001). At a median follow-up of 40 months, 25 (64%) patients with caudate LM recurred compared with 219 (40%) patients with non-caudate LM (P = 0.01). Patients with caudate LM were more likely to have intrahepatic disease as a component of recurrence (caudate: 51% vs. non-caudate: 25%; P = 0.001). No patient recurred on the vena cava or portal vein. Patients with caudate LM had shorter 5-year disease-free and overall survival than patients with non-caudate LM (disease-free: 24% vs. 44%; P = 0.02; overall: 41% vs. 58%; P = 0.02).
Conclusions:
Patients who undergo hepatic resection for caudate LM often present with multiple hepatic tumors and tumors in proximity to the major hepatic veins. Extended hepatectomy is required in the majority, although vascular resection is not frequently necessary; when performed, primary repair is usually possible. Despite resection in this population of patients with multiple and bilateral tumors, and despite close-margin and positive-margin resection in a significant proportion, recurrence on the portal vein or vena cava was not observed, and long-term survival is accomplished (41% 5-year overall survival).
Published
N/A
2015-11-12T12:22:16Z
2015-11-12T12:22:16Z
2007
2015-11-12
Article
1091-255X
http://hdl.handle.net/10725/2551
http://dx.doi.org/10.1007/s11605-006-0045-3
Abdalla, E. K., Ribero, D., Pawlik, T. M., Zorzi, D., Curley, S. A., Muratore, A., ... & Vauthey, J. N. (2007). Resection of hepatic colorectal metastases involving the caudate lobe: perioperative outcome and survival. Journal of Gastrointestinal Surgery, 11(1), 66-72.
http://link.springer.com/article/10.1007/s11605-006-0045-3
en
Journal of Gastrointestinal Surgery
oai:laur.lau.edu.lb:10725/25522016-08-25T10:06:22Zcom_10725_2056col_10725_2077
High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma
Aloia, Thomas
Chamsangavej, Chulsip
Faria, Silvana
Ribero, Dario
Abdalla, Eddie
Vauthey, Nicolas
Curley, Steven
Introduction
Despite the use of radiologic, endoscopic, and laparoscopic staging techniques, the rate of nontherapeutic laparotomies in patients with hilar cholangiocarcinoma remains high. This study evaluated the accuracy of preoperative high-resolution computed tomograpy (HRCT) to determine resectability in this setting.
Patients and Methods
Preoperative helical HRCT (2 contrast phases, rapid intravenous contrast bolus, 2.5-mm section thickness) for 32 consecutive patients who underwent laparotomy for the diagnosis of hilar cholangiocarcinoma from 2000 to 2005 were reviewed by a hepatobiliary radiologist. The accuracy of HRCT was determined by comparison of the imaging interpretation to intraoperative and pathologic findings. The chi-square test was used to identify imaging findings that best predicted unresectability.
Results
Fourteen of the 32 (44%) study patients were unresectable (extension along bile duct, 4; peritoneal metastases, 4; vascular encasement, 3; noncontiguous liver metastases, 2; N2 lymphadenopathy, 1). HRCT correctly predicted resectability in 17 of 18 patients who underwent therapeutic laparotomy (sensitivity = 94%). HRCT correctly predicted the inability to resect in 11 of the remaining 14 cases (specificity = 79%). In the 3 cases in which HRCT predicted resectability and the patient was unresectable, subcentimeter peritoneal disease, a subcentimeter liver metastasis, and distal bile duct involvement were responsible factors. The negative and positive predictive values of HRCT were 92% and 85%, respectively. Individual radiographic findings that best predicted unresectability were peritoneal spread (P = .015) and hepatic artery (P = .006) or portal vein (P = .002) involvement.
Conclusions
Preoperative HRCT accurately predicts resectability in patients with hilar cholangiocarcinoma. Identification of specific radiographic features, in particular major vascular involvement and peritoneal abnormalities, is now used by our group to avoid unnecessary laparotomy.
Published
N/A
2015-11-12T12:30:49Z
2015-11-12T12:30:49Z
2007
2015-11-12
Article
0002-9610
http://hdl.handle.net/10725/2552
http://dx.doi.org/10.1016/j.amjsurg.2006.10.024
Aloia, T. A., Charnsangavej, C., Faria, S., Ribero, D., Abdalla, E. K., Vauthey, J. N., & Curley, S. A. (2007). High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. The American journal of surgery, 193(6), 702-706.
http://www.sciencedirect.com/science/article/pii/S0002961007001997
en
The American Journal of Surgery
oai:laur.lau.edu.lb:10725/25532019-02-26T08:23:24Zcom_10725_2056col_10725_2077
Delayed Recovery after Pancreaticoduodenectomy
A Major Factor Impairing the Delivery of Adjuvant Therapy?
Abdalla, Eddie
Aloia, Thomas
Lee, Jeffrey
Vauthey, Nicolas
Wolff, Robert
Varadhachary, Gauri
Abbruzzese, James
Crane, Christopher
Evans, Douglas
Pisters, Peter
Background
Delayed recovery after pancreaticoduodenectomy (PD) is believed to preclude adjuvant therapy for approximately 30% of patients who undergo elective PD as initial treatment for pancreatic adenocarcinoma. This study reexamined the frequency of delayed recovery and assessed other factors associated with adjuvant therapy administration after PD at a high-volume center.
Study Design
Preoperative and perioperative variables were reviewed in a consecutive series of 85 patients with pancreatic adenocarcinoma undergoing PD without preoperative chemotherapy or radiotherapy from 1990 to 2004.
Results
Study groups included patients undergoing emergency PD (group 1, n = 13); elective PD with good preoperative Eastern Cooperative Oncology Group (ECOG) performance status (PS) (group 2, ECOG PS: 0 to 1, n = 63); and elective PD with marginal preoperative PS (group 3, ECOG PS: 2 to 3, n = 9). Delayed recovery of PS precluded adjuvant therapy in 23% of patients in group 1, 6% of patients in group 2, and 44% of patients in group 3 (p = 0.0001).
Conclusions
The impact of delayed recovery after PD on the delivery of adjuvant therapy depends on the urgency of surgery and the preoperative PS. For patients with good preoperative PS who undergo elective PD at a high-volume center, it is uncommon for delayed recovery to preclude delivery of adjuvant therapy.
Published
N/A
2015-11-12T13:03:58Z
2015-11-12T13:03:58Z
2007
2015-11-12
Article
http://hdl.handle.net/10725/2553
http://dx.doi.org/10.1016/j.jamcollsurg.2006.12.011
Aloia, T. E., Lee, J. E., Vauthey, J. N., Abdalla, E. K., Wolff, R. A., Varadhachary, G. R., ... & Pisters, P. W. (2007). Delayed recovery after pancreaticoduodenectomy: a major factor impairing the delivery of adjuvant therapy?. Journal of the American College of Surgeons, 204(3), 347-355.
http://www.sciencedirect.com/science/article/pii/S107275150601787X
en
Journal of the American College of Surgeons
oai:laur.lau.edu.lb:10725/25542016-08-26T06:42:10Zcom_10725_2056col_10725_2077
Patient Selection and Outcome of Hepatectomy for Noncolorectal Non-Neuroendocrine Liver Metastases
Abdalla, Eddie
Choi, Eugene
Improved patient selection, introduction of more effective systemic treatments including targeted biologic and combined therapies, and the low morbidity and mortality rates of hepatobiliary surgery in centers of excellence are likely to provide continued improvements in outcomes for patients with noncolorectal non-neuroendocrine liver metastases. Further advances in treatment may emerge from better understanding of the underlying tumor biology for each cancer type and application of individualized care to each patien
Published
N/A
2015-11-12T13:23:36Z
2015-11-12T13:23:36Z
2007
2015-11-12
Article
1055-3207
http://hdl.handle.net/10725/2554
http://dx.doi.org/10.1016/j.soc.2007.04.005
Choi, E. A., & Abdalla, E. K. (2007). Patient selection and outcome of hepatectomy for noncolorectal non-neuroendocrine liver metastases. Surgical oncology clinics of North America, 16(3), 557-577.
en
Surgical Oncology Clinics of North America
oai:laur.lau.edu.lb:10725/25552019-02-26T11:14:01Zcom_10725_2056col_10725_2077
Systemic Chemotherapy and Two-Stage Hepatectomy for Extensive Bilateral Colorectal Liver Metastases
Perioperative Safety and Survival
Chun, Yun Shin
Vauthey, Nicolas
Ribero, Dario
Donadon, Matteo
Mullen, John
Eng, Cathy
Madoff, David
Chang, David
Ho, Linus
Kopetz, Scott
Wei, Steven
Curley, Steven
Abdalla, Eddie
Background
Two-stage hepatectomy has been proposed for patients with bilateral colorectal liver metastases (CLM). The aim of this study was to compare the outcome of patients with CLM treated with preoperative chemotherapy followed by one- or two-stage hepatectomy.
Methods
From a prospective database, 214 consecutive patients who received preoperative systemic chemotherapy (fluoropyrimidine with irinotecan or oxaliplatin) followed by planned one- or two-stage hepatectomy were retrospectively analyzed (1998–2006). In patients undergoing two-stage procedures, minor hepatectomy (wedge or segmental resection[s]) was systematically performed before major (more than three segments), second-stage hepatectomy. Preoperative portal vein embolization (PVE) was performed if indicated.
Results
One- (group I) and two-stage(group II) hepatectomies were performed in 184 and 21 patients, respectively. Median number of metastases in groups I and II were two (range 1–20) and seven (range 2–20). All patients in group II had bilateral disease vs 39% in group I. Major hepatectomy was performed in all patients in group II and 79% in group I. PVE was performed in 18 group I and 12 group II patients without increase in morbidity. For group I, group II first stage, and group II second stage, respectively, morbidity (24%, 24%, 43%), median hospital stay (7 days, 6 days, 6.5 days) and 30 days postoperative mortality (2%, 0%, 0%) were not significantly different (P = NS). Median follow-up was 25 months; median survival has not been reached. One- and 3-year overall and disease-free survival rates from the time of hepatic resection were 95% and 75%, 63% and 39%, respectively in group I; 95% and 86%, 70% and 51%, respectively in group II (P = NS).
Conclusions
Two-stage hepatectomy with preoperative chemotherapy results in comparable morbidity and survival rates as one-stage hepatectomy. This approach enables selection and treatment of patients with multiple, bilateral CLM who will benefit from aggressive surgery with good outcomes.
Published
N/A
2015-11-12T13:31:22Z
2015-11-12T13:31:22Z
2007
2015-11-12
Article
1091-255X
http://hdl.handle.net/10725/2555
http://dx.doi.org/10.1007/s11605-007-0272-2
Chun, Y. S., Vauthey, J. N., Ribero, D., Donadon, M., Mullen, J. T., Eng, C., ... & Abdalla, E. K. (2007). Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. Journal of Gastrointestinal Surgery, 11(11), 1498-1505.
http://link.springer.com/article/10.1007/s11605-007-0272-2
en
Journal of Gastrointestinal Surgery
oai_dc///com_10725_2056/100