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INTRODUCTION: In 2011 in France, all kidneys from patients with brain death and from living donors cannot meet the demand for renal transplants. Since 2006, sampling protocols kidneys from non-heart-beating donors (NHBD) are developed to increase the number of renal transplants. The objective was to describe the organization of a protocol NHBD in a non-university hospital. MATERIALS AND METHODS: Patients with inclusion criteria of protocol NHBD of the Agency of Biomedicine were prospectively included between 1st July 2011 and 31 December 2012. The protocol data were comparable to national data. Vascular canulation was performed by urologists. The epidemiological, clinical and biological characteristics of patients included, the different times and deadlines of the protocol, and data of renal transplantation were collected and analyzed. RESULTS: Over the period of 18 months, 16 patients were included in the protocol NHBD, with a median age of 42 years, and 87.5% of males; 93.8% of patients made a cardiac arrest outside the hospital. The median duration of no-flow was 4.3 minutes (0; 23), the median time between the cardiac arrest and admission to hospital was 90 minutes (0; 116), the median time between the cardiac arrest and the start of the normothermic recirculation was 139 minutes (40; 150), and the median duration of normothermic recirculation was 212 minutes (186; 240). For urologists, the median duration of mobilization was 178 minutes and 97 minutes after 20 h. Twenty-four kidneys were collected (75%) and 22 kidneys were transplanted (91.7%). The median duration of cold ischemia was 9 h 12 (5 h 25; 18 h 02). No primary non-function of graft was observed. Delayed graft function was observed in 50% of cases and the median duration of dialysis was 2 days (0; 19). After 12 months of inclusion, our center accounted for 8% of the national census and 16% of transplanted kidneys NHBD. CONCLUSION: The involvement of rescue, coordination, anesthesiologists and urologists, and the concentration of jobs in our center have helped to minimize response times NHBD in the protocol for maximum quality of kidneys taken with transplant rates and results are very encouraging.
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Paro Cardíaco , Trasplante de Riñón , Obtención de Tejidos y Órganos , Adulto , Femenino , Hospitales , Humanos , Masculino , Estudios Prospectivos , Donantes de TejidosRESUMEN
Latissimus dorsi flap is the most commonly used among tissues transfers for breast reconstruction. If its qualities and performances are well known, few papers have studied sequellae of this flap, particularly painful. The purpose of this paper is to provide a contribution about this subject. Postulating the complexity of this step, we limited ourselves initially to an evaluation based on analysis of concise questionnaire mailed to two pools of patients with different delays since their reconstruction using latissimus flap. In the two groups of patients, announced principal embarrassment - logically associated with a gestural limitation - is the feeling of axillo-dorsal rigidity, more pregnant than the pain itself. This one is marked during the 2 to 4 first months in the majority of the patients (68 and 66 %), and can persist several years in some among them (14 %). These after-effects did not prevent almost all of the patients to take again their domestic and professional activities and to express a high level of satisfaction with respect to their reconstruction. The addition of a prospective series studying the postoperative pain after reconstruction with or without latissimus flap tends to confirm that any oncologic breast surgery, ablative or reconstructive, expose to painful sequellae more linked to individual factors than to the technique implemented.
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Mamoplastia/efectos adversos , Músculo Esquelético/trasplante , Dolor Postoperatorio/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Colgajos Quirúrgicos/efectos adversos , Actividades Cotidianas , Adulto , Anciano , Actitud Frente a la Salud , Implantes de Mama/psicología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Mamoplastia/psicología , Persona de Mediana Edad , Actividad Motora/fisiología , Movimiento/fisiología , Rigidez Muscular/fisiopatología , Rigidez Muscular/psicología , Dolor Postoperatorio/psicología , Satisfacción del Paciente , Complicaciones Posoperatorias/psicología , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Seroma/fisiopatología , Seroma/psicología , Encuestas y CuestionariosRESUMEN
INTRODUCTION: The infrahyoid myocutaneous flap was described by Wang et al. in 1986. The horizontal design of the skin paddle is a modification of this technique allowing for a smaller scar. We have been systematically using this modified technique for 10 years. We had for aim to describe the interest of the horizontal infrahyoid myocutaneous flap for cervicofacial carcinology. PATIENTS AND METHODS: A horizontal infrahyoid myocutaneous flap procedure was performed in 276 cervicofacial carcinology patients for lesions of the mouth floor, the mandibular gum, the oropharynx and the tongue between March 1997 and March 2007. RESULTS: No complications were observed in 252 patients. No patient presented with total flap necrosis. DISCUSSION: Modifying the infrahyoid myocutaneous flap technique with a horizontal design of the skin paddle does not modify the reliability of the flap and prevents more extensive scars. The main indications of this technique are defects of the mouth floor, the tongue and the oropharynx.
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Neoplasias de Cabeza y Cuello/cirugía , Músculos del Cuello/trasplante , Trasplante de Piel/métodos , Colgajos Quirúrgicos , Adulto , Anciano , Carcinoma Adenoide Quístico/cirugía , Carcinoma de Células Escamosas/cirugía , Cicatriz/prevención & control , Femenino , Neoplasias Gingivales/cirugía , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Suelo de la Boca/cirugía , Neoplasias de la Boca/cirugía , Neoplasias Orofaríngeas/cirugía , Complicaciones Posoperatorias , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Neoplasias de la Lengua/cirugía , Resultado del Tratamiento , Insuficiencia Venosa/etiologíaRESUMEN
Many studies have shown relative preservation of word priming in subjects with mild amnesia, but some decrease in severe amnesia. This calls into question the degree of separation between implicit and explicit memory. Possible contamination of implicit memory tasks by impaired explicit memory strategies might be obscuring the actual dissociation between the two memory systems. We have developed a method of circumventing explicit memory contamination by using brief duration repeated primes below the awareness threshold of subjects. We have used this approach to evaluate the status of word priming in densely amnesic subjects. One group of amnesic subjects with alcoholic Korsakoff's syndrome and one group of normal elderly control subjects were tested for word priming on a speeded category membership decision task. Implicit or explicit encoding procedures were used in three different experiments. Results demonstrated that brief multiple presentation of words can offer a means of producing word priming in the absence of explicit recognition or recall of the primed words in both amnesic subjects and normal elderly control subjects. Moreover, there was no significant difference in the magnitude of the priming effect between these groups in the three experiments. These findings show that amnesic subjects can exhibit normal levels of word priming. They also suggest that amnesics retain the capacity to encode, store and retrieve information implicity, e.g. unintentionally.
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Trastorno Amnésico Alcohólico/psicología , Atención , Recuerdo Mental , Aprendizaje Verbal , Anciano , Anciano de 80 o más Años , Trastorno Amnésico Alcohólico/diagnóstico , Concienciación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Enmascaramiento Perceptual , Tiempo de Reacción , Retención en PsicologíaRESUMEN
From April 1978 to June 1990, 22 patients with ethmoidal cancer were treated at Fondation Bergonié by a combination of surgery and radiation therapy. The mean age was 59.6 years (range 34-79 years) and the sex ratio is 2.7 (16 males/6 females). Histologic types were: adenocarcinoma, 13 cases; squamous carcinoma, 4 cases; undifferentiated carcinoma, 3 cases and esthesioneuroblastoma, 2 cases. Exposure to wood dust was encountered in 11 patients, especially in cases of adenocarcinoma: 10/13 (77%). Staging according to the classification of the University of Florida was: Stage I, 10 patients; Stage II, 5 patients and Stage III, 7 patients. Resection was considered as complete in 16 cases and only one orbital exenteration was performed. The postoperative radiation therapy delivered a mean given dose of 55.7 Gy (range 50-70 Gy) expressed to the hot spot using a technique adapted to tumor location and extension. Complete remission was achieved in 20 cases. Median follow-up is 28 months. The 5-year overall and disease-free survival are 44% and 38%, respectively. Analysis of recurrences according to staging gives: 5/10 Stage I, 2/5 Stage II and 5/7 Stage III. Recurrence is pejorative since death occurs in all cases within an average of 6 months following salvage treatment, except for three patients still alive within less than 6 months and in second remission. Prognosis of ethmoidal cancer depends on staging and local control.
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Senos Etmoidales , Neoplasias de los Senos Paranasales/terapia , Adenocarcinoma/epidemiología , Adenocarcinoma/etiología , Adenocarcinoma/terapia , Adulto , Anciano , Carcinoma/epidemiología , Carcinoma/etiología , Carcinoma/terapia , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Polvo , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Tumores Neuroectodérmicos Periféricos Primitivos/epidemiología , Tumores Neuroectodérmicos Periféricos Primitivos/terapia , Exposición Profesional , Neoplasias de los Senos Paranasales/epidemiología , Neoplasias de los Senos Paranasales/etiología , Estudios Retrospectivos , Tasa de Supervivencia , MaderaRESUMEN
Depression of cell-mediated immunity is well established in most malignancies and especially in head and neck cancers, and much information is available concerning the defect in helper T lymphocyte function. We now report on impairment of the monocyte-macrophage system. Compared with normal controls we found that patients displayed, on one hand, an increased number of peripheral blood monocytes and, on the other hand, a smaller percentage of HLA-DR+ monocytes. Such peripheral blood monocytes normally failed to secrete factors, including interleukin 1 (IL-1). In addition, we observed that the in vivo induced blastogenesis of peripheral blood lymphocytes from patients, which is spontaneously depressed, is partly restored by medium containing IL-1. We cannot exclude, however, that the observed monocyte dysfunction involves other cytokines. Whether such an immune deficiency is due to secondary malnutrition or to the malignancy (or both) remains unclear.
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Neoplasias de Cabeza y Cuello/inmunología , Monocitos/inmunología , Adulto , Anciano , Femenino , Humanos , Técnicas In Vitro , Interleucina-1/biosíntesis , Leucocitos Mononucleares/clasificación , Leucocitos Mononucleares/inmunología , Activación de Linfocitos , Masculino , Persona de Mediana Edad , Linfocitos T/inmunologíaRESUMEN
A retrospective analysis was carried out of 311 reconstructions of major defects following head and neck cancer treatment. Three hundred thirty-one flaps were used; they included cutaneous flaps from 1972 to 1979 and myocutaneous flaps (MCF) after 1979. The aim of this study was to compare the healing patterns of the two types of flaps used in similar circumstances. Even though the use of myocutaneous flaps reduced necrotic complications, there was no significant improvement in overall healing. In this type of reconstruction, local conditions as well as more general factors have greater prognostic significance. Apart from considerations of reliability, other criteria have led to myocutaneous flaps being the treatment of choice in cervicofacial cancer repair. However, specific indications for the use of cutaneous flaps remain.
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Neoplasias de Cabeza y Cuello/cirugía , Músculos/trasplante , Trasplante de Piel , Colgajos Quirúrgicos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Pronóstico , Dosificación Radioterapéutica , Factores de Tiempo , Cicatrización de Heridas/efectos de la radiaciónRESUMEN
The results of centromammary conservation in 37 patients with 20 mm-median-size breast cancer, located in the subareolar area (SAA), with an infiltration of the nipple-areolar-complex (NAC) in 12 patients and a retraction in 24, are reported. Breast conservative surgery was initially performed in 30 patients; five patients were first treated with chemotherapy; two patients received initial tamoxifen. Surgery comprised tumorectomy plus axillary dissection, with complete resection of the NAC (20 patients), or partial resection (nine patients), or without resection (eight patients). Post-operatively, all patients received 50 Gy external radiotherapy, with an additional external electron boost in 13 patients; 14 patients received adjuvant tamoxifen and two patients adjuvant chemotherapy. With a median follow-up of 49 months, one patient experienced a local failure and four a metastatic failure; 5-year overall actuarial survival and disease-free survival rates were 97%, and 75%. Cosmetic results were excellent in three patients, good in 25, and poor in seven. Breast conservation appears a satisfying treatment in small breast cancer located in SAA.
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Neoplasias de la Mama/terapia , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Terapia Combinada , Estética , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Pezones , Estudios Retrospectivos , Tasa de Supervivencia , Tamoxifeno/uso terapéuticoRESUMEN
Posterior dislocation is a well-described complication of plate-haptic intraocular lenses (IOLs). It usually occurs after an opening in the posterior capsule, either intraoperatively or after a neodymium: YAG capsulotomy occurs. We report a case of anterior luxation of a plate-haptic silicone IOL occurring 4 months after uneventful cataract surgery. This case emphasizes the need for a small and continuous capsulorhexis as well as in-the-bag implantation of plate-haptic IOLs.
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Cámara Anterior/patología , Migración de Cuerpo Extraño/etiología , Lentes Intraoculares , Elastómeros de Silicona , Cámara Anterior/cirugía , Materiales Biocompatibles , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Agudeza VisualRESUMEN
PURPOSE: To assess the accuracy of Goldmann tonometry after refractive surgery. SETTING: Refractive surgery center, Sherbrooke, Quebec, Canada. METHODS: The charts of 824 patients who had radial keratotomy (RK) and 415 who had photorefractive keratectomy (PRK) by the same surgeon were retrospectively reviewed. Of these, 306 RK and 168 PRK patients had discontinued steroid use for at least 4 weeks postoperatively and were thus eligible for evaluation of preoperative and postoperative intraocular pressure (IOP). Only one eye per patient was used for statistical analysis. RESULTS: Preoperative data showed that age, mean keratometry, and pachymetry were related to IOP measurement with the Goldmann tonometer. Pachymetry was related to age and mean keratometry. The mean decrease in measured IOP after RK was 1.0 mm Hg +/- 3.21 (SD) (P < .05). The only positive correlation was with the number of incisions. The mean decrease in measured PRK was 2.4 +/- 3.02 mm Hg (P < .05). Men and older patients had a larger drop in IOP measurements. There was no correlation with any corneal or operative parameter. CONCLUSION: Refractive surgery changed the accuracy of the Goldmann tonometer, causing it to underestimate IOP. The change was more marked in older men who had PRK.
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Córnea/cirugía , Presión Intraocular , Procedimientos Quirúrgicos Refractivos , Tonometría Ocular/normas , Adulto , Córnea/fisiopatología , Femenino , Humanos , Presión Intraocular/fisiología , Queratotomía Radial , Láseres de Excímeros , Masculino , Queratectomía Fotorrefractiva , Errores de Refracción/fisiopatología , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
BACKGROUND: In oral cavity cancer, supraomohyoid neck dissection (SOHND) is becoming more popular for patients with N0 and N1 disease in the neck. The aim of this study was to assess the value of this surgical procedure. METHODS: The study included 237 previously untreated patients with oral cavity cancer. The neck treatment consisted of SOHND or functional neck dissection (FND). One hundred sixty patients underwent postoperative radiation therapy. Survival probabilities, neck recurrences, and distant metastases were analyzed according to the surgical procedure. RESULTS: For patients having undergone SOHND, the 5-year survival probabilities were 70.2% and 76.5% in N0 and N1 necks, respectively. The neck recurrence rate in SOHND was 2%. CONCLUSIONS: SOHND is an effective method of treatment for the clinically negative neck in patients with squamous cell carcinoma of the oral cavity. It also proves efficient, in conjunction with postoperative radiotherapy, for control of neck metastases in selected patients.
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Carcinoma de Células Escamosas/cirugía , Neoplasias de la Boca/cirugía , Disección del Cuello/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Neoplasias de la Boca/radioterapia , Cuello/patología , Recurrencia Local de Neoplasia , Radioterapia Adyuvante , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVES: To present 8 new cases of primary intraosseous carcinoma of the jaws and to review the literature for an analysis of treatment modalities and patient outcomes. DATA SOURCES: A MEDLINE search from 1970 to 1999. The articles chosen and the study of the references of every one that produced additional articles provided database information for 28 patients. Eight new patients from our institutions were added. STUDY SELECTION: Our criteria of inclusion included the absence of ulceration of the oral mucosa, a negative result in the search for a distant primary tumor, and convincing histological documentation. DATA EXTRACTION: The variables of the analysis included age, sex, site of the tumor, condition of the oral mucosa, tumor size, neck status, treatment modalities, recurrences, and survival. DATA SYNTHESIS: Twenty-eight patients were identified in the literature, for a total of 36 patients. There were 28 males (78%) and 8 females (22%) ranging in age from 4 to 76 years (mean, 54 years). The tumor site was the mandible in 33 patients (92%) and the maxilla in 3 (8%). Of the 34 patients treated, 19 (56%) had recurrences. Overall 2- and 4-year survival was 60.5% and 39.9%, respectively. Patients who underwent radical surgery and postoperative radiotherapy (n = 11) had a 2- and 3-year survival probability of 61.3% and 40.9%, respectively, whereas in the remaining patients (n = 25), the rates were 59.7% and 31.3%, respectively (P =.60). CONCLUSIONS: Strict diagnostic criteria must be applied. The prognosis associated with primary intraosseous carcinoma of the jaws is poor and suggests the need for aggressive treatment.
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Neoplasias Maxilomandibulares/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Neoplasias Maxilomandibulares/mortalidad , Neoplasias Maxilomandibulares/patología , Neoplasias Maxilomandibulares/radioterapia , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Pronóstico , Radioterapia Adyuvante , Tasa de SupervivenciaRESUMEN
Six hundred seventy-six patients with ductal carcinoma in situ of the breast (DCIS) from 1971 to 1995 were included in the study. Computerized patient files were retrospectively analyzed. Clinical findings were less frequently reported to reveal DCIS after 1989. Positive mammographic findings were obtained in 87% of patients and were mainly represented by microcalcifications (79.4%). Treatment procedures were breast-conserving surgery (BCS) alone (37.5%), BCS followed by radiation (BCSR) (25.5%), or mastectomy (M) (37%). The actuarial local recurrence was 2.6% in the M group (94 months of follow-up), 14.5% in the BCS group (85,7 months of follow-up), and 7.5% in the BCSR group (78.8 months of follow-up). Predictive factors of recurrence in all patients were invaded margin status and age. In the BCS group, grade was also a predictive factor. The analysis per decade shows that the lesions currently diagnosed are less serious than those of the past. All the recurrence in patients with positive margins was in the same quadrant as the original lesion. This further emphasizes the need for clear margins.
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Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Carcinoma Intraductal no Infiltrante/diagnóstico , Carcinoma Intraductal no Infiltrante/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Radioterapia Adyuvante , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND: Squamous cell carcinomas of the gingiva are relatively rare tumours. Standard treatment is based on surgery and radiotherapy. The extent of bone involvement affects mandibulectary indications. PURPOSE: A retrospective review of squamous cell carcinomas of the gingiva was performed to evaluate the incidence of mandibular or maxillary bone involvement. Indications for marginal and segmental bone resections are specified. MATERIAL: From 1985 to 1996, 83 patients with squamous cell carcinoma of the gingiva were treated at the Department of Surgery (Institut Bergonié, Bordeaux, France) and at the Department of Maxillofacial and Plastic Surgery (Centre Hospitalier Universitaire, Bordeaux, France). Forty-three underwent surgery plus postoperative radiotherapy. Twenty-two had flap reconstructions. Clinical evaluation and panorex roentgenography were the means used to evaluate bony invasion and to decide on the extent of bone resection. METHODS: A retrospective review of 83 consecutive patients was performed. This series is unusual in its homogeneity: surgery was performed by only two individuals and the radiotherapy was the responsibility of just two physicians. Outcome was calculated using the Kaplan-Meier method. RESULTS: Primary local control was achieved in 72 patients (87%). Overall survival and rate of recurrence were comparable to those of other squamous cell carcinomas of the oral cavity and oropharynx. CONCLUSION: Surgical resection continues to be the mainstay of treatment and this study tends to confirm the validity of modified neck dissection and marginal bone resection in suitably selected patients.
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Carcinoma de Células Escamosas/cirugía , Neoplasias Gingivales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Escisión del Ganglio Linfático , Masculino , Neoplasias Mandibulares/cirugía , Neoplasias Maxilares/cirugía , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/prevención & control , Osteotomía/métodos , Radiografía Panorámica , Radioterapia Adyuvante , Reproducibilidad de los Resultados , Estudios Retrospectivos , Estadística como Asunto , Colgajos Quirúrgicos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Fourty-one patients underwent breast reconstruction after mastectomy for cancer and reduction plasty of the second breast, over a 36-month period. These plasties were performed only for reasons of asymmetry, in the absence of any positive preoperative finding. Histologic examination using semiserial sectioning of the whole excised sample detected a high frequency of unsuspected cancer 14/41 (34%). There was a strong predominance of in situ carcinomas 11/41 (27%) over invasive carcinomas 3/41 (7%). These results were compared with those of other bilateral cancer series. When such cancers were detected by random biopsies or mastectomies, the rate of in situ carcinomas was much greater than in cancers detected only by physical and mammographic examination.
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Neoplasias de la Mama/cirugía , Mama/cirugía , Cirugía Plástica , Adulto , Anciano , Biopsia , Neoplasias de la Mama/etiología , Carcinoma in Situ/etiología , Femenino , Estudios de Seguimiento , Humanos , Mastectomía , Persona de Mediana EdadRESUMEN
Authors inquire into repercussions of radiotherapy (RT) on prosthetic mammary reconstruction (PMR) by using the retrospective analysis of 67 cases, 59 of which were performed in irradiated areas. The particular aspect of irradiated prosthesis is evoked regarding 8 cases, and with the support of a literature review. Surgical complications and late results are evaluated comparatively to 339 PMR among non irradiated patients. According to available data in our series, harmfulness of RT not appeared statistically demonstrated. From both their experience and the literature, authors clarify indications of PMR following RT. They conclude to the necessity of a high quality RT, and optimal adaptation of surgical technique to tissular conditions.
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Implantes de Mama , Neoplasias de la Mama/radioterapia , Mama/efectos de la radiación , Mamoplastia , Adulto , Neoplasias de la Mama/cirugía , Femenino , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
During the years 1958-1984, 2 362 patients presenting with breast carcinoma were treated at the Fondation Bergonié by modified radical mastectomy and followed or not by radiotherapy or adjuvant chemotherapy. A retrospective analysis of this series showed that 77 patients (3.3%) presented an isolated locoregional recurrence as the first sign of treatment failure. A chest wall recurrence alone was noted in 47 patients, while 30 presented an involvement of the lymph nodes, sometimes associated with chest wall disease. The prognosis' factors of isolated locoregional recurrence, studied by multidimensional analysis by Cox's model are by decreasing order the disease free interval and the Scarf and Bloom's histologic grade. The median survival is 29 months after isolated locoregional recurrence and the survival curve is very similar to that of patients with isolated bone metastatic recurrences (median survival of 26 months) and slightly better than the median survival of patients with non osseous metastasis (median survival of 16 months).
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Neoplasias de la Mama/mortalidad , Escisión del Ganglio Linfático , Mastectomía , Recurrencia Local de Neoplasia/mortalidad , Axila , Neoplasias Óseas/mortalidad , Neoplasias Óseas/secundario , Neoplasias de la Mama/cirugía , Femenino , Francia , Humanos , Metástasis Linfática , Pronóstico , Estudios Retrospectivos , RiesgoRESUMEN
CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature systematic review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of Standards, Options and Recommendations for the management of squamous carcinoma of the oropharynx. METHODS: Data have been identified by literature search using Medline (1991-1998) and the expert groups personal reference lists. Once the guidelines were defined, the document was submitted for review to national and international independent reviewers and to the medical committees of the 20 French Cancer Centres. RESULTS: The main recommendations for squamous cell carcinoma of the oropharynx management are that: 1) diagnosis and initial assessment should be based on appropriate clinical and radiological findings; 2) the therapeutic strategy is based on surgery, radiotherapy, bradytherapy and chemotherapy; 3) in limited tumours, the recommended strategy involved the use of one of these modality; 4) a multimodality approach is recommended for the treatment of extended resectable tumours. Following results of recent meta-analyses, use of neo-adjuvant chemotherapy is not recommended. The same studies have shown that association of chemotherapy and radiotherapy either in sequence or in combination significantly improve survival of extended curable tumours. These associations are recommended within the framework of clinical trials; 5) follow-up of squamous carcinoma of the oropharynx should involve physical examination of the upper aerodigestive tract and the lymph nodes areas every three months during the first year, every six months during the second year and then every year. An annual chest x-ray is recommended. Other investigations should be performed as indicated by symptoms and clinical manifestations.
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Carcinoma de Células Escamosas/terapia , Neoplasias Orofaríngeas/terapia , HumanosRESUMEN
OBJECTIVE: To assess the risk of local recurrence of intraductal carcinoma of the breast with a large series and a review of literature. METHODS: We present a retrospective study of 331 cases treated for intraductal carcinoma of the breast. Only patients with at least 5 years follow-up were selected. We were specially interested in recurrence risk factors. In these patients with a long follow-up; pathology was reevaluated with new investigation technique. RESULTS: After a median follow-up of 109 months, 40 local recurrences were observed; these lesions were invasive in 23 cases. Only one patient had recurrence after mastectomy. For the others, they had lumpectomy associated with radiotherapy in 12 cases. Histologic features, grade and therapeutic options were evaluated as risk factors of local recurrence. CONCLUSION: Follow-up after lumpectomy for intraductal carcinoma was studied. The status of tumor margins was important; irradiation appeared useful, specially in case of high grade carcinoma but further large prospective randomized studies are needed. The use of prognostic index is interesting, but there are still unanswered questions.