[Sarcoma of the vagina in adult (author's transl)].
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Biomedical subjects
Publications and source records attributed to B Giraud.
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The authors report 8 cases of sarcoma of the uterus and discuss the special characteristics of this type of lesion. It seems that the frequency of sarcoma of the uterus is more importnat than is usually thought : one case out of 100 fibromas in the authors' series. The pre-operative diagnosis is difficult, in particular the radiological signs described by Musset were only found in 2 cases out of 8. On the other hand, the pre-operative diagnosis was made in 5 cases out of 8. The histological diagnosis is difficult and may only be made later. The only treatment is surgical, according to most authors. Chemotherapy may be of interest in the future. A uterine sarcoma should certainly be considered more often, especially in cases of fibroma which undergo rapid change.
Two benign liver tumours are described in women who had taken oral contraceptives. These were cases of focal nodular hyperplasia and a liver cell adenoma. These lesions are benign, and were discovered on routine examination as they were not responsible for any clinical sign, as is usual except in cases of peritoneal rupture, where the patient presents with a dramatic hemoperitoneum. Oral contraceptive were found to be associated as in many recent cases. Oestro-progestins were found to be responsible for an increase in hepatic metabolism, which gave rise to biochemical, histological and sometimes clinical changes in the form of jaundice or a tumour. There is no proof of this mechanism but the supervision of women on contraceptives should include a search for a hepatic tumour for which surgical treatment is necessary to prevent complications.
A means of stopping dramatic vesical hemorrhage due to a hemorrhage cystitis secondary to radiation therapy or a tumor: the selective vesical arterial embolisation.
After colpohysterectomy and myorrhaphy of the levator ani muscles for prolapse, there persists a weak point between the utero-sacral ligaments attached behind the pubic symphysis and the levator ani muscles. The author describes a technical device permitting one to fill this gap by suturing the two fascia on each side of the vagina.
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PURPOSE: Retrospective analysis of the results of radiotherapy in localized prostatic adenocarcinoma. Complications were excluded. PATIENTS AND METHODS: Six-hundred-and-ten T1-T2 adenocarcinomas of the prostate were treated with continuous courses of external beam radiation therapy in 19 participating Institutes between January 1983 and January 1988. The mean follow-up was 10.4 years; the mean age of patients at the beginning of radiotherapy was 68.5 years. RESULTS: A 10-year, local control had been achieved in 86% of T1-T2 (81.4% for T2). The 5- and 10-year metastatic relapse rates were 25.3% and 30% (29% and 38.1% for T2), respectively. At 10 years, 62.4% of T1-T2 were recurrence-free; overall survival rate was 45.8% and cause-specific survival rate was 70.5%; 29.9% of T1-T2 patients were alive and disease-free. T category (TNM), pathologic grade, pelvic lymph node status, local tumor control, and obstructive ureteral symptoms were correlated with survival. The influence of pelvic nodes radiation, dose, overall treatment time, previous endocrine treatment, and transuretral resection was not significant for disease-free survival (alive and disease-free) and other endpoints. CONCLUSION: There was no difference between the French series (1975-1982 and 1983-1988). The results of the literature are comparable to ours. As far as prognostic factors are concerned, this report provides evidence that the explainable variables which influence survival depend on the tumor and patient status.
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The staging of pelvic cancers using imaging techniques is not very precise, even with the most recent methods. However, optimal treatment depends on the results of this staging. In our experiment, we carried out a pelvioscopy prior to any curative treatment on all our patients who had had pelvic cancer for at least three years. Seventy-eight pelvioscopies were performed with 48 patients, entailing minimum morbidity and no mortality. For 23 patients, the lymph nodes were metastasized even though the C.T. were considered normal. With this simple method, staging of pelvic cancers can be improved and this extensive, unnecessary surgery can be avoided in many cases.
A prospective randomized study was carried out to discover the influence of the timing of shoulder physiotherapy after-axillary dissection for breast cancer upon the incidence and duration of lymphatic fluid production and seroma after these operations. Sixty-eight patients underwent a modified radical mastectomy, 31 were submitted to early physiotherapy and 37 to delayed physiotherapy after removal of the suction drainage. In 32 patients this surgery was conservative of the breast; in 16 the physiotherapy was early and in 16 delayed. The shoulder was left free when the physiotherapy was delayed. The mean volume of lymphatic fluid produced after these 100 axillary dissections was 437 cc (range: 50 to 800 cc) with a mean duration of 6.3 days (range: 2 to 11 days). There was a linear relation between the volume and the duration of the lymphatic fluid production. This volume was significantly higher in radical mastectomy than in conservative procedures (486 cc vs 333 cc - p less than 0.02). There was no significant difference in the production of lymphatic fluid with early or delayed physiotherapy, whatever the group of patients: radical or conservative surgery - age - number of excised lymph nodes - lymph node involvement. Five seromas occurred in patients with delayed physiotherapy. Delaying physiotherapy after axillary dissection for breast cancer does not seem to reduce the incidence of lymphatic complication, but the use of a conservative procedure rather than a modified radical mastectomy seems to be able to do so.
Normal and pathologic femoral heads have been studied by MRI at 1.5 Tesla. The study was centered upon avascular necrosis (53 lesions). Twenty normal subjects and three patients with algodystrophy were examined. The osteonecrosis patterns were established from known lesions. A low signal rim surrounds an upper polar zone of conserved (Type I) or decreased (Type II) signal. The lesions age correlates significantly with their type: amongst type I lesions, 6 are asymptomatic and the 21 others have a mean age of 5.5 months; Type II lesions have a mean age of 12.7 months. Fourteen lesions were not seen on plain radiographs and six were not detected by bone scan. The older lesions with femoral head deformation are better depicted by standard radiologic techniques. Conservatively MRI is the most efficient examination for recent avascular necrosis lesions.
Routine mammography screening can detect radiologically evident but subclinical breast anomalies. Insofar as these anomalies can correspond to carcinoma, either in situ or invasive, surgeons are increasingly forced to operate on non-palpable breast lesions. A regulated and strict surgical technic is necessary to ensure exeresis of a radiologically detected focus, while avoiding sufficient adjacent healthy parenchyma and thus reducing the esthetic prejudice to a minimum. Technical artifices are described to assist compliance with these imperatives. First, the periareolar incision is chosen, as a principle, for its cosmetic qualities. Insofar as it provides an often limited approach it can be extended radially. The latter is concealed during closure without major alteration to the areola. Second, the radiating exeresis assists detection and is safer. It also provides glandular reconstruction of good esthetic quality and facilitates follow up surveillance.
A totally implantable system was used for prolonged intravenous treatment in patients whose peripheral veins could no longer be punctured. Our experience showed this device, which was used for short periods in 20 patients, to be an effective solution to the problem of permanent venous access.
A pessary is rarely needed to treat prolapse or incontinence. In certain cases, the anatomical conditions are unsuitable for the use of this device which is sometimes poorly tolerated in the long term. The authors propose an original solution of a vaginal cast made from silastic foam. The technique of making the cast, its advantages and disadvantages are described together with the modifications which it is able to induce on the urodynamic parameters. This technique will certainly be useful in certain rare indications.