Biomedical subjects
B Hoerni
Publications and source records attributed to B Hoerni.
[Multidisciplinary consultation. A diagnosis of AIDS].
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[Hodgkin's disease in developing countries].
The presentation of Hodgkin's disease (HD) is not the same in western countries and in developing countries. In the latter HD remains a severe disease partly because of a delayed diagnosis. Pathology is less favorable, stages are more advanced. Young patients are even more afflicted. Despite difficulties to treat patients, oncologists have to move to treat as well as possible potentially curable disease in order to save many years of active life. HD would be a good model to promote multidisciplinary centers where patients could be cared and cured in the best conditions.
Quality of life during and after treatment of Hodgkin's disease.
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Relationship of histological subtypes to prognosis in early stage Hodgkin's disease: a review of 312 cases in a controlled clinical trial. The Groupe Pierre et Marie Curie.
To assess the prognostic significance of a newer histologic classification of Hodgkin's disease (HD), microscope slides from the time of diagnosis of 312 clinical stage IA or B, IIA or B and IIIA patients were reviewed in 1987, 6-10 years after their participation in a radiochemotherapeutic trial (1976-1982). Overall, the diagnostic reproducibility of the Rye classification by the same pathologist was confirmed. However, a new analysis showed an improvement in the differential diagnosis between HD and non-Hodgkin's lymphomas (NHL) by the identification of 24 NHL (8%) amongst the patients originally diagnosed as HD. Most of the NHL identified on review had been classified originally as mixed cellularity. On review, none of the new histological subtypes of HD was significant for prognosis of relapse-free survival or overall survival. Only identification of NHL was shown to have an independent prognostic value on relapse rate (P = 0.012) and on overall survival (P = 0.10). It is concluded that diagnosis of HD by itself remains, in 1988, the sole histologic factor influencing the prognosis of these patients.
Influence of dose intensity and density on therapeutic and toxic effects in Hodgkin's disease.
From 1972 to 1976, 95 patients with clinical stages I-IIIA Hodgkin's disease were treated by chemotherapy with cyclophosphamide, vinblastine, procarbazine and prednisone (CVPP) before and after extended field radiotherapy. The CVPP schedule gave: (1) a constant drug dosage for each patient independent of body surface or weight; and (2) a total drug dosage dependent on haematological tolerance, since the treatment was given for 21 days or until the leukocyte count dropped to 2 x 10(9) l-1. The drug dosage per unit body surface (or 'dose density') significantly correlates with the drop in leukocyte count (P less than 0.001) and the tumour regression at the end of the induction course (P = 0.020). Disease-free survival is significantly related to dose density (P = 0.050) but not to dose intensity calculated on the duration of treatment (P = 0.240). However, after exclusion of three marginal recurrences due to border-line radiotherapy, the dose intensity significantly correlates with the disease-free survival (P = 0.031) and with the duration of complete remission (r = 0.870).
Value of attitude questionnaires for assessing oncology teaching of medical students: experience of Fondation Bergonié, Bordeaux.
The importance of psychosocial aspects of cancer and cancer patients is now well recognized, but the means for teaching them to medical students and for assessing this teaching are not yet well established. The use of attitude questionnaires appears helpful after our experience over five years among more than 100 students observed during a four-month hospital course. After reviewing this experience we suggest ways to improve such questionnaires and to better include their use in a general assessment of teaching according to well-determined objectives. Such an assessment is necessary for improving education of medical students and for increasing their abilities to better meet the needs of future patients.
Adjuvant therapy by BCG of non-Hodgkin's malignant lymphomas in a controlled trial: an update.
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[Not Available].
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[Informed consent in oncology].
Informed consent is not a new principle in the patient--physician relationship. It emphasizes the basic principle of the patient's autonomy and the respect which is due to him/her. In oncology it covers clinical examination, complementary investigations, different treatments and follow-up. Obtaining the necessary information may be complicated by difficulties concerning the patient, the cancers and the physicians. The problematical aspects can be alleviated if the patient's autonomy is acknowledged and respected and if the physician succeeds in establishing a sound personal relationship with the patient.
Non-Hodgkin's malignant lymphomas in patients older than 80. 70 cases.
In two centers (a comprehensive cancer center and a university hospital) 1300 patients with non-Hodgkin's lymphomas (NHL) were observed during the past 15 years. Seventy patients (5.4%) were diagnosed after they were 80 years old. Thirty-four patients had low-grade NHL, eight had intermediate grade, and 28 had high-grade NHL. The majority of them were classified as Stage I (n = 24) or II (n = 18), and the rest as Stage III (n = 16) or IV (n = 12). Treatment varied with grade of NHL, tumoral extension, and performance status. Forty-seven patients were given chemotherapy, 37 radiotherapy, and six patients had surgery. Overall, treatment was considered to be optimal in 12 patients, good in 34 patients, and limited in 24 patients. Toxicity was minimal in 62 patients, treatment-limiting in two patients, and lethal in six patients. Thirty-seven patients achieved a complete remission (CR), 21 a partial remission, five experienced stabilization, and seven failed to respond. For all patients, the median survival (MS) was 18 months. In contrast to younger patients, malignancy grade had no significant influence. The only significant parameter is CR (P = 0.02). In conclusion, very old patients must be treated correctly but carefully. Better tolerated treatments are needed to improve results that are neither very poor nor as good as in younger patients.
Localized follicular lymphomas: prognosis and survival of stages I and II in a retrospective series of 103 patients.
From 1966 to 1985, 103 patients with a localized (stages I and II) follicular lymphoma (Kiel classification) were treated at the Fondation Bergonié. Clinical staging was performed using, after physical examination, chest X-rays (100%), bipedal lymphangiography (98%) and unilateral bone marrow biopsy (BMB) (51.5%). The patients were then treated by radiotherapy with or without chemotherapy. Overall survival (OS) at 5 and 10 years is 69 and 56.3%, respectively. Relapse-free survival (RFS) is 53.7 and 49%. Unifactorial analysis shows three prognostic parameters to be independently significant in terms of OS: age, stage and B symptoms. In terms of RFS, only 2 factors are significant: age and B symptoms. Multivariate analysis (Cox model) shows that age is a more important prognostic factor than stage.
Brief chemotherapy associated with extended field radiotherapy in Hodgkin's disease. Long-term results in a series of 102 patients with clinical stages I-IIIA.
From 1972 to 1976, 102 patients with stages I-IIIA Hodgkin's disease (HD) were treated by chemotherapy with cyclophosphamide, vinblastine, procarbazine and prednisone (CVPP: two courses) associated with extended field radiotherapy. Staging included neither laparotomy nor splenectomy (clinical staging). Treatment included neither splenic irradiation nor maintenance therapy. Complete remission was achieved for 98 patients and 11 of them recurred up to 94 months after treatment. Median follow-up of this controlled study is 13 years. Disease free survival (DFS) is 87% at 6 years and 84% at 10 and 15 years. Overall survival is 77% at 10 and 74% at 15 years. Disease specific survival is better (91% at 10 and 87% at 15 years) since only 38% (10/26) deaths were due to HD. The other deaths (16/26) with no evidence of HD were due to second cancer and intercurrent disease. Prognostic analysis of DFS by log-rank test gives significance to the following factors: contiguous extra-nodal involvement (P = 0.008), more than 3 involved sites (P = 0.01), signs of compression (P = 0.02), clinical stage IIIA (P = 0.03), infradiaphragmatic stages I-II (P = 0.04). The potential risk of secondary cancer is difficult to assess.
Non-Hodgkin's lymphomas in 137 patients aged 70 years or older: a retrospective European Organization for Research and Treatment of Cancer Lymphoma Group Study.
The results of a European Organization for Research and Treatment of Cancer (EORTC) retrospective study on non-Hodgkin's lymphoma (NHL) in elderly patients (greater than or equal to 70 years of age) seen in Europe in 1984 are reported. A precodified form was sent to 55 European institutes in order to evaluate the incidence of NHL in the elderly with regard to natural history, treatment-related toxicity, response, and survival. Thirteen institutes participated in the study. One hundred thirty-seven cases of NHL were observed in the elderly during 1984, making up 28% of the total number of NHL seen in those institutes. The median age was 77 years; 21% of the patients had favorable (low-grade) and 73% unfavorable (intermediate- and high-grade) histology, according to the Working Formulation. Stage at presentation was localized (I and II) in 60% and advanced in 37% of the patients. Most of the physicians used standard therapy regimens at reduced doses, from the beginning of the treatment. Sixty patients (44%) underwent a "conservative" treatment (one or two antineoplastic drugs or local field radiotherapy) and 77 (56%) an "aggressive" treatment (polychemotherapy regimens or extended field radiotherapy). Response was similar between the two treatment groups, but severe and lethal toxicity was significantly higher among patients treated with aggressive therapy. Prospective randomized studies are clearly needed to define the optimal treatment in elderly patients with advanced unfavorable NHL.
[Not Available].
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[New combination of epirubicine, bleomycin, vinblastine and prednisone (EBVP II) before radiotherapy in localized stages of Hodgkin's disease. Phase II trial in 50 patients].
A new regimen of chemotherapy was used to reduce toxicity of EBVP I: the number of injections and the doses of bleomycin and vinblastine were reduced by half, the duration of treatment by third. Fifty patients with Hodgkin's disease stage I to IIIA, previously untreated, received three courses of this regimen before radiotherapy. Gastro-intestinal toxicity was similar and alopecia was more marked than with EBVP I. Immediate efficacy is similar, with 90% of complete remission and only one failure. This regimen is shorter and more intensive than EBVP I. It deserves larger comparison with previously used chemotherapy in a more extensive controlled trial.
[Diagnosis of cancers. Role of sociopsychological factors].
Early diagnosis of cancer is desirable for improving prognosis and rendering treatment more effective. It depends on the type of cancer and its site in particular. Another factor to be considered is the physician, and his/her knowledge and aptitude to manage a diagnostic problem. It depends specially on the time taken by the patient to seek medical advice. The amount of time taken depends on the patients' psycho-social parameters. Patients who have been poorly educated, who are from a low social class, who are alone or who have a fear of cancer are likely to delay consultation after appearance of symptoms. All these factors are difficult to alter. Physicians should be fully aware of these factors, and be able to recognize them in patients. Good personal doctor-patient relations and subsequent quick medical management appear to be more decisive than mass screening in reducing time required for diagnosis.
[Quality of life of cancer patients and the education of nursing personnel].
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