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Biomedical subjects

C Berger

Publications and source records attributed to C Berger.

At least 181 records · Page 10Linked to original sources
PubMed1994

Radiation therapy in the conservative treatment of carcinoma of the anal canal.

PURPOSE: Radiotherapy is the standard treatment of anal canal carcinoma. We retrospectively analyzed our experience with 108 patients. Special attention was given in evaluating 51 patients who received concomitant chemotherapy with 5-FU-CDDP. METHODS AND MATERIALS: From January 1980 to December 1989, 108 patients with anal canal carcinoma were treated with exclusive radiotherapy at the Centre Hospitalier Lyon Sud. There were 11 men and 97 women, mean age was 65 years (30-86). Histologic types were 94 epidermoid carcinomas, 13 basaloid carcinomas, and one adenocarcinoma. The TNM classification (UICC 87) was: 16 T1 (14.8%), 53 T2 (49%), 33 T3 (39.5%), six T4 (5.5%), 77 N0 (71.3%), 20 N1 (18.5%), nine N2 (8.3%) and two N3 (1.8%). Papillon's radiotherapy technique with a Cobalt direct perineal field was used in 82 patients. Ninety-six patients were treated with an interstitial 192Ir implant with a mean delay of 55 days after the end of the radiotherapy. In 59 patients at least one course of either 5-FU-mitomycin (8) or 5-FU-CDDP was added with at least one course concomitantly to the radiotherapy in 53 patients. RESULTS: A complete response in 104/108 patients (96%) was obtained 2 months after the brachytherapy. A locoregional relapse (local and/or pelvic failure) was seen in 18 patients (16.6%) and inguinal node relapse in nine (8.3%). Eight patients with locoregional recurrence and five with inguinal relapse were salvaged. A systemic failure occurred in six (5.5%) patients. Twenty-nine patients died, 16 of progressive disease. One patient died of treatment related toxicity. The overall 5-year survival was 64% +/- 6 and specific survival 72% +/- 8. None of the patient parameters was found to be statistically significant but there was a trend toward longer 5-year survival in T1-T2 patients and in those with well or moderately differentiated tumors. Noteworthy are the same survival rates for N0 and N1-N3 patients (65 vs. 62%). The objective response and the locoregional failure rates were similar in the patients treated with or without chemotherapy. The difference did not reach statistical significance though it was important for the following parameters: overall survival rates for T1-T2 with and without chemotherapy (94 vs. 61%) and for N1-3 patients (73% vs. 27%). The main prognostic factors in this series were differentiation (5-year overall survival with chemotherapy 95% vs. 27% without chemotherapy p = 0.02) and the response at 3 months after treatment initiation, before brachytherapy implant (5-year overall survival for complete responders and "very good responders" 71% vs. 34% in partial responders p = 0.002). The complications rate was acceptable (Grade III 9%, Grade II 14%). Anal preservation was possible in 85% of the patients (92/108). Nine abdominoperineal resection were performed for recurrence and seven for severe necrosis. The T3-T4 group abdomino perineal resection was 23% while it was 9.2% of the T1-T2 group. CONCLUSION: We confirm that exclusive radiotherapy is the treatment of choice for epidermoid carcinomas of the anal canal. The role of chemotherapy is still unclear.

Adult↗
PubMed1994

[Role of peroperative radiotherapy in the treatment of uterine cancers. Preliminary experience in Lyon].

AIM: Retrospective analysis of Intra operative Radiotherapy (IORT) in recurrent uterine carcinoma (RUC) and prospective pilot study of IORT in advanced cervix cancer (ACC) with high risk of local failure. PATIENTS-TREATMENTS: 1) RUC: from 1988 to 1991, 34 patients with RUC have been treated. Primary cancer was: cervix uterus: 28, endometrium: six. Site of recurrence: centro pelvis: four, latero pelvis: 25, lombo aortic: five. Total gross resection was only possible in 12 patients. A dose of 15 to 22 Gy was given by IORT according to the residual tumour size. External beam irradiation was added in 16 patients; 2) ACC: January 1991 to November 1992, 20 patients were included in this pilot study, stage IIB: seven, stage III: 12, stage IV: 1. Preoperative retroperitoneal pelviscopy showed 13 pN1 patients and NMR imaging ten tumours of 6 cm or larger in diameter. Treatment started with concommitant pelvic irradiation (44 Gy) and one conommitant cycle of 5 Fu-CDDP, followed by a short course of high dose rate upper vagina brachytherapy (4 Gy). Four weeks later a radical Wertheim operation was performed together with IORT on the lateral pelvis. RESULTS: 1) RUC: overall survival (Kaplan Meier) at 4 years is 32% (+/- 8). Local relapse in the fiedl of IORT was observed in six patients. Grade 2-3 complications: six patients (radiation proctitis, neuritis, vertebral collapse, ureteral stenosis); 2) ACC: the median follow up is hort (18 months). Four cases of pelvic relapse, no postoperative death. The first line radio chemotherapy was associated with two G3 early complications. Postoperative radiation complication was less than 10% G3. DISCUSSION: promising results of IORT in RUC have been observed especially if no irradiation is given during the primary treatment. Good feasibility of the pilot study of IORT in ACC was also observed. It could be followed by a multicentric feasibility trial.

Adult↗
PubMed1994

[Treating psychic traumas: a psychiatric emergency].

Interest for the psychopathological field of trauma has experienced a revival over the last fifteen years. Early and active treatment of victims is necessary to attenuate the psychopathological consequences of trauma. However, emergency psychiatry still rarely places a high value on it. This paper presents a case which contains in itself many aspects of psychological responses to psychologically traumatizing events. Trauma induced in this case, in particular, Dissociative Disorders (including a Dissociative Fugue), a Post-Traumatic Stress Disorder, Somatoform Disorders and Phobic Disorders. This case gives us the opportunity to situate the psychiatric emergency--"psychological trauma"--and to illustrate our talk with regard to the principles of mid-term and emergency treatment of victims.

Adult↗
PubMed1994

[Use of tissue plasminogen activator in the treatment of aortic thrombosis in newborn infants].

BACKGROUND--Aortic thrombosis is more frequent since the use of umbilical artery catheters in neonatal intensive care units. Some drugs or surgery are proposed to prevent complications; experience with tissue plasminogen activator (tPA) is still limited. CASE REPORT NO 1--A neonate, weighing 2400 g, developed respiratory distress requiring insertion of a catheter into her umbilical artery at H12. Ultrasonography on day 3 showed aortic thrombosis extending to the right renal artery which was confirmed by angiography. tPA 0.1 mg/kg was administered through the catheter, followed by 0.3 mg/kg/h for 3 hours and heparin, 100 IU/kg/hour for 54 hours. Angiography, performed 18 hours later, showed complete disappearance of the thrombosis. CASE REPORT NO 2--A neonate, weighing 2520 g suffered at 12 hours of life from seizures, apnea and bradycardia which required insertion of a catheter into her umbilical artery. Cyanosis of the right leg with weakening of femoral pulsations, 14 hours later, lead to the diagnosis of aortic thrombosis which was confirmed by aortography. The patient was given tPA 0.1 mg/kg followed by 0.3 mg/kg/h for 3 hours and heparin 100 IU/kg/hour for 6 hours. Amplitude of femoral pulsations strikingly increased within 6 hours with the disappearance of cyanosis. CONCLUSION--These results suggest that tPA can be useful in neonates presenting with aortic thrombosis.

Aorta↗
PubMed1994

[Ultrasonographic survey of the effect of umbilical arterial catheterization in newborn infants].

BACKGROUND: Incidence of aortic thromboses in the neonatal period is significantly increased after umbilicar artery catheterization. POPULATION AND METHODS: Fourty neonates (GA: 34.7 +/- 7.2 wks and birth weight: 2377 +/- 786 g) were prospectively studied in order to assess frequency and natural history of aortic thromboses due to umbilical artery catheterization. Investigation was based on serial real-time ultrasonography (2.3 times/week). Presence of aortic thrombus was correlated with the existence of clinical complications and the results of biological findings (prothrombin and fibrinogen levels; hematocrit) and platelet number. RESULTS: Aortic thrombosis was found in six patients (15%); it was clinically asymptomatic in two (5%). A vascular wall-fixed catheter was shown in ten infants (25%); this finding was associated with thrombosis in five cases and preceded thrombosis in one other. The presence of thrombus and/or abnormal position of the catheter was not correlated with gestational age, birth weight, duration of catheterization, blood hemostasis and results of bacteriological cultures of the tip of the catheter. CONCLUSIONS: Ultrasonographic control must be repeated after umbilical artery catheterization. It permits evaluation of renal flux and can lead to removal of catheter and/or peculiar therapeutic measures.

Aorta↗
PubMed1994

[Generalized idiopathic epilepsy in older children and adolescents].

Generalized idiopathic epilepsies starting between 12 and 18 years of age are mostly represented by juvenile myoclonic epilepsy, juvenile absence epilepsy and grand-mal on awakening. The EEG and clinical description of the seizures, the different epileptic syndromes with their therapeutics, the prognosis and the familial forms with the molecular genetic aspects are studied. The importance of the history for the positive diagnosis is emphasized, in order to display the often overlooked myoclonies occurring in the morning. Differential diagnosis concerns mostly absences which are sometimes difficult to separate from frontal seizures, and in the case of first generalized tonico-clonic seizure, partial epilepsy which needs further investigations, and the exceptional progressive myoclonic epilepsy which begins the same way, but has a totally different prognosis. Psycho-social difficulties due to epilepsy and lack of therapeutic compliance are frequent. The therapeutic results are generally good but there is a high rate of relapse after medication withdrawal.

Adolescent↗
PubMed1994

[Constitutional translocation t(1;6) and Burkitt's lymphoma].

BACKGROUND: The relationship between constitutional chromosome aberrations and a predisposition to malignancy has already been established. CASE REPORT: A 4 year-old boy was admitted suffering from abdominal mass. Biopsies of the tumor and bone marrow showed a stage IV Burkitt's lymphoma. Karyotype showed a constitutional t(1;6)(p36;q22) in initial bone marrow samples and peripheral lymphocytes. No classic Burkitt's type translocation was demonstrated in the malignant bone marrow cells. CONCLUSION: Our case is similar to four other reported cases. The break-points 1p36 and 6q22 seem to be involved in several malignant tumors, especially lymphomas.

Burkitt Lymphoma↗
PubMed1994

[Skier's thumb injury in the child].

Acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb (skier's thumb) is a common skiing injury in adults. Do we find this injury in children? Of the 302 skier's thumbs during the last 4 years we found 24 (8%) injuries in children (mean age 13.4 years) with open growth plates. They had the following diagnosis and consecutive treatment: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter III fracture with open reduction and fixation, 6 avulsion fractures, which were treated twice operatively and 4x conservatively and 3 ruptures of the ligament which needed reconstruction. Supposing the trauma mechanism in adults, we see a different, age-dependent injury pattern in children. The younger had Salter-I- and Salter-II-lesions of the proximal phalanx, where as the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 cases minimally 1 year after the accident showed in 12 a full recovery, in 4 cases small subjective symptoms but full function and in 1 case an ankylosis of the MCP-joint following a postoperative infection.

Adolescent↗
PubMed1993

[Children's shoe: a miniature version of the adult shoe?].

The question arising from this subject, could be answered with "Yes" and "No", since this issue is interpreted differently by footwear manufacturers. During the last 10 years the scientists have achieved essential knowledge concerning the requested standards of children's footwear. These results verify that children's footwear needs to have other characteristical features than adult's footwear. The requested standards on a healthy children's shoe result from the exceptional function (intensity and many-sided motor activity) and the anatomy (elasticity, shape and state) of a child's foot, which is, in contrast to an adult's foot, still developing. Due to these facts there are special requirements and features regarding the fitting, the flexibility and the information. This is explained on some examples.

Adolescent↗
PubMed1993

Delayed interval delivery in quadruplet pregnancy: a case report.

A case report of delayed delivery of a quadruplet pregnancy is presented. This quadruplet pregnancy resulted from in-vitro fertilization. To our knowledge, this case represents the first report of quadruplets delivered on three separate days using the technique of delayed interval delivery. All infants survived and are healthy 2 years later.

Adult↗
PubMed1993

Parental opinions about biomedical research in children in Tours, France.

In order to evaluate parental awareness of the law governing clinical trials in France (Loi Huriet), a study was performed by questionnaire between February and April 1991 in a maternity unit during the days following delivery. The response rate was 59%. 59% of the parents (319/541) were informed of the existence of the law by the media (75%) or their general practitioners (12%). Twenty-one percent (116/541) of the parents would accept the participation of their children in a clinical trial and 74% would refuse. The principal reasons for acceptance were: for the benefit of other children, contribution to medical progress and confidence in physicians. The reasons for refusal were: risk of side effects and unproven efficacy. Parents who would accept had more often received higher education (44%) than parents who would refuse (30%), the latter being less influenced by the explanations of physicians and less willing to accept that a physician should decide for them. Physicians should consider transmitting information directly to parents and indirectly via the media.

Adult↗
PubMed1993

Extracorporeal photopheresis in the treatment of AIDS-related complex: extended trial.

The objective of this study was to further evaluate the relative safety of extracorporeal photopheresis in the treatment of patients with AIDS-related complex. Twenty patients with AIDS-related complex, three from the initial report and 17 additional patients, were enrolled. The patient population had various risk factors. There were nine homosexuals, five heterosexual consorts of human immunodeficiency virus (HIV)-positive patients, four reformed i.v. drug abusers, and two hemophilia patients. The patients received monthly treatment with extracorporeal photopheresis. In 16 of the 19 patients, this study provides evidence of clinical stability over a longer period. The relative stability of beta 2-microglobulin and neopterin levels demonstrates that photopheresis therapy does not have an untoward effect on the degree of activation of the immune system with respect to induction of HIV replication. Antibody titers to the major viral antigens, envelope glycoproteins (gp) 120 and 41, reverse transcriptase enzyme gp 66/31 and 55, and the core protein p24 remained stable throughout the course of therapy. A subjective improvement was noted in the majority of patients. The evaluation of T-cell subsets revealed that the photopheresis treatment did not have a detrimental effect on CD3 and CD8 cells. Some decreases were noted in the CD4 cell counts but the decline may be less than is normally seen at corresponding stages of HIV infection. Skin test responsivity improved in 11 patients, remained unchanged in seven patients, and declined in two. The preliminary results suggest that in HIV disease, extracorporeal photopheresis is safe and warrants a prospective controlled trial.

AIDS-Related Complex↗
PubMed1993

[Skier's thumb injury in the child].

Acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb (skier's thumb) is a common skiing injury in adults. Do we find this injury in children? Of the 302 skier's thumbs during the last 4 years we found 24 (8%) injuries in children (mean age 13.4 years) with open growth plates: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with a radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter II fracture with open reduction and fixation, 6 avulsion fractures which were treated twice operatively and 4 times conservatively and 3 ruptures of the ligament which needed reconstruction. In contrast to adults, we see a different, age dependent injury pattern in children. The younger had Salter-I- and II-lesions of the proximal phalanx, whereas the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 patients one year after the accident showed in 12 a full recovery, in 4 cases full function with minor complaints and in one case an ancylosis of the MCP-joint following a postoperative infection.

Adolescent↗
PubMed1993

[Sexual activity after pelvic irradiation for cancer of the prostate. Evaluation by questionnaire].

In order to determine the influence of pelvic radiotherapy on potency, a questionnaire has been sent to all living patients who had been treated for a prostate carcinoma with exclusive external beam radiotherapy from 1980 to 1991 in Centre Hospitalier Lyon Sud. One hundred and six patients have been asked about the frequency of intercourse prior to and after treatment, and about possible modifications of their sexual activity after radiotherapy. At the time of the study, median follow-up was of 47 months. 5 and 10 years survival rates were respectively 76 and 53% for overall survival, and 65 and 33% for disease-free survival. Severe complications rate related to radiotherapy was 2%. Among the 56 patients who returned a completed questionnaire, 12 (21%) were impotent prior to treatment. During the first year after radiotherapy, 10 patients were given an hormonal treatment and became impotent. Among the other 34 evaluable patients, 20 (59%) patients were still potent one year after radiotherapy, and sexual activity was unchanged for 3 patients (15%), slightly altered for 11 patients (55%) and altered for 6 patients (20%). Erection capacity was modified for 82% of the patients, ejaculation for 59%, orgasm for 47% and libido for 6%. In order to determine prognostic factors of conservation of sexual activity, we analyzed the distribution of potent and impotent patients according to age, tumor stage, Gleason score, frequency of intercourse prior to treatment and size of the radiation fields. Only age < or = 64 was associated with a higher percentage of preservation of potency: 76% versus 59% in patients older than 64 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1992

Trisomy 2 in proliferative fasciitis.

We report trisomy 2 as the sole clonal karyotypic abnormality in a case of proliferative fasciitis. To our knowledge, this is the first cytogenetic report of proliferative fasciitis.

Aged↗