Biomedical subjects
D Friedman
Publications and source records attributed to D Friedman.
[Intrahepatic dilation of the bile ducts. Particularity of a clinical case].
We report the case of a 71 years old male patient with a "simple" form of Caroli's syndrome. The "simple" form is less common than the form associated with congenital hepatic fibrosis. In this case the intrahepatic bile duct dilatation was confined to the segments V and VI, and intrahepatic lithiasis and cholelithiasis were associated. Usually, Caroli's syndrome remains asymptomatic for the first 20 years of the patient's life, sometimes longer, and in few cases for the patient's whole life. "Simple" asymptomatic Caroli's syndrome is generally unrecognized and in our own case it was an intraoperative finding. Patient's age, the presence of a hepatitis C and the absence of malignant changes discouraged us from performing a right hepatectomy and then a Roux-en-Y intrahepatic bile duct jejunal anastomosis was done. One year after the operation the patient is leading a normal life, and he is symptom-free.
Timing of surgery related to menstrual cycle and prognosis of premenopausal women with breast cancer.
The influence of the timing of surgery in relation to the menstrual cycle on the survival of breast cancer patients has been both advocated and disputed. The records of 165 premenopausal M- breast cancer women consecutively operated from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus postoperative radiotherapy. Node-positive patients received adjuvant chemotherapy. Cox regression analysis was used to estimate the relative risk (RR) of death in three models including timing of surgery, age, histology, pT and pN. In each model, patients were divided into two groups according to the criteria proposed by Badwe, Hrushesky, and Senie. Multivariate analysis showed a significant association between pT and pN and survival, whereas no association with survival was observed for the timing of surgery according to either Badwe or Hrushesky or Senie (RR = 1.26, RR = 0.91 and RR = 0.88 respectively). Consensus on the menstrual phase related to the expected best prognosis is still required.
[Lacking effect of timing of surgery in relation to the menstrual cycle on prognosis of breast cancer in premenopausal women].
The influence of timing of surgery in relation to menstrual period on survival of breast cancer patients has been both advanced advocated and disputed. A meta-analysis on published series showed a statistically significant overall odds reduction when surgery is performed in the luteal phase. The records of 165 premenopausal M- breast cancer women, not on hormonal therapies, consecutively operated on from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus operative radiotherapy, Node-positive patients received standard adjuvant chemotherapy. Cox regression analysis was used to estimate the relative risk (RR) of death in three models including timing of surgery, age, histology, pathological T and N. In each model, patients were divided into two groups according to the criteria proposed by Badwe, Hrushesky, and Senie. Multivariate analysis showed a significant association between pT and pN and survival, whereas no association with survival was observed for timing of surgery according to Badwe or Hrushesky or Senie criteria (RR = 1.26, RR = 0.91, and RR = 0.88 respectively). Up-to-date agreement on the menstrual phase and relative expected better prognosis is still lacking.
[Morpho-functional adaptation and motility of the small intestine and colon after extensive intestinal exclusions].
Recent advances in anesthetic and surgical techniques have increased the survival of patients after extensive bowel exclusions. This, in addition to the increased use of intestinal bypass for the treatment of obesity, has substantially increased the number of persons living with a short bowel. Proper management of these individuals is based on a thorough understanding of the pathophysiology of the shortened gastrointestinal tract.