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Biomedical subjects

D Jullien

Publications and source records attributed to D Jullien.

61 records · Page 4Linked to original sources
PubMed1987

[Paget's disease of the nipple without any associated mammary tumor clinically or radiologically detectable. Apropos of 51 cases treated at the Curie Institute].

Between 1960 and 1984, 51 patients with Paget's disease of the nipple, with no concomitant palpable or radiological breast tumour, were treated at the Institut Curie. The diagnosis was made in all cases through a simple biopsy of the nipple and/or the areola. All slides were reviewed for the present study. 20/51 patients were treated conservatively, with external radiotherapy alone (17/20 pts), or limited surgery and radiotherapy (3/20 pts). The mean age was 54 years (range 40 to 80). The median follow-up was 7.5 years. No patients died of breast disease. Three local recurrences occurred and were treated by mastectomy. All were located in the nipple or areola and were Paget's disease without intraduct or invasive carcinoma. The actuarial probability of living 4.5 years free of disease when the breast is preserved with a good cosmetic result is 81%. 31/51 patients underwent mastectomy; 30 a modified mastectomy, 1 a simple mastectomy. The mean age was 66 years (range 55 to 90). Associated intraduct carcinoma was found in 30/31 microscopic examinations. No axillary node invasion was found after dissection of the axilla. In the group treated by surgery, the median follow-up was 5 years. No patient died of breast disease. No chest wall recurrence occurred. The 5 years disease-free survival rate was 87%. This retrospective non randomized study of 51 patients treated for Paget's disease of the nipple suggests that radiotherapy is a valuable alternative to mastectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Prognostic significance of clinical nodal involvement in patients treated by radical radiotherapy for a locally advanced breast cancer.

A group of 230 female patients, treated between 1960-1976 with radical megavoltage radiotherapy for locally advanced breast cancer (T3 greater than 7 cm-T4 Stage), was analyzed retrospectively. Those with inflammatory cancer or evidence of disseminated metastatic disease were excluded. Clinical axillary nodal involvement appears to be a very important prognostic feature. Actuarial disease-free survival at 5 years for the 109 patients with clinically negative nodes (N0N1a) is 52%; whereas it is 28% (p less than 0.001) for the 121 patients with clinically involved nodes (N1b, N2-N3). The 5-year survival following salvage surgery, which was performed on 92/230 patients (40%), correlated with the initial nodal status. It is 62% for the N0 group, but only 27% for those with clinically involved nodes. The survival of the 138 (60%) patients who were treated by radiotherapy only is similar to that obtained in patients who had secondary salvage surgery. This study reinforces the need to stratify patients with locally advanced breast cancer according to the initial clinical status of the axilla when either therapeutic trials are contemplated or the results of treatment are reported. Adjuvant systemic treatment should be strongly considered in patients with clinically involved nodes, since the survival obtained by local treatment alone is poor.

Adult↗
PubMedDate not supplied

Human blood granulocyte macrophage progenitors (GM-CFU) during extended field radiation therapy.

The rate of the clonogenicity of granulocyte macrophage forming cells (GM-CFU) in agar was analysed using mononuclear cells from the peripheral blood of cancer patients undergoing total body irradiation (TBI, 5 patients, 1.5 Gy in 15 days) or hemicorporal irradiation of the lower (LHBI, 5 patients, 15 Gy in 15 days) or upper (UHBI, 4 patients, 15 Gy in 15 days) part of the body. Although the GM-CFU level in the blood is low compared with that in the bone marrow, and shows considerable variability, the preliminary results demonstrated that in most cases the GM-CFU level was increased around the 10th day after the beginning of irradiation, followed by a return to base level within a few days, for LHBI and TBI but not for UHBI. The question of whether the observed peak for the clonogenicity was due to stem cells leaving a radiation-injured compartment of the bone marrow or to vicarious stem cells migrating from non-irradiated regions, or was the result of enhanced activity of colony-stimulating factors, remains to be investigated.

Breast Neoplasms↗
PubMedDate not supplied

Abnormalities suggestive of cardiomyopathy in patients with type 2 diabetes of relatively short duration.

OBJECTIVE: The aim was to assess the presence of cardiomyopathic features in asymptomatic patients with Type 1 and Type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS: Fifty-two (27 Type 1; mean duration: 10.2 +/- 7.4 yr; 25 Type 2, mean duration: 6.5 +/- 4.4 yr) diabetic patients with no signs of ischaemic heart disease or high blood pressure were studied by noninvasive techniques: Holter ECG; Filtered-Amplified ECG (FAECG); Exercise ECG; Echocardiography (BD, TM) and Doppler evaluation of diastolic parameters. Twenty-four healthy subjects matched for age were studied as controls. RESULTS: Holter ECG did not detect rhythm disturbances or features of silent ischaemia in either group of patients. With FAECG, at least one criterion of late ventricular potentials was found in 28% of Type 2 patients, vs 11% of Type 1 patients and 8.3% of control subjects. With exercise ECG, maximum oxygen uptake, anaerobic threshold, and workload performance were all significantly lower in Type 2 patients compared to control subjects. Echocardiography depicted a greater end diastolic interventricular septum thickness in Type 2 patients than in control subjects, with a trend toward left ventricular hypertrophy in 28% of Type 2 and 7.4% of Type 1 patients. Doppler echocardiography revealed a significant decrease in early diastolic peak filling rates (E) in diabetic patients as a whole group (Type 1 + Type 2) compared to controls. Late diastolic peak filling rates (A) were significantly higher in Type 2 patients than in their controls. The E/A ratio was significantly lower in diabetic patients (as a whole group) than in control subjects; this was accounted for mainly by a significant decrease of E/A in Type 2 patients compared to their controls. CONCLUSIONS: Our major finding rests on the disclosure of abnormalities suggestive of cardiomyopathy in Type 2 diabetic patients with a relatively short duration of the known disease, while these alterations appeared in our study less prominent in Type 1 patients despite a longer duration of the disease. Among the various noninvasive techniques, FAECG and Doppler echocardiography used to detect late ventricular potentials and to assess left ventricular diastolic dysfunction, respectively, appear to be suitable tools.

Adolescent↗
PubMedDate not supplied

Type 1 diabetes mellitus and homocyst(e)ine.

High Homocyst(e)ine levels (H) have been recently recognized as a risk factor for atherosclerosis. Patients with Diabetes Mellitus (DM) are prone to atherosclerosis. Therefore, this study was designed to search for the effect of DM on H and their relationship. Forty-one Type 1 diabetic subjects (DS, age 34.8 +/- 12 yr, DM duration: 10.7 +/- 11.1 yr) were compared to 40 age-matched control subject (CS, age 34.2 +/- 9.1 yr). H (measured by ion-exchange chromatography, units: mumol/l) and several parameters (creatininemia; triglycerides; total, HDL, LDL cholesterol; Lp(a); HbA1c; vitamins B9 and B12) were determined after an overnight fast. H were significantly (p = 0.0001) lower in DS (6.8 +/- 2.2) than in CS (9.5 +/- 2.9). This difference was still apparent in male and female subgroups compared to matched CS (p = 0.003 for each). No correlation was found between H and: lipids, vitamins, renal or retinal status. But H seemed to increase with age, especially in women (p = 0.03; r = 0.32). While there is, at this time, no explanation for the lower H observed in DS, it appears that H cannot directly account for accelerated atherosclerosis in DM. Nevertheless, it remains to be established if high, or even normal, H could identify a subgroup of DS at higher risk of precocious and severe atherosclerosis.

Adult↗