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E Leblanc

Publications and source records attributed to E Leblanc.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Value of MRI in symptomatic patients treated with tamoxifen].

PURPOSE: To assess the MR imaging (MRI) findings in symptomatic tamoxifen treated-women with abnormal transvaginal sonography. PATIENTS AND METHODS: From january 1997 to june 2000, 32 consecutive symptomatic tamoxifen treated-women with abnormal transvaginal sonography were prospectively studied by MRI. T1-weighted, T2-weighted, post-contrast T1-weighted and dynamic gradient-echo T1-weighted sequences were used. All patients underwent uterine sampling within one month of MRI. RESULTS: Endometrial thickness at sonography ranged from 5 to 48 mm (mean thickness 19 mm), and on T2-weighted imaging ranged from 3 to 50 mm (mean=25 mm). Three MRI patterns were found. Pattern 1 (13 patients) was defined as homogeneous high signal intensity of the endometrium on T2W images, and signal void in the lumen on gadolinium-enhanced images. Pattern 2 (8 patients) was defined as heterogeneous endometrial signal on T2W images, and latticelike enhancement traversing the endometrial canal on gadolinium-enhanced images. Pattern 3 (11 patients) was defined as heterogeneous signal on T2W images with masses or nodules which were better seen on dynamic gadolinium-enhanced images. In pattern 1 we found 13 atrophic endometrium, in addition there were 4 polypoid glandulo-cystic proliferation (PGCP), and 1 adenomyosis. In pattern 2 we found 3 PGCP, 4 atrophy and 1 polyp without hyperplasia. The 2 carcinomas and the polyps with hyperplasia were found in pattern 3 (11 patients). CONCLUSION: In our experience MRI allows differentiation of lesions which may require surgery from other lesions in which noninvasive follow-up is possible.

Aged↗
PubMed2002

[Cytological history of 148 women presenting with invasive cervical cancer].

OBJECTIVES: The aim of this study was to analyse the cytological history of women presenting with invasive cervical cancer. MATERIAL AND METHODS: Retrospective study of 148 patients treated for invasive cervical cancer in three hospitals of the North Pas de Calais in France. RESULTS: The average age of patients was 49 (26-86). Squamous carcinomas represented 81% of cases (120/148), adenocarcinomas 17% (25/148) and adenosquamous carcinomas 2% (3/148). 36.5% of patients (54/148) had never had a Pap smear. 34.5% (51/148) had had an occasional Pap smear (the last one dated of more than three years). 8.1% (12/148) were lost for follow up after a positive Pap smear. 3.4% (5/148) were treated for cervical dysplasia less than three years before the diagnosis of the cervical cancer. 17.5% (26/148) had had a Pap smear reported as negative less than three years before the diagnosis of the cervical cancer. In this last group, squamous carcinomas represented 57.7% of cases (15/26), adenocarcinomas 38.5% (10/26) and adenosquamous carcinomas 3.8% (1/26). 18 Pap smears of 26 reported as negative less than three years before the diagnosis of the cancer were reviewed. These Pap smears came from 11 patients presenting with squamous carcinoma and seven other presenting with adenocarcinoma. After review, 15 Pap smears were reported as false negatives and two as true negatives. The review was not possible in one case. CONCLUSION: In this study, the failures of cervical cancer screening were essentially attributed to the lack or the insufficiency of screening and the existence of false negatives of the cytology.

Adenocarcinoma↗
PubMed2001

Neoadjuvant chemotherapy for unresectable ovarian carcinoma: a French multicenter study.

BACKGROUND: Initial debulking surgery followed by chemotherapy is the current treatment for International Federation of Gynecology and Obstetrics Stage IIIC/IV ovarian carcinoma but has a limited efficacy when optimal cytoreduction is not achieved at the end of the surgical procedure. An alternative treatment for these patients could be neoadjuvant chemotherapy. The purpose of this retrospective study was to report the results of neoadjuvant chemotherapy in operable patients (no medical contraindication to surgery) presenting with primary unresectable tumors. METHODS: Between January 1996 and March 1999, operable patients presenting with Stage IIIC or IV ovarian carcinoma underwent, in six French gynecologic oncology departments, surgical staging to evaluate tumor resectability. When the tumor was deemed unresectable by standard surgery, the patient received three to six cycles of platinum-based neoadjuvant chemotherapy according to the response and the center's usual protocol. Patients were surgically explored after completion of neoadjuvant chemotherapy when the tumor did not progress during treatment. Debulking was performed during this secondary surgery when a response to chemotherapy was observed. RESULTS: Fifty-four patients were treated by neoadjuvant chemotherapy. The first surgical staging procedure was laparoscopy in 33 patients (61%) and laparotomy in 21 patients (39%). The median number of neoadjuvant chemotherapy cycles was 4 (range, 0-6). Forty-three patients (80%) responded to neoadjuvant chemotherapy and then tumors were debulked. Optimal cytoreduction was obtained in 39 patients (91% of the patients who underwent debulking) and with standard surgery in 32 patients (82%). For patients whose tumors were optimally debulked, blood transfusions were administered to 17 patients (43%), median intensive care unit stay was 0 days (range, 0-7 days), and median postoperative hospital stay was 10 days (range, 4-62 days). Median overall survival for the total series was 22 months. Survival was better for patients debulked after neoadjuvant chemotherapy compared with patients with nondebulked tumors (P < 0.001). CONCLUSIONS: Neoadjuvant chemotherapy for primary unresectable ovarian carcinoma leads to the selection of a subset of patients sensitive to chemotherapy in whom optimal cytoreduction can be achieved after chemotherapy by standard surgery in a high proportion of cases. Conversely, aggressive surgery can be avoided in patients with initial chemoresistance, in whom the prognosis is known to be poor regardless of treatment.

Adult↗
PubMed2000

Extraperitoneal endosurgical aortic and common iliac dissection in the staging of bulky or advanced cervical carcinomas.

BACKGROUND: A pilot study of a new surgical technique for aortic dissection, combining the advantages of extraperitoneal surgery and minimal invasive surgery, was conducted. METHODS: Fifty-three patients underwent infrarenal aortic and common iliac dissection for the staging of bulky or advanced cervical carcinomas. The indication for extended lymph node staging was bulky early stage in 33 patients, International Federation of Gynecology and Obstetrics distal Stage IIB or higher in 14 patients, nonbulky early stage with microscopic positive pelvic lymph nodes in 1 patient, and central recurrence in 5 patients. The lymph node dissection template included the common iliac lymph nodes, the inframesenteric lymph nodes, and the preaortic and lateroaortic infrarenal lymph nodes. The operation was performed using endoscopic techniques with CO(2) insufflation of the extraperitoneal space. RESULTS: The procedure failed in two patients. Nine patients had lymph node biopsy or selective removal of macroscopically positive lymph nodes. For the 42 remaining patients, the average duration of the operation was 125.9 +/- 31.8 minutes and the average number of lymph nodes was 20.7. Overall, 17 patients had positive lymph nodes, in whom disease was macroscopic in 9 patients and microscopic in 8. Overall, the positivity rate was 32%. Five complications occurred, four of them related to the extraperitoneal dissection technique. An intraoperative complication occurred in one patient, in whom a lateral injury to a fixed and dilated ureter was managed by stenting. A postoperative complication occurred in another patient, in whom a retroperitoneal hematoma causing ileus and compression of the upper ureter was managed conservatively. Two symptomatic lymphocysts occurred; one of them required drainage under ultrasound guidance. All patients but one had external radiation therapy tailored according to the aortic lymph node status. After an average follow-up of 18.9 months, 60% of lymph node positive patients and 15% of lymph node negative patients died. Distant recurrence occurred in 53% of lymph node positive patients and 9% of lymph node negative patients. No patient had recurrence in the aortic or common iliac area. Two patients developed radiation enteritis. CONCLUSIONS: This new technique deserves to be used as a tool to identify lymph node positive patients who require extended-field radiation and/or chemotherapy.

Adult↗
PubMed2000

Neuroendocrine tumors of the uterine cervix. Clinicopathologic study of five patients.

Four main clinicopathologic features of neuroendocrine tumors (NETs) of the cervix may be stressed: primary diagnosis at an advanced stage, early nodal metastasis even for low disease, early failure of appropriate local treatment (surgery and/or radiation therapy) and aggressive clinical treatment. Five patients with NET of the uterine cervix (small cell carcinoma type) are reported (one stage I, two stages II, one stage III and one stage IV). One patient was treated by surgery combined with radiation therapy, one by surgery combined with chemotherapy and one by surgery with radiation therapy and chemotherapy. Two patients received radiation therapy alone. Three early stage patients are alive with no evidence of disease 8, 26 and 41 months after diagnosis. The two patients with advanced stage died of disease, 3 and 12 months respectively, after diagnosis. Combination chemotherapy (cisplatin and etoposide) is warranted in disseminated NETs. Neoadjuvant or adjuvant chemotherapy should be combined with radiation therapy and surgery even in early stages.

Adult↗
PubMed2000

Cryogenic detectors below 100 mK for X-ray measurements in metrology

Due to the intrinsic performances of cryogenic detectors such as energy resolution, LPRI has decided to use these devices to improve the quality of the radioactive measurements usually obtained with classical semiconductor detectors. A bolometer with a 10 microg tin absorber has been developed at IAS (Institut d'Astrophysique Spatiale) and has been tested in the cryogenic installation of LPRI; an energy resolution (full width half maximum, FWHM) of 39 eV has been obtained on the Kalpha line of Mn. Besides these good spectrometry results, an absolute activity measurement using bolometers is proposed by adapting an absorber geometry for 4 pi counting.

Journal Article↗
PubMed2000

[Endoscopic para-aortic dissection by the extraperitoneal approach: clinical study of 37 patients].

OBJECTIVE: To give the preliminary results of a series of 37 operations for a para-aortic endoscopic curage by the extraperitoneal passage. MATERIAL AND METHODS: Thirty-seven patients, with an average age of 45.8 +/- 12 years, were operated on for cervical cancer, with an average tumor diameter of 4.9 +/- 1 cm. The indications were: the tumor's diameter > or = 4 cm (N = 24), one FIGO stage > or = IIb distal (N = 10), N+ pelvic (N = 3). The irradiation was pelvic (if N-) or abdominopelvic (if N+). RESULTS: The operation lasted 125.3 +/- 36.8 min, and the average number of ganglions removed was 21.2 +/- 10.2. The upper limit of the curage was submesenteric for nine patients and subrenal for 28. The immediate postoperatory complications were: a retroperitoneal hematoma, an acute intestinal occlusion treated by laparotomy, and a ureteral wound on a fixed ganglion, treated by an endoprosthesis. The number of N+ was ten in all, of which three were macroscopic: 0/1 for stage Ib1; 2/12 (16.7%) for Ib2; 4/14 (28.6%) for IIb proximal; 4/10 (40%) for IIb distal or more. There were 6/26 (23.1%) N+ microscopic cases for subrenal curages, versus 1/8 (12.5%) for submesenteric. (Excluding 3 N+ microscopic cases). All were given postoperatory radiotherapy except for one, who had a widened hysterectomy (N-). After an average follow-up of 9.5 +/- 5.9 months, there were two pelvic recurrences and six at a distance (of which four died). We had a lymphocele superinfection at six weeks on the diverticular sigmoiditis. There was an enteritis in a patient who had an abdominal irradiation after a laparotomy for acute occlusion. CONCLUSION: Out of 36 patients having postoperatory radiotherapy, para-aortic extraperitoneal curage diagnosed seven N+ microscopic cases, allowing 26 uniquely pelvic irradiations.

Adult↗
PubMed2000

[New therapeutic plans for cancer of the cervix].

New methods of staging (MRI, laparoscopic surgery) and therapy (concomitant radio-chemotherapy, debulking of diseased nodes), with a trend towards the reduction of the aggressivity of surgical procedures (minimal access surgery, ovarian preservation, reduction of the extent of radical hysterectomy, uterine conservation) may and should by integrated in new therapeutic protocols. As a consequence, the management of invasive cervical cancer becomes even more multidisciplinary and specialized.

Antineoplastic Agents↗
PubMed2000

[Laparoscopic lumbo-aortic lymphadenectomy in early-stage non-seminomatous germ cell tumors of the testis: Why? How?].

OBJECTIVES: Laparoscopic lumbo-aortic lymphadenectomy is proposed in order to decrease the morbidity of pretreatment lymph node dissections for early stage NSGCT of the testis. Two approaches are presented and compared retrospectively: the transperitoneal approach and the extraperitoneal approach. MATERIAL AND METHODS: From 1991 to 1999, 57 patients with clinical stage I (50) to IIA (7) NSGCT underwent pretreatment laparoscopic investigation of the para-aortic lymph nodes: 32 transumbilical transperitoneal dissections and 25 internal iliac extraperitoneal dissections were performed. RESULTS: Only the 19 patients with lymph node invasion received chemotherapy. All serious complications occurred in the transperitoneal group: 1 case of chylous ascites and 2 cases of transient neurological complications, 2 cases of permanent ejaculation failure and 2 extranodal recurrences among the 38 pN0 patients. CONCLUSIONS: Laparoscopy, especially extraperitoneal, appears to be a safe, effective and appropriate modality for pretreatment lumbo-aortic lymph node evaluation in early stage NSGCT of the testis.

Adult↗
PubMed2000

[Predictive value of abdominopelvic scan for optimal surgery of ovarian carcinoma].

BACKGROUND: Some patients undergo laparoscopy without optimal debulking surgery as initial treatment for advanced ovarian carcinoma. The amount of residual tumor following primary surgery is an important prognosis factor. Neoadjuvant chemotherapy is a new therapeutic approach. Secondary, optimal surgery could be done in better conditions. PURPOSE: To access the ability of preoperative abdominopelvic CT to predict success of debulking surgery for ovarian carcinoma: less than 1cm of residual tumor size after initial surgery. MATERIALS AND METHODS: We reviewed 39 patients (two stage Ic, 1 stage IIc, 22 stage III and 14 stage IV) operated on for ovarian carcinoma between January 1992 and December 1997. Surgical criteria of inability to perform optimal surgical cytoreduction were compared with abdominopelvic CT done the month before. CT scans were prospectively assessed by radiologist A and retrospectively (3 months to 6 years delay) reviewed separately by radiologists A and B without surgical data. RESULTS: Nineteen patients underwent optimal debulking surgery: 13 no residual tumor and 6 with residual lesions under 1cm. The interreader (0.73) and intrareader (0.9) agreement, worked out by Kappa coefficient, was judged good to very good. The sensitivity of CT was 91% with a specificity of 95%. CONCLUSION: These results allowed us to determine which CT criteria were accurate and reproducible to be a helpful for therapeutic choice and to avoid laparotomy without optimal surgery.

Adenocarcinoma↗
PubMed1999

Role of the locus and of the resistance gene on gene amplification frequency in methotrexate resistant Leishmania tarentolae.

The protozoan parasite Leishmania resists the antifolate methotrexate (MTX) by amplifying the R locus dihydrofolate reductase-thymidylate synthase ( dhfr-ts ) gene, the H locus ptr1 pterin reductase gene, and finally by mutation in a common folate/MTX transporter. Amplification of dhfr-ts has never been observed in Leishmania tarentolae MTX resistant mutants while ptr1 amplification is common. We have selected a L.tarentolae ptr1 null mutant for MTX resistance and observed dhfr-ts amplification in this mutant demonstrating that once a preferred resistance mechanism is unavailable, a second one will take over. By introducing the ptr1 gene at the R locus and the dhfr-ts gene at the H locus by gene targeting, we investigated the role of the resistance gene and the locus on the rate of gene amplification. Transfection studies indicated that ptr1 gave higher levels of MTX resistance than dhfr-ts. Consistent with this, when ptr1 was present as part of either the H locus or the R locus it was invariably amplified, while dhfr-ts was only amplified when ptr1 was inactivated. When dhfr-ts was present in a ptr1 null background on both the H locus and the R locus, amplification from the H locus was more frequent suggesting that both the gene and the locus are determining the frequency of gene amplification in Leishmania.

Alleles↗