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Biomedical subjects

F Lacaine

Publications and source records attributed to F Lacaine.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Early stomach cancer. Do not miss it!].

It may be better to use the term of "superficial carcinoma" than "early gastric carcinoma". Out of 194 patients operated on for gastric carcinoma, 37 had a superficial carcinoma (19%). Seventeen had previously been treated for duodenal (n = 10) or gastric (n = 7) ulcer. Out of 23 barium meal examinations, 3 were normal. The macroscopic appearance at endoscopic examination was normal in 4 patients. In these cases the carcinoma was identified in biopsies. At laparotomy the gastric wall was normal in 16 patients. Gastric resection was subtotal (n = 28), total (n = 6), or partial (n = 1). The tumor was multifocal in 8 cases, and associated with intestinal metaplasia in 24 cases. The five-year actuarial survival rate was 77%. It is important to do not miss superficial carcinoma even in patient treated for peptic ulcer, and to perform biopsies even if endoscopic examination is normal. A subtotal gastrectomy may be performed with excellent results.

Actuarial Analysis↗
PubMed1990

[Intraoperative radiotherapy of cancer of the pancreas].

Intra-operative irradiation could overcome some of the problems of conventional "external" radiotherapy, allowing an increase of the tumor dose and better sparing of the normal tissues. The present study reports 14 cases of patients treated by such a technique; 8 cases were pancreatic cancers (only one being surgically removed). The first conventional surgical step was performed in the operating room. The patient, still under general anaesthesia, was then taken to the irradiation room. A linear accelerator (Saturne CGR 20) was utilized to deliver 15-20 Gy to the tumor volume. Three weeks later, the patients received a 40 Gy complementary irradiation by external beams, and 5 Fluorouracil. There were no early post-operative complications. Three patients suffered from painful lesions; pain disappeared in all 3 cases after the intra-operative irradiation. All patients (with the exception of one who was still alive 9 months later) died 4-10 months after treatment. No definitive conclusion can be drawn from this limited case study. However, encouraging results reported by other groups should lead to further studies regarding this possibly promising procedure.

Aged↗
PubMed1990

[Lymph node involvement: the only prognostic factor after curative resection of cancer of the stomach. Results of a multivariate analysis].

The aim of this study was to evaluate the independent influence of clinical and pathological variables on survival of patients with gastric carcinoma using the Cox regression proportional hazard model. Of 156 patients operated on for gastric adenocarcinoma, 46 (29.5%) underwent palliative operation, 24 (15.5%) had a palliative resection, and 86 (55%) had a curative resection. The overall 5-year survival rate was 25 +/- 4%. After curative resection, the 5-year survival rate was 44 +/- 6%. Univariate analysis applied to these patients showed that poor survival was related (p less than 0.01) to: age (over 80 years), absence of epigastric pain, vomiting and dysphagia, total gastrectomy, tumor size (more than 4 cm), lymph node involvement (LNI), invasion through the muscularis propria, absence of intestinal metaplasia near the tumor, and linitis plastica. In multivariate analysis, lymph node involvement was found to be the only independent prognostic factor. The 5-year survival rate was 75.5 +/- 8% without LNI, 28 +/- 10% with proximal LNI and 7 +/- 6% with distal LNI. Our results suggest that classification into 3 LNI groups is the best staging system for curative resection in gastric carcinoma.

Adenocarcinoma↗
PubMed1989

[Adjuvant treatment of cancer of the exocrine pancreas].

Survival at 5 years has been observed in 5 to 10 p. 100 of patients with cancer of the exocrine pancreas and lower biliary tract who underwent surgical resection. However, since radical surgery can only be performed in about one out of five patients, 98 p. 100 of patients with pancreatic cancer receive no more than a palliative treatment. Owing to the sombre prognosis of this type of cancer, special efforts are being made to discover new adjuvant treatments that will enhance the effects of curative or, more often, palliative treatments. These adjuvant treatments fall into three categories: chemotherapy, radiotherapy and hormonal therapy. Most trials have been carried out in cancers of the exocrine pancreas. The main criticism that can be raises against trials conducted in patients with cancer of the biliary tract is that none of them comprised an untreated control group, and in the absence of control group it is impossible to determine whether treatment really improved the patients' survival. This does not apply to trials conducted in patients with cancer of the endocrine pancreas: some trials included a control group chosen at random, whilst in other trials therapeutic effectiveness was judged on the "response rate". Yet an objective "response rate", as can be evaluated by such morphological examination as computerized tomography, is not synonymous with "therapeutic effectiveness", as the latter can only be asserted by an increase of survival. The authors described the adjuvant treatments that have been proposed for pancreatic cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Detection of hepatic metastasis of digestive cancers. Value of enzyme assays and ultrasonography].

Alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH) and aspartate aminotransferase (AsT) assays, as well as ultrasonography are the easiest and least expensive examinations to perform in the diagnosis of hepatic metastases. The 273 patients included in this series had cancer of the digestive tract. The diagnosis of presence or absence of liver metastases was made at surgery and was positive in 38 patients (14 per cent). A receiver operating characteristic (ROC) curve was drawn after computing the sensitivity (Se) and specificity (Sp) of each laboratory determination while the threshold indicating that the value was normal was incremented. The examinations were then compared in terms of Se, Sp, positive predictive value and negative predictive value. The threshold was determined on the ROC curve where less false-positive and more true-positive results were shown. According to predictive values, laboratory determinations could be classified in decreasing order of usefulness as: AP, LDH, GGT and AsT. Ultrasonography had a positive predictive value of 68 per cent a negative predictive value of 95 per cent, both figures being higher than those of any laboratory examination. These results suggest that ultrasonography has a higher diagnostic value than any of the enzyme assays in the detection of hepatic metastases. Moreover, ultrasonography provides morphological information which, in case of liver resection, may be useful to the surgeon.

Alkaline Phosphatase↗
PubMed1989

Prophylactic antibiotherapy in abdominal surgery. First- vs third-generation cephalosporins.

To compare the efficiency of antibioprophylaxis by cefazolin sodium or cefotaxime sodium, 3137 consecutive patients undergoing abdominal surgery were included in a prospective, randomized, controlled, multicenter study. The patients were divided into four strata, according to the degree of contamination during the operation and the risk factors. Within each stratum, the patients were randomized into three groups of treatment: (1) cefazolin, (2) cefotaxime, and (3) nontreatment (control). Antibiotics were administered perioperatively in three intravenous doses of 1 g at eight-hour intervals. Patients undergoing colon surgery or with peritonitis at the time of the operation were excluded from the study. The wound abscess rate was significantly lower in the treated groups than in the control group, except in stratum 3 (contaminated surgery). The percentage of postoperative peritonitis was twice as low in the treated groups as in the control group. There was no difference between the groups receiving cefazolin or cefotaxime. The patients in the treated groups received significantly less postoperative antibiotics than the patients in the control group. In terms of cost, antibioprophylaxis by cefazolin seems to be warranted in all operations with a low anaerobic contamination.

Abdomen↗
PubMed1989

Gallbladder carcinoma: role of radiation therapy.

Gallbladder carcinoma continues to be a discouraging disease. Prognosis after resection still remains poor. Radiation therapy has been used in an attempt to improve the prognosis but only a few series of less than ten cases have been reported. Since 1977 we have treated 20 patients with gallbladder carcinoma with postoperative radiotherapy (mean total dose 4200 radiation absorbed dose). In four patients all the tumour was resected with the intent of cure. In 12 patients, the lesion was partially resected and in four patients no resection was performed. Seven patients in whom the tumour was partially resected or not resected also had chemotherapy. Our evaluation was retrospective and we compared our results with historical control groups comparable with respect to surgical procedures and pathological staging. In patients operated on for cure, one patient is alive at 84 months, the others died at 7, 8 and 33 months. In patients in whom the tumour was partially resected the mean survival time was 8.1 months and two patients are still alive 7.0 months after treatment. According to the Nevin classification the mean survival time in stage IV and V patients was respectively 9.2 and 7.2 months. There was no difference in survival between patients treated or not treated with chemotherapy. This experience is the largest published and suggests that radiotherapy may increase survival after no resection or palliative resection of gallbladder carcinoma.

Adenocarcinoma↗
PubMed1989

Povidone-iodine enema as a preoperative bowel preparation for colorectal surgery. A bacteriologic study.

To evaluate the effects of povidone-iodine (PI) enema on the bacterial flora of colorectal mucosa, the authors studied 113 patients who were candidates for colorectal surgery. The study of the rectum included 72 patients. Total bacterial concentrations after a PI enema (N = 44) were significantly lower than after a simple water enema (N = 12, P less than 0.001), or than after a water enema associated with intravenous metronidazole (N = 16, P less than 0.01). The study of the colon included 41 patients. Total bacterial concentrations did not differ after a PI enema (N = 24) than after a water enema (N = 11); both groups were associated with intravenous metronidazole. In contrast, both preparations significantly reduced bacterial concentrations when compared with oral administration of polyethyleneglycol (N = 6, P less than 0.01). Similar results were observed in rectal and colonic studies, when analysis was restricted to the anaerobic flora. PI is an antiseptic that, when administered alone in an enema or in association with metronidazole, significantly reduces bacterial concentrations in the mucosa of the colon and rectum. It may be proposed as a simple preoperative preparation for colorectal surgery.

Bacteria, Aerobic↗
PubMed1989

Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum. A French prospective controlled study.

In a multicentric trial the postoperative mortality and the 5-year survival of elective total gastrectomy (TG) was compared with subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated on with intent of cure. Two hundred and one patients were included in the study; 32 were excluded after pathologic examination (linitis plastica, superficial cancer, lymphoma). One hundred sixty-nine patients remained for analysis, with 93 undergoing TG and 76 undergoing SG. Elective TG did not increase postoperative mortality (1.3%) compared with SG (3.2%). There was no difference in the 5-year survival rate (48%). Analysis of survival showed no difference in the two techniques when related to nodal involvement and serosal extension. It is concluded that both TG and SG can be performed safely in patients with adenocarcinoma of the antrum; however TG did not increase the survival rate.

Adenocarcinoma↗
PubMed1989

Tuberculous aneurysm of the femoral artery: a complication of bacille Calmette-Guérin vaccine immunotherapy--a case report.

A case of bilateral femoral mycotic aneurysms resulting from bacille Calmette-Guérin vaccine, is reported in a 74-year-old man treated by intravesical immunotherapy. The diagnosis was made after histologic and bacteriologic examinations and biochemical analysis of the acid-fast-baccilli. Treatment consisted of resection and replacement of the femoral arteries, with an expanded polytetrafluoroethylene graft on the left side and a saphenous vein graft on the right side. After surgery the patient was treated with antituberculous chemotherapy for 1 year. The patient was doing well 18 months later.

Aged↗
PubMed1989

[Extracorporeal lithotripsy in the treatment of biliary calculi].

The authors present their experience from February 1988 with biliary lithotripsy in 125 patients. They review the protocol inclusion criteria and the various forms of complementary medical treatment. From this group, 30% of the patients underwent cholecystectomy, 45% received medical treatment and only 25% did not eventually require complementary medical therapy.

Cholelithiasis↗
PubMed1989

[Total gastrectomy versus partial gastrectomy of adenocarcinoma of the antrum. A French prospective controlled study].

In a prospective multicentric trial we compared the post-operative mortality and the 5-year survival of elective total gastrectomy (TG) versus subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated on with intent of cure. Two hundred and one patients were included in the study: thirty two were excluded after pathological examination (linitis plastica, superficial cancer, lymphoma). One hundred and sixty nine patients remained for analysis with 93 TG and 76 SG. Elective TG did not increase post-operative mortality (1.3%) in comparison with SG (3.2%). There was no difference in the 5-year survival rate (48%). Analysis of survival showed no difference in the two techniques when related to nodal involvement and serosal extension. It is concluded that both operations TG and SG can be performed safely in patients with adenocarcinoma of the antrum; however TG did not increase the survival rate.

Adenocarcinoma↗
PubMed1989

[Prognosis of surgically treated colorectal neoplasms. Contribution of multivariate analysis].

Dukes' classification is the most usually used method of staging in colorectal carcinoma. However the pitfalls of this classification may be attested by the multitude of modifications of Dukes' staging during the last sixty years. The aim of our study was to evaluate the influence of 25 variables on survival in colorectal carcinoma using the Cox model. This study was performed in 321 patients operated on for colorectal carcinoma. In the 252 patients who had had a curative resection univariate analysis showed that survival was related to 6 variables: age, juxtatumoral lymph node involvement, an abdominal mass, complicated carcinoma, duration of symptoms, and depth of tumor penetration. Stepwise analysis showed the independent influence of 7 variables on survival: age, lymph node involvement, depth of tumor penetration, duration of symptoms, direct spread, preexisting deficiencies, and sex. A byproduct of the regression coefficient of Cox' model was a numerical value for each of these predictive factors. A single composite score was obtained by adding the individual scores of factors from which a prediction of outcome can be made. Applying this model to each of the 252 patients resected for cure, we established three prognostic groups. They predict survival more accurately than the Dukes' system. Our scoring system based on multivariate analysis must successfully defined prognostic groups of patients in other series. Then, it should be recommended for staging in curative resection for colorectal carcinoma.

Aged↗