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Biomedical subjects

J Dauplat

Publications and source records attributed to J Dauplat.

At least 109 records · Page 6Linked to original sources
PubMed1992

[Cancer of the endometrium caused by antiestrogens].

Tamoxifen is the most widely used non-steroidal antiestrogen compound for adjuvant treatment of postmenopausal breast cancer. Tamoxifen has both antiestrogen and estrogen-agonistic activity, which depends on the target tissue involved owing its systemic distribution. Upon the endometrium the agonistic estrogenic effect, so-called "paradoxical" effect, is suggested to induce proliferative changes such as hyperplasia or carcinoma. The authors report four cases of endometrial cancer developed in postmenopausal patients with breast cancer receiving tamoxifen. According to the literature data, the relationship of the tamoxifen to the endometrial remains uncertain: women with breast cancer are at increased risk for this neoplasm sharing common aetiologic hormonal factors and, in most published case reports, the uterine cavity has not been checked up before starting tamoxifen administration.

Adenocarcinoma↗
PubMed1991

Prevention of radiation enteritis by an absorbable polyglycolic acid mesh sling. A 60-case multicentric study.

Radiation-induced small bowel injury is a limiting factor to postoperative tumoricidal pelvic doses exceeding 4500 to 5000 cGy. Data from a review of the literature showed the inadequacy of medical measures and the bad reproducibility of radiation therapeutic attempts to decrease small intestine damage. Recent studies cited the benefit of a polyglycolic acid mesh to create an absorbable intestinal sling and suspend the loops above the pelvic radiation field. In 60 cases of gynecologic and rectal malignancies with a surgical intestinal morbidity of 8.3% (5 cases), the rate of radiation enteritis was 7% (4 cases) with an average follow-up of 17.8 months (range, 1 to 57 months). The quality of small intestinal elevation and the absence of loop herniation were demonstrated by the barium index. Magnetic resonance imaging was used for checking the polymer polyglycolic acid mesh position and its complete resorption at the third to fifth postoperative month. The authors conclude that this new procedure is safe in selected patients with high pelvic recurrence risk after optimal surgery, in residual disease after debulking surgery, or at the time of exploration for unresectable pelvic tumors. Clinical studies are ongoing to evaluate the long-term efficacy of this surgical technique to prevent chronic radiation enteropathy and improve locoregional control in advanced pelvic carcinomas.

Adult↗
PubMed1991

The lymphatic drainage of the human ovary in vivo investigated by isotopic lymphography before and after the menopause.

The authors report 14 lymphoscintigraphies of the ovary, 8 before and 6 after the menopause. Injection of colloid labeled with technetium 99 m with elective lymphatic absorption was made into the mesovarium under laparoscopic control. Frontal and lateral images of the lymphatic drainage were made with a gamma camera 4-6 h after injection. Even in this short preliminary series, the premenopausal women showed major local and regional lymphatic circulation with drainage to the lumbo-aortic and pelvic nodes. After the menopause the lymphatic flow decreased and drainage was essentially by the aorto-lumbar nodes.

Adult↗
PubMed1991

[Drainage of the upper urinary tract in gynecologic cancers with renal involvement].

Urinary tract obstruction often occurs during the evolution of gynécologic malignancies and its management should be carefully taken in account during treatment of the primary tumor. Authors' experience is based upon 154 urinary drainages undertaken among 119 patients. Causes of urinary tract obstruction are analysed with the different technics of drainage and with the corresponding long term follow up. An original technic called "nephroneo-cystostomia" is described.

Adolescent↗
PubMed1991

[Ovarian transposition with per-celioscopy before curietherapy in stage IA and IB cancer of the uterine cervix].

Ovarian preservation is recommended for young patients with early invasive cancer of the uterine cervix. We describe the laparoscopic technique of ovariopexy we performed among seven patients before brachytherapy and Wertheim surgery and we report our functional results: menopause was avoided in four instances but three failures were observed. The laparoscopic procedure could be improved with coagulation and section of the utero-ovarian ligament, mobilization of the infundibulopelvic ligament; finally the ovary could be transposed in the paracolic gutter. According to the authors, this protocol must be applied only to patients with stage IA or IB squamous cervical cancer, aged less than 35 years.

Adult↗
PubMed1991

[Uterine metastasis of breast cancer. Report of 8 cases].

The authors report a retrospective clinicopathologic study of 8 cases of uterine metastases from breast cancer. This is the largest surgical series dealing with this subject to be published to date. Not autopsy case has been considered. Much information has come out of this analysis and out of the international literature review: secondary location in the uterus can occur many years after the diagnosis and treatment of primary cancer of the breast; infiltration of the endometrium appears as common as infiltration of the myometrium; the histological type is nearly always invasive lobular carcinoma. The later was found in seven out of eight cases; the evaluation of hormone receptor levels in the surgical specimens has shown that most breast cancers metastasizing to the uterus are hormone-dependent.

Aged↗
PubMed1991

[Post-menopausal endometriosis developed during tamoxifen treatment].

The authors report a case of endometriosis (adenomyosis + endometrioma) which occurred in a female patient aged 69 years, who had undergone the menopause 15 years previously and who had been taking Tamoxifen for 7 years as an adjuvant treatment for cancer of the breast. Tamoxifen, a non-steroidal anti-estrogen derived from diethylstilbestrol, has a variable antagonist/agonist so that estrogenic stimulation of the female genital tract may occur, particularly of the endometrial mucosa. The reactivation of the endometriosic foci which had become quiescent under the impact of the natural menopause, which, by iatrogenic analogy is included in the series of paradoxical uterine effects of tamoxifen.

Aged↗
PubMed1990

[Stage III and IV epithelial cancer of the ovary. Prognostic role of surgical tumor reduction].

We report the results of surgical excision prior to chemotherapy in 180 cases of advanced epithelial ovarian carcinoma. In this retrospective study, the mean survival rate at 5 years was 22 percent. It was 40 percent in patient with stage III carcinoma, divided into 60 percent for micronodular carcinomas (stages IIIa + b) and 30 percent for macronodular carcinomas (stage IIIc). However, in cases with optimal initial excision the overall survival rate was the same in patients with macronodular carcinoma as in those with micronodular carcinoma. This finding suggests that surgical excision itself has a favourable effect on the prognosis of this disease.

Adult↗
PubMed1990

[Epithelial cancer of the ovary. Contribution of the experiences of a treatment facility to the current data of prognosis and treatment].

Results obtained by the authors and a review of the literature have made them able to point out recent developments in cases of epithelial cancer of the ovary diagnosed in an advanced stage of the disease. This is the most frequent finding when the diagnosis is made and it is most important in assessing the future prognosis to know how far on the disease has progressed. Cancer of the ovary has long been thought of as a peritoneal disease, but all the same 40% of metastases occur further away and the majority of these are in the pleura or the lung and more rarely in the brain; and all these have been observed. The degree of differentiation is another important element for prognosis. Deciding how differentiated tissue is, is relatively subjective. A scoring protocol is suggested to make the assessment more systematic. The grading can be varied according to the response to treatment. A great majority of authorities believe that reduction of the size of the tumour surgically should be the first procedure but how useful this is has never been proved because there has never been any controlled study. It is possible in most cases to reduce the size of the tumour greatly but often this may need removal of some of the intestines with acceptable morbidity. Chemotherapy with Cisplatin, Cyclophosphamide and in the hands of certain authors, Doxorubicine, has been shown to be helpful in 80% of cases and seems to be the most appropriate treatment.

Carcinoma↗
PubMed1990

[Metrorrhagia and tamoxifen. Apropos of 22 patients treated for cancer of the breast].

The authors report 22 cases of metrorrhagia occurring in the course of adjuvant hormonal therapy for breast cancer using tamoxifen. The anti-oestrogenic effect of this drug is associated with a variable agonistic effect that has been observed in organs with steroid receptors, and especially in the uterus. In this series, the cause of the abnormal bleeding is explained in 17 out of the 22 cases (ie, 3 out of 4) as a paradoxical oestrogen-like effect on the mucosa of the uterus. Two cancers of the endometrium were diagnosed.

Adult↗
PubMed1989

High-dose melphalan and autologous bone marrow support for treatment of ovarian carcinoma with positive second-look operation.

Patients with epithelial ovarian carcinoma (OVCA) and positive second-look operation (SLO) have a poor short-term prognosis. Treatment after SLO is still controversial and pilot studies are justified in an attempt to improve survival of these patients. As OVCA is known to be a chemosensitive tumor, it seems logical to treat these patients with high-dose chemotherapy with the support of an autologous bone marrow transplantation. Fourteen patients underwent primary surgery with tumor debulking followed by cis-platinum-based chemotherapy. SLO was performed in each patient and was microscopically positive in five and macroscopically positive with secondary debulking in nine. All patients were treated after SLO with high-dose melphalan (HDM), 140 mg/m2, and autologous bone marrow support. HDM was well tolerated, with a median time to granulocyte recovery of 21 days. There was no death due to treatment toxicity. The mean follow-up after SLO is 43 months. Five patients (35.7%) are disease free at 30 to 60 months after SLO with no further treatment and, thus, a good quality of life. Four patients are alive with recurrent disease. Five patients died of OVCA; actuarial 3-year survival is 64%. This therapeutic procedure is well tolerated and seems to provide long-term survival for patients with no complete response after first-line chemotherapy. Therefore, it might also be applied to patients at high risk of recurrence after a negative SLO.

Adenocarcinoma↗
PubMed1989

[Subclinical lesions of the breast. Stereotactic localization and biopsy-excision].

Three hundred and eighty nine preoperative localizations were performed in the senology department of the Centre Jean Perrin in 349 patients presenting with an isolated radiological image with no associated clinical signs (discovered on routine or selective screening examinations). The most frequent anomaly detected was the presence of areas of microcalcifications, sometimes associated with a high-density lesion or more rarely an opacity. Systematic enlargements allowed refinement of the surgical indications and reduced the number of tumourectomies performed for benign lesions. The histological results consisted of 41% of neoplastic and borderline lesions with a predominance of in situ or microinvasive forms without lymph node involvement. The mean age at the time of diagnosis was 40 years, i.e. ten years younger that the mean age of cancer diagnosis. The percentage of subclinical cancers discovered in this way, increased by screening and improvement in surgical techniques, has been further increased by enlargements which have improved the precision of surgical indications. Stereotactic localization allows the surgeon and pathologist to more accurately define the lesion while preserving the appearance of the breast.

Biopsy, Needle↗
PubMed1988

Changes in the histocytological grading of epithelial ovarian carcinoma following treatment.

Although the microscopic grade of epithelial ovarian carcinoma is recognized as an important prognostic factor, the grading systems are still controversial. A cytohistological grading system is described using the sum of the scores (from 1 to 4) of eight histological and cytological features. This grading is applied to the initial surgical specimens of 37 patients seen at UCLA Center for the Health Sciences; it is also used for evaluation of pathologic specimens obtained at subsequent laparotomies. The evolution of the score at subsequent laparotomies (stable, increasing, or decreasing) is correlated with the type of therapy, response to treatment, and prognosis. An increasing score at the second-look laparotomy is a poor prognostic factor with a significantly shorter patient survival (p less than 0.05). The tumor score at second-look laparotomy is significantly increased in cases of macroscopically positive operation (p less than 0.05) and tumor progression (p less than 0.001). The type of therapy has no significant effect on the tumor score. A multivariate analysis shows that a decreasing score is related to a lower mitotic activity. Conversely, an increasing score is related to a change in tumor pattern. This study demonstrates the prognostic value of our grading system, which needs to be further validated by prospective studies.

Adenocarcinoma↗