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Biomedical subjects

J Lansac

Publications and source records attributed to J Lansac.

At least 217 records · Page 12Linked to original sources
PubMed1983

[Treatment of cancer of the vulva].

The authors suggest a therapeutic scheme for carcinomata (intra-epithelial, micro-invasive and invasive) of the vulva after reviewing the literature and in the light of their own experience. It seems to them that treatment of these cancers can be carried out in the following way: Intra-epithelial cancers: partial vulvectomy for localised lesions or when treatment should be as conservative as possible. Total vulvectomy, or better still, superficial vulvectomy in other cases. Micro-invasive carcinomata: where the invasion is less than 2 mm: only total vulvectomy. Where the invasion is more than 2 mm: total vulvectomy with bilateral superficial lymphadenectomy. This is carried out as a complete lymphadenectomy when the lymph glands are found to be affected in the operating theatre. Invasive carcinomata: we exclude metastatic cancers where the local treatment is only carried out to give some palliation to the patient and sometimes can be combined with chemotherapy when that is possible. Patients that are operable: total vulvectomy with of course bilateral lymphadenectomy. This can be extended to iliac chains when Cloquet's gland is invaded. Radiotherapy after operation is to be discussed seeing that there are important sequelae from this. Lymph gland involvement can be unilateral in cases of N- stage I unilateral patients. Pelvic exenteration is only to be considered for young women who are in good general health and who have no pelvic metastases.

Combined Modality Therapy↗
PubMed1983

[Study of fetal and placental circulation by ultrasound. New technic in the surveillance of pregnancy].

Echotomography has been used for several years in routine for pregnancy follow-up. The morphological parameters provided by this technique (biparietal diameter, transversal abdominal diameter, length of the limbs...) give an objective information on the foetal growth. The exploration of foetal and placental circulation by Doppler measurement has been used in the past for the detection of the foetal cardiac rythm. The association of Doppler and echotomography allows to know precisely the location of vessels of interest, to quantify blood flow volume transcutaneously, and to determine an index of placental resistance. Recent improvements have simplified the use of this complex technique. Transducers for Doppler and imaging have been placed in the same probe very easy to handle. This system allows a precise localization of Doppler sample volume within the vessel to be explored. The great vessels can be studied all long the pregnancy. Normal Doppler spectrum of umbilical arteries shows an important diastolic flow. This fact is related to the low circulatory resistance of the placenta. When the placental circulatory resistances increase (because of placental infarcts for instance) the diastolic flow decreases in the umbilical arteries. To quantify this modification of umbilical circulation we used an index of the resistance (Pourcelot index) [9]: R = (formula; see text) [A systolic amplitude; D diastolic amplitude]. In normal cases, values of R decrease progressively during the course of the pregnancy. In case of abnormal pregnancies (dysgravidy) the index increases. Abnormal values of R had been correlated with hypotrophy or foetus death. With this duplex system it is also possible to determine the different parameters which are necessary to quantify the foetal blood flow in ml/mn. The first results obtained in dysgravidies confirm the major interest of blood flow study in follow-up and prognosis of high risk pregnancies.

Adult↗
PubMed1983

[Cancer of the vulva. Diagnostic and therapeutic aspects apropos of a series of 90 cases].

The authors present a series of 90 cases of cancer of the vulva of which 10 were intra-epithelial and 80 were invasive. These were studied from the 1st January 1962 through to the 31st December 1980. The mean age was 70.04 years, the range being from 31 to 92 years of age. Most cases however were between the ages of 70 and 80. 37.7% of the patients were debilitated. The condition was brought to notice by the discovery of a tumour in 48.8% of the cases, the onset of pruritus in 20% of cases and pain in 14.4%. Most of the tumours were found on the labia majora and minora (in 52.2%). FIGO classification was of stage I in 12% of cases, stage II in 26.6%, stage III in 33.3% and stage IV in 28%. The methods for treating these conditions have been shown according to whether the tumour was intra-epithelial or invasive. Analysing the results confirms that this kind of cancer has a poor prognosis: 57.6% of survivors after 2 years but only 37.3% after 5 years (an actuariel calculation). 30 cases of relapses were analysed and also the complications that occurred. Among these were most frequently (25%) lymphocoeles, sutures falling out because of necrosis and infection (34.2%), urinary incontinence (35.2%). The circumstances in which the patients died were determined above all by the way the disease evolved locally, but in 13.3% of the cases there was metastatic disease. Finally, the difficulties of the diagnosis and of the definition of micro-invasive cancer of the vulva are commented on. The authors point out that the prognosis depends as much as anything on the amount the lymphatics are involved, the frequency and the problems of therapy that are posed by urinary incontinence which occurs after operation. They then give their ideas for treating the patients.

Adult↗
PubMed1983

[Therapeutic indications for cancers of the ovary in adults].

This is a review of the literature of the indications at present available for treating cancer of the ovary in an adult. These indications should take into account the histology, the stage of the disease, the different therapeutic measures available, whether they are chemotherapy or radiotherapy, as well as the wishes of the patient. This must be taken into account in relationship to her age and her wish to keep her reproductive function, or it may contra-indicate chemotherapy.

Adult↗
PubMed1982

[Haemophilus influenza infections in infants and mothers. Three cases (author's transl)].

The three cases reported were diagnosed at the time of contamination by direct examination and culture, at birth, of placental tissue, gastric fluid and peripheral specimens. The culture media included a chocolate agar medium favourable to the growth of H. influenzae. One of the isolates was beta-lactamase producer and therefore resistant to the group A penicillins usually prescribed. Determination of the M.I.C.s of eight antibiotics showed that cefotaxime constitutes, for the time being, a suitable alternative to penicillins against such strains. Early detection of H. influenzae perinatal infections make it possible to treat neonates before complications develop. Among the 19 cases published, there were 4 cases of meningitis, 8 cases of septicaemia and 1 case of arthritis.

Adult↗
PubMed1982

[Associated Paget's disease of the vulva and of the nipple in the same patient: pathology with ultrastructural study (author's transl)].

A case of Paget's disease of the vulva associated with Paget's disease of the nipple is reported. When the patient was 74-year-old, Paget's disease of the vulva was diagnosed; four years later, Paget's disease of the nipple was detected. Paget's disease of the vulva, although recurrent, is devoid of underlying infiltrating carcinoma. Eccrine sweats glands show different type of lesions consistent with pagetoid extension, in situ carcinoma and epithelial papillary proliferation. Ultrastructural study demonstrates dense granules within Paget's cells. A positive Thiery's cytochemical reaction indicates that these granules contain glycoprotein. Paget's disease of the nipple is associated with an intraductal carcinoma (cribriform type). Some feature of intralobular carcinoma is also observed. No foci of infiltration are found. Oestrogen receptors are detected by the histofluorescence technique of Sin Hang Lee. Few receptors are seen within the intraductal neoplastic cells and within the Paget's cells whereas no receptor at all, are observed within the keratinocytes. Several reports emphasized the relationship between vulvar Paget's disease and infiltrating breast carcinoma. Associated vulvar and nipple Paget's disease is rather rare and was just observed in two cases. These two observations were associated with a mammary infiltrating carcinoma whereas in our case, it remains an in situ carcinoma.

Aged↗
PubMed1982

[Paget's disease of the vulva associated with Paget's disease of the breast. Apropos of a case report. Review of the literature].

It is rare to find associated Paget's disease of the vulva and Paget's disease of the nipple (fewer than 100 cases have been published). A case history with this association in a woman of 72 years of age is reported here. Although the diagnosis of Paget's disease was not made at the same time in the two sites, the treatment was carried out at the same time. This case is, as far as we know, a unique case because the vulval Paget's disease was not accompanied by an infiltrating underlying carcinoma, whereas the nipple Paget condition was associated with a non-invasive cancer of the breast. After reviewing the literature the commentators have developed a clinical and anatomo-pathological plan. A very exact anatomo-pathological study was carried out with a search for oestradiol receptors and these contribute to the establishment of the link between these two pathological states and a way of understanding their pathogenicity better.

Aged↗
PubMed1981

[Hypogonadism and alkylating agents (author's transl)].

The authors have studied the toxicity of alkylating agents on the gonads in the light of three cases. The more frequent prescription of these products in chemotherapy when treating cases in Nephrology, Dermatology, Neurology and Ophthalmology as well as general systemic diseases, should make the doctor prescribing them look out for the risks that the reproductive function runs in their use. Although of course there is no valid discussion of the use of these drugs when life is at stake one should all the same, seeing how their efficacy is increasing and survival is becoming more likely, ask oneself about their bad effects on the gonads, and in particular when they are being used for less serious indications. The gonads are often attacked early and insidiously, the the effects on them often starting before the more spectacular secondary effects such as alopecia or neutropenia. A review of the literature brings to light the following : there is a more marked effect on the gonad when it is the testis than when it is the ovary, which seems to be progressively affected; the lesions become worse and increase according to the pubertal state of the male. As far as testicular damage is concerned, it seems debatable whether is is dose-related or related to the length of treatment, and the chances of recovery on stopping chemotherapy with alkylating agents seen to be overall poor. On the practical level the use of sperm banks may resolve some of the worries about later infertility. As far as women are concerned, the greater resistance of the ovary to the effects should make one careful to employ contraceptive measures which are necessary during and after treatment (for fear of teratogenicity).

Adolescent↗
PubMed1980

[Demonstration of estradiol and progesterone receptors in histological preparations].

Oestradiol receptors were demonstrated using the technique of Sin Hang Lee. Receptors are seen after incubation of a section of breast tissue frozen immediately before, with oestradiol bound to a fluorescent molecule (17 beta-oestradiol-6-carboxymethyloxime-bovine serum albumin-fluorescein isothiocyanate). By the same technique, it is possible to visualise progesterone receptors (11 alpha-hydroxy-progesterone hemisuccinate-bovine serum albuminum-tetramethyl rhodamine isothiocyanate). This technique was applied routinely to all breast specimens sent to the laboratory. There were approximately 30 carcinomas, 10 fibroadenomas and 10 dysplasic lesions. Infiltrating carcinomas contained oestrogenic receptors, their distribution being heterogeneous. They appeared to consist of a mixture in varying proportions of positive and negative cells. Intracanalicular carcinomas contained little or no receptors. Receptors were present in Paget cells whilst surrounding keratinocytes contained none. Young fibroadenomas showed the presence of receptors within their epithelial and fibroblastic elements. By contrast, fibroadenomas in a state of involution were negative. Dysplasias may contain receptors, the quantity and distribution showing no typical pattern. In particular, intracanalicular epithelial proliferations may contain receptors. The results of this technique have not yet been correlated with those of "exchanges in vitro".

Adult↗
PubMed1980

[Ultrasonographic examination of the breast: current use and perspectives (author's transl)].

Ultrasonographic examinations were conducted in one hundred patients with breast tumors (fifty cancers, twenty-five fibro-adenomas, and twenty-five cysts) using a manual apparatus and a 5 megahertz probe. Cysts are easily, diagnosed by ultrasonography if they are larger than 5 mm in diameter, but an equally effective result can be obtained by needle puncture. Results are less valid in fibro-adenomas (3 false positives), but this method is feasible in young women with radio-opaque breasts. Diagnosis by ultrasonography of breast cancers again depends on the size of the tumor (40 p. cent of false negatives in TI cases). The authors presently employ ultrasonography only for the diagnosis of solid, apparently non-malignant tumors, in young women (under 30 years) in whom mammography is ineffective, and for non-palpable radiologically detected opacities. New ultrasonography technics should enable improved results to be obtained when using non-invasive procedures for the diagnosis of breast tumors.

Adenofibroma↗
PubMed1979

[Precancerous lesions of the cervix. Diagnosis and treatment (author's transl)].

In gynaecological practice, the problem of precancerous lesions of the cervix arises under three different circumstances : --ectropion, --dysplasia, --in a young girl when the mother has taken Stilbestrol. The literature is reviewed in these three cases : --ectropion is an anatomical state which does not absolutely require treatment. According to the majority of authors it would not appear that its destruction is useful in the prophylaxis of carcinoma of the cervix; --dysplasia, although it does not always progress to a carcinoma, would seem to be a potentially malignant state, the diagnosis of which must be made by the combination of cytology, colposcopy and biopsy. Treatment is based upon the topography of the lesion, its severity and the age of the patient : either conservative if the patient is young and wishes to have children, or surgical (conisation or hysterectomy) if she is older, does not want any more children or has an additional gynaecological problem. --in the presence of a lesion in a young girl whose mother has taken Stilboestrol, precise diagnosis must be made by biopsy with surveillance and treatment of lesions of adenosis, either by progesterone pessaries or by excision.

Adolescent↗
PubMed1978

[Hormone receptors in gynaecology. Towards practical applications? (author's transl)].

A general review of hormone receptors in gynaecology describes the receptors of the membrane for polypeptide hormones and the receptors for steroids. The hormone stays intact in the case of the membrane receptor and activates by contact a second intra-cellular messenger which then induces protein biosynthesis. The constant of dissociation and the number of binding-sites in the human corpus luteum are established for HCG-LH during the cycle, during pregnancy or at the menopause. The working out of these receptors for levels of polypeptides by radio bio-assay gives biological specificity and radio-immunological exactness. Steroid receptors consist of a cytosol receptor which is activated and transferred to the nucleus to induce protein synthesis. They are well recognised for oestradiol and for progesterone in the endometrium and in pathological breast tissue. Variations in the cytosol receptors and the nucleus receptors are known for different phases of the menstrual cycle. Indications for hormone treatment in cancers of the endometrium and of the breast in human pathological conditions can be improved rapidly by recognition of these receptors.

Binding Sites↗
PubMed1976

[Breast cancer and pregnancy. Apropos of 96 cases followed for 3 and 1/2 years at the Centre Léon Bérard, Lyons].

96 cases where cancer of the breast and pregnancy were associated have been studied at the Léon Bérard Centre of Lyon with a follow-up of at least 3 years. Those patients who had a malignant tumour of the breast, which was treated, and then became pregnant (19 cases) were not made any worse (79 per cent survival in 5 years). This was quite independent of the outcome of the pregnancy. On the other hand, those women (54 cases) in which the cancer was discovered and treated during pregnancy had a far worse prognosis (20 per cent survival in 5 years). This prognosis was made worse by the discovery of the cancer in the third trimester of the pregnancy, and by the presence of lymph node involvement, by termination of pregnancy and by weaning. When malignant tumours were discovered during breast-feeding or weaning (23 cases) the prognosis was equally bad (23 per cent survival in 3 years). The authors discuss the frequency of the association of cancer of the breast and pregnancy, as well as the different factors in the prognosis. They attempt to outline the management that should be carried out in the light of recent publications on this subject.

Abortion, Spontaneous↗