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J Lansac

Publications and source records attributed to J Lansac.

At least 109 records · Page 6Linked to original sources
PubMed1995

[Endocervical adenocarcinoma in situ. A histological entity to know].

We report diagnosis and treatment problems encountered in 4 cases of adenocarcinoma in situ (AIS) of the uterine cervix. The patients' ages ranged from 24 to 45 years. In 2 cases, Pap smears revealed strips of cells showing crowded nuclei and pseudostratification of AIS. In 3 cases, the diagnosis of AIS was confirmed from a colposcopically directed biopsy and, in the last case, from a surgical cone biopsy. In 3 cases, AIS was found to be associated with cervical squamous intraepithelial neoplasia. In all cases, it was difficult to rule out an early invasive adenocarcinoma. Three patients underwent total abdominal hysterectomy. The topographic data of lesions, notably the presence of endocervical AIS in hysterectomy specimen realised 4 years after conization, and a review of literature lead us to propose hysterectomy as a basic treatment. If conization is chosen, it should be cylindrical with adequate diameter and height.

Adenocarcinoma↗
PubMed1995

[Air embolism and exploratory hysteroscopy: myths or realities? Preliminary results].

OBJECTIVE: Authors tried to evaluate the prevalence of air embolism which is a severe complication of carbon dioxide hysteroscopy. DESIGN: On one hand, a retrospective inquiry with 18 hyperbaric oxygen therapy units over a 8 year period (1985 to 1992 included); and on the other hand, a prospective study with monthly survey to 84 public Gynaecology units during a 2 year period (January 1991 the 1st to December 1992 the 31st). RESULTS: From the 18 hyperbaric oxygen therapy units receiving iatrogenic air embolism, gynaecologic endoscopy represent 20% of the patients. Among these, 2/3 come from laparoscopy and 1/3 from hysteroscopy. In the prospective study, 42 public Gynaecology units made 5,140 carbon dioxide hysteroscopies. Three air embolism were declared in this population (i.e. 0.58/1000) with 1 death and 2 recoveries without sequelae after hyperbaric oxygen therapy. CONCLUSION: Analysis of these cases suggest that, for this risk, one should oppose ambulatory hysteroscopy without anaesthesia to hysteroscopy under general anaesthesia with frequent cervical dilatation, prolonged duration and different underlying pathology.

Adult↗
PubMed1995

[Repeated spontaneous abortions: discussion on its etiologies].

Spontaneous abortion (SA) is the most common complication of pregnancy and is estimated to be between 15 to 20% of all clinical pregnancies. However for "recurrent spontaneous abortion" (RSA) the frequency is more difficult to determine (between 0.05 to 1%). The purpose of this paper is to review the literature concerning RSA etiologies. Particular attention has been paid to the male factors contribution in RSA. Because of the poverty of controlled studies, answers to questions about the RSA are very difficult.

Abortion, Habitual↗
PubMed1995

[Management of necrospermia].

Necrospermia is still a poorly documented cause of male infertility. Among infertile subjects, the incidence reported in the literature is 0.2 to 0.48 per cent. We undertook a retrospective study to contribute to the comprehension of this abnormality. Histories, physical examination, analysis of the semen and hormonal dosages performed in necrozoospermic subjects were reviewed. We observed that in patients with necrospermia in at least three semen samples, infections represent 40 per cent of aetiologies. In 20% of the whole population, no aetiology was observed, but abnormalities of the epididymis function was suggested. Through this study, we suggest an aetiological classification and practical guidance in case of necrozoospermia.

Decision Trees↗
PubMed1995

[Association of Takayasu's arteritis, pregnancy and Still's disease].

Two pregnant patients presented with Takayasu's disease predominating in the major branches of the aorta. There was no extention below the diaphragm and no complications. One of the patients had Still's disease which is a predominantly cutaneous form without chronic arthritis. Both pregnancies were uneventful excepting dysgravidia in one case. Two eutrophic infants were born at term. The risk of Takayasu's arteritis associated with pregnancy, as reported in the literature, is mainly due to the consequences of arterial hypertension with pre-eclampsia (60%), heart failure and cerebral vascular events (5%). The major fetal risk is in utero death (2 to 5%), but intra-uterine growth retardation is more frequent (18%). The risk is greatest during the third trimester and during the perinatal period. Fetal involvement is greatest in sever cases and in those treated late. Prevention is based on the initial work-up to identify the disease and possible complications, programming pregnancies and increasing surveillance during periods of risk, defining the delivery route with cesarean section reserved for complications of arteritis (30%), and planned labour with instrumental extraction and epidural anaesthesia with control of the blood pressure. Still's disease has no particular consequence on pregnancy, although sequellae of chronic arthritis of the pelvis may have an impact on obstetrical technique. An association with Takayasu's disease is rare with only one case being reported in the literature; aetiopathology remains unknown.

Adult↗
PubMed1995

[Stage I and II endometrial cancer: should lymphadenectomy still be done?].

Surgical treatment for endometrial carcinomas stage I and II is radical hysterectomy. The role of lymphadenectomy (pelvic and paraaortic) is under discussion. From a retrospective study (multivariate analysis of 320 patients treated by radiosurgical association) and a review of the literature, the authors limit the indications of lymphadenectomy to stage I grade 1 or 2 tumours and without deep tumours invasion into the myometrium (in that case only 10% of pelvic nodes will be involved). Stage II patients or stage I with grade 3 and/or deep tumour invasion into the myometrium do not require lymphadenectomy as post-operative pelvic external beam irradiation will be performed in all cases. Para-aortic lymphadenectomy is not useful as it increases morbidity and the adjuvant treatment in case of lymph node involvement does not improve the survival rate.

Adult↗
PubMed1994

Conservative treatment feasibility with induction chemotherapy, surgery, and radiotherapy for patients with breast carcinoma larger than 3 cm.

BACKGROUND: The traditional surgical treatment for operable breast carcinoma larger than 3 cm is mastectomy. To avoid mutilating surgery, the authors administered primary chemotherapy to 158 patients with operable nonmetastatic large breast carcinoma with a TNM classification of T2 greater than 3 cm and T3 with a lymph node status of N0-N1. Conservative treatment was proposed for patients responding to the chemotherapy and whose tumor was reduced to 3 cm or less. The purpose of the study was to evaluate the feasibility and treatment results of this strategy. METHODS: The mean patient age was 50.4 years. Eighty-two patients had T2 carcinomas greater than 3 cm, and 76 had T3 carcinoma. Fifty-four tumors were classified as lymph node status N0, and 104 as N1. Mean tumor size was 5.6 cm. Patients were treated with three courses of the NVCF regimen (mitoxantrone, vindesin, cyclophosphamide, and 5-fluorouracil) or the EVCF regimen, in which mitoxantrone was replaced by epirubicin every 4 weeks, and then administered with a radiosurgical combination. RESULTS: The overall response rate to induction chemotherapy was 60.8% with 20.2% complete tumor regression. Twenty-one percent of the patients experienced grade 3 or 4 chemotherapy toxic effects, which were all acceptable and reversible. Breast-conserving treatment was feasible in 48.7% of patients (77 of 158). Forty-five patients (28.5%) were treated with a radiosurgical combination (tumorectomy plus radiation therapy), whereas 32 (20.2%) were treated with radiotherapy alone (external irradiation and brachytherapy). Other patients were treated with mastectomy. Age, tumor stage, histology, hormonal status, and hormonal receptor rate had no influence on the frequency of the observed regressions. Isolated recurrences occurred in 11 patients, 6 who were treated conservatively and 5 who were treated with mastectomy. Metastatic relapses were observed in 38 patients (14.6% in the chemotherapy responders and 38.7% in the nonresponders) (P < 0.02). Five-year actuarial survival was 73.2% and was significantly higher for responders to the induction treatment. CONCLUSION: These preliminary results suggest that primary chemotherapy and radiosurgical breast-conserving treatment is feasible and is an alternative to mastectomy for patients with large operable breast carcinoma who are responders to the induction treatment. The long term benefit of this strategy must be evaluated in well designed controlled trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Cell abnormalities associated with human papillomavirus-induced squamous intraepithelial cervical lesions. Multivariate data analysis.

One hundred ninety-six cervical scrapings were obtained for simultaneous research of cell abnormalities in Papanicolaou smears and detection of genital human papillomavirus (HPV) genotypes by polymerase chain reaction in extracted DNA from each clinical sample. The samples described by six discriminant cytologic parameters, and a synthetic HPV-presence/absence parameter provided an efficient matrix for multiple correspondence analysis. This statistical analysis displayed a plurality of HPV-related cell abnormalities in squamous intraepithelial lesions, and a high correspondence between HPV infection and the presence of multinucleated squamous cells, morphologically transformed keratinocytes (dyskaryotic cells), koilocytes, and cellular changes related to epithelial maturation. Because of the low proportion of detectable koilocytes in the HPV-infected scrapings, the authors also inferred that cellular changes related to epithelial maturation and morphologically transformed keratinocytes are the most accurate and efficient cell abnormalities, in terms of frequency and correlation, for cytodiagnosis of HPV-induced or associated squamous intraepithelial cervical lesions.

Adolescent↗
PubMed1994

[How to investigate menometrorrhagias at the time of menopause?].

Metromenorrhagia is common around the time of the menopause. Following a careful history and full gynecological examination, vaginal ultrasonography and hysteroscopy combined with biopsies enable the investigation of such genital bleeding. Vaginal ultrasonography can be used to visualise the uterine cavity and measure the thickness of the endometrium. The term atrophy is used if the latter is less than 5 mm. If, on the contrary, the endometrium is thick or if there is a more notable intracavitary lesion, hysteroscopy and the collection of biopsy material guided by it will provide the diagnosis.

Adult↗
PubMed1994

[Subclinical breast lesions manifested by microcalcifications. Historadiologic correlations. Apropos of a retrospective series of 127 cases].

OBJECTIVE: To ascertain the correlations between the histology and radiology of microcalcifications revealing subclinical carcinoma. TYPE OF STUDY: A retrospective series of 127 exereses of microcalcifications of the breast identified on preoperative radiographs. RESULTS: Histology revealed 43 (33.9%) carcinomas including 72% in situ cancers and 17 borderline lesions (13.3%) for a total of 47.2% cancerous or high risk lesions. 56% of the malignant lesions were diagnosed by mammography during screening. In most cases, conservative treatment was carried out. Axillary node invasion was not found in any of the cases of in situ carcinoma. 16% of the invasive carcinomas were pN+. Re-examination of the radiographs revealed that there was a correlation between the histology and the radiographic findings. 68% (n = 59) of the localizations with less than 30 microcalcifications were benign and 73% (n = 30) were malignant. The triangular appearance of the microcalcification localizations rwas in favour of a carcinoma in 88% (n = 22) cases. The polymorphism microcalcifications within a given localization was suggestive of malignancy in 69% (n = 25%). On the basis of data in the literature, different criteria can be used to provide precise information preoperatively.

Adult↗
PubMed1994

[Catamenial sciatic pain due to endometriosis of the sciatic nerve. Review of the literature, apropos of a case].

Sciatic nerve endometriosis is rare but must be included in the sciatic pain aetiology diagnosis. Typically the patient's sciatic pain is cyclic. Electromyography and computed tomographic scanning or nuclear resonance imagery contribute to the diagnosis. Different mechanisms of this localization have been proposed. The patient often requires conservative surgery with excision of endometriosis from the nerve. Medical treatment (LH-RH analogues) may be associated in young patients who need to preserve reproductive function. Total hysterectomy with bilateral salpingo-oophorectomy may be mandatory in stage III or IV endometriosis and older patients.

Adult↗
PubMed1994

Familial risk of breast cancer in a French case-control study.

The relationship between a family history of cancer and the risk of breast cancer was investigated in a study of 495 breast cancer cases and 785 controls aged 20 to 56 years. A positive association was found between the occurrence of breast cancer and a history of breast cancer in families. This relationship increased linearly with both the number of the affected relatives and with the degree of kinship between the affected relative and the case. The highest risk was observed when a sister was affected by breast cancer. This could be explained by longer common environmental exposures between sisters than between mother and daughter. This could also be explained by a genetic factor segregating under a recessive model. The risk of breast cancer associated with colon, uterus, ovary, and prostate cancer in the family was not significantly different from one. However, the estimated odds ratios associated with a family history of colon cancer increased with the degree of kinship between the affected relative and the case in a similar manner to those of breast cancer. A relationship between the risk of breast cancer and a family history of colon cancer would support the existence of a common familial factor (be it genetic or not) for these cancers. Further genetic epidemiological studies might help to define the mode of inheritance of the same susceptibility to cancer at different sites.

Adult↗
PubMed1994

Familial risk of breast cancer and abortion.

We found that the risk of breast cancer associated with a family history of breast cancer increased with the number of abortions (induced as well as spontaneous) in a study of 495 breast cancer cases and 785 controls aged 20 to 56 years. For the women who had undergone at least two abortions, the risk associated with a family history did not seem to depend on the type of abortion. This finding suggests that the effect of a family history on the risk of breast cancer is modified by event(s) resulting from abortions. Further epidemiological studies should be conducted to verify the existence of this interaction.

Abortion, Induced↗