[Genital infections with Chlamydia trachomatis].
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Chlamydia Infections↗
Biomedical subjects
J Lansac
Publications and source records attributed to J Lansac.
[Primary adenocarcinoma of the fallopian tube. Retrospective study of 16 cases. Prognostic factors].
The authors report the result of a study carried out on 16 cases of tubal adenocarcinoma treated between the years 1975 and 1988. This is a rare gynaecological cancer with a poor prognosis. The mean age of the patients was 57 years, 64.5% of them were menopausal. 25% had had a history of sterility. 29% were nulliparous and 37.5% had previous salpingitis. In 44% of cases the principal clinical signs were a watery discharge and a blood stained discharge. Pelvic pain occurred in 37% of the cases and CT scan showed a pelvic mass in 50% of cases. Hysterosalpingography and ultrasound were two complimentary investigations. The relatively early stage at which first signs of the condition were noted, show the stages of the disease: stage I 68.7%, stage II 25%, stage III 6.2%, stage IV 0%. Surgery above all was the basis of treatment carried out in all cases, and supplemented in 15 out of the 16 cases by added treatment (radiotherapy, chemotherapy of hormone therapy). As far as histology was concerned, well or moderately well differentiated forms were found to predominate (there were 37.5% grade I and 37.5% grade II) against only 26% for grade III. More than half of the tube wall was infiltrated in 50% of cases. The actuarial survival rate after 5 years was 33%. The authors examine the principal factors responsible for the prognosis, the tissue, the early diagnosis and the possibility of removing the tumour completely at the first operation as well as the histological grading and above all the degree of depth of infiltration of the wall of the tube.
Adenocarcinoma↗
[Endometriosis and sterility: whom to treat and how?].
The difficulty in evaluating the efficacy of treatments for endometriosis in terms of sterility results from the frequent confusion between the inhibition of the natural progression of endometriosis and a beneficial effect on fertility. The authors review the supposed benefits and the drawbacks of the various medical and surgical treatments available and medically assisted fertilization (IVF) in the context of the various types of endometriosis damage. They highlight the inadequacy of the AFS score, which gives very similar scores for effects with widely differing impacts on fertility. The authors attempt to identify the therapeutic associations which seem currently to be useful in treating endometriosis and also beneficial in obtaining a pregnancy.
Adult↗
Pasteurella multocida and female genital carcinoma; a case report to dispute the concept of genital opportunistic pathogen.
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Adenocarcinoma↗
Does in vitro capacitation alter chromatin stability of ejaculated human spermatozoa? Cytochemical studies.
In vitro capacitation of human spermatozoa is commonly evaluated by the progressive motility percent. However its effects on sperm chromatin have hardly been studied. Our aim was to determine the extent to which in vitro capacitation with two treatments (B2 or human follicular fluid) alters the chromatin of human spermatozoa, by using two analytical methods, acridine orange staining and Feulgen-DNA cytophotometric measures. Ejaculates were obtained from 23 men participating in our in vitro fertilization program, and several measurements were made on the same ejaculate for each subject. No alteration was observed for the percent of native DNA after capacitation in B2, but spermatozoa incubation during the same time in human follicular fluid was followed by a significant decrease of the percent of native DNA (P less than 0.01). Feulgen-DNA content significantly increased after capacitation in either B2 or follicular fluid (P less than 0.05, P less than 0.001 respectively), and so did sperm nuclear surface area (P less than 0.001). In this study we observed a negative correlation between Feulgen-DNA content and fertilization rate (P less than 0.02). Moreover, the greater effects on Feulgen-DNA content were observed in men with abnormal sperm, whose spontaneous percent of native DNA was lower (P less than 0.05) and Feulgen-DNA content higher (P less than 0.05) than in men with normal sperm. These results indicate that capacitation in B2 as well as in human follicular fluid may alter the chromatin stability of human spermatozoa. Such results suggest a partial decondensation state of human spermatozoa during in vitro capacitation. However, beyond some level of decondensation, the fertilizing ability could be altered.
Acridine Orange↗
Association between breast cancer and family malignancies.
In a case-control study, the relationship between a family history of cancer of the breast, ovary, colon, uterus or prostate and the risk of breast cancer was investigated. The data consisted of family histories from 495 breast cancer cases and 785 controls aged 20-56 years. A positive association was found between the occurrence of breast cancer and a history of breast cancer in the families of the subjects affected. This relationship increased linearly with both the degree of kinship of the affected relatives and with their number. The risk of breast cancer associated with other types of cancer in the family was not significantly different from unity.
Adult↗
Radical hysterectomy for stage I and II endometrial carcinoma: a retrospective analysis of 179 cases.
Total hysterectomy with bilateral salpingo oophorectomy is the traditional treatment for endometrial carcinoma. In an effort to improve local control rates, we have surgically treated our Stage I and II patients with radical hysterectomy and pelvic lymphadenectomy (RH-PL). Between 1976 and 1987 we have treated 179 patients with endometrial adenocarcinoma (125 Stage I and 54 Stage II) with the following modalities. Uterovaginal brachytherapy (60 Gy) was performed first and then 6 weeks later an RH-PL was performed. Twenty-nine patients received external pelvic irradiation (45 Gy) because of tumor invasion beyond the internal two-thirds of the myometrium and/or lymph node involvement. The local control rate was 87% (92% for Stage I, 76% for Stage II). Distant metastases occurred in 24 patients (13%). Five-year actuarial survival rates were 80% for Stage I and 61% for Stage II patients. Prognostic factors were nodal status, histological grading, depth of tumor myometrial invasion, histologic status of the hysterectomy specimen, and peritoneal cytology. Late severe complications occurred for 13 patients (7%). These results are comparable to those published for patients treated with less extensive surgery. We conclude that such an extensive surgery (especially pelvic lymphadenectomy) appears to be useless for all patients with bad prognostic factors requiring pelvic external irradiation. We only still perform external iliac node samples for patients with Stage I grade 1 tumors without deep tumor invasion into the myometrium.
Brachytherapy↗
Oral contraceptives and breast cancer: a French case-control study.
The relationship between the risk of breast cancer and oral contraceptive use was investigated in a case-control study conducted in France between 1983 and 1987 in five public hospitals. Some 464 cases aged 25 to 56 years and 542 matched controls were interviewed about their history of the use of oral contraceptives (OC). Results are given for the entire population and for the subgroup of 358 and 379 premenopausal cases and controls. The multivariate relative risk estimate, for ever user, was 1.5 (p less than 0.01) in the whole group as well as in the premenopausal subgroup (p less than 0.02). However, there was no evidence that the effect varied appreciably according to duration of use, age at first use, use before first full-term pregnancy (FFTP) and time since first or last use. The risk was not altered for any particular brand of OC. We conclude that, because of the widespread attention given to the relationship between OC use and breast cancer, information bias might be responsible for part of the excess in risk observed among OC ever users.
Adenocarcinoma↗
Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989).
To estimate the prevalence and main causes of infertility, a multicentre survey was conducted over 1 year (July 1988-June 1989) in three regions of France. All the 1686 couples in these regions, who consulted a practitioner for primary or secondary infertility during this period, were included in the investigation. The prevalence rate of infertility was found to be 14.1%, indicating that one woman out of seven in France will consult a doctor for an infertility problem during her reproductive life. The main causes of female infertility were ovulation disorders (32%) and tubal damage (26%), and of male infertility oligo-terato-asthenozoospermia (21%), asthenozoospermia (17%), teratozoospermia (10%) and azoospermia (9%). Infertility was also found to be caused by disorders in both the male and female partners together; thus in 39% of cases both the man and woman presented with disorders. The woman alone was responsible for infertility in one-third of cases and the man alone in one-fifth. Unexplained infertility was found in 8% of the couples surveyed.
Adult↗
Argyrophilic cells and ectocervical epithelium.
The purpose of this study was to determine the nature of the argyrophilic cells in the ectocervix and to analyze the different morphologic varieties of argyrophil cell-containing ectocervical epithelia, notably to reappraise the degree of analogy with transitional epithelium. A systematic study of 39 ectocervices was carried out using histochemical and immunohistochemical techniques. Immunodetection of cytokeratins was used to specify the differentiation of the ectocervical linings. Argyrophilic cells were detected in 43% of our specimens. They have been found in several varieties of ectocervical lining: normal-appearing or hyperkeratotic squamous epithelium, "transitional-like" epithelium extending onto the portio, and immature squamous metaplasia from the transformation zone. The term "transitional-like" refers to a stratified nonsquamous epithelium that differs from true urothelium by the absence of superficial differentiation leading to the layer of "umbrella" cells. Two main types of argyrophilic cells have been delineated: serotonin cells and Merkel-type cells. The nature of the argyrophilic cells was dependent on the type of epithelium: Serotonin cells were essentially associated with "transitional-like" epithelium and Merkel-type cells with squamous epithelium. The latter cells were particularly frequent in hyperkeratotic squamous epithelium from uterine prolapse, reinforcing the homology with epidermis.
Adult↗
Chromatin alterations induced by freeze-thawing influence the fertilizing ability of human sperm.
A previous cytochemical study revealed that chromatin alterations could be induced in frozen-thawed human sperm. In order to evaluate the biological consequences of such chromatin alterations, we evaluated the relationship between these chromatin alterations and the drastic decrease or loss of sperm fertilizing ability after freeze-thawing. Using acridine orange staining and Feulgen-DNA quantitative microspectrophotometry, the nuclear variables of sperm were compared using samples which had either recovered, or lost their fertilizing ability after freezing-thawing during artificial inseminations, despite good post-thaw motility. There was a clear decrease in Feulgen-DNA content and nuclear surface values in sperm which exhibited a loss of fertilizing ability. Thus freeze-thawing may alter the DNA/nuclear protein relationships and impair the fertilizing ability of human sperm.
Acridine Orange↗
[Prognostic value of local recurrence after conservative treatment of cancers of the breast ].
To determine the prognostic significance of local relapse after conservative treatment of an invasive carcinoma of the breast, we analysed the results obtained in a series of 512 patients. All patients had a lumpectomy with axillary dissection followed by irradiation. Adjuvant medical treatment was administered to 168 patients. The actuarial 5 years and 10 years overall survival rates were respectively 92.5% and 79.7%. Local relapses occurred in 35 patients (6.8%). The actuarial 5 and 10 years local control rates were respectively 91.2% and 83.6%. In these patients, risk of metastasis was significantly increased as compared with patients without a local relapse. Recurrence in the breast within 2 years of initial treatment several affected the risk of metastasis occurring as compared to later relapses. We conclude that the occurrence of a breast relapse after successful local conservative treatment is a bad prognostic factor, predictive of a high risk for the development of distant metastases.
Adult↗
[Adenocarcinoma of the endometrium. The role of vaginal brachytherapy in the therapeutic sequence].
Surgery is the traditional treatment for endometrial carcinoma stage I and II. Radiotherapy is given to improve local control rate. Vaginal vault curietherapy can reduce vaginal recurrences rate. Chronology of curietherapy (pre or post operative) is under discussion. We have retrospectively analyzed treatment results of patients treated either with pre operative curietherapy (60 Gy) and then radical hysterectomy with bilateral salpingo oophorectomy (RH-BSO) (group 1), or with RH-BSO and then vaginal curietherapy (60 Gy) (group 2). Patients with bad prognostic factors (grade 3 and deep tumor invasion into the myometrium) received pelvic external irradiation and were excluded. 121 patients were in group 1, 63 patients were in group 2. All patients received curietherapy using Cesium 137 sources (one uterine and two vaginal sources in group 1, three vaginal sources in group 2). Total dose delivered to the reference volume was 60 Gy. Doses delivered to some reference points (vagina, rectum, bladder, pelvic wall) were calculated according to the ICRU recommendations. Surgery was at least RH-BSO performed either before or after curietherapy. 82 patients in group 1 and 44 in group 2 had a pelvic lymphadenectomy. Curietherapy data were comparable in the two groups according to the dose distribution to the vagina, rectum and bladder. Reference volume was smaller in the group 2. Local failure rate was 13% in group 1 and 10% in group 2. Distant metastases rate was 12% in group 1 and 9% in group 2. Five year actuarial survival rate was not statistically different between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
[Spontaneous rupture of the membranes before 28 weeks of amenorrhea. Obstetrical and perinatal outcome. Apropos of 28 cases].
The authors studied the outcome of pregnancies after spontaneous rupture of the membranes before 28 weeks of amenorrhoea in a series of 28 women. The mean time of the rupture was at 25 1/2 weeks. The duration of the time of rupture was a mean of 10 days and deliveries occurred between the 19th and the 32nd weeks. In 5 cases with an average term of 22 1/2 weeks the pregnancy was terminated. Caesarean operation was carried out in 4 cases and spontaneous vaginal delivery occurred between the 26th and 30th weeks of amenorrhoea in 19 cases. Chorio-amnionitis was the most common maternal complication (32.1%). Maternal morbidity was high (82%) without important sequelae. Thirty infants were born out of these 28 pregnancies (two sets of twins). 33% of the infants were stillborn, 46.6% died in the neonatal period, all of these from respiratory complications. 20% of the children are still alive, and all of these weighed at least 1,000 grams and were born after 28 weeks. A child that was born at 27 weeks amenorrhoea has serious neurological deficits. Having studied the bibliography on the subject and their own personal experience the authors suggest a routine to carry out in these cases. Although the prognosis is poor, the totality of these factors could encourage obstetrical teams to be conservative so long as they watch very carefully under well defined conditions.
Adolescent↗
[Stage I and II endometrial adenocarcinomas. Prognostic value of lymph node invasion].
In our institution endometrial carcinomas stage I and II were treated with uterovaginal brachytherapy and radical hysterectomy with pelvic lymphadenectomy. We have studied in a retrospective analysis the results of the lymphadenectomy in order to precise his place in the treatment strategy. Between 1976 and 1986, 155 patients were treated these modalities (107 were stage I, 48 were stage II). The mean age was 60.2 years. Brachytherapy delivered 60 Gy and then radical hysterectomy with pelvic lymphadenectomy was performed. 26 patients received a pelvic external beam irradiation on account of lymph node involvement and or deep tumor invasion into the myometrium. 14 patients (9%) had a lymph node involvement. External iliac lymph nodes were involved in 78.5% of these cases. Lymph node involvement rate was higher for stage II, grade 3 tumors and when there was a deep tumor invasion into the myometrium. Pelvic failure rate was 12% for N- patients and 36% for N+ patients. Five years actuarial survival rate was 83% for N- and 41% for N+ patients. Now, we carry out a pelvic external radiotherapy for all stage II, grade 2 or 3 patients and when there is a deep tumor invasion into the myometrium and we do not perform lymphadenectomy for these patients. We perform only external iliac sample for patients with stage I grade 1 tumour without deep tumour invasion.
Adenocarcinoma↗
[Detection of human type 16 papillomavirus in epithelial cells of the uterine cervix].
Cervical cells obtained by scraping from 126 women living in the Tours area, France, were tested for the presence of HPV 16 infection, using the PCR method. In all samples analysed no evidence was found of HPV 16 b subtype. The incidence of HPV 16 infection ranged from 4% in women without history of genital HPV infection to 48% in women with high-grade squamous intraepithelial lesions (SIL). It must be noted that HPV 16 infection is twice as frequent in women with a history of HPV-induced cervical lesions as in those without this history. Thus, a normal cytology does not always mean an absence of HPV infection of the uterine cervix. It may be concluded from these results that detection of cervical HPV 16 infection by the PCR method makes it possible to identify a group of women at high risk of developing SIL or cervical cancer. Regular cytological surveillance of these women who are healthy carriers of HPV 16 without detectable squamous cell abnormalities must be implemented.
Female↗
Is lymphadenectomy useful in the treatment of endometrial carcinoma?
In our institution endometrial carcinoma stages I and II is treated with uterovaginal brachytherapy and radical hysterectomy with pelvic lymphadenectomy. We have made a retrospective analysis of the results of lymphadenectomy to determine its place in the treatment strategy. Between 1976 and 1986, 155 patients were treated with these modalities (107 were stage I, 48 were stage II). The mean age was 60.2 years. Brachytherapy delivered 60 Gy, and then radical hysterectomy with pelvic lymphadenectomy was performed. Twenty-six patients received pelvic external-beam irradiation because of lymph node involvement and or deep tumor invasion into the myometrium. Fourteen patients (9%) had lymph node involvement. External iliac lymph nodes were involved in 78.5% of these cases. The lymph node involvement rate was higher for patients with stage II disease, patients with grade 3 tumors, and patients in whom there was deep tumor invasion into the myometrium. Pelvic failure rate was 12% for node-negative patients and 36% for node-positive patients. The 5-year actuarial survival rates were 83% for node-negative and 41% for node-positive patients. We administer pelvic external-beam radiotherapy to all stage II patients, grade 2 or 3 patients, and patients in whom there is deep tumor invasion into the myometrium. We do not perform lymphadenectomy on these patients. We perform only external iliac sampling for patients with stage I, grade 1 tumor without deep tumor invasion.
Adenocarcinoma↗
Prognostic significance of breast relapse after conservative treatment in node-negative early breast cancer.
The prognostic significance of local relapse after conservative treatment of early stage breast carcinoma has been controversial. To determine the incidence and the prognostic value of a breast relapse, we analyzed the results obtained in a series of patients with pT1pN0 presentation of breast carcinoma treated conservatively without adjuvant medical treatment. From 1976 to 1986, 202 patients with invasive breast carcinoma of less than 2 cm without lymph node involvement were treated with surgery and radiation therapy. The overall survival rate was 97.2% at 5 years. Locoregional relapses occurred in 16 patients (7.9%). In these patients, the overall survival rate was significantly decreased as compared to that of patients without local relapse (87.5% versus 98.3% at 5 years, p less than 0.001). The probability of remaining metastasis-free was also significantly decreased (80.2% vs 91.3%, p less than 0.001). Most relapses (94%) appeared at or close to the primary site. Salvage local treatment was possible in 14/16 patients (87.5%). Age, menopausal status, size and site of primary tumor, histological grade, and boost technique did not influence significantly the risk of local relapse occurrence. We concluded that the occurrence of a breast relapse after a successful local conservative treatment is a pejorative prognostic factor predictive of a high risk of distant metastasis development. There is a need to individualize factors that could allow discrimination of patients with a high probability of local relapse and subsequent metastasis.
Adult↗