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Biomedical subjects

J M David

Publications and source records attributed to J M David.

At least 19 recordsLinked to original sources
PubMed1992

[Reconstruction of the mouth floor with nasolabial flap after cancer resection. Report of 81 cases].

The authors report functional results in a series of 81 patients with carcinoma of the floor of the mouth treated by surgical resection and reconstruction by nasolabial flap. The study confirms the literature concerning advantages and limits of such a flap. With regards to others techniques of reconstruction, nasolabial flap is still perfectly usefull in reconstruction of T2 T3 carcinomas of the floor of the mouth.

Adult↗
PubMed1992

Stage I cutaneous malignant melanoma: risk factors of loco-regional recurrence after wide local excision and clinical perspectives.

Two hundred and nineteen patients admitted to the Centre Claudius Regaud over a 14-year period for a stage I cutaneous malignant melanoma were retrospectively evaluated for loco-regional recurrence rates, risk factors and survival rates following wide primary excision. Five and 8 year survival rates corrected for deaths owing to concurrent illness were 77% and 73%. The loco-regional control rate was 69% (151/219). Distant metastases occurred in 59% (40/68) of patients who had a loco-regional recurrence, versus 11% (16/151) of patients when loco-regional control was obtained (P < 0.001). Multivariate analysis was used to ascertain which risk factors act independently as predictors of poor loco-regional control. Anatomical location of the primary ('head and neck-trunk-hands and feet' vs 'proximal limb') and thickness formed the best model in this respect among 11 prognostic factors studied. Since loco-regional recurrence may be associated with an increased risk of distant metastatic disease, we advocate the use of elective regional lymph node dissection in stage I patients at high risk of loco-regional recurrence in the hope that a portion of these patients may have increased survival owing to lack of development of widespread metastases.

Actuarial Analysis↗
PubMed1992

[Multiple localization and lymphatic involvement of papillary micro-carcinoma of the thyroid. Results of total thyroidectomy with bilateral lymph node excision. Apropos of 38 patients].

This study involved 38 patients with occult papillary carcinoma of the thyroid gland treated by total thyroidectomy and bilateral prophylactic neck dissection. The histological results show the glandular multicentricity on either side, both in single nodule (65%) and in multinodular goiter (73.3%). High risk of cervical spreading clearly appears in papillary carcinoma (18.4% of the patients) even in these small foci (lower than 10 mm). Topography of involvement brings into prominence two main territories: paratracheal, mid and lower jugularly nodes (involved in 92.8% of the positive dissections).

Adolescent↗
PubMed1992

[The treatment of severe dysplasias by CO2 laser: the respective indications for vaporization and conization. 84 cases].

Fifty-nine conisations and 25 vaporizations were carried out using laser CO2 in order to treat a series of 84 cases of severe dysplasias (CIN III). After a follow-up of 4 and 12 months (median period of observation 25 months) it was found that out of 74 patients that were followed up in this way 72 had benefitted from the use of the treatment. There were 5 cases however of recurrence of dysplasia (1 CIN I, 2 CIN II, 2 CIN III). These had further treatment with laser. Four of those were controlled properly, the fifth had to have surgery. Complications of treatment did not occur when vaporization was used and only rarely when conisation was used. With vaporisation it is not possible to obtain a piece for histological examination, but if it is done according to precise criteria it is safe (7 mm depth at least and vaporisation carried out to 3 mm beyond the lesions). It can be used particularly in young patients who have never been pregnant. If these have been examined carefully with directed biopsies taken colposcopically and where the lesion is strictly limited to the exocervix and the transformation zone has been seen and the lesion is small (2 cm of less), 84% were controlled therapeutically and using Bruhat's criteria the success rate was 96%. Conisation was effective for every one of the other cases. Laser CO2 probably lessens local complications of the procedure and if vaporization is carried out on the rim of the cervix better control of the condition is obtained (98% controlled in the period under review).

Adult↗
PubMed1991

Non-randomized comparative study of irradiation alone or in combination with surgery in stage Ib, IIa and "proximal" IIb carcinoma of the cervix.

252 evaluable patients were treated in the Centre Claudius Regaud from January 1974 to December 1983 for stage Ib, IIa or proximal IIb carcinoma of the uterine cervix. This retrospective analysis compares results obtained either by radio-surgical combination therapy (113 patients = RS group) or by exclusive irradiation (139 patients = RT group). The comparison of the two groups in terms of patient age, obesity, associated vascular pathology and previous abdomino-pelvic surgery favored the RS group significantly. The distribution according to clinical stage also significantly favored the RS group. The proportion of patients with stage IIb disease was 12% in the RS group as opposed to 25% for the RT group. Despite unfavorable patient and tumor characteristics, therapeutic results in the RT group were similar to those of the RS group. Pelvic recurrences developed in 18/110 (16%) and 18/139 (13%) of the patients in the RS and RT groups, respectively. Distant metastases occurred in 5/92 (5%) patients in the RS group and 13/121 (11%) patients in the RT group, but the difference was not significant (p less than 0.1). Five year corrected actuarial disease-free survival was 82% in both groups. There were no major early complications in the RT group while four were found in the RS group, of which three were fatal. 2% of patients had major late complications in the RS group versus 6% in the RT group and none were lethal. 25% of the RT group patients had a moderate or mild complication versus 10% in the RS group but 2/3 of these complications recovered without sequellae.

Carcinoma↗
PubMed1991

Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial.

A prospective clinical trial was designed to evaluate efficacy, toxicity, and patient compliance of concomitant postoperative radiotherapy and Cisplatin infusion in patients with Stage III or IV S.C.C. of the head and neck and histological evidence of extra-capsular spread of tumor in lymph node metastase(s). Cisplatin 50 mg IV with forced hydration was given or not every week (i.e., 7 to 9 cycles) concurrently with radiotherapy. Between 1984 and 1988, 83 patients were randomized: 44 were treated by irradiation without chemotherapy (RT group) and 39 by the combined modality (CM group). There was no significant difference between the two groups in terms of patient characteristics, primary sites, tumor differentiation, T.N. stages, or postoperative prognostic factors. All patients completed the planned radiotherapy. There were seven severe toxicities (greater than grade 3) in the RT group. In the CM group, 30 severe toxicities occurred in 16/39 (41%) patients but none was life-threatening. Seven of 39 (18%) patients received less than two-thirds of the scheduled Cisplatin courses because of intolerance, mainly nausea and vomiting. Preliminary results show a better disease-free survival for the CM group (65% at 24 months) than for the RT group (41% at 24 months). This significant difference is largely due to increased loco-regional control in the CM group (79% vs 59%), the actuarial distant metastasis rates in patients controlled above the clavicles not being statistically different in the two groups.

Carcinoma, Squamous Cell↗
PubMed1989

[Lingual necrosis after radiotherapy. Radiation arteritis?].

Describing a case of tongue necrosis five years after Radiotherapy for a T3N0M0 carcinoma of the tonsil, the authors discuss the principal causes of these necrosis and insist on the potentialisation of the effects of radiotherapy on latent arterial disease.

Arteriosclerosis↗
PubMed1989

[Postoperative external irradiation of epidermoid epitheliomas of the larynx and hypopharynx. Analysis of tumor control factors in and outside of the neck].

The authors present a retrospective analysis of 138 patients with squamous cell carcinoma of the hypopharynx and larynx treated with post-operative irradiation. Overall tumoral control rate within the treated areas was 73.9%, uncorrected actuarial survival rates at 3 years and at 5 years were respectively 49.4 and 37.6%. The clinical status (TNM-UICC, 4th edition, 1987) seems to be the main determinant for the prognosis in terms of cervical tumoral control. Patients with N0-N1 nodal stage presented 14/88 (15.9%) cervical failures, while patients staged as N2-N3 presented 22/50 (44%) tumoral recurrences within the treated areas (P less than 0.001). Pyriform sinus tumors were found to present cervical relapses in 13/32 cases (40.6%). This recurrence rate was significantly higher than cervical failure risk in other tumoral sites (P less than 0.05). Cervical relapse (P less than 0.0001), N2-N3 nodal stage and pyriform sinus localization (P less than 0.05) were all found to increase metastasis rate. On the other hand, our results show that the use of post-operative irradiation reduces the prognostic influence of the primary tumor volume; in the same manner, the use of modulated post-operative external irradiation permits the control of microscopically positive surgical margins. In conclusion, the initial staging alone is sufficient to safely evaluate the risk of cervical relapse or metastatic spread; the use of these clinical parameters for selecting patients who could benefit from adjunctive chemotherapy is discussed.

Adult↗
PubMed1988

Hyperbaric effects on sensorimotor reactivity studied with acoustic startle in the rat.

In three experiments, startle responses to brief intense tone-bursts (30 msec, 110 dB, 6000 Hz) and single pulse (0.1 msec) stimulation of the cochlear nucleus and the nucleus reticularis pontis caudalis are studied under high pressures of heliox (from 0 bar to 50 bars) in the rat. For each rat (N = 12), mean amplitude and latency changes in startle responses (nuchal electromyography and whole-body accelerometry) are compared at normobaric pressure and during compression, at a speed of 100 bar/H. The results indicate that high pressures decrease (50% of control size) tone evoked startle by acting on the peripheral auditory organ, probably through middle and/or inner ear barotrauma. The large increases in electrically-elicited startle (250% of control size) from the cochlear and reticular nuclei, under hyperbaric conditions, suggest that high pressures affect sensorimotor reactivity by excitatory action on synaptic transmission in the relays of the acoustic startle reflex arc at the lower brainstem and spinal levels. Startle latencies remain unaffected by the heliox high pressures studied here.

Acoustic Stimulation↗
PubMed1988

Involvement of serotonin in the enhancement of the rat spinal excitability by high pressures.

Using an electrical stimulation of the reticulospinal tract at the level of the medial longitudinal fasciculus, the effects, and the neurochemical mechanisms of these effects, of a progressive increase in helium-oxygen pressures, up to 50 bar, on the spinal cord excitability in the chronic rat are investigated. In control animals, high pressure exposure over 30 bar was found to increase markedly the electromyogram response evoked in nuchal muscles. This startlelike response was monosynaptically induced by stimulation of the reticulospinal tract. Conversly, no hyperbaric alteration in spinal excitability has been observed in animals pretreated with the classical 5-HT antagonist drug metergoline. These results emphasize the importance of spinal cord as a potential target for mediating hyperbaric effects on sensorimotor behaviors (i.e., motor disturbances of the HPNS). Moreover, our work suggests that serotonin could be implicated in hyperbaric spinal cord hyperexcitability.

Animals↗
PubMed1985

[Second-look laparotomy or the search for curable stage III FIGO ovarian epitheliomas. Apropos of a series of 35 cases].

The authors report their experience in 35 cases of second-look laparotomy performed on 35 patients in the Claudius Regaud Centre. The actuarial survival rate at 3 years of patients who had undergone this surgery has been shown to be 41% as against 13% for all Stage III and IV cases randomly taken in this same period (194 cases). Indications for a second-look laparotomy are generally reserved for patients who have responded to chemotherapy after a mean of 6 treatments unless there in an obvious indication to go in. The reasons for this procedure include the idea of assessing completely the state of affairs and if necessary carrying out a large excision operation, knowing full well that the results will depend mainly on the quality of the first treatment given. Survival after second-look laparotomy depends on the mass of neoplastic tissue that is left behind, its size and its position in the peritoneal cavity or in the lumbo-aortic lymph nodes. This makes it possible to define that privileged group of patients that have a good prognosis. These patients who can be cured are those who have no disease in the peritoneal cavity or in the lymph glands. The combination of different ways of treating residual disease in the peritoneum or behind the peritoneum are derived from decisions made following second-look laparotomy. There is no place for radiotherapy of the abdomen and pelvis when there is residual lymph gland disease.

Actuarial Analysis↗
PubMed1984

[Pectoralis major myocutaneous flap in cervicofacial oncology. Apropos of 61 cases].

Personal experience with the use of musculocutaneous flaps from pectoralis major confirmed classical documented data. These flaps are reliable in use, they allow wide tumoral excision to be performed, and are therefore perfectly adapted for cervicofacial cancer surgery; however, carcinologic results have to be weighed against the operative procedures necessary.

Adult↗
PubMed1983

[Suppurative thyroiditis and epithelioma of the piriform sinus].

The authors report a case of suppurative thyroiditis revealing cancer of the piriform sinus. The course ran two distinct phases. Initially, symptoms resolved under methylprednisolone and ampicillin given with a diagnosis of acute thyroiditis. After corticosteroids were discontinued, a tumefaction in the thyroid area recurred, with clinical features indicating centesis that removed 30 cc of pus ORL examination connected this suppurative thyroiditis to an epithelioma of a piriform sinus.

Aged↗