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Biomedical subjects

M Gignoux

Publications and source records attributed to M Gignoux.

At least 73 records · Page 4Linked to original sources
PubMed1993

Involvement of general practitioners in mass screening. Experience of a colorectal cancer mass screening programme in the Calvados region (France).

Good compliance with screening programmes is essential and experience from ongoing studies points to the importance of involving general practitioners (GPs). The aim of this study was to evaluate factors influencing the participation of GPs in a screening programme, as well as acceptance of the test by the population. Fifty GPs were randomly chosen among the 117 practices of three districts in Calvados (France) where haemoccult test-based mass screening for colorectal cancer was underway. Each GP was asked to fill in a personal questionnaire as well as a detailed record for each patient between 45 and 74 years seen in the practice during a 1-week period. The GPs offered the test to 95% of the patients. The overall refusal rate was 7.8%, and was higher in women than in men (9.9% vs 5.9%; P < 0.05). Manual workers had a lower refusal rate than other occupational groups (2.5% vs 8.5%; P < 0.05). The GP's motivation was an important factor in patient compliance: the refusal rate was 5.4% in the case of highly motivated GPs, against 20.0% when the GP was poorly motivated (P < 0.01). GP motivation was higher in urban than in rural areas (P < 0.05) but did not depend on sex, age or the duration or type of practice. According to the GPs, motivating factors were the perceived need for screening, involvement in planning the campaign, and regular feedback. Conversely, a lack of time and the possibility of false-negative results were the most important impediments. This study demonstrates that patient compliance is closely linked to practitioner motivation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Pseudotumoral hyperplasia of Brunner's glands].

Hyperplasia of Brünner's glands is a dysembryoplastic or hyperplasic lesion with an elective location of the proximal duodenum. Symptoms are often non-specific but severe manifestations can occur (haemorrhage, duodenal obstruction). Two cases of hyperplasia of Brünner's glands were reported due to their particularly large size and a misguiding clinical appearance. Difficulties in diagnosis due to this rare benign entity were discussed.

Adult↗
PubMed1993

[Surgical treatment of supralevator rectocele. Value of transanal excision with automatic stapler and linear suture clips].

A retrospective review of 20 rectoceles performed over a four year period (1988-1991) was carried out. The major indication for repair was constipation and outlet obstruction. All patients were objectively quantified by standardized defecography and functional investigations. All patients were repaired via a trans-anal approach using a linear stapler. Sixteen patients were improved with a mean follow-up of 21.8 months.

Adult↗
PubMed1993

[Cancer of the gallbladder. Epidemiology, diagnosis and prognostic factors].

Between 1978 and 1986, 77 cases of primary gallbladder carcinoma were recorded in the Calvados Digestive tumors Registry (covering a population of 589,559 inhabitants) among 125 extra-hepatic bile duct carcinomas. The crude incidence was 2.4/100,000 in females and 0.6 in males (sex-ratio = 3.8). Cholelithiasis was demonstrated in 81.3%. Gallbladder carcinoma was diagnosed correctly preoperatively in only 13.5%. Out of the 74 operated patients, there were only 6 mucosal or sub-mucosal carcinomas and liver involvement was present in 40%. Diagnosis was made post-operatively on the resected specimen in 13 patients (non reoperated) Operative mortality was 24%. The overall survival was 14.7% at one year, 4% at 5 years (median = 3 months). In multivariate analysis the prognostic factors were: curative resection (9 patients, 3-year survival: 55%), parietal extension, liver involvement. No significant trend in prognosis could be demonstrated during the study period.

Actuarial Analysis↗
PubMed1992

[Surgical treatment of inguinal hernia in short-term hospitalization. Prospective survey of 500 consecutive unselected cases. Associations Francaises de Recherche en Chirurgie].

Individual medical and social factors associated with the acceptance and success of short stay surgery for unilateral, uncomplicated inguinal hernia were looked for in 500 consecutive unselected patients. The mean duration of postoperative hospital stay was 3.4 days. Sixty percent of the patients were discharged within the first 48 hours following surgery, including 10 percent who left the hospital in the evening of the operation day. Twenty-two percent of the patients who could have left during these 48 hours refused to do so. The most predictive variable for acceptance and success was a profession requiring little physical activity. Local anaesthesia has been associated with success in the so-called ambulatory surgery, but the methodology of the present study did not permit to establish a cause-effect relationship.

Aged↗
PubMed1992

Influence of rural environment on diagnosis, treatment, and prognosis of colorectal cancer.

STUDY OBJECTIVE: Several studies have shown that residential location (urban or rural) influences the incidence of colorectal cancer. The aim was to investigate the influence of rural environment on colorectal cancer history and survival in a well defined population. DESIGN: Patients with colorectal cancer diagnosed in the department of Calvados (France) were classified by place of residence (urban/rural) and information on clinical symptoms, tumour extension, treatment, and survival was collected. SETTING: The study was population based, in the department of Calvados in France. PATIENTS: During 1978-1984, 1445 colorectal cancers were collected by the Digestive Tract Cancer Registry of Calvados, 1047 with an urban place of residence (544 males and 503 females) and 284 with a rural place of residence (134 males and 150 females). MEASUREMENTS AND MAIN RESULTS: In both sexes, rural patients with colorectal cancers were treated less frequently in a specialised health care centre (40.0%) than patients from an urban population (53.4%). The difference was mainly but not entirely explained by distance from the specialised health care centre. In females in the rural population, cancers were diagnosed more frequently at the stage of severe clinical symptoms (22.1%) and metastases (18.8%) than they were in the urban population (15.5% and 12.3%). In addition among females a rural environment appeared to confer a worse prognosis (relative risk = 1.3). CONCLUSIONS: Our findings suggest an inequality between rural and urban populations, especially for women. The loneliness of rural women leads to a delay in diagnosis and worse survival. In health education campaigns on colorectal cancer, efforts must be made to provide medical information to rural women in order to reduce the delay in diagnosis and improve survival.

Age Factors↗
PubMed1992

[Ileovaginal fistula after ileo-anal anastomosis. Recovery by transposition of the gracilis muscle. Good anatomical and functional result].

One women developed a pouch-vaginal fistula after reconstructive proctocolectomy for ulcerative colitis. This study describes the risk factors which predispose to the development of this rare complication, as well as the various treatment options available. A diverting ileostomy was maintained and gracilis muscle interposition flap was used to treat the patient. An excellent result was achieved. This procedure can be useful in this rare but distressing complication.

Adult↗
PubMed1992

[Assessment of the practice of adjuvant radiotherapy in cancer of the rectum in the department of Calvados].

The effectiveness of adjuvant radiotherapy (ART) in the treatment of rectal cancer (RC) is established for the local control of the tumor, but doubt remains as concerns improvement in survival. The aim of this work was to assess the present techniques and trends of ART in a French department based on a population-based study. From 1978 to 1986, 616 cases of RC were diagnosed in the department of Calvados (France). Tumor was removed in 346 patients (56 percent). Of these 346 cases, 29 percent were irradiated, 3/4 postoperatively and one forth preoperatively. Besides sex and age, the type of surgery (anal sphincter saving or not) and Dukes' tumor stade had an influence on the performance of ART. Thirty-one percent Dukes B tumors and 42.1 percent of Dukes C tumors were irradiated. The practice of ART for these tumors increased significantly from 1978 (18.5 percent) to 1986 (60 percent) (P less than 10(-4)). However, the practice and the distribution of centers performing ART were heterogenous within the department of Calvados. This heterogeneity was neither due to the environment (urban/rural) of the patient nor to the distance between the place of residence and the radiation therapy center. Such an heterogeneity could be explained only by the lack of consensus concerning the practice of ART. Such a consensus could be found considering the results of the latest controlled clinical trials, but definitive conclusions are needed about the effectiveness of ART on the improvement of survival.

Adenocarcinoma↗
PubMed1992

[Adenocarcinoma on endobrachyesophagus. Results and prognostic factors apropos of 19 cases surgically-treated].

The authors report about a retrospective series of 19 operated patients with adenocarcinomas in a columnar lined esophagus. The resection rate was 95%, the postoperative mortality rate was 5.5%. The survival rate following curative exeresis (n = 14) was 32% (+/- 14) at 5 years. All patients with a stage III lesion died after 2 years, while 46% (+/- 19) of those with stage I or II tumors (p less than 0.001) survived at 5 years. In a multivariative analysis, the most important prognostic factor is the histological grade (p less than 0.01), then the extension to the lymph nodes (p less than 0.1). As the adenocarcinoma often reveals the columnar lined esophagus, the improvement of the prognosis certainly depends on the evaluation of the treatment, which combines pre- or postoperative radiation and chemotherapy, in multidepartmental prospective studies.

Adenocarcinoma↗
PubMed1992

[Ileo-vaginal fistula after ileoanal anastomosis. Recovery by transposition of the gracilis muscle. Satisfactory anatomical and functional result].

One woman developed a pouch-vaginal fistula after reconstructive proctocolectomy for ulcerative colitis. This study describes the risk factors which predispose to the development of this rare complication, as well as the various treatment options available. A diverting ileostomy was maintained and gracilis muscle interposition flap was used to treat the patient. An excellent result was achieved. This procedure can be useful in this rare but distressing complication.

Adult↗
PubMed1992

[Subcardial stomach diverticulum and gastroesophageal reflux].

Gastric diverticulum is a rare disease, often benign and specifically located in the right paracardial region. The authors report a case of left paracardial diverticulum with gastro-oesophageal reflux. This association should be treated surgically with resection of the diverticulum, after failure of medical treatment.

Barium Sulfate↗
PubMed1991

[Spontaneous and instrumental perforations of the thoracic esophagus (non-neoplastic, non-caustic). Apropos of 20 cases].

The authors present twenty cases of spontaneous or instrumental perforation of the thoracic esophagus (neoplastic and caustic perforations excluded). The delay before treatment was less than 24 hours in only one case. Mortality rate was 15%, concerning three patients (three cases of Boerhaave's syndrome) treated by T tube drainage. The contribution of exclusion using stapling technique should increase the indications of direct suture, which remains elective treatment. Esophagectomy retains its indications for perforations with pathologic esophagus or late diagnosis.

Adult↗
PubMed1991

[Study of the diffusion of therapeutic progress in a morbidity register. Exemplified by rectal cancer in Calvados].

Recent treatment trends have been studied among 614 rectal cancer cases collected in the Digestive Tract Cancer Registry in the "Département" of Calvados between 1978 and 1986. Of the 343 cases in which the tumour was resected, the sphincter was preserved in 32% of the cases (SP), and 30% had adjuvant radiotherapy (ART). The frequency of sphincter preservation (SP) and ART increased significantly during the study period. For both SP and ART, generalized use was less frequent and implemented later in unspecialized health care centres, even after adjustment for confounding. SP was more widely used in females and younger patients. Starting in 1984, the generalized use of ART - especially in pre-operative therapy - developed considerably, particularly for males and younger patients. Distance from the radiotherapy centre did not influence the radiotherapy rate. The use of morbidity registry data in assessing health care practices gives us a more precise view than hospital series, and provides information that can be extremely useful for formulating future guidelines for health care planning.

Aged↗
PubMed1989

Palliative therapy of inoperable oesophageal carcinoma with radiotherapy and methotrexate: final results of a controlled clinical trial.

Between May 1976 and January 1982, 170 patients were entered in a randomized study comparing a combined treatment consisting of methotrexate followed by irradiation versus radiotherapy alone in patients with non metastatic inoperable oesophageal cancer. Methotrexate was administered subcutaneously in 4 days to a total dose of 24 mg/m2. Radiotherapy was performed, in both groups, at a dose of 56.25 Gy in 25 fractions (5 weeks). The administration of methotrexate did not lead to an increased intolerance to radiotherapy but severe hematological toxicities were observed in 7.8% of the cases. No difference in the duration of survival was detected. Initial performance status of the patients and their weight loss prior to entry on trial were the factors that were most predictive of the patient's prognosis.

Adult↗
PubMed1989

[Importance of the definition of urban zones in the study of cancer risk factors].

1446 cases of colorectal cancer have been collected in the Registry of digestive tract tumours in the "Department" of Calvados with the aim of studying the effect of residential location on cancer incidence. The risk-ratio was different in males and in females and between different types of urban areas. Using the urban category of "Zone de Peuplement Industriel ou Urbain" (ZPIU) increased the observed risk-ratio (1.6 for males, 1.2 for females), and enabled definition of homogeneous populations. This improved classification, thus allowed a more discriminating analysis of the effect of residential location on risk of cancer in both sexes.

Colorectal Neoplasms↗