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Biomedical subjects

M Henry-Amar

Publications and source records attributed to M Henry-Amar.

140 records · Page 8Linked to original sources

[Prevalence of diabetes in a random sample from the gouvernorat of Tunis (author's transl)].

Prevalence of diabetes was estimated on the basis of both interviewing the subjects and measuring fasting blood glucose among a one per cent random sample from the population of the Gouvernorat of Tunis. Sampling was done using the household as unit and three stages of randomization. The number of households investigated was 1 449, a total of 9 712 subjects. In this sample, including 45% of males, mean age is equal to 24.8 years in males and 26.0 in females. Globally, prevalence is equal to 2.3%, half-composed of previously known diabetics. In more than 50% of them, the disease was revealed by cardinal symptoms and 17% are insulin-treated. The frequency of the disease, already known or newly diagnosed, is steadily lower than 1% in the first classes of age and then distinctly increases from thirty years of age in males and forty in females, reaching a value close to 10% after sixty years.

Adolescent↗

[Genetic factors in the etiology of breast cancer (author's transl)].

A review of literature shows that, at present, genetic factors are difficult to distinguish from environmental factors. A number of studies have put into light relationships between factors tranmetted genetically and an increased risk of breast cancer in some women. This might be a reflect of the transmission of a certain susceptibility. However, one of these factors alone cannot explain the increase of the risk. Most likely, as for many types of cancers, the development of breast cancer is due both to a multigenic transmission of a certain susceptibility and to the action of environmental factors. Though, epidemiological studies make possible to identify a high risk population. A regular follow-up of this population would permit early diagnosis and possibly prophylactic measures concerning the known environmental factors, and in particular hormonal factors.

Adult↗

The prognostic significance of large mediastinal masses in the treatment of Hodgkin's disease. The experience of the Institut Gustave-Roussy.

At the Institut Gustave-Roussy we undertook a study of 154 patients with clinical stages I and II Hodgkin's disease treated by irradiation to evaluate the prognostic significance of the mediastinal mass size. The population under study included those patients treated at our institute and entered into the H2 and H5 E.O.R.T.C. trials between 1972 and 1981. Patients were divided into three groups for purposes of analysis; large mediastinal masses (MT ratio greater than or equal to 0.35) were noted in 20 cases (13 per cent), moderate mediastinal invasion (MT ratio less than 0.35) was observed in 60 cases (39 per cent), and 74 patients (48 per cent) had no mediastinal involvement on presentation. Intrathoracic relapses were more frequent in those patients with mediastinal involvement at presentation (p less than 0.001) but there was no statistically significant difference between those patients with 'large' masses and patients with 'small' masses. Additionally multivariate analyses showed that neither the presence nor the size of mediastinal disease adversely affected relapse free survival or overall survival. These results can perhaps be linked to the technique of radiotherapy where a 'split course' technique was habitually used for large masses and the radiation fields were routinely modified during treatment according to the tumour response. Consequently we do not advocate the routine use of extensive primary treatment such as combined modality therapy utilizing MOPP chemotherapy for all patients presenting with bulky mediastinal masses. Rather chemotherapy should be reserved for those tumours which are particularly voluminous (MT ratio greater than 0.50) where primary radiotherapy may potentially result in unsatisfactory late pulmonary complications. We also advise the use of combined modality therapy for those patients who may additionally have certain unfavourable prognostic factors which we have previously identified.

Adolescent↗

[the role of radiotherapy for limited stage Hodgkin's disease in 1999: limitations and perspectives].

The role of radiotherapy in limited stage Hodgkin's disease (HD) has been gradually changing in the past few decades, resulting in the almost complete disappearance of exclusive irradiation treatment. In reality, exclusive radiotherapy yielded satisfactory results in terms of long-term survival, but in 1999 it was becoming impossible not to take into account the late mortality rates observed in all large cohorts of HD patients. This increased mortality rate has been shown to be related to 1) cardiac toxicity of irradiation, and 2) secondary radiation-induced solid tumors. Thus, the search for efficient but less toxic new strategies can no longer be avoided. For clinically staged, limited HD, precisely defined according to specific prognostic factors, the association of chemotherapy and radiotherapy appears more and more as a standard, and with this therapeutic burden comes parallel efforts for its alleviation. The Previous Radiotherapy experience has shown that, after a chemotherapy-induced complete remission, irradiation of only the initially involved areas was enough. Ongoing trials are now exploring the possibility of a dose de-escalation, from the conventional 36 Gy to 20 Gy (as for children HD), and to maybe 0 Gy (no radiotherapy at all). In parallel, deescalation in the number of chemotherapy cycles is also being investigated. For unfavorable cases, the problem is slightly different, as a higher percentage of cases still appears to be refractory to treatment in this subgroup. Thus, while chemo-radiotherapy has clearly became the standard strategy, efforts are essentially being devoted to identify new--and hopefully more efficient--chemotherapy schemes. In Europe, most of these pending questions will be addressed in the recently initiated trials of the EORTC/GELA and of the GHSG (German Hodgkin Study Group), with the aim of offering to patients treatment which could be at least as efficient as the present schedules, and less toxic in the long term.

Cardiovascular System↗

Current trend in the treatment of Hodgkin's disease.

The analysis of three subsequent randomized trials carried out within the frame of the European Organization for Research on Cancer (E.O.R.T.C.) enables to define a strategy for the staging and the treatment of early stages of Hodgkin's disease. Several prognostic factors were identified by multivariate analyses: 1) erythrocyte sedimentation rate, which has a greater impact on relapse-free survival than systemic symptoms but which can be combined with them; the combination of the two is a more powerful prognostic indicator than ESR alone; 2) the number of involved lymphatic areas: patients with one or two lymphatic areas involved (CS I and II2) have a better outcome than stage II patients with 3 or more areas involved (CS II3). Patients with favorable prognostic indicators are submitted to staging laparotomy because for them spleen involvement has a pejorative impact. For patients with unfavorable indicators, the spleen involvement has little prognostic significance and therefore those patients who need, anyway, an aggressive treatment do not undergo staging laparotomy. Patients with favorable prognostic indicators and negative staging laparotomy can be treated by radiotherapy alone, patients with positive laparotomy or patients with unfavorable prognostic indicators are treated by combination of multiple chemotherapy and radiotherapy.

Antineoplastic Combined Chemotherapy Protocols↗