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Biomedical subjects

M Julien

Publications and source records attributed to M Julien.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Postoperative pyoderma gangrenosum and cancer of the breast. Apropos of a case].

Pyoderma gangrenosum (PG) consists of extensive necrotic ulceration with bluish and purplish red margins. This disease is often associated with ulcerative colitis, systemic, hematologic or rheumatic diseases. However post-surgical idiopathic PG can occur. One post-mastectomy case is reported. PG can first be suspected on clinical appearance and the lack of a specific etiology. PG is a diagnosis of exclusion that is made only after other possibilities have been ruled out. The treatment is surgical excision and systemic corticosteroids.

Adult↗
PubMed1989

[A new conservative approach in the treatment of cancer of the rectum].

Between 1980 and 1987, 25 patients with cancer of the middle or lower rectum were treated with preoperative radiotherapy (35 Gy over 3 weeks) followed, a few weeks later, by "tumorectomy". During surgery, a guiding tube was positioned on the tumoral bed for a localized overdose of curietherapy. The superimpression was 20 Gy for submucosal lesions (7 patients) and 25 Gy for lesions that had invaded the muscle coat (8 cases) or reached the serous coat (10 cases). During a mean follow-up period of 40.5 months, there were 5 recurrences and they all appeared before 18 months had elapsed since the end of treatment. Two of these 5 patients are alive and without metastasis 1 year after a secondary abdominoperineal rectal amputation. The 20 patients who showed no recurrence have normal sphincter function and 19 of them are now alive without evidence of malignancy. In cancer of the middle or lower rectum this conservative approach seems to be suitable for patients who cannot benefit from radical surgery or refuse abdominoperineal rectal amputation.

Adult↗
PubMed1989

Acute mononeuropathy with angiotropic lymphoma.

Angiotropic lymphoma can present as a vascular disease in the central nervous system. The patient described in this report had a sudden pain in the region of the right superficial peroneal nerve and a nerve biopsy showed tumoral cells in the lumen of most small blood vessels. This pathology, first described in the skin as malignant angioendotheliomatosis, can be compared with the occurrence of multiple emboli in the vasa nervorum. In recent cases, tumoral markers have evidenced a lymphomatous origin, generally of the B type.

Acute Disease↗
PubMed1989

Factors affecting the birth and death of mutual-help groups: the role of national affiliation, professional involvement, and member focal problem.

Examined the predictive relationship of three variables to the birth and death of mutual-help groups for a statewide New Jersey sample of 3,152 groups over a 2-year period. The three variables studied were group affiliation with a national mutual-help organization, local professional involvement in group activities, and group members' type of focal problem. Log-linear logit analysis revealed that the best-fitting model included Affiliation Status x Professional Involvement, and Affiliation Status x Focal Problem interactions. Among unaffiliated groups, professional involvement was related to lower group mortality, while among affiliated groups it was related to higher group mortality. Unaffiliated behavior control groups had higher odds for mortality and for birth than either unaffiliated life stress groups or unaffiliated medical groups. Among main effect findings, unaffiliated groups had consistently higher odds for birth than affiliated groups. The implications for research and action are discussed.

Humans↗
PubMed1989

A new combined approach in the conservative management of rectal cancer.

Between 1980 and 1987, 25 patients with rectal cancer were treated with a combination of preoperative external irradiation of 35 Gy in 15 fractions over 3 weeks which was followed, 6 to 8 weeks later, by a tumorectomy and peroperative placement of a plastic tube loop for post-operative interstitial therapy by iridium-192. This boost dose was 20 Gy (Paris System) for submucosal lesions (seven patients) and 25 Gy for intramural (eight patients) and extramural (ten patients) lesions. With a mean follow-up of 40.5 months, there have been five local recurrences, the latest occurring 16 months post-tumorectomy. Two of these five patients are alive and disease-free 1 year post salvage abdominoperineal resection. The 20 patients with local control have preserved a full functional sphincter and 19 of them are disease-free; there were few complications. This sphincter preserving combined approach seems promising for patients with tumors of the middle and lower rectum who cannot undergo major surgery and for selected patients who refuse abdominoperineal resection.

Adenocarcinoma↗
PubMed1989

[Extracorporeal lithotripsy in the treatment of biliary calculi].

The authors present their experience from February 1988 with biliary lithotripsy in 125 patients. They review the protocol inclusion criteria and the various forms of complementary medical treatment. From this group, 30% of the patients underwent cholecystectomy, 45% received medical treatment and only 25% did not eventually require complementary medical therapy.

Cholelithiasis↗
PubMed1989

[Splenectomy in hematologic diseases. Indications, technics and early results. A retrospective study of 1095 cases].

Since July 1st, 1958, we have operated 1095 patients with some hematological disease. We review the chief currently accepted surgical indications for splenectomy (Hodgkin's disease no longer being one of them, or seldom so), and we communicate our results pertaining to the immediate postsurgical period. Mortality and morbidity have been 1.36% and 3.28%, respectively. In over 95% of cases, there have been no complications. The low incidence (1.36%) of infection-related complications was partly due to the important number of splenic drains placed. High quality results can only be achieved when tight collaboration exists between hematologists, radiologists and surgeons.

Drainage↗
PubMed1989

[Postoperative pyoderma gangrenosum and cancer of the breast. Apropos of a case].

Pyoderma gangrenosum (PG) is a extending necrotic ulceration with bluish and purplish red margins. This disease is often associated with ulcerative colitis, systemic, hematologic or rheumatic affections. However post-surgical idiopathic PG can occur. One post-mammectomy case is reported. PG can first be suspected on clinical aspect, lack of a specific etiology. PG is a diagnosis of exclusion that is made only after others possibilities are ruled out. The treatment is surgical excision and general corticotherapy.

Adult↗
PubMed1989

[Intubation of proximal biliary stenoses using a new surgical endoprosthesis].

Thirty patients with high biliary tract strictures were treated by a new surgical endoprosthesis, the tolerance of which has been tested experimentally. It is flexible, radiopaque and incompressible with spurs which prevent migration. Following choledochotomy, the endoprosthesis is positioned surgically above the sphincter of Oddi, thereby avoiding ascending cholangitis. Twenty-nine cases presented with neoplastic compression by an inoperable cancer and one case had an early postoperative stricture with loss of substance after right hepatectomy for hepatic metastases. The 29 cancers included 13 gallbladder cancers, 11 cholangiocarcinomas, 10 of which were hilar, and 5 metastatic compressions due to gastrointestinal adenocarcinomas. In three cases, there was loss of substance of biliary tract after intubation. The operative mortality was 3.3% (one pulmonary complication). Resolution of jaundice was obtained in all but 2 cases and pruritus always resolved. The mean survival of the patients with cholangiocarcinoma was 12.2 months while that of patients with gallbladder cancer was 6.33 months with indices of satisfaction, calculated by Bismuth's method, varying between 71% (gallbladder cancer) and 93.5% (hilar cholangiocarcinoma). The patient operated for benign stricture secondary to a hepatectomy scar for metastases died from lung metastases without jaundice after 48 months. The only late complications were 2 cases of cholangitis treated medically, one of which was due to obstruction of the endoprosthesis at the 13th month. The authors conclude that this new type of surgical endoprosthesis constitutes an alternative in the palliative treatment of neoplastic hilar compressions.

Cholestasis↗
PubMed1988

[Can the indications of conservative radiosurgical combination in the treatment of breast cancer be extended?].

In the hope that women with breast cancer unsuitable for primary tumorectomy would benefit from a conservative treatment, we tried to reduce the lesional volume by an initial irradiation of 45 Gy administered in 25 fractions over 35 days. This treatment was applied to 111 patients (69 T2; 42 T3). In 44 cases (40 per cent), tumoral regression enabled a secondary tumorectomy to be performed. In 16 cases (14 per cent), the tumour totally disappeared, and an additional irradiation by endocurietherapy in intermediate dosage could be given. In 51 patients (46 per cent), the tumoral response was poor and the patients underwent, depending on their wishes, either mammectomy (9 cases; 8 per cent) or high-dose endocurietherapy (42 cases; 38 per cent). Analysis of tumoral regression according to size, histological type and mammographic image provided for a better identification of good responders. The cosmetic and oncological results of this preliminary study are satisfactory, with a 95 per cent local control at 5 years after secondary tumorectomy.

Adenocarcinoma↗
PubMed1988

Treatment of inflammatory breast cancer with combination chemotherapy and mastectomy versus breast conservation.

Twenty-six consecutive patients with nonmetastatic inflammatory breast cancer (IBC), were treated in a single institution using the same protocol, and all were followed for at least 48 months. The first phase of treatment consisted of two monthly cycles of combination chemotherapy with Adriamycin (Adria Laboratories, Columbus, OH), vincristine, cyclophosphamide and 5-fluorouracil. Local treatment was then undertaken using in all cases a cobalt 60 beam to deliver 45 Gy to the entire mammary gland and lymph-draining areas. Local treatment was completed either by mastectomy, or by conservation of the breast and interstitial irradiation of the primary tumor site. Chemotherapy was resumed after completion of local treatment for a total of 6 cycles. Metastatic disease occurred in 19 of 26 patients from 8 to 55 months; five patients are alive and free of disease from 48 to 81 months. Failure to control local disease or local recurrences was noted in two of ten patients undergoing mastectomy, and in seven of 13 patients with conservation of the breast. While this difference is not statistically significant we concluded that methods of breast conservation which limit the high dose volume to the tumor site do not assure local control in IBC. The median disease-free survival and overall survival of 12 and 31 months, respectively, are not satisfactory. Better systemic treatment is needed.

Adult↗
PubMed1987

Mortality and morbidity related to severe intrapulmonary shunting in multiple trauma patients.

Of 210 multiple trauma patients admitted to our Intensive Care Unit (ICU), 12 (5%) presented with severe hypoxemic respiratory failure needing mechanical ventilation with an FIO2 of 1.0 because of severe intrapulmonary shunting (IS). Five (42%) of these patients survived and two (17%) died because of their underlying respiratory failure. We found a mean of three etiologic factors in each patient to account for their IS. Nonsurvivors had a lower cardiac index than survivors when they first needed FIO2 of 1.0 and ARDS was more frequent among this group. All patients who survived were in severe hypoxemic respiratory failure in the first 5 days post-trauma; all patients who needed FIO2 of 1.0 later than 5 days post-trauma died. Data collected for patients with similar degree of respiratory failure in coronary care ICU (n = 18), in medical ICU (n = 19), and surgical ICU (n = 21) demonstrated that multiple trauma patients with severe hypoxemic respiratory failure were younger and were hospitalized and ventilated for longer periods of time. In multiple trauma patients, as for patients with cardiogenic pulmonary edema, death was seldom related to respiratory failure itself. We concluded that severe hypoxemic respiratory failure in trauma patients is usually of mixed etiologies. It is a serious cause of morbidity in these patients; however, mortality is seldom directly related to this condition. Severe IS occurring shortly after trauma is of better prognosis than late IS.

Adult↗