Search PubMed⌕ Search

Biomedical subjects

P Cornu

Publications and source records attributed to P Cornu.

At least 55 records · Page 3Linked to original sources
PubMed1999

Treatment of malignant gliomas in the elderly.

The benefit of standard treatment of malignant glioma in older patients is debated. In order to assess the effect of a combination of surgery, radiotherapy and chemotherapy on survival of elderly patients with high grade gliomas, 30 consecutive patients older than 70 years with malignant supratentorial gliomas were studied between 9/93 and 9/96. Median age was 73 years (70-79). The mean Karnofsky performance status (KPS) was 66 (30-100). Patients underwent maximum possible surgery, followed by a course of radiotherapy (45 Gy/25 fractions/5 weeks) with 3 or 4 orthogonal beams and a 2 cm margin around the tumor bed. The administration of chemotherapy was left at the discretion of the responsible physician and 12 patients received reduced dose nitrosourea-based chemotherapy. The overall median survival was 36 weeks. The median time to progression was 26 weeks. Three months after surgery, 26 patients were alive, 5 were in complete response, 2 in partial response and 10 were stabilized. Preradiotherapy KPS was the only significant prognostic factor with a median survival of 40 weeks in patients with KPS > or = 70 and 25 weeks when KPS was < 70 (logrank test, p = 0.05). In responding and stable patients (57% of the group) the median KPS was 68 and 66 at 1 and 3 months after the completion of radiotherapy. There was no case of radiotherapy-induced dementia with this regimen. Four out of 12 patients who received chemotherapy, experienced WHO grade 3/4 hematotoxicity. This study suggest that some patients older than 70 years with KPS > or = 70 may benefit from the treatment of malignant gliomas with surgery followed by reduced dose of limited field radiotherapy. Further studies are needed to define the most appropriate dose of radiotherapy and to evaluate further the risk/benefit ratio of a reduced dose chemotherapy in this population.

Aged↗
PubMed1999

Treatment of supratentorial glioblastoma multiforme with radiotherapy and a combination of BCNU and tamoxifen: a phase II study.

From May 1990 to November 1994, 70 consecutive patients suffering from glioblastoma multiforme were treated following surgery with conventional radiotherapy and adjuvant IV BCNU administered alone or in combination with tamoxifen. Twenty-five patients received BCNU alone (control group A) while 24 patients also received 40 mg of tamoxifen (TMX) PO daily (group B) and 21 received 100 mg of TMX PO daily (group C). There were no significant differences between the 3 groups concerning age, type of resection and median post-operative Karnofsky performance status (KPS). Blood toxicity over grade II occurred in 33.5% of patients receiving TMX versus 12% of patients treated with BCNU alone (p < 0.05). Deep venous thrombosis complications were observed in 4 patients of each TMX group, whereas they were not observed in the control group (p < 0.04). Median time to tumor progression (MTTP) was 35 weeks in the control group and 27 weeks in both TMX groups B and C. Median survival time (MST) was 56, 66 and 51 weeks, respectively. These results suggest that the addition of TMX to standard treatment of glioblastomas does not affect the time to tumor progression and overall survival but may increase the risk of deep venous thrombosis or nitrosourea-induced blood toxicity.

Adult↗
PubMed1999

Treatment of meningeal gliomatosis.

To evaluate whether vigorous treatment is beneficial for patients with meningeal gliomatosis (MG) we reviewed the case records of 20 consecutive patients treated for a symptomatic MG in our center. All received systemic or intrathecal chemotherapy and six received additional cranial or spinal radiotherapy. Six patients (30%) achieved a partial response (one low-grade astrocytoma, two anaplastic astrocytomas, one anaplastic oligodendroglioma and two glioblastomas). In these cases, clinical improvement was associated with radiological improvement on CT scan or MRI in five and with a major cerebrospinal fluid improvement in three. Three patients (15%) were stable for 3 months or more and 11 (55%) had progressive disease. Median survival was longer for the responding patients (10 months) than for the other patients (2 months). This study suggests that some patients with MG may benefit from a treatment combining radiotherapy to symptomatic areas and chemotherapy with agents that cross the blood-brain barrier or are delivered directly into the CSF.

Adult↗
PubMed1998

[Castleman disease: 2 unusual cases].

Castleman's disease is a localized, rare and benign hyperplasia of the lymph nodes, occurring mainly in the mediastinum. Three histologic types--hyalinvascular, plasmacellular and intermediate--have been recognized. We report on two patients with unusual locations of the disease, i.e. the pelvis and the retroperitoneum respectively. These observations show that diagnosis is difficult. They also indicate that, in selected patients, radiotherapy may induce tumor regression and allow the resection of apparently inoperable lesions.

Adult↗
PubMed1998

Analysis of the p21 gene in gliomas.

The p21 gene encodes a cyclin dependent kinase inhibitor protein (p21) which has a tumor suppressive activity in a variety of tumor cell lines. Since, the p21 gene is up-regulated by the p53 tumor suppressor gene, which is frequently mutated in gliomas, acting therefore in the same control pathway, it constitutes a good candidate gene to be also inactivated in these tumors. To test this hypothesis, DNAs from 81 gliomas (48 glioblastomas, 11 anaplastic astrocytomas, 10 low-grade astrocytomas, 12 oligodendrogliomas and mixed gliomas), were investigated for mutations in the p21 coding sequence by denaturant gradient gel electrophoresis followed by sequencing. All these tumors have been previously screened for p53 mutations. Three different DNA variants were identified on codon 31 (17 cases), 27 (1 case) and 117 (1 case) and shown to be also present in matching constitutional DNA, suggesting they were polymorphisms. None of the tumors demonstrated a somatic mutation. No significant correlation between the presence of a p21 variant and the p53 mutation tumor status was observed. In conclusion, mutation in the p21 gene unlikely contributes to the development of gliomas.

Alleles↗
PubMed1998

Are enemas given before abdominal operations useful? A prospective randomised trail.

OBJECTIVE: To assess the effect of preoperative enemas on the recovery of peristalsis after non-colonic abdominal operations. DESIGN: Prospective randomised trail. SETTING: University hospital, Switzerland. SUBJECTS: 116 adult patients (> 16 year old) about to undergo elective non-colonic abdominal operations under general anaesthaesia were considered. INTERVENTION: Two groups were randomised to receive a one litre water and glycerine enema the day before operation (n = 53) or no preoperative intestinal preparation (n = 53). MAIN OUTCOME MEASURES: Return of peristalsis after operation, assessed by auscultation of bowel sounds and time of the first spontaneous faeces. All participants were followed daily for 10 days or until discharge by the same observer. RESULTS: 110 patients gave informed consent, 6 refused to participate, and 4 had to be withdrawn after randomisation, leaving 106 for analysis. The patients without an enema recovered bowel sounds activity sooner (p = 0.02) and passed their first spontaneous faeces significantly earlier (p = 0.01). No subgroup of patients benefited from an enema. CONCLUSION: Preoperative enemas delay rather than improve the return of normal peristalsis after surgery. We recommend this practice should be abandoned.

Abdomen↗
PubMed1998

A case of epidermoid cyst arising from the rostral neuropore: case report.

OBJECTIVE AND IMPORTANCE: Supratentorial epidermoid cysts located on the midline are very rare. We describe the first case of such a cyst arising from the rostral neuropore. CLINICAL PRESENTATION AND INTERVENTION: We report a patient suffering from seizures and progressive frontal syndrome and presenting with a huge cyst developed in the midline at the rostralmost part of the corpus callosum. The patient was operated on, and the cyst was found to be epidermoid. CONCLUSION: Only six cases of supracallosal epidermoid cysts have been reported. In our case, the involved region was located at the exact limit between lamina terminalis and corpus callosum. This region corresponds to the place of the closing rostral neuropore during embryogenesis. We thus propose that the cyst arises from the rostral neuropore and that its eventual deep location is explained by the complex morphogenetic movements affecting the dorsal region of the telencephalic vesicle.

Brain Diseases↗
PubMed1997

High-intensity lesion on T1-weighted MR images in neurofibromatosis type 1: a case of premalignant lesion.

We report a patient with NF1, who was followed up because of an optic glioma and one enhancing lesion presumed to be a pilocytic astrocytoma. T1- and T2-weighted MR images showed also a hyperintense periventricular lesion with no enhancement and no mass effect, of an unsuspected nature. Three years later a glioblastoma multiforme developed at the site of this preceding lesion.

Adult↗
PubMed1997

Amoxycillin/clavulanic acid prophylaxis in elective colorectal surgery: a prospective randomized trial.

In a randomized trial of 440 patients undergoing elective colorectal surgery, the prophylactic efficacy and the safety of amoxycillin/clavulanic acid were compared with that of a control regimen of clindamycin and gentamicin. Surgical wound healing was assessed by the ASEPSIS points scale; it was normal in 86% of patients and the scores for both groups were not statistically different (amoxycillin/clavulanic acid: 11.1; clindamycin + gentamicin: 10.9). Intra-abdominal infections were more frequent in the clindamycin + gentamicin arm of the study (Fisher's exact test, P = 0.035). It is concluded that amoxycillin/clavulanic acid is as effective and safe as clindamycin + gentamicin in the prevention of wound infection and may provide better protection against intra-abdominal infections.

Adolescent↗
PubMed1997

Pallidal stimulation for Parkinson's disease. Two targets?

There has been renewed interest in functional surgery as treatment for Parkinson's disease (PD). Although pallidotomy and chronic pallidal stimulation are highly effective in suppressing levodopa-induced dyskinesia (LID), both methods also seem to be effective in reducing parkinsonian disability. However, the simultaneous improvement of LID and motor signs is hard to explain with the classic model of basal ganglia circuitry. Taking advantage of the fact that deep brain stimulation is reversible and that implanted electrodes contain four discrete stimulation sites, we investigated the effect of stimulation on different sites of the globus pallidus (GP) in five PD patients. Stimulation in the dorsal GP (upper contact) significantly improved gait, akinesia, and rigidity and could induce dyskinesia when patients were in the "off" state. In contrast, stimulation in the posteroventral GP (lower contact) significantly worsened gait and akinesia, although the reduction in rigidity remained. For patients in the "on" state, stimulation in the posteroventral GP dramatically reduced LID but, as in the "off" state, worsened gait and akinesia, thus canceling out the antiparkinsonian effect of levodopa. Our results indicate that stimulation had a striking different effect on parkinsonism and dyskinesia when applied at two different loci of the GP and that stimulation applied in the posteroventral GP produced opposite effects on rigidity and on akinesia. We conclude that parkinsonian signs and LID are a reflection of at least two different anatomofunctional systems within the GP and that this functional organization of the GP needs to be considered when determining the optimal target for surgical treatment of PD.

Adult↗
PubMed1997

[Radiosurgery].

Radiosurgery refers to the possibility of the destruction of a small area in the brain with a high dose of radiation, after determination of the target with stereotactic coordinates. Arteriovenous malformations of small size not treatable by direct surgery are obliterated by radiosurgery in nearly 80 p. 100 of the cases. Cerebral metastasis are also effectively treated with a good local control, especially in case of small solitary lesion. In acoustic tumor, of small and medium size, radiosurgery appears to be an alternative to surgery. Other benign tumors (meningioma, pituitary adenoma) have also been treated, but long-term studies are still necessary to evaluate the efficacy of this technic.

Brain Neoplasms↗
PubMed1996

[Surgery of brain tumors].

Treatment of brain tumors represents a very important chapter of neurological surgery. In fact, surgery is of primary importance in the management of benign or potentially anaplastic brain tumors. It not only provides histological diagnosis but radical surgical removal, when feasible, is the goal standard treatment of a very large group of these lesions. Surgery is directed specifically against tumoral processes which are widely different and heterogeneous anatomically and histologically. Some of them are benign and their treatment is essentially relaying on surgery. Others are anaplastic or malignant and surgery has to be associated with other treatment modalities [radiotherapy and (or) chemotherapy] but remains crucial for the histological assessment of the lesion even obtained from stereotactical biopsy specimens. Whenever possible surgical resection must be proposed because it improves the patient's clinical and functional state and allows a better efficacy of complementary treatments when indicated. These factors correlates with the quality and length of the postoperative radiological and clinical remission.

Adult↗
PubMed1996

Intra arterial chemotherapy with ACNU and radiotherapy in inoperable malignant gliomas.

For the non-operable malignant glioma patients, prognosis remains poor, with a survival of 8 months for the glioblastomas (G), and 15 months for anaplastic astrocytomas (AA). 27 histologic proven malignant gliomas (17 AA and 10 G) were treated between April 1991 and June 1992. Median age was 48 years. The therapeutic protocol consisted of three courses of intra arterial chemotherapy (IAC) with ACNU, at intervals of six weeks, and a localised 60 Gy radiotherapy between the first and the second IAC course. 72 courses of IAC were delivered (2.4 per patient). Response rate was 51.8%. Median survival (MS) was 13 months, with a survival rate of 28% at 24 months. For the AA, MS was 21 months, with a survival rate of 37% at 24 months. For the G, median survival was 10 months. Responders were 65% for AA, 30% for G. Non responders all died before 24 months had relapsed with a MS of 9 months. 54% of responding patients had a 2 years survival. Toxicity were acceptable with 7% of haematological toxicity and partial loss of visual acuity in 11% of the case. No chronic neurological sequellae were noted. We compare theses results with two previous trials, concerning inoperable patients, treated by association of radiotherapy and systemic chemotherapy. Survival seems to be equivalent with HeCNU and with this treatment, but toxicity decrease with ACNU. Early radiotherapy does not increase complications. This treatment can be used for patients with inoperable malignant gliomas.

Adult↗