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P Descamps

Publications and source records attributed to P Descamps.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Endocervical adenocarcinoma in situ. A histological entity to know].

We report diagnosis and treatment problems encountered in 4 cases of adenocarcinoma in situ (AIS) of the uterine cervix. The patients' ages ranged from 24 to 45 years. In 2 cases, Pap smears revealed strips of cells showing crowded nuclei and pseudostratification of AIS. In 3 cases, the diagnosis of AIS was confirmed from a colposcopically directed biopsy and, in the last case, from a surgical cone biopsy. In 3 cases, AIS was found to be associated with cervical squamous intraepithelial neoplasia. In all cases, it was difficult to rule out an early invasive adenocarcinoma. Three patients underwent total abdominal hysterectomy. The topographic data of lesions, notably the presence of endocervical AIS in hysterectomy specimen realised 4 years after conization, and a review of literature lead us to propose hysterectomy as a basic treatment. If conization is chosen, it should be cylindrical with adequate diameter and height.

Adenocarcinoma↗
PubMed1995

[Ethical problems with the current French practice in therapeutic abortions. Part 3: resolving moral dilemmas in fetal medicine].

OBJECTIVE: Based on the information acquired in the first two parts of this study and the data in the literature, to propose ethic codifications for solving moral dilemmas concerning fetal medicine. METHODS: Identification of situations where the object of the conflict is ethics: general methodology propositions for making individual decisions. RESULTS: In all cases a rigorous method is required, based on three main elements: a complete and well documented medical file; the opinion of the couple after appropriate participative communication; case by case collegial discussion. CONCLUSION: The methodology proposed underscores the roles played by health carers: obtain a medical file as complete as possible with prime emphasis on the infant; establish active communication with the parents giving greater value to their free examination of the situation; collegial discussion in order to be pertinent social partners.

Abortion, Therapeutic↗
PubMed1995

[Association of Takayasu's arteritis, pregnancy and Still's disease].

Two pregnant patients presented with Takayasu's disease predominating in the major branches of the aorta. There was no extention below the diaphragm and no complications. One of the patients had Still's disease which is a predominantly cutaneous form without chronic arthritis. Both pregnancies were uneventful excepting dysgravidia in one case. Two eutrophic infants were born at term. The risk of Takayasu's arteritis associated with pregnancy, as reported in the literature, is mainly due to the consequences of arterial hypertension with pre-eclampsia (60%), heart failure and cerebral vascular events (5%). The major fetal risk is in utero death (2 to 5%), but intra-uterine growth retardation is more frequent (18%). The risk is greatest during the third trimester and during the perinatal period. Fetal involvement is greatest in sever cases and in those treated late. Prevention is based on the initial work-up to identify the disease and possible complications, programming pregnancies and increasing surveillance during periods of risk, defining the delivery route with cesarean section reserved for complications of arteritis (30%), and planned labour with instrumental extraction and epidural anaesthesia with control of the blood pressure. Still's disease has no particular consequence on pregnancy, although sequellae of chronic arthritis of the pelvis may have an impact on obstetrical technique. An association with Takayasu's disease is rare with only one case being reported in the literature; aetiopathology remains unknown.

Adult↗
PubMed1995

[Stage I and II endometrial cancer: should lymphadenectomy still be done?].

Surgical treatment for endometrial carcinomas stage I and II is radical hysterectomy. The role of lymphadenectomy (pelvic and paraaortic) is under discussion. From a retrospective study (multivariate analysis of 320 patients treated by radiosurgical association) and a review of the literature, the authors limit the indications of lymphadenectomy to stage I grade 1 or 2 tumours and without deep tumours invasion into the myometrium (in that case only 10% of pelvic nodes will be involved). Stage II patients or stage I with grade 3 and/or deep tumour invasion into the myometrium do not require lymphadenectomy as post-operative pelvic external beam irradiation will be performed in all cases. Para-aortic lymphadenectomy is not useful as it increases morbidity and the adjuvant treatment in case of lymph node involvement does not improve the survival rate.

Adult↗
PubMed1995

[Ethical problems raised by the current French practice of therapeutic abortions. Part I: prospective study for 24 months at the University Hospital of Tours (76 cases)].

OBJECTIVE: Determine the circumstances and conditions concerning ethical problems raised by medical abortions treated in a University hospital. METHODS: Prospective study for 2 years (1 Sept 1991--31 Aug 1993) conducted with a consulting Committee for the antenatal diagnosis and fetal medicine at the University Hospital at Tours. Each discussion of the medical file for proposed medical abortions, the conditions leading to the decision and the ethical recommendations formulated were registered as well as the outcome of the pregnancy and for the infant. RESULTS: There were 76 cases raising ethical problems. They were divided into 3 categories of recommendations: medical abortion (55 cases), abstention with acceptation of possible fetal death in utero (11 cases), conservation of the pregnancy (10 cases). CONCLUSION: A practical attitude could usually be decided after discussion between parents and physicians. A few cases of disagreement were observed which led to uncertainty [correction of incertainty] and diverging opinions concerning the diagnosis and prognosis for the fetal pathology.

Abortion, Therapeutic↗
PubMed1994

Conservative treatment feasibility with induction chemotherapy, surgery, and radiotherapy for patients with breast carcinoma larger than 3 cm.

BACKGROUND: The traditional surgical treatment for operable breast carcinoma larger than 3 cm is mastectomy. To avoid mutilating surgery, the authors administered primary chemotherapy to 158 patients with operable nonmetastatic large breast carcinoma with a TNM classification of T2 greater than 3 cm and T3 with a lymph node status of N0-N1. Conservative treatment was proposed for patients responding to the chemotherapy and whose tumor was reduced to 3 cm or less. The purpose of the study was to evaluate the feasibility and treatment results of this strategy. METHODS: The mean patient age was 50.4 years. Eighty-two patients had T2 carcinomas greater than 3 cm, and 76 had T3 carcinoma. Fifty-four tumors were classified as lymph node status N0, and 104 as N1. Mean tumor size was 5.6 cm. Patients were treated with three courses of the NVCF regimen (mitoxantrone, vindesin, cyclophosphamide, and 5-fluorouracil) or the EVCF regimen, in which mitoxantrone was replaced by epirubicin every 4 weeks, and then administered with a radiosurgical combination. RESULTS: The overall response rate to induction chemotherapy was 60.8% with 20.2% complete tumor regression. Twenty-one percent of the patients experienced grade 3 or 4 chemotherapy toxic effects, which were all acceptable and reversible. Breast-conserving treatment was feasible in 48.7% of patients (77 of 158). Forty-five patients (28.5%) were treated with a radiosurgical combination (tumorectomy plus radiation therapy), whereas 32 (20.2%) were treated with radiotherapy alone (external irradiation and brachytherapy). Other patients were treated with mastectomy. Age, tumor stage, histology, hormonal status, and hormonal receptor rate had no influence on the frequency of the observed regressions. Isolated recurrences occurred in 11 patients, 6 who were treated conservatively and 5 who were treated with mastectomy. Metastatic relapses were observed in 38 patients (14.6% in the chemotherapy responders and 38.7% in the nonresponders) (P < 0.02). Five-year actuarial survival was 73.2% and was significantly higher for responders to the induction treatment. CONCLUSION: These preliminary results suggest that primary chemotherapy and radiosurgical breast-conserving treatment is feasible and is an alternative to mastectomy for patients with large operable breast carcinoma who are responders to the induction treatment. The long term benefit of this strategy must be evaluated in well designed controlled trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

alpha-Linolenic acid content of adipose breast tissue: a host determinant of the risk of early metastasis in breast cancer.

The association between the levels of various fatty acids in adipose breast tissue and the emergence of visceral metastases was prospectively studied in a cohort of 121 patients with an initially localised breast cancer. Adipose breast tissue was obtained at the time of initial surgery, and its fatty acid content analysed by capillary gas chromatography. A low level of alpha-linolenic acid (18:3n-3) in adipose breast tissue was associated with positive axillary lymph node status and with the presence of vascular invasion, but not with tumour size or mitotic index. After an average 31 months of follow-up, 21 patients developed metastases. Large tumour size, high mitotic index, presence of vascular invasion and low level of 18:3n-3 were single factors significantly associated with an increased risk of metastasis. A Cox proportional hazard regression model was used to identify prognostic factors. Low 18:3n-3 level and large tumour size were the two factors predictive of metastases. These results suggest that host alpha-linolenic acid has a specific role in the metastatic process in vivo. Further understanding of the biology of this essential fatty acid of the n-3 series is needed in breast carcinoma.

Adipose Tissue↗
PubMed1994

Determination of itraconazole and its active metabolite in plasma by column liquid chromatography.

Itraconazole is a new triazole antifungal agent. Active orally, this drug is effective against a wide range of fungal pathogens that includes Aspergillus species, and its use in leukemic and AIDS patients is currently on the increase. Oral itraconazole absorption presents up to threefold interindividual variation in man and is reduced in AIDS patients. Consequently an individual itraconazole adjusting dosage is necessary to ensure adequate clinical antifungal activity. Itraconazole undergoes extensive metabolism and the main isolated metabolite, hydroxyitraconazole, is found in plasma at concentrations 2-3-fold higher than parent drug and presents in vitro the same antifungal activity. At present, despite the contribution of this metabolite to the overall activity of the drug, no well-documented assay was reported in the literature for the codetermination of itraconazole and hydroxyitraconazole in plasma. Due to the wide variety of coadministered drugs to patients receiving itraconazole, the purpose of the developed method was to obtain a specific assay sensitive enough for itraconazole therapeutic monitoring. Therefore, a three-step liquid-liquid extraction procedure following by reversed-phase chromatography and spectrofluorimetric detection was performed. This assay allowed determination of 20 ng/ml of both itraconazole and its active metabolite with an acceptable precision using a 0.5-ml plasma sample; no analytic interference was encountered from 45 coadministered drugs tested.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Catamenial sciatic pain due to endometriosis of the sciatic nerve. Review of the literature, apropos of a case].

Sciatic nerve endometriosis is rare but must be included in the sciatic pain aetiology diagnosis. Typically the patient's sciatic pain is cyclic. Electromyography and computed tomographic scanning or nuclear resonance imagery contribute to the diagnosis. Different mechanisms of this localization have been proposed. The patient often requires conservative surgery with excision of endometriosis from the nerve. Medical treatment (LH-RH analogues) may be associated in young patients who need to preserve reproductive function. Total hysterectomy with bilateral salpingo-oophorectomy may be mandatory in stage III or IV endometriosis and older patients.

Adult↗
PubMed1993

Primary chemotherapy and radiosurgical breast-conserving treatment for patients with locally advanced operable breast cancers.

PURPOSE: The traditional surgical treatment for operable breast cancer larger than 3 cm is mastectomy. In order to avoid mutilating surgery, we administered primary chemotherapy to 80 patients with operable non metastatic large breast cancer T2 > 3 cm and T3, N0-N1. The purpose of the study was to evaluate the breast-conserving rate induced by this treatment strategy and determine if it is a safe alternative for women with locally advanced breast carcinomas that are responders to an induction chemotherapy. METHODS AND MATERIALS: The mean age was 50.1 years. Forty-three patients were T2 > 3 cm, 37 were T3. Twenty-six were N0 and 54 were N1. Mean tumor size was 5.4 cm. Patients were treated with three courses of the MVCF regimen (Mitoxantrone, Vindesin, Cyclophosphamide, and 5 Fluorouracil) every 4 weeks and then with a radiosurgical combination. RESULTS: The overall response rate to induction chemotherapy was 51% with 17.5% complete tumor regression. Twenty-one percent of the patients developed grade 3 or 4 chemotherapy toxic effects, all acceptable and reversible. Breast-conserving treatment was feasible in 42.5% (34/80). Twenty patients (25%) were treated with a radiosurgical combination (tumorectomy+radiation therapy), 14 (17.5%) with radiotherapy alone (external irradiation and brachytherapy). Age, tumor stage, histology, hormonal status, hormonal receptors rate had no influence on the frequency of the observed regressions. Isolated recurrences occurred in five patients, two conservatively treated and three treated with mastectomy. Metastatic relapses were observed in 20 patients (12% in the responders and 38.5% in the non responders to chemotherapy) (p < 0.02). Five-year actuarial survival was 73% and was significantly better for responders to the induction treatment. CONCLUSION: These results suggest that primary chemotherapy and radiosurgical breast conserving treatment is a safe alternative to mastectomy for patients with locally advanced operable breast cancer. The long-term benefit of this strategy must be evaluated in well designed controlled trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

[Modeling of feto-placental circulation. Clinical applications apropos of 21 patients having no or inverse diastolic umbilical flow].

The placental resistance index: (S-D)/S (S: represents the amplitude of the systolic peak and D: the amplitude of the telediastolic peak) is constantly inferior to one from the 14th-16th week of amenorrhea during a normal pregnancy. The diastolic umbilical arterial blood flow is continuous because of low placental vascular resistance. From a clinical study of 21 patients with an absent or reversed end diastolic flow in umbilical artery waveforms, an obliterative process in the placental vascular tree was observed. A computer model was used to stimulate the reversed end diastolic flow in umbilical artery waveforms when the placental resistance increased. This haemodynamic approach shows that the placental blood flow decreased, and that the arterial blood pressure, as well as the pulse wave velocity increased when the placental resistance increased. The increase in the difference between the umbilical resistance and the placental resistance caused a reduction of the diastolic flow owing to a progressive increase of the pulse wave velocity reflected. It was concluded that there is a relation between perturbations in placental vascular bed and the flow in umbilical artery waveforms.

Adult↗