Biomedical subjects
Publications and source records attributed to B Brun.
A description of schizophrenia is given from a psychodynamic perspective. The illness is subsequently illuminated by means of different psychological theories, as the characteristic symptomatology is explained through five basic branches of psychology: The psychology of perception, motivation, cognition, personality formation and developmental psychology. Finally, current treatment-strategies are discussed.
We made a retrospective evaluation of clinical and radiologic features, treatment, and outcome of Erdheim-Chester disease, a rare non-Langerhans cell histiocytosis. We had 7 patients coming from 3 French teaching hospitals and reviewed 52 cases from the literature. These cases were considered to have Erdheim-Chester disease when they had either typical bone radiographs (symmetrical long bones osteosclerosis) and/or histologic criteria disclosing histiocytic infiltration without features for Langerhans cell histiocytosis (no S-100 protein, no intracytoplasmic Birbeck granules). Ages at diagnosis ranged from 7 to 84 years (mean +/- SD = 53 +/- 14 yr) with a male/female ratio of 33/26. Bone pain was the most frequent clinical sign (28/59), mostly located in the lower limbs. Exophthalmos and diabetes insipidus were found in respectively 16/59 and 17/59 patients. General symptoms (fever, weight loss) and "xanthomas" (mainly located on the eyelids) were present in 11/59 patients. Retroperitoneal involvement was found in 17/59 patients. Skeletal X-ray showed typical osteosclerosis of the diaphysis of the long bones in 45/59 patients. Bone radiographs showed osteolytic lesions of the flat bones (skull, ribs) in 8 patients. Histologic diagnosis was performed after a bone biopsy (28 patients), a retroorbital biopsy (9 patients), and/or a biopsy of the retroperitoneal infiltration or the kidney (11 patients). Six of our 7 patients but only 5 of 52 patients from the literature had the complete histologic criteria, disclosing no Birbeck granules or S-100 immunostaining. In other cases, histologic results usually described a xanthogranulomatous infiltration by foamy histiocytes nested in fibrosis. Treatment was corticotherapy (20/59), chemotherapy (8/59), radiotherapy (6/59), surgery (3/59) and immunotherapy (1 patient). Twenty-two patients died after a mean follow-up of 32 +/- 30 mo (range, 3-120 mo). In conclusion, Erdheim-Chester disease may be confused with Langerhans cell histiocytosis as it sometimes shares the same clinical (exophthalmos, diabetes insipidus) or radiologic (osteolytic lesions) findings. However, it also appears to have distinctive features. Patients are older and have a worse prognosis than those with Langerhans cell histiocytosis, and the diagnosis relies on the association of specific radiologic and histologic findings.
From April 1987 to October 1992, 67 patients with inoperable squamous cell carcinoma of the head and neck region were included in a randomized trial. All patients had induction chemotherapy with cisplatin (100 mg/m2, D1) and fluorouracil (1 g/m2, from D1 to D5) every three weeks for a total of three cycles. Patients were randomized to concurrent external radiation therapy (70 Gy/39 fractions/8 weeks) and chemotherapy with cisplatin (50 mg/m2 in short infusion, D1, D15, D29, D43) and fluorouracil (5 mg/kg, intra-muscular, every Monday, Wednesday and Friday) (experimental group) versus radiotherapy alone with the same modalities (control group). The followup for living patients was 14 to 60 months with a median of 42 months. Analysis of preliminary results has shown that: 1) early and late side effects are similar in both groups; 2) after completion of treatment, the percentage of patients in complete remission was 71% (20/28) in the experimental group and 43% (12/28) in the control group; this difference was statistically significant among non responders to induction chemotherapy (1/15 versus 13/20, P = 0.001), but non significant among responders (11/13 versus 7/8) and 3) there were no differences between both randomized groups in term of 3-year overall survival and of 3-year loco-regional control. Results are discussed taking into account a review of literature.
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The management of breast cancer in elderly women was analysed by a retrospective study of 150 women over 70 years old referred to our department between 1984 and 1988. 80 were T1-T2, 33 were T3 and 34 were T4. 107 were N0 and 43 were N1-N2. 16 women (11%) were in poor health, preventing conventional treatment. Treatment choice varied with age: 60% of the women aged 70-79 (group 1) and 23% of the oldest women (group 2) were treated conventionally. The use of surgery decreased with age and surgical procedures were conventional in only 85% of the group 1 women and in 56% of the group 2 women. Definitive radiation therapy was used more frequently in the oldest women, as was primary hormone therapy. Quality of follow-up also varied with age. Five-year survival rates were still high in both groups while relapses were frequent. Breast cancer was consequently a frequent cause of death. The increase in the proportion of elderly people with breast cancers over the next few years will require validated guidelines. Specific protocols and specific rules of management must be drawn up.
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From 1981 to 1987, 138 patients with breast cancer unsuitable for primary tumorectomy received initial external radiotherapy (45 Gy/25f/35d) in order to reduce the tumor volume so that secondary limited surgery could be performed. There were 81 T2 and 57 T3. Fifty-seven percent of the patients had a tumor larger than 4.5 cm. After completion of the radiotherapy, 22 patients (16%) showed no more evidence of a tumor either clinically or radiologically and received a boost of 25 Gy. In 52 cases (38%) the tumor regression allowed for secondary tumorectomy followed by a boost of 20 Gy. Sixty-four patients (46%) showed either little or no tumor regression: radical surgery was performed in 14 cases (10%) and high dose boost curietherapy (37 Gy) in the 50 (36%) remaining patients who refused mastectomy. Breast conservation in good condition was thus obtained in 74 patients (54%). Sufficient tumor regression to allow secondary tumorectomy was more often observed in T2 than in T3, in poorly differentiated tumors or mucinous type, and in tumor with well defined mammographic aspects. Actuarial 5-year local control and disease-free survival rates after limited surgery were, respectively, 90% and 73%. No particular complications were observed after secondary tumorectomy. This therapeutic approach is encouraging in patients with large T2 and T3 breast tumors, but a longer follow-up is required to assess definitive conclusions.
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Unlike small breast cancers, which are now treated conservatively by primary tumorectomy, the most important lesions (T2 and T3) as usually treated tumorectomy, the most important lesions (T2 and T3) as usually treated by mastectomy. However, in patients with these large lesions attempts may be made at conserving the breast with reliable oncological safety and good cosmetic results. Depending on clinical presentation, one or the other of two therapeutic approaches may be considered. The most common treatment is preoperative radiotherapy of 45 Gy which, in more than 50 p. 100 of the cases results in a tumoral regression that is sufficient for secondary tumorectomy to be performed. In some patients, the first-line treatment consists of wide tumoral excision as part of a reductive mammaplasty, followed by radiation.
The karyotype of a triploid lemur hybrid, issued from the backcross of an Eulemur macaco male with a female E. coronatus hybrid is reported. The differential negative effect of the multivalents on male and female fertility is discussed.
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As in fertile men, Lemur fulvus mayottensis spermatozoa are pleiomorphic. Percentage of structural defects of semen varies in breeding and nonbreeding seasons. Spermatozoa exhibit acrosomal and flagella abnormalities. These primates could serve as a useful model for teratospermia study, especially because this seasonal variation.
Published reports of arterial stenosis following radiotherapy are reviewed. In oncological practice, this complication is rare but experimental studies have demonstrated the role of irradiation in producing arterial lesions. The histological specificity and the mechanisms of radiation and related arterial lesions are discussed. Atherosclerosis risk factors and chemotherapy could have a synergic role on artery stenosis. Cases reported of arterial stenosis after radiotherapy include subclavicular artery after breast cancer, carotid artery after head and neck cancer, coronary artery and abdominal aorta or its trunks after pelvic and abdominal irradiation. The radiotherapy parameters described are not unusual. Therapeutical modalities and their indications are presented.
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Chronic atrial fibrillation (CAF) may be complicated by asymptomatic small silent cerebral infarctions as well as by stroke. The echocardiographic findings in 29 patients with CAF and 29 controls in sinus rhythm are presented. The cerebral computed tomography (CT) findings in these patients were previously published and significantly more small low-density lesions, probably reflecting previous infarctions, were found in patients with CAF than in controls. The aim of the present study was to evaluate if patients with such cerebral lesions had characteristic echocardiographic abnormalities with special reference to patients with CAF. No significant differences could be detected between the groups with and without cerebral lesions regarding the occurrence of valvular heart disease, left ventricular dysfunction, end-diastolic diameter of the left ventricle, left atrial dimension and left ventricular fractional shortening. Only seven patients with CAF (24%) compared with 21 in sinus rhythm (72%) had normal echocardiograms (P less than 0.001). In conclusion, echocardiography gave no guidance to why some patients developed cerebral low-density areas on CT.