Biomedical subjects

C Milan

Publications and source records attributed to C Milan.

At least 73 records · Page 4Linked to original sources

PubMed1989

A comparison of two diet history questionnaires that measure usual food intake.

This study was conducted during the preparation of a case-control study on patients with adenomatous polyps or cancer of the large bowel. It was done to compare two dietary history methods for assessing individual current dietary intakes. Subjects were interviewed concerning their food consumption by meal in one of the questionnaires and by broad food groups in the other questionnaire. Two groups of 20 volunteers, comparable according to sex and age, were interviewed by a dietitian who used one of the questionnaires. Data on diets obtained with the questionnaire were compared with those of a 14-day dietary record. The subjects were informed of the importance of the validation procedure. Whatever the type of questionnaire, mean daily intakes of nutrients and foods were rather similar for the questionnaires and for the 14-day records. Thus, there were more significant correlations between the questionnaire by meal and the record than between the questionnaire by food group and the record. When using tertiles, it appears that the questionnaire by meal was better at classifying individuals with regard to their food intake than the questionnaire by food groups. Although extrapolating these results to a patient population is not straightforward, it seemed likely that interviewing patients on diet without using a pattern of meals would prove even less reliable than for healthy subjects. The questionnaire by meal was preferred to the questionnaire by food groups for the ongoing case-control study. Further studies are needed to know whether these results could be extrapolated to studies on past diet and to non-Latin populations.

Adult↗

PubMed1989

Multiple myeloma: epidemiological features in a well-defined population in Burgundy, France.

Epidemiological features of multiple myeloma were studied over a seven-year period (1980-86) in the department of Côte d'Or (population 478,000). The crude annual incidence rates were 3.7/100,000 for males and 4.0/100,000 for females. The corresponding age-standardized rates were 2.5 and 2.1. The sex ratio was 1.2. Cumulative rates were 0.3% for both sexes. Age and specific incidence were low before 50 and increased with advancing age up to 85 years in males and females. There was no significant variation in incidence over the seven-year period. The risk of multiple myeloma was slightly higher in urban than in rural areas (the variations were not significant). The period between the beginning of the symptoms and the diagnosis was often short, less than one month in 56% of the cases. When compared to other population based registries the incidence rates are similar to those reported all over the world (except for registries with a high proportion of blacks in the population). Cases have been staged according to Durie and Salmon classification: 32% of the cases were classified as Stage I. This result suggests that globally cases diagnosed in a well-defined population are less severe than those reported in hospital statistics. Survival showed significant differences: there were better rates for patients under 75 and for patients at stage I and II compared with stage III patients. Percentage and morphology of plasma cells also influenced prognosis.

Adult↗

PubMed1989

Epidemiological evidence for distinguishing subsites of colorectal cancer.

The registry of digestive tract tumours established for the department of Cote d'Or (France) was used to study the epidemiological characteristics of large bowel cancer subsites for the period 1976-1983. Age standardised incidence rates for colon cancers were 18.9/100,000 for men and 14.2/100,000 for women. The corresponding rates for rectal cancers were 18.4/100,000 and 10.2/100,000. The sex ratio for right colon cancer (caecum, ascending colon, hepatic flexure, transverse, splenic flexure) was close to 1 and did not change with advancing age, while that for the left colon (sigmoid, descending colon) showed a male excess after 65. For rectal cancer (rectosigmoid junction, rectal ampulla) the male predominance was more marked and occurred earlier, after 55 years of age. There was no significant variation in incidence between rural and urban areas for the different sublocalisations. In males the risk was high in the highest social classes for left colon cancer (p less than 0.01), and among farmers for rectal cancer (p less than 0.01). The risk of left colon cancer in males increased with the comfort of housing (p less than 0.01), but this marker of social class had little influence on incidence for the other localisations in males, or for any localisation in females. No significant variation was found with education. The incidence of colon cancer tended to increase over the 8 years of study. The variations were significant for left colon cancer. For rectal subsites cancer incidence decreased in women (p less than 0.05). The observed differences suggest differences in the aetiological factors within large bowel cancers. Therefore right colon cancer, left colon cancer and rectal cancer should be considered separately in epidemiological analytical investigations.

Aged↗

PubMed1989

Myeloproliferative disorders in the department of Côte d'Or between 1980 and 1986.

By the registry of hematopoietic malignancies in Côte d'Or we studied the 177 cases of myeloproliferative disorders diagnosed between 1980 and 1986, divided into 4 groups: chronic myelogenous leukemia, idiopathic myelofibrosis, polycythemia vera, essential thrombocythemia. The global standardized rates based on the world population were 3.5 per 100,000 in men and 1.9 in women (sex ratio = 1.8). The mean age for myeloproliferative disorders was 61 +/- 16 years. Incidence was slightly higher in urban than in rural areas (NS). The most common means of detection were routine hemogram, fatigue and thrombosis. Five-year survival curves showed large differences in prognosis, from 30% for chronic myelogenous leukaemia to 83% for polycythaemia vera.

Adolescent↗

PubMed1989

[Trends in the incidence of colorectal cancer at the Department of Côte-d'Or between 1976 and 1985].

Colorectal cancer is the leading cause of cancer morbidity in France when both sexes are considered together. There are few available data on time trends, although such data would prove both necessary for planning screening programs and usefull to construct hypotheses on etiological factors. Data from the Registre des Tumeurs Digestives de Côte d'Or permitted to establish time trends for the different locations of colorectal cancer during the 1976-1985 period. Changes in incidence rates as based on the world reference population were studied using a log linear model as well as the Armitage test. Overall colon cancer rates have increased in both sexes. The mean annual increase of left colonic cancer was 3.1 p. 100 in men (p less than 0.05) and 4.0 p. 100 in women (NS), whereas rectal cancer decreased by 2.4 p. 100 in men and 3.3 p. 100 in women (NS). In men, left colonic cancer rates increased mainly in rural areas (+ 7.3 p. 100; p less than 0.05) whereas it increased mainly in urban areas in women (+ 6.0 p. 100; NS). In both sexes, the left colonic cancer increase was particularly noticeable in the 45-64 age group, which could indicate that the observed trend is likely to become more important in the next years. As for rectal cancer, the decrease was most important in the 65-74 age groups. That inversed trend for colon and rectum cancer has already been observed in other countries including the USA and Canada. As the trends we observed for right colon, left colon and rectal cancer differ, colorectal cancer etiology should be studied separately.

Aged↗

PubMed1989

Mortality factors associated with chronic pancreatitis. Unidimensional and multidimensional analysis of a medical-surgical series of 240 patients.

The purpose of the study was to determine (a) the frequency and cause of mortality in patients with chronic pancreatitis; (b) the cumulative survival rates corrected by comparison of patients with a matched French population; and (c) the factors associated with mortality by a unidimensional and multidimensional analysis. The study population consisted of 240 patients (men = 208, women = 32; alcoholic = 210, nonalcoholic = 30) followed for a mean time of 8.7 yr. The status of the patients (dead or alive) was recorded in February 1987. Mean age at onset of chronic pancreatitis was 41.5 yr. Fifty-seven patients died. Mean age at time of death was 52.3 yr. "Overmortality" after 20 yr of course was 35.8% in comparison with a matched French population (p less than 0.0001). Chronic pancreatitis was the direct cause of death for only 19.3% of patients. The main causes of death have been alcoholic hepatopathy (n = 10), cancer (n = 9), postoperative mortality (n = 8). Unidimensional analysis of mortality rates showed that male sex (p less than 0.03), surgery (p less than 0.007), hepatopathy (p less than 0.01), diabetes mellitus (p less than 0.02), and absence of attack of acute pancreatitis (p less than 0.02) were associated with mortality. Multidimensional analysis showed that the following variables were linked with mortality: in a first model including the totality of the study population: surgery (p less than 0.006), hepatopathy (p less than 0.008), no attack of acute pancreatitis (p less than 0.03), male sex (p less than 0.03); in a second model excluding cirrhosis: surgery (p less than 0.001), male sex (p less than 0.06), diabetes mellitus (p less than 0.09). Nevertheless, surgery did not seem to interfere with long-term mortality. The lower mortality of patients with attacks of acute pancreatitis suggests a favorable influence for alcohol abstinence.

Actuarial Analysis↗

PubMed1988

Primary liver cancer in Côte d'Or (France).

The registry of digestive tract tumours established for the department of Cote d'Or (France) was used to study the incidence and some of the characteristics of primary liver cancer (PLC) in this area. The annual age-standardized incidence rate was 7.6/100,000 for males, and 1.8/100,000 for females. As compared to other areas the Cote d'Or is in the intermediate incidence areas. The risk of PLC was higher in urban than in rural areas in men (p less than 0.01). There was no significant variation in PLC incidence over the eight years of the study. Alfafoetoprotein levels over 200 ng/ml were observed in only 48.9% of the cases. Alfafoetoprotein measurement has to be complemented by other investigations in screening of high-risk patients. Liver cirrhosis was present in 70.9% of the cases in which the information was available. The male:female ratio in the non-cirrhotic group was 1.5:1, very different to the 8.8:1 in the cirrhotic group. Cirrhosis was associated with excessive alcohol consumption in 92% of cases. The prevalence of serological markers of hepatitis B virus infection was investigated in 91 patients. Hepatitis Bs-antigen was found in 8.8% and evidence of past or present infection in 28.2%. In view of the prevalence of chronic alcoholism in patients with cirrhosis it is suggested that alcohol leads to an increased risk of cirrhosis followed by an increased incidence of PLC. Further studies are needed to elucidate the eventual role of HBV infection and other suspected environmental factors in the aetiology of PLC.

Adolescent↗

PubMed1988

[Epidemiology of cancers of the small intestine. Evaluation of 10 years' registration at the Cote-d'Or department].

The registry of digestive tract tumours established for the department of Côte-d'Or was used to study the epidemiologic characteristics of cancer of the small intestine. Over a period of 10 years (1976-1985), 42 new cases were recorded. Age standardized incidence rates, based on world standard population, were 0.7/100,000 for males and 0.4/100,000 for females. As compared with the data from other cancer registries, the risk in Côte-d'Or is in the intermediate range. The mean age was 60.9 years for males and 73.3 years for females (P less than 0.05). Adenocarcinomas represented 40% of the cases, lymphomas 20%, carcinoid tumours 20%, sarcomas 17% and undifferentiated carcinomas 2%. The mean time between symptoms and diagnosis was 4.6 months. Lymph node involvement or metastatic disease were found in 3/4 of the cases at time of diagnosis (31/42). Patients were treated by surgery in 95% of the cases. Curative surgery was used in 23 cases (55%). The post-operative death rate was 13% after curative surgery and 37.5% after palliative surgery. The overall survival rates were 39.9% at 1 year, 19.5% at 3 years and 11.7% at 5 years. Prognosis depended on the stage of diagnosis and the finality of surgical treatment. These results indicate that cancers of the small intestine are rare and difficult to diagnose, explaining the delay in diagnosis and the poor prognosis.

Actuarial Analysis↗

PubMed1987

Biliary tract cancers in Cote-d'Or (France): incidence and natural history.

The registry of digestive tract tumours established for the department of Cote-d'Or (France) was used to study the epidemiological characteristics and the natural history of biliary tract cancers. Age standardised incidence rates for gallbladder cancers were 2.7/100,000 for women and 0.9/100,000 for men. The corresponding rates for extrahepatic bile duct cancers were 0.5/100,000 and 1.7/100,000, and for ampulla of Vater cancer 0.3/100,000 and 0.3/100,000. The three cancers differ in their descriptive epidemiology and should be considered separately in epidemiological analytical investigations. The incidence of each of the three diseases increased with age, and cancers of known histological type were mainly adenocarcinomas. Some gallbladder cancers were undifferentiated or squamous cell carcinomas. There was no significant variation in incidence for gallbladder cancer and extrahepatic bile duct cancer over the eight years of the study. The association with gallstones was frequent in gallbladder cancer: 70.5% compared to 13.0% in other biliary tract cancers (less than 0.001). Although the association of gallbladder cancer with gallstones is frequent, few patients with cholelithiasis experience development of a gallbladder cancer. It is necessary to identify among patients with gallstones a subgroup at high risk of gallbladder cancer in whom prophylactic surgery might be justified. Biliary tract cancers are seldom diagnosed early: lymph nodes or visceral metastases were present in 77% of gallbladder cancers, in 83% of extrahepatic bile duct cancers, and in 55% of ampulla of Vater cancers at the time of diagnosis. The corresponding resectability rates were 46.1%, 11.9%, and 38.9%. The five-year overall survival rates were 2.9% for gallbladder cancer, 0% for extrahepatic bile duct cancer, and 18.3% for ampulla of Vater cancer. The corresponding five-year survival rates after surgery for cure were 10.3%, 0%, and 35.7%. Biliary tract cancer still represent a great therapeutic challenge.

Adenocarcinoma↗

PubMed1987

[Cancer of the gallbladder in the Côte d'Or].

The registry of digestive tract tumours established for the department of Côte d'Or was used to study the epidemiologic characteristics and treatment of gallbladder cancer. During 8 years (1976-1983), 139 new cases were recorded. Age standardized incidence rates based on world standard population were 3.1/100,000 for females, 0.9/100,000 for males. As in all population-based studies, there was a female predominance. As compared with the data of other cancer registries the risk in the Côte d'Or is in the intermediate range. The incidence of gallbladder cancer was similar in urban and rural areas, but high risk lieus were identified by the study. The most frequent histologic type was adenocarcinoma (79.5 p. 100). Only 20.9 p. 100 of the patients underwent curative surgery. The overall 1-year survival rate was 14.4 p. 100 and the 5-year survival rate was 2.9 p. 100. The 5-year survival rate was 11.5 p. 100 after curative surgery. These results underline the fact that the prognosis of gallbladder cancer in a well defined population remains poor. The frequency of gallstones was 73.3 p. 100 in females and 56.5 p. 100 in males. Although this association is frequent few people with cholelithiasis develop gallbladder cancer. Among patients with gallstones, a subgroup at high risk of gallbladder cancer, in whom prophylactic surgery might be justified, remains to be identified.

Aged↗

PubMed1986

[Survival in colorectal cancers in population statistics].

Available population based survival statistics for colorectal cancers were compared. The results based on relative survival rates showed similar data in Finland, Norway, Geneva and Cote d'Or. The survival rates were lower in Great Britain and Iceland. Several factors complicate survival comparisons: age, exact localization of the tumour, definitions and distribution of tumour stages. Adjustment of these factors is necessary. If their definitions differ, no conclusion can be based upon the data. Population based survival figures provide public health authorities with a basis for monitoring cancer patient care. They are also useful for assessing the resources required for cancer treatment, follow-up and rehabilitation. They provide clinicians with survival data for reference.

Adult↗

PubMed1986

Haematopoietic malignancies in Côte d'Or (France): a population based study.

A registry of haematopoietic malignancies was established on January 1, 1980 in order to accurately determine the incidence and epidemiological features of these diseases in the department of Côte d'Or (population 478,000). Over five years (1980-1984), 704 new cases were recorded. The crude incidence rates were 32.7 per 100,000 for males and 24.9 per 100,000 for females. The corresponding age standardized rates were 26.4 and 16.7. The sex ratio was 1.6:1. In males, chronic lymphocytic leukaemias were the most common haematopoietic malignancies, followed by non Hodgkin's lymphomas, acute leukaemias and multiple myelomas. In females, multiple myelomas and acute leukaemias preceded non Hodgkin's lymphomas and chronic lymphocytic leukaemias. For men and women, the risk of haematopoietic malignancies was higher in urban areas than in rural areas. Compared to population based registries in other countries, incidence rates are among the highest reported and are particularly high for chronic lymphocytic leukaemia.

Acute Disease↗

PubMed1986

Incidence of hematopoietic malignancies in a well-defined population in France.

A registration of hematopoietic malignancies was established on January 1, 1980, in order to determinate accurately the incidence and epidemiological features of these diseases in the department of Côte d'Or (population 477,908). Information was collected from various sources (public and private laboratories, hospitals, general practitioners and death certificates). Over a 3-year period (1980-1982), 401 new cases were diagnosed among residents of the department. The crude incidence rates were 32.9/100,000 for males and 23.0/100,000 for females. The corresponding age standardized rates (using world standard population) were 26.1 and 15.9, respectively. The sex ratio was 1.8:1. In males, chronic lymphocytic leukemias, Hodgkin's and non-Hodgkin's lymphomas are the most common hematopoietic malignancies, followed by acute leukemias and multiple myelomas. In females, lymphomas are more frequent than acute leukemias, chronic lymphocytic leukemias and multiple myelomas. Compared to population based registries in other countries, incidence rates are among the highest reported, and are particularly high for chronic lymphocytic leukemia.

Adult↗

PubMed1986

[Incidence of chronic lymphocytic leukemia in the Department of Côte-d'Or].

The incidence of chronic lymphocytic leukaemia has been studied over 4 years (1980-1983) in the region of Côte-d'Or (population 478,008). The crude annual incidence rate was 7.0/100,000 for males and 3.5/100,000 for females. The corresponding age standardized rates were 5.6 and 1.8. The sex ratio was 3.1. Compared to other population based registries, the incidence is higher in Côte-d'Or and the rates are among the highest reported in the world for males and females. Age and sex specific incidence rates were low before 50 years of age and increased in older age with a male predominance. The risk of chronic lymphocytic leukaemia was slightly higher in urban than in rural areas. All cases were classified according to Binet's classification: 74% were staged O or I. The ABC classification was applied to cases diagnosed in 1982-1983: 83% were staged A. These results suggest that cases diagnosed in a well-defined population are less severe than those reported in hospital statistics.

Adult↗

PubMed1986

[Cancer of the esophagus in the department of Côte-d'Or].

The registry of digestive tract tumors established for the department of Côte-d' Or was used to study the incidence and characteristics of oesophageal cancer in the area. The crude annual incidence rate was 15.5/100,000 for males, ans 1.1/100,000 for females. The corresponding age standardized rate (world standard) were 12.7 and 0.6. The sex ratio was 21.2. As compared to other cancer registries the Côte-d' Or is in intermediate range for males, in the low range for females. The incidence of oesophageal cancer was similar in urban and rural areas. The risk of oesophageal cancer in males was five times higher in workers than in high executives and professionals. There was no significant variation in oesophageal cancer incidence over the 8 years of the study. Rates tended to decrease slightly in both sexes. Most cancers were squamous cell carcinomas (92%). Adenocarcinomas represented 5% of the cases. The risk of an associated tumour of the upper respiratory and digestive tract was important (17.5%). Only 10.4% of the patients underwent curative surgery, while 53.4% were referred for radiotherapy alone. The overall 1-year survival rate was 18.4%, and the 5-year survival rate was 2.8%. The 5-year survival rate was 7.2% after curative surgery, and 3.2% after radiotherapy. These results underline the fact that the prognosis of oesophageal cancer in a well defined population where only one patient out of ten can benefit from curative surgery, remains poor.

Adenocarcinoma↗

PubMed1986

[Management by specialists of patients with digestive cancers in the Department of Côte-d'Or].

The relative frequency of consultation of the different specialists involved in the diagnosis and treatment of cancer is not well known in France. This study was completed with data collected by the Digestive Tract Cancer Registry in Côte d'Or. Among 3.192 digestive tract cancers diagnosed between 1976 and 1982, 64 p. 100 were treated by gastroenterologists or surgeons. Only 18% of the patients consulted an oncologist. The frequency of consultation of gastroenterologists in the care of digestive tract cancers was independent on the location of the cancer but varied with the place of residence, fluctuating from 69.7% for patients living in the town of Dijon, to 39.9% for patients living in a town with a regional hospital without gastroenterologist. The inverse phenomenon was observed for oncologists. They treated 63.2% of the patients with esophageal cancer and 31.2 p. 100 of patients with rectal cancer, but less than 10 p. 100 of the patients with gastric, colonic, liver, biliary tract or pancreatic cancer. The number of surgeons consulted depended essentially on the operability of the cancer. Between 1976 and 1982 consultation with gastroenterologists and surgeons by patients with digestive tract cancer increased by 4.4 p. 100 (p less than 0.05) and 2.1 p. 100 per year (p less than 0.01), respectively. The frequency of consultation of oncologists remained stable: +0.3 p. 100 per year. These results confirm the importance of a training policy oriented towards specialists who are not oncologists. They must take note of their importance in the diagnosis and the organization of the fight against digestive tract cancers.

Aged↗

PubMed1986

[Does Ming's classification of gastric carcinomas have epidemiologic or prognostic value?].

The population based registry of digestive tract tumours of the country of Cote-d'Or was used to assess the epidemiological and prognostic value of Ming classification. The 211 gastric carcinomas operated or autopsied between 1976 and 1981 in this population were reviewed on a pathological basis. The expansive type (46.0%) was nearly as frequent as the infiltrative type (47.9%). In 6.2% of the cases it was impossible to classify carcinomas in one of these two types. The male/female ratio was higher in the expansive type (3.0) than in the infiltrative type (2.2) and the mean age of patients at the time of diagnosis was higher in the expansive type (69.5 years) than in the infiltrate type (66.4 years p less than 0,05). Ming classification was difficult to use with superficial carcinomas: 9 out of 12 could not be classified. Among invasive cancers only 1.5% were not classified in one of the two types. Polypoid and fungating carcinomas were more often of the expansive type (70.1%). On the contrary infiltrative carcinomas (ulcerated or not) corresponded to the infiltrative type of Ming in 65.6%. It was not possible to extrapolate the WHO classification to the Ming classification. Infiltrative carcinomas were more often associated with hyperplastic stroma (38.1%) than did expansive carcinomas (5.2%) the proportion of carcinomas limited to the digestive wall was higher in the expansive type (21.7%) than in the infiltrative type (5.0%). The survival rate was better in the expansive type (41.4%) than in the infiltrative type (30.1%) but the difference was not significant. The prognosis depended partly on the time of diagnosis. The results suggest that Ming classification has an epidemiological interest. It allows us to distinguish two types of carcinomas that appear quite different on basis of their growth and penetration capacity. However its prognostic interest appears limited.

Adult↗

PubMed1985

Gastric carcinoma in Côte d'Or (France). A population-based study.

The registry of digestive cancer in the Department of Cote d'Or, France, recorded newly diagnosed cases of gastric cancer between 1976 and 1980. The annual incidence rate, adjusted to the world population, was 15.2/100,000 for men and 6.1/100,000 for women. Stomach cancer incidence showed a substantial decline during the 5 yr of the study and this decline was more pronounced in men than in women. The operability rate was 62.4% and the resectability rate was 40.2%. Operative mortality after curative surgery was 17.6%. For all subjects, 17.6%, 29.1%, and 26.0% had localized, regional, and distant disease, respectively. The remaining 27.3%, not operated upon, with no evidence of metastases, had unclassifiable disease. The overall 5-yr corrected survival rate was 16.5%. In the absence of curative surgery all patients died in the 4 yr after diagnosis. After curative surgery the 5-yr corrected survival rate (excluding operative mortality) was 42.8%. The most important determinant of the survival was the pathological stage of the tumor. The age-corrected 5-yr survival was 98.7% for cases limited to the digestive wall, 45.5% for cases involving the serosa, and 26.6% for cases with locoregional extension. These results support the fact that, although declining, gastric cancer remains relatively frequent. Its overall prognosis in a well-defined population, where cases limited to the digestive wall are rare, remains poor.

Actuarial Analysis↗