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C Nos

Publications and source records attributed to C Nos.

At least 37 records · Page 2Linked to original sources
PubMed2001

Prospective evaluation of late cosmetic results following breast reconstruction: I. Implant reconstruction.

The long-term cosmetic outcome of breast implant reconstruction is unknown. The morbidity and cosmetic outcome of 360 patients who underwent immediate postmastectomy breast reconstruction with various types of implants have been analyzed prospectively over a 9-year period. Of these patients, 334 who completed their reconstruction were suitable for evaluation of their cosmetic outcome. The early complication rate (< 2 months) was 9.2 percent, with an explantation rate of 1.7 percent. The late complication rate (> 2 months) was 23 percent, with a pathological capsular contracture rate of 11 percent at 2 years and 15 percent at 5 years and an implant removal rate of 7 percent. The revisional surgery rate was 30.2 percent. The cosmetic results were assessed prospectively using an objective five-point global scale. Every patient was scored at each visit once surgery was completed. The overall cosmetic outcome deteriorated in a linear fashion, from an initial acceptable result of 86 percent 2 years after patients completed their reconstruction to only 54 percent at 5 years. This decline in cosmetic outcome was not associated with the type of implant used, the volume of the implant, the age of the patient, or the type of mastectomy incision employed. Radiotherapy was not a significant factor because only 28 patients were irradiated. Upon Cox model analysis, pathological capsular contracture was the only factor that contributed significantly to a poor cosmetic outcome in which p < 0.0001 (relative risk 6.3). Despite a high revisional surgery rate, deterioration still occurred, suggesting that other unaccounted for variables were responsible. On photographic retrospective review of the patients without capsular contracture who demonstrated deterioration in their cosmetic scores, it became clear that a possible reason for their poor results was late asymmetry produced by the failure of both breasts to undergo symmetrical ptosis with aging.

Adult↗
PubMed2001

[Relevance of combined radiation and surgical treatment of early invasive carcinoma of the cervix].

The aim of this study was to assess the result and the postherapeutic complications rates of preoperative radiation therapy and radical surgery in association, for stage IB to IIB cervical carcinoma. For 1983 to 1990, 314 patients were treated at the Institut Curie for stage IB to IIB cervical carcinoma. For small lesions, less than 4 cm, preoperative uterovaginal brachytherapy was performed (60 to 65 Gy), followed, 6 weeks later, by a modified radical hysterectomy (Piver type 2) with pelvic lymphadenectomy. Larger tumors were treated with pelvic radiotherapy (36 Gy), then by brachytherapy (30 Gy), followed, 6 weeks later, by the same surgical procedure. 82% of the tumors were 4 cm or smaller. 64% of tumors were completely sterilised by the preoperative radiation. 5 and 10-year actuarial survival rates were respectively 81% and 70 %. 5-year actuarial survival rate was 87.5% for stage I and 63% for stage II patients. 5-year local disease free survival rate was 88% for stage I and 73% for stage II patients. All complications were prospectively recorded. The early post operative complication rate was 6.3%, with no urinary complications. The late complication rate was 3.3%, mainly grade 2 sequelae. No ureteral fistulas were observed. By combined preoperative radiotherapy and surgery, adapting the dosimetry and the radicality of the procedure, we obtained cure rates and recurrence rates identical to those obtained with exclusive surgery or radiotherapy alone. However, the complication rate of the association of both adapted treatments, has considerably reduced the early and late complication rate.

Adult↗
PubMed2000

Diagnostic accuracy of sonography and combined sonographic assessment and sonographically guided cytology in nonpalpable solid breast lesions.

PURPOSE: The aim of this study was to assess the diagnostic accuracy of sonography alone and combined sonographic assessment and sonographically guided fine-needle aspiration cytology in solid, nonpalpable lesions of the breast. METHODS: We retrospectively evaluated the sonograms from a series of 174 consecutive nonpalpable masses that were cytologically diagnosed using fine-needle aspiration under sonographic guidance and then histologically verified through surgical excision. We examined the relationships between the findings from sonography, combined sonographic assessment and cytopathology, and histology. RESULTS: Histologically, 95 lesions (55%) were malignant and 79 (45%) were benign. The overall sensitivity of sonography alone for diagnosing cancer was 98. 9% (94 of 95 lesions), and the specificity was 45.6% (36 of 79 lesions). One (3%) of 37 masses considered at sonography to be benign was correctly diagnosed on cytologic examination to be cancer. By establishing the benign status of 11 of 13 masses that were indeterminate at sonography, cytology increased the specificity of the combined method (to 56.3%). Cytology appropriately suspected or confirmed malignancy in 79 (84%) of 94 carcinomas considered at sonography to be suspicious or malignant. CONCLUSIONS: In this study, sonography alone demonstrated a high sensitivity but limited specificity in evaluating nonpalpable breast masses. The addition of sonographically guided cytology substantially increased the specificity of the combined method without compromising sensitivity.

Adult↗
PubMed2000

[Sentinel node and operable breast cancer: utilization of blue dye injection. Pilot study].

STUDY AIM: Sentinel node detection in breast cancer can be realized with colorimetric and isotopic procedures often associated. The aim of this study was to report results obtained with blue dye injection only. PATIENTS AND METHOD: From September 1998 to July 1999, blue dye injection was performed in 73 consecutive patients (mean age: 51 years, range: 36-71 years); 51/70 70% were post-menopausal and half of them were under substitute hormonal treatment; 70% of cancers were discovered through routine mammography. There were 12 bilateral cancers, six of them synchronous, and 84% of cancers were located in the external quadrants. Individualization of sentinel node was performed through blue dye injection into the tumor in case of preoperative diagnosis or in the tumoral site in case of discovery of the cancer through extemporaneous histological examination. RESULTS: 71 out of 73 cancers were classified pT1 and 70% measured 10 mm and over. Individualization of sentinel node failed in two obese patients. Sentinel node invasion concerned one node (n = 7), two nodes (n = 1) and three nodes (n = 1). Conservative treatment was performed in 72 patients out of 73; in case of sentinel node invasion, axillary irradiation was performed without reoperation. CONCLUSION: Blue dye injection for sentinel node individualization is an accurate technique in selected patients in case of small tumors. Reoperation can be avoided and replaced by axillary irradiation in case of N+ tumors. Duration of hospitalization was 48 hours or under in 70/73 patients. Nevertheless isotopic procedure must be recommended as a routine technique in learning centers and for most surgical teams.

Adult↗
PubMed2000

[Sentinel lymph node detection in breast cancer. Experience of the Institut Curie].

Sentinel lymph node biopsy is a recently developed, minimally invasive technique for staging the axilla in breast cancer. This new procedure of selective lymphadenectomy has been the subject of several studies, and a consensus of opinion is starting to form to define indications and methods of identification concerning the use of this technique. At the Institut Curie since 1996, we have been using the Patenté blue dye technique and from 1998 we have used the combination of blue dye and technetium labeled sulfur colloid. This article summarizes the principales aspect of this technique.

Axilla↗
PubMed2000

Detection of MUC1-expressing mammary carcinoma cells in the peripheral blood of breast cancer patients by real-time polymerase chain reaction.

We have prospectively analyzed blood samples of 122 patients with breast disease for the presence of circulating expressing MUC1 cells before and after treatment. Among them, 28 patients had histologically confirmed benign breast disease (group 1), 34 patients had operable breast cancer (group 2), and 60 patients had advanced breast cancer (group 3). Circulating epithelial cells were isolated with BerEP4-coated immunomagnetic beads. Total RNA was extracted and reverse transcribed before analysis by real-time PCR of a MUC1-specific cDNA sequence. The sensitivity of the reverse transcription-PCR tested with blood spiked with MCF7 cells was one cell in 5 ml of blood. The immunomagnetic separation step was mandatory to obtain the maximum specificity. Control samples from healthy donors never displayed cycle threshold (Ct) values for MUC1 lower than 38. Circulating cells (Ct, <38) were detected in 3 of 28 (11%) cases in group 1, in 8 of 34 (24%) cases in group 2, and in 27 of 60 cases (45%) in group 3. A semiquantitative estimate of blood-borne cells could be derived from the Ct value when below 32 (the lowest was 28) or by the number of positive aliquots of the same blood sample. Thus, immunomagnetic separation, followed by MUC1-specific RT-PCR, allows the semiquantitative detection of circulating mammary cells. A significant correlation between the presence of MUC1-positive cells and the group of breast tumors was observed. The clinical significance of blood-borne cells in breast cancer, especially at the operable stage, may be investigated by following these patients.

Adult↗
PubMed2000

[Autologous breast reconstruction with latissimus dorsi flap].

The gold standard technique for autologous breast reconstruction is the transverse rectus abdominis flap (TRAM). Recently, techniques of harvesting a latissimus dorsi flap have been modified in such a way as to increase the flap and allow breast reconstruction without an associated implant. The aim of this study was to evaluate aesthetic results obtained with this method and to assess early morbidity related to the changes in the technique. Between January 1994 and August 1998, 43 patients underwent breast reconstruction with an autologous latissimus dorsi flap. Their postoperative outcome was compared to that of 30 patients who underwent reconstruction with a latissimus dorsi flap associated with an implant. These 43 patients were asked to come back for aesthetic evaluation by a physician and to answer a questionnaire about cosmetic results. Mean duration of follow-up was 18.6 months (range 8 to 60). Mean size of the breast reconstructed with this technique was 340 g (up to 835 g). Dorsal seroma was the most frequent complication (72%), followed by delayed dorsal healing (19%). The frequency of seroma was significantly increased when compared to a classic latissimus dorsi flap (P = 0.003), but frequency of skin slough was not. The aesthetic result was considered satisfactory in 93% of the cases by the patient and 77% of the cases by the physician. In conclusion, the extended latissimus dorsi flap allows reconstruction of small and medium size breasts, with a good aesthetic result. This flap appears to be an interesting alternative to the TRAM flap for autologous reconstruction in selected patients.

Adult↗
PubMed2000

[Value of macroscopic analysis for authentification of axillary sentinel nodes detected by Patent Blue dye alone during breast cancer surgery].

Assessment sentinel node coloration by the patent blue dye technique during breast carcinoma surgery largely depends upon the surgeon. It would therefore be valuable to define a procedure to validate the quality of the surgical specimen. With this aim, we have analyzed a series of 141 cases of sentinel nodes and determined whether the blue color of the node persisted after formalin fixation and could be assessed by examination of the tissue blocks. The pathologist's macroscopic control confirmed blue coloring in 114/141 cases (81%). This rate was similar when the sentinel node was metastatic (82.5%) (40 cases) or non metastatic (81%) (101 cases). Checking the color of the lymph node is a simple method to verify the quality of the surgical specimen. This item should be included in the pathologist's report. Several mechanisms can account for the lack of coloring of true sentinel nodes.

Breast Neoplasms↗
PubMed1999

Second look for ovarian cancer: laparoscopy or Laparotomy? A prospective comparative study.

OBJECTIVE: The objective of this study was to evaluate, for patients with ovarian cancer, the feasibility, reliability, and complications of a laparoscopic second look and to compare them with those of a second look by laparotomy. METHODS: Twenty patients treated by initial surgery and adjuvant chemotherapy for ovarian carcinoma underwent a laparoscopic second look, immediately followed by a comparative laparotomy. All were in complete remission after chemotherapy. Both operations were performed according to a predefined checklist, identical for both surgical techniques and for each patient: after liberation of adhesions, an exhaustive intraperitoneal inspection was performed, with systematic peritoneal cytology and biopsies. Each patient therefore was her own control for the two techniques. RESULTS: The positive predictive value of laparoscopy for the diagnosis of residual disease was 100% (6 of 6 cases), while the negative predictive value was 86% (2 false-negative cases out of 14). Because of the presence of postoperative adhesions, the rate of complete intraperitoneal investigation was 95% for laparotomy versus 41% for laparoscopy. The complication rate of laparoscopy requiring laparotomy was 5.3%. CONCLUSIONS: After treatment of ovarian cancer, a laparoscopic second look appears to be less reliable than one performed by laparotomy. The presence of severe postoperative adhesions is the main obstacle to an exhaustive, reliable, and safe laparoscopic second look.

Adult↗
PubMed1999

[Conservative treatment of multifocal breast cancer: a comparative study].

Conservative treatment of multifocal breast cancer is still very controversial. This retrospective study concerns 56 patients with stage I or II multifocal breast cancer who underwent conservative treatment at the Institut Curie from January 1983 to December 1989. These patients (group 1) were matched with 132 patients with multifocal lesions treated by mastectomy (group 2). Surgical treatment consisted of a single wide lumpectomy followed by external radiotherapy. Adjuvant systemic therapy and regional nodal irradiation were administered as indicated by current protocols. The actuarial 5-year overall survival rate was 94% 6 in group 1, and 90% 6 in group 2 (NS). The actuarial 5-year ipsilateral breast recurrence rate was 11% 8 in group 1, and 11% 5 in group 2 (NS). In group 1 patients, the ipsilateral breast recurrence rate was related neither to type of multifocality nor to presence of intra ductal breast carcinoma, nodal status, tumor margins, radiotherapy boost, or distance between tumors. Consequently, conservative treatment of multifocal breast cancers which can be completely removed by a single lumpectomy seems, when technically feasible, an alternative to mastectomy.

Adult↗
PubMed1999

[Identification of sentinel lymph node in breast cancer: experience from the Institut Curie].

Sentinel lymph node (SN) biopsy is a recently developed, minimally invasive technique for staging the axilla in breast cancer. This new procedure of selective lymphadenectomy has been the subject of several studies, but there is not currently a consensus of opinion to define which is the best method of identification. At the Institut Curie since 1996, we have been using the Patent blue dye. The current series present the result of 122 patients with T1, T2, N0 or N1a breast cancer consecutively operated between december 1997 and august 1998. Sentinel nodes were identified in 107 out of 122 (87.7%) and accurately predicted axillary nodal status in 104 out of 107 (97.1%) cases. Three out of 35 node positive patients would have been missed with sentinel node biopsy alone, for a false negative rate of 8.5%. In all 3 cases, one lymph node presented with a micrometastases. In 15 cases out of 35 with metastatic axillary nodes, the only positive node was the SN (43%). The encouraging results of this study shows that it is possible to identify, in a large number of cases, the sentinel node by means of Patent blue dye only. This article detailed the technique used and reviews the literature concerning other methods of identification.

Adult↗
PubMed1998

Conservative treatment of lower pole breast cancers by bilateral mammoplasty and radiotherapy.

AIMS: This series analyses the results of conservative surgery for large lower pole breast cancers by lumpectomy associated with a bilateral remodelling mammoplasty, in order to avoid residual deformities. METHODS: This retrospective study concerns 50 patients with a lower pole breast cancer treated between 1986 and 1996 by lumpectomy, mammoplasty and irradiation. The contralateral breast was immediately made symmetrical in all cases. The mean tumour size was 32.5 mm. RESULTS: The mean weight of the lumpectomy specimen was 270 g. Resection margins were tumour-free in 90% of cases. The main complication observed was delayed healing, thus postponing post-operative treatment in 6.5% of cases. The median follow-up was 48 months. The 5-year actuarial ipsilateral local recurrence rate was 7% and 5-year actuarial metastasis-free and overall survival rates were 81 and 97%, respectively. Cosmesis was satisfactory in 85% of patients. We observed better results when radiotherapy was performed after rather than prior to surgery (92 vs. 67%: NS). CONCLUSIONS: Performing a bilateral mammoplasty at the time of initial surgery for large breast cancers situated in the lower quadrants of the breast facilitates larger lumpectomies with good cosmetic results.

Adult↗
PubMed1998

Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction.

After conservative treatment for breast cancer, 20% to 30% of patients have a residual deformity that sometimes requires surgical correction. Thirty-five of these patients were operated between 1990 and 1995 at the Institut Curie. The authors classify these sequelae into three types: type I, asymmetrical breasts with no deformity of the treated breast; type II, deformity of the treated breast, compatible with partial reconstruction and breast conservation; and type III, major deformity of the breast, requires mastectomy. Fourteen patients had a type I deformity; all but 1 patient were treated with mammaplasty. Seventy-one percent underwent unilateral surgery contralateral to the irradiated breast; 80% had a satisfactory cosmetic result (good or very good). Seventeen patients had a type II deformity. They were treated by various techniques (implant, mammaplasty, latissimus dorsi flap, or transverse rectus abdominis musculocutaneous flap). Only 43.8% of patients in this group had a late satisfactory cosmetic result. Four patients had a type III deformity. They were treated with mastectomy and immediate reconstruction using a musculocutaneous flap. All 4 patients had a very good cosmetic result. This classification is a valuable guide for technique selection. For type I deformities, surgery to the irradiated breast should be avoided when possible. Type II deformities raise the most difficult therapeutic problems. Because they are mainly postoperative, optimal treatment should be preventive--by performing immediate remodeling of the treated breast before radiotherapy. This pleads for integration of plastic surgical techniques at the time of the original lumpectomy, thus reducing the need for delayed reconstructive surgery.

Adult↗
PubMed1998

Low-dose steroids reduce flu-like symptoms at the initiation of IFNbeta-1b in relapsing-remitting MS.

To determine whether low-dose prednisone reduces flu-like symptoms at the initiation of interferon beta 1-b (IFNbeta-1b), we studied 71 patients with clinically definite, relapsing-remitting multiple sclerosis who were started on IFNbeta-1b. Patients were randomized to receive prednisone plus paracetamol or only paracetamol and were monitored for side effects. Systemic side effects were minimal in the steroid group compared with the nonsteroid group during the first 15 days of treatment (p=0.005). At 3 months, both groups showed a similar frequency of flu-like symptoms. No differences in local reaction between the two groups were observed throughout the study.

Acetaminophen↗
PubMed1998

[Indications for diagnosing nonpalpable breast lesions].

The increasingly widespread use of mammographic screening for breast cancer has induced a considerable increase in the number of surgical biopsies. Fine-needle aspiration and microbiopsies can allow to reduce this number. 1) In patients with nodular densities of benign or indeterminate appearance, a negative fine-needle aspiration indicates that no further investigations are needed. In contrast, complete surgical excision is indicated in cases of stellate images. 2) In patients with potentially malignant microcalcifications, fine-needle aspiration is to little value, and microbiopsies should be performed. Indeterminate (type II or III) calcifications are the best indication, since negative microbiopsies may obviate the need for lumpectomy, if the negative predictive value of microbiopsies is sufficiently high in this indication. Focal suspicious microcalcifications (type IV or V) should be removed surgically for both diagnostic and therapeutic purposes. Type IV or V microcalcifications involving a large area of the breast can be investigated by initial microbiopsy; a positive result allows to recommend immediate mastectomy without prior lumpectomy. Fine-needle aspiration and microbiopsies should be performed as part of a multidisciplinary diagnostic strategy involving radiologists, surgeons, cytopathologists, and pathologists. This approach is the only means of improving the management of non palpable mammographic lesions and of reducing the number of unnecessary operation.

Biopsy↗
PubMed1997

[The development of multiple sclerosis following an isolated episode of optic neuritis. Magnetic resonance study].

BACKGROUND: An important controversy on the development of multiple sclerosis (MS) after an isolated episode of optic neuritis (ON) exists. Magnetic resonance imaging (MRI) is the method of election in order to detect demyelinated lesions in MS. The current study was designed to determine the prevalence of brain abnormalities on MRI and to asses the further development of MS after an isolated idiopathic ON in our population. PATIENTS AND METHODS: From 1991 to 1995, 60 patients with decrease of visual acuity were studied, 35 (28 women, half age 31 +/- 10 years) completed criteria of idiopathic ON. A brain MRI was performed in all patients after the diagnosis of idiopathic ON and they subsequently were followed in the outpatient clinic from our center for a mean time of 29 +/- 16 months. 24 out of the 35 patients were treated with corticosteroids in different ways. RESULTS: It has been found 43% of the patients with idiopathic ON to have brain lesions by MRI. During the follow-up 14% of the patients developed a clinically definite MS; all of them had a pathological brain MRI at the basal evaluation (p = 0.009). None of the patients that were treated with high-dose of intravenously corticosteroids developed MS. CONCLUSIONS: The prevalence of silent cerebral lesions in the MRI after an idiopathic ON is elevated in our population although further development of MS is lower possibly due to the short follow-up carried out. The presence of lesions in the MRI confers a high risk for developing MS after an idiopathic ON.

Adolescent↗