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D von Fournier

Publications and source records attributed to D von Fournier.

At least 37 records · Page 2Linked to original sources
PubMed1993

Decelerating growth and human breast cancer.

BACKGROUND: Improved understanding of human breast cancer growth rates may have many clinical applications. Previous reports have used small numbers of patients and assumed an exponential growth rate. METHODS: The exponential equation and the most commonly used decelerating growth equations, the Gompertz equation and seven generalized forms of the logistic equation, were fitted to mammographic measurements of primary breast cancer using the least squares method. An average of 3.4 observations was made in 113 patients, whereas two measurements were made in another 335 patients. Tumors were assumed to originate as a single cell with the lethal tumor volume assumed to be 2(40) cells. RESULTS: All decelerating equations tested provided a better fit than the exponential, whereas a form of the logistic equation provided the best fit to the data. Limitations in the number of tumor measurements, the assumption of maximal tumor size, and biases inherent in the method of data collection are reviewed. These observations suggest families of curves that characterize breast cancer growth during the early period of clinical observation. CONCLUSIONS: Breast cancer growth in the early clinical period was modeled by a form of the logistic equation. The exponential equation fit the data least well.

Breast Neoplasms↗
PubMed1993

Mammographic assessment of human breast cancer growth and duration.

BACKGROUND: Accumulating data from numerous sources have confirmed that breast cancers have highly variable rates of growth. Contemporary thought supports that collectively the gross rates should decelerate with increasing tumor mass. METHODS: Using composite data derived from mammographically measured growth of breast cancers observed at the Universities of Heidelberg and Louisville, the growth curve providing the best fit to the observed data, and the variance occurring around this curve has been calculated. RESULTS: A generalized logistic equation provided the best fit, with a natural variance ranging from extremely rapidly growing to slowly growing cancer. These data do not cover the entire range of growth rates because cancers appearing acutely between mammograms were observed only once, and some breast cancers never grew. CONCLUSIONS: The highly variable decelerating growth rates of breast cancers are better but incompletely defined, and these rates are of value in considering screening strategies and prognosis.

Adolescent↗
PubMed1993

[Blood supply of malignant and benign tumors of the internal genitals].

Malignant tumours differ mostly from benign lesions in their blood supply. This fact can be used in the sonographic diagnosis of the tumour status. This, however, depends on the availability of ultrasound equipment, capable of demonstrating this difference, which can only be detected in smallest blood vessels, in which the blood flow is extremely slow. We employed the Sonolayer SSH 140A (Toshiba, Japan) and the Quantum 2000 (Siemens, Germany) for diagnosis of lesions of the female inner genital tract. Both instruments could visualize the slow blood flow velocities in the tissues examined. Diagnosis of blood circulation in tumours of the inner genital tract thus seems less dependent on the technology employed as is the case in examining the breasts. 41 patients with ovarian tumours, 31 with endometrial pathology, and 33 with cervical lesions were examined preoperatively. Findings were correlated to histology. The lowest resistance index (RI) measured was evaluated. The following RI values were found: Ovarian tumours: malignant 46%, benign 78% (49%). Tumours of the corpus uteri: malignant 54%, benign 65% (55%). Cervical lesions: malignant 55%, benign 79% (58%). Results in premenopausal women with non-malignant lesions are specified in brackets. Pre- and postmenopausal status proved essential. When compared to breast findings, the difference between benign and malignant tumours of the inner genital tract is less pronounced due to the fact, that, physiologically, these tissues are characterised by a higher blood supply. Differentiation was thus almost impossible in premenopausal women. However, in menopausal patients, a highly significant difference between benign and malignant tumours was found, which could serve as basis for tumour status prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1993

[Breast cancer: results of breast saving treatment].

Two thirds of the breast cancer cases in Heidelberg were treated with breast-preserving therapy (BCT). A reduction in tumor size with preoperative chemotherapy meant that the number of cases could be increased. Segment resection must, however, take place well into healthy tissue, and high-dose irradiation with the boost technique is standard procedure. A prospective randomized comparison showed that the five- to ten-year survival rate was 10% better following BCT than after mastectomy. Local recurrence after five years occurred in 4 to 6% of the cases, in 9% of the cases after mastectomy without postoperative irradiation. Even after ten years, local recurrence did not lower the survival rate. The rate of distant metastases was significantly higher in patients who did not receive postoperative irradiation after tumorectomy. For this reason irradiation must only be omitted in exceptional cases. There was no evidence of local recurrence in 90% of those women who died of distant metastases. Two years after treatment 98% of the women indicated that they would still give BCT preference over mastectomy.

Brachytherapy↗
PubMed1993

[Breast cancer screening. State of the art and introduction to preventive measures].

Carcinoma of the breast is the most frequent cause of death in women aged between approximately 38 and 50 years. At present, 1 out of 14 women in Germany and 1 out of 9 in America suffer from breast cancer within a life time. To date, modern methods of treatment and hormone therapy have only been able to increase long-term survival by about 12%. Trials have shown that early diagnosis alone has been able to increase survival from 20% to 50%. Early diagnosis proved to be most effective when clinical examination plus mammography in two planes was carried out annually. An increase in survival has been achieved in post-menopausal women as a result of screening. 22 percent of breast cancers were detected at a curable in situ stage by means of screening. Even after a limited screening program of 4 examination cycles the increase in survival rate over 15-20 years was significant.

Breast Neoplasms↗
PubMed1993

[Clarification of breast lesions using core-cut, drill and fine needle biopsy].

Interest in needle biopsy methods (core cut-, drill-, and fine-needle biopsy) has recently increased considerably because of the rise in screening mammography and new developments in the therapy of breast cancer. In order to achieve adequate results using needle biopsy and to avoid complications, certain technical details must be strictly adhered to. An experienced surgeon can achieve a sensitivity of above 90% in the diagnosis of breast carcinoma with all three methods. Considering the advantages and disadvantages of these three methods of needle biopsy, we prefer--based on our own experience--high-speed core-cut biopsy for the morphological evaluation of breast lesions.

Biopsy, Needle↗
PubMed1993

[Effect of intracavitary irradiation on the venous system of the pelvis and leg].

A late complication of combined radiotherapy for malignoma of the inner genital tract is leg edema, whether of venous or lymphatic origin, which is not always clear. To analyse the influence of radiotherapy upon the pelvic and leg venous system, we performed sonographic caliber, occlusion plethysmographic and light reflexion rheographic measurements of veins in 32 patients prior and subsequent to irradiation. No statistically significant difference was found between mean values measured with the different methods. A clear deterioration of venous function was detected after treatment. Sonographic examinations of pelvic vessels after radiotherapy showed veins much less clearly outlined and with thicker walls, thus pointing to a direct connection between irradiation and edema of the vein wall. Whereas deterioration of the other parameters may also be explained by, for example, long periods of lying. Since according to our own observations, an insufficiency of the leg venous valves occurs relatively often, sometimes even years later, there is a clear correlation between irradiation and edema of the venous wall, with a slight deterioration of venous function detectable directly after irradiation. In order to prevent vein damage, prophylaxis of thrombosis and vessel topography should therefore always be considered when planning radiotherapy.

Adult↗
PubMed1992

[Ultrasound diagnosis of blood flow in benign and malignant breast tumors].

Malignant tumours can be differentiated from the benign ones by their vascular blood supply. We employed three methods to analyse the blood flow: the angiodynograph, the duplex system, and the continuous-wave Doppler method, and measured the blood flow in 151 patients on the preoperative day. Histology revealed a malignoma in 92 cases and a benign tumour in 59 cases. It was found, that in more than 90% of the malignomas, a high blood flow was identified in or around the tumour by means of the colour method (angiodynography), which could be quantified by the pulsed-wave Doppler. A significantly lower blood flow was evident in the benign tumours with a markedly increased resistance index (by 80%) established by means of the pulsed-wave Doppler. Continuous-wave (CW) Doppler showed a significantly higher blood flow with almost all malignomas in the entire breast, than was the case with benign changes. Our studies showed, that the enhanced blood flow in and around malignant tumours can be visualised by means of update technology, angiodynography being particularly suitable for demonstrating the flow by the B-mode. Quantification, however, is, at present, only possible by employing the duplex method with pulsed-wave Doppler. CW Doppler is suitable only for blood flow diagnosis of the entire organ, but it requires great precision of working method and is time consuming; tumour blood flow cannot be visualised on-target by this method.

Blood Flow Velocity↗
PubMed1992

[Results of treatment in vulvar cancer from 1970 to 1990].

From 1970-1990, 159 patients with invasive malignant tumours of the vulva (150 squamous cell carcinomas) underwent surgery at the University Hospitals, department of gynaecology. Heidelberg (1970-1988) and Homburg/Saar (1988-1990). 73% of the patients were more than 60 years old and 3% were less than 40 years old. The mean age was 69 years. 30% of the patients had diabetes mellitus. As a standard therapy, 101 patients had radical vulvectomy with bilateral inguinal node removal in accordance with S. Way. If nodes were found to be positive, the inguinal/pelvic region was irradiated postsurgically with 40-50 Gy. The 5 years survival rate for all patients with vulvar carcinoma was 69%. For early stage carcinomas (pT1, depth of invasion < or = 1 mm) a restricted radical therapy should be considered. 9 patients with early stage carcinomas survived disease-free for a period of 70 months. Significant prognostic differences were noticed if node histology was N- as opposed to N+ (p < 0.001), if depth of invasion was < or = 1 mm as opposed to > 10 mm (p < 0.001), if stage was pT1 as opposed to pT2 to pT4 (p < 0.001) or if lymphangiosis carcinomatosa (p < 0.01) was present or not. Prognostic differences were also noticed, if cytological grading was done in accordance with Broders (p < 0.09). 27 patients had successful reconstructive surgery with local cutaneous or myocutaneous flaps at the time of initial surgery. The median recovery period after radical vulvectomy with bilateral inguinal lymph node excision was 22 days. The median recovery period after radical vulvectomy with bilateral node removal and reconstructive surgery was 25 days. Early recurrence of carcinoma (< or = 6 months after initial therapy) was 5.9%, late recurrence was 12%.

Aged↗
PubMed1992

[Palliative laser therapy in gynecologic oncology].

Local recurrences of carcinomas of the breast and genitals are a severe psychic and physical strain on the patients. Continuous confrontation with an often visible and generally painful tumour manifestation is an indication for palliative treatment, if other oncological therapies can no longer be employed. In these cases, the possibility of laser use represents a new therapeutic approach. In a pilot study at the University of Heidelberg, Department of Obstetrics and Gynaecology, a palliative laser therapy was performed on 45 patients with locally recurrent carcinomas of the breast (n = 29) and genitals (n = 16). Carbon dioxide and Nd:YAG lasers were utilized for tumour resection, vaporisation and coagulation. This new concept, the combined application of both wavelengths has been proved to be most efficient.

Adult↗
PubMed1992

[Recurrences, the surgical and radiological side effects and new developments in the breast-preserving treatment of breast carcinoma].

In the Department for Gynecology and the Department for Gynecologic Radiology, University of Heidelberg, breast conserving therapy was carried out in 1,330 patients with breast cancer between 1975 and 1990. The tumor size was up to 3 cm, 28% showed positive nodes. The medium age was 47.6 years, segmental resection was the standard operation, whole breast irradiation with 50 Gy and an additional boost of 10 Gy was standard irradiation schedule. After five years (n = 307) the following results were observed: local failure 6.8%, regional lymph node recurrence 2.1%, overall survival 88.3%, disease-free survival 81.2%. Five out of 36 of the death-cases died without recurrence. Significant factors for local failure were following: 1. lymphangiosis of more than 1 cm in size around the tumor (p = 0.03); 2. intra-ductal non-invasive cancer of more than 1 cm in size around the primary (p = 0.01); 3. intra-ductal non-invasive cancer reaches the margin of resection (p less than 0.00001). With segmental resection (2 cm margin macroscopically free of tumor) showed in 19% histologically tumor beyond the margins so-called residuals. In the other three quadrants additional second primaries of (multicentric cancers) macroscopical size could be confirmed in an additional study. In case of high risk for local failure more radicality in operation as well as in irradiation is recommended.

Adult↗
PubMed1992

[Breast cancer screening: current status and introduction as a preventive service].

1. Screening intervals according to Tabar: 1 year in women younger than 50 in order to minimize "interval cancers". 2 years in women older than 50 years. 2. Mammographic views according to Lundgren et al: 2 views at first round 1 oblique view in the following rounds, yearly. All women on risk should attend screening. The identification of useful "high risk groups" is not established. Palpation is recommended at each screening. Self-examination is recommended. Adjuvant therapy should not depend on lymph node status in screening-cancer cases. It should depend on clinical and histological "prognostic factors".

Adult↗
PubMed1992

[Ultrasound diagnosis of fetal lung maturity--a new method].

First results are presented to determine the maturity of fetal lung by sonography. Using the fetal liver as a reference-organ we are avoiding the known pitfalls which made it impossible in the past to standardize the fetal lung changes depending on the age of gestation. We examined 104 patients between week 27 and week 41. In one ultrasound section cut we depicted as well lung and liver. According to the known A-mode we registered frequencies in both organs. The registered frequencies were entered digitally into a computer and checked for f(mean), f(max) and f(min). Afterwards the frequencies of the lung were divided by those of the liver. Of all weeks of gestation the mean value and standard deviation were calculated. We found the liver as an adequate reference-organ, since there is no change of the reflection pattern between the different weeks of gestation, while there are significant changes to be registered in the fetal lung, a cutting line being week 35. A quotient of f(mean) lower than 1.1 hints to lung maturity while values over 1.1 point to immaturity. This was confirmed by several cases of analysis of amniotic fluid (L/S-ratio). Further comparisons with amniotic fluid results will have to validate these findings.

Amniocentesis↗
PubMed1992

[Doppler ultrasound study of breast tumors using color Doppler ultrasound, duplex ultrasound and the CW Doppler ultrasound].

The preoperative examinations by doppler-sonography of 83 patients with tumors of the breast are presented. The examinations are done with newest technique: duplex-sonography in slow-flow-technique (AI 3200, Dornier); colour-sonography in MEM-technique (AI 5200, Dornier) and synchronical colour-doppler++ (Quantum 2000, Siemens) and CW-doppler-sonography (Vasocope 3, Kranzbühler). There is a markable difference between the side of carcinoma and the normal side as well as pre- and postmenopausal patients. No difference is shown in cases of benign tumors and the normal side. The increasing blood flow of a malignant tumor is showed in changing the doppler parameters (A/B-ratio and resistance-index) and in the doppler wave form. The number of vessels found in or around a tumor is not a good criteria to find malignant diseases, the best criteria is the difference between sides of the mamma.

Blood Flow Velocity↗
PubMed1991

[New methods for treating surgically incomplete or inoperable recurrences of gynecologic malignancies].

Following radical or subradical surgery or an inoperable situation of recurrences of gynaecological tumours of the vaginal vault or the pelvic wall we suggest two different techniques of irradiation: 1. transtumoural afterloading-methods with a) flexible probes, and b) non-flexible probes 2. The application of iodine seeds. The objectives of these procedures are direct irradiation of the tumour or tumour-bed with limited irradiation volume, as well as the possibility of a simultaneous spacing and therefore protection of nearby pelvic and abdominal organs, which should not be irradiated and damaged. Examples of the various techniques of the distinguished operative and radiological procedures are presented.

Aged↗
PubMed1991

[Systemic therapy in recurrent and primary advanced cervix cancer].

Therapeutic results in advanced cervical cancer have not been showing any progress for more than 30 years. Only by means of systemic therapy does it seem possible, that further treatment results may be obtained similar to those in squamous cell carcinoma of the head and neck. Therefore, between 1985 and 1990 we tried to apply an aggressive polychemotherapy regimen for 5 days with cisplatinum and 5-fluorouracil with supportive treatment in 47 patients with either primary advanced inoperable (n = 25) or recurrent (n = 22) cervix carcinomas. Complete (n = 12) and partial remissions (n = 24) could be obtained in 36 out of 47 cases (= 77%). However, this high response rate conceals the fact, that this aggressive palliative treatment in case of recurrence and/or distant metastases means a considerable deterioration of quality of life with a median survival time of only 9.5 months. Although primary therapy with combined chemoradiotherapy shows good results, it is, however, only a real advantage for patients with complete response. Taking into account the short period of observation (median 25 months), the overall survival of all primary advanced cervix carcinomas is 13 + months, in case of complete remission 20 + months. It remains to be seen, whether sequential or simultaneous chemoradiotherapy will prove superior. Due to severe haematoxicity (WHO grade IV) after the first 3 treated patients, a dose reduction of 20% of chemotherapy was necessary. No further severe toxicities occurred. By means of supportive care, other side effects could also be well controlled, so that this effective polychemotherapy regimen is not only efficacious but also practicable. Prospective randomised studies are required to determine the importance of exclusive or combined chemoradiotherapy in advanced as well as in operable cancer of the cervix.

Adult↗