Biomedical subjects

E Stöckle

Publications and source records attributed to E Stöckle.

30 records · Page 2Linked to original sources

PubMed1993

[Is there a place for 2nd look laparotomy in the treatment of ovarian cancers?].

The charts of 147 patients with advanced ovarian cancers responding completely (CR) or partially (PR > 50%) to a primary cisplatin-based chemotherapy are reviewed. All fulfilled our criterias to undergo second-look laparotomy. One hundred patients (group A) underwent second-look laparotomy and 47 patients (group B) other features of control: laparoscopy 37 patients, clinical control ten patients. Apart metastatic spread more frequent in group B (A vs B = 10 vs 32%) and tumor grade 1 more frequent in group B (A vs B = 33 vs 49%), the two groups were well balanced concerning tumor characteristics and treatment features. All patients had received a complementary treatment after the second-look procedures. With a median follow-up of 86 months in group A and 104 months in group B, no difference was found in overall nor in recurrence-free survival. Within group A, 34 patients had achieved pathologic proved complete remission. Their 5-year survival was 73% with an incidence of recurrence of 32%. Second-look laparotomy was found an invasive technique with a 15% operative morbidity. Its therapeutic apport seems absent and the diagnostic role limited to indication of radiotherapy in CR patients. Second-look laparotomies should be reserved to trials evaluating its proper place but should not be used systematically to assess tumor response to chemotherapy. The good 5-year survival of the CR mi group suggest the beneficial impact of complementary treatment, but prospective trials are needed to evaluate the place of this treatment.

Adult↗

PubMed1993

[Quality control of care in a surgical department. Experience of the Fondation Berganié].

Activity in a surgical department can be evaluated quantitatively, but is should also be assessed qualitatively. One way to control the quality of care is to determine as accurately as possible the incidence of pre- peri- and post-operative complications and to analyse these date in a critical comparative study. This was accomplished in the surgical department of the Fondation Bergonié, Bordeaux during three test periods over the last five years--March 1987 (127 patients), June-July 1989 (276 patients), and June 1991 (147 patients). Results of this analysis cannot validly be compared with those of other departments with different patient recruitment and activity functions. However, this study within a department with regular, homogeneous activity did demonstrate, over a period of several years, a clear reduction in operative mortality, essentially by improved control of infectious complications by the extensive use of prophylactic antibiotic therapy for all surgery with a septic risk or for debilitated patients. Results also demonstrated the low cost effectiveness of routine pre-operative exploratory examinations.

Anesthesia, General↗

PubMed1992

Colonic metastasis of a renal carcinoma. A case report.

A 64 year-old man with a metastatic clear-cell renal carcinoma experienced low intestinal bleeding. The endoscopy revealed a polypoid mass in the left colon which proved to be a metastasis of the renal carcinoma. This is an uncommon cause of intestinal hemorrhage, and a rare localization of metastatic deposits.

Adenocarcinoma↗

PubMed1992

Prognostic variables for the selection of patients with operable soft tissue sarcomas to be considered in adjuvant chemotherapy trials.

From 1975 to 1988, 144 patients naive of treatment, with non-metastatic soft tissue sarcoma were treated at Fondation Bergonié by surgery, followed by radiotherapy and without chemotherapy. An analysis of prognostic variables was done on this population to determine patients for whom an adjuvant chemotherapy would be relevant. Prognostic variables in overall survival (OS), metastasis-free survival (MFS), disease-free and local free recurrence survivals were analysed by univariate and multivariate analysis. In multivariate analysis using Cox's model, only tumour depth and tumour grade were significant with the MFS end point, while tumour depth, tumour grade and tumour site were significant when considering OS. A predictive stratification for patients is proposed: a favourable prognostic group with grade 1 tumour or superficial, grade 2 tumour (5-year OS: 97.8%; 5-year MFS: 100%); an intermediate prognostic group with deep, grade 2 tumour or superficial, grade 3 tumour (5-year OS: 58.8%; 5-year MFS: 48.1%); and finally a poor prognostic group with deep, grade 3 tumour (5-year OS: 31.7%; 5-year MFS: 34.1%). Patients in the intermediate and poor prognostic groups who present a high metastatic risk are to be considered for adjuvant chemotherapy trials.

Adolescent↗

PubMed1992

[Neoadjuvant chemotherapy and combined conservative treatment of soft tissue sarcoma in the adult].

Between 1980 and 1990, 64 adults with a locally advanced soft tissue sarcoma, but without metastasis, were treated with neoadjuvant chemotherapy before conservative local treatment. Tumour localizations were limbs in 26 patients (40.6%) and other parts of the body in 38 patients (59.4%). Moreover, 27 patients had bone and/or vasculo-nervous axis involvement. Response to chemotherapy was > or = 50% for 23 patients (37.7%) with 3 complete remissions, < 50% for 36 patients and only 2 tumours progressed during chemotherapy. Conservative surgery was thus carried out for 51 patients (79.7%), 11 received external radiotherapy only. At the end of treatment, 49 patients (76.5%) were in complete remission. With a median follow-up of 76 months (range: 25 to 147), 25 patients are alive with no evolutive disease. For the whole population, the actuarial 5-year overall survival is 33.8%. Among the patients who were in complete remission at the end of therapy, 15 developed local recurrences (with metastasis for 7 patients) and 10 became metastatic. Actuarial 5-year overall survival for this subset of patients is 44.8%.

Actuarial Analysis↗

PubMed1991

[Does the Leveen valve still have a place in the treatment of refractory ascites? An evaluation of 107 cases].

One hundred and seven patients have been treated by the peritoneovenous shunt (PVS) : 54 patients from 1979 to 1984 (P1) and 53 patients from 1985 to 1990 (P2). The mean age was 58 years (25-79 years) and 73 % of the patients had a cirrhosis of alcoholic origin. The mortalities at two weeks and one month were 22 % and 26 % for P1 and 6 % and 11 % for P2. The risk of operation was related to the importance of hepatic and kidney insufficiency and to the importance of hyponatremia. Long term outcome depended on the causal illness. At short term, the morbidity can be reduced and the PVS should be indicated earlier in the progression of the illness.

Adult↗

PubMed1991

[Modification of taste in cancer patients].

This paper is a review about the relationship that may exist between taste alterations in cancer patients and cancer itself, surgery, chemotherapy, radiotherapy or symptomatic treatments. Therapeutic strategies dealing with patients with taste alterations are also discussed.

Humans↗

PubMed1991

[Curietherapy-surgery for epidermoid carcinomas of the uterine cervix T1].

Between 1975 and 1985, we have treated 157 patients with carcinoma of the cervix T1. The size of the tumor was always equal or less than 30 mm. Our patient underwent Cesium 137 brachytherapy with Fletchers applicators followed by a modified radical hysterectomy and pelvic lymphadenectomy 4 to 6 weeks later. Intracavitary brachytherapy was performed within three days (low dose rate 0.8-1 Gy/h). The median 60 Gy Isodose was: 65 mm height, 58 mm width and 29 mm thickness. At surgical time we mentioned that vaginal cut out was 2-3 cm and pelvic lymphadenectomy limited to external iliac nodes. The 5 and 10 disease Free Survival was respectively 91.6 and 89.4%. We observed 14 relapses, five were distant metastases only. The tumor size and pelvic node involvement were the main prognostic factors in our data. The sterilization of the cervix wasn't of prognostic value. Complications occurred in 22 patients, 2 (1.3%) were severe urinary injury.

Brachytherapy↗

PubMed1990

Decreased serum tryptophan in patients with HIV-1 infection correlates with increased serum neopterin and with neurologic/psychiatric symptoms.

We investigated serum neopterin, tryptophan, and kynurenine concentrations in 23 HIV-1 seropositive patients (Walter Reed Stage 4-6). Ten patients presented with polyneuropathy and three with dementia, one of the patients with dementia also had polyneuropathy and dementia. We found significant associations between lower trytophan concentrations and neurologic/psychiatric symptoms. The negative correlation of tryptophan with kynurenine and neopterin concentrations indicates activity of indoleamine 2,3-dioxygenase (IDO) in patients. IDO can be induced by cytokines such as interferon-gamma and therefore low tryptophan levels may result from chronic immune stimulation in HIV-1 seropositives.

Acquired Immunodeficiency Syndrome↗

PubMed1990

[Long-term clinical course after second laparotomy in ovarian cancer].

A series of thirty consecutive epithelial ovarian cancer patients were reviewed after long-term follow-up (more than 5 y) since their second-look operation (SLO). All patients had advanced tumors (stages IIb-IV). Primary chemotherapy consisted of a cisplatin-associated regimen. For all patients adjuvant treatment had been planned after completion of the SLO. Mean follow-up after SLO was 68 months (47-103 months). Tumor status at SLO divided the patients in 2 subgroups: Group A = 13 patients (43%), with no evidence of histologically proved disease at time of operation (NED); Group B = 17 patients (57%), with macroscopic persistence of tumor. Survival was significantly better in the first group than in the second (77% at 5 yr vs less than 25%). Recurrence rate in the NED group was 7.7% (1 recurrence at 32 months). Eight of 17 patients with gross tumor at SLO underwent satisfactory resection. However, recurrence rate was high (75%) and survival rate was low (25% at 5 yrs). This result was not significantly better than that of patients with no optimal resection at SLO (9 patients, survival 22%). Second effort resection at SLO does not seem to be beneficial in these patients after partial failure of initial chemotherapy with cisplatin. The usefulness of systematic second look operations is discussed. Controlled randomized trials should be made to determine the exact role of SLO in ovarian cancer treatment.

Adult↗

PubMed1990

[Postoperative radiotherapy in soft tissue sarcomas of the limbs. Analysis of irradiation volumes and doses in a series of 31 cases].

From October 1985 to October 1988, 31 patients with a soft tissue sarcoma of extremities were treated in our institute by conservative resection and post-operative radiation therapy. The initial target volume encompasses the entire musculoskeletal area occupied by the tumor. The compartmental definition of this initial target volume is based on clinical, radiographic, histopathologic and operative findings. We analyzed the irradiated volume in terms of the anatomical definition and feasibility. We then evaluated the distribution of the dose in the irradiated volume. The variation of the dose is always less than 10%. Accordingly, the range of dose in the irradiated volume varies from 45 to 50 Gy in the compartmental volume after a complete resection, and from 55 to 60 Gy in the tumor bed after a marginal or incomplete resection. For this series, the median follow-up is 27 months. We observed 3 distant metastases and 1 progressive disease in the irradiated volume. No locoregional recurrence appeared in the margins or outside the irradiated volume. These preliminary results validate the compartmental definition of the initial target volume. Furthermore, they point out the lack of opportunity to encompass tendinous insertions in the irradiated volume and to boost the scar. Finally, the definition of optimal dose for the control of microscopic residual tumor is discussed.

Adult↗

PubMedDate not supplied

[Conservative treatment of extremity soft tissue sarcomas. Functional evaluation using LENT-SOMA scales and Enneking scoring].

OBJECTIVE: The aim of this prospective study is the feasibility of late effects assessment by LENT-SOMA scales after conservative treatment of soft tissue sarcomas of the extremities and a comparison with the functional evaluation by the Enneking score. PATIENTS AND METHODS: During the systematic follow-up consultations, a series of 32 consecutive patients was evaluated in terms of late effects by LENT-SOMA scales and functional results by the Enneking score. The median time after treatment was 65 months. The treatment consisted of conservative surgery (all cases) followed by radiation therapy (29 cases), often combined with adjuvant therapy (12 concomitant radio-chemotherapy association cases out of 14). The assessment of the toxicity was retrospective for acute effects and prospective for the following late tissue damage: skin/subcutaneous tissues, muscles/soft tissues and peripheral nerves. RESULTS: According to the Enneking score, the global score for the overall series was high (24/30) despite four the scores zero for the psychological acceptance. According to LENT-SOMA scales, a low rate of severe sequellae (grade 3-4) was observed. The occurrence of high-grade sequellae and their functional consequences were not correlated with quality of exerese, dose of radiotherapy or use of concomitant chemotherapy. A complementarity was observed between certain factors of the Enneking score and some criteria of the LENT-SOMA scales, especially of muscles/soft tissues. CONCLUSION: The good quality of functional results was confirmed by the two mean scoring systems for late normal tissue damage. The routine use of LENT-SOMA seems to be more time consuming than the Enneking score (mean time of scoring: 13 versus five minutes). The LENT-SOMA scales are aimed at a detailed description of late toxicity and sequellae while the Enneking score provides a more global evaluation, including the psychological acceptance of treatment. The late effects assessment by the LENT-SOMA scales should be carried on in prospectives studies, especially in case of concomitant radio-chemotherapy.

Adult↗