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Biomedical subjects

F Campana

Publications and source records attributed to F Campana.

At least 19 recordsLinked to original sources
PubMed2006

Breast radiotherapy in women with pectus excavatum (funnel chest): is the lateral decubitus technique an answer? A dosimetric study.

Breast radiotherapy is a technical challenge in women with pectus excavatum. We aim to assess isocentric lateral decubitus (ILD) technique as a means to irradiate breasts for patients with pectus excavatum. Four women presenting with left-sided breast cancers and found to have pectus excavatum were offered breast-conserving treatments. Post-operative breast radiotherapy was indicated (50 Gy) in two patients, with an additional boost to the tumour bed (16 Gy). Both ILD and supine techniques were simulated. We report the dosimetric comparison of these techniques and the acute skin toxicity of ILD radiotherapy. ILD permitted the same breast dose-homogeneity as the supine technique while decreasing breast thickness by 4.5-6.8 cm. The width of lung and/or heart receiving > 20 Gy ranged between 2.1 cm and 4.3 cm with the supine technique and between 0.5 cm and 1.1 cm with ILD. The estimated percentage of ipsilateral lung receiving > 20 Gy ranged from 21% to 34% with the supine technique and from 0% to 5% with ILD. Acute skin toxicity was scored 1 for all patients at completion of ILD radiotherapy. ILD is an effective breast radiotherapy technique for patients with pectus excavatum that preserves the underlying heart and lung from unnecessary toxicity.

Adult↗
PubMed2006

[Multiple verruciform xanthomas of the oral mucosa associated with graft versus host disease].

BACKGROUND: Verruciform xanthoma is an uncommon lesion that occurs primarily on the mucous membranes and more rarely on the skin. A few authors have reported the extremely rare occurrence of multiple lesions. Triggering or enhancing factors have been occasionally described such as an underlying immunosuppression or associated inflammatory mucous or skin diseases. We report, to the best of our knowledge, the first case report of multiple verruciform xanthomas of the oral mucosa in a patient with graft-versus-host disease with specific oral lesions. CASE REPORT: A 57 year-old man presented with an 8-year history of chronic myeloid leukemia. He was considered in complete remission for leukemia after allogenic bone marrow transplantation. Nevertheless, he was still treated with immunosuppressive drugs for oral and cutaneous lesions of chronic graft-versus-host disease. In this context, the patient presented two symmetric lesions of the gingiva. These lesions had progressed over several months. The clinical presentation was similar, with a yellowish and verrucous aspect and a sessile base. Histologic and immunohistochemical analysis led to the diagnosis of multiple verruciform xanthomas. DISCUSSION: The occurrence of multiple lesions of this rare tumour in our patient was probably not fortuitous. Immunosuppression associated with oral chronic inflammatory lesions are certainly involved in the pathogenesis of these two verruciform xanthomas, for example following degeneration of epithelial cells after local chronic irritation and/or reduction of Langerhans cells. Systematic research of enhancing or triggering factors seems essential in verruciform xanthoma.

Bone Marrow Transplantation↗
PubMed2006

Estrogen receptors evolution in neoadjuvant aromatase inhibitor (AI) therapy for breast cancer in elderly women: stability of hormonal receptor expression during treatment.

UNLABELLED: In France, 20% of breast cancers occur in women over the age of 70 and 10% in women over the age of 80. As these women are not included in screening programs, breast cancer is often diagnosed later, at the stage of a large tumor. PURPOSE: To analyze clinical response, possibilities of conservative treatment and course of hormonal receptors in patients receiving neoadjuvant aromatase inhibitor (AI) therapy for at least 6 months. PATIENTS AND METHODS: There were 75 patients, with a mean age of 75 +/- 8 years (range, 58-91 years) received AI for 6 months after the diagnosis of invasive breast cancer with positive hormonal receptors. Clinical and radiologic tumor reduction, the number of conservative treatments and the course of estrogens receptor-labeled cells were determined for each patient. RESULTS: All but 1 of these patients obtained clinical reduction of their tumor. Of these, 86% patients received conservative treatment. In the majority of patients, estrogen receptor (ER) level did not vary between the initial assay and analysis of the operative specimen. DISCUSSION AND CONCLUSION: Aromatase inhibitors are effective as neoadjuvant therapy in ER positive elderly patients with large tumors, as is tamoxifen. Changes in hormone receptor expression during treatment do not predict clinical response. In our experience, neoadjuvant AI therapy should be administered for at least 6 months to optimize clinical response before deciding upon surgery. Discrepancy observed in the literature could be explained by the duration of the treatment.

Aged↗
PubMed2005

[Radiation-induced sarcomas after breast cancer: experience of Institute Curie and review of literature].

Adjuvant radiotherapy to the breast plays a significant role in preventing local failure in women treated for early stage breast cancer. This fact is supported by multiple clinical trials demonstrating that adjuvant radiotherapy decreases the risk of local recurrence and increases the rate of breast preservation, and actually the rules of adjuvant breast irradiation are clearly established. Sarcomas are a rare but recognized complication of radiation therapy for breast carcinoma, and are associated with poor prognosis. The first case of a bone sarcoma after radiation therapy of breast cancer was described by Beck in 1922. In 1948, Cahan et al. defined the criteria for diagnosis of radiation-induced sarcoma. Since then, some studies have reported the incidence of radiation-induced sarcoma after radiotherapy for different cancers. This article reports and discusses the incidence, management and treatment outcome of radiation-induced sarcomas occurring after radiotherapy for breast cancer in our institute. The incidence, histology, latency of appearance, genesis, their treatment and the prognostic factors of these rare tumors are discussed and the literature is reviewed.

Adult↗
PubMed2005

[Comparison of classic simulation and virtual simulation in breast irradiation: prospective study on 14 patients].

PURPOSE: To compare conventional 2D simulation and virtual simulation on 14 patients with breast cancer. PATIENTS AND METHODS: Patients were simulated for treatment using standard procedure. They subsequently underwent CT scan in the treatment position. The CTV was defined as breast tissue. The PTV was obtained by adding a 3D margin of 1 cm around CTV. Organs at risk (lungs and heart) were outlined. Ballistics and dose distribution obtained with the two planning methods were compared. RESULTS: With conventional simulation, 95% of CTV received 95% of the dose prescribed. Virtual simulation significantly improved dosimetric coverage of PTV without increasing irradiation volume of lung and heart. In 2D simulation, using three slices allowed optimisation by adjusting wedge angle. The five-slice plan was a much better predictor of the maximum dose regions when compared to the three-slice plan. Using entire CT data didn't give any benefit. CONCLUSION: Variations in CTV delineation and PTV definition limit interest of virtual simulation. In classic simulation, a 5 CT slice-plan can be used to optimise dose distribution.

Breast Neoplasms↗
PubMed2005

Mucosal pigmentation after oral lichen planus treatment with topical tacrolimus.

Erosive oral lichen planus (OLP) is a painful chronic inflammatory disease that is sometimes resistant to systemic or topical therapies. Topical steroids remain the mainstay of therapy, but topical tacrolimus has recently been used to treat OLP resistant to topical corticosteroids. Topical tacrolimus appears as an effective and safe treatment of symptomatic OLP. We report the first histopathologically documented case of oral mucosa pigmentation after OLP treatment with topical tacrolimus. The relation between tacrolimus treatment and staining was suggested by the appearance of pigmentation during topical tacrolimus treatment and its clinical disappearance when treatment was stopped. Histopathology showed an increase in melanocyte numbers and melanogenesis.

Administration, Cutaneous↗
PubMed2004

Alzheimer's disease and acetylcholinesterase inhibitor agents: a two-year longitudinal study.

Alzheimer's disease (AD) is the most common age-related neurodegenerative disease and an urgent public health problem in many areas of the world. We present the results of the activity of an ad hoc ward, called "Unità di Valutazione Alzheimer " (UVA) (Unit of Evaluation for Alzheimer), along the first two years of the "CRONOS" project (CP). We evaluated the efficacy and safety of acetylcholinesterase inhibitor (AChE-I) agents in the treatment of mild to moderate AD and the population served by the UVA. Three hundred fifty-four patients referred to our ward for cognitive deficits. According to the CP criteria, 66 patients (42 women and 24 men, mean age 74.1 +/- 5.8 years) were enrolled in the study. Evaluation was carried out at baseline and after 3, 9, 15, and 21 months. Our results showed a positive impact of these drugs on patients with mild to moderate AD during the first nine months of treatment. After this period, we observed a progressive lowering of the mini mental state examination (MMSE) scores, with a global impairment of 0.9-1 .0 points per year. The adverse events were generally not troublesome. Our data strongly support the usefulness of UVA in the AD case ascertainment during the early phase of the disease.Moreover, the CP provided a general better knowledge about this important and devastating disease.

Activities of Daily Living↗
PubMed2003

Neo adjuvant Tamoxifen in post menopausal patients with operable breast cancer.

AIMS: Tamoxifen is widely used as adjuvant therapy in receptor positive post menopausal breast cancer. Little is known about its efficacy as neo adjuvant therapy in terms of breast conservation and improved survival. METHODS: We analyzed the tumour response to 20-30 mg Tamoxifen for 6 months in post menopausal patients with oestrogen receptor positive tumours. Treatment included Tamoxifen for 6 months, surgical resection, and irradiation for post menopausal patients refusing initial mastectomy; aged > or =70 years; or with other factors delaying surgery. RESULTS: Between April 1994 and June 1998, 102 patients, age 73+/-87 (54-90) were studied. There were 24 T1, 56 T2, 14 T3, and 8 T4 tumours. Clinical response to Tamoxifen was observed in all patients, with a median size reduction from 31+/-15 (9-70) to 16+/-9 mm (0-50), 15 clinical and 6 complete responses. 88/102 patients were treated conservatively. Radiotherapy was given to 80 and a flash technique to 8 patients. All patients but one are still alive. CONCLUSION: Neo adjuvant Tamoxifen in operable post menopausal ER positive breast cancer is associated with a good clinical response rate and facilitates conservative surgery. Tamoxifen has a valuable role as neo-adjuvant treatment in terms of breast conservation and survival.

Aged↗
PubMed2003

[Respiration-gated radiotherapy: current techniques and potential benefits].

Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart...) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath hold techniques or respiration synchronized gating techniques. Breathhold techniques can be achieved with active, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily breath-hold. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. These techniques presently investigated in several medical centers worldwide. Although promising, the first results obtained in lung and liver cancer patients require confirmation. Physical, technical and physiological questions still remain to be answered. This paper describes the most frequently used gated techniques and the main published clinical reports on the use of respiration-gated radiotherapy in order to evaluate the impact of these techniques.

Breast Neoplasms↗
PubMed2001

Neural network analysis in predicting 2-year survival in elderly people: a new statistical-mathematical approach.

We designed this study to test the usefulness of artificial neural networks (ANN) in assessing 2-year survival in elderly persons, and to understand the net's logical functioning, thus determining the relative importance of the single biological and clinical variables which influence survival. ANN are statistical-mathematical tools able to determine the existence of a correlation between series of data and, once 'trained', to predict output data given input data. Although ANN have been applied in various areas of medical research, they have only very recently been applied in geriatrics (Cacciafesta et al., 2000. Arch. Gerontol. Geriatr. 31 (in press)). We built up an ANN to investigate how 17 clinical variables relating to a sample of 159 elderly people affect survival, and the possibility of predicting 2-year survival or non-survival for each single subject. When tested on a sample of 20 elderly people, the trained network gave the correct answer in 85% of the cases. We then extracted the mathematical function that the net used for calculating the output (survival) for each set of input data (clinical variables). Using this formula, we investigated how some clinical variables influence 2-year survival: we found that a low serum cholesterol level is an unfavourable characteristic in relation to survival. We conclude-despite the fact that the sample studied was relatively small-that ANN are useful in predicting 2-year survival in elderly people. The mathematical function we obtained from the net seems useful in determining the relative importance of single variables related to survival.

Journal Article↗
PubMed2000

A neural network study of the correlation between metabolic-cardiovascular diseases and disability in elderly people.

Numerous studies have affirmed the existence of a correlation between various cardiovascular diseases and functional decline in elderly people. Not much information, however, is available concerning the overall effect of various, possibly coexisting, cardiovascular pathologies, or metabolic conditions notoriously related to them, on determining disability. We wanted to verify if it were possible to assess: (1) The overall importance of various metabolic and cardiovascular diseases which elderly people often suffer from contemporaneously in determining a condition of not self-sufficiency; (2) The possibility of predicting a condition of not self-sufficiency in relation to the above-mentioned pathologies. In order to achieve this aim, we used an artificial neural network: a statistical-mathematical tool able to determine the existence of a correlation between series of data and, once 'trained', to predict output data given the input data. Although artificial neural networks have been applied in various areas of medical research, they have not been previously applied in geriatrics. We have applied this method to a sample of 179 elderly people, demonstrating that seven clinical-biological variables concerning their metabolic and cardiovascular conditions are strictly related, all together, to the presence or otherwise of a functional impairment. When tested on a sample of 20 'unknown' elderly people, the trained network gave the correct answer-self-sufficiency or not self-sufficiency-in 95% of the cases. Despite the fact that the sample studied was relatively small, artificial neural networks are undoubtedly useful in predicting functional impairment in elderly people in relation to the presence of metabolic and cardiovascular diseases.

Journal Article↗
PubMed2000

[Isolated systolic hypertension in the aged].

The prevalence of isolated systolic hypertension (ISH) is age-related. Its connection with the demographic shift experienced during the last century, results in an outstanding role, mainly as risk factor for most disabling diseases such as stroke. Epidemiological research suggests a high prevalence of the disease and--since the cut-off for hypertension has been lowered by the Joint National Committee--figures of the problem are, at the moment, probably underestimated. Several studies provided reliable data about the role of ISH as risk factor for mortality, and cardiovascular and cerebrovascular events. Large clinical trials show that drug therapy has proved effective in lowering blood pressure and in preventing fatal and non fatal related events.

Adolescent↗
PubMed2000

[Radiotherapy of cancer of the breast. Technical problems and new approaches].

Technical problems often arise during irradiation to the breast, chest wall, and regional lymph nodes. The following are among the most frequently encountered problems: avoidance of normal tissues (heart and lungs) during chest wall, internal mammary nodes, and large breast irradiations; dose heterogeneity in large breasts; under- or overdosage at field junctions (breast medial tangent and internal mammary fields in particular). Various technical solutions have been offered: modified treatment positions, field inclinations, and conformal irradiation. Many are currently under evaluation. These new technical approaches in breast cancer irradiation require modern facilities for imaging, simulation, and dosimetry, which help to individually design treatment planning.

Breast Neoplasms↗
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↗
PubMed1997

Development and validation of a liquid chromatographic method for the determination of related substances in verapamil hydrochloride.

The development of a reversed-phase liquid chromatographic method for the determination of related substances in verapamil hydrochloride is described. The method is based on the use of a simple mobile phase on a specialty base-deactivated reversed-phase column. It enables the resolution of 13 related compounds from the parent drug and from each other. Validation of the method showed it to be reproducible, selective, accurate and linear over the concentration range of analysis with a limit of detection of 0.5 microgram ml-1. The developed method proved to be a real improvement compared with the LC test for chromatographic purity described in the USP monograph for verapamil hydrochloride.

Calcium Channel Blockers↗
PubMed1997

Ductal carcinoma in situ of the male breast. Analysis of 31 cases.

From 1970 to 1992, 31 pure ductal carcinoma in situ (DCIS) of the male breast treated in 19 French Regional Cancer Centres were reviewed. They represent 5% of all breast cancers treated in men in the same period. The median age was 58 years, but 6 patients were younger than 40 years. TNM classification (UICC, 1978) showed 12 T0 (discovered only by bloody nipple discharge), 10 T1, 5 T2 and four unclassified tumours (Tx). 11 patients (35.5%) had clinical gynecomastia, and three (10%) had a family history of breast cancer. 6 patients underwent lumpectomy, and 25 mastectomy. Axillary dissection was performed in 19 cases. 6 cases received postoperative irradiation. 15 out of 31 lesions were of the papillary subtype, pure or associated with a cribriform component. The size of the 12 measured lesions varied from 3 to 45 mm. All lymph nodes sampled were negative. With a median follow-up of 83 months, 4 patients (13%) presented a local relapse (LR), respectively, at 12, 27, 36 and 55 months. 3 of these patients had been initially treated by lumpectomy. In one case LR was still in situ, but already infiltrating in the 3 others. Radical salvage surgery was performed in 3 cases, but one patient developed metastases and died 30 months later. The last patient was treated by multiple local excisions and tamoxifen. One 43-year-old patient developed a contralateral DCIS and three others developed a metachronous cancer. The aetiology and risk factors of male breast cancer remain unknown. Gynecomastia, which implies an imbalance between androgen and oestrogen, may be a predisposing factor. As in women, DCIS in the male breast has a good prognosis. Total mastectomy without axillary dissection is the basic treatment. Frequently, the first symptom is a bloody nipple discharge. The age of occurrence is younger than for infiltrating carcinoma, suggesting that DCIS is the first step in the development of breast cancer.

Adult↗
PubMed1996

Metachronous contralateral breast cancer as first event of relapse.

PURPOSE: To determine which clinical, biological, or treatment-related factors of the first and second primary breast cancers influenced the outcome following contralateral breast carcinoma (CBC). METHODS AND MATERIALS: By August 1994, 319 of 6406 patients with clinical Stage 0 to III breast carcinoma treated between 1981 and 1987 at Institut Curie had developed a second breast cancer that was diagnosed more than 6 months following ipsilateral breast cancer. Of these 319 patients, 235 had a CBC as the first recurrent event and constitute the study population. Comparisons of first and second breast tumor characteristics were done using Fisher's exact test. Survival distributions from the date of CBC were compared by the log-rank test. Prognostic factors for local relapses, distant relapses, and survival after CBC were assessed by univariate and multivariate analysis using the Cox proportional hazards model. RESULTS: The diagnosis of CBC was more frequently guided by mammographies than for ipsilateral tumors (p < 0.0001). The proportion of early stage tumors < or = T1 was significantly higher in the opposite breast as compared to the the first primary tumor (p < 0.0001). A greater rate of noninvasive tumors was observed in CBCs (p = 0.0003). Median follow-up time from the diagnosis of CBC was 54 months (1-137). Five-year survival following CBC was 79% (+/- 6). Five-year local (CBC breast or chest wall) and distant failure rates were 15 and 24%, respectively. Time interval to the occurrence of CBC (< 2 years, 2-5 years, > 5 years) had no influence on survival. Cox model analysis showed that the risk factors for distant metastases were stage and progesterone receptor levels of the contralateral tumor. The risk of distant failure in CBC was not influenced by the extent of surgery. CONCLUSIONS: In this selected population of CBCs as first recurrent events, a follow-up policy based on clinical examination and annual mammography enabled the detection of CBCs at an earlier stage than the primary ipsilateral cancer. The outcome after CBC was determined only by the characteristics of the contralateral tumor. Breast-conserving treatment should be recommended when it is feasible. Adjuvant chemotherapy should be delivered according to the same criteria as the primary tumor.

Adult↗