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G Body

Publications and source records attributed to G Body.

At least 19 recordsLinked to original sources
PubMed2006

[Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conservative surgery enhances late toxicities].

PURPOSE: In 1996, a multicenter randomized study comparing after breast-conservative surgery, sequential vs concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) was initiated (ARCOSEIN study). Seven hundred sixteen patients were included in this trial. After a median follow-up of 6.7 (4.3-9) years, we decided to prospectively evaluate the late effects of these two strategies. PATIENTS AND METHODS: A total of 297 patients were asked to follow-up from the five larger including institutions. Seventy-two percent (214 patients) were eligible for late toxicity. After breast-conserving surgery with axillary dissection, patients were treated either with sequential treatment with CT first followed by RT (arm A) or CT administered concurrently with RT (arm B). In all patients, CT regimen combined mitoxantrone (12 mg/m(2)), 5-FU (500 mg/m(2)), and cyclophosphamide (500 mg/m(2)), 6 cycles (day 1-day 21). In arm B, patients received concurrently the first 3 cycles of CT with RT. In arm A, RT started 3 to 5 weeks after the 6th cycle of CT. Conventional RT was delivered to the whole breast using a 2 Gy-fraction protocol to a total dose of 50 Gy (+/-boost to the primary tumour bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist according to the LENT-SOMA scale. Skin pigmentation was also evaluated using a personal 5-points scoring system (excellent, good, moderate, poor, very poor). RESULTS: Among the 214 evaluated patients, 107 were treated in each arm. The two populations were homogeneous for patients', tumors' and treatment characteristics. Subcutaneous fibrosis (SF), telengectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in arm B. Twenty patients experienced grade superior or equal to 2 (SF) in arm B vs five in arm A (P=0.003). Twenty-five and seven patients showed grade superior or equal to 2 (T) in arm B and A, respectively (P=0.001). Forty-four and twenty patients showed grade superior or equal to 2 (BA) in arm B and A, respectively (P=0.0006). Thirty patients experienced grade superior or equal to 3 (SP) in arm B vs fifteen in arm A (P=0.02). No statistical difference was observed between the two arms concerning grade superior or equal to 2 pain, breast oedema, and lymphoedema. No deaths were caused by late toxicity. CONCLUSION: Following breast conserving surgery, the concurrent use of CT with RT is significantly associated with an increase incidence of grade 2 or greater late side effects.

Adult↗
PubMed2005

Power Doppler vascularity index for predicting malignancy of adnexal masses.

OBJECTIVE: To assess the performance of a power Doppler vascularity index in the preoperative diagnosis of ovarian malignancy. METHODS: Adnexal masses (n = 101) were examined prospectively with power Doppler ultrasonography before surgical treatment. The tumor vascularity index (power Doppler index, PDI) was determined by quantification of the number of pixels in a defined region of interest according to the formula: number of colored pixels/(total number of pixels minus the number of pixels in the fluid or avascular areas). It was estimated on selected frames of the tumors using an in-house color-quantifying program added to MATLAB 6.0 software. Inter- and intraobserver reproducibilities of PDI assessment were evaluated. Intratumoral blood flow velocity waveforms were obtained to determine the lowest resistance index (RI). A subjective visual score of power Doppler signals in the tumor was used to classify it as having low, moderate or high vascularity. The discriminatory ability of this score was compared to that of RI and PDI measurement. RESULTS: Histology identified 23 malignant and 78 benign lesions. The PDI was considerably higher in malignant than in benign lesions (0.34 +/- 0.04 vs. 0.12 +/- 0.06; P < 0.001). The intra- and interobserver variabilities of PDI were low (intraclass correlation coefficients of 0.99 and 0.97, respectively). The PDI cut-off value to differentiate malignant from benign tumors was set at 0.265 (26.5% of the tumor being colored). Using this cut-off, sensitivity and specificity were 100% (95% CI, 87.8-100.0) and 97.4% (95% CI, 91.0-99.7) compared to 78.3% (95% CI, 56.3-92.5) and 83.1% (95% CI, 72.9-90.7) for RI (cut-off value of 0.53) and 78.3% (95% CI, 56.3-92.5) and 94.9% (95% CI, 87.4-98.6) for visual scoring. Logistic regression demonstrated that PDI was the best parameter for differentiating between malignant and benign tumors. CONCLUSION: The power Doppler vascularity index obtained using customized color quantifying software has high diagnostic value in discriminating between benign and malignant adnexal masses.

Adnexa Uteri↗
PubMed2004

Predictive factors of early cessation of breastfeeding. A prospective study in a university hospital.

OBJECTIVE: To emphasize the factors involved in early cessation of breastfeeding among patients who have given birth in a high-tech maternity hospital, both during the stay on the maternity ward and before their infants reach the age of 4 months. STUDY DESIGN: Prospective study involving all patients who gave birth during the first 2 months of 2002 in the maternity department of Tours University Hospital, France. Exclusion criteria were preterm delivery before 35 weeks of pregnancy, twin birth and any condition in the newborns that required intensive or long-term hospitalization. The methodology suggested by the World Health Organization in the report "Indicators for Assessing Breastfeeding Practices" was strictly followed, and the breastfeeding status was assessed on the day of discharge from hospital and then in personal telephone conversations with each patient held 1, 2, 3, and 4 months after the date of delivery. The data were analyzed with the Chi-square test or Fisher's Exact Test for the dichotomous variables, and the populations were compared for the continuous variables with the Student test. RESULTS: We studied 115 breastfeeding patients (=57% of the patients who gave birth in the study period). At the time of discharge from hospital, 95% of the 115 were still breastfeeding; the corresponding proportions 1, 2, 3, and 4 months after the birth were 78, 66, 44, and 17%. For patients who were breastfeeding exclusively, the corresponding proportions were: 95, 69, 47, 17, and 6% at discharge from hospital and 1, 2, 3, and 4 months after the birth. We found differences between multiparous and primiparous women only in the timing of the first breastfeeding session and the use of formula supplement while on the maternity ward. There were no differences between the group whose babies were born by cesarean section and those who had vaginal deliveries. The only factor found to be linked with early cessation of breastfeeding during the hospital stay was the lack of previous experience in a multipara who decided to breastfeed for the first time (OR=35.33; 95% CI=2.4531 < OR < 508.925). CONCLUSION: Among the women discharged from the maternity ward with a healthy baby, for a multipara the lack of any previous experience of breastfeeding with earlier babies is the greatest risk factor in early definitive cessation of breastfeeding. Targeting such women would make it possible to provide more support for them when they start breastfeeding and thus hopefully to avoid early cessation.

Adult↗
PubMed2004

Contrast enhanced magnetic resonance imaging underestimates residual disease following neoadjuvant docetaxel based chemotherapy for breast cancer.

AIMS: We prospectively compared the ability of magnetic resonance imaging (MRI) to measure residual breast cancer in patients treated with different neoadjuvant chemotherapy regimen. METHODS: Forty patients with locally advanced breast carcinoma underwent neoadjuvant chemotherapy. Twelve patients received 5-fluoro-uracyl-epirubicin-cyclophosphamide (FEC-group, six cycles), 28 (DXL-group) received docetaxel-based chemotherapy (six cycles DXL-epirubicin: 13 patients, eight cycles DXL alone: 15 patients). All patients had baseline and preoperative MRI. The spread of pathologic residual disease (PRd) was compared to preoperative MRI measures according to chemotherapy regimen. RESULTS: MRI over/underestimation of the spread of residual tumour was never superior to 15mm in FEC group, whereas it appeared in 11/28 (39%, 30-48%-95% CI) patients in DXL group (p=0.017). Tumour shrinkage led to single nodular residual lesions in FEC group, whereas vast numerous microscopic nests were observed in docetaxel group in pathology. CONCLUSION: Among tumours treated with a taxane-containing regimen, residual disease was frequently underestimated by MRI because of PRd features.

Adult↗
PubMed2004

[Flexible bronchoscopy in children. Experience at French centers of pediatric pneumology].

INTRODUCTION: Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS: In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS: Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS: This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.

Bronchoscopes↗
PubMed2003

Neoadjuvant docetaxel for operable breast cancer induces a high pathological response and breast-conservation rate.

Docetaxel (Taxotere), alone or in combination with other anticancer agents, has proven efficacy in the first- and second-line treatment of metastatic breast cancer. This phase II study investigated the efficacy and tolerability of docetaxel as neoadjuvant chemotherapy in women with stage II-III primary operable breast cancer. Patients (n=88) were treated with six cycles of docetaxel at 100 mg m(-2) every 21 days, followed by definitive surgery and radiotherapy. After six cycles of docetaxel, the overall clinical response rate was 68.4% (CI 95%: 58.1-78.7%), including 19.0% complete remissions. Breast conservation was achieved in 72.4% of patients. A high pathological complete response (pCR) rate in breast was confirmed in 15 patients (19.8% (CI 95%: 10.8-28.8%)) on Chevallier's classification restricted to breast and in 27 patients (35.5% (CI 95%: 24.7-46.3%)) on Sataloff's classification. After a median follow-up of 30.8 months, 19 recurrences were documented with a median time to first recurrence of 17.3 months. Patients with stage III tumours had more recurrences than patients with stage II tumours (P=0.02). The principal toxicity of docetaxel is myelosuppression and 70.5% of patients developed grade III or IV neutropenia with 13.6% developing neutropenic sepsis. There was no case of severe cardiac toxicity, thrombocytopenia or any other serious adverse events. In conclusion, neoadjuvant docetaxel induces a high pCR and breast-conservation rate. Docetaxel monotherapy is a highly effective regimen that merits formal comparison with currently used combination regimens in a randomised phase III study.

Antineoplastic Agents, Phytogenic↗
PubMed2003

[Prospective clinical and sonographic assessment of uterine artery embolization as the treatment of symptomatic uterine leiomyomata].

OBJECTIVE: To evaluate the effectiveness of the uterine artery embolization as the treatment of symptomatic uterine leiomyomata. PATIENTS AND METHODS: Eighty-five women with symptoms caused by uterine leiomyomata underwent uterine artery embolization as an alternative to surgery from january 1997 to june 2000. The effectiveness of this method was evaluated by clinical and sonographic examination. RESULTS: The recession average was of 18.9 months. There were ten failures. We had immediate failures (n = 5) with a case of technical failure, one endometrium cancer, one adenomyosis, one larger subserosal leiomyomata and one parametrial leiomyomata. We had recurrences (n = 5) with the occurrence of new leiomyomatas (1 intramural and 3 submucosal) and an evolution of previous leiomyomata. The average volume reduction was 51% for the uterus and 65% for the main fibroid at one year follow-up. Minor complications occurred in 5%. Permanent amenorrhoea was observed for 3.75% of the women. Using cox model, no predictive factors of embolisation effectiveness were found. DISCUSSION AND CONCLUSION: In the treatment of symptomatic uterine leiomyoma, uterine artery embolization is an effective alternative to surgery. After one year and half, we had 12.5% of failures.

Adult↗
PubMed2002

[Male breast cancer: 19 case reports].

Breast cancer is rarely encountered in men. In developed countries, it accounts for less than 1% of cancers in men, whereas in women it represents about 23% of all cancers. A retrospective review was performed on 19 cases of men who underwent surgery for breast carcinoma between 1989 and 2000. The aim of this work was to analyse epidemiological and etiological aspects, circumstances of discovery, pathological characteristics, therapy modalities as well as prognostic factors. The mean age was 65.3 years. A high incidence of overweight, diabetes, hypertension and hypercholesterolemia was found. The most frequent clinical presentation was a firm subareolar lump, at a low stage (stage I 23% and stage II 41%). The most common pathological type was an infiltrating ductal carcinoma (89%). Hormone receptors where most often positive (92% for oestrogen and 100% for progesterone receptors). 84% of patients underwent simple mastectomy and axillary dissection, 74% chest wall irradiation after surgery, 26% received chemotherapy and 42% hormonal therapy. Median follow-up was 52 months. The estimated 2-year overall survival (OS) and disease-free survival (DFS) was respectively 93% and 87.5% and the 5-year OS and DFS respectively 86% and 75%. The management of male and female breast carcinoma is identical, as well as their prognosis at equal stages. However male breast carcinoma is more often diagnosed at a more advanced stage, thus a breast screening in men would permit a sooner diagnosis and a better prognosis.

Adult↗
PubMed2002

[Spontaneous abortions of first trimester pregnancy: is uterine aspiration still in line?].

Spontaneous abortions of first trimester pregnancy is a frequent pathology in gynecology (more than 10% of clinical pregnancy). Since the mid of twentieth century, the gold standard of evacuation of spontaneous abortion is manual vacuum aspiration most of the time under general anesthesia. This method is used in France for all miscarriages after 7 weeks' gestation at the sonography (about 40,000 women in 1999) but complications are not rare. The vaginal sonography and new medical management changes the view. We can now use expectative management or medical management with misoprostol and/or mifepristone. We summarise the current literature and propose a randomised multicentric control trial.

Abortifacient Agents↗
PubMed2002

Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids.

OBJECTIVES: To evaluate sonographic features following uterine artery embolization and to assess using ultrasound the efficacy of embolization as the primary treatment of fibroids. DESIGN: Fifty-eight women (mean age, 44.5 years; range, 33-65 years) suffering from symptoms due to fibroids (menometrorrhagia, bulk-related symptoms, pelvic pain) were followed-up after uterine artery embolization by ultrasound examination at 3 months, 6 months, 1 year and 2 years with assessment of volume and vascularization of fibroids as well as uterine vascularization. RESULTS: Fifty-eight patients were examined at 3 months, 46 at 6 months, 36 at 1 year and 19 at 2 years. Most patients were improved or free of symptoms at 3 months (90%), 6 months (92%) and 1 year (87%) and all monitored patients were free of symptoms at 2 years. Clinical failure of treatment occurred in only two cases (3%). Progressive significant reduction in fibroid size with reference to the baseline was demonstrated during follow-up from 3 months (-29%) to 24 months (-86%). Absence of intrafibroid vessels was observed in all except three cases as early as 3 months, whereas perifibroid vessels persisted in 21 cases. No changes in uterine vascularization or uterine artery resistance were noted. CONCLUSIONS: Uterine artery embolization is a valuable endovascular method for the treatment of fibroids, resulting in marked reduction in fibroid size and disappearance of intrafibroid vessels without reduction in uterine vascularization which is well depicted by sonography.

Adult↗
PubMed2002

[Value of fetal cerebral magnetic resonance imaging for the prenatal diagnosis and prognosis of corpus callosum agenesis].

OBJECTIVE: To evaluate MR contribution to prenatal diagnosis and prognosis of corpus callosum agenesis suspected by ultrasound and to ascertain how and when this examination should be included part in prenatal management of such malformation. PATIENTS AND METHODS: During a six-year period from January 1st 1994 and December 31st 2000, fifteen patients (and fifteen fetuses) were referred to our fetal medicine unit with suspicion of corpus callosum agenesis on prenatal ultrasound. Cerebral MRI was performed in all cases to confirm prenatal diagnosis. In our study, prenatal MRI examinations were retrospectively studied and compared with neuropathological examinations (n=8) or postnatal imaging (n=6). RESULTS: Corpus callosum agenesis were either complete (n=13) or partial (n=1). All were visible on prenatal MRI but only six on prenatal ultrasound. In one case, ultrasound suspicion of corpus callosum agenesis was ruled-out (false positive on prenatal ultrasound) by fetal cerebral MRI. In five cases corpus callosum agenesis was an isolated finding whereas in 12 cases associated malformations were encountered (cerebral n=7 or extra-cerebral n=5). MR depicted 7 of the 12 associated neurologic abnormalities. CONCLUSION: Prenatal MRI is a valuable complementary technique for either diagnosis of corpus callosum agenesis and depiction of associated neurologic abnormalities. Superiority of MR on prenatal sonography and its help in post-mortem examination of the brain (help in the choice of the pathologic technique and localisation of the samples) makes it essential even when pregnancy termination is considered.

Adult↗
PubMed2002

[Value of cervical cerclage in patients at risk of premature delivery].

Cervical cerclage is not recognized as the usual treatment of threatened premature delivery including uterine contractions and cervical modifications. Pregnant women with a threatened premature delivery limited to the presence of a short cervix at digital examination or internal scan may however be offered therapeutic cerclage, different from prophylactic first trimester cervical cerclage, when cervical insufficiency is suspected. Studies on cervical cerclage to prevent premature delivery suffered a poor design and do not allow any strong definitive conclusion. In the presence of a shortened or dilated cervix at digital examination without uterine contractions, there is no strong scientific evidence to support the practice of therapeutic cervical cerclage. Conversely there is however no strong scientific evidence to reject this procedure especially in early pregnancy (before the end of the second trimester). Therefore therapeutic cervical cerclage remains a possible option only if premature labor, intrauterine infection or placental abruption have been ruled-out by a 48 hours inpatient bed rest. In patients without previous history of premature delivery or second trimester miscarriage, there is no scientific evidence to support therapeutic cervical cerclage in presence of a short cervix. Moreover, in this low-risk group cervical length ultrasound screening is not recommended. In patients with one or more previous premature deliveries or second trimester miscarriage but who do not reach Royal College criteria for prophylactic cervical cerclage, there is currently not enough evidence to support a policy of therapeutic cervical cerclage compared to bed rest. This latter recommendation may however depend on the severity of previous obstetrical history.

Bed Rest↗
PubMed2002

[Second trimester cerclage of short cervixes: which technique to use? A retrospective study of 25 cases].

OBJECTIVE: To evaluate pregnancy outcome after therapeutic or emergency cerclage performed on the basis of clinical or/and ultrasound cervical modifications noted before 26 weeks of gestation and to precise which surgical procedure (Shirodkar or McDonald) is the most appropriate in these indications. PATIENTS AND METHODS: Retrospective study between January 1(st) 1996 and December 31(st) 2001 on 25 clinical charts of patients with suspected cervical incompetence who had second trimester cervical cerclage on the basis of clinical or ultrasound cervical length shortening. Patients with first trimester prophylactic cervical cerclage were excluded from analysis. The choice between the two surgical procedures (Shirodkar or McDonald) depended on surgeon preference but the two groups were identical for previous obstetrical history, time of cerclage and cervical modifications. Statistical analysis was performed using Chi 2 test or t-test according to the type of variables. RESULTS: In our series, 9 patients had cervical cerclage performed with Shirodkar (S) procedure and 16 had McDonald cerclage (MD). Mean operating time (S: 52 +/- 18 minutes; MD: 39 +/- 3 minutes; p=0.1) and mean hospital stay (S: 5.2 +/- 1.3 days; MD: 5.3 +/- 1.5 days; p=0.9) were not significantly different between the two procedures. The difference in mean gestational age at delivery, (S: 35.7 +/- 3.2 Wks; MD: 33.2 +/- 2.9 Wks; p=0.5) and in the number of premature deliveries before 32 completed weeks (S: 22.2%; MD: 43.7%; p=0.4) better in Shirodkar group didn't reach statistical signification. No statistical difference was noted in the number of admission in neonatal intensive care unit (S: 22.2%; MD: 31.2%; p=0.9) and in neonatal survival (S: 1 neonatal death; MD: 1 neonatal death) between the two groups. CONCLUSION: No conclusion regarding the most appropriate cervical cerclage procedure can be drawn from our study. However, Shirodkar procedure seems preferable to us due to tendency in a higher mean gestational age at delivery and because it didn't appeared to be longer or more difficult procedure. Multicentric studies may probably give better knowledge in this topic.

Adult↗
PubMed2001

Prenatal diagnosis and early in utero management of fetal dyshormonogenetic goiter.

We present a case of a fetal dyshormonogenetic goiter diagnosed by ultrasound examination at 24 weeks of gestation, in a woman with no past history of thyroid disease or goitrogen treatment and with normal thyroid tests, including absence of auto-antibodies. In this situation, fetal goiter may only be associated with fetal hypothyroidism, therefore cord blood sampling was not performed but early treatment was initiated. Amniotic fluid instillation of thyroid hormone led to a rapid decrease in amniotic fluid volume and a clear reduction in thyroid goiter. However, fetal thyroid volume did not totally normalise, and cord blood analysis at birth showed elevated fetal TSH level. As prenatal treatment of fetal hypothyroidism remains controversial in euthyroid mothers, the main objective is to prevent obstetrical complications of large goiters. Therefore, in some selected cases with no maternal history of thyroid disease and normal thyroid function tests, cordocentesis is not necessary to confirm fetal thyroid status or to adjust fetal treatment.

Adult↗
PubMed2001

Chromosomal defects and associated malformations in fetal cleft lip with or without cleft palate.

OBJECTIVE: To describe the incidence, associated features including chromosomal defects in fetuses, with cleft lip and/or palate and assess the need for karyotyping. METHODS: Retrospective study of 62 cases of prenatally diagnosed facial cleft lip and/or palate in a tertiary fetal medicine unit between January 1991 and December 1999. Chromosome analysis was performed in all fetuses with associated ultrasound findings and in 14 (39%) fetuses with isolated facial clefts. RESULTS: Associated abnormalities were detected in 26 (42%) of the 62 fetuses of which 22 (35%) fetuses had multiple other abnormalities. Central nervous system abnormalities and limb malformations were the most common. Three fetuses had genetic syndromes confirmed after birth. All fetuses with isolated clefts were chromosomally normal, whereas 15 of the 26 with additional abnormalities (58 or 24% of the total group) had chromosomal defects (eight cases of trisomy 13, five of trisomy 18, one unbalanced translocation between chromosomes 7 and 8, and one deletion 4p-). All 22 women who chose not to undergo fetal karyotype analysis delivered phenotypically normal infants. There were five midline clefts; each of them was associated with additional sonographic findings and four were associated with holoprosencephaly. CONCLUSION: Isolated facial clefting is not associated with an increased risk for chromosomal defect. Amniocentesis is recommended when facial cleft is found in association with additional ultrasonographic abnormalities as it is unnecessary for isolated clefts.

Abnormalities, Multiple↗
PubMed2001

Does paraaortic lymphadenectomy have a benefit in the treatment of ovarian cancer that is apparently confined to the ovaries?

We conducted a retrospective review of all epithelial ovarian carcinoma patients with disease that is apparently confined to the ovaries who were treated in the Obstetric and Gynecologic Hospital of the University of Tours. In our hospital, no lymphadenectomies for such epithelial ovarian carcinoma patients are carried out. We studied the survival of these patients that were operated upon from 1 December 1975 until 1 August 1997. 43 epithelial ovarian carcinoma patients were studied; 22 were stage Ia, 1 was stage Ib and 20 were stage Ic. The average age was 58 years (range 27-86 years). 5% (2/43) developed recurrent disease and the rates of disease-free and overall survival after 5 years were 83% and 90.3% respectively. These results are very close to those described in literature for patients who underwent paraaortic and pelvic lymphadenectomy. As no series to date has demonstrated the benefit of paraaortic lymphadenectomy on survival and we know that paraaortic lymphadenectomy increases morbidity, we think it reasonable to propose surgery without lymphadenectomy for the treatment of early ovarian epithelial cancer patients whose disease is apparently confined to the ovaries.

Adult↗