PubMed Health⌕ Search

Biomedical subjects

H Pujol

Publications and source records attributed to H Pujol.

At least 37 records · Page 2Linked to original sources
PubMed1995

Intra-operative radiotherapy in soft tissue sarcomas.

We treated 31 soft tissue sarcoma bearing patients with intraoperative radiation therapy (IORT) with ages ranging from 26 to 71: first curative intent treatment, 16 patients; and recurrent tumors, 15 patients. The tumor site was the pelvis and the retroperitoneal spaces in 13 patients and the limbs or the trunk in 18 patients. The histological type was: malignant histiocytofibroma, 14 patients; liposarcomas, 10 patients; malignant schwanoma, 1 patient; leiomyosarcoma, 2 patients; hemangiopericytoma, 1 patient; embryonic rhabdomyosarcoma, 2 patients; and synovialosarcoma, 1 patient. All the patients were diagnosed without any distant metastatic evolution at the moment of the treatment. All the patients except one underwent a complete surgical excision without any gross residual disease and received an intraoperative radiation single dose of 10 Gy in one case, 12.5 Gy in one case, 13 Gy in one case, 15 Gy in 17 cases, 18 Gy in three cases, 20 Gy in seven cases and 25 Gy in one case. Thereafter the treatment was completed by a postoperative X-ray dose of 45-50 Gy in 4.5-5 weeks for 16 patients. Local control (LC) was obtained in 27 out of 31 patients (87%), with a minimal follow-up duration of 2 years. Eleven out of 31 patients died: seven with local control (one from an intercurrent disease, six from distant metastasis) and four with local failure inside the IORT fields. Twenty patients are alive with no evolutive disease in 19 cases and with a distant metastasis in one case.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Neoplasms↗
PubMed1995

Chest wall reconstruction for radionecrosis after breast carcinoma therapy.

This study aimed at evaluating various reconstructive procedures for chest wall radionecrosis after breast carcinoma therapy. Four different techniques were performed between 1973 and 1992 in 120 patients: latissimus dorsi musculocutaneous flap (LDF; n = 81); transposed omentum and split-thickness skin graft (TGO; n = 20); fasciocutaneous flap (FCF; n = 10), and transverse rectus abdominis musculocutaneous flap (TRAM; n = 9). Initial dose of irradiation ranged from 60 to 110 Gy. The average interval between initial treatment and reconstruction was 11 years. Local recurrence was suspected in 26 patients and was histologically proven after removal in 36 (30%). Surgical procedure results were analyzed by mean hospital stay (8 days for LDF vs. 52 days for TGO), early (13% LDF vs. 60% TGO) and late (7% LDF vs. 35% FCF) complications, second surgery (15% LDF vs. 53% FCF), and functional and cosmetic outcomes. In our experience, the LDF was the first-line flap. The TRAM was used to cover very large defects and when breast reconstruction was needed. When these flaps were impossible or dangerous, we performed a TGO. These three procedures have replaced FCF indications.

Adult↗
PubMed1995

Conservative surgery for low rectal carcinoma after high-dose radiation. Functional and oncologic results.

OBJECTIVE: Using a prospective, nonrandomized study, the authors evaluated the morbidity and functional and oncologic results of conservative surgery for cancer of the lower third of the rectum after high-dose radiation. SUMMARY BACKGROUND DATA: Colo-anal anastomosis has made sphincter conservation for low rectal carcinoma technically feasible. The limits to conservative surgery currently are oncologic rather than technical. Adjuvant radiotherapy has proven its benefit in terms of regional control, with a dose relationship. METHODS: Since June 1990, 27 patients with distal rectal adenocarcinoma were treated by preoperative radiotherapy (40 + 20 Gy delivered with three fields) and curative surgery. The mean distance from the anal verge was 47 mm (27-57 mm), and none of the tumors were fixed (15 T2, 12 T3). RESULTS: Mortality and morbidity were not increased by high-dose preoperative radiation. Twenty-one patients underwent conservative surgery (78%-17 total proctectomies and colo-anal anastomoses, 4 trans-anal resections). After colo-anal anastomosis, all patients with colonic pouch had good results; two patients had moderate results and one patient had poor results after straight colo-anal anastomosis. With a mean follow-up of 24 months, the authors noted 1 postoperative death, 2 disease-linked deaths, 1 controlled regional recurrence, 2 evolutive patients with pulmonary metastases, and 21 disease-free patients. CONCLUSIONS: These first results confirm the possibility of conservative surgery for low rectal carcinoma after high-dose radiation. A prospective, randomized trial could be induced to determine the real role of the 20 Gy boost on the sphincter-saving decision.

Adenocarcinoma↗
PubMed1995

Immediate breast reconstruction revisited.

Immediate breast reconstruction was discussed from the psychological, oncological and surgical points of view. It has been found that at present no adverse effects of the procedure on the course of breast cancer are known, while immediate timing is connected with significant psychological and surgical benefits.

Breast Implants↗
PubMed1994

[Importance of early detection of metastases? Impact on survival and quality of life].

Does early detection of metastasis have an impact on survival and quality of life? This question cannot yet be clearly answered even with respect to breast cancer, the most common tumor found in women and for which high levels of marker CA 15-3 is a relatively reliable indication of metastasis. CA 15-3 is an efficient marker that provides clinicians with a means to detect clinical or radiological signs of breast cancer metastases. There is not yet sound evidence that treating such metastases a few months earlier is useful, but potential advantages of early treatment have also not been disproven. CA 15-3 is still of great economic interest as a reference for post-therapeutic follow-up, since the number of medical imaging tests is reduced, with further testing only required if high levels of this marker are detected.

Biomarkers, Tumor↗
PubMed1994

Cyfra 21-1, a new marker of lung cancer.

The are few outstanding serous markers in the treatment of bronchial cancer. ACE lacks sensitivity and specificity and cannot be used as a diagnostic marker. It has been described as a marker of tumoral mass, although not in our study. Prognostic significance was observed, but only in a univariate analysis. Sensitivity of SCC TA4 varied between studies. In our population, the ROC curve for SCC TA4 showed poor discrimination potential. NSE was shown to be a useful marker in the treatment of patients with small cell cancers. Cytokeratins are expressed by all bronchial cancers. Cytokeratin 19 is a sub-unit detected in simple epithelia and their neoplastic counterparts. During tumoral cell lysis, certain fragments of this cytokeratin may be liberated. The immunoradiometric assay described here is able to detect fragments of cytokeratin 19 (called Cyfra 21-1) in serum. Our study established a correlation between Cyfra 21-1 levels and the cancer stage for NCPC, but not for CPC. In addition, Cyfra 21-1 concentration may be used as a tumoral mass marker. Patients with high Cyfra 21 levels must undergo special treatment to find remote tumors.

Antigens, Neoplasm↗
PubMed1994

Divided latissimus dorsi musculocutaneous flap for chest wall radionecrosis.

A 69-year-old woman with a history of mastectomy and radiotherapy for breast carcinoma demonstrated extensive anterior thoracic wall radionecrosis 22 years later. The latissimus dorsi musculocutaneous flap was chosen to repair two distant ulcerative defects. Chest wall coverage was performed by dividing the muscle into two separate musculocutaneous flaps. Results were particularly promising 6 months after surgery.

Aged↗
PubMed1994

Isolated clustered microcalcifications: diagnostic value of mammography--series of 400 cases with surgical verification.

PURPOSE: To determine the diagnostic value of mammographic criteria in cases of isolated clustered microcalcifications. MATERIALS AND METHODS: Four hundred mammographic studies of isolated clustered microcalcifications for which surgical verification was available were reviewed. A descriptive statistical study was performed to evaluate the distribution of each criterion relative to histopathologic results, followed by a multivariate study to determine statistically significant criteria. Seven breast specialists gave a consensus opinion on the need for surgery. RESULTS: There were 302 benign lesions and 98 cancers. The most useful criteria were vermicular form, linear/branching shape, and irregular size of microcalcification. The number of biopsies recommended with use of these three criteria was 177 instead of the 172 recommended by the experts. CONCLUSION: Use of these three preoperative criteria permits correct diagnosis of most such malignancies (90% in our series vs 67% diagnosed by the experts).

Breast Diseases↗
PubMed1994

[Proctectomy and colo-anal anastomosis after high-dose irradiation of cancers of the lower third of the rectum. Functional and oncological results].

This prospective study was designed to evaluate morbidity and functional and oncological outcomes in patients with carcinoma of the distal third of the rectum treated by high-dose radiation therapy followed by conservative surgery. Twenty-two patients with adenocarcinoma of the distal third of the rectum treated after June 1990 were included in the study. Mean distances separating the tumor from the upper edge of the levator ani muscle and from the anal verge were 17 mm and 47 mm, respectively. None of the tumors were fixed; preoperative stage, established by endoscopic ultrasound, was T2 in 12 patients and T3 in 10. Patients received induction radiation therapy in two series delivered three weeks apart (40 Gy on the pelvis, then 20 Gy on the tumor only) followed by surgical resection (proctectomy with colo-anal anastomosis in 17 cases and amputation in five). After radiation, two tumors were negative for malignant cells, 12 were Astler-Coller B1, two were B2, and six were C2. Mean safety margin after colo-anal anastomosis was 16.8 mm; all the resection margins were negative. Mortality and morbidity were not increased by the high-dose radiation protocol. Conservation of the sphincter was possible in 80% of patients. All the patients were continent. Functional outcome was rated good in 77% of cases, fair in 9% and poor in 4%. During the mean follow-up of 24 months, there were three disease-related deaths, including one due to a strictly regional recurrence; metastatic dissemination to the lungs occurred in two patients and the remaining 17 patients (80%) were disease-free. These data suggest that high-dose radiation therapy followed by conservative surgery ensures satisfactory functional outcomes in patients with carcinomas of the distal rectum. Evaluation of oncological outcomes will require a longer follow-up.

Adenocarcinoma↗
PubMed1994

[Prevention of nicotine addiction in the school environment].

Data analysis concerning tobacco smoking among children and teenagers stresses the need for health education in order to fight against this alarming trend at earliest age. In Montpellier (France) the Cancer Prevention Center of Epidaure develops in collaboration with the Ministry of Education, health education programs on this subject. This paper describes different actions sponsored by the Europe Against Cancer Program. It includes the creation of original and new educational tools. Some of which are aimed at health education training programs for the teachers. It also covers visits to the Epidaure Museum and school projects on smoking prevention. All of these programs are based on the following principles common to all actions carried out at Epidaure: the respect and consideration of children's cultural specificities and knowledge, the adequation of the messages to the social and family environment and that of the school itself, as well as the importance of the body and well being through positive messages.

Adolescent↗
PubMed1994

De-epithelialized latissimus dorsi musculocutaneous flap to reconstruct major chest wall resection after breast carcinoma.

Two cases of chest wall reconstruction after major resection due to breast carcinoma were reported. De-epithelialized latissimus dorsi musculocutaneous flaps were inserted in the skeletal defect in order to protect the underlying tissue and stabilize the thorax. The de-epidermized skin was anchored to the ribs and the sternum. The interest of this autologous procedure was discussed in relation to prosthetic reconstruction. Ease of use, flexibility and resistance to infection were underlined.

Aged↗
PubMed1993

[Conservative surgery of breast cancer. Development of ideas and methods].

Conservative breast cancer surgery has been accepted by the medical profession, but the operative procedures remain to be specified. The decision to conserve the breast must take into account the tumour size/breast volume ratio. The amount of healthy breast tissue to be removed around the tumour must be determined. Quadrantectomy is more secure than wide tumorectomy for local control, at the expense of cosmetic results. It should be reserved to localized intraductal carcinomas and to small invasive tumours of less than 3 cm in diameter but with a large intraductal component. Wide tumorectomy is sufficient for early invasive tumours without intraductal component. The best surgical technique for large carcinomas with preoperative treatment remains to be determined. Defining the operative principles adapted to each clinical situation will make it possible to evaluate the oncological and cosmetic results of conservative treatments. Ideally, the future methods will combine wide excision and partial breast reconstruction using biocompatible implants.

Breast Neoplasms↗
PubMed1993

A prospective study of the prognostic value of cathepsin D levels in breast cancer cytosol.

BACKGROUND: Cathepsin D is a lysosomal protease overexpressed and abnormally secreted in most breast cancer cells. Several retrospective clinical studies have shown that cathepsin D is an independent prognostic factor in breast cancer that is associated with a higher risk of recurrence and a shorter overall survival. METHODS: To the authors' knowledge, this is the first prospective study in which the prognostic value of cathepsin D was studied in 123 patients with primary breast cancer who were followed for 5 years between March 1985 and December 1990. Cathepsin D concentrations in breast cancer cytosol were measured using a solid-phase sandwich immunoenzymatic assay. The most significant prognostic factors were identified by multivariate analysis using the Cox proportional-hazards method. RESULTS: The median value of cathepsin D was 20.8 pmol/mg of protein, which was approximately half than the median value found in subsequent assays done using a commercially available kit and reported in most retrospective studies. The cathepsin D status or level was correlated only with axillary lymph node involvement. A univariate analysis showed that high levels of cathepsin D (> 20 pmol/mg of protein) were correlated with a higher risk of recurrence and a shorter overall survival (P < 0.01 and P < 0.03, respectively). Using multivariate analysis, a high cathepsin D level, a negative progesterone receptor status, and lymph node involvement were the most important factors for predicting relapse-free survival (P = 0.02, P < 0.01, and P < 0.05, respectively). The cathepsin D level had prognostic value in patients with node-positive disease (P = 0.001) and appeared to be particularly useful in association with the progesterone receptor status by isolating a high-risk subgroup of patients (high cathepsin D level; negative progesterone receptor status). CONCLUSIONS: This first prospective study confirmed the prognostic value of the cathepsin D level in association with other major prognostic factors. The next step will be to determine whether the subset of patients with high cathepsin D levels would benefit from adjuvant therapy.

Adult↗
PubMed1993

Serum fragment of cytokeratin subunit 19 measured by CYFRA 21-1 immunoradiometric assay as a marker of lung cancer.

Cytokeratin 19 is a subunit of cytokeratin intermediate filament expressed in simple epithelia and their malignant counterparts. Therefore, it is expressed by respiratory epithelium cells and has been detected in lung cancer specimens. An immunoradiometric assay was used to detect a fragment of the cytokeratin 19, referred to as CYFRA 21-1, in the serum of 165 patients with histologically proved lung cancer (128 non-small cell and 37 small cell lung cancers). This prospective study was conducted to evaluate the reliability of this immunoradiometric assay and to identify the relationship between serum CYFRA 21-1 and different features of lung cancer including prognosis. The minimal detectable concentration detected by this assay was 0.06 ng/ml. The reliability of the immunoradiometric assay was demonstrated by the linear relationship between CYFRA 21-1 measurement and dilution of the serum, the reproducibility of the dosage in intraassay and interassay, and the high sensitivity of the method in discriminating low CYFRA 21-1 concentrations. Using a threshold of 3.6 ng/ml, sensitivity and specificity were 0.52 and 0.87, respectively. The sensitivity of the marker was highest in squamous cell carcinoma and lowest in small cell carcinoma. In non-small cell lung cancer patients, the marker varied significantly according to both stage of the disease (Kruskal-Wallis, 13.7; P < 0.005) and performance status (Kruskal-Wallis, 9.16; P < 0.05) inasmuch as a high serum CYFRA 21-1 level was associated with advanced stages, mediastinal lymph nodes, and poor performance status. Consequently, the marker was significantly lower in patients who were operated upon when compared with unresectable ones. Lung cancer patients with serum CYFRA 21-1 over 3.6 ng/ml proved to have a significantly shorter overall survival than those with a normal serum level (log rank, P = 0.007; Wilcoxon, P = 0.001). The negative prognostic effect of CYFRA 21-1 was highly significant in squamous cell carcinomas whereas it was nonsignificant for the other histologies. In Cox's model analysis, performance status, stage grouping, and CYFRA 21-1 were the only significant determinants of survival. This study supports the use of the serum fragment of cytokeratin subunit 19 CYFRA 21-1 as an independent prognostic marker of squamous cell carcinoma of the lung.

Adult↗
PubMed1993

Conservative treatment for low rectal carcinoma by local excision with or without radiotherapy.

Thirty-seven patients with low rectal carcinoma were treated by transanal resection between January 1979 and December 1988. Adjuvant radiotherapy was used in eight patients before operation, in 13 after operation and six patients had both preoperative and postoperative radiotherapy. The selection criteria for transanal resection were low, superficial tumours treated conservatively with curative intent (group 1, 18 patients) or patients medically unfit for (12) or refusing (seven) abdominoperineal resection (APR) (group 2, 19 patients). In group 1, the local recurrence rate was 11 per cent with an overall 5-year survival rate of 100 per cent. In group 2, the local recurrence rate was 53 per cent with an overall 5-year survival rate of 35 per cent. There was no postoperative mortality and minimal morbidity. Salvage of local failure was by APR in six patients. The survival rate after local recurrence was 70 per cent at 1 year and 30 per cent at 5 years. Transanal resection can be proposed as a curative procedure for selected low, small, minimally infiltrating and well differentiated adenocarcinomas. Local control might be improved by postoperative radiotherapy for Astler-Coller stage B1 tumours or those above 3 cm in diameter. Further trials should examine the results of high-dose (60 Gy) preoperative radiotherapy so that transanal resection might be employed for favourable post-irradiation stage (0 or A) lesions. This new strategy will benefit from a better evaluation of tumour response after primary radiotherapy and an improved assessment of histological excision margins.

Adult↗
PubMed1993

Immunohistochemical study of P-glycoprotein distribution in lung cancer.

Indirect immunoperoxidase was used to determine the reactivity of C219 (P-glycoCHEK C219, Centocor Diagnostics, Malvern, PA), a monoclonal antibody (Mab) with high affinity for an internal epitope of the P-glycoprotein encoded by the multidrug resistance (MDR1) gene, in 40 surgically resected primary lung tumours. C219 reactivity was qualitatively classified in seven small cell lung cancers (SCLC), 29 non small cell lung cancers (NSCLC), and four carcinoid tumours. Ploidy was analysed by means of static cytometry using a computer-assisted image processor following Feulgen staining of cytologic prints of 32/40 lung tumours. Indirect immunoperoxidase reactivities of Mabs S-L 11.14 and MOC-1 were also studied to characterize the expression of cluster 1 lung cancer antigens and hence to determine among the NSCLC those which expressed the neural cell adhesion molecule (NCAM). Eighteen (45%) lung tumours strongly expressed P-glycoprotein as an immunostaining of many islets of malignant cells or almost all malignant cells. In addition, 8/40 tumours (20%) showed a weak reactivity (few immunostained cells) and 14/40 (35%) no reactivity. There was no difference of reactivity when NSCLC were compared with SCLC. The expression of P-glycoprotein in NSCLC did not vary significantly when the stage of disease was considered. Among the 29 NSCLC, 10 (36%) expressed S-L 11.14 and MOC-1. The NCAM positive NSCLC did not show any difference of P-glycoprotein expression in comparison with NCAM negative ones. Finally, C219 immunoperoxidase reactivity did not significantly differ according to the ploidy status. In conclusion, the internal epitope of the P-glycoprotein encoded by the MDR1 gene is frequently expressed by lung tumours of any histological type. This expression is not higher in Stage III and IV lung cancers in comparison with Stage I and II ones, or in NSCLC in comparison with SCLC either. Thus, the C219 related epitope seems to have a weak implication in the lower chemosensitivity of both advanced stages and NSCLC.

ATP Binding Cassette Transporter, Subfamily B, Mem↗