Biomedical subjects
Publications and source records attributed to J C Janser.
The authors report a surgical procedure for prevention of radiation enteritis performed in 24 cases of advanced gynecological and rectosigmoid malignancies with a 12-month median follow-up. Visualization and resorption of the Vicryl mesh were analyzed by means of magnetic resonance imaging.
Used in 13 cases of advanced gynecological and gastrointestinal carcinoma, pelvic exclusion using a suspension of the small intestine above the pelvis using absorbable material. The low-level of morbidity, value in dosimetric estimation, perfect feasibility and low cost of this technique should lead to its more widespread use whilst strictly respecting its indications. Nuclear magnetic resonance has been found to be a particularity novel and valuable method of post-operative investigation in visualisation and assessment of resorption of the polyglactine 910 trellis. Results in this series are analyzed at the end of a 5 to 14 month follow-up period and compared with data from experimental and clinical studies in the recent world literature.
Since they are rare and often latent, gastric metastases from breast cancer, principally lobular, are difficult to diagnose particularly at the isolated stage. The primitive and non specific nature of their symptomatology and the negativity of endoscopic biopsies should lead to early explorative laparotomy. Surgery is often palliative to reduce tumor load and seldom involves complete excision, and can only hope to obtain prolonged survival if followed by chemotherapy, hormone therapy or indeed radiotherapy. Following a recent personal case a review of the worldwide literature was carried out and the principal pathogenic hypotheses were analysed.
Hurthle cell or oxyphil cell tumours of the thyroid, which consist of large cells with eosinophilic granular cytoplasm, rich in mitochondria, have given rise to much controversy in recent years. Difficulty in histological diagnosis (benign or malignant), unexpected evolution, and the possibility of very late recurrence and metastasis occurring in cases which were previously labelled benign, characterise these ambiguous tumours. Their malignant forms are most often classified with vesicular cancers of the thyroid. They differ from the latter by the frequent presence of lymphatic metastases, the lack of effect of I 131 on distant metastases and their poorer prognosis. The experience of the authors is based upon a series of 33 cases of Hurthle cell tumours of the thyroid treated surgically (27 benign, 6 malignant), with a mean age of 44 years for benign lesions and 50 years for cancers (range 17 to 69 years) showing a clear female predominance (66% of cases). They most often presented clinically as a cold thyroid nodule which tended to be larger in the case of cancers (5 out of 6 cases had a diameter of more than 5 cm). The limits of resection were most often dictated by the results of per-operative frozen section: total lobectomy + isthmectomy for benign tumours and total thyroidectomy if macroscopic or histological signs of malignancy were present (spread beyond the capsule, vascular invasion, lymphatic metastases), with cervical node clearance if N+. The 27 cases who underwent surgery for benign tumours have survived (1 single local recurrence after 7 years, without any malignant progression and a median survival of 7 years). No deaths have occurred among the 6 cases of malignant tumours (follow-up ranging from 1 to 9 years, median 5.4 years) but a present metastases. A study of the series published in the literature confirms the difficulty with diagnosis in terms of the benign or malignant nature of the tumours. It also stresses the justification for relatively aggressive surgery on the thyroid parenchyma and the need for a very long period of locoregional and general surveillance in order to assess the results of treatment. Survival rates for malignant forms range from 60 to 65% at 10 years and from 25 to 47% at 15 years.
The development of a malignant process within a tonsillar cyst is controversial. This phenomenon is exceptionally rare, at present only three cases which have been compatible with anatomo-clinical diagnostic criteria have been clearly established. Based on an original case showing a secondary papillary thyroid cancer in a tonsillar cyst, the authors analyse, in the light of recent data from worldwide literature, the various stages in the diagnostic process in both primary and secondary malignant tumours. The therapeutic and prognostic aspects of the two tumour varieties are also discussed.
Despite coded staging of localization studies in cancer of the uterine cervix, numerous authors have attempted to improve knowledge concerning certain prognostic factors, of which the most important in lymph node status. It is with this in view that pre-scalene biopsies are performed. Their adjunction to pretreatment investigations appears to be determining, especially in advanced-stage forms when aggressive surgical (pelvic exenteration), radiation (lomboaortic irradiation) or even chemotherapeutic treatments are being considered. Because of the wide variation in the results in the literature and the lack of precision of the indications of this low-morbidity surgical procedure, the authors decided to define the place of this supraclavicular lymph node investigation for staging. While it need not be systematic in the early stages of the disease, this does not seem to be the case in advanced stages and recurrences which call for a more moderate attitude.
Spontaneous regression of metastases from cancer of kidney is an exceptional event, original but non-specific to this neoplasm. Observed principally in secondary pulmonary localizations this phenomenon occurs most frequently after nephrectomy. A personal case is presented of regression of pulmonary images considered as being metastatic after irradiation of a pelvic metastasis from renal adenocarcinoma, and a literature review carried out. The various pathogenic hypotheses are discussed and the place of nephrectomy for metastatic renal cancer (Robson's stage IV) debated.
Outcome in 190 patients operated upon by first intention for thyroid cancer is analyzed after follow up over more than 5 years. No deaths due to cancer occurred in 57 cases of papillary cancer, but 7 cases presented pulmonary metastases, while the global-5-year survival rate in 63 cases of vesicular cancer (including 25% with preoperative metastases) was 60%. In the absence of preoperative metastases, ans if well differentiated forms are separated from moderately differentiated forms, the respective 5-year survivals were 88 and 45%. The 1-year survival rate for the 42 cases of anaplastic cancer was 15%, while the 5-year rate for 15 cases of medullary cancer was 80%.
Two cases of trophoblastic tumor of placental site are reported, less than 30 such lesions being listed in the published literature. Identification of this tumor from among other trophoblastic lesions is facilitated by immunohistochemical and electron microscopy technics, and demonstration of histoprognostic and biologic criteria improves assessment of evolutory potential of this type of tumor and allows adaptation of therapy. Treatment at the localized stage requires early diagnosis and wide surgical excision, results of chemotherapy in metastatic forms being, inversely than with choriocarcinoma, very deceiving.
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Three cases of central giant cell reparative granulomas of the mandible are reported. The first shows classic manifestations. The second illustrates the role of traumatism in the genesis of these lesions. The third highlights the effect of pregnancy in their growth. The bilateral character of the lesions in this last patient led us to evoke the diagnosis of hyperparathyroidism and cherubism. They were ultimately discarded. A diagnostic approach is proposed which takes into account the location of the lesion and the medical history of the patient. Both experimental data concerning the potential of the cells found in the ramus of the mandible in laboratory animals and notions which apply to the periodontal bone remodelling enable one to better understand and differentiate between the central giant cell reparative granuloma and the genuine cell tumor of the mandible.
Out of 3,340 thyroidectomies (237 for cancer), the authors report 5 cases of thyroid metastases due to clear cell renal cancer. They emphasize the slow development of these metastases. Two cases were operated on 11 years after nephrectomy and one after 27 years. In one case, an intrathyroid metastasis led to the discovery of renal carcinoma. In 3 cases, evolution was rapidly fatal (within the first year). One patient is still alive 6 years after thyroidectomy. The authors emphasize clinical grounds for diagnosis and expose pathology findings that favor longer survival when there is early removal of intrathyroid metastases.
The occurrence of circulating immune complexes (CIC) was investigated in serum samples from 139 patients with breast cancer, using the 125I-C1q binding test. In the 85 cases of regional forms, the level of Clq binding activity did not appear to be correlated with the clinical TN stage, nor with the local treatment of the tumor. Conversely it was clearly elevated in the 13 cases of inflammatory breast tumors, and the decrease of CIC at the post-chemotherapy, but pre-surgical stage may involve the inflammatory signs in this augmentation of CIC. Frequency of occurrence and levels of CIC were slightly increased in the 41 metastatic breast cancer patients when compared to the cases of local breast carcinoma. In the disseminated forms, increase, no change, or decrease of CIC levels showed a poor correlation to progression, stabilisation, or improvement of the disease. CIC seems to be of slight prognostic value in breast cancer with local forms, but regarding progression of the disease, metastatic breast cancer patients with elevated CIC did not prove to be unfavorable group. So far, CIC did not appear to be a tumor marker or an evident prognostic factor of clinical relevance in breast cancer. Assays for antigen-specific CIC might be of greater clinical significance, in breast cancer, than the antigen non specific assays available at present.
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