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Biomedical subjects

J Maurel

Publications and source records attributed to J Maurel.

At least 37 records · Page 2Linked to original sources
PubMed1999

Genetic susceptibility associated with rare HRAS1 variable number of tandem repeats alleles in Spanish non-small cell lung cancer patients.

The highly polymorphic HRAS1 variable number of tandem repeats (VNTR), which maps 1 kb downstream from the human H-ras1 gene, has been described as an inherited predisposing factor in many human cancers. Here, we investigated the association between the presence of rare HRAS1 minisatellite alleles and lung cancer in the population studied. Four hundred sixty-six HRAS1 VNTR alleles from 233 lung cancer patients and 892 alleles from 446 unaffected controls were typed using PCR-long agarose gel electrophoresis assay of peripheral blood lymphocyte DNA. Rare alleles were differentiated from common alleles (a1, a2, a3, and a4) by shifts in electrophoretic mobility. Odds ratio was calculated to evaluate increased risk of lung cancer associated to the presence of rare HRAS1 alleles. A higher percentage of rare HRAS1 VNTR alleles in lung cancer patients than in unaffected controls (32.7 versus 21.9%) was confirmed. The presence of rare alleles was associated with an increased risk of lung cancer (odds ratio = 1.68; P < or = 0.0001), indicating a genetic predisposition to lung cancer. No differences based on other clinicopathological variables were observed. Furthermore, a meta-analysis showed a higher distribution of rare alleles in our study of Caucasian Spaniards than was found in other studies of American and Northern European Caucasian populations. We conclude that the presence of rare HRAS1 VNTR alleles may be an inherited predisposing factor in lung cancer. This presence can be easily determined from peripheral blood samples by PCR-based methods. Furthermore, interracial variations in allele frequencies and variations between Caucasian subpopulations suggest that genetic variations may be involved in susceptibility to lung oncogenesis, especially in certain ethnic populations.

Alleles↗
PubMed1999

[Reporting of resected colonic carcinomas. Assessment of practices in 8 French counties in 1995].

OBJECTIVES: The objective of this work was to study the reporting of resected colonic carcinomas and to compare them with Consensus Guidelines published in January 1998. METHODS: The study included 535 colonic carcinomas collected in 8 French registries in 1995, and chosen by drawing lots. For each report, the presence of the information requested by the Guidelines was looked for. Three synthetic variables were built: 2 scores and one qualitative at 2 classes. The influence of patients, tumour and health care system's characteristics was analysed on the 3 dependent variables. RESULTS: Some important variations were observed for information's percents in reporting. In monovariate analysis, scores were significantly influenced by cancer's sub-location, area of patient's residence, surgical center, type of laboratories and pathologist case volume. In multivariate analysis, significant heterogeneity in practices remained between geographical areas. Types of laboratories and pathologist case volume affected differently dependent variables. CONCLUSION: This study shows the necessity to assess the practices before consensus because of the impact of pathological forms in therapeutic decisions and variations observed.

Aged↗
PubMed1999

[Results and indications of lateral ileostomy functionally terminated in colorectal surgery].

UNLABELLED: Loop ileostomy (LI) ensures fecal diversion to protect an anastomosis or anatomic colorectal or ano-perineal damage. The aim of this retrospective study was to evaluate loop ileostomy morbidity in emergency and planned colorectal surgery. PATIENTS AND METHODS: From 1991 to 1996, 145 loop ileostomies were performed in 139 patients, 77 men and 62 women with a mean age of 48.7 years (15-82). The etiology was a rectal tumor (cancer or large villous tumor n = 47), inflammatory bowel disease (n = 47, ulcerative colitis = 37 and Crohn's disease = 10) Familial Adenomatous Polyposis (n = 13) and other diseases (n = 32). 80% LI (n = 116) protected ileo-anal anastomoses (n = 46) colo-anal anastomoses (n = 45, 26 with colonic pouch), ileo-rectal anastomoses (n = 11) and other anastomoses (n = 15). 20% LI (n = 29) dysfunctional ano-perineal lesions (n = 8), anastomosis leak (n = 4) or distal bowel without intestinal resection (n = 17). RESULTS: 7 deaths were not stoma-related. 91% LI were closed after a mean diversion time of 3.6 months. LI closure was performed by a parastomal (n = 128) or laparotomy procedure (n = 4). Morbidity during LI diversion was observed in 24 patients (16.5%) 12 of whom (8.3%) were operated for small bowel obstruction (n = 6; 4.2%) stoma revision (n = 5; 3.5%) and prolapse (n = 1; 0.7%). 2 patients had peristomal skin excoriations, and 5 patients required readmission for dehydration due to high LI output. Morbidity after LI closure was observed in 12 patients (8.6%) 5 of whom were operated for anastomotic leak (n = 4) or small bowel obstruction (n = 1). Low morbidity and defunctioning efficiency confirm the indications for LI. LI is our first-line stoma in planned or emergency colorectal surgery.

Adenomatous Polyposis Coli↗
PubMed1998

Lymph node harvest reporting in patients with carcinoma of the large bowel: a French population-based study.

BACKGROUND: In patients with resected colorectal carcinoma, lymph node involvement has particular importance for patient prognosis and adjuvant therapy. The network of French cancer registries (FRANCIM) established a study aimed at analyzing the validity of lymph node harvest reporting in a population-based sample. METHODS: The study population was comprised of 1081 resected tumors without distant visceral metastasis and classified using the TNM system. Correlation between the number of examined lymph nodes and the staging of the tumor was examined by logistic regression analysis to establish an estimate of the minimum number of lymph nodes required to determine whether a tumor is lymph node negative. RESULTS: An average of 7.7 +/- 0.2 lymph nodes were examined per specimen in the 851 patients for whom the number of lymph nodes examined was known. The proportion of cases classified as N+ increased significantly with the number of examined lymph nodes (chi-square trend = 24.6; P < 0.0001). If the probability of correct lymph node status assessment is 1 in the reference group (comprised of pathology reports of specimens with > or = 16 examined lymph nodes), the probability of correct N+/N- dichotomization was significantly < 1 for the 1 to 3 lymph nodes group and the 4 to 7 lymph nodes group (i.e., 53.7% of cases). CONCLUSIONS: To comply with current rules for adjuvant chemotherapy, surgeons must provide pathologists with at least eight lymph nodes for optimal N+/N- dichotomization to reduce the risk of misclassification and understaging.

Aged↗
PubMed1998

Seventy-two hour epirubicin infusion plus quinidine in unresectable and metastatic adenocarcinoma of the pancreas: a phase II trial.

Twenty-two previously untreated patients who had unresectable and metastatic pancreatic cancer were treated in a prospective phase II trial with high-dose continuous infusion epirubicin (45 mg/m2 once every 24 hours continuous infusion days 4 through 6) plus quinidine (495 mg once every 24 hours on days 1-6). There were no objective responses (0 of 18 evaluable patients). Subjective responses were achieved in 2 of 21 evaluable patients (9%), all of whom had good performance status (Eastern Cooperative Oncology Group: 0-1). Median survival was 5.7 months for the overall population. Two patients who exhibited symptomatic improvement achieved responses lasting 7 and 13 months, respectively. Toxicity was generally mild and tolerable. Little benefit regarding survival and quality of life was observed with the use of this regimen. The role in chemoresistance of mdrl, p53, and the mismatch repair system was examined.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1997

[Positron emission tomography detection of residual disease in a case of lung cancer].

To date, computed tomography is considered the best procedure to detect either relapse or residual disease in non-small cell lung cancer. However, in recent years several studies have stressed the value of F-18 fluorodeoxyglucose positron emission tomography (FDG PET) which takes advantage of the enhanced glucose uptake observed in neoplastic cells. We present the case of a patient with a locally advanced non-small cell lung cancer who received trimodal treatment with induction chemotherapy followed by surgical resection and postoperative irradiation and lately developed brain metastases which were treated with chemoradiotherapy plus radiosurgery. However a small residual lesion remained in the brain magnetic resonance. Such abnormality was evaluated by means of FDG PET which did not show any increase on FDG uptake. The present case prompt us to review the role of FDG PET as a procedure that enable to detect subclinical disease and its potential usefulness taking into account the improvement in management strategies that has been attained in non-small cell lung cancer.

Adult↗
PubMed1997

Social environment and prognosis of colorectal cancer patients: a French population-based study.

Colorectal cancer is a major public health problem in industrialised countries. Several studies have shown that social environment influences survival in cancer patients in many countries, but the causes remain unknown. In France, very little work has been done in this area. Our aim was to assess whether social environment influences survival of colorectal cancer patients in a well-defined French population and, if so, to what extent this could be explained by differences in stage at diagnosis or in treatment. The study population consisted of 1,642 colorectal cancer patients diagnosed between 1978 and 1987 in the French department of Calvados. Socio-demographic characteristics were assessed in terms of socio-professional category, place of residence (urban vs. rural) and distance from the place of residence to a specialised health-care centre. The relation between social environment, clinical factors and survival was studied using 2 multivariate methods (Cox model and relative survival method). Patients with poorer prognosis were found to be farmers of both sexes and individuals without occupation among males. Differences in survival were not explained entirely even when variations in stage at diagnosis and in treatment were taken into account.

Age Distribution↗
PubMed1997

[Digestive hemorrhage disclosing an angiodysplasia and von Willebrand disease type 2].

The authors report a case of a 76-year-old man, with not past history of abnormal bleeding, who suffered an acute, recurrent, intestinal haemorrhage from extensive angiodysplasia of the colon. Intestinal bleeding and angiodysplasia were associated with a von Willebrand's disease. Genetic analysis showed a point mutation in arginine 611 of the mature von Willebrand's factor subunit (A1 loop) confirming a von Willebrand's disease type 2.

Aged↗
PubMed1997

[Mass screening of colorectal cancer by general practitioners in France: what is the real target population?].

OBJECTIVES: People at high risk of colorectal cancer, due to familial or personal history, or to specific symptoms, are considered not to be concerned by mass screening by Haemoccult test. The aim of this study was to investigate people aged 50 to 74 with high risk of colorectal cancer among general practitioners' practices in the department of Calvados (France). METHODS: A random sample of 200 general practitioners were asked to systematically fill out a questionnaire on Haemoccult II proposal for 50-74 year-old patients for a whole week. RESULTS: Participation rate of general practitioners was 58.5%. According to our findings, 13% of 50-74 years patients are considered not be concerned by mass screening, due to familial or personal history, or to specific symptoms. CONCLUSIONS: Colorectal cancer screening protocol have to be fit to level of risk of colorectal cancer. Involvement of general practitioners in colorectal cancer mass screening allows identification of high risk people who can then be managed with a more suitable screening protocol.

Aged↗
PubMed1996

Contribution of cervical ultrasound and ultrasound fine-needle aspiration biopsy to the staging of thoracic oesophageal carcinoma.

This study was performed to evaluate the use of cervical ultrasonography and ultrasound-guided fine-needle aspiration for pretherapeutic staging of oesophageal cancer. 50 patients with a thoracic-oesophageal cancer (upper third = 8, middle = 36, lower = 6), previously untreated, underwent cervical ultrasonography to detect supraclavicular lymph node metastases (LN). An ultrasound fine-needle aspiration biopsy was attempted in 12 cases of suspected LN. 26 patients were operated on, of which 13 had surgical exploration of the neck. All patients were followed after treatment with special attention to the supraclavicular area. 14 patients (28%) were ultrasonography positive, 5 of 8 in the upper third, 9 of 42 in the two other thirds. Of the 12 patients where a fine-needle biopsy was attempted, 9 showed neoplastic cells (75%). 5 patients had cervical metastatic LN at surgery, and 5 other patients demonstrated supraclavicular LN metastases during the follow-up. There was one false positive and six false negatives from cervical ultrasonography and two false negatives of UGFAB (ultrasound-guided fine-needle aspiration biopsy). The sensitivity and the specificity of the cervical ultrasonography were 68 and 97%, respectively. The pretherapeutic staging was modified: 7 patients initially stage II-III were regraded to stage IV. Cervical ultrasonography is a reliable method of assessment of supraclavicular LN in thoracic oesophageal carcinoma.

Biopsy, Needle↗
PubMed1996

The role of induction (neoadjuvant) chemotherapy in stage IIIA NSCLC.

Induction (neoadjuvant) chemotherapy has become an accepted treatment for stage IIIA (T1-3N2M0) non-small cell lung cancer. In two recent randomized trials, neoadjuvant chemotherapy plus surgery gave an increase in median survival at least fivefold greater than surgery alone. The Spanish Lung Cancer Group trial of preoperative chemotherapy, in which the cisplatin dose was randomized to either 50 mg/m2 or 100 mg/m2 plus 3 g/m2 ifosfamide and 6 mg/m2 mitomycin, examines the effect of K-ras gene mutations on tumor response and survival. Patients whose tumors contain K-ras gene mutations are more likely to develop distant metastases and have lower median survival than patients without such mutations. Microsatellite instability seems to be a frequent mechanism of genetic aberrations. Knowledge about these genetic alterations could have prognostic importance and may identify the patients who should receive the most aggressive additional treatment.

Carcinoma, Non-Small-Cell Lung↗
PubMed1996

[Value of cancer registries in the evaluation of colorectal cancer treatment].

Improvement of health care policy requires an assessment of health care practices. In France, morbidity registries might be the best tool of such an assessment. This study shows how the treatment of colorectal cancer can be assessed by French cancer registries. Two studies were conducted. One cross-sectional on data from 7 cancer registries in 1990 and one longitudinal on data from 2 digestive cancer registries (departments of Calvados and Côte-d'Or) between 1978 and 1990. Cancer resection rate significantly increased from 1978 to 1990. In 1990, mean resection rate was 85%, higher for colon (89%) than rectum (79%). Sphincter preservation rate also significantly increased to 40.8% in 1990. No geographical variations were observed for surgical practices. The use of adjuvant radiotherapy had significantly increased between 1978 and 1990, more rapidly in university centres. In more recent years, the use of radiotherapy concerned 50% of resected rectal cancers without differences between the different types of health care centre. However, in 1990, great geographical variations were observed in the use of adjuvant radiotherapy. Similar geographical variations were observed for the use of chemotherapy which did not increased with time. Colorectal cancers were diagnosed more and more earlier from 1978 to 1990 in both departments of Calvados and Côte-d'Or. The French network of French cancer registries (FRANCIM) provides accurate and reliable knowledge on medical practices, geographical variations and trends. Information is also available on prognosis in cancer patients. Potentialities of cancer registries are not actually well known although such information is required to plan health care policy.

Aged↗
PubMed1996

[Contribution of cancer registries to the evaluation of cancer treatment: on the example of rectal cancer].

Improvement of health care policy requires an assessment of health care practices. In France, morbidity registries might be the best tool for such an assessment. This study shows how the treatment of rectal cancer can be assessed by French cancer registries. Two studies were conducted: a cross-sectional study on data from 7 cancer registries in 1990 and a longitudinal study on data from 2 digestive cancer registries (departments of Calvados and Côte d'Or) between 1978 and 1990. Finally, we conducted a regional audit concerning quality control in rectal resection for cancer in Lower Normandy between 1988 and 1993. In 1990 the mean resection rate was 77.8%. The sphincter preservation rate was also significantly increased to 53.9% in 1990. The use of adjuvant radiotherapy significantly increased between 1978 and 1990, more rapidly in university centres. In more recent years, the use of radiotherapy concerned 50% of resected rectal cancers with no differences between the various types of health care centres. However, in 1990, major geographical variations were observed for the use of adjuvant radiotherapy. Similar geographical variations were observed for the use of chemotherapy which did not increase with time. Rectal cancers were not diagnosed earlier from 1978 to 1990 in the two departments of Calvados and Côte d'Or. The use of reproducible quality criteria (length of distal excision, number of nodes examined and histological status of lateral margins) showed a global deficiency and marked variations between the various types of health care centres and levels of surgical training. The french network of French cancer registries (FRANCIM) provides accurate and reliable knowledge on medical practices, geographical variations, trends and quality control. The potential of cancer registries has not been clearly determined, although such information is required to plan health care policy.

Cross-Sectional Studies↗
PubMed1996

Molecular staging of non-small cell lung cancer according to K-ras genotypes.

We have previously demonstrated a strong association between K-ras gene mutations, as determined by PCR followed by allele-specific oligonucleotide hybridization (ASO-h), and survival in non-small cell lung cancer patients. The purpose of this study was to determine the relationship between tumor aggressiveness and specific-type K-ras point mutations in non-small cell lung cancer. We developed procedures to examine the status of the K-ras gene by ASO-h and by single-strand conformation polymorphism assay of DNA obtained from formalin-fixed paraffin-embedded tumors. K-ras point mutations at codons 12 and 61 were assessed in 275 consecutively treated stage I-IV non-small cell lung cancers. Among patients with stage I disease, median survival time was 41.5 months in those whose tumors had no evidence of K-ras mutations and 27 months in those with K-ras 12 mutations; among patients with stage IIIA disease, median survival time was 7 months in those with K-ras codon 12 aspartic and serine mutations and 15 months for those with other K-ras mutations (P = 0.01). In a multivariate analysis, specific-type K-ras codon 12 point mutation remained a strong predictive factor (hazard ratio for death, 2.06; 95% confidence interval, 1.11-3.81; P = 0.02) after adjustment for other evaluated factors, including TNM stage and histology. Thus, we concluded that in patients with non-small cell lung cancer, specific K-ras 12 point mutations detected by DNA amplification and either ASO-h or single-strand conformation polymorphism methods predicted a significantly increased risk of recurrence and death, independently of stage and histology.

Adult↗