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Biomedical subjects

J P Caujolle

Publications and source records attributed to J P Caujolle.

8 recordsLinked to original sources
PubMed2001

[Proton therapy of occult neovessels in age-related macular degeneration].

INTRODUCTION: The interest of radiation therapy in the management of age-related macular degeneration inaccessible to photocoagulation is still controversial. Our purpose was to demonstrate the feasibility and the possible efficacy of a single dose delivered to the macular region using a 65-MeV proton beam. MATERIAL AND METHODS: A phase II trial was set up using the cyclotron in Nice, France. Fifty-eight patients were included after signing an informed consent. All patients presented with occult subfoveal choroidal neovascularization. A single dose of 9.1 Gy (i.e., 10 Gy cobalt equivalent) was delivered to the macular region. RESULTS: The results were analyzed 3, 6, 12 and, 18 months after proton therapy. At 3 months, the visual acuity was stable or enhanced for 86% of patients, at 6 months for 82.3%, at 12 months for 80%, and at 18 months for 61%. For 22 patients at follow-up at 18 months, the reasons for a decrease in visual acuity were a macular hemorrhage for 4 patients and a progression of the neovascular membrane for 3 patients. No secondary effects related to the treatment have been observed. Regarding the lesions visible on the angiographies (i.e., hemorrhage, exudates, subretinal detachment), we observed a stabilization or a decrease in two-thirds of the cases. CONCLUSION: Preliminary results of single-dose proton therapy are at least comparable to those obtained by other teams. A second study is in progress comparing 3 dose levels, looking for a dose-effect relationship. Furthermore, a randomized study comparing a single proton dose to a placebo will be necessary to assess the long-term value of proton treatment.

Aged↗
PubMed1999

Results of proton therapy of uveal melanomas treated in Nice.

PURPOSE: To present the first results of uveal melanomas treated with the Medicyc Cyclotron 65 MeV proton beam facility in Nice, analyzing the factors that affect the cause-specific survival (CSS), metastatic rate, and reporting the visual outcome. METHODS AND MATERIALS: This study concerns 538 patients referred by French institutions between June 1991 and December 1996. The eye and tumor parameters were measured using ultrasonography and angiography. Since 1994, CT scans were performed in most patients to help determine the axial length and the shape of the ocular globe. Tantalum clips were inserted around the tumor by the referring ophthalmologist. There were 349 posterior pole tumors (64.9%), 130 equatorial tumors (24.1%), and 59 ciliary body tumors (11%). Two hundred four patients (37.9%) had T1 or T2 tumors, and 334 patients (62.1%) had T3 or T4 tumors. The median tumor diameter was 14.6 mm, and the median tumor height was 5.1 mm. All patients received 52 Gy (57.20 Gy Co-equivalent dose) on 4 consecutive days. The data were analyzed by December 1997. RESULTS: The CSS was 77.4% at 78 months, the overall survival was 73.8% and the local control was 89.0%. The CSS was not influenced by the patient age or the site of the tumor. It was 81.5% for T1 and T2 tumors, versus 75% for T3 and T4 tumors (P = 0.035). It was found that the tumor diameter, rather than the height, was the most important parameter affecting outcome. The metastatic rate was 8%. It depended on the T stage, tumor diameter and thickness, but not the tumor site. Thirty-eight enucleations were performed, most of them due to tumor progression and/or glaucoma. One-third of the patients in whom visual acuity was adequately scored before and after treatment had a stable, if not improved vision, and half the patients retained useful vision after treatment. CONCLUSION: The outcome of patients suffering from uveal melanoma and treated with high-energy protons compares favorably with other techniques of treatment. The tumor dimensions affected CSS and metastatic rate. Even though two-thirds of patients had posterior pole tumors, half of them retained useful vision.

Age Factors↗
PubMed1995

["Melanoma 92". epidemiological study of uveal melanoma in France].

PURPOSE: The purposes of this study were to evaluate the incidence of uveal melanoma in France in 1992, to describe the characteristics of the tumors and their treatments. METHODS: This was a retrospective and multicentric study. First a questionnaire was sent to 4575 French ophthalmologists asking whether they had established a diagnosis of uveal melanoma during 1992, and if so, to describe the tumor and its management. Then the patients files were reviewed in the specialized treatment centers (Paris, Lyon, Nice, Strasbourg, Bordeaux, Clermont-Ferrand). All the data were statistically analysed. RESULTS: 412 new cases of uveal melanomas were registered (incidence 0.7/100000) affecting 234 females and 178 males. The cases ranged in age from 7 to 93 years (mean 61.5 years). There were 5 (1%) isolated tumors of the iris, 75 (18%) of the ciliary body, either isolated (10%) either associated to iris and/or to choroïdal tumors and 332 (81%) choroïdal melanomas. 201 (53%) tumors were posterior to the equator and 153 (40%) had a margin at less than 3 mm of the optic disc; 87 (21%) melanomas were detected in asymptomatic patients. In 29 (7%) other cases, the diagnosis was established after enlargement of the tumor. In all other eyes, symptoms were present. 17% of the melanomas were T1, 34% were T2, et 48% were T3. 353 (86%) melanomas were pigmented, 30 (7%) were achromic and 29 (7%) of the mixed color type. 156 (38%) tumors were associated with a retinal detachment. In 12 cases (3%), at presentation there was an extrascleral extension. 9 patients (2%) had metastases (7 to the liver, 1 to the lungs and 1 to the lungs and bones). The study of the patients residence and work did not show any environmental risk factor. The initial treatment was protontherapy in 251 patients (63%), plaque therapy in 91 (23%), enucleation in 40 (10%), and other methods in 18. CONCLUSION: This was the first epidemiologic study conducted in France on this subject. It describes the clinical features of the disease, its geographical display and its management in this country.

Adolescent↗
PubMed1989

[Tuberous sclerosis of Bourneville: contribution of the ophthalmologist in 2 cases].

Bourneville's tuberous sclerosis. Report on two cases. The tuberous sclerosis is a most rare congenital disease belonging to the phacomatoses with a non-predominant neural crest participation. The ophthalmologist's diagnostic does have a real importance because the fundus can show phacomas which are one of the most specific indications of this affection, and therefore it does help for the genetic advice. After the report of two tuberous sclerosis cases showing phacomas, we insist on the ophthalmologic signs and on the principal manifestations of this disease. The main problem to solve will be how to set up the differential diagnostic with a first appearance of a retinoblastoma. Most of the time, the evolution will be a slow increase of the phacomas' number and of their size as well. Sometimes it might be complicated by vitreous hemorrhages which may lead to a vitrectomy. The vital prognostic will be make out according to the general damages.

Adolescent↗
PubMed1989

[Cryosurgery in the treatment of basal cell epithelioma of the eyelids].

Modern cryosurgery, based on impedance measurement, is a valuable addition to excisional surgery and radiation therapy in the management of eyelid malignancies. The advantages of the procedure are the good cosmetic and functional results. For the management of basal cell carcinoma situated near the punctum lacrimale and lacrimal canaliculus, cryosurgery may be preferred to surgery and radiotherapy. We review principles, methods, clinical and histological presentation of cryosurgery and describe our preliminary results.

Aged↗
PubMed1988

[Malignant hyperthermia in ophthalmologic surgery].

Malignant hyperthermia is a potentially fatal complication of general anesthesia that may occur with greater frequency in ptosis and strabismus surgery. The case of a two-year-old girl who suffered a malignant hyperthermia crisis during strabismus surgery is reported. The pathophysiology, clinical features, treatment and pre-anesthetic diagnosis are reviewed in detail.

Anesthesia, General↗