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Biomedical subjects

J Pettavel

Publications and source records attributed to J Pettavel.

At least 37 records · Page 2Linked to original sources

[Reconstruction of the breast after mastectomy].

A wider use of reconstructive surgery of the breast has become possible since Patey-modified mastectomy has been preferred to Halsted classic radical mastectomy for operable breast cancer and routine use of postoperative radiotherapy discontinued in patients eligible for adjuvant chemotherapy. Reconstructive techniques are reviewed and pitfalls subjected to careful scrutiny. It is thought that women might be encouraged to seek earlier medical advice after noticing a lump in the breast if they are alive to the prospect of possibile restoration of the contours of the breast after ablative surgery.

Breast Neoplasms↗

[Role of surgery in the treatment of breast cancer in surgical border-line cases].

Since the turn of the century, a selection of borderline operable cancers of the breast have benefited of preoperative radiotherapy. Adjuvant chemotherapy may enlarge the limits of operability in a foreseeable future especially if applied before surgery. Different clinical classifications and staging procedures are studied as well as their influence on prognosis and their use in evaluating the limits of operability.

Breast Neoplasms↗

[Selection of patients with breast cancer with regard to endocrine therapy].

Predictive tests assisting in selection of breast cancer patients for endocrine therapy have been reviewed. Information gained from histologic sections, such as degree of the tumor differentiation, degree of elastosis, Barr-body count and the DNA content, are valuable predictors of prognosis and response to endocrine therapy. The length of time between mastectomy and recurrence of metastasis is an important factor in predicting response to ablative endocrine surgery. The presence of various enzymes in the tumor tissue, blood groups, immunologic competence, altered metabolism of tryptophan, urinary excretion of steroids and in vitro hormonal responsiveness of the tumor tissue have not been widely used as predictors of tumor response to endocrine therapy. The determination of hormone receptors in primary or metastatic breast tumors is at present the most reliable test in selecting breast cancer patients for endocrine therapy. Future developments in hormone receptor assay may provide a means of tailoring endocrine therapy to the individual patient.

Adrenal Glands↗

[Familial cancer syndrome studies in 4 generations of a family].

An account is given of a family from the Canton of Valais suffering from hereditary adenocarcinomatosis. The pedigree extends over four generations; the first three comprised 47 individuals (28 males, 19 females), of whom 21 (16 males and 5 females), i.e. 44.6%, have malignant tumors. Of the 32 people in the fourth generation, only one individual is affected to date (a girl age 21, IV/4). There were 27 tumors in all: 16 adenocarcinomas of the colon, two gastric adenocarcinomas, one duodenal adenocarcinoma, one rectal adenocarcinoma, one papillary carcinoma of the ovary, one osseous sarcoma, one cutaneous fibrosarcoma, a multiform glioblastoma of the basal nuclei of the brain, a basocellular epithelioma, a cerebral metastasis from an adenocarcinoma, the origine of which has not been established, and a tumor invading the biliary tract. Three members of the family had multiple tumors. In three of the patient the colonic adenocarcinoma was accompanied by one or two polyps. The average age at onset for all tumors was 45 years. It was definitely lower in the third than the second generation (anticipation). The transmission was autosomal dominant, with predilection for the male sex (57.1% male and 26.3% female patients). The penetrance was about 80%. Finally, the diagnostic criteria for hereditary adenocarcinoma are discussed and the different familial forms of cancer are reviewed.

Adenocarcinoma↗

[The use of CEA radioimmunoassay for the detection of recurrence of carcinoma of the large bowel (author's transl)].

Carcinoembryonic antigen (CEA) is a tumor marker defined by specific heterologous antisera. Elevated levels of circulating CEA can be detected by radioimmunoassay in most cases of colorectal carcinoma, depending on the degree of tumor spread. The fact that elevation of CEA level can also be observed in other types of carcinomas and in several nonmalignant conditions greatly limits the value of the CEA test for the early diagnosis of colorectal carcinomas. Repeated CEA measurements and their critical interpretation, however, appear to be of importance after tumor resection for the detection of tumor recurrence during the postoperative follow-up period.

Adenocarcinoma↗

[Value and limits of the determination of carcinoembryonic antigen (CEA) in postoperative evaluation of patients with colonic and rectal carcinomas].

An attempt is made to define the usefulness and limitations of carcinoembryonic antigen (CEA) radioimmunoassay for evaluation of tumor resection and detection of tumor relapse in patients with large-bowel carcinoma. In 45 patients for whom complete tumor resection was reported, all but 5 showed a drop in CEA to normal values after surgery. The 5 patients whose CEA did not fall to below 5 ng/ml showed a subsequent rise in CEA level and later were all found to have a tumor relapse. The results indicate that an incomplete drop in circulating CEA level one month after surgery is a bad prognostic sign. Twenty-two of these patients were followed up by repeated CEA radioimmunoassay for several months after surgery; 8 showed a progressive increase in CEA levels preceding clinical diagnosis of tumor relapse by 2-10 months. The clinical history of these 8 patients is briefly described. The results demonstrate that relapses of colon and rectum carcinoma can be detected by increased CEA levels months before the appearance of any clinical evidence.

Adenocarcinoma↗

[Treatment of primary and secondary liver tumors using a combination of chemotherapy and surgery].

The results obtained with protracted intra-arterial chemotherapy infusions in 60 case of primary or secondary liver tumor are discussed. The treatment should if possible be associated with surgical excision of the dominant tumor mass. Subjective improvement is obtainable in 75% of cases and objective improvement (including longer survival) in 50%. In some exceptionally favourable cases complete histologic disappearance of the metastases has also been achieved. Carcinoembryonic antigen determination appears to be the most reliable follow-up test.

Antineoplastic Agents↗

Detection of recurrence of large-bowel carcinoma by radioimmunoassay of circulating carcinoembryonic antigen (C.E.A.).

The usefulness and limitations of the carcinoembryonic antigen (C.E.A.) radioimmunoassay for the evaluation of tumour resection and for the detection of tumour relapse were studied in patients with large-bowel carcinoma. The level of plasma-C.E.A. was determined before any treatment in a group of 101 patients with histologically proven adenocarcinoma of the colon and rectum. 71% of all patients and 63% of cases with localised tumour (Dukes A and B) had a preoperative C.E.A. value of 5 ng. per ml. or higher. This limit was reached by only 1 of 90 apparently healthy, non-smoking blood-donors. Among 45 patients for whom a complete tumour resection was reported, all patients except 5 showed a drop of C.E.A. to normal values after surgery. The 5 patients whose C.E.A. did not fall to below 5 ng. per ml. showed a subsequent rise in C.E.A. level and were all found later to have a tumour relapse. The results indicate that an incomplete drop of circulating C.E.A. level one month after surgery has a bad prognostic significance. 22 of these patients were followed up by repeated C.E.A. radioimmunoassay for several months after surgery. 8 showed a progressive increase in C.E.A. levels preceding clinical diagnosis of tumour relapse by two to ten months. 6 other patients showed a moderate increase in C.E.A. levels, suggesting a tumour relapse not yet clinically detectable. The remaining 8 patients showed no increase in C.E.A. level above 5 ng. per ml. and no clinical symptoms of relapse. The results demonstrate that relapses of colon and rectum carcinoma can be detected by increased C.E.A. levels months before the appearance of any clinical evidence.

Adenocarcinoma↗