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J R Delpero

Publications and source records attributed to J R Delpero.

At least 73 records · Page 4Linked to original sources
PubMed1995

Polymerase chain reaction detection of circulating melanocytes as a prognostic marker in patients with melanoma.

BACKGROUND AND DESIGN: Polymerase chain reaction (PCR) detection of circulating tumor cells from malignant melanoma (MM) was recently described, but the prognostic value of this method in the treatment of patients with MM remained unclear. In the present prospective study, blood samples (n = 193) were collected from 93 patients with MM: 10 stage I patients after primary tumor resection, 18 patients with regional lymph node metastases before node resection, 33 disease-free but high-risk patients (previously treated for node metastases), and 32 patients with distant metastases. Circulating melanocytes were detected using a reverse transcriptase PCR method that analyzes tyrosinase gene expression. All patients were kept under regular surveillance. RESULTS: The PCR assay was always negative in normal individuals and in subjects with non-MM metastatic cancer, while it was positive in 16 of 32 patients with disseminated MM. Five of eight patients who were PCR-positive before node dissection vs one of 10 who were PCR-negative relapsed within 6 months after surgery. In high-risk but apparently disease-free patients, the risk of relapse within the next 6 months was 3.8 times higher after a positive test result. In patients with distant metastases, a positive PCR predicted rapid disease progression. CONCLUSIONS: These data suggest that PCR detection of circulating melanocytes can be considered as a marker for rapid postoperative relapse after node dissection in patients with MM with regional node metastases, for short-term relapse in high-risk disease-free patients, and for rapid and severe progression in patients with distant metastases. This test may have a crucial interest in the treatment of patients with MM.

Base Sequence↗
PubMed1995

[Feasibility and tolerance evaluation of 2 routes of preoperative administration of interleukin 2].

Preoperative interleukin 2 (IL2) administration has been performed, in order to diminish the post-operative immunodepression in cancer patients. The aim of this study was to compare two different ways of preoperative IL2 administration, ie, intravenous (iv) and subcutaneous (sc), in terms of feasibility and tolerance. Nineteen surgical procedures were performed in 18 patients: a) 10 following the administration of 12 IU/m2/24 hours IL2 IV, with a continuous infusion, from day 5 to day 3 before surgery; b) 9 following the administration of 18 IU IL2, in 2 SC injections per day, from day 4 to day 2 before surgery. Tolerance was evaluated by both clinical and biological parameters, before, during, and after surgery. Hyperthermia and capillary leak syndrome were more important in the iv versus sc injection group. Insomnia and digestive troubles were more frequent in the iv injection group as well. However, we noticed few and equivalent cutaneous and respiratory complications in both groups. In conclusion, the tolerance of IL2 was better after sc versus iv injection. However, the toxicity of iv infusion of IL2 was moderate and could be limited by preventive treatments; moreover there was no consequence on the scheduled surgical procedure.

Adult↗
PubMed1994

Concomitant chemoradiation prior to surgery in the treatment of advanced cervical carcinoma.

In patients with locally advanced cervical cancer, most of the treatment failures occur within the pelvis. In an attempt to improve local control, 40 patients with bulky tumors (stage IB > 5 cm, stage IIB with distal parametrial invasion, and stage III-IVA) were treated between 1988 and 1992 with concurrent chemoradiation (CCR). The whole pelvis received a midplane dose of 45 Gy over 33 days. Daily radiation dose was 1.8 Gy, with twice-daily fractionation in the last 20 patients. Chemotherapy was administered on the 1st and 21st days of radiation therapy (RT) consisting of cisplatin (60 mg/m2), followed by 5-fluorouracil (600 mg/m2/day continuous i.v. infusion) over 96 hr (and decreased to 40 and 400 mg/m2, respectively, in the last 23 patients). CCR was first followed by a single intracavitary application and then by a parametrial boost in stage IIB-III patients and in stage IVA patients with disease reaching the pelvis side wall. Then surgery (colpohysterectomy with lymphadenectomy or pelvic exenteration) was performed in 35 patients. Median follow-up time was 2.6 years (0.6-5.6 years). Acute toxicity (WHO grade 3-4 diarrhea) in 13 patients led to 6 RT interruptions and 4 incomplete RTs. One patient died of a septic episode without leukopenia after completion of CCR. Five postexenteration complications required a second surgical procedure, of which one patient died with tumor and small bowel fistula. One patient developed small bowel late complication and another patient developed urinary late complications. No postoperative or late complications were observed in patients treated with twice-daily fractionation. Pelvic control was achieved in 32 of 40 patients (81 and 74% in stage IB-IIB and stage III-IVA, respectively). Sites of failure were the pelvis (6 cases), metastases (7 cases), and both (2 cases). Two-year survival and DFS rates were 61 and 66%, respectively, in stage IB-IIB and 77 and 65% in stage III-IVA. High SCC-TA4 values significantly worsened DFS rates. In patients with stage III-IVA tumors, additional surgery could be an important component of this treatment strategy and may be compatible with CCR using twice-daily fractionation radiotherapy. However, these results must be confirmed by a large-scale prospective study.

Adult↗
PubMed1994

Pelvic staging of advanced and recurrent gynecologic cancers: contribution of endosonography.

From January 1988 to December 1992, 106 patients with advanced gynecologic cancer were preoperatively explored by clinical examination (CE) and endosonography (ESG) under anesthesia and by computed tomography (CT). Sixty-one tumors were primary and 45 recurrent; the main locations were cervical (73 cases), ovarian (10 cases), and endometrial (8 cases). All the patients were operated. This prospective study compares the data from clinical and imaging examinations with the histologic findings and the surgical reports. Accuracy of the CE, ESG, cytoscopy, and CT was respectively 79, 90, 82, and 80% for vesical involvement (ESG versus CT: P < 0.05). For vesicovaginal septum extension, accuracy of ESG (92%) was statistically better than that of CE (80%) and CT (77%). Accuracy of the CE, ESG, and CT was respectively 93, 97, and 89% for rectal involvement (ESG versus CT: P < 0.02). For rectovaginal septum extension, accuracy of ESG (96%) was statistically better than that of CE (85%) and CT (85%). Endosonography is valuable in the assessment of regional staging of advanced gynecologic cancers. Since it is realized during the clinical examination under anesthesia, this low-cost procedure is easily performed and provided no discomfort to the patients.

Adult↗
PubMed1994

[Vaginal reconstruction by musculocutaneous flap of the rectus abdominis after pelvic cancer surgery. Apropos of 11 cases].

Surgical treatment of gynecological neoplasms leads to two problems: pelvic defect, and vaginal reconstruction. The authors have been using rectus abdominis musculo-cutaneous flap as described by Tobin. Eleven patients have been treated. A horizontal flap was used in one patient and a vertical one for the 10 other patients. The authors had one failure. In the ten other patients the average healing time was 21 days and 5 patients were able to return to sexual activities. The use of rectus abdominis flap would appear to be an easy and reliable technique for pelvic reconstruction.

Adult↗
PubMed1993

[Analgesic effect of transhiatal splanchnectomy in pain from cancer of the pancreas. Apropos of 51 operated cancers].

The greater splanchnic nerves are responsible for sympathetic innervation of the supra mesocolic viscera, and total bilateral neurotomy is efficient to relieve pancreatic pain. Their dissection is easy by a midline transperitoneal route used for pancreatic cancer surgery. The aim of this study was to evaluate the pain relief related to transhiatal bilateral splanchnicotomy in patients with pancreatic cancer. The tumor was unresectable for all the patients, and nobody was operated only to make neurotomy. Twenty two patients had single bilateral splanchnicotomy, and other had an associated biliary and/or digestive diversion. There was not postoperative specific mortality, and postoperative mortality rate was 3.9%. Specific postoperative morbidity rate was 6%. Most of the patients (83.3%) had immediate pain relief, with or without diversion (respectively 80.7% and 86.3%, p = 0.6). Our data suggest that pain recurs for some patients three months after surgery (pain control in respectively 69.2% and 72.7%), but difference was not significant (p = 0.14). Our results demonstrate that transhiatal bilateral splanchnicotomy relieves pain in patients with pancreatic cancer, with a poor specific morbidity.

Adenocarcinoma↗
PubMed1993

Results of a prospective study with comparison of clinical, endosonographic, computed tomography, magnetic resonance imaging and pathologic staging of advanced gynecologic carcinoma and recurrence.

Between January 1988 and April 1991, 57 patients with advanced gynecologic carcinoma were preoperatively evaluated by gynecologic examination and endosonography (ESG) using general anesthesia. Abdominopelvic computed tomography (CT) was performed in 49 patients and magnetic resonance imaging (MRI) in 21 patients. There were 34 primary tumors and 23 instances of recurrence. Causes of gynecologic carcinoma were 38 carcinomas of the cervix uteri (26 primary and 12 recurrences), eight carcinomas of the ovary (four primary and four recurrences), three recurrences of carcinoma of the endometrium, five sarcomas of the uterus (one primary and four recurrences) and three primary carcinomas of the vagina. All of the patients were operated upon. This perspective study compares the data from clinical and imaging examinations to the data obtained from histologic examination of surgical sections. According to anterior or posterior tumor extension, the accuracy of clinical evaluation and preoperative imaging were studied for the posterior vesical wall and the vesicovaginal septum and the anterior rectal wall and the rectovaginal septum. Histologic examination revealed vesical involvement in 17 patients and of the involvement of vesicovaginal septum in 21 patients. The accuracy of the clinical examination, ESG, cystoscopy, CT and MRI was 83, 88, 87, 75 and 81 percent, respectively, for vesical extension. Cystoscopy was not taken into account for evaluation of extension to the vesicovaginal septum--accuracy was 80, 90, 67 and 86 percent for clinical examination, ESG, CT and MRI. Histologic examination showed involvement in the rectum in 14 patients and involvement in the rectovaginal septum in 19 patients. Rectoscopy was performed 13 times. The accuracy of clinical examination, ESG, CT and MRI was 91, 98, 89 and 71 percent, respectively, for extension to the anterior rectal wall. Rectoscopy was not taken into account for evaluation of extension to the rectovaginal septum--accuracy was 80, 96, 75 and 57 percent for clinical examination, ESG, CT and MRI. Endosonography would seem to be useful to complete examinations for regional extension of advanced gynecologic carcinomas. Its accuracy is superior to that of other examinations. Because it is performed using general anesthesia, there is no discomfort for the patient during this low cost procedure.

Cystoscopy↗
PubMed1993

[Electronic sectorial ultrasound endoscopy in benign and malignant tumoral pathology of the stomach. Results in 30 patients].

From October 1991 to July 1992, endoscopic ultrasound examination (EUS) was performed preoperatively in 30 patients with gastrointestinal disease with a new forward-view fiber optic gastroscope with a 5 and 7.5 MHz curved-array linear transducer mounted directly behind the lens. Before EUS examination, endoscopy with biopsy had established the diagnosis of gastric disease in 22 cases: 16 adenocarcinoma, 4 lymphoma, 1 carcinoid tumor and 1 gastric metastasis of a chorionic tumor. In the 8 other cases, endoscopic diagnosis with non productive biopsy was gastric ulcer (1 case), submucosal tumor (5 cases), and large fold gastritis (2 cases). EUS established a correct diagnosis in 6 of these 8 cases (2 leiomyoma, 1 lipoma, 1 lymphoma, 2 gastric linitis). Correct preoperative TN staging was accomplished by EUS in 83.3% and correct preoperative staging for N was accomplished by EUS in 90%. This study shows that EUS a curved-array transducer is useful in preoperative TN staging of gastric tumors.

Adenocarcinoma↗
PubMed1993

[Gastric adenocarcinoma with an endocrine component. Report of nine cases].

Nine gastric adenocarcinomas containing endocrine cells were retrospectively studied to evaluate anatomo-clinical and immunohistochemical features, and the out-come of the patients. These gastric tumors were bulky with frequently lymph node metastasis. The immunohistochemical analysis had shown that all tumors contain EC cells, two tumors D cells, one tumor PP cells, but neither G cells nor A cells were detected. Five-years survival rate of these gastric tumors was slightly but not significantly increased as compared to usual adenocarcinomas (45.5% vs 36.5%). However, one can raise the question of possible control of local hormonal secretions on tumoral growth, particularly the anti-trophic part of the somatostatin.

Adenocarcinoma↗
PubMed1992

Interleukin-2 in association with increasing doses of interferon-gamma in patients with advanced cancer.

Twenty-seven patients with evaluable metastatic cancer were treated with recombinant interleukin-2 (rIL-2) and escalating doses of interferon gamma (IFN-gamma). rIL-2 was infused over a 15 min period at a constant dose (8 x 10(6) IU/m2/8 h x 5 days first cycle, and 8 x 10(6) IU/m2/12 h x 5 days second and third cycles, with 9 days rest between each cycle). IFN-gamma was started 4 days before each cycle of rIL-2 and was given every other day at a dosage of 1 x 10(6) U/m2 x 3/cycle (four patients), 5 x 10(6) U/m2 x 3/cycle (four patients), 5 x 10(6) U/m2 x 5/cycle (four patients) and 10 x 10(6) U/m2 x 5/cycle (15 patients). Common side effects were fluid retention and hepatic toxicity (27 and 15% grade greater than or equal to 2); one ischemic chest pains and one acute respiratory distress occurred. Toxicities were not greater than those described with high dose rIL-2 alone and were similar in each dose level of IFN-gamma. No patient died from the procedure. Four patients responded, one complete response and three partial responses; all were treated with 25 or 50 x 10(6) U/m2/cycle of IFN-gamma (melanoma, two patients; renal cell carcinoma, one patient; lymphoma, one patient). Further phase II studies at these dosages are justified to precisely define the antitumoral efficacy of this association.

Adolescent↗
PubMed1992

[Choice of technique in covering an excision of neoplastic tissue in the inguinal area].

Cancer surgery of the groin may lead to large skin resection with exposure of the femoral vessels. A reliable coverage technique must be chosen to enable this kind of surgery. Six patients were operated on, and ten flaps were used (3 omentum - 3 rectus abdominis - 1 fascia lata - 1 gracilis - 2 latissimus dorsi free flaps). In the light of our results, omentum must be used when laparotomy is associated with inguinal resection and omentum is available. In the other cases, resection size could prohibit the use of local flaps and a contralateral rectus abdominis flap is chosen which allows coverage of the inguinal area down to the middle third of the thigh.

Abdominal Muscles↗
PubMed1992

[Gangrene of the perineum. Plea for a standardized therapeutic management apropos of 50 cases].

From 1988 to 1992, 50 cases of perineal gangrene were treated with a therapeutic protocol combining: a) repeated extensive excisions, b) hyperbaric oxygen therapy, even before surgery if this was possible, and c) intensive care. The mortality rate was 24% (12/50). It was even higher in patients admitted more than 6 hours after diagnosis. The average stay in hospital was of 20 (+/- 2) days. Four patients presented with residual signs. Twenty-eight (56%) had had colostomy for lesions originating in the rectum or threatening the anal margin; 9 of these patients died, while gastrointestinal continuity was restored in another 17 cases. There were three predictive factors of survival in this series: a) early diagnosis and treatment, b) severity index on admission, c) some associations of bacteria.

Adult↗
PubMed1992

Transhiatal bilateral splanchnicotomy for pain control in pancreatic cancer: basic anatomy, surgical technique, and immediate results in fifty-one cases.

The greater splanchnic nerves are largely responsible for innervation of the supramesenteric viscera; their section is known to be efficient to relieve pancreatic pain. Transhiatal splanchnicotomy (THS) is easily performed through a midline laparotomy. The nerve trunks are readily identified in the submediastinal space, far from the pancreatic cancer motivating splanchnicotomy, and can be sectioned safely and completely. After carrying out an anatomic study to determine the level of origin and mode of constitution of the greater splanchnic nerve trunk and its relations to the posterior and lower mediastinum, 51 patients underwent THS for intractable pain caused by unresectable pancreatic adenocarcinoma. THS alone was performed in 22 cases. THS was performed in association with biliary tract diversion or gastroenteroanastomosis in the other cases. All tumors were considered unresectable during surgery, and no patient was operated on with the sole purpose of performing THS. Two deaths (3.9%) were unrelated to THS. Specific morbidity was 6% (one pneumothorax, one chylothorax, and one splenic injury). Immediate postoperative functional results were good in 86.3% of patients treated by THS alone (group 1) and in 80.7% of patients treated by THS and bypass (group II). Functional results decreased to 72.7% in group I and 62.1% in group II, 3 months after surgery. In conclusion, THS appears to be an efficient technique for relief of pancreatic neoplastic pain and need not be combined or confused with medical percutaneous methods of neurolysis.

Aged↗
PubMed1992

[Colposcopy in gynecologic cancers. Retrospective study of 192 examinations].

One hundred and ninety two colposcopic examinations carried out on 183 patients of whom 140 had carcinoma of the cervix, 26 carcinoma of the endometrium and 17 carcinoma of the ovaries were analysed in order to assess the value of colposcopy in patients with gynaecological cancer. The mean distance from the edge of the anus that was looked at was 45 cms--the range being from--130. Out of all the systematic examinations that were carried out before any treatment was started, 103 were for cervical cancer and among these invasion of the rectal mucosa was found in two cases (1.9%). Twelve cases of external pressure on the rectum and 9 cases of recto-colic polyadenomata (8.7%) of which one was malignant. Out of the 14 colposcopies that were carried out for carcinoma of the endometrium one case of rectal invasion was found and one case of external compression. In the 12 cases of cancer of the ovary 2 were found to have recto-colic spread, 1 external compression and 1 malignant polyadenoma. All these cases of spread to the rectum and colon were diagnosed in advanced cases (stage III or IV). In the 63 examinations carried out on follow-up the most common warning sign was a rectal discharge and the most commonly found lesion in the rectum was actinomycotic inflammation of the rectum. The 5 cases of recurrence in the rectum expressed themselves most often by the rectal syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Transanorectal ultrasonography in the evaluation of extension and the monitoring of epidermoid cancers of the anus treated by radiation or chemotherapy].

Twenty-five consecutive patients (5 men and 20 women) with squamous cell anal carcinoma were evaluated by transanorectal ultrasonography (TRUS). The patients were treated with radiotherapy alone (6 cases) or combined concomitant radiotherapy and chemotherapy (19 cases). The ultrasound findings were compared with clinical stage as assessed by digital examination and with pelvic computed tomography. Four tumors in clinical stage T2 showed evidence of external sphincter involvement at ultrasound (UT3) and one tumor in clinical stage T1 showed an invasion of the internal sphincter at ultrasound examination. Low echogenic, rounded structures, interpreted as enlarged lymph nodes, were identified in 8 cases at ultrasound but were not seen with computed tomography. Ultrasonograms were also obtained one month after the achieved end of radiation. Correct staging was by TRUS and CT in 92% and 72% of cases respectively. When combining clinical stage with TRUS, all tumors classified as T1-T2, UT1, UT2 had a complete response to radiotherapy with or without concomitant chemotherapy. TRUS could be a useful adjunct to digital palpation in initial staging and in follow-up after medical treatment of anal canal carcinoma.

Adult↗
PubMed1991

[Obstruction of pancreatic ducts with a fibrin glue. Study after segmentary autotransplantation in dogs].

The effects of the main pancreatic duct with a fibrin sealant have been investigated on an experimental model of segmental pancreatic transplantation in the dog. Fourteen segmental pancreatic transplantations were performed. A cephalic pancreactectomy was performed during the same operating time. The main duct was obstructed with a fibrin sealant (Tissucol modified by addition of a solution of aprotinine concentrated at 10,000 KUI per mL). Biological follow-up consisted in: 1) Intravenous Glucose Tolerance Testing at Day 0 and Day 28 with glycaemia's integral calculus and K V Alues. 2) Measurements of glycaemia and serum amylase every three days from day 0 to day 28. Histological examination of the pancreatic tissue before and after transplantation involved a microscopy analysis reporting the degree of fibrosis and necrosis. The areas of the Langherans islets and of the fibrosis were calculated with informatic area analysis. The study was carried on non diabetic dogs at Day 28. The glycaemia's calculus of IVGTT were not significantly different before and after transplantation (p = 0.291). On the other hand, there was a significant difference of the K Values before and after transplantation (p = 0.006). Histology after transplantation revealed important lesions of fibrosis and normal or hypertropic Langherans islets in most cases. Pancreatic ducts presented with linings thickened with fibrosis. There was no fibrin sealant in the lumen. Obstruction of pancreatic ducts with a fibrin sealant induces an important fibrosis of the pancreatic exocrin tissue allowing the preservation of a satisfactory endocrine function. This technic may be used in clinical practice during the segmental pancreatic transplantations or after cephalic pancreatico-duodenectomy.

Amylases↗