Between January 1, 1980, and July 31, 1985, 168 patients were treated at our institution for chronic lymphocytic leukemia (CLL). Splenectomy was performed on 32 (23 men and 9 women). The mean age of these surgical patients was 59.4 years (range, 43-75). Twenty-four patients had received chemotherapy and/or corticotherapy prior to surgery and 1 of these 24 also underwent splenic radiotherapy. The interval between diagnosis and splenectomy ranged from 1 to 108 months (mean, 33.6 months +/- 28.6). Before splenectomy, 9 patients had platelet counts greater than 100,000/mm3 (3 with normal counts), 18 had counts between 50,000 and 100,000/mm3, and 5 had less than 50,000/mm3. Seven patients had anemia with hemoglobin levels less than 10 g/dl (3 associated with thrombocytopenia); in the other 25 patients, hemoglobin levels were between 10 and 11 g/dl in 12 (9 associated with thrombocytopenia) and greater than 11 g/dl in 13. All patients but one had splenomegaly (mean spleen weight 1780 g +/- 938.7 range, 160-4300 g). One postoperative death was recorded. Postoperative morbidity occurred in 7 of 31 cases; severe infection was never observed. The average duration of hospitalization was 15 +/- 4.7 days (range, 9-28). Twenty-two of the 23 patients with thrombocytopenia less than 100,000/mm3 had complete remission after splenectomy. One had a partial remission that was later completed by means of drug therapy. Two patients relapsed within 6 months and one after 32 months. All but two cases of anemia responded to splenectomy; one patient relapsed. In 15 of 31 surviving patients, further treatment was required within a few weeks or months after surgery. Five patients died at 8, 17, 22, 26, and 35 months, respectively. The other 26 patients are alive and well with a mean follow-up of 34 months (range, 11-71 months). Splenectomy may be an effective treatment for CLL patients with splenomegaly, thrombocytopenia, and/or anemia.

Adult↗

PubMed1987

[Neuropathies and HIV retrovirus infections].

Neurologic complications are frequently observed during HIV-related infections and particularly in AIDS. According to the literature, these complications more often pertain to the central nervous system (CNS) than the peripheral nervous system (PNS). A prospective study was carried out in order to determine the frequency and type of PNS disorders during HIV infections, the neurotropism of which is now well established. Forty-one HIV-infected patients - 5 asymptomatic subjects, 14 ARC (AIDS-related complex) and 22 AIDS patients - were studied from a clinical and biological angle; 40 equally underwent an EMG and nervous conduction velocity tests, 26 a lumbar puncture and 25 a nervous biopsy (associated in three cases with a muscular biopsy). The study showed that a PNS-alteration is extremely frequent (36/41, or 88% of all cases), generally mild or even subclinical (17/36); most often, the aspect is that of a sensitive axonal polyneuropathy. More severe types (polyradiculoneuritis, sensorimotor polyneuropathy, etc.) are equally observed, but much rarer. Whatever their form may be, the PNS-lesions can be observed in so-called asymptomatic subjects (2/5) as well as ARC (12/14) and AIDS (22/22) patients. They are the manifestation either of a direct lesion of the nerve through HIV, or of immune mechanisms (of humoral or cellular mediation) or of both mechanisms combined.

Acquired Immunodeficiency Syndrome↗

PubMed1987

[Esophagojejunal anastomoses with the EEA stapler after total gastrectomy. Technic and immediate results apropos of a recent series of 32 cases].

32 consecutive total gastrectomies for cancer (20 extended total gastrectomies) were carried out through an abdominal approach. Reconstruction using a Rouxen-Y loop (28 cases) or an interposed jejunal loop (four cases) was done with an EEA stapled oesophago jejunostomy: 25 end to side and 5 end to end anastomosis were performed and two technical failures led to complete manual anastomosis. All patients have had post-operative X-ray examination: there was no anastomotic leakage in this series, even in the 3 patients (10%) who have died during the post-operative course. A critical study of this series and eight others one from elsewhere is presented: it is concluded that the stapling device allows an easier and safer oesophagojejunostomy than manual procedure, when great care is taken of technical details.

Adult↗

PubMed1987

[Nonsecreting or so-called malignant adrenocortical tumors. Contribution of immunohistochemistry].

The authors mention two cases of adreno cortical carcinoma treated by surgery. They insist upon complete hormonal exploration in order to assert the characteristic non functioning of these growths. An immuno histo clinical examination of the operated part could complement these biological explorations. The existence of a hormonal secretion brought to light by this method can simplify future biological supervision and establish a reason to apply systematically a complementary treatment of OP'DDD or Ketoconazole. A literary precis is prepared.

Adrenal Cortex Neoplasms↗

PubMed1986

6-day subrenal capsule assay (SRCA) as a predictor of the response of advanced cancers to chemotherapy.

The 6-day subrenal capsule assay (SRCA) chemosensitivity prediction test using fresh human tumor xenografts was performed in BALBc mice for 80 advanced cancer bearing patients. Among 97 SRCA, nine were non-evaluable because patients either received no chemotherapy or non-assayed drugs, and 12 were non-interpretable because of inadequate control growth. One hundred and six correlations were established between test results and clinical response, 56 retrospective (chemotherapy then test) and 50 prospective (test then chemotherapy). Among the 56 retrospective correlations there are 45 true negative (-/-) and three false positive (+/-) corresponding to 48 poor clinical responders; and eight true positive (+/+) and 0 false negative (-/+) corresponding to eight good clinical responders. Among the 50 prospective correlations there are 26 true negative (-/-) and four false positive (+/-) corresponding to 30 poor clinical responders; and 19 true positive (+/+) and one false negative (-/+) corresponding to 20 good clinical responders. In total among the 106 correlations there are 98% good negative correlations and 79% good positive correlations. The SRCA is practicable and is available for routine clinical use providing results relevant to cancer site and reflecting previous treatment status.

Animals↗

PubMed1985

A gliding space between the femoral artery and inguinal ligament: mechanism of formation of false aneurysm.

False aneurysms preferentially arise in the inguinal region subsequent to aorto-femoral bypass. This finding suggests that the position of the inguinal ligament against the anterior surface of the prosthesis may be an etiological factor. Description of the inguinal region, forming a borderline between the trunk and thigh and specific to the erect posture, has been the subject of many anatomical studies. These papers describe mainly the relations between the vascular sheath of the femoral artery, the fascia transversalis and inguinal ligament. Based on a series of anatomical dissections we have found a gliding space between the femoral artery and inguinal ligament. This finding has led us to propose section of the fibrous portion of the inguinal ligament and the insertion of free omentum between the arch of the ligament and prosthesis in order to prevent false aneurysm. Preliminary results obtained with this technique are satisfactory.

Aneurysm↗

PubMed1985

[Digestive localizations of non Hodgkin's malignant lymphoma. Clinical, therapeutic and prognostic aspects. Apropos of 29 cases].

29 cases of non Hodgkin's lymphoma (L.N.H.) involving the gastrointestinal (G.I.) tract were reviewed. Primary G.I. involvement was found in 15 patients (2 occurred after Hodgkin's disease), secondary G.I. involvement in 14 patients. Clinical, barium x-ray studies and endoscopic data, prognostically features, mode and results of therapy were analysed in the two groups. Patients were staged using modified (stage IIE) Ann Arbor system; tumors were classified by the "working formulation of N.H.L. for clinical use" (1982). Patients with primary G.I. stage I E - II E N.H.L. were treated with surgery and radiotherapy or surgery with systemic multiple drugs therapy for patients at high risk for recurrence. Disseminated disease and secondary G.I. N.H.L. were treated by chemotherapy; palliative surgery, with high mortality rate, and radiotherapy were occasionally indicated. 3 patients died and 3 had recurrences (5/6 within 2 years) in the first group. Only 2 patients achieved complete remission in secondary G.I.N.H.L. (median survival time: 14 months). Coeliotomy is necessary for unproved diagnosis or emergencies. This study would indicate that the role of surgery remains important in primary localized G.I. stage I E - II E N.H.L.: although diagnosis might be clearly established on endoscopic biopsies; despite results of primary chemotherapy or radiotherapy on controlling local tumor as reported by others authors. Surgical exploration was an essential step in establishing the extent of disease to plan therapy. Resection prevented the possible local complication associated with primary radiotherapy or chemotherapy. The relative risk of treatment induced second malignancies must be considered in the design of adjuvant therapy.

Adolescent↗

PubMed1985

[Radiation and surgical treatment of cancer of the cervix uteri in proximal stages I and II].

No results from therapeutic trials describing the best therapeutic procedure for cervical carcinoma in stages I and IIa are available. Analysis of a series of 242 cases of cervical carcinoma in stages I and IIa, from 1975 to 1980, treated with radical surgery and radiation therapy, yields a therapeutic approach that envisions the most reliable evaluation of subclinical extension, cure of cervical tumor and prevention of pelvic or extra-pelvic metastases with a minimum of post-radiation problems. The choice of combination surgery and radiation therapy is primarily determined by staging and the volume of the central pelvic tumor. For stages I and IIb (upper third of vagina involved) with central pelvic tumor less than 4 cm in diameter, the usual procedure is recommended i.e. radium application, total hysterectomy with pelvic lymphadenectomy followed by external irradiation of pelvic lymphatics in cases with lymphadenopathy. For stages IIb (obvious parametrial involvement) and for stages I or II with central pelvic tumor between 4 and 6 cm in diameter: total dose external and internal pelvic radiation therapy followed by total hysterectomy without pelvic lymphadenectomy but with exploration of obturator, hypogastric, external iliac, common iliac, and aortic nodes. For the rare supravaginal central pelvic tumors greater than 6 cm in diameter, the risk of clinical evaluative error and incomplete sterility by irradiation alone, warrants first an explorative laparotomy using Wertheim's procedure, then pelvic lymphadenectomy and exploration of pelvic and aortic lymph nodes.

Adult↗

PubMed1984

Primary pedunculated fibrosarcoma of the peritoneum: a case report.

Fibrosarcoma is a primitive, mesenchymal tumor frequently arising from superficially located soft tissues. A case of a primary intraperitoneal, pedunculated fibrosarcoma is reported, initially presenting as an abdominal mass protruding into a large incisional hernia of the anterior abdominal wall. Despite total tumor resection, multiple intraperitoneal tumor nodules of varying sizes were found and resected six months and one year later. The patient died 18 months after the first surgical intervention. This case illustrates the highly malignant behavior and poor prognosis of fibrosarcomas of the peritoneum.

Aged↗

PubMed1984

Anatomical bases of the transhiatus approach to the greater splanchnic nerve.

The level of origin and mode of constitution of the greater splanchnic nerve and its relations in the posterior mediastinum were studied. The aim of this work was to identify the anatomical basis of the transhiatus approach to the right and left greater splanchnic nerves. The azygos venous system was seen to be the main anatomical relation of these nerves. The results of this study should allow the surgeon to perform total bilateral neurotomy.

Humans↗

PubMed1983

[Prediction of response to antineoplastic agents].

It now seems possible to predict response to anti-cancer drugs by means of several methods classified into three groups. Methods in the first group are aimed at determining the intracellular mechanisms required for the drugs to act on the tumoral cells; apart from hormone receptor assays, few of these have practical applications. Methods in the second group are concerned with the action of cytostatic drugs on malignant cells; clonogenic cultures and human tumour xenografts in mice are already routinely used. Finally, methods to evaluate the pharmacokinetics of anticancer drugs are being developed. These three groups of methods can be used in the pre-clinical screening of these drugs or at the clinical trial phase to predict individual responses to chemotherapy.

Animals↗

PubMed1983

[Exploratory laparotomy with splenectomy in the determination of the initial degree of spread of Hodgkin's disease].

Explore the source record for details and available documents.

Hodgkin Disease↗

PubMed1983

[Perineal gangrene. Apropos of 12 cases].

Twelve cases of necrotizing infections of the perineum were seen over a 18 months period. The etiology was various. This serious affection seems to be more frequent now. The diagnosis is often late, particularly in the rectal injuries with a foreign body. Cellulitis was constant. Severe myonecrosis was present in 6 cases. Anaerobic organisms were found in 50% of the cases. Treatment consisted of initial radical debridement and repeated surgery, antibiotics, and hyperbaric oxygen which was systematically used in our cases. The importance of a diverting colostomy that was done in 10 cases was emphasized. The aggressiveness and advancing nature of the infection with myonecrosis, delayed diagnosis and delayed treatment, were the primary factors responsible for death. 4 of the 12 patients died.

Adult↗

PubMed1983

[Prognosis of rectal cancer treated by isolated abdominoperineal amputation. Apropos of 106 cases].

Explore the source record for details and available documents.

Abdomen↗