Menstrual status and breast cancer surgery.
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Adult↗
Biomedical subjects
M Brunet
Publications and source records attributed to M Brunet.
Survival effect of systemic therapy on patients developing metastatic breast carcinoma.
A multivariate analysis was performed to assess the effect of post-relapse systemic therapy on a series of patients with metastatic breast cancer who at initial presentation had no detectable metastases (Mo), were less than or equal to 70 years of age, presented with unilateral localized disease and no other associated malignancy, and were treated between 1965 and 1984 with successive protocols for primary disease and subsequently developed distant metastasis. All 760 patients analyzed relapsed with at least one metastasis, and were studied retrospectively with no selection criteria according to any specific protocol. All had recorded clinical data on menopause, stage, clinical tumor aggressiveness (PEV), initial chemo or hormonal therapy, and time to relapse, and had ongoing follow up at our Center, with salvage chemotherapy and/or hormonal therapy having been given to some but not all patients. A brief metastasis-free survival (p less than 0.000001), and factors associated with electing pre-relapse chemotherapy (p less than 0.000001) were associated with shortened post-relapse survival, while post-relapse therapy (chemo p less than 0.0001, and hormonal p less than 0.00001, replacing chemotherapy in the model) apparently increased post-relapse survival in the group overall. This result was similar in the inoperable patient group [with inflammatory breast carcinoma an additional risk factor (p less than 0.0005)], as well as the operable group. However, in the operable group, when the pathologic criteria of histologic grade and nodal status were introduced into the analysis, post-relapse therapy was not seen to be an important factor for survival in any subgroup.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The concentration of glucose in the culture medium determines the effect of suramin on the growth and differentiation of the human colonic adenocarcinoma cell clone HT29-D4.
Suramin, a drug currently used for advanced malignancy, induces the differentiation of the human colonic adenocarcinoma cell clone HT29-D4 and this process is correlated with a decreased glycolytic activity. We investigated the effects of suramin on HT29-D4 cells in the presence of various glucose concentrations. The main result of this study is that suramin has only an effect on HT29-D4 cell growth and differentiation when the concentration of glucose is above 10 mM. Therefore the efficiency of suramin as an anticancer drug may be greater on poorly differentiated tumoral cells with a high proliferative capacity.
Adenocarcinoma↗
[Long-term results of radio-surgical treatment of operable carcinoma of the cervix uteri].
Four hundred and fifteen women, treated in our institution from 1961 to 1987 for operable carcinoma of the cervix stage I or II, had a radical hysterectomy with pelvic node dissection. Radiotherapy was associated with this surgery in most cases: 90% of the patients received endocavitary radiation, and 30% external radiotherapy, either pre- or post-operatively, in the case of bad prognostic factors. Median follow up was 7 years; overall survival was 77% at 10 years; the rate of local failure is low (36 cases/415 = 8.7%). Multifactorial analysis, using the Cox model, assessed the following independent prognostic factors, significant for the risk of local recurrence (size of the tumor, N +/- , FIGO stage) and for the risk of metastases and death (parametrium invasion, stage, tumor size). Post-operative mortality was 1.2%. Early surgical iatrogeny was easily treated with no long-term sequela, whereas severe complications, due to the association with pelvic irradiation, occurred in 24 out of 124 patients, leading to 7 "illegitimate" deaths.
Adult↗
Cathepsin D: an independent prognostic factor for metastasis of breast cancer.
122 patients with primary breast cancer were followed-up for a median of 4.6 years after surgery. The concentration of cathepsin D in tumour cytosol was strongly related to both metastasis-free survival and disease-free survival and was independent of nine conventional prognostic indices. Cathepsin D assay may prove particularly useful in identifying women who, though without lymph node involvement at presentation, are at high risk of metastatic disease.
Adult↗
Prognostic value of histologic grade nuclear components of Scarff-Bloom-Richardson (SBR). An improved score modification based on a multivariate analysis of 1262 invasive ductal breast carcinomas.
We did a multivariate analysis of 1262 patients with operable, invasive ductal breast carcinoma to assess the prognostic value of the Scarff-Bloom-Richardson (SBR) histologic grading system. Nodal metastasis and SBR were the two most important factors for metastasis-free survival (MFS), P = 10-9 and P = 10-5, respectively, for total study time. In patients who were node negative, the SBR and International Union Against Cancer (UICC) stages were the most important for MFS (P = 4 X 10-4 and P = 0.03). In order to try to improve the SBR prognostic value, we first studied the three components of the SBR separately: ductoglandular differentiation proved the least predictive and nuclear pleomorphism and mitotic index the most predictive. A rearrangement of the two nuclear scores alone produced higher risk values and better risk separation of patient subpopulations than SBR, and eliminated the SBR from the multivariate model. This rearrangement, modified SBR (MSBR), defined five new risk subgroups with statistically different risk ratios for MFS (P = 3 X 10-8). SBR grade II (55% of patients) was separated into three MSBR groups significantly different according to MFS (P = 0.008). In the patients who were node negative, MSBR replaced the SBR and was the most important factor for prediction of relapse of MFS (P less than 0.00001). The MSBR is more accurate and predictive than the standard SBR grade and is particularly useful when the nodal status of the patient is negative or unknown.
Adult↗
Nuclear characteristics as indicators of prognosis in node negative breast cancer patients.
Nine clinical, biologic and histologic variables were evaluated for their significance in predicting the metastasis free survival (MFS) and the overall survival (OS) of 650 histologic node negative breast cancer patients. The variables studied were: menopausal status, UICC clinical stage of disease, Scarff-Bloom and Richardson (SBR) grade and its 3 components, estrogen and progesterone receptors, and anatomic tumor size. Multivariate Cox analyses revealed that histologic grade and clinical stage were the only significant prognostic factors for both MFS and OS. In the SBR grading system, grades I and III clearly have defined those patients with low and high risk for relapse, respectively. However, it is well known that more than 50% of the patients fall into the intermediate risk category, grade II, which provides essentially no useful prognostic information for those patients. To improve the assignment of patients to specific risk groups, a modified grade (MSBR), with five categories ordered according to the degree of malignancy, has been built from the nuclear pleomorphism and the mitotic index of the SBR grade. In combination with clinical stage, MSBR was found to be a prognostic indicator with high discriminatory power and caused the SBR grade to lose its significance. The first three categories of this MSBR may be gathered to designate low risk patients, whereas the last two categories, once combined, contain all the SBR grade III plus 57% of the SBR grade II tumors, and reliably identify high risk node negative patients. We suggest that a systemic adjuvant therapy should be discussed in this high risk group.
Adult↗
Prognostic value of estrogen and progesterone receptors in primary infiltrating ductal breast cancer. A sequential multivariate analysis of 1262 patients.
Nine prognostic variables were evaluated for their significance in predicting the overall survival (OS), the length of disease-free survival (DFS) and the length of metastasis-free survival (MFS) of 1262 patients with primary breast cancer. The variables studied were: UICC clinical stage; menopausal status; histologic grade; number of involved nodes; anatomic tumor size; estrogen and progesterone receptors; local and adjuvant therapies. Three sequential multivariate analyses, at 2, 5 and 10 years, using the Cox proportional hazard regression model, were carried out to identify those variables most highly related to the criteria studied (overall, disease-free, metastasis-free survivals) and especially to fully evaluate the effects of hormonal receptors on prognosis and their stability over time. Our results showed that number of involved nodes and histologic grade were the most significant prognostic factors for all periods of time and whatever the criterion studied; ER had no predictive value while PR was an independent prognostic factor for metastasis-free survival at 2 years (P = 0.01) and 5 years (P = 0.02) but lost its significance at 10 years (P = 0.06). In the subgroup of 261 patients who received prolonged post-operative adjuvant chemotherapies, PR was the main prognostic factor for MFS at 2 years (P = 0.03) and the second at 5 years (P = 0.05) just after number of involved nodes. In the 1001 patients who did not receive prolonged post-operative adjuvant chemotherapies ER was significant for MFS at 5 and 10 years. The present data urge the need for a periodic redefinition of prognostic factors in primary breast cancer.
Adult↗
Comparison of the efficacy of propranolol and amiodarone in suppressing ventricular arrhythmias following myocardial infarction.
The purpose of this prospective randomized trial was to compare the efficacy of propranolol and amiodarone in suppressing ventricular arrhythmias during the first 6 months following myocardial infarction (MI). 97 patients were treated with either amiodarone (n = 48) or propranolol (n = 49) starting on the 9th day following MI. Holter monitoring was carried out on four occasions: on D7, D21, D90 and D180. There was no statistical difference in the incidence of 'major' arrhythmias (an average of at least 10 ventricular premature complexes (VPCs) h-1, multiform or paired VPCs or runs) between the two groups on D7. A significant difference in favour of amiodarone became apparent at D180 (P = 0.04). Patients were also classified according to whether treatment failed or was successful. 'Success' was recorded when arrhythmias remained minor or became minor (less than 10 uniform VPCs h-1) and 'failure' when arrhythmias remained major or became major, or when patients were withdrawn because of side-effects, or lost to follow-up. The difference remained in favour of amiodarone (P = 0.03 at D21; P = 0.05 at D90; P = 0.06 at D180). Evaluation of the percentage reduction in the number of VPCs at D21, D90 or D180 compared with D7 showed superiority of amiodarone at D90 (P less than 0.01) and D180 (P less than 0.04). In this study, the overall effect of amiodarone on ventricular arrhythmias following MI was shown to be superior to that of propranolol.
Aged↗
[Comparative efficacy of amiodarone and propranolol on ventricular arrhythmia in the post-infarction period].
Beta-blockers are known to be effective against post-infarction ventricular arrhythmias and amiodarone has recently been shown to have this property. The purpose of this prospective randomized study was to compare the effects of beta-blockers and amiodarone during the first 6 months following infarction. Nine days after the onset of myocardial infarction, 97 patients were put on either amiodarone (48) or propranolol (49). Holter monitoring was performed on four occasions: on the 7th post-infarction day (baseline), then on the 21st, 90th and 180th days (under treatment). On D7 the two groups were similar in age, sex, risk factors, medical history, characteristics of the infarction and type of arrhythmia. For result analysis purposes the patients were divided into two categories depending on whether their arrhythmia was "moderate" (less than 10 monomorphous and isolated ventricular extrasystoles per hour) or "severe" (at least 10 ventricular extrasystoles per hour, or polymorphous or repetitive ventricular extrasystoles). Concerning the frequency of "severe" arrhythmia, there was no statistical difference between the two treatment groups on D7 (p = 0.53), but differences in favour of amiodarone became increasingly important during the study (p = 0.08 on D21; p = 0.07 on D90; p = 0.04 on D180).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Percutaneous transluminal atherectomy of the femoropopliteal arteries. Technic, indications, results after 6 months].
Percutaneous atherectomy was performed in 25 patients with 30 symptomatic femoro-popliteal stenoses. Twenty-three patients were successfully treated with resolution of claudication and a mean 0.35 increase in the ankle-arm-index. Two early thromboses occurred. Residual stenosis was less-than 30% in 25 lesions, with no dissection, and no embolization. Atherectomy seems to be an effective treatment for eccentric and calcified lesions. At 6 months follow-up (17 patients, 19 lesions) clinical and Doppler improvement remained stable in 14 patients; 2 restenosis and 1 new disease occurred. Atherectomy restores a large lumen with minimal wall trauma, thereby possibly decreasing the restenosis rate.
Adult↗
[An artificial salivary gland. Indications. Technical note concerning installation].
Idiopathic or iatrogenic aptyalism is responsible for disabling odontostomatological symptoms and constitutes a predisposing factor for bucco-dental complications. Drug treatment designed to stimulate the salivary parenchyma is doomed to failure in cases of severe, irreversible alteration of the glandular acini. The only available treatment is palliative consisting of buccal artificial salivation. Two modalities of endobuccal administration of artificial saliva have been developed: prosthesis-reservoir and "artificial salivary gland". The "artificial salivary gland" consists of a system connecting an external reservoir to the buccal cavity via a catheter implanted over part of its path. The artificial saliva stored in the reservoir is advanced mechanically as far as the mouth where it is released according to an adjustable flow rate. The insertion of a medical silicone catheter is an outpatient procedure with a simple postoperative course. Under normal conditions, one millilitre of saliva solution per hour is sufficient to ensure satisfactory humidification of the buccal mucosa. Dysfunction of the system is generally due to a mechanical problem and any consequent alterations are treated as required. The indications for "artificial salivary gland" must be reserved to semi-urgent cases with severe aptyalism and as a therapeutic relay in the context of global management of the aptyalic patient. This new modality of administration could be extended to other diseases requiring endobuccal drip treatment.
Artificial Organs↗
[Rivets for bone fractures].
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Bone Nails↗
Mammal teeth from the Cretaceous of Africa.
We report here the discovery of two mammal teeth from the early Cretaceous of Cameroon. These, and some jaw fragments, all from Cameroon, are the only fossil evidence of mammalian evolution from Africa between late Jurassic and Paleocene, a span of at least 85 million years. A triangular upper tooth lacks the principal internal cusp of marsupials and placentals and is therefore of a similar evolutionary grade to most Jurassic and early Cretaceous therian mammals, but more primitive than the metatherian-eutherian grade. Early Cretaceous, or older, therian mammals are now known from all southern continents except Antarctica. The new find from Cameroon is consistent with the hypothesis that marsupials, the dominant living mammals of South America and Australia, were not present on any Gondwana continents until after the early Cretaceous separation of Africa by the opening of the South Atlantic.
Animals↗
[Assessment of erythrocyte pyrimidine 5'-nucleotidase activity in the detection and early diagnosis of lead poisoning. A comparison with zinc-protoporphyrin].
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5'-Nucleotidase↗
Flow cytometric study of DNA distribution in cytopunctures of benign and malignant breast lesions.
One hundred seventy-eight cytopunctures of mammary lesions were obtained for cytologic diagnosis and flow cytometric (FCM) analysis of the nuclear DNA content. All lesions were excised and evaluated histologically; 106 were carcinomas and 72 were benign lesions. The benign lesions showed a diploid DNA content, with one exception. Among the 106 carcinomas, 35 (33%) were diploid, 14 (13%) were tetraploid and 57 (54%) were aneuploid. For 79 carcinomas, the relationship between ploidy and (1) "T" and "N" of TNM staging, (2) the histologic grading of Scarff, Bloom and Richardson, (3) axillary nodal involvement, (4) the presence of estrogen and progesterone receptors, (5) age and (6) menopausal status was investigated. The percentage of aneuploidy was significantly higher (P less than .05) in grade III tumors as compared to grade I tumors. There was no significant relationship between aneuploidy and the other factors. However, a trend was observed between the lack of steroid receptors and a high probability of the tumor being aneuploid. FCM DNA analysis was also carried out on breast carcinomas obtained at surgery in 40 patients for whom FCM DNA analysis had previously been performed on breast cytopuncture specimens. The FCM DNA analyses were found to be best performed on the samples obtained by cytopuncture, which may increase the yield of tumor cells.
Biopsy↗
[An expert system of aiding decision making in breast pathology connected to a clinical data base].
The René Huguenin Cancer Center holds a medical file for each patient which is intended to store and process medical data. Since 1970, we introduced computerization: a development plan was elaborated and simultaneously a statistical software (Clotilde--GSI/CFRO) was selected. Thus, we now have access to a large database, structured according to medical rationale, and utilizable with methods of artificial intelligence towards three objectives: improved data acquisition, decision making and exploitation. The first application was to breast pathology, which represents one of the Center's primary activities. The structure of the data concerning patients is by all criteria part of the medical knowledge. This information needs to be presented as well as processed with a suitable language. To this end, we chose a language-oriented object, Mering II, usable with Apple and IBM 4 micro-computers. This project has already allowed to work out an operational model.
Breast Neoplasms↗
Competitive prognostic value of clinicopathologic and bioimmunologic factors in primary breast cancer.
Fourteen clinical, pathologic, and pretreatment bioimmunologic variables were evaluated for their significance in predicting the survival or the length of disease-free interval of 55 patients with primary breast cancer. The variables studied were: patient age; clinical stage of disease according to the International Union Against Cancer TNM classification; number of involved nodes; sedimentation rate; peripheral lymphocyte, leucocyte, and monocyte counts; serum levels of immunoglobulins IgG, IgA, and IgM; percentages of E-, "active" E-, and EAC-rosettes; and finally, the lymphoblastic transformation test value (PHA-LTT). A multivariate analysis using the Cox proportional hazards regression model was carried out, in a stepwise manner, to identify those variables most highly related to survival or to the length of disease-free interval. The Cox analysis showed that clinical stage, number of involved nodes, percentage of EAC-rosettes, sedimentation rate, and T-lymphocyte reactivity, (i.e., the T-lymphocyte sensitivity to PHA, expressed as the ratio between the PHA-LTT in counts per minute and the percentage of E-rosettes) were the significant prognostic factors for survival, whereas the number of involved nodes and the sedimentation rate were independent of importance in predicting the length of disease-free interval. The results obtained from this analysis proved the importance of some immunologic parameters in the estimation of prognosis. In addition, a prognostic score for summarizing multiple factors with potential use in stratification was derived from the multivariate analysis.
Blood Sedimentation↗