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P Kauffmann

Publications and source records attributed to P Kauffmann.

At least 19 recordsLinked to original sources
PubMed2000

[Parathyroidectomy by elective route with perioperative measurement of parathyroid hormone. Report of 80 cases].

STUDY AIM: The aim of this study was to report a series of 80 patients treated by unilateral neck exploration for a sporadic primary hyperparathyroidism. PATIENTS AND METHOD: Between April 1992 and November 1998, 80 patients (65 women and 15 men, mean age: 63.5 years) with a single gland enlargement localized by ultrasonography, were operated on through a short unilateral neck incision, under general anesthesia in 72 cases and local in eight cases. The enlarged gland was removed with intraoperative pathological examination and intraoperative monitoring of parathyroid hormone. RESULTS: Mean duration of surgery was 25 minutes. There was no postoperative mortality or morbidity. Mean duration of hospital stay was two days. The enlarged gland was an adenoma in 75 cases and an hyperplasia in five. Adequate intraoperative parathyroid hormone decrease was observed. Postoperative calcemia was normal in 78 patients (97.5%). Among 76 surviving patients, with a 31-month follow-up, there was only a suspicion of persistent hyperparathyroidism in two patients. CONCLUSIONS: Minimal invasive approach by unilateral neck exploration may be performed with safety and efficiency in patients with a single gland enlargement under intraoperative monitoring of parathyroid hormone.

Adult↗
PubMed1999

[Microinvasive ductal carcinoma of the breast. Role of axillary lymph node dissection].

The role of axillary lymph node dissection for microinvasive ductal carcinoma in situ of the breast was analyzed in a series of 60 consecutive cases. Forty-four cases were subclinical mammographically-detected carcinomas revealed by the clusters of microcalcifications. Although pathologists differ in their criteria for microinvasion, the maximal size considered in this retrospective study was 2 mm. Axillary lymph node involvement was found in 3 cases (i.e. 5%) which harbored poor histologic features: comedocarcinoma subtype, high nuclear grade, and size of the ductal carcinoma in situ greater than 3 cm, requiring total mastectomy. While there is no need for axillary dissection in women with pure ductal carcinoma in situ, the management is quite different in proven microinvasion. Owing to the weakness of prognostic information given by cellular, biochemical and molecular features, instead of lymph node status, axillary dissection is still recommended in microinvasive ductal carcinoma in situ.

Adult↗
PubMed1997

[Initial surgery in advanced epithelial cancers of the ovary].

Epithelial ovarian cancer is usually diagnosed at an advanced stage with a bulky tumor in the pelvis and upper abdomen. The most common therapeutic strategy begins by a surgical operation that allows histologic diagnosis, accurate staging and maximal debulking. Since the papers by Griffiths at the end of the seventies, the volume of the residual tumor after surgery appears to be one of the most important prognostic factors in all series. Indeed, patients whose tumor is completely or optimally debulked have greater chances of prolonged survival of about 50% at 5 years. Surgeons experienced in this field can achieve optimal debulking in about 75 to 80% of cases. But, in order to reach this objective, they must often perform an ultra-radical operation with extensive peritonectomies, lymphadenectomies and intestinal resections. Moreover, since 1983, Hacker has shown that the initial tumor bulk was still a poor prognostic factor even after debulking. Today it can be demonstrated that the greater the tumor bulk the more aggressive must be the surgical procedure in order to be optimal and the final benefit will nevertheless be proportionally lower with a higher morbidity rate. This paradigm leads the surgeons to currently try to more accurately assess the initial tumor bulk in order to determine wether the tumor would be optimally debulked by means of a well-standardised operation. If not, the alternative strategy would be 3 chemotherapy courses as front-line treatment before debulking surgery, which hopefully would be easier. Trials are needed in order to validate this strategy despite the fact that some patients will unfortunately have their prognosis jeopardized by the chemoresistance of their tumor.

Carcinoma↗
PubMed1996

[Search for genetic risk in surgical indications in oncology].

We report the case of 68-year-old woman with an adenocarcinoma of the right colon. The family history also suggested that she might also be at risk of ovarian or endometrial cancer. Thus despite the lack of gynecologic symptoms, abdominal hysterectomy and bilateral salpingo-oophorectomy was proposed at the time of the right colectomy endometrial carcinoma was discovered at surgery. This finding and the family pedigree were consistent with the diagnosis of familial Lynch II syndrome. Appropriate biomolecular analyses were undertaken. This case shows the importance of family history taking in patients with cancer. The surgeon should be aware of such situations and correlate indications and procedures with the genetic risk of the patients.

Adenocarcinoma↗
PubMed1996

[Mastectomy with immediate reconstruction for invasive breast cancer. Comments on indications and technique. A series of 112 cases].

A series of 112 mastectomies with immediate breast reconstruction performed in women with invasive cancer of the breast were followed for a mean of 30 months to determine cancer outcome, morbidity and aesthetic results of the different surgical techniques. The patients were divided into 3 groups according to indications: 49 cases with local recurrence after conservative treatment; 37 cases of large or multifocal tumours operated after chemotherapy and radiotherapy; 26 cases after tentative conservative surgery with incomplete tumourectomy. A total of 98 patients (87.5%) were irradiated before mastectomy with immediate breast reconstruction. Twenty-eight simple implants, 50 musculocutaneous flaps using the latissimus dorsi with implant and 34 musculocutaneous flaps with the rectus abdominis. During follow-up 16 patients died and cancer relapsed in 13 surviving patients. Seven local recurrences were observed. In all cases of early relapse, which may have possibly been triggered by immediate breast reconstruction, the patients had very poor prognosis criteria. Surgery took longer for mastectomy with immediate breast reconstruction using the rectus abdominis flap and required transfusion in 88% of the cases. Combining all the techniques, 19% of the patients had postoperative complications and 25% late sequellae. The aesthetic results were considered as good immediately after surgery in 14% of the patients with a simple implant, in 45% of those with a latissimus dorsi flap and in 81% of those with a rectus abdominis flap. Second surgical procedures to improve the aspect were performed in half the patients with a simple implant giving 50% good results, in 40% of the patients with a latissimus dorsi flap giving 68% good results and in 12% of the patients with a rectus abdominis flap giving 84% good results. In this series, patient satisfaction was closely related to the aesthetic quality of the results. Integrated into a well-planned multidisciplinary protocol, mastectomy with immediate breast reconstruction does not appear to affect the cancer outcome. Immediate breast reconstruction is a complex procedure and requires experience in plastic surgery to reduce the number of complications and to improve aesthetic results. Reconstruction with a rectus abdominus flap appears as the superior technique.

Adult↗
PubMed1995

[Post-laparoscopic incisional hernia. Apropos of a case].

Incisional hernia occurred in a patient after laparoscopic hysterectomy. The greater omentum was incarcerated in the tract of the suprapubic trocar (12 mm diameter). Diagnosis and treatment were performed during a second laparoscopy procedure. The greater number of trocar instruments and their larger diameter increases the risk of parietal morbidity after laparoscopic procedures. Elective closures of trocar incisions is recommended when exceeding 10 mm. Prevention of extra-umbilical incisional hernias and dehiscences appears to be more effective when suture is performed under laparoscopic vision with the trocar inserted. Both the aponevrosis and the peritoneal membrane should be treated.

Aged↗
PubMed1994

[Clinically occult invasive cancers of the breast. Apropos of 136 cases].

Between 1978 and 1991, one hundred and thirty-six surgical excision biopsies were performed in our institution for clinically occult breast cancers. A retrospective analysis of histopathologic characteristics was carried out in order to determine the prognostic factors of these cancers detected by mammography. Mammographic findings consisted of microcalcifications alone (49 cases), microcalcifications with opacity (20 cases), stellate opacity (52 cases) and well-circumscribed opacity (12 cases). Preoperative localization was achieved by mammography in 109 cases and ultrasonography in 27 cases. The size of malignant lesions ranged from 3 to 25 mm, 76 lesions were less than 10 mm in diameter. The histopathologic findings were as follows: invasive ductal cancer (IDC) 113 cases (83%), invasive lobular cancer (ILC) 11 cases (8%), ductal or lobular cancer in situ with microinvasion 12 cases (9%). Breast conserving treatment was performed in 106 cases (78%). A high proportion of well differentiated tumors was encountered-59 grade I (52%) were identified out of 113 IDC-and the incidence of axillary node metastases was less than 10%. Clinically occult breast cancers seem to exhibit favorable prognostic factors.

Adult↗
PubMed1994

[Immediate breast reconstruction following mastectomy for recurrence after conservative treatment].

The authors report their experience with immediate breast reconstruction following salvage mastectomy for local recurrence of invasive breast cancer after conservative treatment. From January 1987 to December 1992, among 91 immediate breast reconstructions, 41 were performed for this indication. The results and complications were analyzed for each of the three techniques used: simple prosthesis (n = 5), latissimus dorsi flap with prosthesis (n = 26), trans abdominalis musculocutaneous flap--TRAM flap (n = 10). Immediate flap reconstruction appears to be required in cases of either early or late local relapse since the skin has been irradiated and the mastectomy must be extensive. The transrectus abdominalis flap allows more extensive resection and gives better cosmetic results without the need for a prosthesis.

Adult↗
PubMed1994

[Latissimus dorsi myocutaneous flaps in oncologic breast surgery. 101 cases].

The authors report their experience of the use of a latissimus dorsi myocutaneous flap in reparative surgery after total or partial mastectomy for invasive breast cancer. The series, including 101 cases, was separated into four groups on the basis of the context: I--thoracic radionecrosis (5 cases); II--chest wall cover (24 cases); III--immediate breast reconstruction (57 cases); deferred breast reconstruction (15 cases). The well-known vascular reliability of this pediculated flap was confirmed here by the low incidence of necrosis (3%), always marginal. Other complications were not attributable to the flap itself but to concomitant radiodystrophic skin lesions and the presence of the prosthetic implant in the case of breast reconstruction.

Adult↗
PubMed1993

[Bowel resections in cancers of the ovary ].

The authors report a retrospective series of 32 patients who were operated on by resection of bowel at various stages during the progress of epithelial pathology of malignant ovaries. These operations were carried out in one group during the initial operation, in a second group during a "second-look" operation and in a third group when late recurrences had occurred. Removal of bowel was possible to remove completely or to optimum effect malignant cell bearing areas in 22 cases (59%) and less than optimal reductions in 15 cases (41%). Forty-five different segments of bowel were resected consisting of 18 of the rectum and sigmoid, 11 of the right side of the colon, 9 transverse or left colon, and 5 of the small intestine and 2 of the stomach. One patient died from cardio-respiratory failure immediately after the operation. Seven cases had septic abdominal complications but they settled quickly without further surgery. It was not possible on studying the follow-up of these patients to find any statistically significant improvement in those who had complete or optimum resection as compared with those who were less completely operated on, and those who were operated on in a late stage of the illness. All the same even if it is not possible to show that there is a significant improvement in survival in the populations that have been compared in this study, it does seem advisable to practice bowel resection in order to reduce as much as possible cancer bearing cells so that chemotherapy can be applied more effectively and thus improve the prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

[Uterine metastases originating from breast cancer. Apropos of 12 cases].

The authors report a retrospective clinicopathologic analysis based on 12 cases of uterine metastases from breast cancer. The myometrium was more often involved than the endometrium, and a metastatic lesion occurred in an interstitial leiomyoma in one case. Bilateral ovarian involvement was associated in 11 cases. The histopathological type was predominantly represented by invasive lobular breast cancer in 10 cases: in this series, 3 subtypes were identified, the solid variant (6 cases), the classical variant (2 cases), and the alveolar variant (2 cases). The steroid receptor status in the tumor specimens was found to be constantly positive. The literature concerning the pathologic diagnosis was reviewed: most breast cancers metastasizing to the female genital tract and to the peritoneal surface appeared to be invasive lobular cancers.

Aged↗
PubMed1993

[Intestinal metastases from breast cancer. Apropos of 8 cases].

Eight patients with intestinal metastases from breast cancer are described. The different clinical presentations and pathological types are studied. The difficulty in distinguishing such uncommon secondary sites of breast cancer from primary intestinal cancer is emphasized. Attention should be paid to intestinal symptoms in women with a history of infiltrating lobular breast cancer: in agreement with recent literature data the lobular type seems mainly responsible for gastrointestinal and peritoneal involvement originating from breast cancer (7 cases out of 8 in our series). Prolonged survival could be obtained if no metastases elsewhere were found with appropriate treatment including ablative surgery, chemotherapy and hormonotherapy.

Aged↗
PubMed1993

[Association of breast cancer and cancer of the uterus. 34 case reports].

A retrospective series of 34 cases of breast cancer combined with uterine cancer is reported. Cancers of the endometrium differed from cervical cancers by their number, 2.2 x more frequent (22 vs 10) and by the sequence of onset: they generally precede breast cancer, whereas they tend to follow cervical cancers. In contrast to the breast cancer/uterine cervical cancer association, which is considered to be fortuitous, the breast cancer/cancer of the uterine body association appears to be determined by a hormonal context. Through a review of the literature, a unifying endocrine theory is constructed, based on the role of hyperestrogenesis in mammary and endometrial carcinogenesis.

Adult↗
PubMed1992

[Pelvic and para-aortic lymphadenectomy in primary cancer of the ovary].

The results of pelvic and para-aortic lymphadenectomy performed in 24 patients with primary ovarian cancer are reported. The lymph node invasion rate was 20 percent in stages where the disease was apparently limited to the pelvis, and 73 percent in more advanced stages. Invasion was as frequently found at postoperative second-look laparotomy (54 percent) as at initial exploratory laparotomy (46 percent). Retroperitoneal expansion equally involved the pelvic and para-aortic lymph nodes: among 12 patients with positive lymphadenectomy, 8 had combined pelvic and para-aortic invasion, 2 had exclusively pelvic invasion and 2 had exclusively para-aortic invasion. We would therefore recommend to perform lymphadenectomy during the first operation, particularly in presumed stage I or II cancer, and to dissect the lymph nodes in both the pelvic cavity and the lumbo-aortic region.

Adult↗
PubMed1992

[Demons-Meigs' syndrome. A case of thecoma and ovarian fibroma].

The authors report two cases of Demons-Meigs' syndrome, one following an ovarian fibrothecoma and the other an ovarian fibroma. There was a striking rise in the serum CA 125 level which was higher than 200 UI/ml, suggestive of cancer of the ovary in both cases. With the help of the literature data, the clinicopathological features of this rare condition and the different hypotheses concerning its aetiology are commented.

Aged↗
PubMed1992

Intracholedocal metastatic thrombus of renal adenocarcinoma.

The authors report about the intraoperative discovery of a metastatic thrombus in the common bile duct, produced by a right renal adenocarcinoma metastasized in the Vth segment of the liver. As far as the treatment is concerned, in addition to nephrectomy, the use of a simple device allowed intraluminal irradiation with radioiridium. Although this approach is palliative, it resulted from the desire to maintain the patency of the common bile duct by controlling tumor proliferation within the duct. The pathogenesis of this proliferation is discussed. In our opinion, the favorable outcome after 18 months confirms the merits of this therapeutic attitude, which can be used for such tumoral extensions.

Aged↗
PubMed1991

Prevention of radiation enteritis by an absorbable polyglycolic acid mesh sling. A 60-case multicentric study.

Radiation-induced small bowel injury is a limiting factor to postoperative tumoricidal pelvic doses exceeding 4500 to 5000 cGy. Data from a review of the literature showed the inadequacy of medical measures and the bad reproducibility of radiation therapeutic attempts to decrease small intestine damage. Recent studies cited the benefit of a polyglycolic acid mesh to create an absorbable intestinal sling and suspend the loops above the pelvic radiation field. In 60 cases of gynecologic and rectal malignancies with a surgical intestinal morbidity of 8.3% (5 cases), the rate of radiation enteritis was 7% (4 cases) with an average follow-up of 17.8 months (range, 1 to 57 months). The quality of small intestinal elevation and the absence of loop herniation were demonstrated by the barium index. Magnetic resonance imaging was used for checking the polymer polyglycolic acid mesh position and its complete resorption at the third to fifth postoperative month. The authors conclude that this new procedure is safe in selected patients with high pelvic recurrence risk after optimal surgery, in residual disease after debulking surgery, or at the time of exploration for unresectable pelvic tumors. Clinical studies are ongoing to evaluate the long-term efficacy of this surgical technique to prevent chronic radiation enteropathy and improve locoregional control in advanced pelvic carcinomas.

Adult↗