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  • 1
    Electronic Resource
    Electronic Resource
    Splenectomy for myeloproliferative disorders (1985)
    Springer
    World journal of surgery 9 (1985), S. 431-436 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La splénectomie permet de supprimer radicalement l'hypersplénisme des syndromes myéloprolifératifs. Une semaine après l'ablation de la rate on constate une amélioration du nombre des leucocytes, des plaquettes et des erythrocytes. Les symptômes inhérents au développement de la splénomégalie qui accompagne ces syndromes disparaissent également. L'évolution reste cependant inexorable. La maladie de la moelle osseuse donne lieu à une réponse hypocellulaire ou hypercellulaire qui se traduit par de multiples états pathologiques. L'étude de 50 malades qui ont subi une splénectomie pour syndromes myéloprolifératifs de 1967 à 1980 montre que la morbidité et la mortalité postopératoire sont faibles. Environ 15% des malades atteints de syndromes myéloprolifératifs relèvent de la splénectomie. Les études préopératoires de la cinétique du fer et de l'index de séquestration permettent de prévoir les effets hématologiques de la splénectomie mais non de définir l'évolution même des syndromes myéloprolifératifs. Les indications de la splénectomie reposent davantage sur les données de la clinique.
    Abstract: Resumen La esplenectomía es altamente efectiva en la reversión del hiperesplenismo asociado con desórdenes mieloproliferativos (DMP). Usualmente se observa mejoría significativa en los recuentos de leucocitos, plaquetas y eritrocitos en el curso de la primera semana después de la esplenectomía. Así mismo se logra el control de los síntomas asociados con la esplenomegalia progresiva que se presenta en estas entidades. La esplenectomía, sin embargo, no afecta la evolución inexorable de los DMP, los cuales parecen ser causados por daño repetido por agentes físicos, químicos, virus, radiation ionizante y drogas a la población de las células madres (“stem”) de múltiple potencial hematopoyécico. Las respuestas hipercelulares e hipocelulares a esta lésion de la médula ósea resulta en una variedad de entidades patológicas. Una revisión de 50 pacientes tratados con esplenectomía para DMP entre 1967 y 1980 demostró que la operación puede ser realizada con muy baja mortalidad y mínima morbilidad. Alrededor del 15% de estos pacientes con DMP requirieron esplenectomía. Estudios preoperatorios de tipo ferroquinético y de secuestro de hematíes con radionúclidos, a pesar de ser útiles en la predicción de la respuesta hematológica a la esplenectomía, no constituyen la única indicatión para operación ni proveen informatión suficiente para determinar pronóstico, o sea el resultado final en los pacientes esplenectomizados. Son costosos y significan tiempo y esfuerzo considerables; en realidad ahora son realizados con menor frecuencia que en el pasado. La selección de los pacientes con DMP para esplenectomia se hace en forma óptima con base en información clínica. Las indicaciones primarias para esplenectomía en pacientes con DMP son el hiperesplenismo de grado suficiente que requiera transfusiones frecuentes, o la esplenomegalia sintomática que produzca dolor. Indicaciones menos frecuentes son aquellas asociadas con hipertensión portal y hemorragia varicosa, generalmente como resultado de metaplasia meloide masiva del hígado.
    Notes: Abstract Splenectomy is highly successful in reversing hypersplenism associated with myeloproliferative disorders (MPD). Significant improvement in leukocyte, platelet, and erythrocyte counts usually occurs within 1 week of splenectomy. Relief of symptoms associated with progressive splenomegaly seen with these entities is also achieved by splenectomy. Splenectomy, however, does not affect the inexorable course of these MPD, which appear to be caused by repeated damage to the pluripotential hematopoietic stem cell population. Hypercellular and hypocellular responses to this bone marrow injury result in a variety of disease states. A review of 50 patients treated with splenectomy for MPD from 1967 to 1980 demonstrated that the operation can be performed with a low mortality rate and minimal morbidity. About 15% of those patients presenting with MPD required splenectomy. Preoperative radionuclide ferrokinetic and sequestration studies, while good predictors of hematological response to splenectomy, do not provide information that impacts on the eventual outcome of splenectomized patients. Selection of patients with MPD for splenectomy is best made on clinical grounds.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01655278
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  • 2
    Electronic Resource
    Electronic Resource
    The role of staging laparotomy in combined modality therapy of Hodgkin's disease: A new treatment plan based on a 6-year experience (1978)
    Springer
    World journal of surgery 2 (1978), S. 101-105 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Entre 1969 et 1974, 187 malades atteints de maladie de Hodgkin ont subi une laparotomie pour préciser le stade de l'affection. Dans 59 cas (32%), cette exploration a modifié le plan thérapeutique. Les réévaluations les plus importantes ont été: 20 cas sont passés du stade IIA au stade IIIA, 6 de IIIA à IA, 14 de IIIA à IIA, 12 de IIB à IIIB et 4 de IIIB à IIB. Sur 101 malades classés stade II, 32 (32%) sont devenus des stades III; sur 61 malades classés stade III, 24 (39%) sont passés aux stades I ou II. Quarante-quatre malades au stade IIIA ont reçu une irradiation ganglionnaire totale de 3600–4000 rad, et leur espérance de survie à 5 ans sans récidive est de 52%. Il n'y a eu aucune récidive chez 11 patients au stade IIB traités par irradiation en capeline et périaortique combinée à une chimiothérapie (moutarde azotée, vincristine, procarbazine et prednisone: MOPP). Sur 19 cas au stade IIIB traités par irradiation ganglionnaire totale et MOPP, 3 seulement ont récidivé. Il y a 100% de survies sans récidive pour les malades au stade IIB traités par irradiation + MOPP, et 77% pour les stades IIIB. Ces résultats remarquables nous ont amenés à modifier les schémas thérapeutiques. Les stades IIA clinique et IIA histologique, et les stades IIB sont maintenant traités par irradiation en capeline et périaortique + MOPP. Les stades IIIA clinique et IIIA histologique, et les stades IIIB sont traités par irradiation ganglionnaire totale + MOPP. Dans notre série, la laparotomie s'est donc révélée être un acte essentiel pour prescrire une thérapeutique précise et efficace.
    Notes: Abstract From 1969 to 1974, staging laparotomy was performed on 187 consecutive patients with Hodgkin's disease. Laparotomy changed the type of therapy in 59 of 187 patients (32%). Major staging revisions were: IIA to IIIA, 20 patients; IIIA to IA, 6 patients; IIIA to IIA, 12 patients; IIB to IIIB, 14 patients; and IIIB to IIB, 4 patients. Of stage II patients, 32 of 101 (32%) became stage III and of stage III patients, 24 of 61 (39%) became stage I or II. Forty-four patients with stage IIIA disease received 3,600–4,000 rad total nodal irradiation and their probability of relapse-free survival at 5 years was 52%. No relapses occurred in 11 stage IIB patients given combination of mantle and periaortic irradiation plus MOPP. Only 3 of 19 stage IIIB patients treated with total nodal irradiation and MOPP relapsed. Stage IIB patients with combined therapy had a diseasefree survival of 100%, while stage IIIB patients had a relapse-free survival of 77%. These striking results have led to a new treatment plan. Clinical stage IIA, pathological stage IIIA patients, and those with stage IIB disease now receive a combination of mantle and periaortic irradiation plus MOPP. Clinical stage IIIA, pathological stage IIIA patients, as well as those with stage IIIB disease, receive total nodal irradiation and MOPP. Surgical staging in this series has proved essential for effective and precise therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01574473
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  • 3
    Electronic Resource
    Electronic Resource
    Risk factors and management of local recurrence following breast conservation surgery (1994)
    Springer
    World journal of surgery 18 (1994), S. 76-80 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Un certain nombre de facteurs histologiques et thérapeutiques, peuvent, soit individuellement, soit combinés, prédire un risque accru de récidive locale après chirurgie conservatrice mais aucun ne condamne cette technique en ce qui concerne la diminution de la survie. La récidive locale est en rapport avec la possibilité de tumeur résiduelle non irradiée ou de tumeur résiduelle trop importante malgré une radiothérapie locale. Certains facteurs semblent associés à un risque de récidive locale et de récidive à distance alors que d'autres semblent favoriser la récidive locale sans influencer les métastases à distance. Globalement, le lien entre la récidive locale et le risque de métastases à distance n'est pas très bien déterminé. L'efficacité de la chìmiothérapie pour diminuer la fréquence des métastases à distance après une récidive locale n'a pas encore été évalué. La mastectomie est le traitement de choix pour la récidive locale après chirurgie conservatrice associée à la radiothérapie. Un nombre tout à fait limité de patientes sont candidates pour une deuxième intervention à visée conservatrice.
    Abstract: Resumen Aunque se pueden identificar varios factores histológicos pertinentes al tratamiento que individualmente y en combinación predicen un mayor riesgo de recurrencia local luego de cirugía conservadora del seno, ninguno de ellos compromete la supervivencia hasta el punto de contraindicar este tipo de cirugía. La recurrencia en el seno está asociada con el riesgo de tumor residual, después de la tumorectomía si el seno no es irradiado, y con el riesgo de gran cantidad de enfermedad residual si se ha utilizado irradiación solamente. Ciertos factores de riesgo parecen predecir tanto la recurrencia local como la recurrencia a distancia, mientras otros parecen ejercer un efecto menor sobre el riesgo de metástasis. Globalmente, todavía es pobre el conocimiento sobre la recurrencia local en el seno y sobre el riesgo de metástasis sistémicas. Por lo demás, la eficacìa de la quimioterapia en cuanto a la disminución del riesgo de metástasis sistémicas luego de una recurrencia en el seno no ha sido valorada. Unas pocas pacientes pueden ser candidatas para un segundo intento de conservación del seno luego de recurrencia local.
    Notes: Abstract Although a number of histologic and treatment factors that individually and in combination predict for an increased risk of local recurrence after breast conserving surgery can be identified, none so obviously compromises survival that breast conservation is contraindicated because that risk factor is present. In-breast recurrence is associated with the risk of any disease remaining after lumpectomy if the breast is not irradiated and the risk of large amounts of residual disease if irradiation is used. Some risk factors appear to predict for both local recurrence and distant recurrence, whereas others predict an increased risk of local recurrence but appear to have little effect on the risk of metastatic disease. Overall, the relation between in-breast recurrence and the risk of systemic metastases is poorly understood. Furthermore, the efficacy of chemotherapy in decreasing the risk of systemic metastases after in-breast recurrence has not been evaluated. Mastectomy is the treatment of choice for in-breast recurrence after breast conserving surgery and radiation therapy. A few patients are candidates for a second attempt at breast conservation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00348195
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  • 4
    Electronic Resource
    Electronic Resource
    Insurance coverage of patients with breast cancer in the 1991 Commission on Cancer patient care evaluation study (1994)
    Springer
    Annals of surgical oncology 1 (1994), S. 462-467 
    Details
    ISSN: 1534-4681
    Keywords: Breast cancer ; Insurance ; Stage ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Trends in the care of patients with cancer are monitored annually by the Commission on Cancer of the American College of Surgeons. In 1991 a patient care evaluation study of breast cancer was conducted, which among other questions examined the correlation of health insurance with type or quality of care delivered for breast cancer on a national basis. Methods: The tumor registry system of the American College of Surgeons was used to obtain data on patients with breast cancer diagnosed in 1983 and 1990. Trends in diagnosis and treatment were correlated with the type of insurance or lack of insurance. Results: Data were obtained from hospitals in 50 states on a total of 41,651 patients. The largest number of patients were covered by Medicare. Fewer than 5% were considered medically indigent. Medically indigent patients presented with higher stage disease and did not participate in a trend toward downstaging, which occurred between the two study years. The treatment of medically indigent patients appeared to be appropriate and comparable with better insured patients. Insurance type (health maintenance organization vs. private) did not affect stage, treatment, or outcome. Decisions to use controversial therapies, such as chemotherapy for stage I disease, did not appear to be financially driven. Conclusion: A nationwide pattern of care study for breast cancer indicates that medically indigent patients present with more advanced disease compared with better insured patients, but once the diagnosis is made, treatment and outcome have little to do with insurance type.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303610
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  • 5
    Electronic Resource
    Electronic Resource
    Treatment trends for ductal carcinoma in situ of the breast (1995)
    Springer
    Annals of surgical oncology 2 (1995), S. 207-213 
    Details
    ISSN: 1534-4681
    Keywords: Treatment trends ; Ductal carcinoma in situ ; Breast ; Breast conservation treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: As a result of clinical trial publications, breast conservation treatment has been increasingly used for invasive breast cancer. The patterns of care for ductal carcinoma in situ (DCIS) were analyzed for the years 1985, 1986, 1988, 1990, and 1991 to determine whether the same treatment principles had been applied to patients with noninvasive disease. Methods: Data submitted on 20,556 patients with DCIS during the 5 study years were analyzed with regard to basic demographics and treatment trends. Results: Breast-conserving surgery for DCIS increased from 20.9% in 1985 to 35.4% in 1991. Modified radical mastectomy remained constant at 42%. Axillary node surgery increased from 52% in 1985 to 58.5% in 1991. The use of radiation therapy for patients with partial mastectomy and no lymph node dissection ranges from 24.2% in 1990 to 37.7% in 1985, with 31.1% receiving radiation therapy in 1991. Patients undergoing lymph node dissection with partial mastectomy were more than twice as likely to receive postoperative radiation therapy than were patients without lymph node dissection. Conclusions: Modified radical mastectomy remains the most common surgical procedure, despite the eligibility of many women for breast conservation treatment. As of 1991 the majority of women were still undergoing axillary lymph node surgery despite a node positivity rate of ≈1%. Radiation therapy is significantly underused in patients with partial mastectomy, especially when no nodes were removed. Clinical trial results and professional education for DCIS treatment should change these trends.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02307025
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  • 6
    Electronic Resource
    Electronic Resource
    Patients with early breast cancer benefit from effective axillary treatment (1985)
    Springer
    Breast cancer research and treatment 5 (1985), S. 17-21 
    Details
    ISSN: 1573-7217
    Keywords: breast cancer ; axillary treatment ; surgery ; radiation ; dissection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have reviewed the available clinical data on the benefit of axillary treatment in patients with early breast cancer. The results of these studies suggest that perhaps 5–10% of patients are cured by effective axillary treatment. We conclude that effective axillary treatment should still be considered an essential aspect of primary treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01807645
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