Assessment of algorithms for identifying patients with triple-class refractory multiple myeloma using real-world data

Objective: Patients with triple-class refractory (TCR) multiple myeloma (MM) have limited treatment options and poor prognoses. This high unmet need has prompted the development of new therapies allowing for improved outcomes for these patients. Recently, new targeted therapies for the treatment of patients with relapsed or refractory MM have been approved based on single-arm clinical trial results. Real-world (RW) data enable a better understanding of the effectiveness of new therapies in clinical practice and provide external controls for single-arm studies. However, using RW data to identify patients with TCR MM is challenging and subject to limitations. Methods: In this retrospective cohort study of an analysis of the COTA electronic health record (EHR) database, we used four algorithms to define refractory status and created four groups of patients with TCR MM initiating post-TCR therapy. Each algorithm relied on slightly different criteria to identify TCR patients, but all were based on the International Myeloma Working Group (IMWG)-derived and/or healthcare provider (HCP)-reported progressions within the database. Results: A total of 3815 patients with newly diagnosed MM met the eligibility criteria for this study. The choice of the algorithm did not impact the characteristics of identified patients with TCR MM (Algorithm 1 [n = 404], Algorithm 2 [n = 123], Algorithm 3 [n = 404], and Algorithm 4 [n = 375]), including their demographic and disease characteristics, MM treatment history, or treatment patterns received after becoming TCR. However, identifying TCR MM using a combination of IMWG-derived and HCP-reported progressions allowed up to a 70% increase in the size of the identified group of patients compared with using only IMWG-derived progressions. Conclusion: In RW settings, progressions from both IMWG-derived data and physician reports may be used to identify patients with TCR MM.

The Incidence of Cancer in Contralateral Reduction Mammaplasty after Mastectomy and Reconstruction of the Removed Breast

Fourty-one patients underwent breast reconstruction after mastectomy for cancer and reduction plasty of the second breast, over a 36-month period. These plasties were performed only for reasons of asymmetry, in the absence of any positive preoperative finding. Histologic examination using semiserial sectioning of the whole excised sample detected a high frequency of unsuspected cancer 14/41 (34%). There was a strong predominance of in situ carcinomas 11/41 (27%) over invasive carcinomas 3/41 (7%). These results were compared with those of other bilateral cancer series. When such cancers were detected by random biopsies or mastectomies, the rate of in situ carcinomas was much greater than in cancers detected only by physical and mammographic examination.

[Contribution to the study of painful and functional sequellae after breast reconstruction using latissimus dorsi flap. Investigation into 149 patients]

Latissimus dorsi flap is the most commonly used among tissues transfers for breast reconstruction. If its qualities and performances are well known, few papers have studied sequellae of this flap, particularly painful. The purpose of this paper is to provide a contribution about this subject. Postulating the complexity of this step, we limited ourselves initially to an evaluation based on analysis of concise questionnaire mailed to two pools of patients with different delays since their reconstruction using latissimus flap. In the two groups of patients, announced principal embarrassment - logically associated with a gestural limitation - is the feeling of axillo-dorsal rigidity, more pregnant than the pain itself. This one is marked during the 2 to 4 first months in the majority of the patients (68 and 66 %), and can persist several years in some among them (14 %). These after-effects did not prevent almost all of the patients to take again their domestic and professional activities and to express a high level of satisfaction with respect to their reconstruction. The addition of a prospective series studying the postoperative pain after reconstruction with or without latissimus flap tends to confirm that any oncologic breast surgery, ablative or reconstructive, expose to painful sequellae more linked to individual factors than to the technique implemented.

[Primary intraosseous carcinoma of the jaws: results of treatment of 9 cases and proposed classification]

INTRODUCTION

Primary intraosseous carcinoma of the jaws is a rare squamous cell carcinoma arising in the jaw, having no initial connection with the oral mucosa and presumably developing from residues of the odontogenic epithelium.

OBJECTIVES

To present 9 cases and to propose a staging system of primary intraosseous carcinoma of the jaws.

CASES AND METHODS

Careful assessment of the clinical, radiological and histological examination of the specimens identified 9 patients with primary intraosseous carcinoma of the jaws.

RESULTS

The male/female ratio was 8/1 and the mean age of patients at the time of diagnosis was 61.7 years. All lesions were located in the mandible. Usually, clinical symptoms had benign aspect and delay the diagnosis. Radiographic features were unilocular osteolytic lesion and ill-defined margins were usually noted with a mean tumor size of 3.4 centimeters. The mean delay of the diagnosis was 4.9 months. Surgery at the tumor site consisted of hemi-mandibulectomy in all cases. All patients but one had neck dissection. The postoperative radiotherapy mean dose was 62.6 Gy. Histologically, most squamous cell carcinomas were well differentiated with keratinization. All lymph nodes metastasis had capsular involved. Complications occurred in 2 cases. Four patients had recurrences in the mean delay of 13.8 months. The estimated overall 2-and 5-years survival was 65% and 46.5% respectively.

DISCUSSION

Primary intra-osseous carcinoma of the jaws is a rare tumor none classified by UICC with poor prognosis. We recommend an aggressive treatment with postoperative radiotherapy. We propose a computer tomographic classification: T1 (tumor strictly intra-osseous), T2 (tumor with cortical destruction without involvement of adjacent soft-tissues) and T3 (tumor involvement of adjacent soft-tissues).

Analysis of 676 Cases of Ductal Carcinoma in Situ of the Breast From 1971 to 1995

Six hundred seventy-six patients with ductal carcinoma in situ of the breast (DCIS) from 1971 to 1995 were included in the study. Computerized patient files were retrospectively analyzed. Clinical findings were less frequently reported to reveal DCIS after 1989. Positive mammographic findings were obtained in 87% of patients and were mainly represented by microcalcifications (79.4%). Treatment procedures were breast-conserving surgery (BCS) alone (37.5%), BCS followed by radiation (BCSR) (25.5%), or mastectomy (M) (37%). The actuarial local recurrence was 2.6% in the M group (94 months of follow-up), 14.5% in the BCS group (85,7 months of follow-up), and 7.5% in the BCSR group (78.8 months of follow-up). Predictive factors of recurrence in all patients were invaded margin status and age. In the BCS group, grade was also a predictive factor. The analysis per decade shows that the lesions currently diagnosed are less serious than those of the past. All the recurrence in patients with positive margins was in the same quadrant as the original lesion. This further emphasizes the need for clear margins.

Primary intraosseous carcinoma of the jaws

OBJECTIVES

To present 8 new cases of primary intraosseous carcinoma of the jaws and to review the literature for an analysis of treatment modalities and patient outcomes.

DATA SOURCES

A MEDLINE search from 1970 to 1999. The articles chosen and the study of the references of every one that produced additional articles provided database information for 28 patients. Eight new patients from our institutions were added.

STUDY SELECTION

Our criteria of inclusion included the absence of ulceration of the oral mucosa, a negative result in the search for a distant primary tumor, and convincing histological documentation.

DATA EXTRACTION

The variables of the analysis included age, sex, site of the tumor, condition of the oral mucosa, tumor size, neck status, treatment modalities, recurrences, and survival.

DATA SYNTHESIS

Twenty-eight patients were identified in the literature, for a total of 36 patients. There were 28 males (78%) and 8 females (22%) ranging in age from 4 to 76 years (mean, 54 years). The tumor site was the mandible in 33 patients (92%) and the maxilla in 3 (8%). Of the 34 patients treated, 19 (56%) had recurrences. Overall 2- and 4-year survival was 60.5% and 39.9%, respectively. Patients who underwent radical surgery and postoperative radiotherapy (n = 11) had a 2- and 3-year survival probability of 61.3% and 40.9%, respectively, whereas in the remaining patients (n = 25), the rates were 59.7% and 31.3%, respectively (P =.60).

CONCLUSIONS

Strict diagnostic criteria must be applied. The prognosis associated with primary intraosseous carcinoma of the jaws is poor and suggests the need for aggressive treatment.

Dislocation of a plate-haptic silicone intraocular lens into the anterior chamber

Posterior dislocation is a well-described complication of plate-haptic intraocular lenses (IOLs). It usually occurs after an opening in the posterior capsule, either intraoperatively or after a neodymium: YAG capsulotomy occurs. We report a case of anterior luxation of a plate-haptic silicone IOL occurring 4 months after uneventful cataract surgery. This case emphasizes the need for a small and continuous capsulorhexis as well as in-the-bag implantation of plate-haptic IOLs.

Outcome of squamous cell carcinoma of the gingiva: a follow-up study of 83 cases

BACKGROUND

Squamous cell carcinomas of the gingiva are relatively rare tumours. Standard treatment is based on surgery and radiotherapy. The extent of bone involvement affects mandibulectary indications.

PURPOSE

A retrospective review of squamous cell carcinomas of the gingiva was performed to evaluate the incidence of mandibular or maxillary bone involvement. Indications for marginal and segmental bone resections are specified.

MATERIAL

From 1985 to 1996, 83 patients with squamous cell carcinoma of the gingiva were treated at the Department of Surgery (Institut Bergonié, Bordeaux, France) and at the Department of Maxillofacial and Plastic Surgery (Centre Hospitalier Universitaire, Bordeaux, France). Forty-three underwent surgery plus postoperative radiotherapy. Twenty-two had flap reconstructions. Clinical evaluation and panorex roentgenography were the means used to evaluate bony invasion and to decide on the extent of bone resection.

METHODS

A retrospective review of 83 consecutive patients was performed. This series is unusual in its homogeneity: surgery was performed by only two individuals and the radiotherapy was the responsibility of just two physicians. Outcome was calculated using the Kaplan-Meier method.

RESULTS

Primary local control was achieved in 72 patients (87%). Overall survival and rate of recurrence were comparable to those of other squamous cell carcinomas of the oral cavity and oropharynx.

CONCLUSION

Surgical resection continues to be the mainstay of treatment and this study tends to confirm the validity of modified neck dissection and marginal bone resection in suitably selected patients.

[Contribution to the study of the future of silicon-gel breast implants in mammary reconstruction after cancer: concerning 205 implants]

Long term follow-up of 187 women with mammary reconstruction using 205 silicone-gel implants enables a retrospective analysis of the evolution of both patients and their prosthesis. Most patients have not presented local or general disease related to implant leakages. However, these leakages are not uncommon, being present in nearly one-third of 38 explantations motivated by aesthetic considerations (of which 50% are capsular retractions). All the ruptured or pre-ruptured implants are more than seven years old. Leakage frequency sharply increases after ten years. Authors tried to assess the place of radiologic evaluations (digitized costal profile, ultrasound, MRI...) in order to detect deterioration of the prosthesis. Although suspicions raised by these evaluations have made it possible to adequately target the explantations, pathogenicity of silicone-gel implants appears low enough to confirm the predominance of clinical follow-up.

Supraomohyoid neck dissection in cancer of the oral cavity

BACKGROUND

In oral cavity cancer, supraomohyoid neck dissection (SOHND) is becoming more popular for patients with N0 and N1 disease in the neck. The aim of this study was to assess the value of this surgical procedure.

METHODS

The study included 237 previously untreated patients with oral cavity cancer. The neck treatment consisted of SOHND or functional neck dissection (FND). One hundred sixty patients underwent postoperative radiation therapy. Survival probabilities, neck recurrences, and distant metastases were analyzed according to the surgical procedure.

RESULTS

For patients having undergone SOHND, the 5-year survival probabilities were 70.2% and 76.5% in N0 and N1 necks, respectively. The neck recurrence rate in SOHND was 2%.

CONCLUSIONS

SOHND is an effective method of treatment for the clinically negative neck in patients with squamous cell carcinoma of the oral cavity. It also proves efficient, in conjunction with postoperative radiotherapy, for control of neck metastases in selected patients.

[Standards, options and recommendations (SOR) for clinical care of squamous cell carcinoma of the oropharynx. Groupe de travail SOR]

CONTEXT

The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature systematic review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.

OBJECTIVES

To develop clinical practice guidelines according to the definitions of Standards, Options and Recommendations for the management of squamous carcinoma of the oropharynx.

METHODS

Data have been identified by literature search using Medline (1991-1998) and the expert groups personal reference lists. Once the guidelines were defined, the document was submitted for review to national and international independent reviewers and to the medical committees of the 20 French Cancer Centres.

RESULTS

The main recommendations for squamous cell carcinoma of the oropharynx management are that: 1) diagnosis and initial assessment should be based on appropriate clinical and radiological findings; 2) the therapeutic strategy is based on surgery, radiotherapy, bradytherapy and chemotherapy; 3) in limited tumours, the recommended strategy involved the use of one of these modality; 4) a multimodality approach is recommended for the treatment of extended resectable tumours. Following results of recent meta-analyses, use of neo-adjuvant chemotherapy is not recommended. The same studies have shown that association of chemotherapy and radiotherapy either in sequence or in combination significantly improve survival of extended curable tumours. These associations are recommended within the framework of clinical trials; 5) follow-up of squamous carcinoma of the oropharynx should involve physical examination of the upper aerodigestive tract and the lymph nodes areas every three months during the first year, every six months during the second year and then every year. An annual chest x-ray is recommended. Other investigations should be performed as indicated by symptoms and clinical manifestations.

[Results of 10 years of a randomized trial of neoadjuvant chemotherapy in breast cancers larger than 3 cm]

AIM OF THE STUDY

The aim of this randomised trial was to determine advantages and drawbacks of neo-adjuvant chemotherapy in patients with operable breast cancers > 3 cm.

MATERIAL AND METHODS

Two hundred and seventy-two women (age 70) with operable breast cancers larger than 3 cm (T2-3/N0-1/M0) were included in a randomised trial from January 1, 1985 to April 30, 1989. Patients in group A (n = 138) were treated by mastectomy and axillary node dissection. Adjuvant chemotherapy was indicated for 104 patients with axillary node involvement (n = 82) or negative oestrogen and progesterone receptors (EPR-) (n = 22). Patients in group B (n = 134) were treated by initial chemotherapy (identical as in group A) followed by locoregional treatment according to the response. Before treatment, the average of clinical tumoural diameter was 43 mm.

RESULTS

The median follow-up was 124 months. In group B, 49 patients (36.5%) were resistant to chemotherapy; a conservative breast surgical treatment was performed in the other 84 patients sensitive to chemotherapy (62.6%). In this last subgroup, 19 (22.6%) needed a secondary mastectomy because of locoregional recurrence. Survival rates were not different in groups A and B, but loco-regional recurrences were frequent in group B. At 10 years, the overall survival rate was 60% and half of living patients in group B were free of cancer and with their breast.

CONCLUSION

Neoadjuvant chemotherapy permitted in two-thirds of cases breast conservation treatment, initially considered to be impossible. Locoregional recurrences are more frequent than after mastectomy and adjuvant chemotherapy.

[Recurrence after treatment of breast intraductal carcinoma]

OBJECTIVE

To assess the risk of local recurrence of intraductal carcinoma of the breast with a large series and a review of literature.

METHODS

We present a retrospective study of 331 cases treated for intraductal carcinoma of the breast. Only patients with at least 5 years follow-up were selected. We were specially interested in recurrence risk factors. In these patients with a long follow-up; pathology was reevaluated with new investigation technique.

RESULTS

After a median follow-up of 109 months, 40 local recurrences were observed; these lesions were invasive in 23 cases. Only one patient had recurrence after mastectomy. For the others, they had lumpectomy associated with radiotherapy in 12 cases. Histologic features, grade and therapeutic options were evaluated as risk factors of local recurrence.

CONCLUSION

Follow-up after lumpectomy for intraductal carcinoma was studied. The status of tumor margins was important; irradiation appeared useful, specially in case of high grade carcinoma but further large prospective randomized studies are needed. The use of prognostic index is interesting, but there are still unanswered questions.

[Prosthetic breast reconstruction and radiotherapy: analysis of 67 cases)]

Authors inquire into repercussions of radiotherapy (RT) on prosthetic mammary reconstruction (PMR) by using the retrospective analysis of 67 cases, 59 of which were performed in irradiated areas. The particular aspect of irradiated prosthesis is evoked regarding 8 cases, and with the support of a literature review. Surgical complications and late results are evaluated comparatively to 339 PMR among non irradiated patients. According to available data in our series, harmfulness of RT not appeared statistically demonstrated. From both their experience and the literature, authors clarify indications of PMR following RT. They conclude to the necessity of a high quality RT, and optimal adaptation of surgical technique to tissular conditions.

Accuracy of Goldmann tonometry after refractive surgery

PURPOSE

To assess the accuracy of Goldmann tonometry after refractive surgery.

SETTING

Refractive surgery center, Sherbrooke, Quebec, Canada.

METHODS

The charts of 824 patients who had radial keratotomy (RK) and 415 who had photorefractive keratectomy (PRK) by the same surgeon were retrospectively reviewed. Of these, 306 RK and 168 PRK patients had discontinued steroid use for at least 4 weeks postoperatively and were thus eligible for evaluation of preoperative and postoperative intraocular pressure (IOP). Only one eye per patient was used for statistical analysis.

RESULTS

Preoperative data showed that age, mean keratometry, and pachymetry were related to IOP measurement with the Goldmann tonometer. Pachymetry was related to age and mean keratometry. The mean decrease in measured IOP after RK was 1.0 mm Hg +/- 3.21 (SD) (P < .05). The only positive correlation was with the number of incisions. The mean decrease in measured PRK was 2.4 +/- 3.02 mm Hg (P < .05). Men and older patients had a larger drop in IOP measurements. There was no correlation with any corneal or operative parameter.

CONCLUSION

Refractive surgery changed the accuracy of the Goldmann tonometer, causing it to underestimate IOP. The change was more marked in older men who had PRK.

Word priming with brief multiple presentation technique: preservation in amnesia

Many studies have shown relative preservation of word priming in subjects with mild amnesia, but some decrease in severe amnesia. This calls into question the degree of separation between implicit and explicit memory. Possible contamination of implicit memory tasks by impaired explicit memory strategies might be obscuring the actual dissociation between the two memory systems. We have developed a method of circumventing explicit memory contamination by using brief duration repeated primes below the awareness threshold of subjects. We have used this approach to evaluate the status of word priming in densely amnesic subjects. One group of amnesic subjects with alcoholic Korsakoff's syndrome and one group of normal elderly control subjects were tested for word priming on a speeded category membership decision task. Implicit or explicit encoding procedures were used in three different experiments. Results demonstrated that brief multiple presentation of words can offer a means of producing word priming in the absence of explicit recognition or recall of the primed words in both amnesic subjects and normal elderly control subjects. Moreover, there was no significant difference in the magnitude of the priming effect between these groups in the three experiments. These findings show that amnesic subjects can exhibit normal levels of word priming. They also suggest that amnesics retain the capacity to encode, store and retrieve information implicity, e.g. unintentionally.

[Breast reconstruction after breast cancer: a review of a 12-year-long experience]

The experience of 428 mammary reconstructions (MR) performed by the same surgeon, evaluated more than two years after surgery, enable the authors to try to determine possible correlations between results of MR and methods employed. Antibiotic prevention and tissue expansion only appear to have a significant influence on MR issue, whereas capsular contracture and aesthetic result did not seem correlated with prior radiotherapy or texture of the wall implant. This study confirms the low morbidity of MR. As regards quality of life, MR provides a noticeable benefit to a wide majority of patients. No method has been proved to be higher, or not advisable, against others. So, indications must be modulated in every case, patronizing better compromise between safety, quality and stability of morphologic result, and need expressed by each patient.

[Infrahyoid musculocutaneous flaps: anatomical bases and indications in cervicofacial oncologic surgery]

The infrahyoïd myocutaneous flap has been described by Wang in 1986. Its use seems still limited, although its obvious interest in head and neck reconstructive surgery, especially in oropharyngeal area. Authors expound anatomic bases of this flap, and a 62 case's experience confirming its potential.

Conservation treatment in subareolar breast cancers

The results of centromammary conservation in 37 patients with 20 mm-median-size breast cancer, located in the subareolar area (SAA), with an infiltration of the nipple-areolar-complex (NAC) in 12 patients and a retraction in 24, are reported. Breast conservative surgery was initially performed in 30 patients; five patients were first treated with chemotherapy; two patients received initial tamoxifen. Surgery comprised tumorectomy plus axillary dissection, with complete resection of the NAC (20 patients), or partial resection (nine patients), or without resection (eight patients). Post-operatively, all patients received 50 Gy external radiotherapy, with an additional external electron boost in 13 patients; 14 patients received adjuvant tamoxifen and two patients adjuvant chemotherapy. With a median follow-up of 49 months, one patient experienced a local failure and four a metastatic failure; 5-year overall actuarial survival and disease-free survival rates were 97%, and 75%. Cosmetic results were excellent in three patients, good in 25, and poor in seven. Breast conservation appears a satisfying treatment in small breast cancer located in SAA.

[Musculocutaneous flap of latissimus dorsi in breast reconstruction. Results of a series of 163 cases]

One-hundred and sixty-three consecutive latissimus dorsi myocutaneous flap breast reconstructions performed after modified radical mastectomy between 1982 and 1991 were reviewed. Patients were followed for an average of 4.7 years after reconstruction. Satisfactory result was obtained in the majority of cases. Surgery of the opposite breast was performed on 1/3 patients of the initial group. Peri-operative and long term complications, of which capsular contracture, are reviewed and appeared infrequent. Latissimus dorsi myocutaneous flap breast reconstruction usually mit patient expectations, with a minimum of procedures and low morbidity.

[Quality control of care in a surgical department. Experience of the Fondation Berganié]

Activity in a surgical department can be evaluated quantitatively, but is should also be assessed qualitatively. One way to control the quality of care is to determine as accurately as possible the incidence of pre- peri- and post-operative complications and to analyse these date in a critical comparative study. This was accomplished in the surgical department of the Fondation Bergonié, Bordeaux during three test periods over the last five years--March 1987 (127 patients), June-July 1989 (276 patients), and June 1991 (147 patients). Results of this analysis cannot validly be compared with those of other departments with different patient recruitment and activity functions. However, this study within a department with regular, homogeneous activity did demonstrate, over a period of several years, a clear reduction in operative mortality, essentially by improved control of infectious complications by the extensive use of prophylactic antibiotic therapy for all surgery with a septic risk or for debilitated patients. Results also demonstrated the low cost effectiveness of routine pre-operative exploratory examinations.

Ethmoidal cancers: a retrospective study of 22 cases

From April 1978 to June 1990, 22 patients with ethmoidal cancer were treated at Fondation Bergonié by a combination of surgery and radiation therapy. The mean age was 59.6 years (range 34-79 years) and the sex ratio is 2.7 (16 males/6 females). Histologic types were: adenocarcinoma, 13 cases; squamous carcinoma, 4 cases; undifferentiated carcinoma, 3 cases and esthesioneuroblastoma, 2 cases. Exposure to wood dust was encountered in 11 patients, especially in cases of adenocarcinoma: 10/13 (77%). Staging according to the classification of the University of Florida was: Stage I, 10 patients; Stage II, 5 patients and Stage III, 7 patients. Resection was considered as complete in 16 cases and only one orbital exenteration was performed. The postoperative radiation therapy delivered a mean given dose of 55.7 Gy (range 50-70 Gy) expressed to the hot spot using a technique adapted to tumor location and extension. Complete remission was achieved in 20 cases. Median follow-up is 28 months. The 5-year overall and disease-free survival are 44% and 38%, respectively. Analysis of recurrences according to staging gives: 5/10 Stage I, 2/5 Stage II and 5/7 Stage III. Recurrence is pejorative since death occurs in all cases within an average of 6 months following salvage treatment, except for three patients still alive within less than 6 months and in second remission. Prognosis of ethmoidal cancer depends on staging and local control.

Impairment of monocyte functions in advanced head and neck cancer

Depression of cell-mediated immunity is well established in most malignancies and especially in head and neck cancers, and much information is available concerning the defect in helper T lymphocyte function. We now report on impairment of the monocyte-macrophage system. Compared with normal controls we found that patients displayed, on one hand, an increased number of peripheral blood monocytes and, on the other hand, a smaller percentage of HLA-DR+ monocytes. Such peripheral blood monocytes normally failed to secrete factors, including interleukin 1 (IL-1). In addition, we observed that the in vivo induced blastogenesis of peripheral blood lymphocytes from patients, which is spontaneously depressed, is partly restored by medium containing IL-1. We cannot exclude, however, that the observed monocyte dysfunction involves other cytokines. Whether such an immune deficiency is due to secondary malnutrition or to the malignancy (or both) remains unclear.

[Conservative axillary curettage in the treatment of operable breast cancers]

Functional motor and sensory sequelae of conservative or non-conservative treatment of breast cancer are due essentially to axillary curettage, during which the nerve branches crossing the axillary pyramid are often sectioned. Analysis of axillary glands is now fundamental for determination of prognosis and adjuvant treatment required. The present report demonstrates that knowledge of the glandular state can be obtained, while limiting functional sequelae, by careful dissection of axilla avoiding all nervous elements (motor nerves of latissimus dorsi, serratus anterior and pectorals, perforating intercostal sensory nerves) and the must important vascular structures (inferior scapula pedicle and pedicle of pectoral muscles.

[Immediate repair of urethroperineal fistulas after abdominoperineal amputation by means of a cutaneo-muscular flap of the gluteus maximus. Apropos of 2 successfully treated cases]

Although a rare complication, the development of a urethro-perineal urinary fistula immediately after abdomino-perineal amputation is a difficult problem to solve. The fragility of the membranous urethra immediately in contact with the exenterated pelvic cavity which takes several weeks to fill in makes any attempt at isolated direct suture very hazardous. Secondary repair is also frequently difficult and the "functional prognosis is far from being always favourable". The major handicap resulting from the perpetuation of this type of fistula has led us to propose an attempt at immediate repair as soon as it is diagnosed with filling of the pelvi-perineal cavity by a cutaneo-muscular flap taken from gluteus maximus. In the two cases in which this treatment was performed, the fistula was cured and a good quality functional result was obtained.

Cutaneous versus myocutaneous flaps in the repair of major defects in head and neck cancer: a study of 331 flaps

A retrospective analysis was carried out of 311 reconstructions of major defects following head and neck cancer treatment. Three hundred thirty-one flaps were used; they included cutaneous flaps from 1972 to 1979 and myocutaneous flaps (MCF) after 1979. The aim of this study was to compare the healing patterns of the two types of flaps used in similar circumstances. Even though the use of myocutaneous flaps reduced necrotic complications, there was no significant improvement in overall healing. In this type of reconstruction, local conditions as well as more general factors have greater prognostic significance. Apart from considerations of reliability, other criteria have led to myocutaneous flaps being the treatment of choice in cervicofacial cancer repair. However, specific indications for the use of cutaneous flaps remain.

Effects of pressure on the infrared spectra of some heterocyclic organosilicon and organogermanium compounds

Measurements have been made of the infrared spectra of eight solid heterocyclic organosilicon and organogermanium compounds at pressures up to 5 GPa at normal temperature. Evidence is found of reversible conformational changes under pressure, and of phase transitions in some of the compounds. Unexpectedly, it appears that compression does not favour the transannular interaction that exists, in some cases, between the heteroatom (silicon or germanium) and a functional group on the opposite side of the ring.

[A comprehensive diagnostic and therapeutic approach to cervical lymph node metastasis from unknown primary site (author's transl)]

Cervical lymph nodes metastasis from unknown primary lesion are rather infrequent but constitute a specific problem. The present study reports the results obtained from a series of fifty patients treated for such lesions from 1964 to 1976. It emphasizes that a comprehensive therapeutic approach is warranted and should combine surgery and radiation on the cervical areas and irradiation of mucosae that may harbour the primary.