Rapidly growing breast cancer: results of a retrospective analysis with a study of prognostic factors

Between January 1977 and December 1982, 66 consecutive patients have been treated for unilateral, rapidly progressing, non metastatic breast cancer. They were divided into three groups: Group A (n = 10): tumor whom volume had increased during the 2 months before diagnosis; Group B (n = 30): inflammatory signs (erythema, skin oedema, elevated local temperature) involving less than one half of the breast; Group C (n = 26): inflammatory signs involving more than one half of the breast. All patients where managed similarly: 3 to 4 courses of chemotherapy (CMF: n = 24; AVCF: n = 42), then loco regional irradiation therapy with cobalt 60, followed by maintenance chemotherapy, only if the first chemotherapy had proved effective (CMF: n = 13; AVCF: n = 27). Nine patients with residual tumor after radiotherapy underwent mastectomy with axillary dissection. The actuarial 5 years survival for the whole group is 29%, and respectively 49%, 38% and 9% for the groups A, B and C. The median disease free intervals are 43, 29 and 12 months respectively. Fifteen prognostic factors likely to influence overall survival or disease free survival were evaluated. With univariate analysis, 8 factors were found to be of individual prognostic value: extent of initial erythema, erythema present after initial chemotherapy, erythema present after radiotherapy, non menopaused status, tumor diameter greater than 10 cms, residual breast tumor (clinical or radiographic) after maintenance chemotherapy, supra clavicular adenopathy (N3). Age at the diagnosis, type of chemotherapy, or performance of a radical mastectomy did not influence the prognosis. Multivariate analysis using the Cox-model isolated 3 factors of bad prognosis: erythema involving the whole breast at initial diagnosis, erythema present at the end of initial chemotherapy, N3.     

Hydronephrosis after aortofemoral bypass graft. A prospective study

This prospective study was designed to determine the frequency and natural history of hydroureteronephrosis (HUN) after placement of an aortobifemoral vascular graft. A total of 30 patients were evaluated by the study protocol, which included: pre and postoperative biological kidney function tests, preoperative and early postoperative (14th day) intravenous pyelograms and a late (mean 18th month) urologic examination by renal ultrasonic tomography. Four asymptomatic, early cases of HUN were observed in the 57 ureters examined (7%); all four complications regressed in less than 30 days. No cases of symptomatic early or late HUN were observed in this series. Asymptomatic early HUN was a frequent complication in our series (7%) but its benign course does not justify systematic screening. These asymptomatic complications contrast with the symptomatic cases of early or late HUN reported in the literature which necessitated urologic and vascular investigations.     

Primary neuroendocrine cutaneous carcinoma or Merkel cell carcinoma. Review of the literature]

The neuroendocrine carcinomas of the skin, also called Merkel cell carcinomas, are unusual malignancies mostly observed in the elderly. They are diagnosed by a pathologist: ultrastructural studies and immunohistochemistry support the diagnosis. The prognosis is poor. Lymph nodes and metastases quickly arise although sometimes, they are discovered immediately. A combination of surgery and radiotherapy is recommended. Metastases and unresectable tumors should be treated by chemotherapy.     

Recovery of chronic hepatitis B- delta infection by zidovudine and recombinant interferon alpha combination therapy in a patient with Kaposi's sarcoma associated with HIV infection]

A 39 years old homosexual male suffering from chronic type B hepatitis superinfected by HDV, and positive for anti-HIV1 was treated with zidovudine associated with high doses of recombinant interferon alpha for onset of an extensive cutaneous Kaposi sarcoma. Other than the long-lasting disappearance of Kaposi's lesions, this therapy was followed by complete recovery from hepatitis B and D. Serological and hepatic clearance of both viruses was marked by two successive cytolytic peaks separated by a 9 month interval. The patient's immunologic status has remained stable at 30 months. To our knowledge, such a success had never been reported in the literature and the clearance of both hepatitis B and D viruses in an AIDS patient stands in sharp contrast with the usual rapidly progressive evolution of those triple coinfections. This phenomenon illustrates the potential benefits of zidovudine in association with high dose of interferon alpha in HIV patients suffering from hepatitis D.     

Herpesvirus, cytomegalovirus, human sperm and assisted fertilization

BACKGROUND: The effect of viral particles on the motility of human sperm and the relationship between sperm and virus are of importance particularly in assisted fertilization. METHODS: We incubated ejaculated sperm with or without seminal fluid with either herpes simplex virus type 2 (HSV2) or human cytomegalovirus (HCMV). For each experiment, 5 x 10(5) sperm were incubated with a viral load of between 10(4) and 10(6) plaque-forming units. RESULTS: We detected no apparent variations in the percentage of motile forms when sperm were incubated with either HSV2 or HCMV. Using a computer-aided semen analysis system, a slight difference was reported in the percentage of motile forms when seminal fluid-free sperm were incubated with HSV2 (57.18 versus 64.43 in the control). Although the mean amplitude of lateral head displacement and the curvilinear velocity were significantly higher in infected sperm, the difference in straight line velocity was not statistically significantly different. Few viral particles (HSV2 or HCMV) adhered to the sperm membrane in the presence of seminal fluid. However, more particles stuck when in the absence of seminal fluid, particularly with HSV2 (8% of sperm sections for HSV2; 4% for HCMV). CONCLUSIONS: The relationship between sperm and viruses depends on the type of virus present as well as the presence or absence of seminal fluid. Motility is not a good enough criterion on which to prove the presence of viral elements, either in the medium or on the sperm.