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Bozec A.,Institut Universitaire de France | Ceruse P.,Center Hospitalier Lyon Sud Pierre Benite
Oncologie | Year: 2015

Surgery plays a central role in the multimodal and personalized therapeutic management of head and neck cancers. While complying with general rules of oncologic surgery, head and neck surgery has become more conservative. Head and neck surgery removes more selectively the anatomical structures that are invaded by the tumor and spares the normal healthy tissues. Progress of surgical approaches, endoscopic and transoral (laser, robot-assisted surgery) surgery development, as well as advances in reconstructive surgery have led to reduction in surgical morbidity and improvement in postoperative surgical outcomes. © 2015, Springer-Verlag France. Source

Herisse A.-L.,Nice University Hospital Center | Chiaverini C.,Nice University Hospital Center | Boralevi F.,Bordeaux University Hospital Center | Maruani A.,Service de dermatologie | And 2 more authors.
Annales de Dermatologie et de Venereologie | Year: 2014

Background Pigmented purpuric dermatosis (or Schamberg's disease) is characterized by chronic macular purpura and capillaritis. It is more common in young adult males and adolescents and is generally localized on the lower limbs. In this article, we report on five young children with generalized Schamberg's disease. Patients and methods Five children (aged 13 months to 5 years) were included in this retrospective study. Time to consultation delay ranged from 15 days to 1 year. Results All patients presented asymptomatic generalized macular purpura. Skin biopsies were performed in 4 cases and were characteristic. The results of coagulation tests and complete blood counts were within the normal range in all patients. The clinical course was chronic, with periods of improvement and worsening. No treatment was prescribed. Discussion Schamberg's disease is uncommon in childhood. Our observations suggest that this diagnosis is not exceptional. Clinical appearance, setting and normal blood count values are sufficient to enable a diagnosis to be made. The clinical course is generally chronic, and as yet no treatments have demonstrated efficacy. Source

Skowron F.,Service de dermatologie | Poulhalon N.,University of Lyon | Balme B.,Center Hospitalier Lyon Sud Pierre Benite | Touzet S.,Hospices Civils de Lyon | Thomas L.,University of Lyon
Annales de Dermatologie et de Venereologie | Year: 2014

Background Eccrine porocarcinoma is a rare cutaneous tumor arising from the intra-epidermal portion of eccrine sweat glands, the acrosyringium. Histoprognostic studies in large series are rare. Herein, we report a retrospective study of 50 cases. Patients and methods Fifty cases of porocarcinoma were retrieved from a histopathological register. Each histopathological sample was evaluated for the following criteria: presence or absence of dermal invasion, pattern of the infiltrative component (pushing or infiltrative), tumor thickness, lymphovascular emboli, perineural invasion and mitotic index. Clinical data and outcome were also retrieved for each patient. Results Mean patient age was 77 years (range: 43-99 years). The mean duration of progression prior to diagnosis was 4 years and 5 months. The 2 most common skin locations were the head (38%) and lower limbs (20%). The lesions showed no specific distinctive clinical features. Six cases were in situ, and 44 were invasive (23 with limited infiltration and 20 with scattered infiltration). Mean tumor thickness was 4.37 mm (range: 0.5 to 20 mm). Neighboring or remote epidermal involvement was noted in 7 cases. Lymphovascular emboli were observed in 3 cases. No cases of neurotropism were observed. The average mitotic index was 6.5 mitoses/high power (×400) field. A mean follow-up of 24.3 months was available for 48 patients. Local recurrence was noted in 5 patients, 4 of whom died from visceral metastases. These 5 cases showed no distinctive clinical features, a scattered pattern of the invasive component, cuticular cells, significant tumor thickness (mean 12.8 mm, range 9-20 mm), and an elevated mitotic index. Two histopathological criteria were significantly associated with a metastatic outcome: scattered pattern of the dermal invasive component (P = 0.04) and significant tumor thickness, above 10 mm (P < 0.01). Conclusion Porocarcinoma is a tumor without any particular clinical criteria to distinguish it from squamous cell carcinoma. The architecture of the invasive component and tumor thickness constitute 2 important histoprognostic criteria. © 2014 Elsevier Masson SAS. Tous droits reserves. Source

Chia C.S.,The Surgical Center | Glehen O.,Center Hospitalier Lyon Sud Pierre Benite | Glehen O.,University of Lyon | Bakrin N.,Center Hospitalier Lyon Sud Pierre Benite | And 9 more authors.
Annals of Surgical Oncology | Year: 2015

Introduction: Intraperitoneal (IP) vascular endothelial growth factor (VEGF) levels have been shown to vary in the peritoneal cavity of patients with peritoneal surface malignancies. Our purpose was to correlate levels of IP VEGF with overall and disease-free survival to identify whether IP VEGF can be used to prognosticate patients and the possible role of IP bevacizumab. Methods: From February to October 2012, 97 consecutive patients with peritoneal carcinomatosis were treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Intravenous (IV) VEGF levels were taken before surgery, whereas IP VEGF levels were taken at various time points during and after surgery. Results: Median follow-up was 19.48 months. On univariate analysis, a lower IP VEGF taken just after incision (T1) was associated with improved overall (P = 0.0004) and disease-free survival (P = 0.0006) at 2 years. A lower T1/IV VEGF ratio also was associated with improved overall (P = 0.004) and disease-free survival (P = 0.0051). On multivariate analysis, a lower T1 was associated with improved overall survival, whereas a lower T1/IV VEGF was associated with improved disease-free survival. On subset analysis, these two variables were associated with improved survival in colorectal cancers. Conclusions: A lower IP VEGF level prior to surgery is associated with improved survival. The use of preoperative intraperitoneal bevacizumab for patients with a heavy disease load should be considered, especially in colorectal cancers. © 2015, Society of Surgical Oncology. Source

Passot G.,Center Hospitalier Lyon Sud Pierre Benite | Passot G.,University of Lyon | Bakrin N.,Center Hospitalier Lyon Sud Pierre Benite | Bakrin N.,University of Lyon | And 8 more authors.
European Journal of Surgical Oncology | Year: 2014

Introduction Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have demonstrated promising results in the treatment of peritoneal carcinomatosis (PC). The purpose of this study was to assess the impact of this combined procedure on quality of life (QoL). Materials and methods A prospective single centre study of 216 consecutive patients treated with CRS and HIPEC was conducted using the Gastro-Intestinal Quality of Life Index questionnaire (GIQLI), completed preoperatively and at 1, 3, 6 and 12 months. Results Questionnaire compliance was 81%, 90%, 89%, 89% and 74% at baseline, 1, 3, 6 and 12 months respectively. QoL was significantly decreased up to 6 months and returned to baseline at 12 months. In multivariate analysis, factors decreasing QoL were origin of PC at 3 months, presence of stoma at 6 months and length of surgery over 270 min and disease recurrence at 12 months. Conclusions Despite morbidity associated with CRS and HIPEC, QoL returned to baseline at one year after surgery. This treatment strategy should be considered for the treatment of peritoneal carcinomatosis. © 2013 Elsevier Ltd. All rights reserved. Source

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