Pierre Dor

A prognostic index for thyroid carcinoma. A study of the E.O.R.T.C. thyroid cancer cooperative group

Abstract Using survival from all causes of death as an endpoint, the prognostic significance of age, sex, cell type, clinical extent of tumor, lymph node status and number of metastatic sites (all recorded at the time of diagnosis) was studied in a set of data for 500 patients with histologically confirmed thyroid carcinoma. Each of these variables was found to have prognostic significance when examined singly, but some were strongly correlated with others. A simple prognostic index based on a multivariate analysis using a Weibull survival model is presented which allows one to assess the joint effects of the prognostic variables and indentifies patients with markedly different survival probabilities. The index may be used to predict survival for individual patients as an adjustment variable in treatment comparisons, or as a stratification variable in designing prospective randomized trials of treatment.

Prophylactic antibiotics in oral, pharyngeal and laryngeal surgery for cancer: (a double-blind study).

Ampicillin plus Cloxacillin (2 gm of each daily) or a placebo were given at random and on a double blind basis to 52 and 50 patients undergoing oral, laryngeal or pharyngeal surgery for neoplastic lesions.

Antimicrobial prophylaxis for major head and neck surgery in cancer patients.

A total of 113 patients were randomly allocated to receive either ticarcillin plus clavulanic acid (total dose, 20.8 g) or clindamycin (total dose, 2.4 g) plus amikacin (total dose, 1 g) as perioperative antimicrobial prophylaxis for major head and neck surgery. The two groups were similar in age, prior antineoplastic treatment (surgery, chemotherapy, and radiotherapy) or tracheostomy, and the various types of surgery including radical neck dissection. The wound infection rate was 10% in the group of patients receiving clindamycin plus amikacin and 36% in the group receiving ticarcillin plus clavulanic acid (P less than 0.05). Initiation of systemic antibiotic therapy within 15 days of surgery was necessary for 20 and 45% of these patients, respectively (P less than 0.05). The distribution of microorganisms causing wound infections was comparable in both groups, except for anaerobes, which were isolated predominantly from patients who had received ticarcillin plus clavulanic acid.

Wide vertical hemipharyngolaryngectomy with immediate glottic and pharyngeal reconstruction using a radial forearm free flap: Preliminary results

We propose a new technique of wide vertical hemipharyngolaryngectomy which combines resection of laterally localized extended pharyngolaryngeal tumors with immediate microsurgical reconstruction using a radial forearm free flap, including the tendon of the palmaris longus. It eliminates the limitations of resections, which are usually performed to avoid closure difficulties of the resulting defect.

Antimicrobial prophylaxis for major head and neck surgery in cancer patients: sulbactam-ampicillin versus clindamycin-amikacin.

A total of 99 patients with head and neck cancer who were to undergo surgery were randomized in a prospective comparative study of sulbactam-ampicillin (1:2 ratio; four doses of 3 g of ampicillin and 1.5 g of sulbactam intravenously [i.v.] every 6 h) versus clindamycin (four doses of 600 mg i.v. every 6 h)-amikacin (two doses of 500 mg i.v. every 12 h) as prophylaxis starting at the induction of anesthesia. The two groups of evaluable patients (43 in the clindamycin-amikacin treatment group and 42 in the sulbactam-ampicillin treatment group) were comparable as far as age (mean, 57 years; range, 21 to 84 years), sex ratio (71 males, 28 females), weight (mean, 66 kg; range, 40 to 69 kg), indication for surgery (first surgery, 48 patients; recurrence, 37 patients), previous anticancer treatment (surgery, radiation therapy, chemotherapy), type of surgery, and stage of cancer. The overall infection rate (wound, bacteremia, and bronchopneumonia) within 20 days after surgery was 20 patients in each group. Wound infections occurred in 14 (33%) sulbactam-ampicillin-treated patients and 9 (21%) clindamycin-amikacin-treated patients (P = 0.19; not significant). The rates of bacteremia were 2 and 4%, respectively. The rates of bronchopneumonia were 14.3 and 23.2%, respectively (P was not significant). Most infections were polymicrobial, but strict anaerobes were recovered only from patients who received sulbactam-ampicillin. Antimicrobial treatment was required within 20 days after surgery for 42% of the sulbactam-ampicillin-treated patients and 44% of the clindamycin-amikacin-treated patients. By comparison with previous studies, we observed a decreased efficacy of antimicrobial prophylaxis in patients with head and neck cancer undergoing surgery because of the increased proportion of patients who were at very high risk for infection (extensive excision and plastic reconstruction in patients with recurrent stage III and IV cancers) and because of the longer duration of surgery.

Papillary and follicular thyroid carcinoma. Individualization of the treatment according to the prognosis of the disease.

A retrospective study of a continuous series of 152 patients is presented: the patients were treated between 1 January 1955 and 31 December 1981 for a papillary or a follicular thyroid carcinoma. The prognostic index, proposed by the EORTC Thyroid Cancer Cooperative Group in 1979, was calculated for each patient. According to the survival curves and recurrences after treatment, the study shows a clear-cut difference in prognosis if the prognostic index is below 50 or is equal to or above 50. This observation supports the proposal of minimal treatment for less aggressive tumors and extensive treatment for the high risk patients. The actual treatment plan is: (1) total lobectomy when the tumor is unilateral and the prognostic index below 50, but total thyroidectomy in the other cases; (2) lymph node surgery only in cases of node involvement. Instead of a radical neck dissection, a more conservative procedure should be performed, removing the lymphatic chains and preserving the sterno-cleidomastoid muscle, the internal jugular vein and the spinal accessory nerve; (3) no postoperative radioiodine for low risk patients with complete removal of the tumor; (4) postoperative thyroid hormone at doses suppressing secretion of TSH for all patients.

Adrenal secretion of estrogens, glucocorticosteroids and mineralocorticosteroids in the dog

Abstract The secretion rates of cortisol, corticosterone, aldosterone, estradiol and estrone by isolated adrenal glands perfused in situ were compared to each other. The following conclusions are drawn: 1. 1. The canine adrenal gland is capable of secreting estrogens bu the secretion is extremely low even under intense ACTH stimulation. By extrapolation, this suggests that most of the estrogens produced by castrate or postmenopausal women might derive from a peripheral conversion of the adrenal androgens. 2. 2. In nephrectomized dogs the adrenal cortex behaves as a single functional unit with respect to cortisol, corticosterone and aldosterone secretion in response to various degrees of ACTH stimulation. This observation stresses the non-specific dependence of aldosterone on ACTH.