Between 1976 and 1982, 59 patients with locally advanced breast cancer were treated with preoperative supervoltage radiotherapy, adjuvant preoperative and postoperative hormonochemotherapy, and modified radical mastectomy. Systemic treatment, which was started simultaneously with radiotherapy, consisted of a combination of daily oral tamoxifen and a monthly alternation of Doxorubicin + vincristine and cyclophosphamide + methotrexate + 5-fluorouracil (CMF). One of each cycle was given preoperatively at half dosage and five of each were repeated postoperatively at full dosage. All patients became operable. Results of pathologic examination of the operative specimen, available in 51 patients, showed complete disappearance of tumor tissue in breast areas in eight patients, of which three still had positive axillary nodes. After a median follow-up time of 6 years locoregional failure was observed in 12 patients (20%) but in only three (5%) did it occur before distant failure. The actuarial median survival of the entire patient population is close to 4 years. Seven patients are alive without recurrence at greater than 9 years. This aggressive multidisciplinary treatment approach is associated with a projected 30% long-term survival (10 years), excellent local control, but substantial toxicity.
R~sum6Dans le cadre de la pr6sente @tude, les auteurs ont d6montr6, que l'angioscintigraphie cdrdbrale doit @tre rdalisde ~ l'aide d'une dvaluation programmde permettant une exploitation numdrique des donndes. Ainsi elle eonstitue une mdthode non traumatisante permettant d'exclure une affection vasculaire des gros vaisseaux edrdbraux sans devoir proe6der ~ des examens compldmentaires.En effet, en cas de pathologde vasculaire prouvde, la diffdrence de perfusion entre les deux hdmisphgres est supdrieure ~ 20%. Par ailleurs, dans le groupe tdmoin, l'@cart de perfusion reste infgrieur & 20%, ce qui signe l'absence de ldsions vasculaires pouvant amener des troubles neurologiques. I1 ressort done de ce travail qu'une analyse dynamique de la perfusion c6r6brale par du 99 mTc permet une approehe valable et reproductible d'une pathologie vasculaire cdr6brale suspeetde.
Summary
Advantage o] Programmed Evaluation o/ Cerebral Angioscintigraphy in Vascular DiseaseAngioscintigraphy augmented by programmed analysis of cerebral perfusion provides a technique of remarkable diagnostic accuracy which, compared to otherinvestigations, is both simple and safe. This study shows that a 20% perfusion difference between the cerebral hemispheres indicates a vascular anomaly requiring further investigation. The examination is mainly a way of examining territories of supply by major blood vessels in eases of vascular disease. It allows the elimination of vascular lesions from diagnosis when the perfusion difference between the cerebral hemispheres is less than 20%. This is particularly helpful in cases where large blood vessel disease is suspected.
In their study of a case of lethal midline-granuloma, the authors describe the relations between this affection, Wegener’s granulomatosis and lymphoma. The case under review illustrates the difficulty in accurately defining the nosologic picture of the disease. Anatomo-pathological examinations present two possibilities: one being malignant granuloma of the Stewart type, the other that of lymphoma. From its subsequent evolution, we may eventually learn whether this is purely a local illness or represents the onset of a systemic disease.
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