Clinical outcome of rectal cancer in patients ≥ 80 years treated in southern France (PACA region) between 2002 and 2005.

BACKGROUND: Rectal cancer in patients aged ≥ 80 years is increasingly more frequent. Little is known regarding their clinical history and outcome after treatment. This retrospective study was undertaken to provide data on this situation. MATERIAL AND METHOD: A questionnaire was sent to the medical doctors of 414 patients listed in the database of Régime Général of Sécurité Sociale, living in the Provence-Alpes-Côte d'Azur (PACA) region between 2002 and 2005, aged ≥ 80 years, and registered as having rectal cancer. Survival was analyzed and correlated with patients' and treatment characteristics. RESULTS: Validated questionnaire was available for 78 patients representing close to 20% of the PACA-targeted population. The majority of patients presented a T3 tumor treated with surgery (61 cases). Median follow-up for the 78 patients was 42 months and the 5-year overall survival was 51%. In the multivariate analysis, the main prognostic factors were gender (better survival in women), age ≤ 85 years, and most of all performance of surgery. CONCLUSION: Rectal cancer for patients between 79 and 85 years does not differ much from that in younger patients and can be treated in a similar manner--depending on the patient's general condition. In patients > 85 years, it is advisable to reduce surgical trauma as much as possible.

[Applying social network analysis to the health system]. / L'analyse des réseaux sociaux appliquée au système de santé.

BACKGROUND: Social network analysis is a method for describing and contextualising the structural relationships amongst social entities. The aim of this study was to assess the relationships between hospitals through the use of an example of a hospital that takes care of myocardial infarction in the region of Provence Alpes Côte d'Azur (PACA). METHOD: This retrospective study included all patients hospitalised for acute coronary syndrome in the PACA region between January and June 2000. The description analysis consisted of making a graph describing the transfer of patients between hospitals to calculate indicators for the centrality of the hospital and its prestige. The graph was also used to determine and measure the sub-group cohesion (cliques) and the density of the hospital network. RESULTS: A total of 2049 patients suffering from myocardial infarction were admitted to 78 hospitals during the study period. There were 867 transfers from one hospital to another. 51 cliques were highlighted; 29 hospitals do not belong to a clique. Among the 49 hospitals who do belong to sub-groups, 50% are linked to two cliques. Eight hospitals belong to more than 8 sub-groups, and the maximum number of sub-groups to which a hospital is linked is 12. The density of the hospital network is 0.12. CONCLUSIONS: Social network analysis is a field of research open and adaptable to the public health scene. This method could be applied to the evaluation of health and hospital administration and management networks.

[Quality assessment in the follow-up of cervical pap smears showing cytological abnormalities]. / Evaluation de la qualité de la prise en charge des frottis du col utérin comportant des anomalies cytologiques.

The aim of this paper is to report on how AFAQAP guidelines regarding the technical and diagnostic levels of cervical smears as well as the ANAES guidelines relating to the clinical follow-up of abnormal smears are applied. The material upon which the study is based was collected from a series of cervical smears representing 10% of those paid for by the French Social Security over a one year period in the Bouches du Rhône district. It appears that the identification of the quality of the sampling done by the pathology lab was poor (21.5%). With respect to the clinical follow-up of abnormal smears, the number of patients with whom there was no follow-up was rather high (12%), the treatment methods were heterogeneous and the clinical care for high grade lesions was insufficient in some cases. We have highlighted the need for follow-up within a group of subnormal smears not usually classified as pathological, but whose neglect would lead to a detrimental rate of false negatives for the patients concerned.

[Role of surgery in the strategy of primary local and regional treatment of stage I and II cancer of the endometrium]. / Place de la chirurgie dans la stratégie du traitement loco-régional primaire des cancers de l'endomètre aux stades I et II cliniques.

Having seen 192 cases of cancer of the endometrium treated at the Institute Paoli-Calmettes between the years 1975 and 1980, the authors have been able to evaluate the place of surgery in the planning of treatment of Stage I and II cases. They hold that: Laparatomy is well tolerated, in 90% of cases of Stage I, 88% of cases of Stage II, 70% of older than 70 years of age and 79% of patients who have some wasting there was no operative mortality. The need to re-explore Stage I and Stage II cases surgically (14%) especially when invasion of the ovaries had not been recognized before histological examination exists. The bad influence of the 5 year survival rate of histological grade 3 or where the myometrium was deeply invaded or where the pelvic lymph nodes were invaded. Studying this personal series and other series found is the literature shows that there is no great value in clearing the pelvis of lymph nodes in order to plan the post-surgical treatment. This is because generally lymph node involvement in the pelvis is associated with other factors that are unfavourable prognostically and these factors can be determined more easily than by removing the lymph nodes. They are, grade 3, invasion of the cervix, positive peritoneal cytology and when the myometrium has been invaded more than 50%. It was only in two cases out of 122 that study of the lymph nodes of the pelvis altered the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)