Download or read book Estimation et interpr tation de l effet pronostique d une grossesse survenant apr s le traitement d un cancer du sein written by Alexia Savignoni and published by . This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Le cancer du sein a touché près de 49000 femmes en France en 2012. Deux pour cents surviennent chez des femmes de moins de 35 ans. Comme beaucoup de femmes reportent leur maternité à plus tard, les médecins font de plus en plus face aux questions relatives à une grossesse post-traitement. L'histoire reproductive, les influences hormonales et le cancer du sein semblent liés. Pourtant aucune étude n'a rapporté d'impact péjoratif de la grossesse sur l'évolution du cancer ; par contre beaucoup d'études ont annoncé que la grossesse n'avait aucun impact, et pourrait même avoir un effet de protection à long terme. Toutefois l'interprétation des résultats est souvent limitée par un biais de confusion connu, le « healthy mother bias » : seules les femmes se sentant en bonne santé vont mener une grossesse. La grossesse est donc un événement dont la survenue est liée au statut pronostique de la patiente et qui pourrait interagir avec l'hormonosensibilité du cancer du sein. Pour tenter de prendre en compte ce biais de confusion dans l'estimation et l'interprétation de l'effet d'une grossesse qui est un événement survenant au cours du temps, nous avons exploré deux approches. La grossesse est assimilée à une exposition survenant au cours du temps. Dans un premier temps nous avons appliqué le modèle « illness-death » sur des données de cohorte : l'exposition est l'état intermédiaire dont la valeur dépend du temps ; l'estimation des facteurs influençant le passage vers l'exposition permet une évaluation qualitative de la confusion. L'effet de l'exposition est étudié à partir de la comparaison des transitions vers l'événement d'intérêt : celles ayant eu l'événement intermédiaire versus les autres. Cet effet est estimé en prenant en compte l'interaction entre les facteurs pronostiques caractérisant le niveau de gravité de la maladie et l'exposition. Dans la seconde approche, nous avons constitué, à partir de la cohorte, des paires composées d'un sujet exposé et d'un sujet non exposé. Dans la littérature, l'appariement est réalisé en créant les paires a posteriori comme si la grossesse était connue lors du diagnostic du cancer. Nous proposons, dans ce cas particulier où l'événement caractérisant les sujets d'une paire survient au cours du temps, une nouvelle méthode d'appariement. De plus, nous étudions des modèles d'analyse connus et dédiés aux données censurées corrélées : le modèle de Cox stratifié de Holt et Prentice, le plus utilisé, et le modèle de Cox de Lee Wei et Amato. Tout le travail est basé sur une large étude de simulation afin d'estimer et interpréter l'effet pronostique d'un événement survenant au cours du temps et en lien avec le statut pronostique. Les conclusions de ces simulations ont été appliquées à l'analyse d'une cohorte réelle de patientes jeunes traitées pour un cancer du sein, afin d'évaluer l'effet d'une éventuelle grossesse post-traitement sur l'évolution de la maladie.
Download or read book Evaluation de l impact pronostique de la grossesse chez les patientes g es de moins de 35 ans atteintes d un cancer du sein written by Daphné Duval-Tassy and published by . This book was released on 2007 with total page 74 pages. Available in PDF, EPUB and Kindle. Book excerpt: Notre étude rétrospective, basée sur une population de 908 patientes suivies pendant une période moyenne de 7 ans, a permis d'analyser l'impact pronostique d'une grossesse chez des patientes traitées pour un cancer du sein invasif durant les années 1990 à 2000. Une grossesse dans l'année précédant le diagnostic a montré, en analyse univariée, un effet défavorable sur le taux de survie globale et sans rechute locale. En analyse multivariée, la grossesse reste un facteur pronostic indépendant de récidive locorégionale mais n'est plus un facteur pronostic significatif de décès et de rechute métastatique. Pour les grossesses survenant après le traitement, les patientes étudiées étaient plus jeunes, présentaient moins d'antécédents familiaux et moins d'envahissement ganglionnaire axillaire. Après ajustement des facteurs pronostiques, la grossesse ne s'est pas avérée être un facteur de mauvais pronostic de décès. Chez les patientes ayant présenté une grossesse après traitement, il n'y a pas de différence du taux de survie quel que soit le statut des récepteurs hormonaux de la tumeur du sein. Les patientes désireuses d'entreprendre une grossesse peuvent être conseillées grâce aux résultats donnés par un score pronostique réparti en quatre classes. Les patientes de bon pronostic (score 1) présentaient un risque de récidive annuel bas constant dans le temps, un délais d'attente court est donc envisageable, en tenant compte du bénéfice potentiel de l'hormonothérapie chez les patientes aux récepteurs hormonaux positifs. Les patientes de mauvais pronostic (score 4) présentaient un risque annuel de récidive majoré les cinq premières années puis équivalent aux autres patientes après 80 mois. Un délais d'attente de cinq ans après le traitement est donc préconisé.
Download or read book Competing Risks and Multistate Models with R written by Jan Beyersmann and published by Springer Science & Business Media. This book was released on 2011-11-18 with total page 249 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book covers competing risks and multistate models, sometimes summarized as event history analysis. These models generalize the analysis of time to a single event (survival analysis) to analysing the timing of distinct terminal events (competing risks) and possible intermediate events (multistate models). Both R and multistate methods are promoted with a focus on nonparametric methods.
Download or read book Breast Cancer in Young Women written by Oreste Gentilini and published by Springer Nature. This book was released on 2020-02-07 with total page 218 pages. Available in PDF, EPUB and Kindle. Book excerpt: This contributed book covers all aspects concerning the clinical scenario of breast cancer in young women, providing physicians with the latest information on the topic. Young women are a special subset of patients whose care requires dedicated expertise. The book, written and edited by internationally recognized experts who have been directly involved in the international consensus guidelines for breast cancer in young women, pays particular attention to how the disease and its planned treatment can be effectively communicated to young patients. Highly informative and carefully structured, it provides both theoretical and practice-oriented insight for practitioners and professionals involved in the different phases of treatment, from diagnosis to intervention, to follow-up – without neglecting the important role played by prevention.
Download or read book Principles and Practice of Fertility Preservation written by Jacques Donnez and published by Cambridge University Press. This book was released on 2011-02-03 with total page 569 pages. Available in PDF, EPUB and Kindle. Book excerpt: The specialty of fertility preservation offers patients with cancer, who are rendered infertile by chemo- and radiotherapy, the opportunity to realize their reproductive potential. This gold-standard publication defines the specialty. The full range of techniques and scientific concepts is covered in detail, and the author team includes many of the world's leading experts in the field. The book opens with introductions to fertility preservation in both cancer and non-cancer patients, followed by cancer biology, epidemiology and treatment, and reproductive biology and cryobiology. Subsequent sections cover fertility preservation strategies in males and females, including medical/surgical procedures, ART, cryopreservation and transplantation of both ovarian tissue and the whole ovary, and in-vitro follicle growth and maturation. Concluding chapters address future technologies, as well as ethical, legal and religious issues. Richly illustrated throughout, this is a key resource for all clinicians specializing in reproductive medicine, gynecology, oncology, hematology, endocrinology and infertility.
Download or read book Critical Care Nursing written by Linda Diann Urden and published by Saunders. This book was released on 2010 with total page 1242 pages. Available in PDF, EPUB and Kindle. Book excerpt: Focusing on critical care nursing, this full-color text provides an examination of the important aspects of critical care nursing. It is organized in ten units around alterations in body systems.
Download or read book Dynamic Regression Models for Survival Data written by Torben Martinussen and published by Springer Science & Business Media. This book was released on 2007-11-24 with total page 471 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book studies and applies modern flexible regression models for survival data with a special focus on extensions of the Cox model and alternative models with the aim of describing time-varying effects of explanatory variables. Use of the suggested models and methods is illustrated on real data examples, using the R-package timereg developed by the authors, which is applied throughout the book with worked examples for the data sets.
Download or read book Prognostic Factors in Cancer written by Paul Hermanek and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 303 pages. Available in PDF, EPUB and Kindle. Book excerpt: M. K. Gospodarowicz, P. Hermanek, and D. E. Henson Attention to innovations in cancer treatment has tended to eclipse the importance of prognostic assessment. However, the recognition that prognostic factors often have a greater impact on outcome than available therapies and the proliferation of biochemical, molecular, and genetic markers have resulted in renewed interest in this field. The outcome in patients with cancer is determined by a combination of numerous factors. Presently, the most widely recognized are the extent of disease, histologic type of tumor, and treatment. It has been known for some time that additional factors also influence outcome. These include histologic grade, lymphatic or vascular invasion, mitotic index, performance status, symptoms, and most recently genetic and biochemical markers. It is the aim of this volume to compile those prognostic factors that have emerged as important determinants of outcome for tumors at various sites. This compilation represents the first phase of a more extensive process to integrate all prognostic factors in cancer to further enhance the prediction of outcome following treatment. Certain issues surround ing the assessment and reporting of prognostic factors are also considered. Importance of Prognostic Factors Prognostic factors in cancer often have an immense influence on outcome, while treatment often has a much weaker effect. For example, the influence of the presence of lymph node involvement on survival of patients with metastatic breast cancer is much greater than the effect of adjuvant treatment with tamoxifen in the same group of patients [5].
Download or read book Analysis of Multivariate Survival Data written by Philip Hougaard and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 559 pages. Available in PDF, EPUB and Kindle. Book excerpt: Survival data or more general time-to-event data occur in many areas, including medicine, biology, engineering, economics, and demography, but previously standard methods have requested that all time variables are univariate and independent. This book extends the field by allowing for multivariate times. As the field is rather new, the concepts and the possible types of data are described in detail. Four different approaches to the analysis of such data are presented from an applied point of view.
Download or read book The Treatment of Glomerulonephritis written by C.D. Pusey and published by Springer Science & Business Media. This book was released on 2007-05-28 with total page 233 pages. Available in PDF, EPUB and Kindle. Book excerpt: Glomerulonephritis is one of the commonest causes of end-stage renal failure worldwide. Although there have been considerable advances in the management of renal failure by dialysis and transplantation, there has been relatively little progress in its prevention. This volume sets out to review current practice in the treatment of glomerulonephritis, which is aimed both at controlling the clinical manifestations, e.g. nephrotic syndrome, and at preventing the progression to renal failure. The term glomerulonephritis covers a wide range of conditions with different immunological, histological and clinical features. This volume therefore starts with reviews of the immunology and pathology of different types of glomerulonephritis. This is followed by detailed consideration of the treatment of the commoner primary and secondary forms of the disease. There are separate chapters on special circumstances, such as glomerulonephritis in pregnancy or following renal transplantation. In each chapter, attempts are made to review the evidence for the effectiveness of treatment, based on controlled trials, immunopathological principles and the authors' considerable experience. Although some aspects of the treatment of glomerulonephritis can be found in the standard texts on renal disease, this volume provides an up-to-date, thoroughly referenced, and practical guide to management. As such, it should be of value to nephrologists and general physicians, including those in training, and to postgraduate students of nephrology.
Download or read book Placenta Accreta Syndrome written by Robert Silver and published by CRC Press. This book was released on 2017-06-12 with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt: Placenta accreta comprises a spectrum of disorders where all or part of the placenta becomes attached to the muscular wall of the uterus, which can result in life-threatening hemorrhage at the time of delivery. Previous surgical procedures (including cesarean delivery) and placenta previa are important risk factors, and the incidence is dramatically increasing. This important practical guide to how clinicians should diagnose and manage placenta accreta will be an invaluable reference for all obstetricians and maternal-fetal specialists.
Download or read book Stochastic Simulation written by Brian D. Ripley and published by John Wiley & Sons. This book was released on 2009-09-25 with total page 258 pages. Available in PDF, EPUB and Kindle. Book excerpt: WILEY-INTERSCIENCE PAPERBACK SERIES The Wiley-Interscience Paperback Series consists of selected books that have been made more accessible to consumers in an effort to increase global appeal and general circulation. With these new unabridged softcover volumes, Wiley hopes to extend the lives of these works by making them available to future generations of statisticians, mathematicians, and scientists. ". . .this is a very competently written and useful addition to the statistical literature; a book every statistician should look at and that many should study!" —Short Book Reviews, International Statistical Institute ". . .reading this book was an enjoyable learning experience. The suggestions and recommendations on the methods [make] this book an excellent reference for anyone interested in simulation. With its compact structure and good coverage of material, it [is] an excellent textbook for a simulation course." —Technometrics ". . .this work is an excellent comprehensive guide to simulation methods, written by a very competent author. It is especially recommended for those users of simulation methods who want more than a 'cook book'. " —Mathematics Abstracts This book is a comprehensive guide to simulation methods with explicit recommendations of methods and algorithms. It covers both the technical aspects of the subject, such as the generation of random numbers, non-uniform random variates and stochastic processes, and the use of simulation. Supported by the relevant mathematical theory, the text contains a great deal of unpublished research material, including coverage of the analysis of shift-register generators, sensitivity analysis of normal variate generators, analysis of simulation output, and more.
Download or read book Elements of Simulation written by Byron J.T. Morgan and published by CRC Press. This book was released on 1984-10-01 with total page 372 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a guide to the elements of simulation in statistics, which will include developments and which may be used either as a teaching text or as a source of reference. It is widely used for teaching statistics in schools.
Download or read book The Pediatric Diagnostic Examination written by Donald E. Greydanus and published by McGraw Hill Professional. This book was released on 2007-12-05 with total page 833 pages. Available in PDF, EPUB and Kindle. Book excerpt: An essential guide to interpreting signs and symptoms in infants, children, and adolescents [Copy:] This well-illustrated, full-color handbook offers a logical, systematic approach to differential diagnosis is children, and is ideal for developing the skills and confidence necessary for diagnosing pediatric patients. Incorporating must-know anatomy, pathophysiology, and diagnostic tools, Pediatric Diagnostic Examination will sharpen your ability to effectively manage every step of the diagnostic examination process. Features: Icons that lead you quickly and easily to key signs, problems, findings, and syndromes Easy-to-follow, consistent template for all chapters, covering physiology and mechanics, functional anatomy, taking patient history, key symptoms and signs, suspicions, diagnostic tools, and important clinical alerts Useful for diagnosing children of all ages Coverage of all regions and systems Numerous diagrams, tables, and clinical photographs-all in full-color Written by practicing pediatricians experienced enough to know the complications and pitfalls you will encounter in daily practice
Download or read book Molecular Mechanisms of Hormone Action written by Gesellschaft für Biologische Chemie. Colloquium and published by . This book was released on 1989 with total page 224 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Trauma and Pregnancy written by Christine E. Haycock and published by . This book was released on 1985 with total page 234 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Neurofibromatosis Type 1 written by Meena Upadhyaya and published by Springer Science & Business Media. This book was released on 2013-01-29 with total page 711 pages. Available in PDF, EPUB and Kindle. Book excerpt: Neurofibromatosis type 1 (NF1), caused by mutational inactivation of the NF1 tumour suppressor gene, is one of the most common dominantly inherited human disorders, affecting 1 in 3000 individuals worldwide. This book presents in concise fashion, but as comprehensively as possible, our current state of knowledge on the molecular genetics, molecular biology and cellular biology of this tumour predisposition syndrome. Written by internationally recognized experts in the field, the 44 chapters that constitute this edited volume provide the reader with a broad overview of the clinical features of the disease, the structure and expression of the NF1 gene, its germ line and somatic mutational spectra and genotype-phenotype relationships, the structure and function of its protein product (neurofibromin), NF1 modifying loci, the molecular pathology of NF1-associated tumours, animal models of the disease, psycho-social aspects and future prospects for therapeutic treatment.
