Alain P Rousseau

Université du Québec, Québec, Quebec, Canada

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Publications (6)15.86 Total impact

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    ABSTRACT: Objet Evaluation des complications oculaires et métastatiques chez des patients ayant été traités en première intention par thermothérapie transpupillaire (TTT) pour des lésions choroïdiennes mélanocytaires indéterminées. Nature Rétrospective d’une série de cas Participants Huit patients présentant des lésions mélanocytaires choroïdiennes indéterminées traités par TTT. Méthodes Une revue rétrospective des dossiers a été faite pour les patients qui, ayant un nouveau diagnostic de lésion mélanocytaire choroïdienne indéterminée, avaient reçu au moins trois sessions de TTT entre 2002 et 2011. La meilleure acuité visuelle corrigée et les dimensions des lésions ont été mesurées à la base et durant le suivi. Les complications relevées comprenaient la croissance, les métastases, la mortalité reliée au mélanome et les complications associées au traitement. Résultats La moyenne des épaisseurs initiales était de 2,0 ± 0,8 mm. Les patients avaient une moyenne de 3,0 ± 0,9 facteurs de risque de croissance de la lésion. Trois patients (38 %) ont démontré une croissance de la lésion. Deux (25 %) des patients avaient une sévère perte visuelle (> 1,0 logMAR) reliée directement au traitement TTT. Il n'y a pas de décès directement liés aux métastases. Conclusion Malgré la sélection attentive des patients et le traitement systématique avec au moins trois sessions de TTT, l’utilisation en première intention du TTT pour traiter les patients ayant des lésions mélanocytaires choroïdiennes indéterminées avec ≥1 facteur de risque de croissance de lésion a démontré un mauvais contrôle de la lésion locale et la possibilité de sévères complications oculaires.
    Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie. 10/2014; 49(5):464–467.
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    ABSTRACT: Purpose. Overexpression of hypoxia inducible factor-1 alpha (HIF-1α) has been found in several cancers and is thought to correlate with aggressive disease. The purpose of our study was to investigate the influence of HIF-1α on clinical outcome in uveal melanoma (UM) along with proliferative (MIB-1) and vascular (CD31, VEGF-A) markers. Methods. A retrospective analysis was carried out on UM tumors from 88 patients. HIF-1α, MIB-1, CD31 and VEGF-A expression, as well as necrosis were assessed by immunohistochemistry and hematoxylin/eosin (H&E) on paraffin-embedded UM tumor sections using a Tissue Microarray (TMA). The bivariate analysis involving HIF-1α expression and clinicopathological covariates was performed using the Chi-square test. The association of clinicopathological covariates and HIF-1α expression with patient survival was evaluated using the Kaplan-Meier approach and Cox proportional-hazards regression analysis. Results. Among our study population, 56 patients (63.6%) had high levels of HIF-1α expression. High expression of HIF-1α was associated with high expression of MIB-1 (P=0.04), CD31 (P=0.03) and VEGF-A (P<0.0001), as well as necrosis (P=0.04). However, high HIF-1α expression was not correlated with cell type, largest macroscopic tumor dimension or thickness, anterior margin, pigmentation or mitotic figures. Patients with high HIF-1α expression did not showed a reduced survival when compared to patients with low HIF-1α expression (P=0.92). Finally, HIF-1α expression was not increased after irradiation. Conclusions. An increase in HIF-1α expression is significantly associated with proliferative (MIB-1) and vascular (CD31 and VEGF-A) markers, as well as necrosis in UM. However, there is no correlation between high HIF-1α expression and patient survival.
    Investigative ophthalmology & visual science 01/2014; · 3.43 Impact Factor
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    ABSTRACT: Purpose The purpose of this study was to assess the ocular and systemic outcomes of patients treated by transpupillary thermotherapy (TTT) for suspicious choroidal nevi at our oncology centre. Methods A retrospective chart review was conducted for all patients with a newly diagnosed small suspicious choroidal nevus treated by TTT at our oncology centre from the date of acquisition of the laser (2002) to September 2011. Standard treatment consisted of three TTT sessions. Patients with two or more risk factors for tumour growth were systematically treated. Ocular and systemic outcomes were reviewed and compared with those of similar patients that were observed between 1990 and 2008. Results Our preliminary data include 8 patients treated by TTT and 56 patients that were followed-up without treatment. Of the treated patients, 3 (37.5%) showed progression with a mean time to recurrence of 13 months. Of the observed patients, 23 (41%) showed progression with a mean time to recurrence of 41 months. There were no reported deaths in the treated group, and 3 (5.4%) deaths due to metastatic melanoma in the observation group. Conclusion Despite careful patient selection, primary TTT for small suspicious choroidal nevi showed poor local tumour control. No deaths due to metastatic melanoma were reported in the follow-up of treated patients, and mortality remained low in the observation group.
    Acta ophthalmologica 09/2012; 90(s249). · 2.44 Impact Factor
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    ABSTRACT: To study the relevance of liver function test (LFT) results for early detection of liver metastasis of uveal melanoma. Evaluation of diagnostic test. Eighty-eight patients were included in whom metastasis developed while undergoing semiannual follow-up with LFTs, including aspartate-aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyltransferase (γGT), lactate dehydrogenase (LDH), and phosphatase alkaline (PA). As controls, 174 patients with uveal melanoma without metastasis were included. The diagnostic attributes of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each test were estimated from cross-tabulation tables of test results according to the diagnosis of metastasis. The proportions of false-positive results between groups of patients with and without metastasis were compared in log-binomial regression models. Sensitivity, specificity, PPV, NPV, and cost evaluation. Metastases were detected after LFT abnormality (at least 1 abnormal test result) in 40 (45%) patients. The overall sensitivity of LFTs ranged from 12.5% to 58.0%, and the PPV ranged from 9.4% to 38.6%. The overall specificity and NPV were 90% or greater. The proportions of false-positive results between groups of patients with and without metastasis did not differ significantly (all P≥0.38). Using a cost evaluation, semi-annual screening by LFTs was calculated to cost $35.5/year per patient, including liver imaging induced by true and false-positive results. Isolated or combined LFTs for AST, ALT, γGT, LDH, and PA are not helpful for detection of early metastasis. However, the high NPVs suggest that LFT screening can allow clinicians to reassure the patient when the LFT results are negative.
    Ophthalmology 06/2012; 119(8):1590-5. · 5.56 Impact Factor
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    ABSTRACT: Purpose The liver is the main target for screening for uveal melanoma metastasis, which could be achieved by liver function tests (LFTs). The aim of our study is to analyze the relevance of LFTs for detection of metastatic disease in term of prognostic value and cost evaluationMethods Patients (n=88, who developed metastasis while undergoing semi-annual follow-up with LFTs including aspartate-aminotransferase (AST), alanine-aminotransferase (ALT), gammagutamylransferase (γGT), lactodeshydrogenase (LDH), and phosphatase alkaline (PA) were included. For assessing the level of LFTs for metastasis only the one preceding screening LFTs before the diagnostic by imaging was recorded. Consecutive patients (n=174) with uveal melanoma were chosen as control from patients who did not develop metastasisResults We were able to detect metastasis after LFTs abnormality in 40 (45%) patients. However, at the time of the one preceding screening LFTs before the metastasis diagnosis, 51(58%) patients had at least one abnormal LFT. The metastasis diagnosis was missed in 11 patients (13%). The overall sensitivity of LFTs ranged from 12.5 to 58.0% and the predictive positive value ranged from 9.4 to 38.6%. Interestingly we observed false positives in 20.3% with the variable “at least one abnormal LFT”. Using financial approach, we calculated the semi-annual screening by LFTs.Conclusion Using the most important retrospective series analyzing semi-annually all LFTs, we demonstrate that LFTs screening (AST, ALT, γGT, LDH and PA) is not relevant for detection of early metastasis even if the over cost induced by imaging requested for false positive is low
    Acta ophthalmologica 09/2011; 89(s248). · 2.44 Impact Factor
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    ABSTRACT: Uveal melanoma (UM) is the most common primary cancer of the eye, resulting not only in vision loss, but also in metastatic death. This study attempts to identify changes in the patterns of gene expression that lead to malignant transformation and proliferation of normal uveal melanocytes (UVM) using the Suppressive Subtractive Hybridization (SSH) technique. The SSH technique was used to isolate genes that are differentially expressed in the TP31 cell line derived from a primary UM compared to UVM. The expression level of selected genes was further validated by microarray, semi-quantitative RT-PCR and western blot analyses. Analysis of the subtracted libraries revealed that 37 and 36 genes were, respectively, up- and downregulated in TP31 cells compared to UVM. Differential expression of the majority of these genes was confirmed by comparing UM cells with UVM by microarray. The expression pattern of selected genes was analyzed by semi-quantitative RT-PCR and western blot, and was found to be consistent with the SSH findings. We demonstrated that the SSH technique is efficient to detect differentially expressed genes in UM. The genes identified in this study represent valuable candidates for further functional analysis in UM and should be informative in studying the biology of this tumor.
    Molecular vision 01/2011; 17:1324-33. · 1.99 Impact Factor