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Biomedical subjects

D Arpin

Publications and source records attributed to D Arpin.

17 recordsLinked to original sources
PubMed2000

Prospective evaluation of early lung toxicity following three-dimensional conformal radiation therapy in non-small-cell lung cancer: preliminary results.

PURPOSE: Radiation pneumonitis is the restricting complication following lung cancer irradiation. The correlation between dose-volume histograms (DVHs) and pneumonitis, with a clinical, radiological, and respiratory function evaluation was assessed. Special endpoint was the evaluation of respiratory function after three-dimensional conformal radiotherapy (3D-CRT). METHODS AND MATERIALS: Fifty-four patients with non metastatic non-small-cell lung cancer (NSCLC) were treated with a curative intent with 3D-CRT (66 Gy). Thirty-one patients were treated postoperatively (pneumonectomy in 9 patients) for residual tumor or massive nodal involvement (N2 or N3); 23 patients were treated with exclusive radiotherapy. Clinical evaluation, CT scan, and pulmonary functional tests were performed before and 6 weeks after irradiation. The DVHs were calculated applying lung density heterogeneity. RESULTS: Twenty patients had radiation pneumonitis. Irradiation significantly decreased total lung capacity. Volume of the PTV2 (more than 200 cm(3)) was a significant prognostic factor for lung complication. CONCLUSION: DVHs combined with initial pulmonary functional tests can predict pulmonary toxicity and could allow us to adjust volume that received total highest dose with acceptable toxicity.

Adenocarcinoma↗
PubMed1999

Small-cell lung cancer: patients included in clinical trials are not representative of the patient population as a whole.

PURPOSE: To determine the clinical characteristics of the subpopulation of patients not included in clinical trials, their outcome, and the reasons for their ineligibility and non-participation. PATIENTS AND METHODS: We studied 57 patients (out of 178 consecutive patients with SCLC), who were not included in any of the three successive clinical trials completed at our center during the study period. We also compared 37 patients excluded from the largest clinical trial to their 73 included counterparts. RESULTS: Reasons for ineligibility (n = 53) included low Karnofsky index (n = 17), advanced age (n = 12), non-feasible long-term follow-up (n = 12), previous history of cancer (n = 8), contraindication for anthracyclines (n = 5), and other medical reasons (n = 11). Only four eligible patients were not included in the trials. As compared to patients included in the studies, non-included patients had a significantly lower Karnofsky index, were older, presented more frequently with metastatic disease, and had a lower response rate to treatment and a shorter survival. However, exclusion from the trial was not an independent prognostic factor by multivariate analysis. CONCLUSIONS: Selection biases were unlikely in the three trials, based on the high ratio of included/eligible patients. However, the subgroup of patients included in the trials was not representative of the patient population as a whole because of restrictive eligibility criteria. Results from published clinical trials to the overall population should be extrapolated only with caution. We suggest that the proportion and major characteristics of ineligible and non-participating patients be mentioned in any publication of a clinical trial.

Adult↗
PubMed1997

[Tracheal stenosis of inflammatory aspect].

We report a case of tracheal leishmaniasis with stenosis in a 52 year-old female originative from the Gard region (South of France). The unusual localization acknowledges for the difficulties met in setting the diagnosis which was established through cytological examination of bronchial brushing. Though rare, leishmaniasis infection must be suspected in all cases of mucosal lesions occurring in patients living in endemic areas.

Bronchoscopy↗
PubMed1996

The limits of chemotherapy dose intensification using granulocyte colony stimulating factor alone in extensive small cell lung cancer.

Human Recombinant Granulocyte Colony Stimulating Factor (G-CSF) allows rapid neutrophil recovery after chemotherapy-induced leukopenia. In a prospective series of 54 patients with extensive small cell lung cancer, we evaluated the feasibility and efficacy of accelerated delivery of the AVI chemotherapy regimen. Treatment consisted of Doxorubicin 50 mg/m2 day 1, Etoposide 120 mg/m2 day 1-3 and Ifosfamide 2 g/m2 (+ Mesna 4 g) day 1 and 2 given every 2 weeks and followed by G-CSF (Neupogen, Amgen Roche 5 micrograms/kg/day s.c. day 4-14). Twenty-seven (50%) patients could not receive the total of six courses, seven because of severe septic complication, 10 because of Grade 4 thrombopenia, seven because of non-response and three because of patient refusal. Chemotherapy had to be delayed in 58 out of the 244 administered courses and this was due to thrombopenia in 48% of cases. The probability of optimal dose-on-time administration was 64% at three courses. The mean actually received dose intensity was 93% at six courses (27 patients treated). It was increased by 76% compared to our previously published conventional 3-week interval chemotherapy. The median neutrophil nadirs were stable during the successive treatment courses while haemoglobin and platelet values significantly worsened from cycle 1 to cycle 6. The overall response rate after three courses was 77% in the 48 evaluable patients. The median survival is 8 months overall and 5 months disease free. The actuarial survival is 22% at 2 years. We conclude that substantial dose intensification with accelerated chemotherapy and G-CSF support is feasible. However, the rate of severe infectious episodes is too high and thrombopenia is the main limiting factor. Either growth factors active on the megacaryocytic lineage or haematological rescue with peripheral blood stem cells might be useful in this setting.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Clinical and radiological aspects of Villaret's syndrome.

A 68-year-old man with a history of large cell lung carcinoma presented 1 year after surgical management of the initial lesion, with a complete unilateral IX-XII cranial nerve palsy with Horner's sign. This rare multiple cranial nerve palsy is called Villaret's syndrome. It suggests an extracranial lesion located in the retroparotid space. Complete basal skull radiology work up including computed tomography and magnetic resonance imaging confirmed the location of the causal lesion in the retroparotid space.

Aged↗
PubMed1995

Catheter-related bacteremia associated with coagulase-positive Staphylococcus intermedius.

We report a case of catheter-related bacteremia in a 63-year-old patient caused by Staphylococcus intermedius. Clinical resolution of the infection was obtained after removal of the intravenous device and antibiotic treatment. This observation emphasizes the risk of confusion between S. intermedius and Staphylococcus aureus if only a coagulase test is done.

Bacteremia↗
PubMed1993

Optimal delivery of dose in cancer chemotherapy with the support of haematopoietic growth factors.

The delivery of cancer chemotherapy is often non-optimal because of dose reductions and delays related to various toxic effects. These result in a decrease of the dose intensity as well as of the relative dose intensity of a given regimen compared to a reference protocol. In retrospective studies, such modifications have been shown to negatively influence the therapeutic results in many clinical situations. The ability of haematopoietic growth factors to reduce chemotherapy-related neutropenia and its associated infectious complications allows better dose-on-time delivery of the chemotherapeutic drugs. The potential therapeutic impact of this effect remains to be determined in prospective studies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

[Value of C-reactive protein determination in small cell lung cancer].

A prospective analysis of serum levels of C-reactive protein (CRP) has been conducted on a series of 39 small cell lung cancer (SCLC) patients during the first course of chemotherapy in order to evaluate the predictive value of this marker on tumoral extension at diagnosis and response to therapy. Serum levels of CRP were measured before chemotherapy (day 0) and during the first two days of treatment (day 1, day 2). Twenty-three of 32 evaluable patients (71%) had extensive disease. The mean pre-treatment CRP level was significantly higher in this group than in the group of patients with limited disease (52.3 mg/l vs 15.8 mg/l, P = 0.02). Twenty-three patients responded to treatment and nine did not. The evolution of serum CRP levels in both groups was compared between day 0 and day 2. A more than two-fold increase of initial CRP levels showed a 100% predictive value for response. On the other hand, a decrease by more than 50% of initial serum levels was associated with a negative predictive value of 75% for response. We conclude that the follow-up of CRP levels during initial chemotherapy of SCLC might be useful in the initial evaluation of tumoral extension and in the early prediction of response to therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

[Comparison of 2 cisplatin and etoposide dosages in relapsing small cell lung cancer].

The synergistic combination of cisplatinum and etoposide appears as the best second line treatment in patients relapsing from small cell lung carcinoma (SCLC). In order to test the dose-effect relationship of cisplatinum and etoposide in this situation, we have performed a randomised phase II trial comparing 2 five-day regimens: cisplatinum 20 mg/m2/day+etoposide 60 mg/m2/day (arm A) versus cisplatinum 40 mg/m2/day+etoposide 100 mg/m2/day (arm B) every 4 weeks. Thirty-seven patients were included (arm A: 18, arm B: 19), and 32 were considered to be eligible (arm A: 15, arm B: 17). Eight patients were non evaluable, five of them because of toxic death occurring prior to the second course (arm A: one from neutropenia; arm B: three from neutropenia and one from thrombopenia). The two groups were well balanced with regard to the main prognostic factors (age, sex, performance status, LDH level, response to induction chemotherapy). An objective response was observed in 10/24 evaluable patients (arm A: 4, arm B: 6) and was considered as complete in one patient in arm A and in 2 pts in arm B; these two patients presented with cerebral metastases and their response lasted 9 and 15 weeks respectively. The mean duration of response was 11 weeks in arm A and 10.5 weeks in arm B. The median actuarial survival of the overall population of eligible patients was 15 weeks: 13 weeks in arm A and 16.5 weeks in arm B. The study was discontinued because of the 23.5% toxic deaths rate in the high doses arm in this heavily pre-treated population of patients. However, the high response rate (54% overall, 35% considering toxic death as a failure) is impressive and presents evidence for the dose/effect relationship in SCLC.

Aged↗
PubMed1990

Contracture test and histologic and histochemical analyses of muscle biopsy specimens from horses with exertional rhabdomyolysis.

Biopsy specimens of the cutaneous omobrachialis muscle were obtained from 10 horses with a problem of myositis from mild exercise. One horse had been evaluated previously and malignant hyperthermia-like contractures developed in its muscle biopsy specimen during the contracture test. In this study, the halothane-caffeine contracture test and histologic and histochemical evaluations were performed on muscle biopsy specimens. In the contracture test, no muscle biopsy specimen developed contracture in the presence of 2 or 4% halothane alone. The mean (+/- SEM) caffeine-specific concentration in the presence of halothane was 5.23 +/- 0.5 mM for 2% halothane, and 4.46 +/- 0.6 mM for 4% halothane. The caffeine-specific concentration values were not significantly different. Contracture response for any muscle specimen did not resemble contracture associated with malignant hyperthermia. The cutaneous omobrachialis muscle was composed of type-II fibers, with type-I fibers seldom seen. For 9 of the 10 horses, overall fiber morphology was normal; 1 horse had necrotic fibers. Of the 10 muscle specimens, 9 had fibers that had positive reaction for alkaline phosphatase activity; 3 muscle specimens contained ringed myofibers. Three horses of this study were administered general anesthesia; 2 were research horses, anesthetized with halothane and succinylcholine, and 1 was a clinical case given halothane anesthesia plus a non-depolarizing muscle relaxant. One research horse developed a malignant hyperthermia-like reaction to anesthesia, with severe rhabdomyolysis evident after anesthesia, and an episode of muscle cramping in its stall 2 days after anesthesia. The other 2 horses had unremarkable postanesthetic periods.

Anesthesia↗
PubMed1988

Neuromuscular and cardiovascular effects of atracurium administered to healthy horses anesthetized with halothane.

Neuromuscular and cardiovascular effects of atracurium, a nondepolarizing neuromuscular blocking agent, were evaluated in 10 halothane-anesthetized adult horses. Hind limb digital extensor tension (hoof twitch) was measured with a strain gauge to quantitate the muscle relaxant effects of atracurium. Response of facial muscles was compared with hoof twitch. Five injections of atracurium were given. Initial mean (+/- SEM) dosage of 0.07 +/- 0.01 mg of atracurium/kg of body weight caused 98.6 +/- 0.8% reduction of the preinjection hoof twitch. Subsequent dosages of 0.04 +/- 0.003 mg/kg induced a degree of relaxation similar to that induced by the initial dose. Duration of paralysis from maximal effect to 10% recovery of twitch was 12.2 +/- 1.5 minutes for the first injection. This was significantly (P less than 0.05) different from subsequent paralysis periods, which lasted approximately 7 minutes. The 10% to 75% recovery time after all injections was similar-approximately 16 minutes. The facial muscles were less affected objectively by atracurium than was the hind limb. Atracurium did not cause cardiovascular changes. When the hoof twitch had recovered to 95% of its tension before atracurium administration, 0.5 mg of edrophonium/kg, was given to antagonize neuromuscular blockade. Within 5 minutes of edrophonium administration, twitch tension exceeded that measured before atracurium administrations. Within 2 minutes of edrophonium administration, blood pressure began to increase and continued to increase approximately 10 mm of Hg above the value measured before edrophonium administration. Heart rate was not affected by edrophonium. Other muscarinic side effects of edrophonium were not observed. Of the 10 horses, 9 had good, unremarkable recovery to standing position. One horse had a violent recovery period.

Anesthesia, Inhalation↗
PubMed1986

Neuromuscular and cardiovascular effects of atracurium in ponies anesthetized with halothane.

Atracurium besylate, a recently developed, intermediate-duration acting, neuromuscular-blocking agent, was given to 15 halothane-anesthetized ponies to produce surgical relaxation (95% to 99% reduction of hoof twitch). All 15 ponies were given 3 injections; 8 of the 15 ponies were given 2 additional injections. Initial dosage of 0.11 +/- 0.01 mg/kg (mean +/- SD) and all subsequent injections of 0.052 mg/kg produced desired relaxation. Paralysis phase (maximum twitch reduction to 10% twitch recovery) lasted 24 +/- 5 minutes for the initial injection. Paralysis from subsequent injections lasted for a slightly shorter time. Recovery phase (10% to 75% twitch recovery) was similar for all injections (initial and repeated) and lasted approximately 11 minutes. Cardiovascular side effects were not seen. Reversal of effects of atracurium with administration of 0.5 mg of edrophonium/kg was achieved when the evoked digital extensor tension (twitch height) had returned to 95% of base line after the last atracurium injection. Edrophonium caused systolic blood pressure to increase 121% +/- 7% of base-line pressure, which was 133 +/- 18 mm of Hg. Heart rate changed to 93% +/- 9% of base line after edrophonium was given, which was 49 +/- 7 beat/min, but this change did not occur until after the blood pressure increased. Recovery to standing was smooth and strong. Five ponies stood on their first attempt to rise, 5 on the 2nd attempt, 2 on the 3rd, and 1 on the 4th. Seven ponies stood within 30 minutes after transportation to the recovery stall, 7 within an hour.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMedDate not supplied

Experience and directions using cardiopulmonary support in fifty-three consecutive cases.

Emergency cardiopulmonary support (CPS) was instituted in 53 consecutive patients for acute life threatening pathologies. Indications for CPS deployment were: cardiac arrest, 60% (n = 32); cardiogenic shock, 20.4% (n = 11), supported angioplasty, 13% (n = 7); and adult respiratory distress syndrome, 5.6% (n = 3). Cardiopulmonary support was successfully deployed in 51 of the 53 patients (96%), resulting in a mean blood pressure greater than or equal to 60 mmHg, CO greater than or equal to 3-5 L/min, and partial pressure of oxygen greater than or equal to 100 mmHg, with venous oxygen saturation greater than or equal to 60%. The average time from arrest to CPS deployment was 40 minutes. Seventy-nine major cardiovascular procedures were done in these 51 patients (average, 1.5/patient). The duration of support ranged from 1 to 75 hrs (mean, 16.1 hrs). Twenty-seven patients (53%) were weaned, 13 successfully (32%), with 11 (85%) surviving greater than 24 hrs, and six (46%), greater than 30 days. The other 24 patients (47%) were transferred to other treatment modalities, including cardiac surgery and bridge-to-transplant ventricular assist devices. Four of these patients died (17%), whereas 20 (83%) survived. Of these survivors, 19 (95%) survived greater than 24 hrs, whereas 11 (55%) survived greater than 30 days. The overall survival using the CPS system is 59% short-term (greater than 24 hrs.), and 33% long-term (greater than 30 days). In conclusion, the CPS system is a potent and effective resuscitative tool. It requires transfer to other treatment modalities for survival in most cases.

Adult↗
PubMedDate not supplied

Bone marrow metastases detection in small cell lung cancer. A review.

Small cell lung cancer is known to carry a high capacity to metastasize in various sites including bone marrow. We here review the respective sensitivities of classical cyto-histological methods and of more recently described techniques such as cell cultures, immunostaining with monoclonal antibodies and magnetic resonance imaging. These new and somehow less aggressive methods allow the detection of malignant cells in 50% or more of patients with small cell lung cancer. However, their potential usefulness in the staging of such patients as well as their therapeutic and clinical implications remain undetermined. Their possible clinical value needs to be evaluated in future trials.

Antibodies, Monoclonal↗