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Biomedical subjects

E Lemarie

Publications and source records attributed to E Lemarie.

At least 19 recordsLinked to original sources
PubMed2004

Randomised, multicentre phase II study assessing two doses of docetaxel (75 or 100 mg/m2) as second-line monotherapy for non-small-cell lung cancer.

BACKGROUND: The survival benefit associated with first-line chemotherapy in advanced lung cancer led to the need for second-line chemotherapy. Docetaxel (Taxotere) has proven efficacy in both settings. This study evaluated the safety and efficacy of two doses of docetaxel in patients with non-small-cell lung cancer who had failed first-line platinum-based chemotherapy. PATIENTS AND METHODS: In total, 182 patients from 24 French centres were randomised and treated with either docetaxel 75 mg/m(2) (arm A) or 100 mg/m(2) (arm B) every 3 weeks. Baseline characteristics were well balanced, except more patients in arm A had metastatic disease (91.4% versus 78.7%) and therefore the median number of sites involved for arm A was three compared with two for arm B. RESULTS: Median time to treatment failure was 1.34 months [95% confidence interval (CI) 1.28-1.64] for arm A and 1.64 months (95% CI 1.34-2.62) for arm B. Median overall survival was 4.7 months (95% CI 3.8-5.9) for arm A versus 6.7 months (95% CI 4.8-7.1) for arm B. According to a blinded expert panel, disease control was achieved in 35 (43.8%) patients in arm A and 39 (49.4%) patients in arm B. More patients in arm B experienced grade 3-4 neutropenia (B: 72.7% versus A: 44.0%), asthenia (B: 20.2% versus A: 10.8%) and infection (B: 6.7% versus A: 2.2%). Three treatment-related deaths were reported in each arm. CONCLUSIONS: The optimal docetaxel dosage in this second-line setting is 75 mg/m(2), as it has a more favourable safety profile and on balance a similar efficacy to the 100 mg/m(2) dose.

Adult↗
PubMed2003

[Pneumopathy due to isocyanate hypersensitivity: recognition as an occupational disease].

INTRODUCTION: Hypersensitivity pneumopathies (HSP) are listed as number 66 in the list of occupational diseases but this list includes regulatory requirements that are not applicable to isocyanates. The authors report the case of a worker exposed to isophane di-isocyanate (IPDI) during the manufacture of polyurethane foam. CASE REPORT: The diagnosis of HSP was based on the clinical presentation (dyspnoea, fever, crepitant rales) and the complimentary investigations (ground glass appearance on the thoracic CT scan, lymphocytosis in the broncho-alveolar lavage). It was confirmed by trans-bronchial biopsy. Only the functional assessment (airflow obstruction and absence of marked reduction in CO transfer) was atypical. With regard to the role of isocyanates the number of published cases (49 since the first observation in 1976) shows that this aetiology is rare. In the case presented the chronology of symptoms (regression following exclusion and immediate relapse following re-exposure) and the absence of exposure to other agents known to cause HSP confirm the aetiology with near certainty. This case was recognised within the framework of the complimentary procedure that allows for unlisted diseases. CONCLUSION: In order to assist the management and recognition of HSP due to isocyanates there is good reason to raise the awareness of the medical profession and to extend the list of occupational diseases.

Alveolitis, Extrinsic Allergic↗
PubMed2003

[Miliary pulmonary tuberculosis following intravesical BCG-therapy].

A patient given intravesical BCG immunotherapy developed miliary pulmonary tuberculosis. After resection of a superficial bladder tumor, the patient was given weekly intravesical BCG infusions. After the 4th session, the patient developed fever (40 degrees C), shivers, dry cough, profuse sweating, and weight loss. Initially, the chest x-ray was normal. The patient was given isoniazid (5 mg/kg) in a single-drug regimen. Rapid degradation of the general status led to a new chest x-ray, 10 days later, which demonstrated a reticulonodular syndrome. High-resolution thoracic CT confirmed the diagnosis of miliary pulmonary tuberculosis. A three-drug antituberculosis regimen associated with corticosteroids was followed by restoration of the general status. Antituberculosis therapy was continued for 9 months. The 9-month thoracic CT revealed a smaller number of micronodules in the pulmonary parenchyma. This case illustrates the discussion concerning the appropriate treatment for patients who develop a systemic infection after intravesical BCG-therapy.

Adjuvants, Immunologic↗
PubMed2002

ZD0473 treatment in lung cancer: an overview of the clinical trial results.

Three open-label, non-comparative, multicentre Phase II trials have examined the efficacy and tolerability of ZD0473 as first-and second-line therapy in non-small-cell lung cancer (NSCLC) patients and second-line therapy in small-cell lung cancer (SCLC) patients. Patients with second-line NSCLC or SCLC were evaluated as either platinum-sensitive or -resistant, based upon their time to relapse/progression after platinum-based therapy. First-line NSCLC patients (n = 18) received a total of 60 treatment cycles (median number per patient 2.5) whilst second-line NSCLC (n = 50) and SCLC (n = 48) patients both received a total of 127 treatment cycles (median number per patient 2.0). Grade 3/4 anaemia, neutropenia and thrombocytopenia was observed in: 38.8%, 22.2% and 27.7% of first-line NSCLC patients; 12.0%, 24.0% and 50% of second-line NSCLC patients; and 10.4%, 25.0% and 47.9% of second-line SCLC patients, respectively. The most common grade 3/4 non-haematological toxicities in all three trials were lethargy and dyspnoea. No clinically significant oto-, nephro- or neurotoxicity was observed. The first-line treatment of NSCLC produced an overall response rate (OR) of 6.3%. No OR was seen after second-line treatment of NSCLC, while ORs of 15.4% and 8.3% were seen in the platinum-resistant and -sensitive second-line SCLC patients, respectively.

Adult↗
PubMed2002

Systemic sclerosis and occupational risk factors: a case-control study.

AIMS: A case-control study was carried out between 1998 and 2000 to investigate the relation between systemic sclerosis and occupational exposure. METHODS: Eighty cases of systemic sclerosis admitted consecutively to the Department of Internal Medicine at the University Hospital of Tours from 1998 to 2000 were included. For each case, two age, gender, and smoking habits matched controls hospitalised during the same period in the same department were selected. A committee of experts was set up retrospectively to assess occupational exposure. Exposure to silica dust and organic solvents (such as trichlorethylene and other chlorinated solvents, and benzene and other aromatic solvents) was investigated using semiquantitative estimates of exposure. An exposure score was calculated for each subject based on probability, intensity, daily frequency, and duration of exposure for each period of employment. The final cumulative exposure score was obtained, taking into account all periods of employment. RESULTS: Significant associations with SS were observed for crystalline silica, trichlorethylene, chlorinated solvents, toluene, aromatic solvents, ketones, white spirit, epoxy resins, and welding fumes. Risk of SS was significantly associated with a high final cumulative exposure score of occupational exposure to crystalline silica, trichlorethylene, chlorinated solvents, welding fumes, and any types of solvents. CONCLUSION: Results confirm the influence of occupational risk factors in the occurrence of SS in both men and women. The link is not only with silica but also with other compounds such as solvents.

Case-Control Studies↗
PubMed2002

[Bronchectasia and microscopic polyangeitis].

Microscopic polyangeitis is a necrosing vascularitis with pulmonary and renal tropism. Localized in the lung, microscopic polyangeitis leads to intra-alveolar hemorrhage. We report our observations in two patients who presented with concomitant bronchectasia. The parallel course of these two conditions suggests a possible relationship. We propose a pathophysiological approach involving a direct role of polymorphonuclear neutrophils and neutrophilic proteases secreted in response to activation of anti-polymorphonuclear cytoplasm anti-bodies (ANCA) during microscopic polyangeitis aggravating bronchectasia.

Aged↗
PubMed2001

Oral vinorelbine: feasibility and safety profile.

BACKGROUND: Patient preference as well as concerns and difficulties with intravenous access and pharmaco-economic issues have driven the development of oral vinorelbine. PATIENTS AND METHODS: Four phase II studies were conducted in chemotherapy-naive non-small-cell lung cancer (NSCLC) and as first-line chemotherapy of advanced breast cancer (ABC). As recommended in the phase I dose-finding study, the first step used a weekly dose of 80 mg/m2. This regimen was associated with an excessive rate of early deaths (10%) due to complicated neutropenia and led to discontinuation of the first two studies. In a second step, the dose of 60 mg/m2/week was given for the first three courses and subsequently increased to 80 mg/m2/week, in the absence of severe neutropenia. RESULTS: One hundred and thirty eight patients (76 with NSCLC and 62 with ABC) received this regimen, of whom only five were unable to undergo dose escalation. The incidence of febrile neutropenia and neutropenic sepsis were low (2.9 and 3.6%, respectively). Although severe events were uncommon, nausea/vomiting and diarrhoea were frequent and primary prophylaxis with antiemetics should be recommended. CONCLUSIONS: Overall, the safety profile of oral vinorelbine at 60 mg/m2/week for the first three courses with escalation to 80 mg/m2 is qualitatively comparable to that of i.v. vinorelbine at standard doses. Similarly to i.v. chemotherapy, close haematological monitoring is necessary.

Administration, Oral↗
PubMed2001

[Standards, options and recommendations for the management of locally advanced non small cell lung carcinoma].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of locally advanced non small cell lung carcinoma. METHODS: Data were identified by searching Medline and the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers and to the medical committees of the 20 French Cancer Centres. RESULTS: The main recommendations are: 1) The management of the locally advanced non small cell lung carcinoma has two main goals: firstly to obtain local control of the disease (or to at least delay local progression in order to improve the survival or relapse free survival), and secondly to prevent the development of metastases. 2) There is a consensus that locally advanced non small cell lung carcinoma should be irradiated. External beam radiotherapy should be of optimal quality and delivered at a minimal dose of 60 Gy by standard fractionation. For patients with a poor life expectancy, this can be delivered as a split-course or hypofractionated scheme. 3) Treatment for patients with a performance status of 0-1 should consist of short duration induction chemotherapy (with a least two drugs one of which must be cisplatin), combined sequentially with conventional radiotherapy. 4) Surgery is contraindicated in extensive N3 disease. Combined radio-chemotherapy (adjuvant or neoadjuvant) is not indicated outside clinical trials. Surgery is justified in stage N2 disease as good local control can be achieved. T4-N0 disease should be treated surgically with curative intent.

Adult↗
PubMed2001

[Standards, Options and Recommendations for the management of stage I or II primary bronchial cancers treated exclusively with radiotherapy].

CONTEXT: The 'Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French cancer centres and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone. METHODS: Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers, and to the medical committees of the 20 French cancer centres. RESULTS: The main recommendations for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone are: 1) The curative external irradiation with a continual course is an alternative to surgery only in the case of medically inoperable tumors or because the patient refuses surgery; 2) The external irradiation of the primary tumor only without the mediastinum could be proposed in peripheral stage IA. In proximal stage IA and IB, external irradiation should be carried out only as part of prospective randomised controlled trials comparing a localised irradiation of the primary tumor with a large irradiation of the mediastinum and the primary tumor. The treated volume must include the macroscopic tumoral volume with or without the microscopic tumoral volume and with a security margin from 1.5 to 2 cm; 3) There is a benefit to delivering a total dose in the primary tumor higher than 60 Gy in so far as the proposed irradiation, taking into account the respiratory function, does not increase the likelihood of severe adverse events due to radiation; and 4) The change in fractionation, the radiochemotherapy combination, the endobronchial brachytherapy with high dose rate alone or with external irradiation could be proposed only as part of prospective controlled trials for tumors classified as stage IB or II.

Aged↗
PubMed2001

[Beginning rheumatoid arthritis revealed during bronchiectasis surinfections. Value of cyclic antibiotherapy?].

Incidence of symptomatic bronchiectasis (BR) occurs in around 2% in patients with late rheumatoid arthritis (RA). Its seems that the association BR-RA could be a worsening factor for outcome of RA patients. A 58-year-old woman without dry syndrome, suffering from bronchial purulence over one year was admitted to the Department of Pneumology for hemoptysis and arthritis (knees, ankles, and wrists). Three prior episodes of inflammatory articular pain had occurred after transient bronchial purulence or pneumonitis. CT-scan showed bilateral bronchiectasis. Diagnosis of early RA was proved after the third episode of bronchial purulence related to a strain of Haemophilus influenzae. A strain of Coxiella burnetii was probably responsible for one of the three bronchial surinfections. Latex and Waaler Rose tests were transiently positive during the first episode, and became positive after the third one. At that time, RA was relevant in view of ARA criteria. Cyclic prophylactic antibiotic regimens could be proposed to patients suffering from RA-BR association, in contrast to the cases of patients with isolated BR. This approach could prevent destabilization of RA and reinforce of anti-rheumatic therapy. Activation and release of cytokines (NFk-B, TNF-alpha), and/or bacterial epitopes seems to be directly responsible for the articular destabilization.

Anti-Bacterial Agents↗
PubMed2000

A phase II study of docetaxel and vinorelbine combination chemotherapy in patients with advanced non-small cell lung cancer.

A phase II study was conducted to determine the efficacy and the safety of docetaxel combined with vinorelbine as first-line chemotherapy in patients with metastatic or unresectable non-small cell lung cancer (NSCLC). 39 patients, median age 54 years (range: 35-69), with stage IIIB (5 patients; 13%) or IV (34 patients; 87%) NSCLC were treated with 75 mg/m(2) docetaxel given intravenously (i. v.) over 1 h on day 1 and with 20 mg/m(2) vinorelbine given i.v. over 15 to 30 min on days 1 and 5. Cycles were repeated every 3 weeks. 9 of the 39 patients had a partial response (overall response rate 23.1%, 95% confidence interval (CI): 11.1-39.3%) with a median duration of response of 20 weeks (95% CI; 17-30). The median survival was 40 weeks (95% CI: 21-49 weeks) with a 1-year survival rate of 31% in the intent-to-treat population. Neutropenia grade IV occurred in 33 patients (92%). 16 patients (41%) experienced febrile neutropenia with a concomitant stomatitis in 9 patients (23%). One patient died due to febrile neutropenia associated with a grade 4 stomatitis and 1 patient due to a septicaemia concomitant with a grade 4 neutropenia. Although the combination of docetaxel and vinorelbine is feasible, the efficacy does not seem to be improved compared with single-agent docetaxel or vinorelbine and the rate of febrile neutropenia is unacceptable in this population with incurable disease. Therefore, different doses and/or schedules are to be explored.

Adult↗
PubMed2000

[An unusual thoracic opacity].

We report a case of a paraspinal meningocele in a 37-year-old man with no other clinical manifestation. The diagnosis was established on the basis of the computed tomography and magnetic resonance imaging features.

Adult↗
PubMed1997

[Thymoma and dilatation of the bronchi].

Thyomas are benign or malignant lymphoepitelial tumors often associated with parathymic syndromes. A 74-year-old subject developed a recurrent thyoma over 15 year with bronchial dilatations and repeated bronchopulmonary and sinus infections. This clinical presentation suggests Good's syndrome which combines thyoma, bronchial dilatations and hypogammaglobulinemia.

Agammaglobulinemia↗
PubMed1995

Imaging of pulmonary disease in rheumatoid arthritis using J001X scintigraphy: preliminary results.

The purpose of this study was to determine the ability of technetium-99m J001X scintigraphy to image active pulmonary involvement in patients suffering from rheumatoid arthritis (RA). J001X is a fully characterized acylated poly(1,3)galactoside, isolated from Klebsiella membranes, which is able to bind recruited macrophages after aerosol administration. J001X scintigraphy was compared with high-resolution computed tomography (HRCT), pulmonary function tests (PFTs) and bronchoalveolar lavage (BAL) in 15 patients suffering from RA. Patients were considered to have pulmonary involvement when they had an interstitial syndrome on HRCT and a decrease of 20% in TCO/VE (transfer coefficient) on PFTs and/or an abnormal BAL (lymphocytosis higher than 20% and/or percentage of neutrophils higher than 10%). Pulmonary involvement was present in eight patients, and absent in seven. Of the eight patients with pulmonary involvement, all had abnormal BAL, two had an interstitial syndrome on HRCT, two had decreased TCO/VE and three had positive J001X scintigraphy. Of the seven patients without pulmonary involvement, six had normal BAL (not available in one), two had an interstitial syndrome on HRCT, one had decreased TCO/VE and two had positive J001X scintigraphy. According to our gold standard of pulmonary involvement, the sensitivity of J001X scintigraphy for the detection of pulmonary involvement in RA was 37.5%, the specificity was 71.4% and the positive predictive value was 60%. The ability of J001X scintigraphy to detect active pulmonary involvement during RA appears unclear in this study but it may detect processes unnoticed by the other modalities. These patients will be followed 12 and 24 months later and the changes in J001X scintigraphy, HRCT and PFTs will be compared to demonstrate whether J001X scintigraphy is able to assess an active process in the pulmonary involvement during RA and to specify its predictive value.

Adult↗
PubMed1995

Acute respiratory infections in children: a community-based study comparing a primary health center and a pediatric unit, Republic of Guinea.

OBJECTIVE: A community-based study was carried out in the Republic of Guinea in order to evaluate the frequency of occurrence, severity of illness, risk factors and the results of planned treatment of acute respiratory infections (ARI) in children under the age of 15 years. DESIGN: The study was performed over a 1-year period in 2 distinct areas, 1 rural and 1 urban. A total of 2622 ARI were identified among children under 15 years of age. In the rural area, data were collected by primary health-care workers and by 2 physicians who were trained to supervise the study. RESULTS: Among the rural population, 1422 ARI were identified. In the city center, Conakry, 1200 ARI were identified in one children's hospital. The child population under 5 years of age was significantly greater in the rural area (95.2%) than in the city center (83.2%) (P < 0.0001). Malnutrition affected 10.6% of all the children. There were discrepancies in symptoms and signs affecting the 2 groups but the severity scores, including children under 5 years of age, were not significantly different: including children under 5 years of age, were not significantly different: 10-11% of the children were considered to have severe disease and 6.2% required urgent referral to hospital. Upper and lower respiratory infections (URI and LRI) were equally represented (49.9% and 50.1% respectively). Distribution of each type of ARI was significantly different in the 2 groups: there were significantly more URI in the city center, especially tonsillitis. Bronchitis and bronchopneumonia occurred significantly more often in the rural area. Pneumonia and bronchopneumonia represented 9.8% of all ARI. Use of antibiotic therapy was known in 2557 patients: 1268 URI and 1289 LRI. In children with URI, 69.7% did not receive antibiotic therapy, 29.9% received 1 antibiotic and 0.03% received 2 antibiotics successively. Children from the city center received significantly more antibiotics than in the rural health center. In children with LRI, 17.8% did not receive antibiotic therapy, 81.7% received 1 antibiotic and 0.05% received 2 antibiotics successively. There was no significant difference between the 2 centers in antibiotic prescription. Clinical outcome showed that 93% of children were considered to be cured at day 7 and 99.4% at day 14. 14 children with severe pneumonia died. The infection cost (antibiotics plus other drugs prescribed as supportive care) was 0.45 US$ per child in the rural area and 9.7 US$ in the children's hospital. CONCLUSION: This supervised study constitutes the first large longitudinal study concerning respiratory infections in West Africa. It demonstrates that simple guidelines are valid in order to prevent mortality and complications. Care appropriate to population requirements in term of infectious diseases can be delivered with low cost and low technology.

Acute Disease↗
PubMed1995

Deposition of amphotericin B aerosols in pulmonary aspergilloma.

The aim of the present study was to characterize amphotericin B aerosols nebulized by ultrasonic and jet nebulizers and to study their deposition and pharmacokinetics in patients with pulmonary mycetoma. The aerodynamic behaviour and pulmonary deposition of amphotericin B particles were measured using a direct isotopic method based on stable labelling of the drug with 99mTc. Each nebulizer was bench tested for inhaled mass and particle size distribution. Three patients suffering from pulmonary aspergilloma were enrolled for a 4 week clinical study. They received 5 mg of amphotericin B daily delivered by either Fisoneb or DP100 (ultrasonic) or Respirgard II (jet) nebulizers. Deposition of radiolabelled amphotericin B was measured once with each nebulizer using a gamma-camera. In two patients, amphotericin B serum concentration was monitored over a 330 min period after the nebulization had been completed. Inhaled masses of the three nebulizers, assessed as % of labelled drug caught in inspiratory filter in duplicate experiments, were: 5.8 and 3.6% for Respirgard II; 26.5 and 28.3% with Fisoneb; 5.9 and 6.3% for DP100. Mass median aerodynamic diameter (mean +/- SD) results were: 0.28 +/- 0.04 micron with Respirgard II; 4.82 +/- 0.78 microns with Fisoneb; and 2.27 +/- 1.14 microns with DP100. Because of larger particles and significantly greater inhaled mass, Fisoneb delivered more amphotericin B to the central airways, the lung periphery and in the mycetoma lung regions. Amphotericin B serum concentrations correlated with pulmonary deposition and remained below 25 ng.mL-1. No untoward effects were reported by the patients during the 4 week trial.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗