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Biomedical subjects

E Souetre

Publications and source records attributed to E Souetre.

At least 19 recordsLinked to original sources
PubMed1996

Is paclitaxel and cisplatin a cost-effective first-line therapy for advance ovarian carcinoma?

BACKGROUND: Paclitaxel and cisplatin use for the treatment of advanced ovarian carcinoma (AOC) has been shown to increase median survival duration. An evaluation was performed on the economic consequences of treating AOC patients with combined paclitaxel and cisplatin chemotherapy compared with current usual care, i.e., combined cyclophosphamide and cisplatin chemotherapy. METHODS: Linear modeling techniques combined with retrospective chart analysis were used to predict the clinical progression and treatment of AOC patients until death. Cost-effectiveness analysis comparing paclitaxel and cisplatin and usual care was performed from a simplified Ministry of Health perspective. RESULTS: Assuming a 50% increase in survival for paclitaxel and cisplatin patients, an assumption supported by recent clinical trial data, this treatment showed an average lifetime cost per patient of $50,054 Cdn compared with a cost of $36,837 Cdn for usual care. The incremental cost of the paclitaxel and cisplatin treatment over the usual treatment was $20,355 Cdn per life year gained. These results withstood extensive sensitivity analyses. CONCLUSIONS: Paclitaxel, in combination with cisplatin, appears to be a cost-effective first-line treatment for AOC. A moderate increase in incremental cost compares favorably with other life-saving strategies currently in use. As more data become available for the use of paclitaxel, this pilot study will provide a basis for more extensive economic evaluation of paclitaxel.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Comorbid anxious signs and symptoms in major depression: impact on functional work capacity and comparative treatment outcomes.

Psychological distress is a driver both of direct and indirect health care costs. Depression compromises functional well-being, such as work productivity. Comorbid anxious features often complicate the recognition of depression and may herald a poor prognosis. We report the results of a cross-sectional naturalistic study to determine the impact of three interventions (no antidepressant, fluoxetine, or tricyclic antidepressant therapy) on relative risk of work days lost in 454 French outpatients with either major or minor depression. Most depressed patients also manifested anxious features (76% with a Hamilton Rating Scale for Anxiety score > or = 12). The presence of anxiety was related to the severity of depression, work absenteeism, and current social instability. Depression severity (Hamilton Rating Scale for Depression score > or = 26, including the contributions of anxious symptoms), psychiatric comorbidity, and psychomotor retardation best predicted continued work absenteeism. Patients with major depression were more likely to receive an antidepressant if they had a past history of depressive episodes and/or previous work disability. Patients with minor depression were less likely to receive drug therapy than patients with major depression, despite their current work disability. Among patients who received fluoxetine or a tricyclic antidepressant for at least 8 weeks, fluoxetine was associated with statistically significantly lower mean anxiety and depression scores and fewer work days missed.

Absenteeism↗
PubMed1992

[Medico-economic strategy for biliary lithiasis].

The purpose of this study was to assess the relevance of a medico-economic evaluation of gallstones. In other words, would it be possible to define economic criteria that would permit to select the best therapeutic method whilst respecting medical ethics? The frequency of gallstones, the high consumption of goods and medical services they require and the important loss of productivity that ensues justify this approach. The medical literature and a number of experts have made it possible to evaluate the advantages and drawbacks of each therapeutic method by defining its indications according to criteria of effectiveness such as duration of survival, quality of life of asymptomatic patients, gallbladder clearance, etc. We have tried to find out whether the introduction of medico-economic criteria in this pathology was likely to modify the various therapeutic methods available at present. We give here three examples. The first one is that of asymptomatic gallstones where the introduction of a cost/effectiveness ratio let to the conclusion that abstention is better than surgical treatment. The second example is a comparison of costs between cholecystectomy and medical treatment in high risk patients; the result was that surgery is preferable at the age of 50 years and medical treatment from 70 years onward. Finally, a comparison between surgery and lithotrity including the cost/effectiveness ratio concluded in favour of surgery. However, ethical, methodological and conceptual problems taking into account the value of human life, the difficulty to evaluate the quality of life and exterior incitations make it necessary to moderate the practical applications of these results.

Cholelithiasis↗
PubMed1990

Open trial of a calcium antagonist, nimodipine, in acute mania.

Following previous works showing an action of calcium channel blockers in mania, this trial explores the clinical efficiency of another anticalcic agent, nimodipine, which has been selected for its specific action on the CNS. Our design has been a 7-day controlled open trial. We included six inpatients diagnosed according to DSM III-R criteria as having mild to acute mania. Evaluations have been made by clinical scales, electroencephalography, electrocardiography, and extensive biological blood tests. No other medication than nimodipine was allowed excepted i.m. droperidol in case of severe excitement. We used nimodipine at a dose of 360 mg/day. The results showed good clinical efficiency in each of our six inpatients, with an important and significant improvement of scales scores. We noticed an early and significant action on mood without important sedative effect. The treatment has been well tolerated, without biological effects. Further studies are needed, but nimodipine could be an alternative treatment to the neuroleptics with a different type of action, less sedative and more specific on mood.

Acute Disease↗
PubMed1990

5-Methoxypsoralen as a specific stimulating agent of melatonin secretion in humans.

The endocrine effects of the linear furocoumarin, 5-methoxypsoralen (Bergapten), were investigated in 11 normal adults according to a cross-over design with 2 conditions: a 1-week trial with 5-methoxypsoralen (5MOP) administered daily (40 mg/orally) at 0900 h, and after a 1-week period of washout, a similar 1-week trial with daily administrations of 5MOP at 2100 h. The subjects were living under normal nychtohemeral conditions. The plasma levels of melatonin, cortisol, TSH, PRL, and GH were evaluated by hourly blood samples over 24-h periods on the preceding day and on the last day of each condition. Our main finding is that 5MOP specifically stimulates melatonin secretion in humans, with a pronounced effect when administered during the dark phase of the day (at 2100 h). The other endocrine rhythms were unaffected by 5MOP administration. Melatonin has been shown to interact with the regulation of the human circadian system; this specific stimulation may, therefore, be of great interest in disorders associated with abnormalities of circadian rhythms.

5-Methoxypsoralen↗
PubMed1990

[Hourly serum cortisol assay over 24hr by immunoenzymology in depression].

Enzymoimmunoassays have been developed as alternatives to radioimmunoassays because they obviate the need for labelled compounds yet offering comparable specificity. The authors used an enzymoimmunoassay to investigate hourly serum cortisol levels over 24 hours in 6 patients (aged over 40 years) with endogenous depression (4 unipolar depressions, under antidepressor treatment and 2 bipolar depressions, without medication) and in 2 controls, aged 20 and 47 years. In agreement with literature data, a clear circadian rhythm was observed in controls and in the depressed patients, and hypercorticism was noted in one depressed patient. A trend towards phase advance in depression was seen in both the treated and untreated patients.

Adult↗
PubMed1990

Phase-shifting effects of bright morning light as treatment for delayed sleep phase syndrome.

Bright light has recently been shown to have phase-shifting effects on human circadian rhythms. In this study we applied this effect to 20 patients with delayed sleep phase syndrome (DSPS) who were unable to fall asleep at conventional clock times and had a problem staying alert in the morning. In a controlled treatment study, we found that 2 h of bright light exposure in the morning together with light restriction in the evening successfully phase advanced circadian rhythms of core body temperature and multiple sleep latencies in these patients. This finding corroborates the importance of light for entraining human circadian rhythms.

Arousal↗
PubMed1989

Course of psychosis in Algeria and in France: about 342 cases observed from 1975 to 1985.

The aim of this study was to compare the evolution of psychotic patients in Algeria and in France. In 1975, 105 patients were selected in Algeria and 237 in France. Ten years later, in 1985, all these patients were interviewed. In 1985, we investigated for each subject the evolution of the following parameters: sex, age, DSM-III axis 1 and 5, marital status, social welfare work, and treatment variables. Our results indicate that the improvement of the psychosocial adaptation (DSM-III axis 5) is slightly better in Algeria than in France. Medical and social support seems to be quantitatively less important in Algeria.

Adult↗
PubMed1988

Twenty-four-hour profiles of body temperature and plasma TSH in bipolar patients during depression and during remission and in normal control subjects.

The 24-hour patterns of body temperature and plasma thyrotropin (TSH) were measured in eight bipolar patients in both depressed and recovered (after 3 weeks of treatment) states and in eight normal control subjects. Clear circadian patterns were detected for both temperature and TSH. Nocturnal body temperature was increased and the nocturnal surge of TSH was blunted during depression; these abnormalities were corrected after recovery. The inverse relationship between changes in body temperature and TSH levels at night suggests that changes in thermoregulation may be responsible for the neuroendocrine disturbance and may play a role in the pathophysiology of depression.

Bipolar Disorder↗
PubMed1987

5-Methoxypsoralen increases the plasma melatonin levels in humans.

The aim of this study was to evaluate the acute effects of 5-methoxypsoralen (5-MOP) on the melatonin secretion in humans. Eleven normal volunteers were investigated before (drug-free) and after 6-day periods of treatment with oral 5-MOP, first administered daily at 9 A.M. and after a 1-week free interval administered daily at 9 P.M. Under nyctohemeral conditions, the plasma melatonin levels were evaluated over a 24-h period in each session by hourly blood samples and radioimmunoassay. The sensitivity of the retina to light was also evaluated by means of electroretinography performed at 11 A.M. before and after a morning administration of 5-MOP. Plasma levels of melatonin were significantly increased from the second hour after 5-MOP administration. The hourly mean levels were significantly higher after 5-MOP administration compared to baseline values. This increased secretion was more pronounced after evening than after morning administration. Also, 5-MOP increases the sensitivity of the retina to light under photopic conditions and in the early stages of the dark adaptation period, as observed under scotopic conditions.

5-Methoxypsoralen↗
PubMed1986

The circadian rhythm of plasma thyrotropin in depression and recovery.

The 24-hr patterns of plasma thyrotropin have been observed in 12 endogenous depressed patients in both depressed and recovered states and in 13 normal subjects. A clear circadian rhythm was detected in controls with high values at night. In depression, the circadian rhythm was altered with amplitude reduction and blunted nocturnal secretion, abnormalities particularly relevant in bipolar patients. This flattened profile could be linked to the blunted response of TSH to TRH administration reported in depressed patients. Normal nyctohemeral patterns have been restored after recovery. These chronobiological abnormalities as well as their normalization under antidepressant drugs seem to be similar to those reported for various parameters (e.g. temperature, cortisol, etc) in depression which could support the chronobiological hypothesis for affective disorders.

Antidepressive Agents↗
PubMed1985

[Circadian rhythms and depression].

The degree to which nature's cycles influence our body is now obvious, owing to the recent progress of chronobiology. It seems thus that the harmonious internal organization of our circadian rhythms depends on the dual influence of the internal clocks as well as the external temporal informations. These endogenous pacemakers, able to spontaneously generate a rhythmicity the period of which is close to 24 hours, could be triggered by environmental informations, such as light/dark or sleep/Wake cycles, on a 24 hours schedule. The disruption of this entrainment could be involved in major affective disorders. This internal or external desynchronisation seems thus to be the central concept of different models for depression. The internal coincidence model suggests that a phase advance of the strong oscillator in reference to the weak oscillator causes depression. An external coincidence model suggests that depression is caused when light/dark cycle or photoperiod provide too little illumination during a critical photosensitive interval which could be located in the second half of the night. At last, a model comparing the biological rhythms of depressed patients and of healthy volunteers during temporal isolation, suggests that the internal clocks of depressed subjects could be temporarily "blind" to environmental time cues involving internal desynchronisation. These emerging findings should open a new therapeutic approach for depression.

Antidepressive Agents, Tricyclic↗
PubMedDate not supplied

[Biological indices in schizo-affective disorders].

Besides the well-defined nosological groups such as schizophrenia and affective disorders, the so-called schizoaffective disorders remain in an intermediate position. Biological features tend to build up links between these two disorders and support the hypothesis of a biological continuum between schizophrenia and affective disorders. Among these biological factors, neuroendocrinology, brain neurotransmission and sleep seem to be particularly relevant. This "continuum" hypothesis may also be supported by therapeutical and epidemiological data.

Amino Acids↗
PubMedDate not supplied

[Circadian rhythm of plasma norepinephrine in depressive disorders. Preliminary study].

The biological desynchronisation hypothesis of (endogenous) depressive disorders arises from the disturbances in the circadian rhythmicity of several biological functions in depressive illness and clinical improvement during various sleep deprivation processes. Furthermore, supportive evidence exists to postulate a central noradrenergic dysfunction, at least in a sub group of depressive disorders. We studied the 24 h kinetics of plasma norepinephrine in patients suffering from Affective Disorders-Major Depressive Episode according to DSM III criteria. Blood samples were drawn hourly from an indwelling venous catheter in supine subjects. Plasma NE was measured by HPLC with electrochemical detection. 5 patients (age: 35-63) were studied in base line drug free depressive state and compared with 5 control subjects (age: 44-53), then, in 4 patients, on the 8th and 21st days under antidepressant treatment. Control subjects exhibited a circadian rhythm of TP but a weak amplitude and low values during sleep, as previously described. Depressed patients did not display any rhythmicity because of a reduced amplitude and high plasma levels during sleep. Antidepressants did not restore the rhythm. Our results suggest a rhythmic instability involving a circadian lability linked to an ultradian release during sleep. This NA disinhibition could participate in the depressive desynchronisation and the potential relationships with sleep disorders must be discussed.

Adult↗
PubMedDate not supplied

[Circadian rhythms of the central temperature and blood cortisol in endogenous depression].

Beside neurochemical imbalances, there are numerous disruptions of circadian rhythms in endogenous depression. Recent studies have actually shown instability in rhythmicity and phase advance of many circadian rhythms in depression (central temperature, cortisol, urinary MHPG...). We have observed the longitudinal evolution of circadian rhythms (core temperature, plasma cortisol) of depressed patients who were treated by a two weeks phase-advance process, then with antidepressant drugs. Our results show that clinical improvement during phase-advance process is much faster than under tricyclics, with the same Hamilton scale level after two weeks of treatment. From a biological point of view, we show an ultradian instability, a phase advance (2 to 4 hours) and modifications of averages and amplitudes of circadian rhythms. These abnormalities tend to disappear during phase-advance process and antidepressant therapy. Phase response curves to the phase shift in depressed patients could be explained by a bad sensitivity of these subjects to external synchronisers linked to an internal dyschronism. These disturbances lead us to link desynchronisation and endogenous depression.

Antidepressive Agents↗