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Biomedical subjects

G Lelièvre

Publications and source records attributed to G Lelièvre.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Incidence and clinical expressions of microvascular complications in patients receiving kidney graft and treated with cyclosporine].

Reported cases of HUS/TTP (hemolytic uremic syndrome/thrombotic thrombopenic purpura) with cyclosporin (CsA) are more and more frequent, which led us to evaluate the incidence of microangiopathic process in kidney graft patients. In our first retrospective study we noted 9.4 percent of HUS/TTP among 117 patients. We tried to detect infraclinical hemolytic events prospectively in 40 new patients by systematic measurement of haptoglobin levels after introduction of CsA. The incidence of falls in haptoglobin levels was 25 percent. The immunological context was always noted: rejection crisis in 5 cases, cytomegalovirus infection in 3 cases, isolated markers of lymphocyte-activity in 2 cases. We never found a clinical or infraclinical form of microangiopathic process without a symptomatic or asymptomatic immunological complication. Monitoring haptoglobin levels make it possible to detect early endothelial injuries which could be linked to the future arteriolopathy described with CsA therapy.

Cyclosporine↗
PubMed1992

Incidence and clinical profile of microvascular complications in renal allografted patients treated with cyclosporine.

The incidence of cyclosporine (CsA) vascular toxicity is open to debate. We attempted to evaluate the incidence of hemolytic accidents in our series of patients taking all clinical forms into consideration. From January, 1989, to December, 1990, 117 patients received kidneys from cadaver donors and were treated with CsA. Five patients presented hemolytic uremic syndrome (HUS) accompanied by a rejection crisis; 6 patients presented hemolytic anemia associated in 2 cases with marked thrombocytopenia without any evidence of rejection. Cytomegalovirus (CMV) infection was diagnosed in 2 patients and bacterial infection preceded hemolysis in 2 other cases, suggesting a triggering factor. In addition, when we systematically determined haptoglobin levels after introduction of CsA treatment, we found asymptomatic hemolytic episodes more frequently. Our incidence of hemolytic accidents was approximately 10%. Hemolysis could indicate ischemic vascular damage leading to arteriolar medial hyalinosis preceding fibrosis in CsA nephrotoxicity. Thus, it would be interesting to detect asymptomatic forms of hemolysis by monitoring haptoglobin levels. This approach could lead to a reduction of the CsA dose in patients presenting low haptoglobin levels, even in the absence of evidence of nephrotoxicity.

Adult↗
PubMed1991

[Auricular chondritis, malignant glomerulonephritis and pulmonary hemorrhage].

Relapsing polychondritis is a rare connective tissue disorder characterized by inflammation of cartilagenous structures such as ears, nose, joints, trachea and larynx. Renal disease is unusual. A 41 years old man presented with auricular chondritis, subacute renal failure and lung hemorrhage. A renal biopsy disclosed a diffuse proliferative glomerulonephritis with extensive crescents. Immunofluorescent studies suggested a GNRP type III so called "non immunologic disease". He was treated by prednisone and plasmapheresis with rapid disappearance of pulmonary hemorrhages and good renal functional improvement.

Adult↗
PubMed1990

Randomized study of 5 fluorouracil and cis platin as neoadjuvant therapy in head and neck cancer: a preliminary report.

A randomized prospective study of 5 fluorouracil (5-FU) and Cis platin preceding definitive local treatment for squamous cell carcinoma of the head and neck region was initiated in September 1986. Seventy-five patients were stratified by site (oral cavity-12, oropharynx-28, larynx-16, hypopharynx-19), and by Stage (Stage II-20, Stage III-43, Stage IV-12) and randomized to receive definitive local treatment (surgery and post-operative radiation or radiation alone) or chemotherapy followed by definitive local treatment. Chemotherapy consisted of three cycles of 120 hr 5-FU infusion 1 g/m2/day plus Cis platin 100 mg/m2 on day 1 on each cycle. Response to chemotherapy was complete in 17 patients (46%) for an overall response rate of 68%. All the patients have completed therapy with a median follow-up of more than 12 months. After local treatment, the complete response rate is 84% for the control group and 86% in the chemotherapy group. Actuarial disease-free survival at 1 year is 61% in the control group and 73% in the chemotherapy group (p = 0.25). These preliminary results show that in spite of initial tumor response, neoadjuvant chemotherapy does not improve long-term control and survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[Rapidly progressive glomerulonephritis in pneumoconiotic coal miners].

We review a series of 11 silicotic coal miners demonstrating a progressive renal failure with a syndrome of rapidly progressive glomerulonephritis. Renal biopsies reveal crescentic glomerulonephritides associated three times with angeitis. These cases confirm that silica induced glomerulonephritides can be an occupational hazard and warrant further clinical and epidemiological research.

Adult↗
PubMed1989

[Taste in healthy subjects. Influence of alcohol and tobacco consumption].

To define the factors which may affect gustatory function, 42 healthy subjects, without any apparent taste disorder were randomly selected and investigated by electro-gustometry and chemical gustometry. A deterioration in taste discrimination was noted in drinkers in comparison with non-drinkers, both on electro-gustometry, mean threshold (SEM: 88.0 +/- 26.5 versus 47.4 +/- 7.3 microA; p less than 0.05), and also on chemical gustometry (15.1 +/- 2.1 versus 17.4 +/- 0.7; p = 0.05) and also in smokers compared with non smokers (mean of electrical thresholds SEM 104.2 +/- 22.8 versus 38.3 +/- 5.2 microA; p less than 0.01, mean of chemical scores SEM 14.3 +/- 1.1 versus 17.9 +/- 0.9; p less than 0.05). Multivariate analysis demonstrated the influence of the two factors alcohol and tobacco on taste, evaluated by electrogustometry (R2 = 0.36) or chemical gustometry (R2 = 0.28). These results suggest that alcohol and tobacco are liable to influence gustatory function in healthy subjects thereby suggesting that this influence should be taken into account using a corrective factor.

Adult↗
PubMed1989

[The posterior pharyngeal wall in pharyngo-laryngeal cancer. Spontaneous healing after excision].

Malignant lesions arising from the posterior pharyngeal wall, or spreading to involve it, present a therapeutic problem in cancer surgery as witnessed by the number of techniques proposed and used. In general, they require longer operating time, sometimes need a double team of surgeons and sometimes specialised training. There is an increased risk of complications. The experience with pharyngoplasty using mucosal or musculo-mucosal flaps, which leave the donor site bare, raised the possibility of partial repair in circular pharyngo-laryngectomy. A myocutaneous flap is sutured in "gutter" fashion anteriorly opposite the posterior pharyngeal wall which in fact consists of the prevertebral aponeurosis laid bare. Repair was not performed in certain partial posterior pharyngectomies. Seven patients underwent surgery using this technique. Four circular pharyngo-laryngectomies, including 2 as second stage procedures were performed. Healing occurred in all cases. No breakdown of sutures occurred. Oral feeding was possible from D12 on average and patients were discharged on D18. Three posterior pharyngectomies, including 1 as a second stage procedure, were performed. Feeding was possible in 2 patients on D15 and discharge on D18. These encouraging results suggest that this reliable, rapid single stage procedure technique should be adopted.

Follow-Up Studies↗
PubMed1987

[Critical study and role of partial vertical reconstructive laryngectomies with epiglottoplasty by the Tucker method. Apropos of 18 cases].

Two groups could be distinguished in a series of 18 patients with glottic lesions: one with pure glottic tumors (12 cases) and the other with tumors extending beyond the glottic region (6 cases). All patients but one were operated upon by first intention for epidermoid carcinoma, but also for associated pronounced dysplasia. The so-called Tucker technique was used with slight modifications (less extensive resection of thyroid cartilage, conservation of the two arytenoid cartilages). The postoperative course was satisfactory with decanulation and ablation on the 13th day, and a mean hospital stay of 22 days. Two postoperative deaths due to vascular complications occurred and one patient developed a swinging epiglottis after 2 years. The remaining 16 patients are all alive, including 8 after less than 3 years. Analogous results were noted in an analysis of a total of 93 case-reports from 5 different series of patients. This method provides an elegant and satisfactory repair of pure cordal surgery, but adds nothing from the oncologic point of view since other better adapted and currently well defined operations have to be envisaged for lesions extending beyond this region.

Adult↗
PubMed1986

[Acute interstitial nephritis and uveitis in the adult: apropos of 3 cases].

Acute renal failure due to tubulo-interstitial nephritis accompanied by uveitis has been observed in 3 young women (TINU syndrome). In these 3 cases, the nephropathy was preceded (1-3 months) by asthenia, anorexia, weight loss and a major inflammatory syndrome. Nonsteroidal anti-inflammatory drugs (NSAID) administration was noted. In 2 cases, uveitis appeared after the nephropathy had subsided. Renal biopsies performed in the 3 patients revealed mainly interstitial changes with mononuclear cell infiltration; immunofluorescence studies were negative. Although the severity of renal failure varied among patients, renal function recovered completely, returning to normal within 2, 3 and 24 months respectively, on corticosteroid therapy. The TINU syndrome is a rare situation compared to drug-induced acute interstitial nephritis, including NSAID related-nephritis. However, the real incidence of this syndrome might be underestimated since the uveitis can appear a few weeks later and its origin may not be related to the renal episode.

Acute Disease↗
PubMed1985

[Risk of bone disease as a result of fluoride intake in chronic renal insufficiency].

Four cases of osteosclerosis were observed in patients with renal failure. All subjects presented with moderate reduction in renal function which had been stabilized for several years. Osteosclerosis appeared progressively but was clinically symptomatic in only one patient. Fluoride intoxication was ascertained on the basis of X-ray examination and bone biopsy. In addition, the source of fluoride intoxication was easily recognized as the drinking water (2 to 3 1/day), "Vichy Saint Yorre" commercial mineral water (fluoride concentration 9 mg/l) in 3 cases, and tap water in the fourth case. These observations emphasize the risk of high chronic fluoride intake in patients with renal failure, even with mild reduction of glomerular filtration rate.

Adult↗
PubMed1984

[Initial polychemotherapy in the treatment of cancers of the head and neck. The efficacy and tolerance of 2 nonrandomized combinations in 48 patients].

Before loco regional treatment for head and neck cancer forty eight patients received one or the other of the following combined chemotherapy regimens: Regimen A (28 patients): high dosage methotrexate, bleomycin, cis-platin; regimen B (20 patients): common dosage methotrexate, bleomycin, hydroxyurea, vincristin. The effectiveness of regimen A seemed better than that of regimen B (46% responses versus 20%). This assessment must be accepted with caution, since, although the organization of treatment was strictly similar in the two groups, the study was not randomized, and there were noticeable differences between the two groups. Regimen B was associated with no toxicity. Regimen A was responsible for two fatalities. These two cases were linked to high dosage methotrexate. However, a combined chemotherapy regimen of type A with the high dosage methotrexate replaced by intermediate dosage methotrexate, seems feasible to us. Loco regional treatment was not impaired by initial chemotherapy with either regimen.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

[Role of iridium-192 endocurietherapy in the treatment of T1 and T2 tumors of the tonsillar region].

From July 1971 to August 1981, 31 selected patients with T1, T2 tumours of the Tonsillar region were treated according to the following protocol: Telecobalt therapy to the primary site and to neck nodes to a dose of 45 Gy, Brachytherapy to the primary site to a dose of 25-30 Gy using iridium 192, Boost dose to involved neck nodes, with electrons, or radical neck dissection, wether N1, N2 or N3. The actuarial survival free of disease is 76% for the whole group and 86% for the NO group. The local control rate is 100% without any recurrences at the primary site having been observed. Disease control in the neck is 94% overall and 100% for the NO group. The effects on salivary function were reduced in comparison with telecobalt therapy alone. These favourable results favour the use of this protocol for superficial, minimally infiltrating tumours less than 4 cm in diameter without obvious extension to the base of the tongue or retromolar trigone.

Adult↗
PubMed1984

[Use of the pectoralis major myocutaneous flap in transmaxillary buccopharyngectomy].

Pectoralis major musculocutaneous flaps were used for reconstruction after transmaxillary buccopharyngectomy to treat 22 patients with large oropharyngeal tumors. Short and medium term results are discussed. Large excisions such as these raise many functional problems, even though the use of a musculocutaneous flap for reconstruction is a valid procedure from the anatomical point of view. The cancer prognosis must still be reserved as follow up is still limited for these cases.

Carcinoma, Squamous Cell↗
PubMed1984

[Acute interstitial nephritis and Meckel's diverticulum].

A case of acute haematogenous interstitial nephritis secondary to bacterial infection of a Meckel's diverticulum is reported. The incidence of acute infectious interstitial nephritis with a gastro-intestinal portal of entry is discussed.

Acute Disease↗