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Biomedical subjects

J Merrer

Publications and source records attributed to J Merrer.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Classical anticoagulant treatment of venous thromboembolic disease in cancer patients. Apropos of a retrospective study of 71 patients].

In order to evaluate the efficiency of classical anticoagulant therapy for venous thromboembolic disease in cancer patients, we retrospectively analysed 71 patients treated with intravenous heparin first and then with antivitamin K. After a mean follow-up of 185 +/- 25 days, 23 patients (33%) were dead; nine patients (12%) had suffered from major haemorrhagic complications, which were not fatal, four of which were due to heparin overdosage; 17 patients (24%) showed recurrent venous thromboembolic disease. According to univariate statistical analysis, risk of major bleeding was not associated with the presence of either thrombocytopenia, abnormal blood coagulation, metastases and/or any other hemorrhagic risk factors; recurrence of venous thromboembolic disease was not associated with the presence of other risk factors for venous thromboembolic disease, nor with the presence or absence of metastases and/or of ongoing chemotherapy. Such results suggest that classical anticoagulant therapy for venous thromboembolic disease in cancer patients is neither effective nor safe. The present retrospective study underlines needs for further prospective analyses in order to evaluate potential benefit from other therapeutic strategies, such as use of low molecular weight heparins and/or vena cava filter placement.

4-Hydroxycoumarins↗
PubMed1995

Small intestinal stricture complicating superior mesenteric vein thrombosis. A study of three cases.

Mesenteric vein thrombosis associated with intestinal stricture, as a consequence of intestinal ischaemia, has only been mentioned twice in published works. The clinical, biological, and morphological aspects as well as the treatment of this morbid association were studied in three patients. In all, a two stage clinical course (initial acute abdominal pain and fever, followed by chronic intestinal obstruction), corresponding to the sequence thrombosis/stricture, was found. x Ray studies showed a regularly contoured intestinal stricture. Surgical resection was required in all three cases for stricture, associated in one case with mesenteric infarction. Anticoagulation treatment was used to preclude recurrence. Increased clinical awareness could lead to the diagnosis of intestinal stricture secondary to mesenteric vein thrombosis more often and at an earlier stage. Treatment consists of evaluation of predisposing features, intestinal resection when necessary, and anticoagulation therapy, as indicated.

Adult↗
PubMed1992

[Staging evaluation and surveillance in tumors of the testicle].

In 1992, the staging and follow-up of testicular germ cell tumours is based on a combination of computed tomography and tumour markers. Due to the development of medical imaging over the last decade, abdominal and thoracic CT has now replaced the combination of lymphography and pulmonary tomographies. Testicular ultrasonography is valuable for the diagnosis and contributes to staging and follow-up. The chest x-ray is still performed and MRI has very exceptional indications. Tumour markers, essentially alpha-foetoprotein and the free beta fraction of human chorionic gonadotrophin, are useful in more than 80% of NSGCTs and about 15% of seminomas (beta-HCG alone). A very high initial level often indicates a poor prognosis. Monitoring of markers is essential after exclusive orchidectomy and to assess the efficacy of chemotherapy.

Aftercare↗
PubMed1992

[Therapeutic modalities for germinal testicular tumors, excluding surgery. Radiotherapy--chemotherapy].

There are two other treatments for germ cell tumours of the testis apart from surgery: radiotherapy and chemotherapy. Radiotherapy is ideally administered with a linear accelerator delivering photons and electrons. The dose is well established and smaller volumes are now irradiated. The precision is increased by CT and by the use of personalized shields. Radiotherapy is indicated in pure seminomas, with two exceptions: rare seminomas with a large tumour mass (2%), rare palliative indications for non-seminomatous germ cell tumours. Chemotherapy, following the progress due to the combination of vinblastine and bleomycin, has been based, for the last 10 years, on cisplatin, which must be administered at the correct dose. VP 16, ifosfamide and other drugs have also been introduced. In forms with a poor prognosis and depending on the clinical course, this chemotherapy should be administered at high doses with the protection of autologous bone marrow transplantation. This requires an appropriate infrastructure and a well trained team. The short-term and long-term effects of radiotherapy are more clearly defined than effects of chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

[Therapeutic indications for germinal testicular tumors].

The therapeutic indications for germ cell tumours of the testis depend on the histology (pure seminoma: 45%, non-seminomatous germ cell tumour: 55%), the extension and the severity of the prognosis. The well standardised approach to pure seminomas is less clear for non-seminomatous germ cell tumours. Stage I, IIAB pure seminomas (95 to 98% of cases) should be irradiated. The dose and target volume are adapted to prophylactic (I) and curative (II) objectives. Rare seminomas with a large tumour bulk should be treated with chemotherapy. Survival is close to 100%. Stage I non-seminomatous germ cell tumour offers several theoretical possibilities. Radiotherapy is not very popular and chemotherapy appears to be to aggressive, lumboaortic lymph node dissection is being replaced by new imaging modalities and simple follow-up requires a rigorous and disciplined approach. At the Val-de-Grâce hospital (France) since 1987, we perform simple orchidectomy in favourable stage I disease: 80% are cured with no other treatment, 20% relapse and are cured by chemotherapy, in the unfavourable stage I cancers (histology, markers) or with uncertain follow-up, limited chemotherapy is performed (3 cycles of EP). Stage II and more advanced non-seminomatous germ cell tumours are divided into moderate forms (IIA, B, III, IVL1) and major forms (IIC, IVL2, L3, H+, CNS+). In the exclusive infradiaphragmatic involvement of moderate forms, some authors propose bilateral lumboaortic lymph node dissection which is invasive surgery with an efficacy declining from 90% (IIA) to 50% (IIB). The majority of teams, particularly Val-de-Grâce, administer 3 or 4 courses of BEP followed by assessment (CT scan - markers) and salvage surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Mature teratomas of testicular origin. Discussion of 12 cases].

Between 1979 and 1989, 135 patients with a non-seminomatous germ cell tumour of the tests were treated in the Val de Grâce Military Hospital in Paris. In twelve patients, histological examination of a residual mass after chemotherapy revealed the presence of mature teratoma. Although this tumour, considered to be benign, generally represents a favourable form of the initial tumour, it nevertheless has a potential for progression. The possibility of long-term recurrences, which are sometimes difficult to eradicate, justifies very careful long-term surveillance of these patients. The authors report three particularly demonstrative cases and present a review of the literature.

Adult↗
PubMed1990

[Cancer of the testis, sarcoidosis and neurinoma].

The association of testicular cancer, sarcoidosis and neuroma is reported. Review of the literature revealed the rarity of the association of testicular cancer and sarcoidosis which is probably a chance association, but which is important in the context of staging, as overstaging may lead to useless or even dangerous treatment.

Adult↗
PubMed1990

[Advanced testicular seminoma: treatment of residual masses after chemotherapy. A review of 3 cases].

Based on 3 cases of advanced testicular seminoma classified as stage IIC, the treatment of residual masses after chemotherapy is discussed. The excellent therapeutic response confirmed by histological study of the residual masses, which show a fibrotic or necrotic appearance, allows the adoption of a strategy using imaging techniques: either there is persistence of a gland mass syndrome and resection needs to be carried our or retroperitoneal fibrosis is visualised and careful follow up would appear to be sufficient.

Adult↗
PubMed1989

[Prognosis of post-anoxic coma].

The outcome of anoxic coma following cardiac arrest depends on the aetiological circumstances, on pre-existing visceral deficiencies and on the duration of inefficient circulation. Outside the extreme cases of prompt return to consciousness or early death, in many patients this course is marked by neurological sequelae of varying severity which may result in a persistent vegetative state. Initially, there is nothing that can predict the quality of survival, but within 72 hours the neurological examination usually makes it possible to foresee irreversible situations with permanent loss of consciousness. The decisional problems that ensue are discussed.

Coma↗
PubMed1989

[Exeresis of residual masses of germinal tumors of the testis after chemotherapy].

Between 1978 and 1988, amongst the 184 patients treated at the Hôpital du Val de Grâce for a testicular germ cell tumour, 47 patients underwent resection of residual masses after chemotherapy: 27 patients were classified as stage II and 20 were classified as stage III. The chemotherapy, administered for 3 to 6 cycles, used three types of protocols: VAB 6, PVeBV or BEP. Resection of residual masses was only undertaken after return to normal of the biological markers with persistently abnormal medical imaging. Histology of the testicular tumour revealed 3 seminomas and 44 non-seminomatous germ cell tumours. The histology of the residual masses after retroperitoneal lymphadenectomy (42 operations), thoracotomy (9 operations) or craniotomy (1 operation) revealed 22 cases of fibrosis or necrosis (47%), 10 cases of teratoma (21%), 8 cases of cancer (17%) and 7 normal cases (15%). The progression towards fibrosis, necrosis or nature teratoma is synonymous with cure, but the persistence of cancer cells corresponds to a very poor prognosis even after salvage treatment.

Antineoplastic Agents↗
PubMed1989

[Solitary listerial abscess of the brain stem. Cure with antibiotic treatment].

A healthy 26-year-old man, without initially presenting fever, rapidly developed a focal right pontomedullary deficit associated with an aseptic lymphocytic meningitis. The diagnosis of Listeria infection was confirmed by blood cultures. CT and MRI demonstrated an abscess extending from the superior cerebellar peduncle to the lateral portion of the medulla. Immunological controls gave no indication of deficiency. With ampicillin therapy, started on the 5th day, clinical recovery was almost complete, but a soft palate right paresis persisted as the unique sequel. Antibiotic therapy was maintained for 5 months up to normal CSF and CT. One year after the onset, MRI was also normal. The rare nature of listerial abscess in the brainstem is discussed with regard to rhombencephalitides.

Adult↗
PubMed1988

[Biological markers and germinal tumors of the testis. Value and limitations of the assay of chorionic gonadotrophin hormone and alpha-fetoprotein].

Between 1978 and 1985, 128 patients with germinal tumors of the testes were treated at the Val-de-Grâce Hospital; biological market levels--beta HCG and AFP--were determined before and after orchidectomy in the peripheral blood and during orchidectomy in testicular blood in 76 patients. HCG levels were elevated in 13% of seminomas and HCG and/or AFP levels were elevated in 76% of non seminomas; the sensitivity of the determination was greater in testicular blood. However, in our study, there was no parallelism between marker levels before orchidectomy and tumor stage or prognosis. The change in HCG and/or AFP levels appears to an index of the response to therapy: 4 patients with high HCG and/or AFP levels during chemotherapy died. The diagnosis of recurrence is not always documented by elevated marker levels and monitoring must always documented by elevated marker levels and monitoring must always include both determination of marker levels and imaging.

Chorionic Gonadotropin↗
PubMed1987

[Analysis of factors related to early mortality in digestive hemorrhage caused by portal hypertension].

In order to determine immediate criteria of prognosis for patients with portal hypertension hospitalized for digestive hemorrhage, in an intensive care unit, 18 variables were recorded during the 24 hours following admission in 65 patients. Data related to death were age, ascites, hepatic encephalopathy, shock, active hemorrhage, acute pneumonia, decrease in prothrombin time, use of esophageal balloon tamponade, use of mechanical ventilation, number of red blood cell units transfused. Discriminant analysis yielded a linear combination of 4 variables which best separated survivors from non survivors with the following equation: F = 0.330 X hepatic encephalopathy + 0.433 X shock + 0.226 X active hemorrhage + 0.0097 X age - 0.396. The threshold decision of the hemorrhage prognosis index (HPI) was F = 0.57; 80 p 100 of all patients were correctly classified. In order to be validated, HPI was compared with a general (SAPS) and specific (Pugh's classification) scoring system, in a prospective study of 57 episodes of digestive hemorrhage. In this study, sensitivity was better with HPI than with SAPS (0.70 versus 0.45), specificity was higher with HPI than with Pugh's classification (0.86 versus 0.70). Percentage of correctly classified patients was higher using HPI (81 p. 100) than SAPS (77 p. 100) and Pugh's classification (68 p. 100). We suggest that the HPI, determined with 4 easily defined and recorded variables should be used prospectively to compare efficacy of different treatments.

Adult↗