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Biomedical subjects

J Migueres

Publications and source records attributed to J Migueres.

At least 19 recordsLinked to original sources
PubMed1992

Six vs twelve cycles for complete responders to chemotherapy in small cell lung cancer: definitive results of a randomized clinical trial. The "Petites Cellules" Group.

Of 320 patients with small cell lung cancer (SCLC) entered into a clinical trial of chemotherapy between January 1983 and September 1985, 106 patients achieved a complete response. The induction chemotherapy used was lomustine 60 mg.m-2 p.o., cyclophosphamide 1 g.m-2 i.v., doxorubicin 45 mg.m-2 i.v. and etoposide 150 mg.m-2 i.v., every four weeks. Lomustine was only given for the first three cycles. Seventy nine of the 106 patients still in complete response after six chemotherapy cycles were subsequently randomized to receive either six more cycles or no more treatment until relapse. In this group of 79 patients, a difference was shown from the time of inclusion between the 51 patients with limited disease and the 28 patients with disseminated disease, with overall median survivals of 395 and 165 days, respectively, (p = 0.0002). No difference was shown between the two treatment groups: the median survival was 332 days from the time of second randomization with a two year survival rate of 28% for the patients randomized to receive six more cycles and 246 days and 22% for those randomized to receive no more treatment (add 147 days to obtain overall median survival). Continuing chemotherapy for more than six cycles to patients in complete response did not improve survival.

Aged↗
PubMed1991

Activity of intrapleural recombinant gamma-interferon in malignant mesothelioma.

Twenty-two consecutive patients with malignant diffuse pleural mesothelioma were treated with recombinant gamma-interferon by the intrapleural route. Diagnosis was made by thoracoscopic examination and all cases were confirmed by the French Mesothelioma Panel of Pathologist. Patients were staged based on thoracoscopic examination and computed tomography (CT) scan: 12 patients were classified as Stage I and 10 were Stage II. A solution of gamma-interferon (40 X 106 U) was infused twice a week over 2 months. Every patient experienced fever. One patient had a Grade 2 leukopenia and one patient suffered from pleural empyema. Response evaluation was based on the following: (1) CT scan performed 2 weeks after treatment ended, and (2) repeat thoracoscopic examination with histopathologic verification in nine patients who had demonstrated a stabilization or a regression of the disease on CT scan. From the original group, 19 patients could be evaluated. Four complete thoracoscopic histopathologic responses and one partial response were observed in Stage I patients (56%). One partial response was observed in Stage II patients.

Alkaline Phosphatase↗
PubMed1991

Amiodarone-induced pulmonary toxicity. Immunoallergologic tests and bronchoalveolar lavage phospholipid content.

Amiodarone (A) is a widely-used antiarrhythmic drug. Pulmonary toxicity is the most serious adverse effect with an estimated mortality of 1 to 33 percent. In order to determine an element helpful for diagnosis, we examined four patients with amiodarone-induced pulmonary toxicity, three patients treated with A, without evidence of pulmonary toxicity but with a main underlying pulmonary disease, and four healthy volunteers. Daily and cumulative doses or duration of treatment were similar in the first two groups. Pulmonary function tests (spirometry, CO-diffusing capacity, arterial blood gases), roentgenographic examinations, pulmonary biopsies or immunoallergologic tests (skin reaction, lymphoblastic transformation test and human basophile degranulation test) did not provide any discriminatory element. In APT+, we observed an increased cellularity of the bronchoalveolar lavage. Neither the differential cell count nor the presence of foamy macrophages were distinguishable between APT+ and APT-. The phospholipid composition of BAL fluid showed a decreased total phospholipid and phospholipid/protein ratio in all patients compared to normal subjects. These changes reflect more the severity of pulmonary disease than the specificity of the causative agent. However, we observed that the unique PL which decreases in APT- and remains normal in APT+ is phosphatidyl-serine + phosphatidylinositol (PS + PI). This has to be confirmed and should be evaluated at different stages of the disease to determine an eventual specific element. We conclude that there are no data currently available to establish the diagnosis of APT except perhaps for the analysis of BAL PL content.

Aged↗
PubMed1990

[Mediastinal tuberculous adenopathies in Djibouti. Report of 159 cases].

One hundred and fifty-nine cases of confirmed mediastinal tuberculous adenopathy were analysed retrospectively. This series, which is the first reported in French-speaking Africa, shows that the disease is not uncommon there, and not restricted to black Africans living in Europe. The clinical symptoms are not specific. Radiography is more interesting, and the extreme scarcity of bacillys-containing expectoration encourages endoscopy. The finding of a fistula at fibroscopy confirms the diagnosis. This easy examination is particularly useful since M. tuberculosis can be grown in cultures from ground bronchial fistula biopsies in 86% of the cases. Associated tuberculous lesions in other sites are very frequent (45%), as is extension of the disease from lymph nodes to lung tissue (79%). This clinical form of tuberculosis can be treated with modern short course chemotherapy which is remarkably effective.

Adolescent↗
PubMed1989

[Infection and asthma].

Infection is frequent in all stages and forms of asthma. It is a source of exacerbations of all degrees of severity. Bacterial infection, especially with commensal organisms from the upper respiratory tract, may cause bronchial hyperreactivity (HRB) by various mechanisms, specific--microbial delayed hypersensitivity, probably rate; IgE-dependent hypersensitivity others non-specific: bronchial inflammation, source of mediators of bronchial constriction; activation of complement, direct histamine liberation; beta blockage...; or mixed mechanisms. Respiratory viral infection probably plays the most important role in the natural history of asthmatic disease, especially in infants and young children by inducing or amplifying HRB and creating a transitory obstructive syndrome of the small airways. This virus-induced HRB may develop into a respiratory syncytial virus viraemia at first or remain latent found by tests of bronchial activity. The pathogenic mechanisms of this HRB are often multi-factorial and interlinked: they are chiefly linked to the various cytopathic effects of the virus on the respiratory epithelium, to the viral inflammation; but also to disturbance of the equilibrium of the autonomous nervous system (beta blockage, excitation of the cholinergic receptors); finally in some areas, to virus-induced amplification of the local and systemic immune responses by IgE that favours clinical consideration of atopy.

Asthma↗
PubMed1989

[Bronchial hyperreactivity in non-asthmatic patients harboring a uterine fibroma].

One of the etiological factors of female late onset asthma lies in endocrine disorders and it often occurs during a period of hormonal instability (menopause or premenopause). Moreover various studies have shown increased allergic manifestations in women with gynecological problems (dysmenorrhea, premenstrual syndrome). Gynecological pathology is found in 30% of 67 women who suffer from late onset asthma. Prospective studies were carried out in 28 women with surgical uterine fibroma, to investigate bronchial hyperreactivity (BHR). The study included atopic research through questioning and allergy skin tests; spirographic respiratory function study, airway resistance, carbachol BHR with determination of the threshold dose (FEV1 20% decrease). Carbachol BHR was found in 8/28 persons (28%), but with no clinical manifestations. None of the patients smoke and only one suffers from mite-allergic rhinitis-conjunctivitis without asthma. BHR is often found in asymptomatic women with uterine fibroma. Is this BHR due to an autonomic dysregulation or to a hormonal malfunction? This hypothesis would require further studies to elucidate, since premenstrual asthma worsening is a well known phenomenon, which can be improved by progesterone. This may suggest a possible link between hormonal malfunction and BHR in women. A long term survey will facilitate detection of late onset asthma.

Adult↗
PubMed1987

Prevalence of legionellosis among adults: a study of community-acquired pneumonia in France.

Over a 24-month period, 274 patients with community-acquired pneumonia were hospitalized in Departments of Medicine at hospitals in Bordeaux, Lyon, Marseille, and Toulouse. Etiology of the pneumonia was determined either by organism identification or by indirect immunofluorescence in only 139 cases (51%). The most frequently isolated etiological agents were Streptococcus pneumoniae (34 cases), Legionella pneumophila (29 cases) and Mycoplasma pneumoniae (24 cases). The majority of patients with legionellosis were male (79%), middle aged (mean age: 53 years), and living in urban areas (69%). Their clinical features were atypical and did not differ from those of other pneumonias. Four patients with legionellosis (13.8%) died. L. pneumophila was isolated directly in only three instances. The study confirms the high prevalence of legionellosis (20%) among pneumonias of identified etiology. The fact that these cases had an atypical clinical presentation and that isolation of the organism was difficult reinforce the need to apply the CDC criteria for the interpretation of positive serological titers.

Age Factors↗
PubMed1987

[Cardiac tolerance of a beta 2-sympathomimetic spray in 37 asthmatic adults monitored by Holter recording].

Thirty-seven asthmatic adults (27 women, 10 men), aged 28 to 70 yrs (mean 50. yrs), in a stable condition, were studied to assess the cardiac tolerance of B2SM sprays. These patients had no cardiac arrhythmia (checked by echocardiography), no hypertension and no hyperthyroidism. Two thirds had severe asthma, and 16 suffered from chronic asthma. After their condition was stabilized, they continued their previous treatment, consisting of theophylline (34 cases), moderate corticotherapy (19 cases), atropine spray (14 cases). Holter monitoring was performed before and 3 days after the institution of treatment by Fenoterol spray at 1,600 micrograms per day in 4 doses at fixed times. Gasometry was tested immediately before and during the protocol. Before B2SM treatment, 26 patients had a normal Holter, 11 had an abnormal first recording (4 important atrial ectopic beats (EBs), 5 ventricular EBs, 1 associating the two), 1 patient had an episode of ventricular tachycardia (VT). With Fenoterol, we observed (with no clinical manifestation) the aggravation of 1 pre-existing atrial EBs and 2 ventricular EBs. Two patients had a short episode of tachycardia but the role of Fenoterol was uncertain: one case was an elderly hypoxaemic patient and in the second a high theophylline level (20 mg/l) was found. The arrhythmogenic property peculiar to B2SM in spray form seems low at the dose we used. However in this study and in certain circumstances, such as hypoxemia, metabolic acidosis, or theophylline overload, the use B2SM may have contributed, together with other factors, to induce disquieting infraclinical cardiac dysrhythmia. We stress that this short-term study involved stable asthmatic patients under surveillance in hospital conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Pulmonary lipogranulomatosis due to excessive consumption of apples.

A 55-year-old man was admitted for treatment of unstable angina. Chest x-ray films showed a micronodular pattern, but there were no respiratory symptoms. Autopsy, carried out following sudden death, revealed pulmonary granulomas surrounding lipid crystals. The same crystals were found elsewhere: lymph nodes, spleen, liver, adrenal glands, and were composed of aliphatic hydrocarbons of vegetal origin, mainly C29H60. Investigation of the case history revealed excessive consumption of apples, to which the hydrocarbon deposition could be attributed, since C29H60 is a natural constituent of the cuticular wax in apple peel. This is a unique example of pulmonary granulomatosis due to storage of vegetal hydrocarbons of dietary origin.

Dietary Fats↗
PubMed1985

[Double-blind study of Biostim in the prevention of superinfection in patients with chronic bronchopathy].

In a multicenter trial conducted with patients suffering from chronic bronchopathy, Biostim, an immunomodulating compound of biological origin has been studied using the double-blind placebo-controlled method for prevention of respiratory tract infections. One hundred and ten patients from 10 french pneumology health centers entered the study. The treatment was administered at random in three sequences of 8 days a month for 3 months (2 mg/day the first month, 1 mg/day the second and third months). Patients were separated into 2 groups regarding severity of the disease: group I (non complicated chronic bronchitis); group II (obstructive chronic bronchitis with or without respiratory failure). Patients were examined during 6 months with a monthly appraisal of number, duration and treatment clinically defined infectious episodes. The study of propensity to infections with respect to severity of the disease in patients given placebo showed a significantly lower number of infectious episodes in group I when compared to group II. In the group I (patients suffering from simple chronic bronchitis), no significant difference could be noted between placebo and Biostim but, at all events, the low frequency of episodes makes it difficult to evidence a protective effect in such a group. In contrast, with patients presenting a high infectious risk (group II), one can observe in Biostim treated patients compared with placebo group a significant decrease of infectious episodes and a larger number of patients standing free of episodes throughout the whole period of trial. Tolerance to Biostim has revealed itself satisfactory.

Adjuvants, Immunologic↗
PubMed1984

[Castleman's tumor with thoracic localization. Apropos of a case].

Castleman tumor usually presents as a mediastinal tumor which is never accurately diagnosed before surgery. Pathological findings and postoperative course establish the benign nature of this tumor. However, plasmocytic forms with prominent hematologic manifestations may be difficult to distinguish from a malignant lymphoma or thymoma. Differential diagnosis is all the more important that no complementary postoperative treatment is indicated in benign lymphoid tumors.

Adult↗
PubMed1981

[Noxytioline in the local treatment of empyema (author's transl)].

The importance assumed by local treatment in non-tuberculous purulent pleurisy has suggested that intrapleural applications of a broad spectrum antiseptic could be as useful as in peritonitis. Fifteen adult patients with empyema secondary, in most cases, to local, usually Gram-negative, infections were treated with combined antibiotic therapy and locally administered noxytioline. The patients underwent 3 to 30 intrapleural lavages (average 9) via a pleurotomy drainage tube (11 cases) or after pleural puncture (4 cases). Results were very satisfactory in 12 out of 15 cases, with mild pleural sequelae in 8 cases. No local or systemic reactions were observed. This treatment proved particularly effective in 5 difficult cases.

Adult↗
PubMed1981

[Indications for intrapleural talc under pleuroscopic control in malignant recurrent pleural effusions. Based on 26 cases (author's transl)].

A review of ten years' experience of talc pleurodesis applied to the treatment of permanently recurrent carcinomatous pleural effusions. Twenty six patients aged between 35 and 83 years, suffering from metastatic pleural effusions, underwent pleuroscopy with local anaesthesia followed by powdering with talc, then suction drainage. There were 8 failures (30%), including 4 early deaths and 4 survivals of less than 4 months with no reduction in the effusion. Three results proved to be poor because of early extra-thoracic metastases (11.5%). There were 15 useful results, with drying up without return of the effusion and comfortable survival for 3 months to 7 years, including 8 of more than a year. These figures, somewhat unfavourable in comparison with those found in the recent literature (up to 90% useful results) were biased by the inclusion of patients who were in fact beyond help (excessive age, markedly impaired general condition, too advanced pleuro-pulmonary lesions, multiple metastases) which represent classical contraindications to the use of the talc technique. It emphasizes the best indications, based upon a sufficiently long life expectancy, good local pleuro-pulmonary state, the virtual restriction of malignant disease to the pleura, residual therapeutic possibilities-all conditions frequently found in cases of pleural carcinomatosis of mammary origin.

Adult↗
PubMed1979

[Value of vascular tests in the diagnosis and therapeutical indications of pulmonary embolism on a pneumological background (author's transl)].

The diagnosis of mislaying forms of pulmonary embolism, where even angiography was not pathognomonic, induced the use of a phlebography on lower limbs in patients where this diagnosis was suspected. The revelation of a distal thrombo-phlebitis and even more so an iliocaval one, becomes a major value when the clinical and paraclinical data remained arguable. The comparative study of diagnostic usual clinical and paraclinical elements (radiographies, E.C.G., gasometries and scintigraphies) confirmed, in 22 patients, the value of phlebography. On a pneumological background, it is useful to perform this examination, most of the time : a) on patients over 55, when a cardiorespiratory decompensation remained unexplained in a patient with chronic respiratory insufficiency, or even an unproved hemoptysis; b) but mostly before 55, in case of painful pneumopathy above all if it is bilateral and recurring, or in case of paroxysmal bronchospasm without atopic ground, when a belated asthma could be thought of. Finally vascular tests induced the fitting in situ of a clamp or "umbrella" in the vena cava in 7 patients out of 22.

Adult↗
PubMed1979

[Isotopic indicators in the diagnosis of malignant pleurisies (author's transl)].

The tracers that are used in thoracic pathology have an elective tumoural affinity, present such a special reaction towards pleural effusions that we were led to study Bleomycin labelled with Cobalt 57 in 34 cases of pleurisy of various etiologies. The hyperfixation, circumscribed to the effusion in all these cases, presented a double problem : of radiobiological risk and of diagnostic significance. We tried to solve the last problem by means of a precise protocol applied to 16 cases, quantifying comparatively the specific radio-activity of pleural fluid and serum and studying the evolution of the pleural serous gradient, after injection of 2 mCi of labelled Bleomycin in 16 patients with suspected malignant pleurisy. From this limited study, it appeared that the sero-pleural gradient of the tracer, 24 hours after injection, was very high, above 5 and up to 15 in 7 malignant pleurisies out of 8; between 2 and 4 in others. It was sometimes below 5 and less in effusions, non malignant or doubtful. This gradient decreased very rapidly to reach 0 on the fourth day, except in recurring chronic effusions. Pending the confirmation of results, after a prolonged experiment, this protocol appeared valuable for diagnostic and physiopathological reasons.

Adult↗