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Biomedical subjects

M Brunat-Mentigny

Publications and source records attributed to M Brunat-Mentigny.

At least 91 records · Page 5Linked to original sources

[Evaluation of the transfer of Algerian children with cancer to the Léon-Bérard center (1984-1987)].

From 1984 to 1987, 80 pediatric oncology patients were transferred from Algeria to the centre Léon-Bérard (Lyon, France). Diagnoses were mainly lymphomas neuroblastomas and bone tumours (75% of the total number of cases). Survival (39% at 46 months), number of hospitalization days (12,655) and cost (29,324,254 FF) were calculated. These costs were compared with the mean annual public health allocation per capita in Algeria and with the French limitations on accepting transfer of spending money for children from abroad. New directions are suggested to improve the efficiency of these transfers to optimize the use of limited resources in both countries and to increase survival of individual patients.

Algeria↗

[Efficacy of the "8 drugs in a day" protocol in brain tumors in children].

In the present study, the "8 drugs in 1 day" regimen was tested in 54 children: 27 relapses (brain and/or spinal and/or meningeal sites), 10 refractory progressive diseases, 13 macroscopic residual tumors after partial excision and/or radiotherapy; in 4 cases, this regimen was prescribed as first line treatment. The response rate (complete and partial remission) was 46%. Results were very encouraging in medalloblastomas with a response rate of 76.5% whereas in brain stem gliomas it was only 23% and 33% in other astrocytomas. Immediate toxicity, mainly hematological, was very moderate. These results justify to propose this regimen as adjuvant chemotherapy, mostly in medulloblastomas and to plan other similar trials, using the most active drugs which seem presently to be alkylating and platinum-derived agents.

Adolescent↗

[Methotrexate poisoning: value of exchange transfusion].

The authors report on a case of methotrexate (MTX) intoxication occurring in a young boy treated for osteosarcoma. Exchange transfusion was shown to be an effective method. Respective indications of MTX removal methods are discussed: haemodialysis and charcoal haemoperfusion should be proposed for massive and acute intoxications; exchange-transfusion may be proposed as a treatment for prolonged and moderate intoxications.

Acute Kidney Injury↗

[Cardiotoxicity of anthracyclines in children. Contribution of anthracyclines in pediatric oncology].

Anthracyclines induced cardiotoxicity in children remains a major problem. Classical data are found: cumulative dose, way of injection, anterior cardiopathy, cardiac area irradiation, interaction with other cytotoxic drugs ad age. 2 kinds of disorders are recorded: 1) Acute rhythmic dysfunctions, early and often transitory; 2) congestive heart failure often not reversible and depending on total dose. Prognostic is still poor and intricate with prognostic of the tumor. Over all incidence is 2.7%. Very young children seem to be more sensitive. Continuous infusion is less toxic than IV bolus. Studies with new anthracyclines are yet uncommon but seems to be comparative with adult literature. Monitoring is identical to adults. EKG is of minor interest. Endomyocardial biopsies have been reported. There is no prognostic value of ultrasound tomogram, but exercise echocardiography can be performed. Nuclide fraction ejection is more reliable.

Adolescent↗

Metastatic interstitial pneumonitis after autologous bone marrow transplantation. A consequence of reinjection of malignant cells?

Two cases of fatal interstitial pneumonitis developing after an autologous bone marrow transplantation are described. In both cases the autopsy revealed diffuse malignant pulmonary involvement. The first case involved a 4-year-old boy who had a Burkitt's lymphoma; the second case involved a 4-year-old girl with a neuroblastoma. The authors postulate that in these cases, the clinical picture may have been related to reinfusion of malignant cells.

Abdominal Neoplasms↗

Radionuclide bone imaging in diaphyseal aclasis with malignant change.

Chondrosarcoma is a rare complication in hereditary multiple exostoses. The six patients in this study have had a complete follow-up and constitute the largest group of such cases to have been studied so far. Five patients had histologic evidence of malignancy. Since histologic examination can be very difficult, any other diagnostic features, may it be clinical, radiologic, or scintigraphical, should be taken into account for early surgical treatment. Bone scintigraphic examination is a valuable adjunct to early diagnosis of malignant change by showing highest uptake in malignant areas. It is also very useful for posttherapeutic follow-up.

Adolescent↗

The response to initial chemotherapy as a prognostic factor in localized Ewing's sarcoma.

Ninety-five children with localized Ewing's sarcoma were included in a prospective cooperative study. All patients received initial chemotherapy with the purpose of early prevention of metastases and improvement of the conditions of the subsequent local therapy, radiotherapy in all cases, surgical resection in selected cases. Clinical response to initial chemotherapy was evaluated in 67 patients who had measurable soft tissue mass or functional symptoms. This response appeared highly correlated with outcome as the disease-free survival was 57.3% for the 41 good responders and 9% for the 26 bad responders (P less than 0.00001), though 23 of these bad responders reached complete remission with radiotherapy. This study also confirms the prognostic significance for survival of the site of the primary tumor on axial skeleton or on limbs. Nevertheless, this factor had no predictive value for response to chemotherapy, which thus appears to be an independent factor.

Adolescent↗

[Burkitt's lymphoma in 1985].

Burkitt Lymphoma is a model for either clinical research and fundamental research. Initially described in Africa, it is the most frequent of all childhood Lymphoma. Burkitt Lymphoma allowed in the laboratory to study the virus cancer relationship, the chromosome cancer relationship, the gene and cancer relationship and the oncogene and cancer relationship. This study is made considerably more easy because of the numerous cell lines which were established from malignant cells at different stages of the disease. Patients who have a complete remission of more than 8 months could be considered as cure of the disease. Then, B.L. is also a model for clinical study because we can conclude rapidly the efficacy or not of a new protocol. Since 1980, overall survival in France has moved from 40 to 80%. Chemotherapy alone is responsible for these results either by conventional protocol or in a small % cases by massive therapy followed by autologous bone marrow transplantation.

Africa↗

Stage III non-seminomatous germ cell tumours of the testis--patients treated at the Centre Leon Berard.

The study of the survival of a series of patients with stage III non-seminomatous germ cell tumours of the testis enables us to confirm two points: the use of cis-platinum has multiplied the survival rate for stage III patients by 3, the concept of stage III includes various metastatic states with different prognoses. The use of a sub-classification, like that proposed by Samuels, allows for a better definition of the natural history of these lesions.

Combined Modality Therapy↗

[Epiphysiolysis of the hip following radiotherapy of pelvic tumors in early infancy. Apropos of 5 new cases].

Five personal cases of slipped capital femoral epiphysis in children submitted to pelvic radiotherapy and nineteen similar observations are reported. This complication appears around 6 years after radiotherapy; its frequency increases with high radiations doses and associated chemotherapy. Weakening of the epiphyseal plate is probably involved whatever radiations voltages. Surgical treatments should be confined to epiphysis fixation. As this complication can secondarily affect the other hip, preventive controlateral fixation must be discussed.

Antineoplastic Agents↗

Paraaortic lymphadenectomy is not necessary in the treatment of localized paratesticular rhabdomyosarcoma.

Paraaortic lymphadenectomy is routinely recommended to treat paratesticular rhabdomyosarcoma (RMS) because of the high incidence of lymph node involvement. Taking into account the effectiveness of chemotherapy to sterilize micrometastases and aiming to reduce short-term and long-term side effects due to lymph node dissection, the RMS Group of the SIOP decided to avoid lymphadenectomy in Stage I paratesticular RMS defined by (1) complete tumor removal with negative cord section and (2) negative pedal lymphangiography. A series of 19 children (mean age 5 years, 6 months), treated between 1971 and 1981, were analyzed. Eighteen of 19 patients received adjuvant chemotherapy, using vincristine, actinomycin, cyclophosphamide, singly or alternately with vincristine, Adriamycin (doxorubicin) every 3 weeks. Duration was either 18 months (7 cases) or 8 months (11 cases). Fourteen patients are in first remission with a follow-up of more than 3 years (median 5 years); three are disease-free 35, 23, and 20 months since diagnosis; two patients are alive without evolutive disease, 32 and 56 months after an abdominal relapse. Results obtained in this series demonstrate the ineffectiveness of systematic paraaortic lymphadenectomy in Stage I paratesticular RMS and the effectiveness of chemotherapy to eradicate occult micrometastases, which obviously may exist in paraaortic lymph nodes in spite of apparently normal lymphographic findings.

Antineoplastic Combined Chemotherapy Protocols↗

Abdominal Burkitt-type lymphomas in Algeria.

In a previous retrospective analysis from the principal paediatric centres of Algeria, Burkitt-type lymphomas (BL) were shown to account for around 46.5% of the total childhood non-Hodgkin's malignant lymphomas in that country. In the present study, a series of 49 abdominal BL from the Paediatric Clinic of Surgery, Mustapha Hospital, Algiers, has been studied. The age distribution shows a peak between 4 and 5 years of age, and the sex ratio is (M:F) 2.26:1. The disease is characterized by a rapid evolution in the absence of therapy. The major problem is an explosive form of the disease, which at present seems difficult to control in this country. Fifteen of the 49 patients (30.6%) died before completion of the first course of chemotherapy; however, complete remission (CR) was obtained for 30 patients (61%). Overall survival was 42.85% (21/49), whereas survival of patients who reached CR is 70% (21/30). When CR was obtained, deaths were related to cerebrospinal fluid involvement, local recurrence, secondary bone marrow involvement or therapeutic accidents. All patients alive with no evidence of disease (NED) 8-months after CR can be considered definitively cured. Epstein-Barr virus (EBV) serology performed on 31 BL patients and on a control group of 25 children with other malignant tumours showed that most Algerian BL have elevated EBV titres. A search for viral markers within malignant cells in 17 patients indicated that 88% (15/17) of the BL cases were EBV-associated. Analysis of the immunological and cytogenetic data showed that, as in the rest of the world, these BL cases involve proliferation of B-cell-type lymphocytes, with characteristic cytogenetic translocations involving chromosome 8. This report represents the most detailed description so far of BL from an area in non-equatorial Africa and the first report of a large series from North Africa.

Abdominal Neoplasms↗