PubMed Health⌕ Search

Biomedical subjects

M C Douard

Publications and source records attributed to M C Douard.

At least 19 recordsLinked to original sources
PubMed2002

[Metabolic radiotherapy: what role will it have in 2001?].

Metabolic radiotherapy is a new therapy for management of bone pain in patients with bone metastatic prostate carcinoma. Strontium-89 and Samarium-153 concentrate in bone metastases and radiate them. A pain decrease is obtained in 60-70% of cases. Side effects are a significant hematological depression without great clinical consequences if good therapeutic indications are respected. Our multidisciplinary experience of these radionuclides in 54 performed treatments shows a rate of good responders of 66% with a rate of excellent results (total decrease of pain) in 47%. The therapeutic effectiveness is correlated with pain intensity measured by Visual Analogic Scale (VAS) and equivalent dose of morphine. Radionuclide therapy should be applied to patients as early as possible after establishment of bone metastases.

Adenocarcinoma↗
PubMed2001

Venous access port--related bacteremia in patients with acquired immunodeficiency syndrome or cancer: the reservoir as a diagnostic and therapeutic tool.

To describe the rate of response to an antibiotic-lock technique (ALT) in the treatment of venous access port (VAP)--related bacteremia and to analyze the role of the reservoir in the persistence of infection, we reported the data from 12 human immunodeficiency virus--infected and 8 oncologic patients with VAP-related bacteremia. The ALT consisted of intracatheter delivery of antibiotics and was associated with a systemic antibiotic infusion. We monitored clinical manifestations and performed qualitative and quantitative blood cultures during and at the end of the treatment. Four patients had catheters removed before antibiotic treatment. Of the 16 patients who were treated with the ALT, 5 (31%) were cured, as determined by negative cultures of blood and of samples from the catheter; 2 (12.5%) were cured but had recurrent infection with another microorganism; and 9 (56%) had persistent positive cultures of blood and of samples from the tip, reservoir, or both of the VAP. Limited efficacy of the ALT might be explained by the presence of deposits of fibrin that include clusters of bacteria inside the reservoir of the port.

AIDS-Related Opportunistic Infections↗
PubMed1999

Diagnosis of venous access port-related infections.

The accumulation of infected clots under the silicone septum of the reservoir of venous access ports (VAPs) has been reported. We analyzed the relationship between these deposits and the occurrence of VAP-related bloodstream infections (VAP-BSIs) by (1) evaluating the accuracy of paired quantitative blood cultures for diagnosing VAP-BSI before the removal of the device and (2) assessing the accuracy of cultures of the tip and septum (i.e., the internal lumen of the VAP) for diagnosing VAP-BSI after removal of the device. Over a 16-month period, all VAPs removed were prospectively investigated. Before VAP removal, paired quantitative blood cultures were 77% sensitive and 100% specific and had a positive predictive value of 100% and a negative predictive value of 98% for diagnosing VAP-BSI. After VAP removal, tip culture was only 46% sensitive, whereas septum culture was 93.3% sensitive for confirming the diagnosis of VAP-BSI. Thus infected deposits that accumulate under the VAP septum are the source of VAP-BSI.

Adolescent↗
PubMed1999

Long-term central venous catheter infection in HIV-infected and cancer patients: a multicenter cohort study.

OBJECTIVES: To evaluate and compare the risk of long-term central venous catheter (CVC) infection in human immunodeficiency virus (HIV)-infected and cancer patients. DESIGN: Prospective multicenter cohort study based on active surveillance of long-term CVC manipulations and patient outcome over a 6-month period. SETTING: Services of infectious diseases and oncology of 12 university hospitals in Paris, France. PARTICIPANTS: In 1995, all HIV and cancer patients with solid malignancy were included at the time of long-term CVC implantation. RESULTS: Overall, 31.6% of long-term CVC infections were identified in 32% of 201 HIV and 5% of 255 cancer patients. Most were associated with bacteremia, most commonly coagulase-negative staphylococci. The long-term CVC time-related infection risk was greater in HIV than in cancer patients (3.78 vs 0.39 infections per 1,000 long-term CVC days; P<.001). The independent risk factors of long-term CVC infection were as follows: in HIV patients, frequency of long-term CVC handling and neutropenia; in cancer patients, poor Karnofsky performance status; in both HIV and cancer patients, recent history of bacterial infection. The risk of long-term CVC infection was similar for tunneled catheters and venous access ports in each population. CONCLUSIONS: Prevention of long-term CVC infection should focus first on better sterile precautions while handling long-term CVC, especially in HIV patients who have frequent and daily use of the long-term CVC.

Bacteremia↗
PubMed1999

[Elements for a cost/utility analysis of long term intravenous devices].

Three long-term intravenous infusion strategies were compared, namely an implantable port (IP), a tunneled central catheter (TCC), and repeated peripheral catheterization (RPC). A decision analysis model was used in which the sequence of decisions and their possible consequences was described as a decision tree for each of the three strategies. The likelihood of each event occurring was determined based on a literature review. Each event was assigned a cost and a utility. Direct medical costs for the society include the cost of the material, the cost of implantation and removal of the device in the operating room, and the cost of treating complications directly ascribable to the strategy used. Utility is a combination of efficacy (as evaluated based on the likelihood of use of the strategy for one year) and quality of life (as evaluated by experts). In the basic analysis, RPC was the most cost-saving method but had an adverse effect on quality of life (0.82). The cost of using IC or TCC for one year was higher, with the main contributors to the excess cost being the insertion procedure and the management of complications (primarily deep vein thrombosis and infection). Quality of life was better with IC (0.98) than with TCC (0.93). IC also had a higher cost-utility ratio (11,738 French francs [FF]) versus 17,393 FF). A one-way sensitivity comparison of IC and TCC showed that the only realistic change capable of reversing the order between these two methods was a decrease by one-third in the risk of infection with TCCs. This model, used here for the first time, establishes that IC is superior over TCC.

Catheterization↗
PubMed1999

[Infectious complications of long term intravenous devices: incidence, risk factors, diagnostic tools].

Implantable venous ports and Hickman central venous catheters are widely used in patients with cancer, blood disorders, or HIV infection, both for in-hospital care and at home. Infectious complications are among the common causes for readmission in these patients. The present review discusses the incidence, risk factors, and diagnostic tools for infectious complications associated with long-term venous access devices.

Catheterization↗
PubMed1997

Catheter fragments embolization.

Although the use of central venous silicone catheters is widespread, little is known about the incidence of catheter rupture and embolization. Over a three-year period, 3916 silicone catheters were inserted in 3672 patients in the authors' hospital. Catheter or catheter fragments embolism occurred in 4 patients (1.2 embolizations per 1000 patients treated). Inappropriate mechanical deobstruction attempts resulted in 2 embolizations, and hence, these should be avoided. Chest roentgenography failed to detect the small fragments within the heart silhouette in 2 cases. Two-dimensional echocardiography showed the separated catheter fragment in all 4 cases. All four catheter fragments were subsequently removed from the right-heart chambers.

Adult↗
PubMed1996

[Pain in lumbar puncture. Results of a 2-year discussion at the French Society of Pediatric Oncology].

BACKGROUND: Lumbar puncture is a common procedure in pediatric onco-hematology. Repeated invasive painful procedures may contribute to increase distress displayed during medical treatment, and cause regression, depression and other psychological disorders. MATERIAL AND METHODS: A two-year workshop of the Société française d'oncologie pédiatrique was reviewed through a questionnaire assessing changes in technical management of lumbar puncture, local anesthesia, sedation and cognitive-behavioral interventions. RESULTS: Significant changes were found for pain assessment, local anesthesia procedures, and nitrous oxide administration. The extensive use of the Emla cream largely contributed to reduce pain. Anxiety however remained an unsolved problem, particularly among young children. CONCLUSION: Pain in pediatrics remains a major challenge. This workshop is a model of reflexion to achieve a better management of pain during invasive medical procedures.

Anesthetics, Local↗
PubMed1991

Quantitative blood cultures for diagnosis and management of catheter-related sepsis in pediatric hematology and oncology patients.

Paired quantitative blood cultures collected simultaneously via catheter and peripheral vein in Isolator 1.5 ml tubes, were performed in 50 febrile hematology children. Samples were taken to diagnose catheter-related sepsis (CRS) without catheter removal and to monitor the therapeutic efficiency of antimicrobials administered through the infected device by infusion and/or by the antibiotic lock technique (ALT). In 7 children (14%) the colony counts from catheter blood samples were 30-fold higher than the colony counts from peripheral samples, suggesting CRS; in 7 other patients (14%), identical colony counts in both samples suggested sepsis was not catheter-related. One patient (2%) had septicemia caused by E. coli found in the urinary tract; only the peripheral blood cultures were positive. In 6 patients (12%), the Isolator system was not effective for diagnosing bacteremia or CRS; in 29 patients (58%) the febrile episode was not microbiologically documented. All episodes of CRS were cured whatever the treatment was: infusion or ALT.

Anti-Bacterial Agents↗
PubMed1986

[Induction therapy of acute leukemia in children. Current results and problems related to therapeutic aplasia. Apropos of 146 cases].

Between 1983 and 1984, 146 children have been treated in the pediatric hematology department of Saint-Louis Hospital (Paris) for induction of acute leukemia (AL). 119 had an acute lymphocytic leukemia (ALL) and 27 an acute non lymphocytic leukemia (ANLL). The rate of complete remission was 94% for all patients (97% in ALL and 81.5% in ANLL). Fever occurred in 95% of children with positive blood cultures in one third on these. Four children died between the fifth and the twenty fifth days after onset of treatment from sepsis. One of these patients was a neonate with ANLL. 127 patients had a central venous line during induction used for blood sampling and treatment (chemotherapy, antibiotics, parenteral nutrition, platelets and red blood cells infusions). This supportive care is very important to improve prognosis of the AL particularly in very intensive chemotherapy.

Acute Disease↗
PubMed1985

[Central venous catheterization in pediatric hematology].

Central venous catheters (CVC) have proven to be a reliable route of the administration of chemotherapy, saline, blood cells and nutritional support in patients with malignant haematological disease. However, infection remained one of the most important causes of morbidity associated with this procedure. The aims of this study were a) to evaluate the efficacy of laminar air flow to prevent CVC infections, b) to study morbidity associated with polyethylene (PE) and silicone (S) catheters, and c) to evaluate the part played by increasing staff practice. 177 CVC were inserted in 170 children during a period of 20 months. Ages ranged from 5 months to 15 years (mean: 7 years). All the S CVC were tunnelled whereas, because of their rigidity, none of the PE CVC were. At the time of their removal, bacteriological samples from the CVC skin exit site, blood drawn through the catheter and the tips of these CVC were cultured. During the first period (one year), three groups of CVC were studied: in group 1, 37 S CVC in patients placed in a non-sterile ward; in group 2, 40 S CVC in children nursed under laminar air flow; in group 3, 60 PE CVC in patients of a non-sterile ward. During the second period (8 months), 40 new S CVC were inserted in children nursed in non-sterile wards, but after nursing staff training (group 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Epidermoid cysts of the spleen. Apropos of 2 cases].

The authors report two new cases of splenic epidermoid cyst. They stress the importance of sonography and the need for thorough examination of the surgical specimen for establishing the diagnosis. They also discuss several etiological hypotheses. Although uncommon, the possibility of an epidermoid cyst must always be considered once the echinococcal nature of the cyst has been ruled out, in all cases of splenic cysts in children or young adults.

Adult↗