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Biomedical subjects

M Estève

Publications and source records attributed to M Estève.

14 recordsLinked to original sources
PubMed2006

Combined proton beam radiotherapy and transpupillary thermotherapy for large uveal melanomas: a randomized study of 151 patients.

INTRODUCTION: Exudation from the tumour scar and glaucoma can be major problems after proton beam irradiation of uveal melanoma and can sometimes lead to secondary enucleation. We conducted a randomized study to determine whether systematic transpupillary thermotherapy (TTT) after proton beam radiotherapy could have a beneficial effect. PATIENTS AND METHOD: Between February 1999 and April 2003, all the patients treated by proton beam radiotherapy for uveal melanomas >/=7 mm thick or >/=15 mm in diameter were included in this study after giving their informed consent. One half of the patients received proton beam radiotherapy alone (60 Gy in 4 fractions) and the other half received the same dose of proton beam radiotherapy followed by TTT at 1, 6 and 12 months. All the information concerning the initial tumour parameters, treatments and follow-up was recorded and a statistical analysis was performed. RESULTS: We randomized 151 patients. The median follow-up was 38 months. The 2 groups of patients were similar in terms of age, gender and tumour characteristics. The patients treated with TTT showed a greater reduction of tumour thickness (p = 0.06), less retinal detachment at the latest follow-up (p = 0.14) and a lower secondary enucleation rate (p = 0.02). DISCUSSION: The present study is the first randomized analysis to demonstrate a significant decrease in the secondary enucleation rate in patients treated with TTT after proton beam radiotherapy. Further studies should be performed to determine whether TTT could be beneficial to smaller tumours and to define its optimal dose.

Adult↗
PubMed2005

[Functional results of retinoblastoma treatment with local treatment used in isolation or associated with chemotherapy].

INTRODUCTION: Because of long-term complications of external beam radiation in retinoblastoma, a new therapeutic modality using chemotherapy and local treatments is used whenever possible. We conducted a retrospective study to evaluate visual results. PATIENTS AND METHOD: We studied visual acuity and ocular side effects in children presenting uni- or bilateral retinoblastoma in whom we were able to achieve conservative management without external beam treatment. The treatments that were used included chemotherapy, chemothermotherapy, diode laser, iodine 125 plaque brachytherapy, and cryotherapy. The initial characteristics (diameter, subretinal or vitreous seeding, and location) of each tumor, the treatments used, their results, and the visual function after age 4 years were recorded. RESULTS: We treated 429 children for retinoblastoma at the Curie Institute between October 1994 and December 2002. Two hundred twenty-seven eyes had conservative treatment without external beam. We were able to study the visual function in 102 eyes at a median age of 67 months. The median follow-up after the end of the treatment was 5 years. The mean visual acuity was 20/37 and 60% of the children had visual acuity of more than 20/40. Macular alteration was observed in 34 eyes. Statistical analysis showed that a larger tumor diameter of the retinal surface (p<0.0003) and location close to the macula (p<0.0001) were the most significant risk factors for vision loss. CONCLUSION: The visual results of the treatment of retinoblastoma by chemotherapy and local treatments is good when the tumors are not located close to the macula. Larger tumors also have a worse prognosis for vision.

Child, Preschool↗
PubMed1999

Positive effect of regional analgesia (RA) in terminal stage paediatric chondrosarcoma: a case report and the review of the literature.

A 10-year-old girl was treated for progressive left pelvic chondrosarcoma and severe local pain radiating to the ipsilateral lower extremity. Despite high doses of opioids, pain was poorly controlled and treatment resulted in urine retention and constipation. Positive effect on pain (143 out of 181 days) was obtained by regional analgesia. Continuous lumbar epidural opioid infusion led to pain relief and disappearance of symptoms. Port-catheter dysfunction necessitated a change of epidural catheter and the patient was treated that with morphine, bupivacaine and clonidine plus clonazepam which resulted in relief of constipation and restoration of urinary function. The patient subsequently developed an abscess required or subarachoid infusion (morphine associated with clonazepam, clomipramine and corticosteroids). Later bilateral controlateral cordotomy was performed due to absence of analgesia and the patient subsequently died of tumour progression.

Adrenal Cortex Hormones↗
PubMed1995

[Interactions between opioids and local anesthetics at the level of the dorsal horn of the spinal cord].

For many years, local anaesthetic drugs, given spinally, have been used to control pain after surgery or during parturition. For nearly 20 years, we have known that opioids given by the same way have an analgesic effect. However the later group do not provide satisfactory analgesia in several pain contexts but also give troublesome side effects; local anaesthetics are associated also with side effects. Experimental and clinical studies have shown that the combination of local anaesthetics with opioids provides some degree of synergism, associated with a reduction of side effects. Further studies are needed to confirm the analgesic benefit and the potential decrease of side effects, but also to determine the minimal effective dose regimen in relation with the type of pain.

Analgesics, Opioid↗
PubMed1995

[Reflex sympathetic algodystrophies. Preventive and therapeutic aspects].

Deafferentation syndromes have in common the existence of a physical injury and/or of a functional impairment of a nerve, either somatosensory afferent (Phantom Limb Pain) and/or sympathetic efferent (Reflex Sympathetic Dystrophy). These progressively debilitating syndromes are the witness of the absence of self-limitation of neuronal sensitization, which is normally the evolution of any painful stimulation of spinal cord neurons. To some extent deafferentation syndromes could be defined as a maladaptive neuronal plasticity. The lack of complete understanding of underlying pathophysiological mechanisms gives account of the wide variety of proposed treatments and of their unpredictable and variable efficacy. This fact is also due in part to the lack of controlled studies of most of the therapeutic propositions, whose purported efficacy is usually based on anecdotal reports. Finally, the role of prevention must be strongly emphasized, focusing, if those syndromes are likely to occur following surgery, on the importance of pre- and postoperative efficient analgesia, and also, possibly, on the preemptive role of regional anaesthetic techniques.

Anesthesia, Conduction↗
PubMed1994

"SUNCT" syndrome. A case of transformation from trigeminal neuralgia?

A patient with typical trigeminal neuralgia involving the first branch of the nerve developed short-lasting unilateral attacks in the same area which were associated with severe vasomotor phenomena consistent with the recently described SUNCT syndrome. This evolution suggests that SUNCT might correspond, at least in this case, to a "transformed" trigeminal neuralgia and emphasizes the close relationship between these unilateral facial pain syndromes.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1994

[Transcutaneous fentanyl].

Soon available in Europe, fentanyl transdermal system (Transdermal Therapeutic System: TTS fentanyl) is a new, easy and non invasive way for delivery of a strong opioid. Skin is not only a transit site for transdermal administered drugs, but is an active barrier and acts as a reservoir after removal of the delivery system. Use of transdermal fentanyl has first been studied for the treatment of postoperative pain. But the great latency of the kinetics of fentanyl by this way certainly moderates this indication. Latency is a much less important problem for chronic administration in cancer pain. This could be an interesting indication for TTS fentanyl. But there are still troubles in converting previous opioid therapy doses when initiating transdermal administration, and in controlling breakthrough pain, so common in cancer patients. Further clinical studies are needed to determine optimal conversion rules and elaborate guidelines for control of acute pain episodes with "rescue doses".

Administration, Cutaneous↗
PubMed1993

[Treatment of algodystrophies. The point of view of an anesthetist].

Algodystrophy is a complex and heterogenous syndrome, better defined as a subtype of Reflex Sympathetic Dystrophy syndrome (RSD). The pathophysiological theory of RSD has been supported by basic studies and clinical efficacy of sympathetic blocks. Results may be good, but some of RSD are not responsive to sympathetic blocks, and distinction between sympathetic dependent and independent pain has been proposed as subtypes of RSD. Physiotherapy is an essential part of RSD treatment. Sympathetic blocks and other analgesic therapies are performed in order to permit painless action of the physiotherapy against sick limbs stiffness. The rule must be: no painful physiotherapy. Use of other kind of drugs has yet to be defined. Calcitonin is potentially beneficial, but must be given in combination with blocks. Some new treatments rise interesting fundamental questions and some of them are under evaluation. Psychological support is the third part of treatment of these chronic pain patients. Multidisciplinary organisation, as offered by pain centers, can help to understand this syndrome and to elaborate guidelines for diagnosis, treatment and research programs.

Autonomic Nerve Block↗
PubMed1992

A comparative study of controlled-release morphine (CRM) suspension and CRM tablets in chronic cancer pain.

This study compared the efficacy and the adverse effects of controlled-release morphine (CRM) suspension (SAR 213) and CRM tablets (Moscontin) in the treatment of cancer pain. This multicenter, randomized, double-blind, double-dummy, crossover study was carried out on 52 patients. Each patient received both study treatments given at an equivalent dosage of morphine during each of two 7-day periods. The primary outcome variable was the severity of pain assessed three times daily by means of a visual analogue scale. Secondary criteria of efficacy were the severity of pain assessed by verbal rating scale, the need for "rescue" doses of immediate-release morphine, treatment preference, and indices of quality of life (activity, mood, sleep). There were no statistically significant differences in the parameters assessed when comparing the two groups. This study shows that, when prescribed at the same doses, CRM suspension and CRM tablets have similar efficacy and adverse effects, as well as the same duration of action. The results of this first clinical study carried out on CRM suspension are especially relevant for patients with cancer pain who have difficulty swallowing.

Delayed-Action Preparations↗
PubMed1990

[Continuous block of the femoral nerve after surgery of the knee: pharmacokinetics of bupivacaine].

Ten ASA Class 1 and 2 patients, aged from 16 to 56 years (mean +/- SD: 37 +/- 17 years), scheduled for knee surgery were studied. At the end of the surgical procedure under general anesthesia, an epidural catheter was inserted in the femoral space. After X-ray opacification, a bolus of 2.5 mg.kg-1 of 0.5% bupivacaine with epinephrine was injected. A maintenance infusion was performed during 48 hours with 0.25 mg.kg-1.h-1 of 0.125% bupivacaine without epinephrine. Pain score recorded with an visual analogue scale was 5.0 +/- 1.9 before femoral block. Pain score decreased significantly from 6 to 48 hours. Plasma bupivacaine levels at 24, 36 and 48 hours were significantly higher than the levels obtained at 30 min, 1, 6 and 12 hours. Mean plasma bupivacaine level at steady state was 1.78 +/- 0.59 micrograms.ml-1. Clearance of bupivacaine was 2.59 +/- 0.91 ml.min-1.kg-1. No neurologic complications have been recorded.

Adolescent↗
PubMed1985

[Chemotherapy via tunneled central venous catheter left in place between drug courses. Prospective study in 98 ambulatory patients].

Chemotherapy is normally given during several months and requires a good vascular access. Repeated injections of cytotoxic agents are harmful for peripheral veins. We report here a prospective study on 98 ambulatory patients provided with a tunneled central venous catheter left in situ between drug administration. The catheter is inserted either in the subclavian or the internal jugular vein. Between chemotherapy drugs injection, heparin is given once a week in the catheter. Among the several advantages reported with this technique: easiness of drug injection, comfort of patients, possibility of new insertions in an other site in case of occlusion and the low cost. This technique is a "routine" at the Institut Curie since 5 years. Advantages and side effects of this technique are compared with arterio-venous shunting or totally implantable devices used by other authors.

Antineoplastic Agents↗
PubMed1978

[A study of two proteins associated with pregnancy. HPL and SPI glycoprotein, in the serum of 692 pregnant women (author's transl)].

The authors study the evolution of the levels of two proteins found in pregnancy (HPL and SP1 glycoprotein) in the serum of 692 pregnant women. They establish normal and pathological zones. They study particular cases (twins, hydramnios and kidney pathologies). The relationships between fetal distress, maturity, and the fetal weight at birth are analysed.

Birth Weight↗
PubMedDate not supplied

[Liver tumors around the vena cava. Strategy for surgical approach of segments I and IX].

The technical problems raised by the delicate surgery of tumours of the liver developing around the vena cava, with and without invasion of segments I and IX was studied on the basis of 7 cases reports. The intra- or extra-hepatic pedicule route, the denudation of the entire retrohepatic vena cava, and the clamping needed for exsanguinous surgery are presented together with future perspectives including 3-D liver imaging, stimulation of liver regeneration potential and ex-vivo techniques are discussed with the aim of more and more carcinological liver surgery.

Aged↗