PubMed Health⌕ Search

Biomedical subjects

N Girard

Publications and source records attributed to N Girard.

At least 19 recordsLinked to original sources
PubMed2007

[Chemoradiation for locally advanced non-small cell lung cancer].

Chemoradiation is one of the major therapeutic options in thoracic oncology: besides surgery, the best treatment for early-stage tumors, and chemotherapy, not only used in metastatic tumors, but also in a neoadjuvant and adjuvant setting, chemoradiation is the standard strategy for unresectable locally advanced non-small cell lung cancer. Its current modalities include three-dimensional conformal techniques, allowing dose escalation and sequential and concurrent combination with new generation cytotoxic agents to occur. Phase III trials are currently evaluating the benefit from induction and consolidation chemotherapy in this setting. New techniques of radiation may also increase the efficacy and the feasibility of radiation. This constant progress makes chemoradiation one of the most promising combined treatments in thoracic oncology.

Antineoplastic Agents↗
PubMed2007

[Therapeutic strategies in superior sulcus tumors: a model for combined modality therapy in non-small cell lung cancer].

Superior sulcus tumors have been individualized among other non-small cell lung cancers because of their characteristic clinical presentation in connection with their local extension to the chest wall and the brachial plexus. For a long time considered as marginally resectable, superior sulcus tumors have been treated since the early 1960's, with a combined approach including preoperative radiotherapy and curative-intent surgery. Surgical resection includes both thoracic, cervical and neurosurgical approach, and aims at obtaining complete resection, which has been identified as a determining prognostic factor in most reported series. Two recent phase II trials showed the benefit, both regarding resectability and local control rates, and survival of combined therapeutic strategies including induction platinum-based chemoradiation, extensive surgical resection, and adjuvant chemotherapy. Adjuvant radiotherapy is not recommended at the time, but needs to be re-evaluated regarding its recent technical optimisation. Similarly to other locally advanced non-small cell lung cancers, exclusive chemoradiation is the standard treatment of unresectable superior sulcus tumors. In this way, radiotherapy has shown to offer a prolonged analgesia in more than 75% of cases, and is associated with concurrent or sequential chemotherapy, with comparable results to those observed in stage III lung cancer. These developments make superior sulcus tumors a therapeutic model for locally advanced non-small cell lung cancer, whereby the benefit of combined multimodal strategies including induction chemoradiation and surgical resection are currently evaluated in phase III trials.

Carcinoma, Non-Small-Cell Lung↗
PubMed2006

[Neoadjuvant chemoradiation in non-small cell lung cancer].

In 2006 preoperative chemoradiation is a major part of the treatment of stage III locally advanced non-small cell lung cancer. Previous studies have clearly demonstrated the feasibility both regarding toxicities and resectability rates of the sequential and concurrent combination of radiation to chemotherapy in a neoadjuvant setting. However, induction chemoradiation has never been randomly compared to exclusive preoperative chemotherapy. Besides, the doses of radiation and the optimal drug combination remain undetermined at the time. Regarding the global therapeutic strategy of stage III non-small cell lung cancer, recently reported phase III trials evaluating the role of surgical resection after induction chemotherapy or chemoradiation, all showed the prognostic importance of the tumoral and mediastinal downstaging to select patients really benefiting from surgery. These developments make of the treatment of locally advanced non-small cell lung cancer a model for multimodal therapeutic strategies combining chemotherapy, radiotherapy and surgery.

Antineoplastic Agents↗
PubMed2006

[Surgery and chemoradiation in stage IIIA non-small cell lung cancer].

Combination of surgery and radiotherapy has become a standard regimen in multiple cancers. Because of its toxicity and the higher metastatic potential of lung cancer, leading to underestimate the impact of loco-regional treatments, this strategy is currently used only in a clinical trial setting. Recent results from phase III studies comparing surgery and radiotherapy in stage IIIA-N2 locally advanced non-small cell lung cancer after induction treatment showed that surgery should only be performed in patients presenting with a major mediastinal downstaging and possible curative resection within a lobectomy. In all other cases, exclusive chemoradiation remains the therapeutic standard at the time. In this way, all patients with stage III non-small cell lung cancer may receive induction treatment, consisting either in chemotherapy or in sequential or concurrent chemoradiation, which has shown its feasibility and its efficacy regarding tumor response, resectability and local control rates. These two induction regimens are currently compared in randomized trials including stage III resectable and unresectable tumors at time of diagnosis. These developments make treatment of locally advanced non-small cell lung cancer a model for multimodal strategies in oncology, combining chemotherapy, radiotherapy and surgery.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

Gemcitabine and radiation therapy in non-small cell lung cancer: state of the art.

Stage III non-small cell lung cancer (NSCLC) treatment is evolving. There are several choices available regarding which chemotherapy to use and how to optimally combine them with radiotherapy. Gemcitabine (Gemzar, Eli Lilly and Company, Indianapolis, USA) is a chemotherapeutic agent with activity in NSCLC, and preclinical studies have shown that gemcitabine is a potent radiosensitizer. These two characteristics make gemcitabine a potential option when treating patients with stage III NSCLC. This review article describes the efficacy and tolerance of gemcitabine when combined with radiation in those patients. Gemcitabine used concurrently with radiation, as an induction regimen before radiation, and as a consolidation regimen after radiation is reviewed.

Antineoplastic Agents↗
PubMed2006

Fetal magnetic resonance hydrography: evaluation of a single-shot thick-slab RARE (rapid acquisition with relaxation enhancement) sequence in fetal thoracoabdominal pathology.

OBJECTIVES: To evaluate the potential of a single-shot thick-slab RARE (rapid acquisition with relaxation enhancement) sequence in fetal thoracoabdominal magnetic resonance (MR) examinations compared with multislice T2-weighted sequence and postnatal imaging. METHODS: RARE sequence is rapid and provides very heavily T2-weighted images. Twenty-seven fetal thoracoabdominal MR imaging examinations were performed at 23-38 weeks using our conventional protocol. This included thin multislice T2-weighted half-Fourier acquired single-shot turbo spin-echo (HASTE) sequence and thin-slice GE (gradient echo) T1-weighted images with a 1.5-T MR unit. A single-shot thick-slab (60 mm) RARE sequence was added to all MR examinations. The acquisitions were obtained with the mother breath-holding. The thick-slab heavily T2-weighted images were compared with HASTE sequence images and with postnatal imaging in all cases. RESULTS: The thick-slab RARE sequence did not show additional abnormalities compared with the conventional protocol but displayed an overall view of the urinary tract, tracheobronchial tract and small bowel. It gave information that was highly correlated with postnatal imaging, such as abdominal plain films, chest film or cystography. The quality of the thick-slab RARE images was considered as good in 13 cases (48%), moderate in 12 cases (45%) and poor in two cases (7%). CONCLUSION: Although thick-slab RARE sequence does not show additional abnormalities compared with the conventional protocol, it illustrates very nicely static fluids such as those in urinary dilatation, the esophagus and small bowel (normal or dilated) and thoracic cystic masses. It is very rapid (5 s) to perform, allows fetal hydrography, and correlates well with postnatal imaging.

Adult↗
PubMed2006

[Study of 3 white matter fiber trackings using MRI diffusion].

UNLABELLED: The aim of this study is to evaluate the interest of diffusion weighted MRI for the study of white matter fiber tracking. METHODS: Fifteen subjects having undergone diffusion weighted MRI have been included. Three white matter fiber trackings have been studied for each subject: interhemispheric transcallosum, optic radiations and pyramidal tracts. The results were compared to an atlas of human anatomy. RESULTS: All the white matter tracts studied have been visualized. The morphology of the three white matter tracts was similar to standard anatomy. The orientation of the three white matter tracts was determined in 100% of the cases. CONCLUSION: diffusion weighted MRI allowed the morphological study of all the analyzed white matter tracts. This technique might, therefore, help to evaluate nerve fiber tracts and guide neurosurgical interventions.

Brain↗
PubMed2005

Delineation of the clinical phenotype associated with OPHN1 mutations based on the clinical and neuropsychological evaluation of three families.

Recent reports have demonstrated that mutations in the OPHN1 gene were responsible for a syndromic rather than non-specific mental retardation. Abnormalities of the posterior fossa with cerebellar hypoplasia have been demonstrated in all male patients reported to date. We report here a new family with X-linked mental retardation due to mutation in OPHN1 and present unpublished data about two families previously reported, concerning the facial and psychological phenotype of affected males and carrier females. Our study confirms that cerebellar hypoplasia is a hallmark of this syndrome. In addition, affected males display facial similarities that can help the diagnosis. Most carrier females have mild mental retardation and subtle facial changes.

Cytoskeletal Proteins↗
PubMed2005

[Tolerance and efficacy of conformal radiotherapy for hepatocellular carcinoma in cirrhotic patients. Results of the French RTF1 phase II trial].

PURPOSE: While some patients presenting with hepatocellular carcinoma (HCC) benefit from curative therapies (transplantation, surgery, percutaneous ablation), others are only candidates for palliative options such as chemoembolization or symptomatic care. Although conventional external-beam radiotherapy of the liver is regarded as little efficient and potentially toxic in cirrhotic patients, 3-dimensional conformal radiotherapy (CRT), by decreasing the amount of normal liver included in the radiation portal, allows dose escalation to occur without increasing the risk of radiation-induced hepatitis. This trial was designed to assess the efficacy and tolerance of CRT for small-size HCC in cirrhotic patients. PATIENTS AND METHODS: Prospective phase II trial including stage A/B cirrhotic patients with small-size HCC not suitable for curative treatments; CRT consisted in a standard fractionation radiation, with a total dose of 66 Gy. RESULTS: Twenty-seven patients were included, 15 of whom had previously been treated for HCC; mean age was 68. Among the 23 assessable patients, 18 (78%) presented with complete response, 3 (13%) with partial response, and 2 with no response. Acute complications occurred in 24 patients, and were mainly acceptable (grade 1/2: 22 patients, grade 3/4: 11 patients, 4 (15%) of whom had clinical and/or hematological toxicities). Only 2 (9%) grade 3/4 clinical and/or hematological late toxicities are reported. CONCLUSION: CRT is a non-invasive curative technique highly suitable for small-size HCC in cirrhotic patients; further investigations are needed to compare it to the other available treatments, and to integrate it into the curative therapeutic algorithm of HCC.

Aged↗
PubMed2005

[Consumption of hand-hygiene products in health establishments in the west of France].

OBJECTIVES: The study had for aim to investigate hand hygiene product use in French hospitals between 2000 and 2003. DESIGN: A questionnaire was sent in 2002 and 2 more in 2003 and 2004 (for 2000 to 2003) requiring data on type of hospital, number of beds, staff members, admissions and patient-day, litres of mild soap, antiseptic soap and alcohol-based rub used and price per litre. Indices were calculated accordingly. RESULTS: 574 hospitals answered over the 4 year period (average 143 per year) representing an average of 50 000 beds/year, 80 000 full-time staff positions, 1.2 million admissions and 16 millions patient-days. The median consumption of mild soap was 3.8 l per bed, 2.7 l per staff member, 2.4 l per 100 admissions, and 10.6 ml per patient-day. The median consumption of antiseptic soap was 1 l per bed, 0.8 l per staff member, 4.8 l per 100 admissions, and 3.2 ml per patient-day. The median consumption of alcohol-based rub (HAS) was 0.3 l per bed, 0.3 l per staff-member, 1.5 l per admission, and 0.9 l per patient-day. Between 2000 and 2003, HAS use significantly increased from 69 to 88% (a relative increase of 31%) and the median consumption increased from 0.5 ml to 1.5 ml per patient-day. 370 fully completed grids gave a number of 7 opportunities per patient-day with less than 1 for HAS. CONCLUSION: The best indicator for an infection control practitioners is the quantity of alcohol-based solution in ml/patient-day and HAS per patient-day is the reference.

Alcohols↗
PubMed2005

[Pediatric supratentorial oligodendrogliomas: Marseilles and Lyons experiences].

BACKGROUND AND PURPOSE: The goal of this study was to analyze the main aspects of oligodendrogliomas observed in children. METHOD: The records of 35 children aged 15 years or younger (23 from Marseilles and 12 from Lyons) were reviewed. Clinical signs and symptoms, imaging findings (CT scan and pre- and post-operative MRI), extent of surgical resection, histology according to the WHO and Ste-Anne grading and survival were analysed. Considering all these factors, a statistical analyzis was undertaken in order to identify prognostic factors. DISCUSSION AND CONCLUSION: Oligodendrogliomas are rare tumors in children. The most important differential diagnosis to discuss is dysembryoplastic neuroepithelial tumor. Our study allowed us to distinguish several subgroups of patients with a different prognosis: thalamic tumors with a dismal prognosis versus hemispheric tumors. A group of cortical tumors we called "DNT-like" (hemispheric cortical tumor, isolated epilepsy, without neurological deficit and reased ICP, without edema and mass effect on MRI) with an excellent prognosis like the group with epilepsy. Histological grading (grade A/grade B and grade II/grade III) is also a prognostic factor.

Adolescent↗
PubMed2005

[Imaging features of neurofibromatosis type 2].

Neurofibromatosis type 2 (NF2) is a separate entity from von Recklinghausen's disease (NF1) and is much less frequent than NF1. The major feature of NF2 is the presence in nearly all affected individuals of bilateral vestibular schwannomas. Imaging of the entire central nervous system is necessary, including evaluation of the cerebral parenchyma, the pontocerebellar angles, the spinal cord as well as the lumbar nerve roots, because the affected individuals can develop tumours from schwann cells, meningeal cells and from ependymocytes.

Central Nervous System Neoplasms↗
PubMed2004

Fetal brain injury.

Improvements in MRI techniques widen the indications for fetal brain imaging and fetal brain injury represents the third indication of fetal brain magnetic resonance imaging (MRI) after the evaluation of suspected central nervous system (CNS) malformations and ventricular dilatation. Optimal MR imaging technique is necessary in order to collect as much data as possible about the fetal brain. Diffusion images can be used routinely in addition to the standard protocol of fetal brain MRI that consists of T1 and T2 weighted images of the fetal brain. Monovoxel proton magnetic resonance spectroscopy can also be performed in utero, but this technique is still more part of research protocol than of routine clinical protocol. Fetal brain injury includes hypoxia-ischemia, congenital infections (especially toxoplasmosis and cytomegalovirus infections), brain damage due to malformation such as vascular brain malformation and heart malformation, pregnancies at risk of fetal brain damage, and even inherited metabolic diseases, especially mitochondrial diseases. MRI findings in fetal brain injury consist of acute or chronic lesions that can be seen alone or in combination. Acute response of the fetal brain is less commonly seen than the chronic response compared to the brain response encountered in the postnatal period.

Brain Injuries↗
PubMed2004

[French experience of gefitinib in non-small cell bronchial carcinoma].

INTRODUCTION: Gefitinib (Iressa, ZD 1839; AstraZeneca) is a selective Epidermal Growth Factor receptor tyrosine kinase inhibitor. In two randomized phase II trials (IDEAL 1 and IDEAL 2), it has demonstrated an activity against NSCLC, showing partial response and symptoms improvement rates respectively in about 20% and 40% of patients. Multivariate analyses revealed that being a woman, a non-smoker and having an adenocarcinoma was associated with response rate. METHODS: We describe a retrospective study of patients receiving Gefitinib as a third line compassionate treatment of NSCLC. RESULTS: We enrolled 37 patients (29 men, 8 women). Tumors included 25 adenocarcinoma, 4 squamous cell carcinoma, 7 large cell carcinoma, and 1 neuroendocrine carcinoma. Partial response rate was 8.1%, and stable disease rate 27.0%. The 3 responders were all non-smoker women, with an histological type of adenocarcinoma. Symptoms improvement was observed in 59.5% of patients. Main toxicities were diarrhoea and skin reactions. We observed that responding patients had more adverse drugs-related reactions than stable or non-responding patients. CONCLUSIONS: Gefitinib is a meaningful active therapy in NSCLC with a favorable toxicity profile. We suggest that being a woman, a never-smoker and having an adenocarcinoma may be clinical predictive factors of response to Gefitinib.

Adult↗
PubMed2004

[Opportunistic infections and sarcoidosis].

INTRODUCTION: In spite of CD4+ T-lymphocytopenia and corticosteroids-induced immune suppression, the risk of opportunistic infection is not usually considered to be increased in sarcoidosis. METHODS: We describe 5 cases of opportunistic infection in patients with sarcoidosis and CD4+ T- lymphocytopenia. A systematic review of the literature was done. RESULTS: We describe 2 cases of chronic necroziting aspergillosis, one case of Mycobacterium avium complex pneumonia, one case of pneumocystis pneumonia, and one case of cryptoccocal meningitidis in five patients with sarcoidosis. Four patients were receiving corticosteroids at time of diagnosis. Four patients had CD4+ T-lymphocytopenia. In the literature, we documented 65 cases reports of sarcoidosis complicated by opportunistic infection. At the time of infection diagnosis, 36 patients were receiving corticosteroids. CD4+ T-lymphocytopenia was present in 5 of 11 reported cases. Cryptococcosis was the most common reported infection. CONCLUSION: Opportunistic infectious complications are rare in patients with sarcoidosis. Opportunistic infections mainly occur in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Except for cryptococcosis, sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.

Adrenal Cortex Hormones↗
PubMed2003

[Imaging of neonatal neurological disorders].

Neonatal brain disorders consist of a wide chapter including brain malformations, hypoxic-ischemic encephalopathy, intracranial infections, perinatal trauma and metabolic encephalopathies. The aim of this review paper is to describe the main imaging modalities (ultrasonography, CT, MRI) that are used extensively for the diagnosis of neonatal brain disorders, with their respective advantages and limitations, to illustrate and describe the main brain lesions encountered in the neonatal period, particularly with MRI since its role has increased over the recent years. We will focus on hypoxic-ischemic encephalopathy, materno-fetal infections, metabolic encephalopathies and stroke, those four conditions being the most frequent so far. Imaging modalities, especially MRI, by showing the extent of brain damage, are part of the prognostic factors in cases of infective causes and of hypoxic-ischemic origin. MRI is also very efficient in showing brain damage as atrophy and white matter abnormalities suggestive of an underlying abnormal brain of metabolic origin.

Age Factors↗
PubMed2003

[MRI and in utero ventriculomegaly].

Ventriculomegaly constitutes the major indication of fetal brain MRI. MRI is therefore of utmost importance to look for a cause through the depiction of criteria of malformations and through the definition of criteria of destructive lesions. Malformations and destructive lesions are the most common causes of ventricular dilatation. Some challenging points are worth mentioning in term of mechanism with the challenge of hydrocephalus (in term of increased in intracranial pressure) and of isolated ventriculomegaly. The image itself is also challenging since a similar image may be of different origin. In term of natural history of fetal brain injury an irregular, nodular aspect of the ventricular wall and/or the germinal matrix is often the only pathologic MRI finding that is known to be of clastic origin. In term of prognosis the challenge is represented by the isolated mild ventriculomegaly, the literature being quite confusing. The purpose of this review paper is to highlight the underlying mechanisms and pathophysiology of ventricular dilatation based on results from the literature as well as from personal experience.

Cerebral Ventricles↗