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Biomedical subjects

R Touraine

Publications and source records attributed to R Touraine.

At least 19 recordsLinked to original sources
PubMed1992

l-folinic acid versus d,l-folinic acid in rescue of high-dose methotrexate therapy in children.

BACKGROUND: At this time, folinic acid (FA) is commercially available as the racemic mixture d,l-FA, whose biological activity is supported by natural l-FA. The administration of d,l-FA results in the accumulation of d-FA in plasma relative to the active l-FA form; in vitro studies have shown that d-FA can compete with the polyglutamation of methotrexate (MTX). PURPOSE: Our purpose was to compare, on a pharmacokinetic, biological, and clinical basis, the racemic mixture d,l-FA with the pure l-FA in rescue of high-dose MTX therapy (5 g/m2) in children with acute lymphocytic leukemia (ALL). METHODS: Eighteen children with ALL were entered in this trial, which was planned with a crossover design. Four cycles of MTX were administered to each patient, and rescue was achieved orally every 6 hours at a dose of 12 mg/m2 for d,l-FA and 6 mg/m2 for pure l-FA. The d,l-FA and l-FA rescues were alternated from one cycle to the next. d-FA, l-FA, and the active metabolite 5-methyltetrahydrofolate (5-MTHF) were measured in plasma using a stereospecific high-performance liquid chromatography assay. RESULTS: Considering total active folate levels (l-FA + 5-MTHF), mean residual concentrations were similar for rescue by d,l-FA and l-FA, after two and six intakes, respectively: 92 and 186 nM for d,l-FA rescue versus 100 and 184 nM for l-FA rescue. Intra-individual comparison of total active folates (l-FA + 5-MTHF) did not show any significant difference between d,l-FA rescue and l-FA rescue. After administration of d,l-FA, the accumulation of d-FA in plasma was confirmed. For both types of FA rescue, MTX terminal half-lives were identical (average value, 13.9 hours). Considering each type of toxic effect (hematologic, hepatic, renal, and digestive), there was no significant difference in the proportion of toxic cycles following l-FA rescue or d,l-FA rescue. CONCLUSION: The administration of the pure l-FA, compared with the administration of the racemic mixture, results in comparable blood profiles of active folates and MTX, leads to equivalent treatment tolerance, and avoids the plasma accumulation of d-FA.

Adolescent↗
PubMed1992

Sclerodermatous chronic graft-versus-host disease. Analysis of seven cases.

BACKGROUND: Sclerodermatous chronic graft-versus-host disease is a disabling complication after allogeneic bone marrow transplantation from HLA-identical sibling donors. Only a few series of patients have been reported and the dermatologic features have never been extensively described. OBJECTIVE: The purpose of the study was to describe clinical and biologic features of chronic sclerodermatous graft-versus-host disease and to compare them with scleroderma. METHODS: We reviewed 196 patients grafted between April 1973 and July 1987 with survival times sufficient to be at risk of chronic graft-versus-host disease. Seven had the sclerodermatous form. RESULTS: Most patients had disseminated sclerosis of the trunk and the proximal portions of the limbs. In two cases, atrophy of the skin was predominant, corresponding with a severe clinical evolution. Periorbital pigmentation was observed as an initial manifestation in three cases. Visceral manifestations resembled those observed in scleroderma but histologic and immunologic studies demonstrated clear differences. Response to therapy was variable. CONCLUSION: Chronic sclerodermatous graft-versus-host disease may realize two different patterns. Major atrophy is associated with a more severe progression.

Adolescent↗
PubMed1990

[Postoperative pyoderma gangrenosum and cancer of the breast. Apropos of a case].

Pyoderma gangrenosum (PG) consists of extensive necrotic ulceration with bluish and purplish red margins. This disease is often associated with ulcerative colitis, systemic, hematologic or rheumatic diseases. However post-surgical idiopathic PG can occur. One post-mastectomy case is reported. PG can first be suspected on clinical appearance and the lack of a specific etiology. PG is a diagnosis of exclusion that is made only after other possibilities have been ruled out. The treatment is surgical excision and systemic corticosteroids.

Adult↗
PubMed1990

[Dermatologists facing the risk of viral transmission. Analysis of the precautionary measures of 472 practitioners].

On the occasion of the "Journées Dermatologiques de Paris", in March 1988 we designed a survey to evaluate the sterile practices of French dermatologists in the "AIDS era". During the two days meeting, attended by 2,584 participants, 472 questionnaire forms were filled in (answer rate 18.5 p. 100). Among responders 43 p. 100 were exclusively office-based, 13 p. 100 only worked in hospitals, and 44 p. 100 were practicing both in office and hospital. The overall utilisation of gloves by French dermatologists remained highly variable, depending on the procedure. For example 6.7 p. 100 of responders reported never using gloves for excisions, 13 p. 100 for shave biopsies, 18 p. 100 for punch biopsies, 40 p. 100 for curettage and 47 p. 100 for electrocoagulation. Five per cent of the dermatologists surveyed did not sterilize their curettes regularly and 42 p. 100 their electrocoagulation needles. Heat sterilization was the most commonly used, in 69 p. 100 of cases for curettes and 42 p. 100 for electrocoagulation needles. On the other hand, chemical tray sterilization was used in 58 p. 100 of the cases for electrocoagulation needles, and in 31 p. 100 for curettes. For chemical sterilization, 63 p. 100 of responders used alcohol, 15 p. 100 glutaraldehyde, 15 p. 100 sodium hydrochloride, and 7 p. 100 other agents, mainly quartenary ammonium compounds. Twelve per cent of the physicians surveyed have adopted the practice of using a single electrocoagulation needle, belonging to each patient, for long term repeated procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1990

Prognostic factors and predictive signs of malignancy in adult dermatomyositis. A study of 32 cases.

Dermatomyositis (DM) is an inflammatory myopathy with a severe prognosis mainly determined by its association with malignancy. We present the results of a study of 32 adults with DM. Our aim was to define predictive signs of cancer and establish prognostic factors according to patient survival. Thirteen (41%) of the 32 patients had DM associated with malignancy. After 7 years of follow-up, the overall mortality rate was 52%. Mortality was higher for patients with malignancy. Cutaneous necrosis and an elevated erythrocyte sedimentation rate appeared as potential markers of associated malignancy. Classic signs of poor prognosis, such as age and association with cancer were found. Interestingly, extensive cutaneous lesions on the trunk and an elevated erythrocyte sedimentation rate were also more frequent among the patients who died. Our results demonstrate that selected groups of patients with DM, in part defined by cutaneous signs, have a poor prognosis.

Adult↗
PubMed1989

[Negativity of Borrelia burgdorferi serology in scleroderma en plaques].

The occurrence of morphea has been attributed to Borrelia, burgdorferi infection, but the relationship between localised scleroderma and borreliosis remains controverted. Antibodies directed against B. burgdorferi were looked for in 21 patients (18 female and 3 male, aged from 8 to 63 years) whose disease had been present for 6 weeks to 13 years. One patient had a single morphea, two had monomelic scleroderma and 18 had multiple localised morpheas. The search for antibodies was conducted in these 21 patients and in 200 blood donors from the Paris region by indirect immunofluorescence techniques, using the CDC method where only antibody titers of 1/256 or more are significant. Serology was lower than 1/256 in 20 cases and equal to 1/256 in one case. Among the 200 blood donors, five (2.5%) had antibody titers of 1/256 or more. None of the patients studied had been exposed to tick bite due to their occupation or place of residence. We therefore found no evidence of a link between B. burgdorferi infection and morphea in the Paris region.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Postoperative pyoderma gangrenosum and cancer of the breast. Apropos of a case].

Pyoderma gangrenosum (PG) is a extending necrotic ulceration with bluish and purplish red margins. This disease is often associated with ulcerative colitis, systemic, hematologic or rheumatic affections. However post-surgical idiopathic PG can occur. One post-mammectomy case is reported. PG can first be suspected on clinical aspect, lack of a specific etiology. PG is a diagnosis of exclusion that is made only after others possibilities are ruled out. The treatment is surgical excision and general corticotherapy.

Adult↗
PubMed1988

[Mucociliary function of 10 patients with ankylosing spondylarthritis with normal lung radiographs].

Bi-apical pulmonary fibrosis particular to ankylosing spondylitis is found in 1 to 10% of cases. The non-specific fibrosis or fibrosis of a more specific character such as iritis or the aortic disease are discussed. The fibrosis may be provoked by repeated infections which would favour an eventual hypoventilation at the apices secondary to the rigidity of the thoracic cage. To test this hypothesis we have studied muco-ciliary clearance in 10 subjects presenting with ankylosing spondylitis without any pulmonary radiological lesion and have compared these to 7 control subjects. No statistical difference was found in the clearance rate between the control subjects and the patients on the one hand (whether or not they had extra articular manifestations) and between the different areas of the lung (notably superior and inferior) in patients on the other hand. Thus this bi-apical fibrosis does not seem to explain the phenomena repeated infections at the apices which might have been favoured by any secondary deficiency in muco-ciliary clearance and hypoventilation of the apices. It seems most likely that the fibrosis has a specific origin related to the nature of the disease.

Adult↗