Biomedical subjects

A Flahault

Publications and source records attributed to A Flahault.

At least 73 records · Page 4Linked to original sources

PubMed1999

Effect of aspirin in pregnant women is dependent on increase in bleeding time.

OBJECTIVES: Randomized trials with low-dose aspirin to prevent preeclampsia and intrauterine growth restriction have yielded conflicting results. In particular, 3 recent large trials were not conclusive. Study designs, however, varied greatly regarding selection of patients, dose of aspirin, and timing of treatment, all of which can be determinants of the results. Retrospectively analyzing the conditions associated with failure or success of aspirin may therefore help to draw up new hypotheses and prepare for more specific randomized trials. STUDY DESIGN: We studied a historical cohort of 187 pregnant women who were considered at high risk for preeclampsia, intrauterine growth restriction, or both and were therefore treated with low-dose aspirin between 1989 and 1994. Various epidemiologic, clinical, and laboratory data were extracted from the files. Univariate and multivariate analyses were performed to search for independent parameters associated with the outcome of pregnancy. RESULTS: Age, parity, weight, height, and race had no influence on the outcome. The success rate was higher when treatment was given because of previous poor pregnancy outcomes than when it was given for other indications, and the patients with successful therapy had started aspirin earlier than had those with therapy failure (17.7 vs 20.0 weeks' gestation, P =.04). After multivariate analysis an increase in Ivy bleeding time after 10 days of treatment by >2 minutes was an independent predictor of a better outcome (odds ratio 0.22, 95% confidence interval 0.09-0.51). Borderline statistical significance was observed for aspirin initiation before 17 weeks' gestation (odds ratio 0.44, 95% confidence interval 0.18-1. 08). Abnormal uterine artery Doppler velocimetric scan at 20-24 weeks' gestation (odds ratio 3.31, 95% confidence interval 1.41-7.7), abnormal umbilical artery Doppler velocimetric scan after 26 weeks' gestation (odds ratio 37.6, 95% confidence interval 3.96-357), and use of antihypertensive therapy (odds ratio 6.06, 95% confidence interval 2.45-15) were independent predictors of poor outcome. CONCLUSIONS: Efficacy of aspirin seems optimal when bleeding time increases >/=2 minutes with treatment, indicating a more powerful antiplatelet effect. This suggests that the dose of aspirin should be adjusted according to a biologic marker of the antiplatelet effect. A prospective trial is warranted to test this hypothesis.

Adult↗

PubMed1999

How do general practitioners approach hepatitis C virus screening in France?

To estimate the prevalence of infection by hepatitis C virus (HCV) in general practice, and to investigate attitudes to screening for HCV, a specific questionnaire was sent to the sentinel general practitioners (SGPs) of the French Sentinel Network. From the figures reported by SGPs, the number of anti-HCV tests performed in general practice during the six months before the survey (July December 1994) was extrapolated to about 350,000 tests for the whole of France during all of 1994 (95% CI: 314,000 382.000). Of the 312 participating SGPs, 224 (72%) had prescribed at least one anti-HCV test during these six months. and 217 (70%) knew of at least one anti-HCV-positive patient in their practice. With regard to their screening attitudes. 244 SGPs (78%) said they had prescribed anti-HCV tests for patients with no signs of previous or recent hepatitis infection; SGPs who had at least two HCV-positive patients in their practice were more likely to screen for anti-HCV than SGPs who did not (94% vs. 72%, p < 0.001). The main reason for prescription were that patients had an anti-HIV-positive status, were intravenous drug users and/or were blood transfusion recipients. For the 88 SGPs who had not prescribed any anti-HCV test during the six months before the study, the main reasons given were that few patients were at risk in their practice (81 SGPs) and that the risk factors for HCV infection were not well known (12 SGPs). Only 6 SGPs gave the absence of effective treatment as a reason for non-prescription. From the figures reported by SGPs, we extrapolated to 100,000 (95% CI: 90,000-110.000) the number of anti-HCV-positive patients known by the 52,000 French general practitioners in 1994. These results indicate that the Sentinel network may be a useful tool for assessing the evolution of attitudes to HCV screening in general practice.

Adolescent↗

PubMed1999

Impact of guidelines implemented in a paris university hospital: application to the use of antiemetics by cancer patients.

AIMS: To assess the impact with time of guidelines on antiemetic use in an 850-bed Paris university hospital with a high proportion of cancer patients. METHODS: Guidelines on the use of antiemetics available in cancer chemotherapy were drafted according to the Delphi technique. Their implementation was based upon a patient-specific antiemetic prescription form. To assess the impact of guideline implementation over time, discrepancies between current practice and the guidelines were compared before guideline implementation (between March and August 1995) and after implementation (between March and August 1997, and March and August 1998). RESULTS: Before the Delphi panel's guidelines were implemented, 5-HT3 antagonists were inappropriately administered in 70% of cases. After guideline implementation, this proportion dropped significantly (P<0.0001, Fisher's exact test) to 22% between March and August 1997 and 28% between March and August 1998. CONCLUSIONS: Implementation of guidelines seems to have resulted in significant changes with time, although a causal relationship has not been demonstrated. The development of guidelines by our hospital's multidisciplinary working group helped the various consultants to adjust medical practices to take account of these changes.

Academic Medical Centers↗

PubMed1999

Diarrhoea-related morbidity and rotavirus infection in France.

To assess the importance of diarrhoea in France and, specifically, rotavirus-related diarrhoea among children, we reviewed data obtained from three complementary sources: (1) general practitioner (GP) sentinel surveillance; (2) hospital discharge data from paediatric hospitals; and (3) laboratory based surveillance. The GP sentinel network is based on 500 physicians who electronically notify new cases of eight illnesses, including diarrhoea, each week. It was estimated that about 3.3 million patients seek medical attention for diarrhoea from their GP each year, with a winter outbreak associated with an increased rate of isolation of rotavirus. A national system of hospital discharge diagnosis was used to estimate the burden of diarrhoeal morbidity in two paediatric wards in Tours, France. Between 1994 and 1996, 1164 patients under 15 y of age (9.7% of all admissions) were admitted for diarrhoea, of whom 83% were reported as having viral gastroenteritis; 14.3% were dehydrated and 52% were under 1y old. Hospital admissions had a seasonal pattern similar to notifications from sentinel GP for children under 5 y old. A centralized laboratory surveillance network representing 17 of the 22 French regions describes a rotavirus outbreak each winter that is concomitant of outbreaks detected by the GP sentinel network and seen in hospitals. Most of the isolates (98%) identified through this surveillance system are among children under 5y of age. All the data reviewed in this study indicate that the epidemiology of rotavirus diarrhoea in France fits well with what has been reported in other developed countries.

Adolescent↗

PubMed1999

AIDS-related Pneumocystis carinii pneumonia in the era of adjunctive steroids: implication of BAL neutrophilia.

Factors predictive of mortality in patients with AIDS and Pneumocystis carinii pneumonia (PCP) were identified before the introduction of adjunctive steroids, but they have not been reevaluated since. Because PCP still occurs in AIDS, remaining fatal in some cases, we conducted a multivariate analysis of factors predicting mortality in patients with HIV-positive PCP managed from 1990 to 1995, i.e., after the consensus conference on the use of adjunctive steroids. The predictive value of clinical, laboratory, and bronchoalveolar lavage (BAL) data at admission and during the course of PCP was studied retrospectively using multivariate methods, in 144 patients with AIDS. Overall mortality was 21.5%. The univariate analysis identified seven factors predictive of 90-d mortality: Pa(O(2)) on room air < 60 mm Hg, lactate dehydrogenase > 1,000 IU, albuminemia < 30 g/L, BAL neutrophilia > 10%, nosocomial infection, pneumothorax, and a need for mechanical ventilation. Four of these factors were independently associated with 90-d mortality in the multivariate analysis; among them, two were evaluable at admission, namely, Pa(O(2)) < 60 mm Hg on room air and BAL neutrophilia > 10%, and two during hospitalization, namely, the development of pneumothorax and a need for mechanical ventilation. Moreover, BAL neutrophilia was correlated to occurrence of pneumothorax and a need for mechanical ventilation. In the era of adjunctive steroid use, AIDS-related PCP remains fairly common. Two independent factors evaluable at admission, Pa(O(2)) on room air and BAL neutrophilia, are predictive of death.

AIDS-Related Opportunistic Infections↗

PubMed1999

Reactive oxygen and nitrogen intermediates increase transforming growth factor-beta1 release from human epithelial alveolar cells through two different mechanisms.

Transforming growth factor (TGF)-beta1 is a growth factor involved in the mechanisms of lung repair and fibrosis that follow inflammatory processes. We sought to examine the link between the generation of reactive oxygen intermediates (ROI) or reactive nitrogen intermediates (RNI) by inflammatory cells and the expression of TGF-beta1 by alveolar epithelial cells. Exposure of the A549 lung epithelial cell line to either an ROI generating system (xanthine and xanthine oxidase) or an RNI donor (S-nitroso-N-acetyl-penicillamine [SNAP]) promoted a time- and dose-dependent increase in TGF-beta1 release, as measured by a specific enzyme-linked immunosorbent assay. At the peak, the levels of TGF-beta1 were twice the control values. The induction of TGF-beta1 release by ROI was blunted by catalase and unaffected by superoxide dismutase, indicating the involvement of hydrogen peroxide. The response was also blunted by 5, 6-dichloro-1-beta-D-ribofuranosyl benzimidazole (DRB), a specific RNA polymerase II inhibitor, and accompanied by a corresponding increase in TGF-beta1 messenger RNA, as measured by quantitative/competitive reverse transcription polymerase chain reaction, suggesting the involvement of transcriptional mechanisms and possibly other downstream mechanisms. In contrast, RNI-induced TGF-beta1 release was unaffected by DRB and blunted by the protein synthesis inhibitor cycloheximide, suggesting the involvement of translational and post-translational mechanisms. This response required cyclic guanosine monophosphate (cGMP)- mediated processes because (1) immunoreactive cGMP accumulated in the culture medium of SNAP-treated cells; (2) SNAP-induced TGF-beta1 release was blunted by KT 5823, an inhibitor of cGMP-dependent protein kinase; and (3) similar increase in TGF-beta1 release was obtained by cell exposure to membrane-permeable dibutyryl-cGMP or to atrial natriuretic factor, a known agonist of particulate guanylate cyclase. These data suggest that in vitro exposure of human alveolar epithelial cells to ROI and RNI enhances TGF-beta1 release through different mechanisms. In vivo, this control may constitute a molecular link between inflammatory and fibrotic processes.

Arginine↗

PubMed1999

Thrombocytopenia in a surgical ICU.

STUDY OBJECTIVES: To assess the incidence of thrombocytopenia in surgical ICU patients, the factors associated with thrombocytopenia, the outcome of thrombocytopenic patients, and the possible mechanisms involved. DESIGN: Prospective study. SETTING: An 8-bed surgical ICU in an 885-bed teaching hospital. PATIENTS: 147 consecutive patients admitted to the surgical ICU during a 6-month period. MAIN OUTCOME MEASURES: Incidence of thrombocytopenia (defined by a platelet count < 100,000/mm3), risk factors for thrombocytopenia, or death in thrombocytopenic patients identified by a stepwise logistic regression analysis, as well as the mechanisms involved. RESULTS: Thrombocytopenia occurred in 52 patients (35%) with a mortality rate of 38%, compared with a 20% mortality rate in nonthrombocytopenic patients (p = 0.02). Sepsis, episodes of bleeding or transfusions, and an acute physiology and chronic health evaluation (APACHE) II score of > 15 were the independent risk factors identified for thrombocytopenia. The correction of thrombocytopenia was a protective factor reducing the risk of mortality in thrombocytopenic patients. Disseminated intravascular coagulation was found in 40% of thrombocytopenic patients, elevated platelet-associated IgG in 33%, and hemophagocytic histiocytes in 67%. Combinations of two of these mechanisms were demonstrated in one quarter of thrombocytopenic patients. CONCLUSIONS: Sepsis was the major independent risk factor identified. Thrombocytopenic patients had a higher ICU mortality due to the severity of overall clinical status. Bone marrow examination could be diagnostic when no obvious causes are demonstrated. Thrombocytopenia probably reflects the severity and course of an underlying pathologic condition, as its correction appears to be a good prognostic factor.

APACHE↗

PubMed1999

[Warts, swimming pools and atopy: a case control study conducted in a private dermatology practice].

OBJECTIVE: Our purpose was to study two risk factors of warts, i.e., swimming pool frequentation and atopy. PATIENTS AND METHODS: A case-control study was performed in four dermatologists' private offices. The cases were patients consulting for the first time for warts; the controls were patients consulting for the first time for acne. RESULTS: Univariate analysis performed in 153 questionnaires (including 86 cases and 67 controls) showed an association between warts with swimming pool frequentation one year before consulting and between warts and history of atopy. Multivariate analysis showed an association between warts and history of atopy (OR: 4.20; confidence interval at 95 p. 100 = (1.52-11.6). The link between warts and frequentation of swimming pool one year before is not significant (OR: 1.81; confidence interval at 95 p. 100 = (0.78-4.21)) but shows a tendency. DISCUSSION: This last point should be confirmed in further studies. Additionally, this study showed that this kind of clinical research can be carried out in dermatologist private practice.

Acne Vulgaris↗

PubMed1998

The geographical spread of influenza.

How infectious diseases spread in space within one cycle of an epidemic is an important question that has received considerable theoretical attention. There are, however, few empirical studies to support theoretical approaches, because data are scarce. Weekly reports obtained since 1984 from a network of general practitioners spanning the entire French territory allows the analysis of the spatio-temporal dynamics of influenza over a fine spatial scale. This analysis indicates that diffusion over long distances, possibly due to global transportation systems, is so quick that homogeneous global mixing occurs before the epidemic builds up within infected patches. A simple model in which the total number of cases is given by the empirical time-series and cases are randomly assigned to patches according to the population weight of the patches exhibits the same spatio-temporal properties as real epidemic cycles: homogeneous mixing models constitute appropriate descriptions, except in the vicinity of the epidemic's peak, where geographic heterogeneities play a role.

Epidemiologic Studies↗

PubMed1998

FluNet as a tool for global monitoring of influenza on the Web.

In collaboration with the Institut National de la Santé et de la Recherche Médicale, the World Health Organization (WHO) has developed an Internet application linking the global WHO network of influenza centers (FluNet; http://oms.b3e.jussieu.fr/flunet/). During 1997, 22 pilot centers entered data on influenza activity and viral laboratory results directly into FluNet via secured access. In addition, 54 centers sent data to WHO for entry. Four countries (the Russian Federation, Romania, Sweden, and the United Kingdom) reported widespread outbreaks of at least 4 weeks' duration. The FluNet server ran 24 hours a day without interruption. To improve management and enhance standardization of reporting, this early-alert system for the global monitoring of influenza provides international and national authorities, the public, and the media with full access to real-time epidemiological and virological information.

Disease Outbreaks↗

PubMed1998

Fetal hemoglobin and F-cell responses to long-term hydroxyurea treatment in young sickle cell patients. The French Study Group on Sickle Cell Disease.

We have studied the cellular and molecular responses to long-term hydroxyurea (HU) treatment in 29 severely affected young patients with sickle cell disease (mean age, 10.9 +/- 4.1 years). Patients received HU at 20 mg/kg/d on 4 consecutive days per week initially, with a monthly escalated dose avoiding marrow-toxicity (mean steady-state dose, 34.2 +/- 4.6 mg/kg/d) for 12 to 36 months (mean duration, 22 months). The studied parameters were hemoglobin F (HbF), F reticulocytes (F retics), F cells, the amount of HbF per F cell (F/F cell), polymer tendency at 40% and 70% oxygen saturation, and hemolysis. Initial HbF (Fi) was dispersed (from 0.85% to 13.9%). HbF increased in all patients but 1. HbF at maximal response (Fmax) reached a sustained level varying from a 1.5-fold to a 16-fold Fi after a variable delay (6 to 24 months). Fmax was not related to HU dosage, but triangle upF (Fmax - Fi) was strongly correlated to triangle upMCV (MCVmax - MCVi). HbF increase resulted from the increase of both F cells and F/F cell. In this rather short series, Fi and Fmax were not significantly associated with age, gender, or beta-globin haplotype. Neither Fmax nor triangle upF was related to bone marrow reserve, as measured by baseline reticulocyte or neutrophil counts. However, Fmax was highly dependent on Fi. When patients are individualized into three groups according to Fmax (group 1, Fmax >20% [12 patients]; group 2, 10% < Fmax < 20% [11 patients]; group 3, Fmax <10% [5 patients]), Fi is significantly different between groups, being the highest in group 1. In addition, the best responders (group 1) were significantly different from patients in the two other groups with higher levels of total hemoglobin, decreased bilirubin, and decreased polymer tendency.

Adolescent↗

PubMed1998

Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial.

BACKGROUND/AIMS: Norfloxacin is useful to prevent infections in hospitalized cirrhotic patients with low ascitic fluid protein concentrations. It is also effective in preventing the recurrence of spontaneous bacterial peritonitis. The aim of our study was to determine the efficacy of norfloxacin in the primary prophylaxis of gram-negative bacilli infections in cirrhotic patients with low ascitic fluid protein levels (<15 g/l). METHODS: One hundred and seven patients were randomized to receive norfloxacin (400 mg/day; n=53) or placebo (n=54) for 6 months. The patients had no history of infection since cirrhosis diagnosis and no active infection. RESULTS: The probability of gram-negative infection was significantly lower among patients treated with norfloxacin than among those treated with placebo. Six gram-negative bacilli infections occurred in the placebo group and none in the treatment group. Severe infections (spontaneous bacterial peritonitis, neutrocytic ascites and bacteremia) developed in nine patients in the placebo group (17%) and in one patient in the norfloxacin group (2%; p<0.03). There was no between-group difference in the overall rate of infection or in survival. In ten patients from the norfloxacin group, gram-negative bacilli not present in baseline stool cultures were transiently isolated in follow-up cultures. CONCLUSIONS: These data show that primary prophylaxis with norfloxacin for 6 months is effective in the prevention of infections caused by gram-negative bacilli in cirrhotic patients with low ascitic fluid total protein levels.

Adult↗

PubMed1998

A space-time criterion for early detection of epidemics of influenza-like-illness.

OBJECTIVES: To develop a method based on a space-time criterion for early detection of epidemics of influenza-like-illness in France. METHODS: Since 1984, the French Communicable Diseases computer Network (FCDN) routinely detects epidemics of influenza-like-illness when the national incidence rate is, for 2 consecutive weeks, above a threshold computed by a periodic regression model. It appears that some areas reported early increases in incidence several weeks before the national epidemic. An optimised space-time criterion allows an early detection of the epidemic periods. RESULTS: Applying this space-time criterion to the last 11 epidemics (from 1986), the sensitivity was 0.82 and the specificity was 0.99. CONCLUSION: This simple procedure can be used as an additional tool for early detection of an epidemic taking into account the distribution of new cases in space and time.

Disease Outbreaks↗

PubMed1998

Six years of sentinel surveillance of hepatitis B in general practice in France.

Despite the availability of a safe and efficacious vaccine, new cases of infection by hepatitis B virus (HBV) still occur at a substantial rate. This increases the current prevalence of chronic HBV carriers (10% of newly infected subjects) and in the long run, will raise the incidence of chronic liver disease. The surveillance of viral hepatitis commenced in December 1990 by the French sentinel network for electronic surveillance of communicable diseases. Between 1991 and 1996, a decrease in the annual incidence was observed although it was not significant (p = 0.06). The mean number of cases for this period was 12 per 100,000 inhabitants. The sex ratio (M/F) was 1.6 (p<0.01) and the median age, 32 years. Heterosexual transmission was suspected in 25% of cases, homo-bisexual transmission in 10%, use of injected drugs in 19%, percutaneous exposure in 9%, and blood transfusion or hemodialysis in 6%. Although the incidence of HBV infection is decreasing, the prevalence of chronic infection will continue to rise. However, the universal hepatitis B immunisation strategy proposed by WHO will dramatically limit the expansion of the population of chronically infected subjects if high coverage is achieved rapidly.

Adolescent↗

PubMed1998

Comparative evaluation by semiquantitative reverse transcriptase polymerase chain reaction of MDR1, MRP and GSTp gene expression in breast carcinomas.

Identification and quantitative evaluation of drug resistance markers are essential to assess the impact of multidrug resistance (MDR) in clinical oncology. The MDR1 gene confers pleiotropic drug resistance in tumour cells, but other molecular mechanisms are also involved in drug resistance. In particular, the clinical pattern of expression of the other MDR-related genes is unclear and their interrelationships are still unknown. Here, we report standardization of the procedures used to determine a reliable method of semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR) using a standard series of drug-sensitive and increasingly resistant cell lines to evaluate the expression of three MDR-related genes, i.e. MDR1 (multidrug resistance gene 1), MRP (multidrug resistance related protein) and GSTp (glutathione-S-transferase p), reported to be endogenous standard genes for normalization of mRNAs. A total of 74 breast cancer surgical biopsies, obtained before any treatment, were evaluated by this method. When compared with classical clinical and laboratory findings, GSTp mRNA level was higher in diploid tumours. However, the main finding of our study suggests a clear relationship between two of these MDR-related gene expressions, namely GSTp and MRP. This finding provides new insight into human breast tumours, which may possibly be linked to the glutathione conjugate carrier function of MRP. Well defined semiquantitative RT-PCR procedures can therefore constitute a powerful tool to investigate MDR phenotype at mRNA levels of different related genes in small and precious tumour biopsy specimens.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed1998

Role of videoendoscopy in assessment of pharyngeal function in oropharyngeal dysphagia: comparison with videofluoroscopy and manometry.

OBJECTIVE: The purpose of the current report is to evaluate the ability of videoendoscopic swallowing study in assessing pharyngeal propulsion and aspiration episodes when compared with videofluoroscopy and manometry. STUDY DESIGN: Prospective study. METHODS: Thirty-four patients with oropharyngeal dysphagia underwent videoendoscopy of swallowing to assess pharyngeal propulsion as pathologic or nonpathologic, and aspiration. These features were compared with those found on manometry and videofluoroscopy, which were considered as the reference examinations. Sensitivity, specificity, and positive and negative predictive values of videoendoscopy were estimated, with their 95% confidence intervals. RESULTS: A total agreement between videoendoscopy and videofluoroscopy was found in 76.4% of cases for pharyngeal propulsion and in 82.3% for aspiration. This rate for pharyngeal propulsion reached 82.3% between videoendoscopy and manometry. Moreover, in 24 cases (70.5%) in which videofluoroscopy and manometry agreed for pharyngeal propulsion, 22 were assessed similarly through fiberoscopy. When using fluoroscopy and manometry as reference examinations, videoendoscopy detected nearly 90% (95% confidence interval [CI] = 0.80, 1.0) of impaired pharyngeal propulsion. Concerning aspiration, 70% (95% CI = 0.54, 0.85) of events detected by videoendoscopy were also observed on videofluoroscopy. Sensitivity, specificity, and positive and negative predictive values of videoendoscopy reached a higher rate (90% to 92.8%) when agreement was found between fluoroscopy and manometry. CONCLUSIONS: Videoendoscopy is an examination that can be used to detect inexpensively pharyngeal propulsion disorders and aspiration episodes.

Adult↗

PubMed1998

Neuropsychological prediction of dementia in Parkinson's disease.

OBJECTIVE: To identify neuropsychological characteristics predictive of later dementia in Parkinson's disease. METHODS: A comprehensive neuropsychological test battery was administered to a cohort of 89 initially non-demented patients with Parkinson's disease consecutively enrolled at a specialised Parkinson's disease clinic. They were reassessed after a mean of 3.5 years for the diagnosis of dementia. The Cox proportional hazards model was used to identify baseline characteristics predictive of dementia. RESULTS: Only four of the baseline clinical characteristics of Parkinson's disease and neuropsychological variables remained independently linked to subsequent development of dementia: the age of onset of Parkinson's disease (>60 years; relative risk (RR) 4.1, 95% confidence interval (95% CI) 1.8-24.0, p<0.03), the picture completion subtest of the Wechsler adult intelligence scale (score<10; RR 4.9, 95% CI 1.0-24.1, p<0.02), the interference section of the Stroop test (score<21; RR 3.8, p=0.08), and a verbal fluency task (score<9; RR 2.7, 95% CI 0.8-9.1, p=0.09). Depressive symptoms and the severity of motor impairment were not predictive of dementia. CONCLUSION: These features are different from the neuropsychological characteristics predictive of Alzheimer's dementia in healthy elderly people (mainly memory and language performance). They are in keeping with the well known specificity of the impairments in Parkinson's disease for visuospatial abilities and difficulties in inhibiting irrelevant stimuli. It is postulated that the composite nature of the picture completion subtest, involving several cognitive abilities impaired in Parkinson's disease, explains its sensitivity.

Aged↗

PubMed1998

Neutrophil alveolitis in bronchioloalveolar carcinoma: induction by tumor-derived interleukin-8 and relation to clinical outcome.

Tumor infiltrate, predominantly constituted by lymphocytes, may represent an important prognostic factor in bronchioloalveolar carcinoma (BAC), in addition to tumor extension and histological type. In the present study, we determined the presence, the origin, and the prognostic importance of neutrophils that also participate in leukocyte infiltrates of BAC. Neutrophil alveolitis was determined immunohistochemically in both lung biopsies and bronchoalveolar lavage (BAL) fluid samples from 29 patients with histologically proved BAC. The local expression of interleukin (IL)-8 was determined by immunohistochemical and immunoenzymatic techniques. Neutrophil counts were analyzed in relation to the clinical outcome of patients by the Kaplan-Meier method and Cox's univariate and stepwise multivariate models. Lymphocytes and neutrophils dominated the inflammatory cell population in the lower respiratory tract of patients with BAC. Neutrophils were located mainly in the alveolar lumen and seldom in alveolar wall whereas lymphocytes were exclusively present in alveolar wall. A relationship was observed between the number of neutrophils and the level of IL-8 in BAL fluid suggesting the involvement of that chemokine in neutrophil recruitment. The tumor cells were the predominant cells that appeared to express IL-8 by immunolocalization. The presence of increased numbers of neutrophils was significantly associated with a poorer outcome in patients with BAC (P = 0.02). In a multivariate analysis, the neutrophil percentage in BAL fluid was an independent predictor of clinical outcome. The risk of death was increased substantially (rate ratio, 5.2; 95% confidence interval, 1.1 to 24.7) among patients with BAL neutrophil percentage of > or = 39% (median of the distribution) as compared with the others. In BAC, neutrophils accumulate in the alveolar lumen. Elaboration of IL-8 by tumor cells may be responsible for this event, which is associated with a significantly higher risk of death.

Adenocarcinoma, Bronchiolo-Alveolar↗