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Biomedical subjects

A Rey

Publications and source records attributed to A Rey.

At least 145 records · Page 8Linked to original sources
PubMed1993

Prognostic factors in non-seminomatous germ cell tumours of the testis. Experience at the Institut Gustave-Roussy.

The original prognostic model in non-seminomatous germ cell tumours of the testis at the Institut Gustave-Roussy was updated in a larger patient population. As in the former model human chorionic gonadotrophin (hCG) and alpha-feto-protein (AFP) serum concentrations attained prognostic significance in the multivariate analysis. We studied two important issues in this patient population: the impact of expressing hCG values in mass units and of the introduction of etoposide-containing chemotherapy. Etoposide has a major impact on the determination of the prognostic group limits which are considerably increased. It is, thus, suggested to reevaluate prognostic models in patient populations treated by modern chemotherapy regimens.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Cranial pachymeningitis of unknown origin: a study of seven cases.

We report seven patients with cranial pachymeningitis of unknown origin in whom the main clinical features were headaches, ataxia, and cranial nerve palsies. CSF showed inflammatory changes. CT and MRI showed thickening of the falx and of the tentorium. The clinical course was chronic. Four patients improved with prednisolone but became steroid-dependent: in two cases, radiotherapy had no lasting improvement and in one, azathioprine permitted a reduction of the corticosteroids. Five patients had biopsy of the tentorium cerebelli or of the temporal dura mater. In two cases, autopsy revealed extensive pachymeningitis without parenchymal changes. In all instances, microscopic examination of the dura mater showed a cellular infiltrate of polymorphic cells; there were no epithelioid granulomas. Review of the literature discloses seven similar cases. We discuss the relationship of these lesions with inflammatory meningeal masses, the focal pachymeningitis of the Tolosa-Hunt syndrome, and multifocal fibrosis.

Adult↗
PubMed1993

Neonatal cardiovascular dynamics in relation to matroclinous and patroclinous history of high blood pressure.

Genetic risk is a primary contributing factor to the predisposition of a newborn child to elevated blood pressure later in life. An index of this factor is needed to assess in the neonate the success or failure of preventive interventions instituted for the pregnant women. This index could be based on characteristics of blood pressure and heart rate variability measured during the first 2 days after birth. In the search for such an index, the systolic and diastolic blood pressures and heart rates of 127 newborn babies were automatically monitored at about 30-min intervals for 48 h with a Nippon Colin device, starting early after birth. Circadian parameters (obtained by the linear least-squares fit of a 24-h cosine curve to each individual series) and descriptive statistics for the three circulatory variables were used in a multiple regression analysis to compute a linear prediction function for the cardiovascular risk score. This score was obtained for each neonate on the basis of the presence or absence of overt cardiovascular disease, elevated blood pressure, or obesity across two generations, those of the newborn's parents and grandparents. Results from regression indicate that the best model includes the circadian amplitudes of systolic and diastolic blood pressure and the circadian ranges of systolic blood pressure and heart rate. The contributions from patroclinous versus matroclinous family history were then compared. Results show that linear prediction models include the same variables for both paternal and maternal cardiovascular risk score. These results provide a neonatal index of cardiovascular risk, to be used later for the evaluation of the effects on the newborn of intervention for the pregnant women.

Blood Pressure↗
PubMed1993

[Comparative pharmacokinetics of antibiotics in blood, csf and brain].

The Knowledge of the antibiotic's cerebral diffusion is essential to define a of neurosurgical antibioprophylaxis' strategy. Without references in the medical world-literature, we've decided to compare the pharmacological kinetics in the blood, the cerebrospinal fluid and the sound cerebral tissue of common used molecules in neurosurgery that is to say: amoxicillin, cefamandole, metronidazole and pefloxacin. The results show that the cerebral levels of metronidazole and pefloxacine are rapidly high with an extended duration (> 10 times the M.I.C. of the sensitive bacteriae), but the tissue penetration of amoxicillin is hazardous and shot-duration for cefamandole (undosable after 3 hours).

Adult↗
PubMed1993

Ross operation using a bovine bioprosthetic valve with autologous pericardial conduit in the pulmonary position.

Between 1 February 1992 and 1 March 1993, we performed Ross's aortic replacement in 7 men and 4 women with rheumatic heart disease. The patients' ages ranged from 22 to 60 years (mean, 41 years). All 11 patients had aortic valve disease; 2 also had mitral valve disease. In all patients, the right ventricular outflow tract was reconstructed using an autologous pericardial conduit containing a bovine cardiac valve bioprosthesis manufactured at our institution. The 2 patients who had mitral valve disease underwent a concomitant mitral valvuloplasty. In 1 patient, minimal aortic regurgitation was documented by means of transesophageal echocardiography immediately after the cessation of cardiopulmonary bypass, but no hemodynamic compromise was noted. In another patient, mediastinal exploration was required for bleeding, 3.5 hours postoperatively. The follow-up period ranged from 6 to 16 months (mean, 11.3 months). Results were assessed by means of clinical and transesophageal echocardiographic studies. No infection or technical failure was encountered. No patient died. All patients remain asymptomatic, and follow-up echocardiography has revealed no transaortic or transpulmonary gradient. The Ross operation was chosen for this group of patients because it avoids the use of mechanical valves and subsequent anticoagulant therapy. Most of our patients have a low income and a history of noncompliance with the strict postoperative drug regimen. Although the short-term results have been excellent with the Ross operation and our combination bioprosthesis, long-term evaluation is needed.

Adult↗
PubMed1992

Preoperative care of infants with nephroblastoma. The International Society of Pediatric Oncology 6 experience.

The International Society of Pediatric Oncology (SIOP) recommends preoperative treatment in the management of eligible patients with Wilms' tumor. Until 1980, children younger than 12 months of age (infants) at diagnosis had been excluded from the SIOP trials. SIOP 6, conducted from 1980 to 1987, was the first SIOP study to include infants older than 6 months of age. This retrospective analysis of 145 infants registered to SIOP 6 demonstrates that in infants older than 6 months and having favorable histology (FH), a two-drug preoperative chemotherapy (CT) regimen of 4 weeks significantly ameliorated stage distribution as determined at delayed surgery but did not affect a good outcome. However, the CT dose utilized in SIOP 6 resulted in an unacceptable toxicity in this age group, and SIOP 9, the new SIOP study of Wilms' tumor, recommends a reduced dose of CT in infants. Preoperative CT is not recommended in infants younger than 6 months of age. Specifically, the high incidence (29%) of mesoblastic nephroma in this age group does not justify such an approach. Histopathologic diagnosis should be obtained in these patients before any treatment.

Age Factors↗
PubMed1992

A phase II trial of early intensive chemotherapy with autologous bone marrow transplantation in the treatment of poor prognosis non seminomatous germ cell tumors.

Twenty-eight patients with poor prognosis, advanced metastatic non seminomatous germ cell tumors (NSGCT) were treated with early high dose chemotherapy and autologous bone marrow transplantation (ABMT) rescue. The primary tumor was testicular in 19 patients and extragonadal in nine patients. For 19 patients with a testicular primary, the median probability of complete remission (CR) was 0.05 according to our prognostic mathematical model based on pretreatment levels of serum HCG and AFP. The same prognostic model was used for extragonadal primaries. Treatment consisted of two cycles of a modified double dose of cisplatin, vinblastine, bleomycin, VP-16 regimen (mPVeBV) followed by a high dose cisplatin-etoposide-cyclophosphamide regimen (PEC) followed by ABMT. Of the 28 patients, 17 (61%) achieved CR, one of which was surgical CR (sCR), five died of rapidly progressive disease early during the first cycle of mPVeBV, two had treatment-related deaths, three did not respond and one patient refused treatment. Of the 17 patients initially in CR, three relapsed after 4, 4 and 7 months respectively and have subsequently died. Two other patients died while still in CR: one committed suicide and one died of an infectious complication due to transfusion-related AIDS. Twelve patients are alive in CR after a median follow-up of 66 months (range 7-72 months). The non parametric 3-year survival rate is 40%. To demonstrate the effect of intensive chemotherapy with ABMT, a randomized multicenter French study was set up to evaluate the PVeBV regimen with or without high dose treatment and ABMT in poor risk NSGCT patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

[Spontaneous sphenoidal rhinorrhea].

We describe the case of a woman, who presents a spontaneous rhinorrhea. The metrizamid computerized tomographic cisternography proves the precise anatomic location of the dural osseous defect, in the left sphenoidal sinus. Transsphenoidal approach terminated the leakage in a single procedure, without shunt.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1991

M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for advanced carcinoma of the bladder. The French Federation of Cancer Centers experience.

70 patients with advanced transitional cell carcinoma of the bladder received methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC). Complete responses (CR) were obtained in 13 of the 67 (19%) evaluable patients and partial responses (PR) in 25 patients for an objective response rate of 57% (95% CI 45-69%). Of the 54 patients who have had a minimum follow-up of 2 years, 8 patients (15%) are disease-free or have stable residual disease. Median survival of the 70 patients was 13 months. Toxicity was acceptable with no drug-related deaths. Because of myelosuppression, only 15 patients (21%) received treatment without delays in drug administration or modifications from the planned schedule. Our results confirm that this regimen is effective, with some patients being long-term survivors.

Adult↗
PubMed1991

[Study of high doses of carboplatin as a first choice in the therapy of advanced ovarian cancers].

Thirty female patients with ovarian cancer of poor prognosis were included in a chemotherapy trial using high dose IV carboplatin--800 mg/m2 every 5 weeks. The subjects had three to six cycles prior to second laparotomy. Twenty-eight patients were assessable. There was no neurological, auditory or renal toxicity. Limiting toxicity was haematological, the mean neutrophil count was less than 650 mm3 and the mean platelet count less than 30,000/mm3. No death occurred from toxicity. The clinical response rate was 67%, and the surgical response rate 53.5%, with 15% complete histological responses. Survival at 18 months is 36%. A trial concerning 36 patients treated with an association of carboplatin at the same dose combined with cyclophosphamide has just been completed and the results are being analyzed.

Adenocarcinoma↗
PubMed1990

[Schistosomiasis of the spinal cord. Contribution of magnetic resonance imaging].

The authors report a case of spinal cord schistosomiasis presenting as myelitis, with rapidly developing deficit, signs of severe cerebrospinal fluid inflammation, normal myelography and computerized tomography. The patient's country of origin suggested schistosomiasis, and the diagnosis was confirmed by serology and rectal biopsy which showed eggs of Schistosoma mansoni. Magnetic resonance imaging was helpful as it confirmed the absence of spinal cord compression and showed a lesion of the conus medullaris, this region being the most frequent site of schistosomial myelitis.

Adult↗
PubMed1990

Spina bifida: a chick embryo experimental model.

Neural Tube Defects (NTD) can be induced in the chick embryo with relative ease in order to provide an experimental tool for investigation of such disabling malformations. Domestic hen (Gallus gallus) eggs were incubated at 37.5 degrees C and 80% humidity for 24 h. At that moment, 5 ml of albumen were aspirated by sterile puncture of the shell, and the incubation was resumed. The embryos were recovered and studied at the 8th, 10th and 14th days. Almost half (45%) of the 602 treated embryos survived and 73 of them (12%) had various malformations. Thirty-six (6%) suffered NTD of which 30 were open myelomeningocele, 2 meningocele and 4 encephalocele. The anatomy of the defects was astonishingly similar to that of the human malformation. Whether these experimental NTD are induced by mechanical or nutritional modifications of the internal environment of the egg is unknown, but the similarity of the lesion with those in humans make them suitable for further investigation of these issues. We believe that this relatively simple and inexpensive model is a suitable tool for research on spina bifida.

Animals↗
PubMed1990

Treatment of malignant gliomas with surgery, intra-arterial infusions of 1-(2-hydroxyethyl)chloroethylnitrosourea, and radiation therapy: a phase II study.

Forty patients with malignant supratentorial gliomas were treated with surgery, intra-arterial infusions of 1-(2-hydroxyethyl)chloroethylnitrosourea, and radiation therapy. The median duration of survival was 12 months; it differed according to the histological subtype (over 30 months for patients with anaplastic astrocytomas or anaplastic oligodendroglioma and 10.5 months for glioblastoma; P = 0.0025). Serious complications of monocular blindness and leukoencephalopathy were observed in four patients (10%).

Adolescent↗
PubMed1990

Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results.

To evaluate the long-term results of endovascular treatment with particles in the management of thoracic intramedullary arteriovenous malformations (AVMs), the authors retrospectively reviewed the angiographic and clinical findings in 35 patients. Follow-up was 1-15 years (mean, 6 years) in 28 patients and 6-10 months (mean, 7 months) in seven. A total of 158 embolization procedures were performed in 35 patients. Revascularization occurred frequently, necessitating multiple endovascular sessions. Long-term clinical evaluation showed clinical improvement, compared with the initial status before treatment, in 63% of the patients. Clinical aggravation due to embolization was observed in seven patients (20%) after 12 of the 158 endovascular sessions (8%). These results are better than those reported after surgery and indicate that embolization with particles is an efficient and safe tool in the treatment of thoracic intramedullary AVMs.

Adult↗