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Biomedical subjects

B Chevallier

Publications and source records attributed to B Chevallier.

At least 91 records · Page 5Linked to original sources
PubMed1993

Epirubicin and ifosfamide in advanced soft tissue sarcoma: a phase II study.

Thirty patients with previously untreated and measurable or evaluable advanced soft tissue sarcoma entered this phase II study. Median age was 53 years (range: 24-71 years). Starting dose of Epirubicin was 100 mg/m2 IV bolus on day 1 combined with Ifosfamide, 2.5 g/m2, as a 6-hr IV infusion on day 1 and day 2 with uroprotection with Uromitexan, 1.6 g/m2, on day 1 and day 2. This schedule was repeated every 3 weeks. In case of minimal myelosuppression, the dose of Epirubicin was increased by 10 mg/m2 up to 130 mg/m2. Ifosfamide dosage was not increased. Mean cumulative dose of Epirubicin received was 477 +/- 272 mg/m2 (range: 200-1200 mg/m2). Of 27 evaluable patients (WHO criteria), 13 had a partial response (48%), 4 showed no change (15%), and 10 had progressive disease (37%). Median time to progression was 27 weeks. Of 27 patients evaluable for toxicity, hematological toxicity at day 21 was mild. Nonhematological toxicities consisted of nausea and vomiting in 82% of patients (WHO grade 3-4 = 19%), stomatitis in 44.5% (WHO grade 3 = 7.5%), and alopecia in 96% (WHO grade 2-3 = 89%). Appearance of cardiac dysfunction without heart failure during the treatment led to discontinuation of this chemotherapy in 3 patients. The results of this study show that the combination of Epirubicin and Ifosfamide is effective in advanced soft tissue sarcoma with an acceptable toxicity. However, we cannot conclude from this trial whether combination Epirubicin and Ifosfamide is superior to Epirubicin alone.

Adult↗
PubMed1993

[Inflammatory breast cancer].

Inflammatory breast cancer is a rare disease characterized by a frequently fatal outcome despite combined modality approach used. Its precise definition is mainly clinical. A positive skin biopsy does not seem to be mandatory to establish the diagnosis. Induction chemotherapy applied before loco regional treatment has improved the 5 year overall survival. This chemotherapy is followed by a loco regional treatment consisting of either surgery or radiotherapy. The use of adjuvant chemotherapy is classical but its real value has never been assessed by appropriate randomized trials. Therapeutic improvements will perhaps come from more intensive induction chemotherapy regimen or from intensification of adjuvant treatment. Adequate randomized trials are needed to progress with this disease.

Adolescent↗
PubMed1993

[CA 15.3 and early diagnosis of recurrence in breast cancer].

This retrospective study shows the advantage of the CA 15.3 assay for the early detection of relapse in breast cancer. It involved 473 women with invasive canalar carcinoma who had local recurrence or metastasis and/or an elevation of CA 15.3 (> 35 kU/l). The positive predictive value is excellent (97.7%). Sensitivity is poor for local relapse (13.7%), but a marker elevation at this time is a good prognostic factor of further distant metastasis (88%). It is better in the case of distant metastasis (74%), especially in bone and and liver localizations. CA 15.3 measurement at two month intervals may allow an early detection in 40% of distant metastasis. These results confirm the need of trials to test the benefits in terms of survival of early treatment of breast cancer metastasis only proved by CA 15.3 elevation, without any clinical or radiological finding.

Adult↗
PubMed1993

[Treatment of advanced breast cancer in postmenopausal women with droloxifene: results of a double-blind phase II trial for dose determination].

To determine the optimal daily dose of a new antiestrogen, droloxifene, for the treatment of advanced breast cancer, we have conducted a multicenter, randomized, double blind trial. Postmenopausal women with advanced breast cancer, who could not benefit from loco regional therapy, with positive or unknown estrogen or progesterone receptors were entered in this study. Droloxifene was administered in a double blind randomized design, with daily dose of either 20 (group I), 40 (group II) or 100 mg (group III). None of the patients had received previous systemic antitumor therapy, with the exception of adjuvant chemotherapy terminated at least one year before the patient's recruitment. Patients with at least one measurable tumoral lesion were entered into the trial. Three hundred and sixty nine patients have been enrolled, 234 are fully evaluable for efficacy. Objective response rate (CR + PR) is 31.1, 44.6 and 41.9% for the groups I, II and III respectively (P = NS). Time to response has been short: in the three groups, 50% of the responses have been observed within the 2 first months of treatment. Time to disease progression is 6, 8.3 and 6 months respectively for the 20, 40 and 100 mg/day treatment group. Side effects have been moderate and not dose related. Hot flushes and gastro intestinal disorders have been observed most often. This promising new drug deserves further study and randomized comparison versus tamoxifen.

Aged↗
PubMed1993

Inflammatory breast cancer. Pilot study of intensive induction chemotherapy (FEC-HD) results in a high histologic response rate.

Between July 1988 and May 1990, we treated 45 women with newly diagnosed, unilateral, nonmetastatic, inflammatory breast cancer with an intensive neoadjuvant chemotherapy regimen (FEC-HD) repeated every 21 days, followed by surgery or radiation therapy. Evaluation of efficacy performed 3 to 4 weeks after at least 2 cycles showed disappearance of inflammatory signs in 91% of the patients and improvement in the remaining 9%. With regard to primary tumor and lymph nodes, there were 13 (28.9%) clinical complete responses, 30 (66.6%) partial responses, and 2 (4.5%) without change. No progressive disease was observed. Hematologic toxicity from this regimen was high with grade 4 neutropenia observed at day 14 in 100% of the patients. Retreatment at day 21 was possible in 83% of the cycles. Grade 1 or 2 infections occurred in 102 cycles out of 176 (57.9%). Grade 3 infections were seen in 9 cycles (5%). No septicemia or septic shock occurred. No toxic death occurred. After induction chemotherapy, locoregional treatment consisted of modified radical mastectomy in 39 patients and radiotherapy alone in 6. The mastectomy specimen showed no residual invasive tumor (primary tumor and lymph nodes) in 10 cases (25.6%). Two patients judged as partial responders were in fact histologic complete responders. The clinical and histological response rates observed appeared very promising. For this reason we are currently testing FEC-HD with or without GCSF in a randomized multicenter trial with correction of neutropenia, disease-free survival, and overall survival as main end points.

Adenocarcinoma↗
PubMed1993

[Disclosure by neurologic signs of right subclavian aneurysm. Post-traumatic aneurysm?].

BACKGROUND: Aneurysms of the subclavian artery are rare in childhood and may be due to traumatic, infectious or congenital causes. CASE REPORT: A 15 year-old boy presented with a sudden left visual disturbance plus decreased muscle strength and paresthesias of the left arm; these manifestations disappeared within 15 minutes. His neurological examination on admission was normal. The right arm radial pulse was weak and the blood pressures of the right and left arms were significantly different. Doppler showed a right subclavian artery aneurysm containing several clots, that was confirmed by angiography. There were no signs of inflammation or indication of autoimmune disease. This aneurysm might have been caused by trauma as the patient had had a violent cervical traumatism after a diving accident 2 years earlier. The aneurysm was surgically removed and the right vertebral artery arising from it was reimplanted. Histological examination of the aneurysm gave no evidence of etiology. The post-surgical MRI showed no brain abnormaly. CONCLUSIONS: This aneurysm is probably of post-traumatic origin. The cerebral disturbance could be due to embolism or transient ischemia; the latter is more compatible with the normal NMR.

Adolescent↗
PubMed1993

[Metastatic basal cell carcinoma].

A case of basal cell carcinoma in a 17-year old male patient complicated, 5 years later, by inguinal and pulmonary metastases is reported. This clinical case raises two problems: the reality of the entity and the long-term follow-up of this type of tumours.

Adolescent↗
PubMed1992

Value of somatosensory evoked potentials in saphenous entrapment neuropathy.

Neuralgia of the saphenous nerve (SN) is a rare clinical syndrome simulating a vascular disorder of the lower extremities. In four cases, the presenting complaint was persistent pain on the medial aspect of the knee. Examination revealed tenderness over the site of exit of the SN form the femoral canal. Femoral nerve motor conduction, quadriceps H-reflex and EMG of the leg muscles were normal. The sensory nerve action potential of the SN in the leg was not obtained in some patients, even in the unaffected leg. SEP were therefore preferred for diagnosis and performed at the infrapatellar and descending branches of the right and left SN and recordings from the Cz'-Fz electrode. Latency and amplitude differences were evaluated and compared with a control group of healthy subjects. An alteration in the SEP from one branch was observed on the painful side. Posterior tibial responses were normal. In one case, pain resolved immediately after neurolysis, confirming SN entrapment above the femoral canal, before its division. Pain resolved in two other cases and persisted in the last after medical treatment. SEP studies are valuable in the diagnosis of an isolated lesion of the SN.

Adult↗
PubMed1992

[Primary neuroendocrine cutaneous carcinoma or Merkel cell carcinoma. Review of the literature].

The neuroendocrine carcinomas of the skin, also called Merkel cell carcinomas, are unusual malignancies mostly observed in the elderly. They are diagnosed by a pathologist: ultrastructural studies and immunohistochemistry support the diagnosis. The prognosis is poor. Lymph nodes and metastases quickly arise although sometimes, they are discovered immediately. A combination of surgery and radiotherapy is recommended. Metastases and unresectable tumors should be treated by chemotherapy.

Carcinoma, Merkel Cell↗
PubMed1992

[Multicenter study of sodium alginate in the treatment of regurgitation in infants].

An open multicenter study was performed to assess the efficacy and safety of alginic acid in two different dosages in 76 pediatric patients with gastroesophageal reflux confirmed by pH monitoring. Among the 69 patients in whom endoscopy was carried out before treatment, 18 had erythematous esophagitis and 5 had erosive esophagitis. Irrespective of the dosage used, the frequency of regurgitation and vomiting decreased significantly (p < 0.00001 and p = 0.01, respectively). Clinical and biochemical tolerance were outstanding and no adverse effects were recorded. On the basis of these data, the recommended dosage is 1 to 2 ml/kg/day in divided doses after meals.

Alginates↗
PubMed1992

Phase II study of tetrahydropyranyl adriamycin (pirarubicin) in elderly patients with advanced breast cancer.

Thirty elderly (over 70 years) women with measurable advanced breast cancer entered into this Phase II study. An initial dose of 30 mg/m2 of pirarubicin (THP) every 3 weeks was given intravenously. THP was escalated by levels of 10 mg/m2 according to the blood cell count done at day 14 and day 21 until a maximum dose per cycle of 70 mg/m2 was reached. The mean total cumulative dose of THP received was 204 mg/m2 (range 30-710 mg/m2). The mean number of cycles given was 5.5 (range 1-24). Of 28 evaluable patients, 1 achieved a complete response (CR), 6 had a partial response (PR) (CR + PR = 25%; 95% confidence interval 9-41%), 13 showed no change, and 5 had a progressive disease. The median time to progression was 3 months (range 0.5-18+ months). Of 28 patients evaluable for toxicity, the hematologic toxicity at day 15 was neutropenia grade 3 and 4 in 61% of the patients and thrombopenia grade 3 and 4, 0% of cycles. No cumulative hematologic toxicity was detected. Nonhematologic toxicities consisted of nausea and vomiting in 50% of patients (WHO grade 3 = 5%) and alopecia in 64% (WHO grade 2-3 = 36%). No stomatitis occurred. No cardiac toxicity was observed. The results of this study show that THP is an active drug in elderly patients with advanced breast cancer. Because of its safety, THP deserves further investigation in this application.

Adenocarcinoma↗
PubMed1992

[Cervical Castleman's disease in a 12 year-old child].

A case of unifocal cervical Castleman's disease without systemic manifestations occurring in a 12 year-old child is reported. Histological examination showed the characteristic features of angiofollicular lymph node hyperplasia. The results of immunological and in situ hybridization studies are also reported. A local IL6 secretion in the interfollicular areas was demonstrated.

Castleman Disease↗
PubMed1992

[Kala-azar].

The incidence of infantile visceral leishmaniasis is currently increasing, at least in the Mediterranean region. Most cases seen in France occur on the Mediterranean coast or are imported from Africa. However, contamination in other regions of France is not an exceptional occurrence and may raise diagnostic problems. The parasite reservoir is the dog population in which the prevalence of Leishmania infection is particularly high in the Provence and Cévennes regions. Both teenagers and young children may be affected by this disease, whose clinical manifestations may be misleading. The typical symptomatic triad, i.e., anemia-fever-enlarged spleen, may be incomplete, especially as a result of the intermittent character of the fever. Patients may remain afebrile for long periods. Diagnosis rests on demonstration of the parasite in bone marrow specimens (several biopsies are often required) or in the spleen. Bacteriologic studies using a special medium are helpful. Serologic tests are sensitive and specific but often become positive only late in the disease. Management still rests on pentavalent antimonial compounds. Advances have been made in the understanding of the toxic effects and rules for optimal use of these drugs. Improved insight into the parasite's biology may result in use of new forms of treatment; allopurinol is at present the only recent addition to the armamentarium which has been proved effective in humans when given in combination with an antimonial compound.

Africa↗