Evaluation of Albicans ID plates.
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Candida albicans↗
Biomedical subjects
B Lebeau
Publications and source records attributed to B Lebeau.
Using bronchoscopy and biopsy to diagnose early inhalation injury. Macroscopic and histologic findings.
OBJECTIVE: To learn the value of bronchoscopy and biopsy in the early diagnosis of inhalation injury ARDS. SETTING: Burn Center, CHU Saint-Antoine, Paris, France. DESIGN: 130 consecutively admitted burn patients were bronchoscoped on admission. MEASUREMENTS: The appearance of the bronchial tree was recorded, and biopsies were taken from spurs of the proximal and distal branches of the right bronchi. RESULTS: Either bronchoscopy or biopsy was positive in 46 cases. Twenty three of 44 patients with chemical inhalation injury developed ARDS (52%). Of 83 negative cases only 6 developed ARDS (7%). CONCLUSION: Bronchoscopy with biopsy is useful in predicting the development of ARDS in burn patients.
Adult↗
[Evolving identities of bronchopulmonary adenocarcinomas].
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Adenocarcinoma↗
Auxacolor, a new commercial system for yeast identification: evaluation of 182 strains comparatively with ID 32C.
The incidence of deep candidiasis, particularly in immunocompromised patients, and the emergence of less sensitive yeast species to new antifungal agents explain the interest of their rapid identification. A new identification system, Auxacolor (Sanofi Diagnostics Pasteur), has been evaluated, comparatively to ID 32C strip taken in reference (bioMérieux SA). These systems include respectively 13 and 29 carbohydrate assimilation tests. One hundred and sixty-nine strains belonging to 17 common yeast species isolated from biological specimens were identified. Moreover, 13 strains belonging to seven species rarely isolated and not included in the Auxacolor data base were tested. Correct biochemical profiles were obtained with 95.2% of the strains from the first panel. These profiles alone permit correct identification of 62.7% of them (n = 106). The remainders (Candida glabrata, Candida krusei, Candida guilliermondii, Candida inconspicua and Candida lipolytica) require time consuming additional morphological observations for a definitive identification. However, the time needed to obtain the biochemical profiles of these 106 strains was shorter when using Auxacolor: 77.4% of the strains were identified at 24 h with Auxacolor and 47.1% were identified at 24 h with ID 32C. Species from the second panel were not identified (seven strains) or incorrectly identified (six strains). The Auxacolor system was found to be reliable when performed in conjunction with morphological tests and easy to use for the identification of most medically important yeasts.
Evaluation Studies as Topic↗
[Allopurinol hypersensitivity. A possible cause of hepatitis and mucocutaneous eruptions in a patient undergoing antitubercular treatment].
The authors describe a case of drug-induced cytolytic hepatitis probably secondary to hypersensitivity to allopurinol which was prescribed incorrectly for secondary hyperuricaemia during treatment with pyrazinamide. The diagnosis was reviewed in view of the late occurrence of hepatitis in relation to the onset of the antituberculous treatment, the absence of a viral aetiology and the presence of clinical manifestations, biological and histological features which were compatible with hypersensitivity to allopurinol. The authors recalled that the type of uricaemia induced by pyrazinamide is most often asymptomatic and does not require any treatment with uric acid lowering drugs. Cessation of pyrazinamide is justified in cases of symptomatic hyperuricaemia but when the indications for pyrazinamide are imperative, treatment with an eliminator of uric acid is indicated. Allopurinol is contra-indicated in association with pyrazinamide on account of its inhibitory reaction to xanthine oxidase. Xanthine oxidase decreases the level pyrazinoic acid, a metabolite of pyrazinamide, which is responsible for the inhibition of the tubular secretion of uric acid.
Adult↗
Cost-analysis of four diagnostic strategies for Pneumocystis carinii pneumonia in HIV-infected subjects.
The aim of this study was to analyse the cost-effectiveness ratio of four diagnostic strategies for Pneumocystis carinii pneumonia (PCP) in patients infected with human immunodeficiency virus (HIV). Two hundred and ten HIV-infected patients with suspected PCP underwent induced-sputum (IS) followed, if negative, by bronchoalveolar lavage (BAL); 85 of these patients were able to undergo an exercise test (ET), prior to induced sputum and BAL. The following strategies were analysed: BAL strategy (BAL whenever PCP is suspected); IS strategy (induced sputum followed by BAL if negative); exercise test (ET) strategy, (ET followed by BAL if the results are abnormal); and the ES (exercise sputum) strategy (i.e. BAL only after abnormal ET and negative IS). The cost of each strategy was calculated by taking into account only direct costs; the conditions in which two given strategies would be cost-equivalent were also evaluated. The prevalence of PCP in this population was 31%; IS had 100% specificity and 71% sensitivity, whilst ET had 100% sensitivity and 77% specificity. The costs of BAL, IS, ET and ES strategies were 210,000, 191,940, 140,700 and 112,700 FF, respectively. The ES strategy is, thus, most suitable for our unit. The most economic strategy depends not only on the cost and characteristics of the procedures, but also on the prevalence of PCP in the test population. In conclusion, we developed a model for use by diagnostic centres in choosing the most suitable strategy, on the basis of the local prevalence of PCP.
AIDS-Related Opportunistic Infections↗
Subcutaneous heparin treatment increases survival in small cell lung cancer. "Petites Cellules" Group.
BACKGROUND: A positive influence of anticoagulant treatment in small cell lung cancer (SCLC) has been suggested by experimental and clinical data. METHODS: In a multicenter clinical trial, 277 patients with SCLC were randomized either to receive or not to receive subcutaneous heparin injections for 5 weeks at effective doses, which were monitored by blood coagulation tests. All patients received one of the two chemotherapy regimens studied in this trial, for eight courses in the case of patients with complete or partial response, and subsequently were randomized to receive delayed thoracic radiotherapy after these eight courses. RESULTS: In comparison to the 139 patients who did not receive heparin, the 138 patients who received anticoagulant treatment obtained better complete response rates (37% vs. 23%, P = 0.004), better median survival (317 days vs. 261 days, P = 0.01), and better survival rates at 1, 2, and 3 years (40% vs. 30%, 11% vs. 9% and 9% vs. 6%, respectively). At subgroups analysis, the results on survival were obtained for limited forms (P = 0.03) but not for extensive diseases (P = 0.31). No important bleeding or thrombocytopenia was related to heparin treatment. CONCLUSIONS: These results confirm the value of anticoagulant treatment in SCLC, already suspected for warfarin and now proven for heparin, but the modes of administration and the biologic explanations for this activity still warrant further investigation.
Aged↗
[Treatment of small cell bronchopulmonary cancers].
nn small cell lung cancer, the main treatment modality is chemotherapy, combinated with early thoracic radiation therapy for patients with complete response. The treatment of relapse with chemotherapy is efficient. The precocity of the response after initiating multimodality treatment is the main prognosis factor. The prophylactic cranial irradiation reduce the frequency of brain metastases, but has no significant effect on survival. Patients with very limited small cell lung cancer (TNM stage I and II) can be managed by surgery. Association with colony stimulating factors can lessen the severity of neutropenic and infectious episodes. The role of maintenance therapy by interferon alpha in clinically disease free patients is suggested.
Antineoplastic Combined Chemotherapy Protocols↗
Vinorelbine versus vinorelbine plus cisplatin in advanced non-small cell lung cancer: a randomized trial.
PURPOSE: The purpose of the study was to assess the possible benefit of the combination vinorelbine (NVB)-cisplatin (DDP) in comparison with NVB alone in advanced non-small cell lung cancer (NSCLC), not treated previously. It also involved confirmation of the efficacy of vinorelbine as monotherapy. PATIENTS AND METHODS: In this phase III trial, 231 eligible patients were stratified by centre and randomized to receive either NVB alone, 30 mg/m2/week or the combination of NVB 30 mg/m2/week and DDP 80 mg/m2/3 weeks. Patients were to be treated for a minimum of 6 weeks, with the first response assessment performed 9 weeks after the beginning of treatment. RESULTS: The two groups differed in terms of objective response rates (16% and 43%, respectively, p = 0.0001) and median time to progression (10 weeks and 20 weeks, p = 0.0001). However, the difference was not significant for median survival time (32 weeks, 33 weeks, p = 0.48). The addition of DDP resulted in an increase in toxicity, in particular renal, hematologic, neurologic and emetic. This toxicity led to treatment discontinuation in 8% and 21% of patients, respectively. Respectively 3% and 13% of patients stopped treatment early during objective response (toxicity or refusal). CONCLUSIONS: The NVB-DDP combination increased objective response rates and time to progression in comparison with NVB alone, but did not influence the survival of patients. The activity of NVB in the treatment of advanced NSCLC was confirmed.
Antineoplastic Agents↗
Long-term compliance to continuous positive airway pressure therapy (nCPAP) set up during a split-night polysomnography.
We studied prospectively the acute and long-term compliance with nasal continuous positive airway pressure (nCPAP) therapy set up during a split-night polysomnography in 31 patients suffering from severe obstructive sleep apnea syndrome (OSAS). The mean apnea-hypopnea index (AHI) was 66 +/- 23/hour. An effective nCPAP (AHI < 10/hour in all sleep stages in the dorsal decubitus) was titrated in 27/31 patients. The mean effective nCPAP was 11 +/- 2 cm H2O. In three patients, a subsequent night was necessary to determine the effective nCPAP during rapid eye movement sleep, and one patient did not support the treatment. Of the 27 patients with successful titration, 21 accepted home treatment, three chose a surgical procedure and three refused to be treated. Of the 21 accepting home treatment, one patient did not receive his insurance agreement and could not participate in follow-up. Among the 20 other patients, four interrupted their treatment during the 1st month because of discomfort, and 16 were followed for 285 +/- 84 days. The daily rate of nCPAP use for the compliant patients was 6.7 +/- 1.5 hours. These preliminary results indicate that a split-night technique is reliable and cost saving in a majority of patients suffering from severe OSAS.
Adult↗
Fiberoptic bronchoscopy for the early diagnosis of subglottal inhalation injury: comparative value in the assessment of prognosis.
The aim of this study was to determine the value of bronchoscopy in the early diagnosis of inhalation injury. A total of 130 burn patients underwent bronchoscopy on admission to a specialized center. In order to validate the method and the bronchoscopist's conclusions, they underwent staged bronchial biopsies. Using the histologic findings as the "gold standard," bronchoscopy proved to be sensitive (sensitivity, 0.79) and highly specific (specificity, 0.94) for the diagnosis of inhalation injury. In addition, it was more reliable than the circumstances of the injury, the clinical findings, and complementary tests. In a one-dimensional analysis, bronchoscopy-proven inhalation injury was one of the most strongly predictive variables for the onset of ARDS and death. The analysis of survival curves confirmed that inhalation injury portends a bad outcome in burn patients. It was used to predict the likelihood of ARDS and death at the time of admission with a view to early specific treatment.
Adult↗
[Pleural needle biopsy].
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Biopsy, Needle↗
[Invasive aspergillosis: management of mycological diagnosis].
Establishing the diagnosis of invasive aspergillosis consists primarily in the detection of Aspergillus hyphae, the invading form of the fungus, mainly from respiratory tract specimens and by cultural isolation. In this overview of the topic, we emphasise the major obstacles to the successful diagnosis of this fungal infection. The authors describe then the general procedures for histopathological and mycological diagnosis (samples, choice of method and the interpretation of results). Finally, they summarise, from literature the success rate in detecting Aspergillus, depending on the potentially infected sites and the specimens examined (broncho-pulmonary or extra-pulmonary).
Aspergillosis↗
An ongoing randomized study of neoadjuvant chemotherapy in resectable non-small cell lung cancer.
The purpose of this trial is to assess the possible benefit of neoadjuvant chemotherapy before surgery in patients with operable non-small cell lung cancer. Patients with operable stages I (except T 1N0), II, or IIIA disease are eligible for this ongoing trial. Patients are randomized into two arms. Surgery is performed first in group I; patients found to have T3 tumors or N2 lymph nodes are given postoperative radiotherapy. Group 2 patients start with two cycles of chemotherapy; following surgery, two more cycles are administered in responder patients and, as in group I, patients with T3 tumors or N2 lymph nodes are given radiotherapy. Chemotherapy is the MIP protocol: mitomycin 6 mg/m2 day I, ifosfamide 1.5 g/m2 days 1 to 3, cisplatin 30 mg/m2 days I to 3, and mesna 1,200 mg/m2 days 1 to 3. One hundred fifty patients were enrolled between June 1991 and September 1993. By the time this report was prepared, 117 patients had completed all assigned treatment, 63 in group I and 54 in group 2. There were two ineligible patients, one in each group. Forty-nine patients underwent thoracotomy in the chemotherapy-surgery group and 62 in the surgery-only group. There was only one progression after two cycles of chemotherapy. Rates of exploratory and incomplete surgery were 17% in group I and 12% in group 2. The trial is ongoing.
Adult↗
[Diagnosis of primary lung cancers].
Symptoms of bronchial cancers are varied and misleading, source of late diagnosis which had to be avoided by systematic suspicion in front of all symptoms from a "high-smoker". Fiberoptic bronchoscopy is the best exam for anatomic diagnosis of central forms. It is normal in peripheral forms but may yet be useful by directed samplings. If negative, it may be necessary to perform thoracotomy or transthoracic needle punction if surgery is contra-indicated. Pretherapeutic assessment of loco-regional and metastatic extension has recently profited by new imaging and endoscopic techniques, useful to the best realisation of TNM classification.
Humans↗
No effect of an antiaggregant treatment with aspirin in small cell lung cancer treated with CCAVP16 chemotherapy. Results from a randomized clinical trial of 303 patients. The "Petites Cellules" Group.
BACKGROUND: Experimental, and more recently, clinical data have suggested the influence of hemostasis in the spread of malignant disease. METHODS: To complete research in this type of coagulation and cancer, a multicentric randomized clinical trial was performed, including 303 patients with small cell lung cancer (SCLC), treated by the addition of aspirin at 1 g/day (a dosage at which aspirin is considered to be a platelet aggregation inhibitor) to combined chemotherapy. RESULTS: Survival was not increased in the aspirin-treated group (P = 0.90). The analysis according to the extent of disease (limited or extensive disease) did not modify that conclusion. CONCLUSIONS: This result does not confirm the hypothesis that, in SCLC, aspirin (a platelet aggregation inhibitor) reduces metastasis formation and local tumor thrombogenesis.
Adult↗
Superior vena cava syndrome in small-cell lung cancer.
BACKGROUND: The aim of this study was to analyze the features of the superior vena cava syndrome (SVCS) as initial characteristics in small-cell lung cancer: incidence, dissemination of disease, diagnostic procedures, efficacy and toxic effects of chemotherapy, and median survival in patients with SVCS. METHODS: In a prospective series of 724 patients with biopsy-proved small-cell lung cancer seen during a 6-year period, we reviewed data from patients who also had SVCS. RESULTS: The incidence of SVCS was 87 of 724 at the time of diagnosis. Initial emergency radiation therapy was not used in these patients. Diagnostic procedures in these patients were not associated with mortality. Rapid initiation of intensive chemotherapy, often with heparin therapy, resulted in complete or partial responses in 81% and no response in 12%; data were not evaluable in 7%. Two of these 87 patients died of aplasia within 4 weeks of chemotherapy. Median survival was not significantly different in the patients with SVCS (median, 42 weeks) and without SVCS (median, 40 weeks). A significant increase in initial brain metastases at the time of diagnosis was observed in patients with SVCS (22% vs 11%). CONCLUSIONS: Intensive chemotherapy is the first line of therapy in small-cell lung cancer. Histologic diagnostic procedures must be performed in patients with SVCS to adapt the treatment to the underlying cause. Initial emergency radiotherapy, before diagnosis or chemotherapy, does not seem to be useful in these patients. Computed tomography of the brain should be performed routinely in patients with SVCS, and prophylactic brain irradiation could be helpful in such patients. Apparently SVCS is not a poor prognostic factor in treated small-cell lung cancer.
Adult↗
[Food-related fungal infection risk in agranulocytosis. Mycological control of 273 food items offered to patients hospitalized in sterile units].
In sterile hospital units filamentous fungal infections are an unacceptable risk in patients with prolonged agranulocytosis. The occurrence of 3 successive cases in the Sterile unit of University Hospital of Grenoble prompted us to investigate in all elements of sterile unit, and notably food-processing. Two cooked rice dishes given to these patients were found to contain a substantial amount of Aspergillus fumigatus and were probably responsible for these infections. A more detailed study was carried out to evaluate the degree of food contamination by fungi in sterile unit. The study included 97 cooked dishes which had been sterilized in a 250 degrees oven for 40 minutes and 176 industrially packed foods delivered in single packs (e.g. milk and its derivatives, sweets and drinks). Each foodstuff was mycologically examined 3 to 5 times in different packs according to a procedure used in food analysis laboratories and raised to the standards of mycological examination. In this way, a 3-monthly food testing protocol in sterile unit could be set up. This protocol has a dual purpose: regular checking of the cooked dishes chain and maximum diversification of the dishes.
Agranulocytosis↗