Search PubMed⌕ Search

Biomedical subjects

B Milleron

Publications and source records attributed to B Milleron.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Drug-induced pneumopathies accompanied by acute respiratory insufficiency].

Drug induced pneumonias accompanying acute respiratory failure are defined by a delay in presentation of less two months and severe hypoxaemia (PaO2 < 60 mmHg in ambient air). They are poorly indexed, often poorly understood by the clinician and pose difficult problems both of diagnosis and treatment. This general review touches successively on hypoxaemic drug induced pneumonia observed in oncology and haematology then those observed outside this very specific context. In each of the two groups five questions are posed: 1) Which patients? 2) Which clinical patterns? 3) What initial diagnostic discussion? 4) Which successful elements support the drug induced hypothesis? 5) What outcome? The replies obtained were compared to case reports from the literature (188 references) or from recent general reviews concerned more specifically with the hypoxaemic forms.

Acute Disease↗
PubMed1995

CYP2D6 genotype and lung cancer risk according to histologic type and tobacco exposure.

Polymorphism for CYP2D6 was determined genetically as part of a hospital-based case-control study. The cases were males with a histologically confirmed lung cancer diagnosis, < 75 years old, and no previous cancer diagnosis. Male controls were matched for age, hospital and residence area. This study includes 301 cases and 310 controls. A DNA bank was established for 547 patients (89.5%), and genotypes for CYP2D6 were differentiated by the Heim and Meyer method for the DNA samples of 249 cases and 271 controls. Among the cases, the frequencies of homozygous for the wild-type (EM), heterozygous (HEM) and homozygous for the mutant alleles (PM) were 62%, 32% and 7%; among the controls: 57%, 37% and 6%. Using EM as the reference, and adjusting for age, hospital and residence, we estimated the odds ratios for the HEM group and the PM group at 0.8 (95% CI [0.5-1.2]) and 1.1 (95% CI [0.5-2.4]) respectively. The PM frequency among the cases of adenocarcinoma was twice as high as among the controls (OR = 1.8, 95% CI [0.7-4.9]). This result was not observed among squamous and small cell carcinoma (OR = 0.7, 95% CI [0.3-1.8]). Twelve different case-control studies on CYP2D6 and lung cancer have so far been performed; the ORs they estimate range from 0.1 to 2.0, with a median value of approximately 0.6. This result lends some support to the hypothesis that belonging to the PM group is associated with a slight protective effect against lung cancer, but does not take into account the possibility that results may vary according to histologic type. In this context, the suggestion of a positive relationship between CYP2D6 and adenocarcinoma seems to us to merit investigation.

Adult↗
PubMed1995

Silica-associated connective tissue disease. A study of 24 cases.

We prospectively studied all patients hospitalized for connective tissue disease (CTD) in our French rheumatology clinic from January 1979 to December 1989. Our aims were 1) to determine if CTDs associated with occupational exposure to silica (Si) are currently observed in a rheumatology clinic, and, if so, 2) to describe the major features of Si-associated CTD, and 3) to specify which individuals are affected by Si-associated CTD. Patients were divided into 2 groups based on their responses to a questionnaire: those who had been exposed to Si, and those who had no occupational exposure to Si. Among the 764 patients with CTD studied, 24 (3%) were patients with Si-associated CTD and 740 (97%) were patients with non-Si-associated CTD. The sex ratio between the 2 groups was significantly different with a high frequency of men and of immigrants in the Si-associated CTD group. Two thirds of the patients exposed to Si were male miners or sandblasters, but the other third had more unusual exposures to Si, which may involve members of all socio-economics sectors and both sexes, such as sculpture or exposure to abrasive powders. Progressive systemic sclerosis (PSS) was significantly more prevalent in the Si-associated CTD group. This group also consisted of patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), dermatomyositis (DM), and other autoimmune diseases. Si-associated CTD was characterized by the frequency of radiologic lung fibrosis, impaired pulmonary function tests, secondary Sjögren syndrome, and antinuclear antibodies. The number of mineral particles and crystalline Si content were raised in all the bronchoalveolar lavage specimens of Si-exposed patients but in none of those of nonexposed patients. In some cases of Si-associated CTD, the disease was reversible after early cessation of Si exposure. Epidemiologic studies are required to confirm our hypothesis that not only PSS and RA but also SLE and DM are associated with occupational exposure to Si. Pending such results, exposure to Si should be sought in the history of any patient with CTD, especially in a male patient with pulmonary signs, and if present, exposure should be stopped. In the meantime, steps should be taken to ensure that workers exposed to Si in all environments have adequate protection.

Adult↗
PubMed1995

Bronchogenic cyst presenting as mediastinal mass with pleural effusion.

Mediastinal bronchogenic cysts are usually identified on computed tomography (CT) as well-defined masses of variable density that may contain rim calcifications. Pleural effusion has never been described in association with these cysts. We report two cases of bronchogenic cysts with unusual presentation because of an association with a pleural effusion not explained by pulmonary infection. The patients were studied with CT scan (n = 2) and magnetic resonance imaging (MRI) of the chest (n = 1). In the first case, the pleural effusion directed diagnosis towards lung tumour; and the diagnosis of bronchogenic cyst was made on thoracotomy. In the second case, bronchogenic cyst was suspected on MRI findings. Inflammatory reaction was also suspected on the CT scan, which showed enhancement of the cyst edge. In both cases, surgical excision of the cyst was difficult because of pericystic adhesions to adjacent organs. Therefore, solely on the finding of a pleural effusion, pericystic inflammation had to be suspected.

Bronchogenic Cyst↗
PubMed1995

[Hemoptysis in sarcoidosis. Apropos of 6 cases including 4 with fatal outcome].

Haemoptysis rarely occurs in sarcoidosis. Most cases usually occur in patients with advanced disease and major fibrosis. We observed 6 cases including 5 with fibrosis and 1 with inaugural unilateral lymph node involvement. Haemoptysis is a sign of gravity since it is the second most frequent cause of death described in the literature. In our series 4 of the 6 cases were fatal. Aspergillus colonization of a cavity is the most frequently found aggravating factor. Ideally, surgery is indicated but usually cannot be performed due to the patients respiratory function and the extent of the lesions. Oral drugs have little effect. Certain authors have had success with local, initially intrabronchic anti-aspergillus treatment. CT-guided application is often helpful. Embolization may stop the bleeding but in the long-term, a more or less voluminous haemoptysis often recurs. Other causes of bleeding are rare. Systemic hypervascularization of sarcoidosis lesions has been proposed as one mechanism other than infection. The cause may also be a simple granuloma. Symptomatic initial treatment by embolization is also proposed in these cases. Finally, massive haemoptysis can occur by erosion of the pulmonary artery due to a necrotic sarcoidosis lesion. In our series, surgery was impossible in three patients who died. In the three others, embolization was possible in 2 and the third underwent successful surgery.

Adolescent↗
PubMed1995

[Efficacy of the granisetron/solumedrol combination in the control of drug-induced acute nausea and vomiting. Results of a prospective survey].

5 HT3 antagonist are effective drugs to control chemotherapy induced nausea and vomiting, but their optimum utilisation remain to be codify. In order to estimate efficacity of granisetron and solumedrol and to improve predictive factors of failure of antiserotoninergic agents, a prospective study have been realised 41 patients. During the first course of chemotherapy, 83% of patients presented less than two nausea and vomiting per day. Those results were the same from the first to the last course of chemotherapy. This study allowed to estimate anxiety of patients and maintain the hypothesis that more a antiemetic regimen is efficient less the predictive factors have a prognosis value.

Antiemetics↗
PubMed1995

[Contribution of bronchoalveolar lavage in immunosuppressed patients].

The safety of bronchoalveolar lavage has been greatly contributed to its widespread use in immunodepressed patients. This examination has changed the diagnostic approach to many lung diseases and often eliminates the need to open the thorax to make a lung biopsy. Bronchoalveolar lavage can be used to screen for a large number of diseases, particularly those due to infectious agents. In non-infectious diseases, the contribution of bronchoalveolar lavage is more limited. The impact of molecular biology techniques remains to be established.

Bronchoalveolar Lavage Fluid↗
PubMed1995

[Role of hematopoietic growth factors in bronchial cancerology].

Haematological growth factors constitute a major development in haematological and oncological practice. There are many questions raised as to their place and their optimal usage in the treatment of bronchial cancer. Growth factors enable the dose of chemotherapy to be increased by 20-40%, the limiting factor being thrombocytopenia and non-haematological toxicity. Nevertheless, a dose response relationship has never been clearly shown with chemotherapy for small cell and non-small cell carcinoma. Prescribing growth factor prophylactically enables a reduction in both the depth and duration of neutropaenia. Randomised studies which have evaluated G-CSF and GM-CSF for prophylaxis of infections in patients treated for small cell carcinoma lead to the same conclusions: a diminution in febrile episodes with neutropaenia, the duration of hospital stay and in the prescription of antibiotics. It seems justifiable to prescribe growth factors in patients presenting with a febrile illness and aplasia after the first treatment without growth factor in small cell carcinoma. It seems equally legitimate to prescribe these drugs in non-small cell carcinoma which have responded to chemotherapy at the price of aplasia. Outside these circumstances, it does not seem appropriate to prescribe these factors as first intention to those patients receiving conventional doses of chemotherapy who had not been treated before. There does not yet exist clear data for their use in established febrile conditions. The economic assessment has been limited to studies of minima-listing costs. No study of cost-effectiveness and cost-utility has been carried out to date.

Antineoplastic Agents↗
PubMed1994

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↗
PubMed1994

Vitamin D metabolism by alveolar immune cells in tuberculosis: correlation with calcium metabolism and clinical manifestations.

The aim of this study was to investigate the relationship between the pulmonary vitamin D metabolism in tuberculosis and the calcium metabolism abnormalities and other clinical characteristics of the disease. The metabolism of 25-hydroxyvitamin D3 (25(OH)D3) by alveolar immune cells recovered by bronchoalveolar lavage (BAL) was evaluated in parallel to the results of calcium metabolism, 25(OH) D and 1,25 dihydroxyvitamin D (1,25(OH)2D) plasma levels and other clinical parameters obtained in 14 tuberculosis patients. Whilst predominant metabolites produced by lavage cells in patients and controls were 5(E)--and 5(Z) -19-nor-10-oxo-25(OH)D3, 1,25(OH)2D3 was produced by cells from all tuberculosis patients but not by cells from controls. Calcium metabolism abnormalities were observed in only some patients, but the production of 1,25 (OH)2D3 by lavage cells was found to correlate both with 1,25(OH)2D levels (r = 0.67) and post-load urinary calcium excretion (r = 0.59). 1,25(OH)2D3 production by lavage cells was increased in patients of black origin, and those presenting with hilar adenopathy without pulmonary infiltrates, and was correlated with the number of lymphocytes recovered by lavage (r = 0.87). We conclude that 1,25(OH)2D3 production by alveolar immune cells makes a major contribution to the abnormalities in calcium metabolism seen in tuberculosis patients, and may be partly dependent on the clinical characteristics evaluated here.

Adult↗
PubMed1994

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↗
PubMed1993

Increased expression and occupancy of receptors for tumour necrosis factor on blood monocytes from tuberculosis patients.

Blood monocytes from tuberculosis patients release high amounts of tumour necrosis factor-alpha (TNF-alpha). Because the biological efficiency of TNF-alpha would depend on the expression of TNF-alpha receptors on target cells, we thought to analyse the capacity of blood monocytes from a group of patients with pulmonary tuberculosis to bind 125I-TNF-alpha. We report a slight but not significant enhancement in specific binding of 125I-TNF-alpha on monocytes of 15 consecutively studied patients compared with 10 controls. Per cent cell surface bound and internalized 125I-TNF-alpha was identical in the two groups. To evaluate the receptor occupancy by endogenously generated TNF-alpha, similar experiments were performed after cell exposure to low-pH glycine buffer. Under these conditions, specific binding of 125I-TNF-alpha was significantly higher on tuberculosis monocytes compared with control monocytes. Moreover, the occupancy of TNF-alpha receptors by endogenously generated TNF-alpha that was found to be significantly higher on tuberculosis monocytes than on control monocytes, was directly related to the enhanced capacity of mononuclear cells to generate TNF-alpha in vitro. It normalized after 3 months of antituberculous therapy. Scatchard analysis of the binding data revealed that tuberculosis infection caused a significant increase in high affinity 125I-TNF-alpha binding to monocytes without any significant change in the dissociation constant. Collectively, these results indicate an up-regulation of TNF-alpha generation and binding to blood monocytes in patients with pulmonary tuberculosis. They provide support to the hypothesis that TNF-alpha is of critical importance in the pathogenesis of this infection.

Adult↗
PubMed1993

Sarcoidosis associated with leucocytoclastic vasculitis. A case report and review of the literature.

We report on a patient presenting with cutaneous leucocytoclastic vasculitis in association with sarcoidosis. Detailed investigations did not show evidence of infectious or neoplastic diseases. Vasculitis was therefore considered to be secondary to sarcoidosis. A review of 4 other previously reported cases reveals a common presentation with the association of vasculitic skin lesions with deep cutaneous nodules, mediastinal lymph nodes and arthritis. The role of antibody response in leucocytoclastic vasculitis is discussed.

Female↗