Search PubMed⌕ Search

Biomedical subjects

C Boutin

Publications and source records attributed to C Boutin.

At least 91 records · Page 5Linked to original sources
PubMed1995

Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy.

The purpose of this randomized prospective study was to assess the efficacy of local radiotherapy in preventing malignant seeding along invasive diagnostic procedures (cytology, needle biopsy, thoracoscopy, or chest tube placement) in patients with malignant pleural mesothelioma. Forty consecutive patients with histologically proven malignant mesothelioma were enrolled. Twenty patients received three daily sessions of radiotherapy at a dosage of 7 Gy 10 to 15 days after thoracoscopy. The other 20 patients did not receive radiotherapy. None of the 20 patients treated developed entry tract metastasis. In contrast, 8 of the 20 (40%) patients who were not treated developed metastases. These findings confirm the efficacy and safety of early local radiotherapy in preventing malignant seeding after invasive diagnostic procedures in patients with malignant pleural mesothelioma.

Aged↗
PubMed1995

[An experimental model of pleural adenocarcinoma constructed by the implantation of intact human neoplastic tissue in the nude mouse. The prognostic value of a lesion of the visceral pleura].

In certain cases pleural adenocarcinoma can behave like a primary tumour of the pleura. If the origin of this type of tumour is not clearly established, the macroscopic aspect of the pleura explored by thoracoscopy enables a distinction to be made between isolated disease of the parietal pleura and mixed disease of both the parietal and visceral pleura. The object of this study was to evaluate the prognosis of tumour disease of the visceral pleura. Using a murine model (the nude mouse) of cancer of both visceral and parietal pleura induced by implanting histologically intact human carcinoma, we have compared the symptoms of survival of the two groups of mice as well as the local and regional dissemination and metastases of the implanted tumour. The growth of the tumour was suspected by the appearance of weight loss, signs of respiratory difficulty and/or cachexia. Autopsy examination allowed a measure of the size of tumour dissemination. A pleural cancer, histologically identical to the initial human tumour with invasion of the neighbouring structures as one sees in man, was obtained in all the implants. Nevertheless, contralateral mediastinal lymph node metastases were only found in mice with implants on the visceral pleura. The median survival was 27.9 days and 31 days respectively for implanted mice on the visceral pleura and on the parietal pleura. Mice with implants on the visceral pleural lost more weight than those implanted on the parietal pleura (p < 0.001). The results of this study show that the models of parietal pleura and visceral pleura each correspond to an early stage disease and to a stage of advanced disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1995

Medical thoracoscopy. Technical details.

In summary, thoracoscopy offers several possibilities for diagnostic and therapeutic uses. Thoracoscopy helps in the diagnosis of pleural-based malignancy or tuberculosis with a high degree of accuracy when routine studies and closed needle pleural biopsies have failed. In patients in whom adequate visualization is possible, an unequivocal pathological diagnosis of benign diseases can be made with a specificity approaching 100%. Thoracoscopy is effective in the management of malignant pleural effusion and spontaneous pneumothorax.

Biopsy↗
PubMed1994

Intrapleural treatment with recombinant gamma-interferon in early stage malignant pleural mesothelioma.

BACKGROUND: This report presents the results of a prospective multi-institutional study of intrapleural treatment with gamma-interferon in patients with Butchart's Stages I and II epithelial or mixed malignant pleural mesothelioma. METHODS: Interferon was administered at a dose of 40 million units twice a week for 8 weeks intrapleurally via a catheter or an implantable port. Thoracoscopic or surgical biopsy was performed if computed tomography scan 2 weeks after the end of treatment demonstrated a reduction in tumor size. Survival was calculated after a follow-up of at least 18 months. Prognostic factors were identified by univariate and multivariate analyses (Cox model). RESULTS: Eighty-nine patients were included over 46 months. Eight histologically confirmed complete responses and nine partial responses with at least a 50% reduction in tumor size were obtained. The overall response rate was 20%. Most responses were achieved in patients with early stage disease. The response rate for patients with Stage I disease was 45%. Tolerance of interferon was good. Treatment was performed on an outpatient basis. The main side effects were hyperthermia, liver toxicity, neutropenia, and catheter-related infection. CONCLUSIONS: Gamma-interferon is effective mainly in Stage I mesothelioma, especially if the tumor is confined to the parietal or diaphragmatic pleura (Stage IA).

Aged↗
PubMed1994

Pharmacokinetics of intrapleural recombinant interleukin-2 in immunotherapy for malignant pleural effusion.

BACKGROUND: The authors measured pharmacokinetic parameters before, during, and after immunotherapy by continuous intrapleural infusion of recombinant interleukin-2 (rIL-2) and correlated the resulting data with clinical effects in nine patients with malignant pleural effusion. METHODS: The underlying disease was malignant mesothelioma in five patients and adenocarcinoma in four patients. Continuous intrapleural infusion of rIL-2 was performed for 5 days at 21 x 10(6) IU/m2/day. Maximum tolerated dose previously was determined to be 24 x 10(6) IU/m2/day in a Phase I study. Peak levels, the areas under the concentration curve (AUC), and drug half-lives were measured in pleural fluid and plasma samples collected at 0 (baseline), 12, 24, 48, 72, 96, and 120 hours during infusion and at 2, 6, 8, 32, 44, 56, 80, and 120 hours after the end of infusion. RESULTS: High and prolonged intracavitary drug levels were achieved in all but two patients, with a statistically significant correlation between peak values and AUC. Four patients achieved objective responses according to World Health Organization criteria. Neither of the patients with undetectable rIL-2 levels had response to therapy. Serum rIL-2 levels were low regardless intrapleural levels. Mean AUC was lower in the plasma than in the pleural fluid. CONCLUSIONS: This study demonstrates that continuous intrapleural infusion of rIL-2 is an active method of treatment for malignant pleural effusion. The low serum levels associated with this method greatly improve tolerance. The results also indicate that the concentration and duration of intrapleural rIL-2 levels may depend on the extent of pleural invasion. Additional study is needed to confirm this finding.

Adenocarcinoma↗
PubMed1994

"Patient-like" nude mouse metastatic model of advanced human pleural cancer.

Pleural cancer in humans is a frequently occurring tumor. Recently, clinical trials have suggested that chemotherapy and immunotherapy administered intrapleurally may elicit responses in early-stage diseases. However, at radiological and pleural endoscopic evaluation, most of the patients are found to have a visceral pleural involvement that is generally refractory to therapy and leads to a poor prognosis. The goal of this study was to construct a nude mouse model of human parietal- and visceral-pleural cancer that could reflect the clinical picture for this disease. The model could then be useful for drug discovery for pleural cancer. A well-differentiated human lung adenocarcinoma was used as intact tissue for implantation. Ten mice underwent parietal-pleural implantation and ten mice visceral-pleural implantation via a novel thoracotomy procedure we have developed. Symptoms of tumor growth were determined from weight loss, respiratory distress, or debilitation. Actual tumor growth and spread were measured at autopsy. The mouse survival curves of each group were estimated by the Kaplan-Meier method and the difference of the median survival times was assessed by the Log-rank test. The slopes of mean-mouse weight curves were compared using a standard two-sample t-test. A 100% take rate was achieved in constructing the pleural cancer models. Tumor growth was initially assessed by symptomatology and survival: the median survival time was, respectively, 27.9 days and 31 days for visceral-pleural and parietal-pleural implanted groups (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1994

Immunocytochemical characterization of cell lines from human malignant mesothelioma: characterization of human mesothelioma cell lines by immunocytochemistry with a panel of monoclonal antibodies.

A panel of nine monoclonal antibodies was used to characterize human mesothelioma cell lines that we established from human malignant mesothelioma. The antigens detected were cytokeratin, vimentin, epithelial membrane antigen, carcinoembryonic antigen, Leu-M1 (CD15), desmin, factor VIII-related antigen (von Willebrand factor antigen), OV632, and ME1, a specific monoclonal antibody directed against human malignant mesothelioma. The technique used was the alkaline phosphatase anti-alkaline phosphatase method. All 30 cell lines, either epithelial, sarcomatous, or mixed, showed strong reactivity with cytokeratin and vimentin antibodies. None of the cell lines demonstrated any reactivity with carcinoembryonic antigen, Leu-M1, or factor VIII antibodies; moreover, all of 22 cell lines studied were positive for ME1 antibody and 10 of 12 cell lines studied were positive for OV632. Some interesting features were noted: only two of the 30 cell lines presented a weak positive staining with epithelial membrane antigen, and nine of 19 cell lines tested demonstrated a cytoplasmic staining pattern with desmin antibody. These results show that established human mesothelioma cell lines still possess the immunocytochemical characteristics that are basically consistent with the immunohistochemical features described in tumor tissues of malignant mesothelioma. These characteristics can be used to identify the mesothelioma cells grown from human malignant mesothelioma. Hence, the mesothelioma cell lines will provide a useful tool for the investigation of the cell biology of the tumor and the mechanisms of mesothelial cell transformation, as well as the in vitro evaluation of the effects of some drugs in order to develop new therapies for malignant mesothelioma.

Actins↗
PubMed1994

Myocardial perfusion, function and exercise tolerance after the arterial switch operation.

OBJECTIVES: This study was conducted to determine the prevalence of myocardial perfusion abnormalities at rest and exercise and to assess exercise capacity in children after the arterial switch operation. BACKGROUND: There have been sporadic reports of myocardial ischemia or sudden death in children after the arterial switch operation for transposition of the great arteries, possibly related to inadequate coronary perfusion due to kinking or stenosis of the translocated coronary arteries. METHODS: Myocardial perfusion at rest and peak exercise was assessed using the scintigraphic agent technetium-99m methoxyisobutyl isonitrile (sestamibi). Exercise capacity was determined with a modified Bruce protocol. Ambulatory electrocardiographic (ECG) Holter monitoring was performed. Ventricular function, contractility and wall motion were assessed echocardiographically. RESULTS: Twenty-three children (aged 4.2 to 7.9 years) underwent evaluation. Abnormalities were found on the rest perfusion scans in 22 children (95.6%). The left ventricular myocardium was divided into 13 segments for analysis. Of 299 rest segments, 225 (75.3%) were normal, 11 (3.7%) showed mild defects, 45 (15%) moderate defects and 18 (6%) severe defects at rest. At peak exercise, 237 segments (79.3%) were normal, 24 (8%) showed mild defects, 33 (11%) moderate defects and 5 (1.7%) severe defects. Compared with rest studies, myocardial perfusion grade at exercise was unchanged in 246 segments (82.3%), improved in 42 (14%) and worsened in 11 (3.7%). All patients had normal exercise tolerance without symptoms or ischemic ECG changes. No ventricular tachycardia was seen on Holter monitoring. All patients had a shortening fraction > or = 27%. Left ventricular contractility was normal in 12 children in whom it was assessed. Regional wall motion was normal in 17 children with adequate echocardiographic images for this analysis. CONCLUSIONS: Myocardial perfusion scan abnormalities assessed by technetium-99m sestamibi are common after an arterial switch operation. These abnormalities are of uncertain clinical significance and generally lessen with exercise. The normal exercise tolerance without symptoms or ECG changes suggests that myocardial perfusion is adequate during the physiologic stress of exercise in children up to 8 years after an arterial switch operation.

Child, Preschool↗
PubMed1994

Rapid two-stage arterial switch operation. Evaluation of left ventricular systolic mechanics late after an acute pressure overload stimulus in infancy.

BACKGROUND: Banding of the pulmonary artery to induce left ventricular (LV) hypertrophy followed by arterial switch operation (ASO) within 2 weeks has been performed when a primary ASO was considered high risk because of inadequate LV hypertrophy. METHODS AND RESULTS: Potential adverse myocardial effects of the two-stage procedure were examined by comparing outcome in 18 patients after a rapid two-stage ASO with 33 patients after a primary ASO. Regional wall motion was assessed. Echocardiographic and noninvasive pressure data were combined to obtain LV dimension, wall thickness, mass, fractional shortening, rate-corrected mean velocity of shortening, and end-systolic wall stress. Afterload-adjusted velocity of shortening was obtained as a load-independent index of contractility. In the two-stage ASO group, the magnitude and rate of hypertrophy after pulmonary artery banding were measured serially. No wall motion abnormalities were seen in either group. Systolic dysfunction due to higher afterload and lower contractility was observed in the two-stage ASO group. Contractility below the limits of normal was seen in 25% of two-stage ASO compared with 3% of primary ASO; however, symptomatic or progressive LV dysfunction was not observed. There was a significant inverse relation between the peak rate of hypertrophy immediately after banding and contractility at late exam. Lower ejection fraction before and early after pulmonary artery banding correlated with depressed contractility on late examination. CONCLUSIONS: Myocardial contractility is lower after the two-stage ASO than after a primary repair. Severe or progressive dysfunction was not seen. A very high peak rate of hypertrophy and severe LV dysfunction after banding predict a greater reduction in late contractility.

Acute Disease↗
PubMed1994

Rapid two-stage arterial switch operation. Acquisition of left ventricular mass after pulmonary artery banding in infants with transposition of the great arteries.

BACKGROUND: Banding of the pulmonary artery (PAB) in preparation for arterial switch operation (ASO) in patients with transposition of the great arteries (TGA) represents a unique model of acute left ventricular pressure overload in humans. METHODS AND RESULTS: To establish the rate, magnitude, and determinants of left ventricular hypertrophy and the acute effect on ventricular function, serial bidimensional echocardiographic evaluations were performed on 26 patients with TGA after PAB. Mass, volume, and ejection fraction of the left ventricle were measured. Cardiac catheterization data before PAB and again before ASO were reviewed. The mean interval between the PAB and ASO was 9 +/- 4 days. The left ventricular to right ventricular pressure ratio before PAB was 0.5 and increased to 1.0 before ASO. The mean percentage increase in left ventricular mass from PAB to ASO was 96%, 95% of which was achieved in the first 7 days. The average rate of left ventricular hypertrophy for the entire period was 0.06 g/h and was 0.19 g/h during the interval from PAB to attainment of maximum left ventricular mass. The most rapid rate of hypertrophy was seen by day 2, with an exponential fall in the growth rate thereafter approaching zero by day 7. Ejection fraction was significantly reduced at 12 hours after PAB, but mean values returned to pre-PAB levels by 3.5 days after banding. The absolute rate of left ventricular hypertrophy correlated directly with body surface area but not to other hemodynamic variables. CONCLUSIONS: Doubling of left ventricular mass can be achieved in 1 week after PAB. Function falls acutely due to afterload excess and/or depressed contractility but recovers rapidly as compensatory hypertrophy occurs.

Echocardiography↗
PubMed1994

Implantable access system for prolonged intrapleural immunotherapy.

We describe our experience using an implantable Port-A-Cath access system for intrapleural administration of gamma-interferon (gamma-IFN) in malignant mesothelioma patients. Twenty nine patients, with histologically proven malignant mesotheliomas were included in this study. To avoid complications the device was implanted in a subcutaneous pocket, and the catheter was connected via a tunnel. Also, a suction drain was installed in the pocket after placement. This procedure greatly reduced the high infection rate (64%) encountered with conventional open chest tubes. Patients' tolerance was excellent and maintenance minimal. In our opinion, the Port-A-Cath system is the most suitable device for intra-cavitary long-term therapy of malignant pleural effusions.

Aged↗
PubMed1994

Environmental asbestotic pleural plaques in northeast Corsica: correlations with airborne and pleural mineralogic analysis.

We report a prevalence study of environmental pleural plaques in subjects over 50 years old from the northeastern Corsican village of Murato, built on asbestos surface deposits. The percentage of plaques was 41%, versus 7.5% in the control village of Vezzani. Although surface deposits contain both chrysotile and tremolite, airborne pollution and asbestos lung burden of exposed inhabitants consist essentially of tremolite as assessed by transmission electron microscopy (TEM). However, TEM analysis of the parietal pleura of three animals bred in exposed areas showed a predominance of short fibers of chrysotile. The respective roles of tremolite and chrysotile in inducing pleural plaques in Corsica should thus be considered.

Aged↗
PubMed1994

Thoracoscopic findings in spontaneous pneumothorax in AIDS.

Six patients with the acquired immunodeficiency syndrome (AIDS) who suffered eight spontaneous pneumothoraces between January 1990 and January 1993 underwent videothoracoscopy. The predominant macroscopic findings, found in four patients on five occasions, were white-yellow nodules dispersed throughout the lung surface. In addition, in one patient, these lesions were associated with multiple small apical bullae and, in another, a large reddish nodule with several smaller white satellite nodules was noted on the parietal pleura. Methenamine silver stain of biopsy samples of both the visceral and parietal nodules in these patients showed the presence of Pneumocystis carinii. May-Grunwald-Giemsa stain of brushing samples of visceral lesions revealed P-carinii in two patients. In one of these patients, previously performed bronchoalveolar lavage (BAL) had not yielded P-carinii. On two occasions, the thoracoscopic findings were unremarkable, although in one of these patients, computed tomography (CT) had shown a large thick-walled cyst near the left hilum and BAL revealed P-carinii. Talc poudrage through the thoracoscopic cannula followed by chest tube drainage was performed in all patients and was successful in treating three of five with proved P-carinii pneumonia-related pneumothorax. The etiology of pneumothorax in AIDS and the diagnostic and therapeutic utility of videothoracoscopy in these patients are discussed.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Pleurodesis. Indications and review of symphyseal agents].

Recurrent or chronic pneumothorax and neoplasm of the pleura are the major indications for pleurodesis. However certain chronic or recurrent forms of pleural affections of mechanical origin or secondary chylothorax may not respond to aetiologic treatment and could benefit from therapeutic pleural symphysis. The objective may be reached with several physical and chemical agents including cyclins and talcum powder among the most effective products devoid of major risk. The classic surgical techniques have been abandoned in favour of interventional thoracoscopy to obtain pleural abrasion and pleurectomy. Promising results have been obtained.

Bleomycin↗
PubMed1994

[Idiopathic dilatation of the pulmonary artery. Echocardiographic aspects].

The authors compared 30 patients with at least one clinical sign of idiopathic dilatation of the pulmonary artery, with a group of 20 normal control subjects in order to establish diagnostic criteria for this condition. In the first group, 17 had characteristic radiological findings and 13 others had clinical signs of idiopathic dilatation of the pulmonary artery. Comparison with the control group showed significant differences (p < 0.05) in 4 parameters: 1) the diameter of the pulmonary artery at the bifurcation/m2 body surface area (2.8 +/- o.4 cm versus 2.4 +/- 0.4 cm), 2) the diameter of the aorta 2 cm beyond the aortic valve/m2 of body surface area (1.7 +/- 0.3 cm versus 2.1 +/- 0.7 cm), 3) the ratio of pulmonary artery/aortic diameters at the valve rings (1.4 +/- 0.2 versus 1.1 +/- 0.02); 4) the ratio of the aorta 2 cm beyond the valve/aortic ring (1.02 +/- 0.07 versus 1.09 +/- 0.09). The diagnostic criteria of idiopathic dilatation of the pulmonary artery in the absence of cardiac or pulmonary disease are: 1) ratio of pulmonary artery diameter at its bifurcation/aortic ring diameter or 2 cm beyond the aortic valve of > or = 1.4; 2) ratio of pulmonary/aortic ring diameters > or = 1.5.

Adolescent↗