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Biomedical subjects

C Chastang

Publications and source records attributed to C Chastang.

At least 127 records · Page 7Linked to original sources
PubMed1993

[Prospective study of the prescription of non-steroidal anti-inflammatory agents in a reception medical service of a university hospital. Influence of the prescriptor].

Non-steroidal anti-inflammatory drugs (NSAIDs) are estimated to be excessively prescribed. We have prospectively collected all drug prescriptions written by 50 doctors in an Outpatient Service, during a 5-day period. The purpose of this study was to draw the outline of NSAID prescriptors. Junior doctors (66%) wrote more controversial NSAID prescriptions (66%) than other doctors.

Ambulatory Care↗
PubMed1993

Plasma exchange morbidity in Guillain-Barré syndrome: results from the French prospective, randomized, multicenter study. The French Cooperative Group.

OBJECTIVES: To describe all adverse events occurring during plasma exchange sessions in adult patients with the Guillain-Barré syndrome. To analyze these events with regard to the technical modalities and biological changes induced by sessions, and to try to identify a population at high risk for adverse events. DESIGN: Double-blind, randomized, prospective, multicenter trial. SETTING: A total of 28 French and Swiss intensive care units. PATIENTS: The study is based on 220 patients allocated either to plasma exchange (n = 109) or not (n = 111). This study focused on 105 patients who received at least one plasma exchange, with replacement fluid secondly allocated by randomization to albumin, or fresh frozen plasma. A total of 105 patients underwent 390 plasma exchanges. Fifty-five patients received albumin (208 sessions) as replacement fluid, and 50 patients received fresh frozen plasma (182 sessions). INTERVENTIONS: Prospective monitoring of patients for each session including technical modalities, adverse effects, and biological parameters. MEASUREMENTS AND MAIN RESULTS: A total of 253 adverse incidents were recorded. At least one adverse incident occurred in 39% of plasma exchange sessions among 80 (76%) patients. In 15 patients, plasma exchange treatment had to be discontinued because of severe intolerance (six patients, including three patients with severe bradycardias), intercurrent complications, mainly infections (four patients), and technical difficulties. One patient with pneumococcal septicemia and pneumonia died during the second plasma exchange session. Fresh frozen plasma was associated with more adverse incidents than albumin (135 vs. 118, p = .008). The occurrence of adverse events was also related to the preplasma exchange hemoglobin level assessed before the session (p = .04). Otherwise, the frequency of adverse effects did not depend on technical modalities (type of equipment, anticoagulation). Age, sex, previous history, neurologic severity, and the need for mechanical ventilation, as assessed on inclusion in the study, did not modify the risk of adverse effects. Finally, occurrence of bradycardia did not rely on initial neurologic severity. CONCLUSIONS: These results confirm that fresh frozen plasma should be abandoned as replacement fluid in plasma exchanges of Guillain-Barré syndrome patients. They also underline the need for close monitoring of patients during sessions and, especially, the respect of treatment contraindications. Some adverse incidents could be attributed to the underlying disease rather than to the plasma exchange session.

Albumins↗
PubMed1993

A randomized trial of delayed thoracic radiotherapy in complete responder patients with small-cell lung cancer. Petites Cellules Group.

In small-cell lung cancer, the optimal combination of chemotherapy and radiotherapy is not clearly established. To assess the value of delayed thoracic radiotherapy, we performed a randomized clinical trial in 53 complete responder patients after eight courses of chemotherapy. Twenty-seven patients received a mean of 46.5 Gy-equivalent of radiotherapy and 26 patients received no treatment until relapse. No patient dropped out of the study. Median survival time from radiotherapy randomization was 316 days in the radiotherapy group and 496 days in the no radiotherapy group. No difference was observed in survival between the two groups (p = 0.66, log-rank test) perhaps because of the small sample size. In fact, this delayed thoracic radiotherapy seemed to worsen the outcome of complete responders with small-cell lung cancer and should be avoided.

Aged↗
PubMed1993

[Immunoglobulins or plasma exchange? Guillain-Barré syndrome: indications for plasma exchange and immunoglobulins].

The effect of plasma exchange (PE) in the Guillain-Barré syndrome (GBS) has been evaluated in 4 randomized clinical trials. A positive effect could be excluded in only one study conducted in Great Britain which included 29 patients. The more powerful studies conducted in Sweden (39 patients), in North America (245 patients) and in France (220 patients) demonstrated that early use of four PEs in patients with a GBS severe enough to require assistance in walking was followed by decreased duration and severity of the acute phase. These conclusions were ratified at a North American consensus conference. More recently, PE has been demonstrated to increase the number of patients who recover normal muscular power after a 1-year follow-up. The French trial also demonstrated that diluted albumin should be preferred over fresh frozen plasma. The number of plasma exchanges and the role of PE in initially benign forms is of great importance and is now under study by a cooperative group in France. The effect of immunoglobulins (IgG) was recently investigated in a randomized trial including 150 patients. In this study, high doses (0.4 g/kg/day for 5 days) were compared with 5 PE administered between days 7 and 14 in children and adults who, at inclusion, were unable to walk. The main result was that the outcome at one month was good with IgG as with PE. Treatment is easier with IgG, and morbidity is lower. Direct costs are similar. If IgG are shown to be as effective as PE, IgG should be given for GBS.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraindications↗
PubMed1993

[Smoking habits of French general practitioners. Results of a representative sample of 1,012 physicians].

General practitioners are in a position to influence the behaviour of the general population, notably as regards their smoking habits. This study aims to estimate the smoking habits of general practitioners in France, taken from a representative sample of 1012 general practitioners. The overall percentage of medical smokers rose in 1987 to 37%. The smoking habits varied according to age; thus if one considers current medical non-smokers, the oldest group are often ex-smokers, while the youngest are usually those who have never smoked. Compared to information obtained in 1980 from the medical population, one notes that there has been a fall in the level of doctors who smoke, whilst the proportion of doctors who have never smoked has risen considerably during the same period, particularly amongst young doctors.

Adult↗
PubMed1992

Bone densitometry in patients with multiple myeloma.

PURPOSE, PATIENTS, AND METHODS: We performed dual-energy x-ray absorptiometry in 10 selected patients with aggressive multiple myeloma in whom substantial tumor mass reduction was achieved after high-dose chemoradiotherapy followed by autologous blood stem cell transplantation. RESULTS: In most cases, bone mineral density (BMD) of the spine was initially low (Mean Z score: -2.69, SEM 0.76) and dramatically increased after treatment (mean increase 16.4%; 7.7% with 95% confidence interval 2.2 to 12.2, excluding one patient whose spine BMD increased by 94.8%). In contrast, skeletal roentgenograms, computed tomographic scans, and magnetic resonance imaging did not reveal any significant improvement of patients' bone lesions. CONCLUSIONS: In patients with multiple myeloma, bone densitometry could be a useful way to assess the efficacy of treatment on bone status.

Absorptiometry, Photon↗
PubMed1992

Effects of brief early exposure to partially hydrolyzed and whole cow milk proteins.

Clinical experience ("the dangerous bottle") and experimental evidence indicate that the early life of an infant is particularly important for the development of the immune responses to food antigens. However, the clinical and immunologic consequences of a brief exposure to, or avoidance of, food antigens during the neonatal period in human infants are poorly understood and documented. We present the preliminary results of a prospective controlled study of 256 normal breast-fed infants randomly assigned to receive (blind) either an adapted formula (Nidina) or a partially hydrolyzed formula (Nidal HA) as a supplement to breast-feeding for a few days when necessary, and to be examined at days 5, 90, 150, and 365. The results indicated that (1) the prevalence of clinical symptoms and of total and specific IgE responses was not statistically different in the two groups of infants and (2) infants fed a hydrolyzed formula had median titers of specific IgG lower than those fed an adapted formula; the difference was significant for alpha-lactalbumin at day 90 (p < 0.005) and for alpha-lactalbumin (p < 0.05), casein (p < 0.05), and hydrolyzed formula (p < 0.01) at day 150. Humoral immune responses of breast-fed infants to food antigens thus appear to be modulated by early, short-term exposure to them.

Breast Feeding↗
PubMed1992

Single-dose amoxycillin-clavulanic acid vs. cefotetan for prophylaxis in elective colorectal surgery: a multicentre, prospective, randomized study. The PRODIGE Group.

A prospective, multicentre, randomized trial was carried out in 19 hospitals in order to compare the efficacy of amoxycillin-clavulanic acid with cefotetan as antibiotic prophylaxis in patients undergoing elective colorectal surgery. Since the main purpose of the study was to demonstrate equivalence between the two regimens, the protocol planned the inclusion of 200 patients. Eligible patients were randomly assigned to receive either amoxycillin-clavulanic acid (2.2 g) or cefotetan (2 g) in a single infusion on the induction of anaesthesia. Failure of prophylaxis was defined as occurrence of infection of intestinal origin, either minor (wound cellulitis) or major (abscess, peritonitis, septicaemia) within the 30-day postoperative period. Among 221 randomized patients, 208 (105 amoxycillin-clavulanic acid, 103 cefotetan) aged 66 +/- 12 years (mean +/- SD) were evaluated while 13 were withdrawn. Colorectal cancer was the indication for surgery in 73% of cases. Eleven (10 +/- 6%, 95% confidence interval) and 13 (13 +/- 7%) failures were observed in the amoxycillin-clavulanic acid and cefotetan groups (P = 0.63 chi-square test) respectively. Most infections occurred before the 10th postoperative day (8% failures at this time, estimated by the Kaplan-Meier method). The results of the trial demonstrate that amoxycillin-clavulanic acid and cefotetan have similar efficacy when used for prophylaxis of infection after elective colorectal surgery.

Adult↗
PubMed1992

Outcome of patients with systemic rheumatic disease admitted to medical intensive care units.

The outcome of patients admitted to intensive care units is known to be influenced by such factors as age, previous health status, severity of disease, and diagnosis. To estimate the outcome of such patients with systemic rheumatic diseases and to determine if the severity of these diseases unfavourably influences the prognosis at the time of admission to a medical intensive care unit, the clinical courses of all patients with systemic rheumatic disease admitted to two medical intensive care units between January 1978 and December 1988 were studied retrospectively. Sixty nine patients with systemic lupus erythematosus (n = 16), necrotising vasculitis (n = 19), rheumatoid arthritis (n = 19), and other systemic rheumatic diseases (n = 15) were included. The mean (SD) age on admission into the medical intensive care unit was 53 (17) years and the mean simplified acute physiological score was 12 (5.5). The principal diagnoses on admission were infectious complications (29/69 patients) and acute exacerbation of the systemic rheumatic disease (19/69 patients). The death rate in the medical intensive care unit was 33% (23/69 patients) and was similar to that of a non-selected population with comparable simplified acute physiological score. The death rate in hospital was 42% (29/69 patients). Infection was the main cause of death in the medical intensive care unit (19/23 patients) and the infection was mainly acquired in the unit. Only the simplified acute physiological score on admission was a statistically significant prognostic factor: the simplified acute physiological score in patients who died was 15 (5.2) v 9.9 (4.7) for survivors. Long term outcome analysis showed that 83% (33/40 patients) of patients were still alive after admission to the medical intensive care unit with a follow up time between two months and nine years (mean 38 months). The death rate was relatively high and was mainly due to nosocomial infections. It was not different, however, from that of nonselected patients and the long term prognosis was highly favourable. This shows that the complications are often reversible, particularly infectious applications, and justifies admission to the medical intensive care unit of this group of patients.

Adult↗
PubMed1992

[Seraspenide (acetylSDKP): phase I-II trial study of inhibitor of hematopoiesis protects against toxicity of aracytine and ifosfamide monochemotherapies].

Seraspenide, a synthetic tetrapeptide, inhibits cell cycle entry of normal hematopoietic stem cells. In mice it protects hemopoiesis against the damage caused by cytarabine, cyclophosphamide and carboplatin. Seraspenide has been given to 53 cancer patients undergoing monochemotherapy with cytarabine and ifosfamide in a double-blind cross-over randomized study. A significant protection of peripheral blood cells has been observed. Seraspenide has been devoided of toxicity.

Cytarabine↗
PubMed1992

Six vs twelve cycles for complete responders to chemotherapy in small cell lung cancer: definitive results of a randomized clinical trial. The "Petites Cellules" Group.

Of 320 patients with small cell lung cancer (SCLC) entered into a clinical trial of chemotherapy between January 1983 and September 1985, 106 patients achieved a complete response. The induction chemotherapy used was lomustine 60 mg.m-2 p.o., cyclophosphamide 1 g.m-2 i.v., doxorubicin 45 mg.m-2 i.v. and etoposide 150 mg.m-2 i.v., every four weeks. Lomustine was only given for the first three cycles. Seventy nine of the 106 patients still in complete response after six chemotherapy cycles were subsequently randomized to receive either six more cycles or no more treatment until relapse. In this group of 79 patients, a difference was shown from the time of inclusion between the 51 patients with limited disease and the 28 patients with disseminated disease, with overall median survivals of 395 and 165 days, respectively, (p = 0.0002). No difference was shown between the two treatment groups: the median survival was 332 days from the time of second randomization with a two year survival rate of 28% for the patients randomized to receive six more cycles and 246 days and 22% for those randomized to receive no more treatment (add 147 days to obtain overall median survival). Continuing chemotherapy for more than six cycles to patients in complete response did not improve survival.

Aged↗
PubMed1992

[Peroperative cholangiography in cholelithiasis. Results of a multivariate analysis].

This study was done to select patients with a low risk of common bile duct (CBD) stones in whom operative cholangiography could be avoided. Operative cholangiography was performed upon 511 patients. Two different groups of patients were identified: patients with CBD stones visualized by CBD exploration (n = 90) and patients with no CBD stones at the time of operative cholangiography (n = 42). Multivariate analysis (stepwise logistic regression) showed that five variables were correlated with the presence of CBD stones: size of CBD equal to or greater than 12 millimeters, gallstones equal to or less than 10 millimeters, advanced age, chronic or acute cholecystitis and pas history of biliary colic. Using a scoring system, a group of patients with a low risk (less than 2%) of CBD stones could be easily determined. In this group of patients, operative cholangiography may be avoided.

Adult↗