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Biomedical subjects

C Chatelain

Publications and source records attributed to C Chatelain.

At least 55 records · Page 3Linked to original sources
PubMed1995

Thrombopoietic effects and toxicity of interleukin-6 in patients with ovarian cancer before and after chemotherapy: a multicentric placebo-controlled, randomized phase Ib study.

Recombinant human interleukin-6 (IL-6) has previously been shown to increase platelet counts in normal and sublethally irradiated mice, dogs, and primates. To assess its tolerance and efficacy in clinical use, we performed a randomized phase Ib study in patients with ovarian carcinoma. IL-6 was administered during an initial 7-day cycle before any chemotherapy. Beginning 7 days later, six cycles of chemotherapy containing carboplatin were administered every 3 weeks. During chemotherapy cycles 2 to 6, IL-6 was administered from day 4 through day 17 at escalating dose levels from 0.5 to 10 micrograms/kg/d. At each level, three patients received IL-6 and one patient received a placebo. During the prechemotherapy cycle of IL-6, a dose-dependent increase in platelet count was observed from day 12 to 15 and was maximal on day 15 (r = .77; P < .01). The median ploidy of bone marrow megakaryocytes shifted from 16 N to 32 N after 7 days of the initial prechemotherapy IL-6 administration. Dose-dependent increases in C-reactive protein (CRP) and fibrinogen levels were observed on day 8 (P < .0001 for both). A significant decrease in hemoglobin level occured rapidly after initiation of IL-6 therapy and was maximal on day 8 (P < .001). When given after chemotherapy, IL-6 accelerated platelet recovery after chemotherapy cycles 2 to 6. Postponements of scheduled chemotherapy due to thrombocytopenia were less frequent in patients treated with IL-6. No difference in either neutrophils or peripheral blood progenitor assays was observed during or after IL-6 treatment. Toxicity of IL-6 appeared mild and was not dose-limiting up to 10 micrograms/kg/d. Systemic symptoms such as fever, headache, and myalgia were the main side effects and were easily relieved by acetaminophen administration. No biologic toxicity was observed. The data indicate that IL-6 is a well-tolerated cytokine and capable of accelerating platelet recovery in patients receiving chemotherapy.

Acute-Phase Proteins↗
PubMed1995

[Artificial urinary sphincter].

The artificial urinary sphincter is a totally implantable hydraulic prosthesis designed to restore continence without inducing dysuria. It is composed of 3 silicone elastomer elements: a periurethral or pericervical cuff, a pressure regulating reservoir balloon inserted in the retropubic space, and a pump situated in the scrotum or labia majora. The prosthesis is filled with a liquid containing a contrast agent. Pressure on the pump allows passage of liquid from the cuff towards the balloon and allows micturition. After 3 to 4 minutes, the liquid is automatically transferred from the balloon to the cuff to restore continence. The artificial sphincter is currently a very effective therapeutic solution in cases of severe urinary incontinence with 3 main indications: persistent incontinence after prostatic surgery, recurrent incontinence in women due to sphincter insufficiency, and certain forms of neurogenic incontinence. The Pitié-Salpêtrière Urology Department's experience currently consists of 200 implantations performed over the last 10 years. The overall success rate varies from 80 to 90% according to sex and the aetiology of incontinence, in patients in whom the sphincter remains in place. In fact, there is a risk of explantation due to erosion of the tissues by the cuff or infection, but this risk is less than 15%. The risk of prosthesis failure is about 20%, but after correction of the defective element, cure is achieved in almost every case. Analysis of the results in the first 120 patients with the two most frequent aetiologies and with at least three years' follow-up (range: 3 to 10 years) reveals: in a series of 75 men, treated for severe incontinence persisting more than one year after surgery for benign prostatic hyperplasia, the explantation rate was 15% and, in the patients in whom the sphincter remained in place, complete cure was obtained in 73% of cases without any incontinence, while 17% of patients suffered from minimal incontinence, not requiring protection, 7% had moderate incontinence requiring protection and 3% were considered to be failures. The revision rate for technical failure was 24%. In a series of 45 women with recurrent incontinence after surgery, due to sphincter insufficiency, the explanation rate was 13% and, in women in whom the sphincter remained in place, complete success was obtain in 78% of cases without any incontinence, while 17% suffered from minimal incontinence, usually not requiring protection, 5% require protection, with no failures and a revision rate for technical failure of 24%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1995

[Malformation of the renal venous system and caudal vena cava presenting as recurrent hematuria].

The authors report a case of haematuria secondary to ureteric varices due to a complex venous malformation. After excluding a neoplastic and infectious cause, this rare cause of haematuria must be considered in patients presenting with unilateral upper tract haematuria. In this case, the diagnosis was made during adulthood. It was suspected on intravenous urography and confirmed by computed tomography.

Abnormalities, Multiple↗
PubMed1994

French multicentre trial comparing Casodex (ICI 176,334) monotherapy with castration plus nilutamide in metastatic prostate cancer: a preliminary report.

This trial compares Casodex (ICI 176,334) monotherapy with the combination of castration (medical or surgical) plus nilutamide. The trial is now closed to entry, 270 patients having been recruited from 32 French centres. As it is too early to present efficacy data, only patient characteristics and interim tolerability data appear in this paper. In the combined treatment group, interstitial pneumonitis (4.5%) was observed, leading to withdrawal from the trial. Other adverse events leading to withdrawal included dyspnoea and ocular problems. There was also 1 case of hepatitis in this treatment group. In the Casodex treatment group, only 6 patients (as compared with 13 in the combined treatment group) withdrew from the trial because of adverse events. As expected with this group, the adverse events were mainly pharmacological effects of an anti-androgen as monotherapy. In the majority of patients, the effects of gynaecomastia and breast tenderness did not result in withdrawal.

Aged↗
PubMed1994

[Current therapeutic modalities for cancer of the prostate].

The treatment of prostatic adenocarcinoma is no longer limited to systematic and blind oestrogen therapy. Modern methods of investigation now allow us to determine with much greater precision the site, size and extent of the tumour as well as its histological features. Therapeutic modalities have also been improved and diversified and should now be selected according to the clinical stage of the tumour and, less precisely, according to its cellular aggressiveness potential (grade). Schematically, the major therapeutic approaches are as follows: because of their slow and uncertain natural history, incidental tumours (stage T1a and b) may not require any immediate treatment provided they are submitted to long-term surveillance. Cancers confined to the prostate gland (stages T1b, T2) warrant local therapy, which may be curative at this stage: radical prostatectomy or radiotherapy. The principal problem at this stage remains the difficult assessment of lymph node involvement. Locally more advanced cancers (stages T3-T4) are no longer amenable to curative treatment and opinions are divided between combined (and aggressive) local treatments and hormone therapy. Disseminated, metastatic cancers (stages D2, M+) are treated by hormone therapy which may consist of a combination of androgen deprivation by LHRH analogues or surgery and antiandrogens with a direct prostatic action. Although very effective in the majority of cases, the action of this treatment is limited in time. When the "hormone escape" phase is reached, no specific chemotherapy is available and only palliative measures can try to maintain an acceptable quality of life for a limited period of time.

Combined Modality Therapy↗
PubMed1994

[Torsion of the spermatic cord. Current controversies].

The diagnosis of torsion of the spermatic pedicle is primarily clinical, despite the many studies concerning the value of complementary investigations. Currently available imaging modalities are limited either by their lack of sensitivity or by their lack of availability. The absence of well established evidence of direct impairment of contralateral testicular exocrine function is in favour of conservative treatment whenever the local conditions are suitable.

Humans↗
PubMed1994

[Prevalence of severe arterial hypertension in patients with renal grafts and surgical indications. Experience of the La Pitié Hospital].

Five hundred eighty five renal transplantations were performed in our group from January 1982 to December 1992. The observed incidence of hypertension in this group is 45%. Invasive treatment was indicated in 20 hypertensive patients (3.4%): 4 patients had bilateral-nephrectomy and 16 patients were treated for renal artery stenosis. This last group consisted of 12 men and 4 women (mean age of 36 years), who received a cadaveric transplant. 7 patients were hypertensive prior to transplantation. Only 25% of the patients received cyclosporine. Initial nephropathy was a glomerular in 9 cases. Before surgical treatment, an average of 3.2 anti-hypertensive drugs were necessary to control arterial pressure. Percutaneous transluminal angioplasty was indicated in 11 patients, whereas surgical correction of arterial stenosis was realized in 6 cases. Angioplasty was associated with poor results (persistent HTA and renal failure in 7 out of 11 patients). After surgery of renal artery, all patients had normal blood pressure. Renal artery stenosis would require surgical treatment, when possible. If not, percutaneous transluminal angioplasty will be proposed. The most efficient surgical procedure seems to be resection of the structure and termino-terminal anastomosis. When usable, internal iliac artery can be sutured beyond the stenosis.

Adult↗
PubMed1993

Dose-dependent interleukin-3 stimulation of thrombopoiesis and neutropoiesis in patients with small-cell lung carcinoma before and following chemotherapy: a placebo-controlled randomized phase Ib study.

PURPOSE: To evaluate the safety, tolerance, and hematologic effects of recombinant human interleukin-3 (IL-3) in patients with small-cell lung cancer (SCLC) before and following multiagent antineoplastic therapy in a placebo-controlled, randomized, double-blind study. PATIENTS AND METHODS: Twenty-eight patients (22 men and six women; median age, 60 years) with previously untreated SCLC entered the study. Patients were assigned to six groups of escalating-dose IL-3 ranging from 0.25 to 10 micrograms/kg/d administered by continuous infusion for 7 days, with one patient in each group receiving placebo. After a 1-week interval, the first of three cycles of carboplatin, etoposide (VP16), and epirubicin (CVE) given every 3 weeks was administered. The second cycle of CVE was followed by 7 days of IL-3 administered at the same daily dose as administered during the first infusion. RESULTS: The maximum-tolerated dose was not encountered in this study. Fever was the most frequently observed side effect. Before any chemotherapy, World Health Organization (WHO) grade II fever only appeared at doses > or = 2.5 micrograms/kg/d. Other side effects included rash, headache, and myalgia. During the first infusion of IL-3, before administration of chemotherapy, dose-dependent increases in peripheral-platelet counts (r = .613; P < .001) and neutrophil counts (r = .505; P = .007) were observed. Following the second cycle of CVE, recovery of peripheral platelet counts was faster as compared with the first cycle of CVE for patients treated with 7.5 and 10 micrograms/kg of IL-3 (P = .021). Chemotherapy postponements due to myelotoxicity were also less frequent following the second cycle of CVE as compared with the first for patients treated with > or = 2.5 micrograms/kg of IL-3 (P = .036). Compared with an age-matched historical group receiving identical chemotherapy (n = 191), administration of IL-3 did not modify either disease-free survival or overall patient survival rates. CONCLUSION: IL-3 is well tolerated at doses up to 10 micrograms/kg/d. In the absence of chemotherapy, biologic effects on both neutrophils and platelets were seen at doses > or = 2.5 micrograms/kg/d. IL-3 infusion following the second cycle of CVE appears to reduce chemotherapy-induced myelosuppression, but does not alter tumor response or patient survival rates.

Adult↗
PubMed1993

[Current questions and controversies on the treatment of prostate cancer].

The treatment of prostatic adenocarcinoma is the subject of debate and controversy at all stages of the disease. At the initial "subclinical" stage, discovered in transurethral resection or prostatectomy specimens, the conservative approach generally adopted should sometimes be replaced by curative treatment in young patients or in the case of high grade cancers. The localised, intraprostatic stage is amenable to curative treatment. However, radical prostatectomy may not be indicated in the presence of lymph node metastases and the discovery of positive margins on histological examination of the resection specimen raises the question of the necessity and the chronology of complementary treatments. At the stage of locally advanced cancer, all therapeutic modalities have been proposed in various combinations. The most controversial question concerns neoadjuvant endocrine therapy prior to radical prostatectomy. Metastatic disease is treated by endocrine therapy. However, the necessity of complete androgen blockade chemotherapy has still not been demonstrated. No effective therapeutic solution has yet been found for "endocrine escape", but a number of palliative measures should improve the quality of the patient's limited survival.

Adenocarcinoma↗