Search PubMed⌕ Search

Biomedical subjects

D Espinouse

Publications and source records attributed to D Espinouse.

At least 37 records · Page 2Linked to original sources
PubMed1995

Isepamicin once daily plus ceftriaxone versus amikacin plus ceftriaxone in febrile neutropenic patients.

Isepamicin is a new aminoglycoside with in-vitro activity superior to amikacin. It is a poor substrate for the 6'-aminoacetyltransferase-I enzyme which inactivates amikacin and therefore organisms possessing this enzyme are not resistant to isepamicin. The aim of this study was to compare the efficacy and safety of co-administration of isepamicin once daily plus ceftriaxone to amikacin twice daily plus ceftriaxone to amikacin twice daily plus ceftriaxone in febrile neutropenic cancer patients. Febrile episodes in 235 patients (156 in isepamicin group and 79 in amikacin group) were treated in this study. They occurred in 218 different patients. Fifteen patients were enrolled twice and one three times. Response rates to the two treatment regimens for microbiologically documented episodes, clinically documented episodes and further unexplained fever were similar. Tolerance of the treatment regimens, as measured by serum creatinine levels, hypoaccousia and cutaneous allergy was also similar in both treatment groups. In conclusion, isepamicin given once daily when combined with ceftriaxone in the treatment of febrile episodes in neutropenic cancer patients was as effective and no more toxic than amikacin.

Adolescent↗
PubMed1994

Heterogeneity of acute lymphoblastic leukemia in HIV-seropositive patients.

BACKGROUND: As opposed to large-cell or Burkitt's-type non-Hodgkin's lymphoma, acute lymphoblastic leukemia (ALL) is rarely observed in HIV-seropositive patients and is not a criteria of AIDS in the 1986 classification established by the C.D.C. Furthermore, the few cases of ALL reported so far were B-cell ALL, Burkitt's-type. DESIGN: We recently observed, with unexpected frequency, ALL cases in this setting: over a 5-year period, 5 of 25 HIV-positive patients referred to our center for hematological malignancies, had ALL. Three patients, who had previously been asymptomatic with regard to HIV infection, had typical Burkitt's-type ALL. Complete remission was achieved in all cases with high-dose lymphoma-type chemotherapy regimens, but 2 patients relapsed 3 and 27 months after diagnosis. Their clinical characteristics and outcome are discussed with reference to the cases reported thus far in the literature. One patient had common early pre-B ALL with the Philadelphia chromosome, and one had a T-cell ALL with an unusual CD7+, CD4-, CD8- phenotype. Prognosis was very poor in both cases. CONCLUSION: The exact incidence and the therapeutic management of B-cell ALL in HIV-positive patients warrants further evaluation. In addition, we show that there may be a heterogeneity among ALL cases in this setting, with the first description of 2 non-Burkitt's ALL with atypical features in HIV-positive patients.

Adult↗
PubMed1994

[Major pancytopenia in Biermer disease. 5 cases].

Five cases of Biermer's disease presenting as pancytopenia were observed over a 17-year period. In all cases, haemorrhagic and/or infectious complications occurred. The myelogram revealed qualitative medullary deficiency and laboratory data led to diagnosis. The importance of prompt substitutive therapy is underlined.

Aged↗
PubMed1993

Peripheral blood stem cells harvested after chemotherapy and GM-CSF for treatment intensification in patients with advanced lymphoproliferative diseases.

Peripheral blood stem cells (PBSC) from 15 patients with advanced non-Hodgkin's lymphoma (NHL), two patients with chronic lymphocytic leukemia, and two patients with myeloma were collected by continuous-flow leukapheresis after chemotherapy with MIV (mitoxantrone, ifosfamide, and etoposide, five patients) or high-dose cyclophosphamide (14 patients), followed by administration of GM-CSF. Sixteen patients (84%) had persistent marrow involvement at time of inclusion. Results were compared to those obtained in a control group of similar age and disease status in whom collection had been performed after MIV chemotherapy alone. The number of mononuclear cells, granulocyte-macrophage colony-forming units (CFU-GM), CD34+ cells were higher in GM-CSF treated patients with a lower mean number of leukapheresis (3.5 versus 6.4). Among the 19 patients harvested after chemotherapy plus GM-CSF, more progenitor cells were obtained in the cyclophosphamide group than in the MIV group. In all these patients except one, the number of mononuclear cells was sufficient to realize a transplantation. Seventeen patients received intensification with BEAM regimen (8 patients) or cyclophosphamide plus etoposide and total body irradiation (9 patients). Two patients failed to reconstitute correct hematopoiesis and three early toxic deaths occurred for a total of five procedure-related deaths. Nine of these 17 patients are in persistent complete remission with a median post-transplant follow-up of 18 months. Time to reach granulocyte and platelet recovery was not correlated with the number of mononuclear cells, CFU-GM, granulocyte-erythroid-macrophage-megakaryocyte colony-forming units (CFU-GEMM), CD34+ cells, and CD34+ CD33- cells but with the number of previous chemotherapy regimens. PBSC harvesting is achievable after chemotherapy plus GM-CSF in heavily pretreated patients with persistent marrow involvement. Moreover, these cells are able to reconstitute correct hematopoiesis after intensive treatment in these patients.

Adult↗
PubMed1992

Intensive radio-chemotherapy with peripheral blood stem cell transplantation in young patients with chronic lymphocytic leukemia.

Two patients with previously treated CLL received autologous PBSC transplantation after total body irradiation and high-dose chemotherapy. Before intensification, a partial marrow response had been obtained in both patients, with disappearance of peripheral blood involvement as shown by immunophenotypic assessment using fludarabine. PBSC collection was performed after a single course of high-dose cyclophosphamide followed by GM-CSF administration. One patient failed to reconstitute normal hematopoiesis and died 3 months post-transplant. The other is in continuous complete remission 12 months after intensification. This strategy in young patients with poor prognosis CLL warrants further investigation.

Adult↗
PubMed1991

Coagulase-negative staphylococci emerging during teicoplanin therapy and problems in the determination of their sensitivity.

Four strains of coagulase-negative Staphylococcus spp. were isolated from blood cultures taken from two neutropenic patients; in three cases while they were receiving teicoplanin as part of an antimicrobial therapeutic regimen. Results of teicoplanin susceptibility tests carried out on these strains varied according to the technique used. The strains were susceptible by disc-diffusion testing, but the MIC of teicoplanin was 8-16 mg/l, when tested according to the recommendations of the Antibiogram Committee of the French Society of Microbiology, and thus categorized as of intermediate susceptibility. It seems reasonable to avoid using teicoplanin for the treatment of infections caused by coagulase-negative staphylococci until technical problems encountered in the in-vitro determination of susceptibility have been resolved.

Adult↗
PubMed1990

[An imipenem-cilastatin combination in the treatment of infection in hemato-oncology].

The efficacy and tolerability of imipenem-cilastatin were studied in 66 haemato-oncology patients from 16 centres presenting with a bacteriologically proven infection; 29 of the patients had neutropenia (less than 500/sq.mm). The drug was given as monotherapy in 30 cases, as bitherapy in 29 cases and as tritherapy in 7 cases. The initial clinical diagnosis was septicaemia in 29 patients, various severe infections in 31 and fever of unknown origin in 6. The infection was bacteriologically documented in 55 patients; the remaining 11 patients were kept in the study and the results of their treatment were taken into account. One-hundred and fourteen bacterial strains were isolated, including 64 Gram-negative organisms, 48 Gram-negative organisms and 2 anaerobes. Treatment was discontinued in 4 patients, due to lack of response in 2 and to adverse events (haemolytic shock, Lyell's syndrome) in 2. Five patients died during the study: 4 of an underlying pathology, the infection having subsided, and 1 of persistent infection and the above-mentioned Lyell's syndrome. Clinical success was achieved in 63 patients (95.5 per cent), including 27 of the 29 patients with neutropenia (93.1 per cent). Among the 114 strains isolated, 106 were eradicated, 5 persisted and only 1 became resistant (outcome not available in 10 cases). Apart from the haemolytic shock and Lyell's syndrome, haematological and hepatic alterations were minor and not obviously due to imipenem-cilastatin. Three cases of colonization and 3 cases of superinfection were recorded during the study.

Adult↗
PubMed1990

Massive mediastinal extramedullary hematopoiesis in hereditary spherocytosis: a case report.

A case of extramedullary hematopoiesis (EMH) with a massive mediastinal mass in a 72-year-old woman with hereditary spherocytosis is reported. Several cases of EMH have been described in nonsplenectomized adults with hereditary spherocytosis, and it is thought to be a consequence of long-term stimulation of erythropoiesis. The exact mechanism remains controversial. EMH should be considered in the differential diagnosis of an asymptomatic paravertebral mass.

Aged↗
PubMed1990

[The use of teicoplanin in neutropenic patients: values and limits].

The efficacy and the safety of teicoplanin were evaluated for the treatment of febrile episodes in neutropenic patients. A total of 18 patients received teicoplanin once daily as an intravenous injection of 200 mg in 6 patients (after a loading dose of 400 mg) or 400 mg in 12 patients (loading dose: 800 mg). The mean duration of therapy was 15.9 days (range 9 to 39 days). In all patients teicoplanin was combined with another antibiotic usually a beta-lactam. Thirteen of 18 patients were successfully treated. Three febrile episodes proved to be microbiologically documented infections and were cured by teicoplanin: one Streptococcus mitis and two methicillin-resistant (methi-R) Staphylococcus epidermidis bacteremias. Neither toxicity nor side effects were observed in the reported group. Six patients experiencing reactions to vancomycin (2 cases of cutaneous allergy) or to vancomycin and amphotericin B combination (4 cases of nephrotoxicity) were subsequently treated with teicoplanin without any evidence of cross-sensitivity. We observed emergence of teicoplanin-resistant coagulase-negative Staphylococcus in 3 patients receiving teicoplanin: 20, 18 and 8 days after a first febrile episode cured by teicoplanin and a beta-lactam, they developed fever while receiving the same antibiotic regimen. Methi-R Staphylococcus epidermidis was isolated from blood cultures in the first patient and methi-R Staphylococcus haemolyticus in the two other patients. In one patient, successfully treated by teicoplanin for a first febrile episode related to a methi-R Staphylococcus epidermidis, emergence of Staphylococcus haemolyticus occurred 8 days later while the patient was on teicoplanin therapy (6 mg/kg). MICs of teicoplanin were 16 mg/l for the two Staphylococcus strains isolated in this patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Occurrence of a circulating anticoagulant, factor V inhibitor after surgical intervention].

A case is reported of an endogenous inhibitor to factor V occurring one month after subtotal gastrectomy and splenectomy, with peroperative radiotherapy, for gastric adenocarcinoma. Preoperative coagulation tests were normal: 31 s for activated kephalin time (control 31 s) and 93% for prothrombin level. There was a fall in this latter during the first three postoperative days. Four hundred ml plasma without cryoprotein were therefore given, bringing the coagulation tests back to the normal range. On day 25, a routine check showed an activated kephalin time of 71 s (control 31 s), a prothrombin level of 13% with a thrombin time of 18 s (control 18 s). There was no associated haemorrhagic diathesis. Measurement of all the individual coagulation factors showed that there was a fall in factor V level (0.05 IU.ml-1). A large amount of antifactor V antibody was then found (47 IU.ml-1). No treatment was undertaken, the patient being so well. Two months later, the antibody had disappeared. The usual circumstances in which this antibody can be seen and the management of the related severe haemorrhages are discussed.

Aged↗
PubMed1989

[IgM kappa gastric plasmacytoma].

A case of gastric plasmacytoma in a 50-year old woman was reported. Immunofluorescent and immunoperoxidase studies were performed. Polyclonal antibodies reactive with immunoglobulin chains and a panel of 14 monoclonal antibodies reactive with B and T cells, and epithelial cells were used. These studies showed that the tumor cells produced IgM Kappa molecules whereas no monotypic immunoglobulin could be detected in the serum and urine. On the other hand the tumor cells had the immunologic phenotype of plasma cells. This helps diagnosis: some lymphomas with plasmocytic differentiation could also produce a monotypic immunoglobulin. Treatment using a combination of surgery, radio and polychimiotherapy was effective, leading to complete remission.

Female↗
PubMed1988

The syndrome of abnormal chromatin clumping in leucocytes: a myelodysplastic disorder with proliferative features?

Five patients presenting extremely exaggerated chromatin clumping in leucocytes, associated with a loss of segmentation, are described. Peripheral cytopenia, a high percentage of circulating immature granulocytes (chiefly myelocytes) with variable leucocytosis, marrow hypercellularity with granulocytic hyperplasia and moderate dysplastic changes in erythroblastic and megakaryocytic lines, constitute, together with the granulocytic nuclear anomaly, the characteristic features of the studied cases. Cytogenetic analysis showed a clonal 12p anomaly in one of the three cases available for study. Survival was poor with a median of 15 months, bleeding and infections being responsible for the majority of deaths. All these findings point to abnormal chromatin clumping in leucocytes as the marker of a true entity with both myelodysplastic and myeloproliferative features. We propose that it take its place among myelodysplastic syndromes (MDS) beside chronic myelomonocytic leukaemia (CMML), with which it shares many similarities in clinical and biological behaviour.

Aged↗
PubMed1986

Intra-cytoplasmic crystalline inclusions in acute myeloid leukemia: a rare event.

Unusual intracytoplasmic crystal-like inclusions within granulocytic precursor cells from a patient with acute myeloid leukemia (AML) are described. Based upon their cytochemical and immunochemical properties, the possible composition and origin of these inclusions are discussed. They represent a rare event in leukemic cell metabolism since, to our knowledge, only 1 case with identical characteristics has previously been reported.

Aged↗