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Biomedical subjects

D Vervloet

Publications and source records attributed to D Vervloet.

At least 73 records · Page 4Linked to original sources
PubMed1999

Aggressive form of pleural epithelioid haemangioendothelioma: complete response after chemotherapy.

Epithelioid haemangioendotheliomas are rare tumours of endothelial origin. They can develop in any tissue but occur principally in the lung and liver. Their usual course is a slow progression, so that they can be treated by surgery. In aggressive forms, no treatment has proved efficient to date. This study, describes a case of bilateral pleural epithelioid haemangioendothelioma that extended to the peritoneum. The histological diagnosis was confirmed by both conventional examination and immunohistochemistry. After six courses of carboplatine plus etoposide, a complete response was obtained. The complete remission is still lasting at 18 months after the diagnosis and the patient is healthy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Prevalence of muscle relaxant sensitivity in a general population: implications for a preoperative screening.

BACKGROUND: Muscle relaxants (MR) are responsible for 59% of peroperative anaphylactic reactions. A major issue would be to determine whether a systematic preoperative screening in the general population should be recommended. OBJECTIVE: The purpose of the study was to evaluate the prevalence of muscle relaxant sensitivity in a sample of the general population and to assess the role of possible risk factors. METHODS: Two hundred and fifty-eight subjects, aged 20-40 years, visiting a health care centre for a check-up were evaluated. Protocol included a questionnaire (occupation, symptoms of atopy, previous surgery, history of drug allergy), skin-prick tests to four commercial muscle relaxants and measurement of specific IgE against quaternary ammonium ions. Atopy was evaluated by skin-prick tests to common inhalant allergens and by a Phadiatop test. RESULTS: Of the study group, 9.3% had either a positive skin test to one or more muscle relaxant or a presence of specific IgE to quaternary ammonium ions. No risk factor was identified in the studied group. CONCLUSION: Since the rate of MR sensitivity is much higher than the anticipated rate of peroperative reactions due to allergy, a systematic preoperative screening for MR allergy should not be recommended for adults in a general population.

Adult↗
PubMed1999

Gaseous air pollution and atopy.

BACKGROUND: Photochemical air pollutants are commonly thought to be implicated in the gradual increase in the prevalence of atopy. However, no epidemiological data are available. METHODS: To clarify this issue, we performed a cross-sectional epidemiological survey in 2604 primary school children, 10 and 11 years old, living in seven communities among which some have the highest photochemical exposure in France. The mean levels of the main gaseous air pollutants (SO2, NO2 and O3) were measured during a 2-month period in 1993. The protocol included a standardized questionnaire, skin prick tests to common aeroallergens and in the atopic children, collection of a sample of mattress dust to measure group 1 mite allergens. Atopy was only defined on the basis of the skin prick tests. RESULTS: Percentage of positive skin tests and the number of positive skin tests were similar in the different communities looked at. The distribution of dust samples with a group 1 allergen level greater than 2 microg/g dust, was also similar. Logistic regression analysis including potential confounding factors, as well as the mean level of air pollutants, did not demonstrate any association between atopy and mean SO2, NO2 and O3 levels. CONCLUSION: The increase in photochemical air pollutants is unlikely to be a major determinant for the recent increase in the prevalence of atopy.

Air Pollutants↗
PubMed1999

Prevalence of self-reported respiratory symptoms in workers exposed to isocyanates.

Until now, no survey had been conducted to assess the prevalence of respiratory symptoms in a large population that had been occupationally exposed to isocyanates, compared with that in a control group. We performed such a survey, using questionnaires administered by occupational physicians. Overall, 1114 workers' questionnaires (585 exposed and 529 control) were analyzed. Exposed workers, primarily painters from small factories, reported significantly (P < 0.05) more wheezing (8.6% vs 3.6%), more breathlessness with wheezing (3.4% vs 0.6%) in the last year, and more rhinitis (33.1% vs 19.1%) than did control workers. A trend for more asthma (2.1% vs 0.8%; P < or = 0.07) was also observed. Furthermore, 16.4%, 16.2%, and 10.6% of exposed workers reported (respectively) cough, rhinitis, and chest tightness when working in contact with isocyanates. We conclude that isocyanate-exposed workers demonstrate significantly higher prevalence rates of rhinitic and asthmatic symptoms than do control subjects.

Adult↗
PubMed1999

Haemoptysis after breath-hold diving.

Pulmonary oedema has been described in swimmers and self-contained underwater breathing apparatus (Scuba) divers. This study reports three cases of haemoptysis secondary to alveolar haemorrhage in breath-hold divers. Contributory factors, such as haemodynamic modifications secondary to immersion, cold exposure, exercise and exposure to an increase in ambient pressure, could explain this type of accident. Furthermore, these divers had taken aspirin, which may have aggravated the bleeding.

Adult↗
PubMed1999

[Modes of administration of inhaled corticosteroids in mild to moderate persistent asthma].

Inhaled corticosteroids are the treatment of choice for asthma. However, poor compliance by patients is one of the principal difficulties forced by clinicians. Thus, it seems important to propose the minimal daily number of doses. This study has compared the various modes of administration of inhaler corticosteroids and was carried out in patients with mild to moderate persistent asthma. Thus, comparing two to four doses per day shows an identical efficacy if the dose is less than 800 micrograms per day. At higher doses only two studies have been carried out and there are discordant results. The studies compare two doses versus one single dose per day and equally disagree with numerous works in favor of a single daily dose. In the single study carried out for at least twelve months the twice daily dose was the most effective. Thus it seems reasonable to suggest a single dose for mild persistent asthmatics. For moderate persistent asthmatics the choice between a single or twice daily dose would depend on the therapeutic compliance of the patient.

Administration, Inhalation↗
PubMed1999

[Acute pleurisy revealing post-myocardial infarction syndrome].

We report a case of Dressler's syndrome in which the diagnosis was made following an investigation of pleurisy which the laboratory data revealed as inflammatory. A myocardial infarction which had occurred two months earlier had passed unnoticed. The principal value of this case was to draw attention to the syndrome which may initially be a pleurisy but also clinically the picture may mimic pneumonia, both alone or together may be associated with classical pericarditis. Pleurisy occurs in Dressler's syndrome but it is rarely the presenting diagnosis as the cardiac picture tends to predominate.

Acute Disease↗
PubMed1999

EGEA (Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy)-- descriptive characteristics.

The Epidemiological study on the Genetics and Environment of Asthma (EGEA) was planned to assess genetic, environmental risk factors and their interactions for asthma and for the two related traits of bronchial hyperresponsiveness and atopy. The population examined includes 348 nuclear families ascertained by one asthmatic (213 adult and 135 paediatric probands) and 416 controls, totalling 1,847 subjects (EGEA I). Prevalences of asthma, skin prick test response, high IgE and bronchial hyperresponsiveness were for parents, siblings, and offspring of cases intermediate between cases and spouses or controls, both in adults and children, confirming the familial resemblance for asthma and related traits. With an additional sample of 40 families ascertained by two asthmatic siblings (EGEA II), a total of 119 families with two asthmatic siblings has been ascertained for a genome screening.

Adolescent↗
PubMed1998

A 6-month comparison between formoterol and salmeterol in patients with reversible obstructive airways disease.

The aim of this randomized, open, parallel group study was to compare the clinical efficacy of formoterol dry powder capsule 12 micrograms b.i.d. and salmeterol dry powder 50 micrograms b.i.d. in the treatment of patients with reversible obstructive airways disease. The 6-month treatment was preceded by a 2 week run-in period. Morning pre-dose peak expiratory flow (PEF) during the last 7 days of treatment was the primary variable. Throughout the study, patients recorded morning and evening pre-dose PEF, use of rescue medication, respiratory symptoms and adverse events. Clinic visits were scheduled at monthly intervals. Of the 482 patients randomized (equal numbers in the two treatment groups), 428 completed the study. Four hundred and twenty-five patients were included in the efficacy analysis for the primary variable. For mean morning pre-dose PEF during the last 7 days of treatment, the 95% confidence interval (CI) for the treatment contrast formoterol minus salmeterol was included entirely in the pre-defined range of equivalence (CI limits = -8.69, +9.841 min-1). This was also the case for the morning PEF during the last week before each clinic visit. For mean evening pre-dose PEF, the estimated treatment contrasts showed a trend towards superiority of formoterol over salmeterol, which became statistically significant at 2, 3 and 4 months (P < 0.05; estimated contrasts 7.27, 10.45 and 10.511 min-1, respectively). No treatment group differences were found in use of rescue medication and respiratory symptom scores. The incidence of adverse events was similar in the two groups. These findings demonstrate that formoterol 12 micrograms b.i.d. and salmeterol 50 micrograms b.i.d., both formulated as dry powders, have similar long-term efficacy and safety profiles in patients with reversible obstructive airways disease.

Administration, Inhalation↗
PubMed1998

Alveolar macrophage interleukin (IL)-10 and IL-12 production in atopic asthma.

Inflammation in asthma is characterized by a Th2 response. In many experimental systems, this response can be regulated by interleukin (IL)-10 and IL-12. IL-10 deactivates T cells, and IL-12 reorients the response toward a Th1 pattern. Alveolar macrophages (AM) can secrete both of these cytokines, and thus regulate T-cell behavior in asthma. They can enhance the Th2 response by turning off their secretion of IL-10 and IL-12, or tend to downregulate it by producing these cytokines. To elucidate that point, we assayed the AM IL-10 and IL-12 from 11 asthmatic patients and four controls. Six asthmatics were treated by inhaled corticosteroids. AM were recovered by bronchoalveolar lavage (BAL). They were isolated and cultured for 24 h without stimulation or in the presence of lipopolysaccharide (LPS). IL-10 and the p40 subunit of IL-12 were assayed in the BAL fluid and in AM culture supernatants by ELISA. Spontaneous AM IL-10 production was higher in asthmatics, particularly in the treated group. The AM IL-10 production after stimulation by LPS was also elevated in asthmatics, but was mainly so in untreated patients. IL-12 levels were higher in BAL fluids from untreated patients than from controls. The IL-12 production of LPS-stimulated-AM from these patients was increased. These results show that AM are at least primed for the production of IL-10 and IL-12 in asthma, and suggest that these cells could be involved in the resolution of the asthmatic inflammation.

Administration, Inhalation↗
PubMed1998

Rhinitis alone or rhinitis plus asthma: what makes the difference?

This paper examines the clinical expression of asthma in a group of patients displaying rhinitis according to age, sex, associated symptoms, smoking, familial history of asthma, atopy, type of sensitization to aeroallergens (pollens and/or indoor allergens), total serum immunoglobulin E (IgE), and blood eosinophils. A total of 117 adults with rhinitis were analysed on the basis of symptoms. Among them, 51 also displayed asthma, defined as a history of recurrent episodes of dyspnoea with a reversible airflow obstruction or a positive methacholine challenge. The logistic regression analysis carried out in a stepwise approach, combining several factors, showed that various parameters affected the risk of having asthma associated with rhinitis. A further analysis was made in 74 rhinitis patients comparing 42 subjects without nonallergic airway hyperresponsiveness (NAAH) to 32 patients with asthma and NAAH. Atopy, high total serum IgE levels, elevated blood eosinophil count and maternal asthma were associated with asthma. Furthermore, in atopic patients, pollen sensitization was more closely related to rhinitis alone, whereas sensitization to indoor allergens was a major determinant for the association of asthma with the symptoms of rhinitis. The same risk factors as those found in the clinical part of the study discriminated the patients with rhinitis without NAAH from those with rhinitis, asthma and NAAH. In conclusion, this study gives new insights into the relationships between asthma and rhinitis.

Adult↗
PubMed1998

[Role of eosinophilia in atopic pathology].

Atopy corresponds to a heightened predisposition to develop an IgE-mediated reaction to allergens in the environment. Symptomatic manifestations of atopy include skin disorders, rhinitis, and allergic asthma. Tissue infiltration by polynuclear eosinophils is a shared feature of all atopic diseases. In asthma, eosinophilic infiltration is considered as a pathognomonic finding, proportional to severity. Eosinophils have been linked directly to epithelial damage responsible for asthma symptoms as a result of massive production of basic proteins which are toxic for the mucosa. Eosinophils also produce fibrosis-inducing cytokines and contribute to remodeling of the airway. Activation of Th2 lymphocytes accounts for the influx of eosinophils into the airway via production not only of IL-5 but also of chemokines such as RANTES, MCP-3, and, above all, eotaxine. Resolution of airway inflammation in asthma is related to eosinophil apoptosis occurring spontaneously or therapeutically in response to anti-inflammatory agents. Based on current data, eosinophils can be considered as a pivotal factor in the occurrence of atopic manifestations and thus constitute a prime target for future immunotherapies.

Anti-Inflammatory Agents↗
PubMed1998

Long-acting beta-2 agonists. An attempted response to various questions which can be posed by pneumonologists.

The use of long acting beta 2 agonists is an undeniable improvement in the treatment of certain types of asthma. It enables better control of unstable asthma, improves and gives a superior quality of life. Current work confirms however that when used in the long term they ought to be associated with anti-inflammatory treatment. If they do not produce any important secondary effects, even when used for a long period, it is not currently possible to confirm that their prolonged use does not change the intensity of their bronchodilator effect and/or the intensity of the bronchodilator effect of the short acting beta 2 stimulants. Some studies have shown that their addition to basic treatment with inhaled steroids is more effective than increasing the inhaled steroids. Other studies are necessary to know if they may enable the reduction in inhaled corticosteroids and how far.

Administration, Inhalation↗
PubMed1998

[Clinical case of the month. Discomfort at the dentist's office: latex allergy, a diagnosis often unrecognized].

We report a case of urticaria with Quincke's oedema due to latex allergy appearing after dental care. The clinical manifestations of latex hypersensitivity are variable, from simple contact urticaria to generalised anaphylactic symptoms (Quincke's oedema, anaphylactic shock). Immunologically, it corresponds to an immediate-type hypersensitivity mediated by specific IgE antibodies. The diagnosis can be confirmed by skin prick-testing, determination of serum specific IgE antibodies, or realistic provocation tests. At present, latex avoidance is the only available treatment and is the key to prevent allergic reactions in latex-sensitized individuals.

Adult↗