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Biomedical subjects

G Leverger

Publications and source records attributed to G Leverger.

At least 163 records · Page 9Linked to original sources
PubMed1987

[Treatment of Hodgkin's disease in children with chemotherapy and low-dose radiation].

In 1982 a French cooperative study for Hodgkin's disease was designed to minimize adverse side effects of therapy in childhood. Initial staging is clinical, omitting laparotomy. Objectives are: comparing 4 ABVD to 2 MOPP alternating with 2 ABVD in CS IA et IIA, assessing the value of 3 MOPP + 3 ABVD in CS IB, IIB, III et IV in terms of remission induction and duration of remission and assessing the effectiveness of radiotherapy at dose of 20 Gy given to all good responders to chemotherapy in involved fields and lombo-splenic fields for CS IB, IIB, III and IV. We present preliminary results. Of the 120 evaluable patients 94% had a good response to initial chemotherapy and received 20 Gy. The rate of local control of these patients is very high as only 2 relapsed in previously irradiated nodes. Actuarial 3 years survival rate and relapse free survival are respectively 98% and 86%.

Adolescent↗
PubMed1987

[Treatment of febrile episodes in neutropenic children by ceftazidime combined with netilmicin. Results of a multicenter study apropos of 88 cases].

Infection is the most important cause of mortality in leucopenic patients. A broad spectrum antibiotic therapy is imperative in febrile and neutropenic patients. In a multicentric study we have used ceftazidime (100 mg/kg/d) and netilmicin (6 mg/kg/d) in 88 children (fever greater than or equal to 38.5 degrees C, neutropenia less than 500/mm3) treated for acute leukemias (59), non Hodgkin lymphomas (13) or solid tumors (16). Median age was 7 years (2 months-16 years). In patients who continued to remain febrile, vancomycin (40 mg/kg/d) was added after 48 hours. The effective treatment was continued until a neutrophil count greater than 1,000/mm3. The first combination (ceftazidime + netilmicin) was effective in 64 children (73%) and the second combination (ceftazidime + netilmicin + vancomycin) in 11 patients. Bacteria were isolated in 39 children: Escherichia coli: 9, Staphylococcus epidermidis: 9, Staphylococcus aureus: 8, Streptococcus: 6, Pseudomonas aeruginosa: 3, Streptococcus pneumoniae: 1, Haemophilus: 1, Klebsiella pneumoniae: 1, Proteus: 1, Serratia: 1, Flavobacterium: 1. In these 39 patients, 30 became apyretic with ceftazidime and netilmicin and 6 after vancomycin. All blood culture were negative after the first combination. The median duration of antibiotic therapy was 14 days (5-9 days: 28, 10-20 days: 43, greater than 20 days: 17). There were no death, no superinfection. Tolerance was good without kidney or liver or biological perturbation. We conclude that the combination ceftazidime and netilmicin is effective in neutropenic children.

Adolescent↗
PubMed1987

[HIV infections and transfusions].

The prevalence of AIDS now approaches 1% in patients with hemophilia and laboratory evidence of abnormal immunoregulation is found in 50% of patients with severe hemophilia. Current evidence indicates that a human retrovirus HIV/LAV is the etiologic agent which can be transmitted through the administration of blood products. We reported 7 cases in childhood, 5 acute leukemia, 1 metastatic neuroblastoma, and 1 severe aplastic anemia in whom AIDS occurred after administration of blood products. To date 5 patients are alive and 2 have died of infections. It is suggested that the use of steroids or antineoplastic agents increases the incidence of AIDS in patients infected with HIV/LAV because of altered immune suppression. The maintenance treatment is difficult in these patients. The widespread use of HIV serology to screen donated blood should help to prevent AIDS transmission in leukemic patients.

Acquired Immunodeficiency Syndrome↗
PubMed1987

[Importance of anthracyclines in infants in the treatment of acute lymphoblastic and non-lymphoblastic leukemias].

Induction treatment of acute non lymphoblastic leukemia in children and in adults must include anthracyclines, but the best anthracycline is still in discussion. In acute lymphoblastic leukemia the use of anthracycline is discussed according to the initial prognostic factors: needful in high risk patients, useless in good risk. In intermediate risk patient, most cooperative protocols include one anthracycline in induction.

Acute Disease↗
PubMed1986

[Piperacillin combined with netilmicin and cloxacillin. Usefulness in the treatment of febrile episodes in neutropenic children].

No preventive treatment other than intestinal decontamination with oral colimycin was given. Antibiotic therapy with piperacillin 200-300 mg/kg, netilmicin 6-7.5 mg/kg and cloxacillin 50-100 mg/kg was initiated within 6 to 12 hours of clinical onset, using a central catheter. Twenty-nine children with bone marrow aplasia and less than 1000 leucocytes/mm3 were treated: 20 had acute lymphoblastic leukaemia or lymphoma (first episode 13, relapse 7, including 3 undergoing bone marrow transplantation), 6 had acute myeloblastic leukaemia (first episode 4, relapse during transplantation 2), and there was 1 case each of idiopathic bone marrow aplasia, metastatic sympathico-blastoma and lymphohistiocytosis. Mean age was 9 years (range: 2-19 years). The combined antibiotic therapy was continued until recovery from aplasia in case of success and discontinued after 48 hours in case of failure. Bacteriological examinations were negative in 19 patients and positive in 10; 13 strains were isolated, mostly staphylococci and streptococci. Apyrexia was obtained in 24 patients, 11 of whom had a rise of temperature with negative bacteriology about 10 days later. There were 4 initial failures and one unassessable result. An atopic patient developed a skin rash on the 3rd day of treatment. There was no death, no superinfection and non clinical or biochemical side-effect. It is concluded that the piperacillin-netilmicin -cloxacillin combination, which gave a high success rate and was well tolerated, can be recommended in neutropenic children with febrile episodes.

Adolescent↗
PubMed1986

Effect of L-asparaginase therapy for acute lymphoblastic leukemia on plasma vitamin K-dependent coagulation factors and inhibitors.

Vitamin K-dependent proteins were measured sequentially by immunoassay in eight patients with acute lymphoblastic leukemia receiving L-asparaginase (1000 U/kg/day) for 10 days as induction therapy, in combination with vincristine or vindesine, daunorubicin, cyclophosphamide, and prednisone. The level of each protein was significantly decreased during L-asparaginase therapy, but both the time course of change and the severity of decrease differed among the proteins. The decrease in protein C, factor IX, and factor X was observed earlier than the decrease in protein S and factor II. In the first days of L-asparaginase therapy the protein C level was significantly lower than those of the other vitamin K-dependent proteins. The transient imbalance in the levels of plasma vitamin K-dependent proteins observed in the first days of treatment may contribute to the risk of thrombosis associated with L-asparaginase therapy.

Adolescent↗
PubMed1986

Timentin (ticarcillin and clavulanic acid) in combination with aminoglycosides in the treatment of febrile episodes in neutropenic children.

Timentin (ticarcillin + clavulanic acid) combined with an aminoglycoside usually netilmicin, was given to 33 children with neutropenic haematological malignancies. The combination of Timentin and aminoglycoside was effective treatment in 27 (87%) of 31 febrile episodes. There were four failures and three results which could not be interpreted. Bacteriological investigations were positive in 13 patients, three strains were resistant to ticarcillin but all were sensitive to Timentin. Clinical success, based upon reduction of fever within 48 h of treatment, was identical whether an organism was isolated or not. The combination of Timentin plus aminoglycoside was very successful and represents one of the best combinations available for empirical treatment for febrile neutropenic children.

Adolescent↗
PubMed1986

Acute lymphoblastic leukemia in very young children. Diagnostic and therapeutic aspects of 43 cases.

Between 1974 and 1982, 43 children less than 2 years of age were treated in the hematology department of Hospital Saint-Louis for acute lymphoblastic leukemia (ALL). Of the patients who presented before 18 months of age, 80% had a WBC greater than 100,000 microliter and/or a great tumor bulk. As a result of our experience, treatment regimens have been changed here from conventional chemotherapy to a very intensive program with a heavy induction (vincristine, daunorubicin, cyclophosphamide, prednisone, and L-asparaginase) and monthly reinductions with the same drugs plus ArA-C, without maintenance. Prophylaxis included CNS irradiation (16-24 Gy) after 12 months of age, plus intrathecal methotrexate. Complete remission (CR) occurred in 78% before 18 months and in 100% between 18 and 24 months of age at diagnosis. In this report the probability of a prolonged CR (33% at 2 years) was the same before and after 12 months of age. However, younger patients were more intensively treated. The prognosis for children less than 1 year of age who received very intensive chemotherapy has greatly improved, with a significantly higher probability of long CR (p less than 0.02). Presently, 10 of 43 children are in CR 27 months to 8 years after diagnosis. Of 18 patients aged less than 1 year at diagnosis, four are in CR. No relapse occurred after 23 months. None of these patients presented with important sequellae, with the exception of one child who suffered from severe bacterial meningitis. An aggressive chemotherapy program is indicated in patients less than 2 years of age. The feasibility of this mode of treatment in young patients is possible only with the help of specific supportive care.

Acute Disease↗
PubMed1986

[Monoblastic (M5a) form of relapse in acute myeloblastic (M2) leukemia with t(8;21)].

An exceptional case of acute myeloblastic leukemia (M2) with t(8;21) relapsed as an acute monoblastic leukemia (M5). At that time only a minority of metaphases exhibited a t(8;21) and/or abnormality of chromosome No 11 long arm whereas various other chromosomal changes were present. The existence of a relapse of M2 with t(8;21) as M5 is discussed in relation to the commitment of the cells which became leukemic, and to the possibility of a second leukemia.

Child↗
PubMed1986

[Induction therapy of acute leukemia in children. Current results and problems related to therapeutic aplasia. Apropos of 146 cases].

Between 1983 and 1984, 146 children have been treated in the pediatric hematology department of Saint-Louis Hospital (Paris) for induction of acute leukemia (AL). 119 had an acute lymphocytic leukemia (ALL) and 27 an acute non lymphocytic leukemia (ANLL). The rate of complete remission was 94% for all patients (97% in ALL and 81.5% in ANLL). Fever occurred in 95% of children with positive blood cultures in one third on these. Four children died between the fifth and the twenty fifth days after onset of treatment from sepsis. One of these patients was a neonate with ANLL. 127 patients had a central venous line during induction used for blood sampling and treatment (chemotherapy, antibiotics, parenteral nutrition, platelets and red blood cells infusions). This supportive care is very important to improve prognosis of the AL particularly in very intensive chemotherapy.

Acute Disease↗
PubMed1986

[Acute lymphoblastic leukemia in Burkitt cells: clinical, therapeutic and prognostic aspects].

This presentation reports on patients with 13 B - acute lymphoblastic leukemia (ALL), treated with intensive chemotherapy. To date 5 patients are alive, in complete remission (greater than 24 months), 4 of them had CNS disease at diagnosis; 7 patients relapsed, 2 to 4 months after complete remission, 6 of them having CNS relapse, isolated or with bone marrow involvement. The improvement in prognosis of B-ALL results from intensive chemotherapy, but the prognosis remains poor because of early relapses, especially CNS relapses (survival rate is less than 50%). The authors propose new therapeutic approaches.

Adolescent↗
PubMed1985

Cytidine deaminase activity of human normal and malignant lymphoid cells.

Cytidine deaminase activity was determined by a radioisotopic assay in extracts of peripheral blood mononuclear cells of normal individuals and of patients with acute lymphoblastic leukaemia. The normal enzyme activity had a broad pH optimum between pH 6.5 and 8.0; apparent Km values for cytidine and deoxycytidine were 3.6 +/- 0.6 mumol/l and 26.5 +/- 3.5 mumol/l, respectively; the activity was resistant to heat inactivation; of the various effectors tested, only uridine, deoxyuridine and tetrahydroxyuridine had inhibitory effects. Cytidine deaminase activity was markedly decreased in lymphoblasts of patients with acute lymphoblastic leukaemia; enzyme activity was related to the percentage of circulating blast cells, and not to the clinical, cytological or immunological characters of the leukaemia.

B-Lymphocytes↗
PubMed1985

[Central venous catheterization in pediatric hematology].

Central venous catheters (CVC) have proven to be a reliable route of the administration of chemotherapy, saline, blood cells and nutritional support in patients with malignant haematological disease. However, infection remained one of the most important causes of morbidity associated with this procedure. The aims of this study were a) to evaluate the efficacy of laminar air flow to prevent CVC infections, b) to study morbidity associated with polyethylene (PE) and silicone (S) catheters, and c) to evaluate the part played by increasing staff practice. 177 CVC were inserted in 170 children during a period of 20 months. Ages ranged from 5 months to 15 years (mean: 7 years). All the S CVC were tunnelled whereas, because of their rigidity, none of the PE CVC were. At the time of their removal, bacteriological samples from the CVC skin exit site, blood drawn through the catheter and the tips of these CVC were cultured. During the first period (one year), three groups of CVC were studied: in group 1, 37 S CVC in patients placed in a non-sterile ward; in group 2, 40 S CVC in children nursed under laminar air flow; in group 3, 60 PE CVC in patients of a non-sterile ward. During the second period (8 months), 40 new S CVC were inserted in children nursed in non-sterile wards, but after nursing staff training (group 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗