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Biomedical subjects

G Meuret

Publications and source records attributed to G Meuret.

At least 19 recordsLinked to original sources
PubMed2000

[Importance of home care personally to individuals with advanced cancer and their families].

OBJECTIVE: The objective of the study is to evaluate the importance of home care for patients with advanced tumor diseases and for their families. METHODS: The analysis was based on structured interviews with relatives of patients with terminal tumor diseases. They had participated in the home care of 50 consecutively treated patients 2 years previously. The value of home care was evaluated on the basis of the personal experience of those concerned. RESULTS: The answers were largely consistent. The holistic concept of palliative therapy could be implemented by a specialized home care team at a high quality level. Under the favorable conditions of the familiar surroundings, an atmosphere of trust developed as a result of the cooperation with the family members, people close to the patients and with family doctors. It contributed to a relatively high quality of life and to alleviate the emotional stress. Most of those involved were able to accept the hand of fate. On this basis, the terminal phase could be satisfactorily arranged and preparations made for a good quality of death. During the home care, appreciation of the value of the family increased. The intensified family relations were mostly sustained after the patient's death. The results document the great personal importance of home care for patients, their caretakers and families. CONCLUSION: The positive experience and the awareness of having contributed substantially to coping with the life crisis made it easier for the bereaved to grieve and to rearrange their life.

Bereavement↗
PubMed1996

Patient-controlled analgesia (PCA) in the domiciliary care of tumour patients.

Patient-controlled analgesia (PCA) was administered in the domiciliary environment in 143 pre-terminally and terminally ill tumour patients suffering either from excruciating chronic pain or severe chronic/acute complex pain that could not be relieved adequately by oral analgesia. Morphine solutions were infused subcutaneously in concentrations between 1% and 3%. The intravenous route was preferred in patients with indwelling catheters or those susceptible to inflammatory skin reactions at the infusion site. After initial dose adjustment, lasting 2-3 days, the morphine amounts infused by PCA reached a median of 93 mg day(-1) (range 12-464 mg day(-1)). The median was 28% lower than the median dose administered orally. A total of 84% of patients utilized the option of bolus self-administration. The median percentage administered via the bolus mode amounted to 5.3% of the total requirements. During the course of treatment, morphine requirements increased by a median of 2.3 mg day(-1) (range -29 +52 mg day(-1)). Most patients were treated continuously in the home care setting until death, the median duration being 27 days (range 1-437 days). The terminal morphine demands reached a median of 188 mg day(-1) (range 15-1008 mg day(-1)). PCA turned out to be safe and effective, attaining excellent results in 95 (66%) patients and satisfactory pain relief in 43 (30%). PCA proved to be insufficient in five (4%) cases. Side-effects were mild: constipation, fatigue, nausea and local inflammatory skin reactions occurred in 9%. Thus, with support from an experienced mobile nursing team, PCA can be safely administered in the terminal domiciliary care of tumour patients. PCA is superior to oral analgesia, especially in the treatment of severe oscillating pain. PCA provides adequate pain control in about 96% of patients who are poorly responsive to oral opioids.

Analgesia, Patient-Controlled↗
PubMed1990

High-intensity therapy versus low-intensity therapy in advanced breast cancer patients.

The aim of this study was to evaluate the significance of response to the first two cycles of FEC (5-fluorouracil, 4-epirubicin, cyclophosphamide) in patients with advanced breast cancer. A total of 99 patients entered the study. They showed either high risk criteria and were previously untreated or showed low risk criteria and were pretreated by hormonal therapies. Eighty-two patients were evaluable. In 22 (27%) who had disease progression despite two cycles of FEC, further therapeutic attempts proved ineffective, the median survival being 2.8 months. The remaining patients responded either by stable disease (SD, n = 29; 35%), by partial or by complete remission (PR, CR, n = 31; 38%). These 60 patients were randomized to two regimes of maintenance therapy: FEC every 3 weeks or LMF (leukeran, methotrexate, 5-fluorouracil) every 6 weeks. The subsequent course of the disease was not different in both arms. It was neither influenced by the quality of early response, i.e. SD, PR, CR, nor by the intensity of chemotherapy. The prognostic impact of early response to two cycles of FEC proved to be higher than other prognostic parameters in the patients examined. Thus, early response may serve as a valid guide to adapt maintenance chemotherapy in individual patients with advanced breast cancer.

Adult↗
PubMed1989

Compliance of physicians and patients with a consensus protocol for treatment of advanced breast cancer.

In a multicenter study we used a consensus protocol including more than five subsequent therapeutic steps for treatment of patients with advanced breast cancer. A total of 335 evaluable patients from 27 participating hospitals were allocated to a low- or high-risk group, receiving different therapies during the initial phase of treatment. About half of these patients were treated without protocol violations (compliers). The protocol non-compliers were divided into three groups: those receiving more intensive therapy than recommended, those with similarly intensive, and those with less intensive therapy. The reasons for protocol violations were analysed. The intensity of the therapy given actually was correlated with the survival of subgroups. Median survival times were significantly longer in 208 low-risk than in 127 high-risk patients (P less than 0.0001), marginally longer in 165 compliers than in 170 non-compliers (P less than 0.04), significantly longer in low-risk compliers than in low-risk non-compliers (P = 0.002), and significantly shorter in high-risk compliers than in high-risk non-compliers (P = 0.007). Survival of all subgroups of low-risk non-compliers was the same regardless of the actual therapies given. The survival of high-risk patients who received less intensive therapy was significantly longer than that of high-risk compliers (P = 0.015). After six cycles of successful chemotherapy there was no difference, either in time to progression or in survival, between patients who had received either maintenance therapy or no therapy. We postulate that the groups of low-risk and high-risk patients comprised patients with different prognoses. Among low-risk patients, survival of the subgroup with poor prognosis (low-risk non-compliers) was not influenced by therapy. Among high-risk patients, a subgroup with poor prognosis may have been overtreated by using standard chemotherapies as recommended in our consensus protocol.

Breast Neoplasms↗
PubMed1987

[Concept of treatment of metastatic breast cancer outside university clinics: description of the method and evaluation of efficacy].

It has been recognized during the past decade that it may be advantageous to develop complex strategies for treatment of metastatic breast cancer (MBC). In these strategies the type and efficacy of preceding therapies and the compliance of the patients have to be considered. Since about 80% of all patients with MBC are treated outside university hospitals it should be tested if a complex strategy for treatment of MBC can be realized in these institutions. The method was based on three principles: There was an exchange of data between participating institutions and study center after each visit of a patient. Second, there was one data sheet for admission of a patient to the study and fifteen sheets for follow-up documentation each with a different bottom line; in the bottom line of these sheets two therapies according to the strategy were proposed, one in case of 'no progression' and another in case of 'progression' of the disease. Third, a copy of completed sheets had to be returned to the study center; the study center provided the next sheet with the appropriate treatment recommendation. 335 evaluable patients were prospectively recruited from 27 participating institutions between January 1983 and December 1985. Based on the estimated incidence of MBC in the region, it was calculated that 45% of all MBC patients of the region had been admitted to the study. Only 27% of these patients were treated at the university hospital indicating that 85% of all MBC patients of the region were treated outside university hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

[Acute leukemias in adulthood--cure in sight?].

Better results have been achieved in the treatment of acute leukemia of adults by adaptation of therapeutic strategy to increased knowledge and to subtle differentiation of the various forms of the disease. The higher the resistance of leukemic blasts to chemotherapy, the more aggressive the induction therapy necessary to achieve favourable results. Intensive therapy produces a transient phase of bone marrow aplasia in which the patients must be protected by supportive care. Sensitivity to chemotherapy is relatively low in acute myelocytic leukemia. Therefore, the maximum tolerable dose of multi-drug chemotherapy is necessary to induce complete remissions (CR), which can be achieved in about 75% of patients under 65 years. Up to 40% remain in continuous remission longer than 3 years. The recurrence rate is high. Relapses are highly resistant to therapy, and therefore bone marrow transplantation is considered during the first CR. Most cases with acute lymphocytic leukemia are associated with higher sensitivity to chemotherapy. Less aggressive induction therapy in combination with maintenance therapy achieves CR in up to 85% of patients, about half of whom remain in continuous remission more than 3 years. Most of these cases can be regarded as cured.

Acute Disease↗
PubMed1983

A new distending laryngoscope for diagnosis and microsurgery of the larynx.

A new laryngoscope was developed in order to improve visualization of the larynx and to better adapt the instrument to individual clinical circumstances. As such, the Kleinsasser laryngoscope was divided into two parts, with the width between the two halves changed by adjustment of a screw. The lower part of the instrument can also be moved to provide more space near the larynx. Since the laryngoscope is open laterally, there is more space for the operator, and shorter instruments can be used for endolaryngeal manipulations. The endoscope can be used for intubation as well as for injection. With the new instrument the advantages of the Kleinsasser laryngoscope with the Killian suspension endoscope have been combined.

Humans↗
PubMed1983

[Successful treatment of brain metastases in breast cancer with blood-brain barrier-impervious cytostatics and hormones].

11 patients (age 36-60 years) with breast cancer and CT-scan documented brain metastases (BM) were treated with hormonochemotherapy: 5-fluorouracil 500 mg/m2 i.v. day 1 + 8, adriamycin 50 mg/m2 i.v. day 1, cyclophosphamide 500 mg/m2 i.v. day 1-q4 weeks (FAC) and tamoxifen (TXF) 20 mg/day per os. Ovarectomy was carried out in 3 praemenopausal patients. In 3 cases single BM were surgically resected (2 subtotal, 1 total). One patient was shunted due to a hydrocephalus occlusus. Complete response (CR), i.e. normalization of CT-scan and disappearance of CNS related symptoms, was achieved in 9 out of 11 patients. One patient with partial remission (PR) and another with progressive disease died 6 and 5 months after diagnosis of BM. The median duration of remissions of all patients was 12 (5-43) months. The median survival time from diagnosis of BM was 15 (5-44) months and from mastectomy 46 (26-142) months. The cumulative probability of surviving was 63% one year after diagnosis of BM. One relapsing patient achieved a second CR, another a PR by whole brain irradiation. 4 patients survived more than 18 months from the diagnosis of BM. It appears that chemo-hormonotherapy provides a rational approach to palliation in breast cancer patients with BM in prolonging the survival.

Adult↗
PubMed1982

[Treatment results in unselected small cell bronchial carcinoma patients].

18 of 36 consecutive patients with small cell carcinoma of the lung received a combination of chemotherapy (Adriblastin, Oncovin, Cyclophosphamide) and radiotherapy (primary tumor and CNS). This treatment resulted in a response rte of 78%, and in a median survival of 10.6 months ("limited disease" 13 months, "extensive disease" 9 months). Complete remissions were obtained only in 4 of 18 patients, 4 patients of these were long-term survivors (greater than 18 months). Due to heart diseases, age, or poor general condition 18 patients received a milder combination of chemotherapy ("COM", "VP-O-C") and tumor irradiation. The response rate was 66%. Complete remission was achieved in only 2 of 18 patients. The median survival rate was 8.6 ("limited disease" 10.5 months, "extensive disease" 6.0 months). Survival exceeded 18 months in 4 of these patients. The toxicity was mild, the mean cumulative duration of hospitalization was 78 (30-120) days per patient.

Adult↗
PubMed1982

[Controlled respiration with a new "jet-ventilator" in the microsurgery of the larynx. An experimental study on dogs (author's transl)].

To combine the open jet-ventilation system with the security of the closed respiration we developed a new "jet-ventilator". Using a modification of the Carden-tube when we closed the upper part of the intratracheal tube, we had to remove the air by suction during the expiration time. With a pressure-analizer and transducer we could prevent negative and high pressure in the trachea. In experimental studies on six dogs we saw good blood gas analyzers as well as good circulatory parameters. With this method we were able to observe ventilation between eight and nine hours.

Animals↗
PubMed1982

[Studies of monocytopoiesis in patients with malignant disease and after immunostimulation with BCG, using 3H-thymidine as a DNA-label (author's transl)].

Monocytopoiesis and blood monocytes were investigated in patients with Hodgkin's disease, non-Hodgkin lymphomas, mycosis fungoides, breast cancer or melanoma. The investigation was carried out before surgery and just before each application of BCG. Monocyte production was increased in untreated patients. Postoperative prophylactic BCG-vaccination gave rise to increased proliferation activity. However monocyte production returned to normal between the 4th and 6th month of BCG immunotherapy. These results indicate that monocytopoiesis is stimulated by human tumors. BCG immunostimulation is able to increase proliferation activity during the first month of treatment only.

BCG Vaccine↗
PubMed1981

The kinetics of mononuclear phagocytes in man.

This paper summarizes the essential steps of a systematic cell kinetic analysis of monocytopoiesis in bone marrow and blood monocytes in man [14]. The results are interpreted on the basis of current concepts hypothesizing that blood monocytes have only one source, i.e., monocytopoiesis in bone marrow [8,9], that cells move undirectionally from bone marrow to blood and tissue, and that monocytopoiesis is governed by several control mechanisms. Macrophage kinetics are not discussed because comprehensive studies in man are lacking and due to the present controversy between the notion that all tissue macrophages arise from blood monocytes and the other one which assumes that macrophage precursors exist in tissue [6].

Bone Marrow Cells↗
PubMed1980

[Treatment of severe febrile neutropenia (author's transl)].

Random allocation of 22 patients with benign and malignant diseases with neutrophil counts of up to 1 X 10(9)/l blood and probably infection-caused fever of more than 38 degrees C to intravenous treatment with one of the following antibiotic combinations was performed: carbenicillin (6 g/m(2) . 6 h) plus sisomicin (45 g/m2 . 6 h) or mezlocillin (3 g/m2 . 6 h) plus sisomicin (45 g/m2 . 6 h). Both combinations were tolerated equally well. Patients became afebrile in 16 out of 23 treatment periods. Seven out of 11 patients responded to carbenicillin - sisomicin, and 9 out of 12 to mezlocillin - sisomicin. Mezlocillin thus leads to equal success of treatment in febrile neutropenia as the double dose of carbenicillin when both antibiotics are combined with the same aminoglycoside.

Agranulocytosis↗