[Regression during chemotherapy of lytic bone lesions in a patient with type B malignant non-Hodgkin's lymphoma].
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Acromion↗
Biomedical subjects
J Gabarre
Publications and source records attributed to J Gabarre.
[Stage I and II Hodgkin's disease with enlarged mediastinum in adults. Apropos of 24 cases].
We have reported a retrospective study on 24 cases of supra-diaphragmatic Hodgkin's disease Stage I and II, with massive mediastinal invasion, followed from January 1981 to October 1986 and treated first with chemotherapy and then supra-diaphragmatic mantle type radiotherapy up to a dose of 40 Gy in 20 sessions and over 26 days; inverted irradiation was given to the aorto-lumbar region and the spleen up to a dose of 30 Gy in 15 sessions over 19 days. Supplementary irradiation to the superior mediastinum on average 10 Gy in five sessions over five days was given in two cases and five Gy in three sessions over three days in four cases. After initial chemotherapy there appeared to be a complete remission in 29% (7 out of 24), there was a partial remission in 71% (17 out of 24), of which one gave a 25% response, two a 50% response and 14 gave a response of greater than 80%. After radiotherapy the remission rate appeared complete in 96% (23 out of 24). The overall survival was 90% (19 out of 21) with a mean follow up of 45 months (range 8-78 months) with a complete remission level of 85.5% (18 out of 21). For the 13 cases followed for five years the overall survival level and the level of survival in complete remission was 84.5% (11 out of 13) and 77% (10 out of 13) respectively. We have seen symptomatic post radiotherapy pneumonia. The association of chemo and radiotherapy in this limited series of patients has enabled us to obtain a satisfying duration of remission.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Alternating chemotherapy and radiation therapy in the treatment of advanced Hodgkin's disease.
During the period from 1982 to 1987, 19 patients with advanced Hodgkin's disease, clinical stages IIIB and IV underwent treatment with combination chemotherapy and radiotherapy. Alternating chemotherapy (3 cycles of CVCPP/3 cycles of ABVD) was sandwiched with low-dose total nodal irradiation including the splenic area; at the end of the chemotherapy, a supplemental 20 Gy radiotherapy was sometimes delivered to bulky previously involved sites. The complete remission rate was 84.2% (16/19 patients) and actuarial survival was 85% at 48 months. These preliminary results show that the alternating technique for combining chemotherapy and sandwiched irradiation is feasible and improves the outcome in advanced Hodgkin's disease. Patients with mediastinal masses associated with pulmonary and/or pleural involvement may need more aggressive chemotherapy at an earlier phase of the treatment program.
Adolescent↗
[Splenic abscess disclosing endocarditis].
A 54 year old man, hospitalised for thoraco-abdominal pain resulting from a septicemia which gives positive hemocultures for streptococcus D Bovis, is diagnosed to have a splenic abscess which will require splenectomy. At the same time, an endocarditis develops and gets worse, with auriculo-ventricular blockade and, especially, major aortic insufficiency, which is the cause of death by a brutal and massive pulmonary oedema. In the progression of an endocarditis, the occurrence of a splenic abscess, primary localisation of the initial septicemia or the secondary of an arterial septic embolism, is a rare contingency compared to the frequency of splenomegaly or splenic infarction: less than 2 percent of the cases in the literature. This very atypical and exceptional case serves as a reminder, on the one hand, of the diagnostic inadequacy of echocardiography which cannot visualise vegetation in the course of progressive endocarditis, and, on the other, of the prognostic importance of auriculoventricular blockade in septal and aortic endocardial lesions.
Abscess↗
Multicentre combined chemotherapy protocol for large cell advanced non Hodgkin's lymphoma.
Between October 1985 and October 1989, 75 previously untreated patients with stage III and IV non Hodgkin's lymphoma, large cell type, were treated with an alternating weekly chemotherapy regimen including the following drugs: week 1: Doxorubicin, vincristine, cyclophosphamide, bleomycin, and intrathecal (i.th.) methotrexate and cytarabine; week 2: Methotrexate with leucovorin rescue; week 3: Doxorubicin, ifosfamide with mesna, etoposide, and i.th. methotrexate and cytarabine; week 4: Methotrexate with leucovorin rescue. Complete responders after three cycles according to this schedule (12 weeks) were given 18 gys cranial irradiation and randomized between one additional cycle or three monthly CHOP (consolidation treatment). Among 66 evaluable patients, 53 achieved a complete remission (CR 80 per cent) and seven a partial remission (11 per cent). There were six failures, and nine early deaths during the initial phase, mostly due to septic problems. Forty-one of the 53 CR patients (77.3 per cent) have remained free of disease with a median follow-up of 15 months (1-49). Eight of the 12 relapses occurred during the first year, the four others at 13, 14, 16 and 38 months respectively. The 2-year survival was 63 per cent for the whole group, and 77 per cent for the CR group. No difference has been observed up until now between the two groups with different consolidation treatment. Therefore, this protocol seems to be able to produce a high rate of complete and durable remission. The analysis of prognostic factors suggests that some high-risk patients should be considered for intensification therapy with the support of autologous bone marrow transplantation.
Adolescent↗
[Long-term effects of splenectomy for immune thrombopenic purpura related to human immunodeficiency virus. A retrospective study from 2 groups, with and without splenectomy].
In order to evaluate the long-term effects of splenectomy in patients with human immunodeficiency virus-related immune thrombocytopenic purpura (ITP), we studied retrospectively two populations of patients: 21 had undergone splenectomy and 18 had not. At the time of diagnosis the first population had on average lower platelet counts than the second one. After a mean follow-up of 47 +/- 9 months the situation has been reversed: the population that underwent splenectomy had significantly higher platelet counts than that without splenectomy (190.600 +/- 55.300/mm3 versus 91.500 +/- 55.300/mm3, P less than 0.001). Moreover 76 percent of the patients with splenectomy versus 50 percent in the population without splenectomy were in complete remission of ITP at the last follow-up. It therefore seems that splenectomy had a statistically positive effect on platelet counts without worsening the immune status. Indeed, the clinical course towards AIDS was the same in both populations (35 percent in patients with splenectomy and 22 percent without, P = NS). Following splenectomy, the total blood lymphocytes count was increased, especially the CD8 population, while the CD4 count remains unchanged; these findings seem to be a common feature after splenectomy.
Acquired Immunodeficiency Syndrome↗