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Jean-Jacques Grob

Publications and source records attributed to Jean-Jacques Grob.

11 recordsLinked to original sources
PubMed2006

Gamma-Knife radiosurgery in the management of melanoma patients with brain metastases: a series of 106 patients without whole-brain radiotherapy.

PURPOSE: To assess retrospectively a strategy that uses Gamma-Knife radiosurgery (GKR) in the management of patients with brain metastases (BMs) of malignant melanoma (MM). METHODS: GKR without whole-brain radiotherapy (WBRT) was performed for patients with Karnofsky Performance Status (KPS) of 60 or above who harbored 1 to 4 BMs of 30 mm or less and was repeated as often as needed. Survival was assessed in the whole population, whereas local-control rates were assessed for patients with follow-up longer than 3 months. RESULTS: A total of 221 BMs were treated in 106 patients; 61.3% had a single BM. Median survival from the time of GKR was 5.09 months. Control rate of treated BMs was 83.7%, with 14% of complete response (14 BMs), 42% of partial response (41 BMs), and 43% of stabilization (43 BMs). In multivariate analysis, survival prognosis factors retained were KPS greater than 80, cortical or subcortical location, and Score Index for Radiosurgery (SIR) greater than 6. On the basis of KPS, BM location, and age, a score called MM-GKR, predictive of survival in our population, was defined. CONCLUSION: Gamma-Knife radiosurgery provides a surgery-like ability to obtain control of a solitary BM and could be consider as an alternative treatment to the combination of GKR+WBRT as a palliative strategy. MM-GKR classification is more adapted to MM patients than are SIR, RPA and Brain Score for Brain Metastasis.

Adult↗
PubMed2006

Superiority of a cognitive education with photographs over ABCD criteria in the education of the general population to the early detection of melanoma: a randomized study.

Most education campaigns for melanoma (MM) detection in the general population have used the "ABCD" algorithm, although recognition of objects in the real life is based on a holistic image recognition rather than on analytic criteria. The objective was to compare analytic (ABCD) and cognitive (photographs) strategies for teaching self-recognition of MM. A prospective 4-arm stratified randomized trial in 255 individuals compared 3 realistic educative interventions by leaflets: 1) ABCD algorithm ("ABCD"), 2) a set of photographs chosen to stimulate recognition of MM among benign pigmented lesions ("Cog"), 3) photographs + explanations ("Cog-Ex" arm) and 4) no intervention ("NI"). A 40-slides test was performed before intervention (T0), 1 week after (T1) and after induction of anxiety (T2). In the "ABCD" arm, sensitivity slightly improved (80 to 83.8%, p = 0.04), but specificity dropped from 65.1 to 56.3% (p < 0.001), with no benefit in accuracy as compared to "NI". In "Cog" arm, there was no change in sensitivity, but a strong increase in specificity (65.9 to 81.1%, p < 0.001) and accuracy (42.1 to 53.1%, p < 0.001). "Cog-ex" resulted in similar although lower benefit. Under stress (T2), there was a dramatic loss of specificity and accuracy in "ABCD" arm (65.1 to 44.1%, p < 0.001 and 40.8% to 35.8%, p < or = 0.001) without higher gain in sensitivity, while sensitivity and accuracy increased (p < 0.005) after "Cog" leaflet, without decreasing specificity. Finally, the "ABCD" message alone does not seem efficacious and is even worse in the context of anxiety, whereas a quick look at a few photographs is sufficient to improve the ability of the laymen to recognize a MM just by optimizing their spontaneous image recognition capacities. Education by photographs is a realistic strategy which should replace or complete "ABCD" message in the campaigns for self-detection of MM.

Adolescent↗
PubMed2006

Urticaria and quality of life.

The common perspective of physicians on chronic urticaria (CU) refers to a benign disorder with no pain and no threat to function or life. Heath-related quality-of-life (HRQOL) tools have demonstrated the extent to which physicians underestimate the impact of this disorder. From the patient perspective, CU affects as many dimensions of the HRQOL as some life-threatening diseases or well-recognized disabling chronic skin disorders, such as psoriasis or atopic dermatitis. Pruritus as well as swelling and wheals triggered by unavoidable events, such as pressure or sweating, greatly contribute to HRQOL impairment. Recent trials have suggested that dermatology-specific HRQOL instruments could be more relevant than more objective severity scores when studying and comparing the benefit of various therapeutic strategies in chronic idiopathic urticaria.

Chronic Disease↗
PubMed2006

[Clinical practice guideline: 2005 update of recommendations for the management of patients with cutaneous melanoma without distant metastases (summary report)].

CONTEXT: The National French federation of comprehensive cancer centres (FNCLCC) and the French society of dermatology (SFD) initiated together the update of clinical practice guideline for the management of patients with cutaneous melanoma in collaboration with the French national cancer institute and with specialists from French public universities, general hospitals and private clinics. This work is based on the methodology developed in the "Standards, Options and Recommendations" (SOR) project. OBJECTIVES: To update SOR guidelines for the management of patients with cutaneous melanoma previously validated in 1998 and French melanoma consensus conference published by SFD and ANAES in 1995. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been developed, they are reviewed by independent reviewers. RESULTS: This article is a summary version of the updated clinical practice guidelines with algorithms. The main questions addressed by the expert group in this update concerned (1) The new AJCC-UICC classification (2) Excision margins (3) Sentinel node biopsy (4) Adjuvant treatments (5) Initial staging and follow up of operated patients.

Algorithms↗
PubMed2005

Randomized controlled trial testing the impact of high-protection sunscreens on sun-exposure behavior.

OBJECTIVE: High-protection sunscreens have been suspected to prompt people to increase sun exposure, and thus to increase skin cancer risk. We tested the influence of both the actual protection (sun protection factor [SPF]) and the information about protection (label) on sun-exposure behavior. DESIGN: Randomized controlled trial. SETTING: Four French seaside resorts during summer 2001. PARTICIPANTS: A total of 367 healthy subjects during their 1-week holiday. Outcome was assessable in 98% of them. INTERVENTION: Subjects were offered free sunscreens, with randomization into the following study arms: (1) SPF 40 labeled as "high protection"; (2) SPF 40 labeled as "basic protection"; and (3) SPF 12 labeled as "basic protection." Arm 4, ie, SPF 12 labeled as "high protection," was not implemented for ethical reasons. Subjects were not aware of the real target of the study and were blinded to the SPF value. MAIN OUTCOME MEASURE: Duration of sunbathing exposure during 1 week. Secondary outcomes were occurrence of sunburns and amount of sunscreen used. Influences of SPF and label were assessed separately. RESULTS: Compared with the low-SPF group, the high-SPF group did not have longer sunbathing exposure (12.9 +/- 7.2 h/wk for high SPF vs 14.6 +/- 6.7 h/wk for low SPF; P = .06), experienced fewer sunburns (14% vs 24%; P = .049), and used less sunscreen (median, 30 g vs 109 g; P<.001). The label "high protection" or "basic protection" had no influence on these end points. CONCLUSIONS: In this adult population, higher SPF had no influence on duration of sun exposure and offered better protection against sunburns. Although higher SPF may increase sun exposure duration in specific populations, this effect cannot be viewed as a universal side effect of high-SPF sunscreens.

Adolescent↗
PubMed2004

[Epidemiology and prevention of melanoma].

Melanoma incidence and mortality are still increasing, but new leveling-off and even decreasing trends are detected in young women generations in a few countries, where intensive prevention and screening campaigns have been conducted. Sun avoidance remains the basis of prevention, but is facing hard societal resistances. Sunscreens have a more and more theoretical protective profile, but in the real life, their ability to prevent skin cancers is quite uncertain. Some pieces of the melanoma genetic puzzle have been identified, but are not yet useful for the practical identification of patients at high risk for melanoma. Early detection is still the key for improving melanoma mortality. The most useful signs for melanoma detection are the impression of overall irregularity as compared to common nevi, the "ugly duckling sign" and a recent change. However, a subgroup of biologically aggressive melanoma will probably remain out of reach of early detection, due to their very rapid growth. In order to promote self-detection in the general population, a cognitive strategy using photographs is probably more efficacious than teaching the classical "ABCD" algorithm.

Early Diagnosis↗
PubMed2004

Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma: results of a multicenter randomized prospective trial.

BACKGROUND: Photodynamic therapy (PDT) is increasingly used as a noninvasive treatment for nodular basal cell carcinoma (BCC), without a sound evidence base. OBJECTIVE: To compare topical PDT, with the use of the sensitizer methyl aminolevulinate, and standard excision surgery in nodular BCC. DESIGN: Prospective, randomized study. SETTING: University dermatology departments. PATIENTS: A total of 101 adults with previously untreated nodular BCC. INTERVENTIONS: Patients received methyl aminolevulinate PDT (n = 52) or surgery (n = 49). The PDT was given twice, 7 days apart, with methyl aminolevulinate cream (160 mg/g) and 75 J/cm(2) red light (570-670 nm). Thirteen patients with a noncomplete response to PDT at 3 months (24% lesions) were retreated. OUTCOME MEASURES: Primary end point was clinically assessed lesion clearance at 3 months after treatment. Secondary end points were sustained response rate at 12 months and cosmetic outcome at 3 and 12 months. Cosmesis and lesion recurrence were further assessed at 24 months. RESULTS: Data from 97 patients (105 lesions) were included in the 3-month per-protocol analysis. Complete response rates did not differ significantly between groups (51/52 [98%] lesions with surgery vs 48/53 [91%] lesions with methyl aminolevulinate PDT; difference [95% confidence interval], 4.8% (-3.4% to 13.0%]; P =.25). At 12 months, tumor-free rates were 50 (96%) of 52 lesions with surgery vs 44 (83%) of 53 with methyl aminolevulinate PDT (P =.15). More patients treated with methyl aminolevulinate PDT than surgery had an excellent or good cosmetic outcome at all time points (significant at 12 and 24 months on patient assessment, P<.05, and at 3, 12, and 24 months on investigator evaluation, P<.001). At 24 months, 5 lesions that had initially cleared with methyl aminolevulinate PDT had recurred, compared with 1 after surgery. CONCLUSIONS: Methyl aminolevulinate PDT is an effective treatment for nodular BCC, and while there is a trend for higher recurrence with this modality, it conveys the advantage over surgery of better cosmesis.

Administration, Topical↗
PubMed2004

Killing efficacy of a new silicon phthalocyanine in human melanoma cells treated with photodynamic therapy by early activation of mitochondrion-mediated apoptosis.

Photodynamic therapy (PDT) is a promising therapeutic modality that utilizes a combination of a photosensitizer and visible light for the destruction of diseased tissues. Using human-pigmented melanoma cells, we examined the photokilling efficacy of new silicon-phthalocyanines (SiPc) that bore bulky axial substituents. The bis(cholesteryloxy) derivate (Chol-O-SiPc) displayed the best in vitro photokilling efficacy (LD(50) = 6-8 x 10(-9) M) and was seven to nine times more potent than chloro-aluminium Pc (ClAlPc), a known photosensitizer used as a reference. Although Chol-O-SiPc was half as potent as ClAlPc for promoting photo-oxidative membrane damage in a cell-free assay, early events of mitochondrion-mediated apoptosis upon PDT were triggered much faster, as demonstrated by kinetics studies examining cells with permeabilized mitochondrial membranes, cytochrome c release and caspase-9 activation. Inhibition of caspase-9 activity by a substrate analogue argued for its central role in the proapoptotic events leading to cell death by Chol-O-SiPc PDT. In addition, immunoblots showed that Bcl-2 antiapoptotic oncoprotein was not a primary target of Chol-O-SiPc in M3Dau cells treated with PDT. Conclusively, Chol-O-SiPc is a useful new photosensitizer with the property of triggering cell apoptosis mediated by mitochondria.

Apoptosis↗
PubMed2003

French people and skin diseases: results of a survey using a representative sample.

OBJECTIVE: To evaluate, from the patients' viewpoint, the prevalence, management, and impact of main dermatologic disorders in France. DESIGN: Survey conducted from March 28 to May 6, 2002, with the Sofres Taylor Nelson Institute on 10,000 households using 1 questionnaire per household. SETTING: General community. PATIENTS: A total of 25,441 subjects from 10,000 households determined to be representative of the French population and regularly surveyed by the Taylor Nelson Sofres Institute. MAIN OUTCOME MEASURES: Estimation of the prevalence of skin disorders by the French population. RESULTS: Of the 10 000 households, 7466 (74.7%) returned the questionnaire, which was completed for 18,137 (71.3%) of the 25,441 subjects. Of those, 15,742 reported having had skin problems since birth, or, by extrapolation, 86.8% (47.29 million) of the French population; 7841 reported having had skin problems in the past 24 months, or, by extrapolation, 43.2% (23.53 million) of the French population; and 28.7% said that their skin problems impaired their daily life. However, 61% of the sample were satisfied with their dermatologist. CONCLUSION: This survey of perceived health status in France highlights both the prevalence of skin disorders and the underestimation of the effects of dermatologic disorders in public health. A majority of the French population is satisfied with the care supplied by dermatologists.

Adolescent↗
PubMed2003

Randomized clinical trials for psoriasis 1977-2000: the EDEN survey.

This study aims to describe the range of treatment comparisons, study designs and quality of reporting of randomized clinical trials (RCTs) in psoriasis published in a variety of medical and dermatological journals, and to analyze time trends with quality items. Hand-searching of clinical trials of psoriasis published from 1977 to 2000 in 13 medical or dermatological journals, selected as relevant to a European readership, was performed. A total of 249 trials published in 226 papers were classified as RCTs. Of these, 139 (55.8%) employed a parallel control group design, 107 (43.0%) studies adopted a self-control design and 3 (1.2%) a cross-over design. The median number of patients recruited per study was 40 (range 6-699). Overall, 55 different treatment modalities, including topical, ultraviolet-based, systemic, and other miscellaneous therapies were assessed. Only 31 (12.5%) RCTs were comparative studies of treatment modalities in different therapeutic classes. Most of the studies were short-term with a median study duration of 7 weeks (range 1-104), with only 18 studies (7.2%) lasting for more than four months. A variety of outcome measures including 44 different score systems were employed. According to the conclusions of the authors, 196 (78.7%) studies were judged to provide striking or definite observations in favor of one of the treatments examined. No important variations over time were documented for quality items. Based on our survey we have identified an enormous range of treatments that have been evaluated for psoriasis over the examined period. Most studies were short-term, and only a handful compared treatment options in different therapeutic classes. Since we did not examine all the relevant journals, the number of treatment options may be even greater than we have documented. There is an urgent need to reset the research agenda focusing on long-term comparative RCTs. Editors of major medical and dermatological journals are urged to take a role in improving the quality of RCT reporting.

Clinical Trials as Topic↗