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Biomedical subjects

L Jeannin

Publications and source records attributed to L Jeannin.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Comparison of relative survival vs. classical survival. Apropos of primary bronchial cancer].

The aim of the study is to compare the usefulness of a recent relative survival model versus more classical methods for univariate and multivariate survival analysis, applied to a population of patients with surgically cured non small cell lung cancer, in determination of prognostic factors and appreciation of the exact role of age on survival. We studied 156 patients surgically treated between 1975 and 1988. Both univariate and multivariate analysis were performed, using the actuarial method and the Cox model for crude survival and the additive Hakulinen model (1985) for relative survival (total risk of death equal to natural risk of death in general population plus disease specific risk of death) which is an age-adjusted survival corrected for normal life expectancy. In addition, the loss in life expectancy was also calculated. Our 156 patients (including six females), whose age ranged from 30 to 78 (mean age 59) were almost all current or former smokers (97%) and 63% had clinical trouble. Squamous cell carcinoma was the most common histology (76%) before adenocarcinomas (20%). Pneumonectomy and lobectomy were equally performed. Post surgical TNM staging was stage I = 78 (50.3%), II = 23 (14.8%), IIIa = 44 (28.4%), IIIb = 10 (6.5%). By 31 December 1990, 116 patients had died, 24 were alive and 16 lost to follow-up. In univariate analysis, overall survival is (crude/relative): 1 year (75.8%/77.5%), 2 years (53.8%/56.0%), 5 years (28.7%/32.5%), 10 years (14.4%/18.9%). Univariate prognostic factors are histopathology, surgical procedure and post operative TNM staging. The overall loss in life expectancy is 71.4% (5.5 years of life expectancy vs 19.21). The loss is higher for the younger patients than for the older ones (73% for the 30-49 year old group--59.2% for the more than 70 year old group). In multivariate analysis, prognostic factors are: Cox model: post-surgical TNM staging, histopathology and age (RR = 2.18 [1.13-4.23] for patients over 65); Hakulinen model: TNM staging. In this model, age is no longer a significant prognostic factor. In conclusion, this study confirmed the poor prognosis of NSCLC, even if a curative surgical procedure has been possible, with a 5-year survival of 48% for stage I tumours but only 6% for stage III tumours. The most significant prognostic factor is the post-surgical TNM staging. The relative survival model of Hakulinen dismissed age as a significant prognostic factor.(ABSTRACT TRUNCATED AT 400 WORDS)

Actuarial Analysis↗
PubMed1994

[Lympho-epithelial lesions induced by plasma cells in a pulmonary MALT lymphoma].

One case of pulmonary lymphoma of MALT origin is reported. The diagnosis was made by histological and immunohistological study of surgical specimen. Cytologically, the tumoral proliferation was made by an admixture of centrocyte-like cells, small lymphocytes and vacuolized plasma cells. Lympho-epithelial lesions were particular because induced by tumoral plasma cells. From this case, problems of diagnosis and physiopathology of pulmonary MALT lymphomas are discussed.

Cell Division↗
PubMed1993

Age and prognosis of non-small cell lung cancer. Usefulness of a relative survival model.

The aim of our study was the comparative evaluation of a relative survival model and a Cox model to determine the prognostic factors of survival for patients with surgically cured non-small cell lung cancer (NSCLC). We focused particularly on the exact role of age in this survival. 156 patients treated between 1975 and 1988 were studied. Both univariate and multivariate analyses were performed, using the actuarial method and the Cox model for crude survival and the Hakulinen model for relative survival. This study confirmed the poor prognosis of NSCLC, even if a curative surgical procedure has been possible, with a 5-year survival of 48% for stage I tumours but only 6% for stage III tumours. The most significant prognostic factor was the postsurgical TNM staging. The relative survival method of Hakulinen dismissed age as a significant prognostic factor. Our study underlines the usefulness of relative survival methods which should be more frequently employed to allow comparisons between series of different origin and to set up multicentre therapeutic trials.

Adult↗
PubMed1993

Celiprolol pneumonitis.

We report on a patient who developed hypersensitivity pneumonitis during treatment with the beta-blocker, celiprolol. The clinical picture was a severe alveolitis, with compromised gas exchange. Inadvertent subsequent rechallenge with celiprolol led to recurrence of the pneumonitis, 10 weeks after drug readministration. Again, the pneumonitis was fully reversible. Lymphocytes were elevated in bronchoalveolar lavage, and progressively normalized upon discontinuation of the drug. This case is reminiscent of pneumonitis to other beta-blockers, which are reviewed here.

Adrenergic beta-Antagonists↗
PubMed1992

[Community-acquired pneumonia in healthy adults: 188 patients treated with spiramycin in private practice].

One hundred and eighty eight outpatients with community acquired pneumonia have been treated by spiramycin in general practice. Community acquired pneumonia was defined by the association of fever > or = 38 degrees C, respiratory symptoms as cough, sputum production, dyspnea or thoracic pain, and pulmonary opacity on the chest X-Ray. The mean age of patients was 44.7 +/- 16.6 and few of them had concomitant chronic illness, as cardiovascular (9%) or bronchopulmonary disease (9%). Twenty one percent of patients have been included after a previous antibiotherapy failure. In 92% on these cases, prior antibiotherapy was a beta lactam. At inclusion, the fever was greater than 39 degrees C in 56% of patients, 58% had localized crepitations at the chest auscultation. The chest X-Ray was performed 1.4 +/- 2.1 days after inclusion and showed a lobar consolidation in 77%. One third of patients presented a clinical picture evoking acute bacterial pneumonia. One hundred and seventy one patients have been reviewed for a second evaluation 4 +/- 1.5 days after inclusion. One hundred and eighty seven patients have visited for the long term follow up 19 +/- 6.5 days after the onset of treatment. Ninety six per cent of them have consulted with a control chest X-ray. At this visit, the antibiotherapy was changed in 2 other patients with of failure. Overall, 83% of patients were clinically and radiologically cured by Spiramycin 3 MU twice a day for 13 +/- 3.5 days. Fourteen percent of patients were improved without necessity of changing the antibiotic regimen. This study confirms the efficacy of spiramycin in the management of community acquired pneumoniae in general practice, either in first line therapy of after the failure of beta lactam.

Adult↗
PubMed1992

[Nitrosourea-induced lung diseases].

Nitrosoureas belong to the group of alkylating agents, and are increasingly used in the treatment of brain malignancies, due to their excellent penetration through the hemo-meningeal barrier. Since 1976, pulmonary toxicity from nitrosoureas has emerged as a significant problem, especially with BCNU, and 72 cases are available in the literature for review. While it is difficult to ascertain the exact prevalence of nitrosourea lung (estimate range between 1 and 20%), it is now clear that a direct relationship exists between cumulated exposure to the nitrosourea, and the likelihood of developing pulmonary toxicity. The clinical picture is that of a diffuse, severe fibrosis with hypoxemia. Histopathology, available in 55 reports, showed diffuse bland fibrosis. The outcome is poor with 67% of the patients dead by the time of publication. While we feel that corticosteroids should be tried for any possible beneficial effect, they seem to be of limited help.

Adult↗
PubMed1991

Pharmacokinetics and metabolism of nilutamide in the isolated rat lung.

Nilutamide (N) is a potent antiandrogen used in the treatment of diffuse carcinoma of the prostate. The drug has been implicated in a few instances of pneumonitis in man. The present studies were carried out to examine N disposition in the isolated perfused lung (IPL) from rats. Both recirculating and single-pass IPL were used. Recirculation was run for 60 min at concentrations of N ranging between 12 and 120 microM (+1 mu Ci [14C]N). Single-pass perfusions were run for 30 min (uptake, 10 min; efflux, 20 min) at inflowing concentrations ranging from 12 to 480 microM (+1 mu Ci [14C]N). Nilutamide was concentrated in the recirculating IPL, and tissue to medium ratio (T/M) ranged between 6.6 and 4.2, depending on the inflowing concentration of N (Cin). High performance liquid chromatography analysis of extracts of 60-min lung homogenates demonstrated the primary amino metabolite of N in addition to the parent compound. This indicated reduction of the nitro moiety of N by lung tissues. At 60 min and Cin = 40 microM, 17.6 +/- 4.7% of the radioactivity present in lung was accounted for by the metabolite. Perfusate samples contained low to undetectable amounts of the metabolite. No metabolism of N was detected in single-pass IPL, possibly because of the shorter duration of experiments. Amount of N taken up in lung and T/M were similar to those found in recirculating preparations. Uptake of N in the single-pass IPL was proportional to N concentration up to 480 microM.(ABSTRACT TRUNCATED AT 250 WORDS)

Androgen Antagonists↗
PubMed1991

[Respiratory manifestations of hemorrhagic rectocolitis].

Several respiratory complications have been described in patients with ulcerative colitis (UC), and are the subject of this review. Involvement of the bronchial tree is the most frequent of them. Chronic bronchitis (16 patients) and bilateral bronchiectasis (16 patients) are responsible for chronic disabling bronchial suppuration. Symptoms related to the bronchial disease most often develop in patients in whom the diagnosis of ulcerative colitis is already established (88% of cases). Occurrence before the diagnosis of UC is possible, but unusual. Bronchial involvement can develop in patients whose UC is in complete remission, or who have undergone coloproctectomy up to several years earlier. Impressive improvement of cough and sputum production commonly occur following inhaled steroids. This is of great diagnostic and therapeutic significance. Other complications include subacute asphyxiating tracheal obstruction due to intralumenal inflammatory overgrowth (1 patient), small airways disease and panbronchiolitis (2 patients), BOOP (4 patients), pulmonary angiitis (6 patients), desquamative interstitial pneumonitis and granulomatosis (2 and 3 patients respectively), biapical pulmonary infiltrates (2 patients) and serositis. In addition, UC patients can develop less specific pulmonary problems such as pulmonary edema, pulmonary embolism and sulfasalazopyridine-induced pneumonitis and fibrosis.

Bronchial Diseases↗
PubMed1991

[Reflections on the management of suspected recent pulmonary embolism].

Pulmonary Embolism (EP) remains a major challenge for the physician, despite increasingly sophisticated investigations and efficient therapeutic programs. Many reasons explain persistent difficulties: the disorder crosses all specialties. A wide variety of clinical presentations has to be considered according to the size of the thrombus, the coexisting conditions ("predisposing factors") and the prior cardio pulmonary status. Major investigations include perfusion and ventilation lung scans, pulmonary angiography, invasive and non invasive investigations of the deep venous system. But obvious practical limitations exist; selection of the most suitable test includes severity of the present patient condition and risk of an early recurrence of EP; risk of the contemplated therapeutic procedure if the diagnosis of EP is confirmed; skillfulness required for the selected investigation. Angiography is mandatory if a substantial hemorrhagic risk exists, if massive EP is suspected, and if at risk treatment procedures are contemplated. In the other cases, and in the absence of significant pulmonary pathology, a lung perfusion scan is the advisable procedure; the diagnosis is excluded if the scan is normal. Previous or current significant pulmonary pathology requires angiography. However, proof of coexisting deep venous thrombosis is an alternative way to enhance the diagnosis in case of poor clinical conditions or other practical considerations.

Angiography, Digital Subtraction↗
PubMed1990

[Pneumopathy caused by methotrexate].

Methotrexate, an antifolate cytotoxic drug, is used in anticancer chemotherapy as well as an immuno suppressive in rheumatoid arthritis. It is responsible for numerous secondary effects, amongst which is a characteristic acute pneumonia known since 1969. This pneumonitis has been described in detail, up to the present time in 78 cases gathered in this review. The prevalence of this complication is estimated at around 7%. This pneumonia may occur whatever the age, indication for which methotrexate is prescribed, the route of administration of the product (including the intra-thecal route) and the dose. It includes dyspnoea, fever, (sometimes quite marked) and frequently an acute reversible respiratory failure. Radiologically the opacities are usually diffuse interstitial and symmetrical with a basal predominance with sometimes some confluence and occasionally a pleural reaction. In a small number of cases a transient mediastinal adenopathy has been described. Respiratory function tests show a rapidly developing restrictive syndrome accompanied by hypoxia and hypocapnia. Broncho-alveolar lavage is characterised by hypercellularity with a frank and apparently transitory lymphocytosis. Histologically the most frequent lesion sighted is an extensive acute granulomatous reaction with or without oedema. Most often the outcome is favourable (75% of cases). However 6 deaths due to respiratory failure have been reported. Even though there has not been any formal test, steroid therapy in high dosage seems to accelerate recovery. Progress to an irreversible pulmonary fibrosis is possible but rare. The mechanism of this drug related acute pneumonia is not known but would seem to resemble that of other granulomatosis. Besides this rapidly progressive pneumonitis, methotrexate is responsible for a very small number of cases of severe pulmonary oedema and of acute painful pleurisies.

Adult↗
PubMed1990

Pharmacokinetics of amiodarone in the isolated rat lung.

In these studies we examined the kinetics of amiodarone (Am) uptake and efflux in/from the lung, and the influence of other amphiphilics on these processes. We used single-pass perfused isolated lungs from rats. Medium containing Am (30 microM + 1 microCi of [14C]Am) was perfused through the lung for 20 min (uptake), followed by 20 min of perfusion with drug-free medium (efflux). Lack of metabolism enabled us to follow Am by measuring the amount of radioactivity in perfusate and lung. Other concentrations of Am (3, 60 and 120 microM; n = 2-4 each) were also examined. Inhibited uptake and accelerated efflux of Am were attempted with the pneumophilic amphiphilics chlorimipramine, chlorphentermine, chlorpromazine, verapamil and with the main metabolite of Am: desethylamiodarone (60 and/or 240 microM; n = 3-4 lungs each). Lung extracted Am extensively during uptake. The amount of Am accumulated at 20 min (inflowing concentration: 30 microM) averaged 1307 +/- 109 (S.E.) nmol/g, corresponding to a tissue to medium ratio of 43.3 +/- 1.6. Spontaneous efflux of Am was incomplete. At 40 min, 862 +/- 105 nmol of Am remained bound per g of lung, suggesting sequestration of Am in a slowly effluxable pool in which calculations show that more than 50% of the drug will ultimately persist. Uptake and efflux rates obey biexponential kinetics, indicating storage into two pools. Uptake rate and the amount of Am accumulated in lung at 20 min increased in proportion to inflowing concentration up to 60 microM. At 120 microM the increase was less. Neither amphiphilic was capable of inhibiting Am uptake, whereas only chlorphentermine significantly accelerated Am efflux.(ABSTRACT TRUNCATED AT 250 WORDS)

Amiodarone↗
PubMed1989

Bronchiolitis obliterans organising pneumonia in patients taking acebutolol or amiodarone.

Two patients, treated with acebutolol and amiodarone respectively, developed a disease clinically, radiologically, and pathologically indistinguishable from bronchiolitis obliterans organising pneumonia. In one case recovery followed discontinuation of acebutolol; in the other case cessation of amiodarone had no effect, and corticosteroids were required. In addition to these patients, several cases of bronchiolitis obliterans organising pneumonia have been reported during treatment with gold salts, amiodarone, and miscellaneous other drugs. Taken together, this information supports the view that bronchiolitis obliterans organising pneumonia may be a form of response by the lungs to insult by drugs.

Acebutolol↗