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Biomedical subjects

M Guiguet

Publications and source records attributed to M Guiguet.

At least 55 records · Page 3Linked to original sources
PubMed1996

Drug use and aplastic anaemia: the French experience. French Cooperative Group for the Epidemiological Study of Aplastic Anaemia.

The cause of the rare and severe condition of aplastic anaemia is largely unknown, although certain drugs have been implicated as possible aetiological factors, mostly through the evidence of case reports. A case-control study was conducted in metropolitan France between 1985 and 1988 to investigate aetiological factors in aplastic anaemia. It was conducted in parallel with the establishment of a national register of the incidence of aplastic anaemia, which started in May 1984. The controls used in the study consisted of 2 hospitalized controls (i.e. patients admitted to hospital at the same time as the case) and a neighbour control named by the case. All three controls were matched for age and sex, and were interviewed by the same investigator as the case. A total of 147 cases, 287 hospitalized controls and 108 neighbour controls were interviewed. An association of varying degrees was noted between aplastic anaemia and the following conditions or treatments: clinical hepatitis during the past 6 months; history of chronic immune disorder (mainly rheumatoid arthritis); gold salts and D-penicillamine; colchicine and allo-thiopurinol; acetaminophen and salicylates. This survey confirmed the vanishing role of previously known toxic agents in the aetiology of aplastic anaemia. Some differences observed between the results of the present study and those published previously suggest that targeted studies on each category of drug according to specific disease areas should be initiated.

Anemia, Aplastic↗
PubMed1995

Early tracheotomy in neutropenic, mechanically ventilated patients: rationale and results of a pilot study.

Despite substantial advances in the management of such patients, the prognosis of ventilated neutropenic patients remains grim. The objective of our study was to evaluate the benefit of tracheotomy in this category of patients, in terms of mortality while they were in the intensive-care unit and nosocomial pneumonias. The charts of 53 consecutive, ventilated, neutropenic patients, or those destined to be imminently neutropenic, admitted to our intensive-care unit during a 4-year period, have been retrospectively reviewed. Tracheotomy was performed at the bedside or in the operating room: 20 patients underwent tracheotomy within 48 h of mechanical ventilation (ET group), while 33 were tracheotomized later or remained intubated (INT group). The two groups were comparable with regard to the underlying disease, respiratory failure, mechanical ventilation patterns and severity scores, but neutropenia was more profound in the ET group. Mortality while in the intensive-care unit was similar (ET: 70%; INT: 78.8%). However, the survival curves showed a trend towards longer survival in the ET group, even after adjustment for the degree of neutropenia (log-rank test: P = 0.07). The incidence of pneumonias was similar in both groups. No major complications of tracheotomy were reported. These findings suggest that a tracheotomy could be proposed for neutropenic patients requiring mechanical ventilation, in order to prolong their survival beyond the end of the neutropenic period. A prospective study is underway to confirm these preliminary results.

Adolescent↗
PubMed1995

Safety of tracheotomy in neutropenic patients: a retrospective study of 26 consecutive cases.

OBJECTIVE: To evaluate the safety of tracheotomy in neutropenic ventilated cancer patients, in terms of infectious and haemorrhagic complications. DESIGN: Retrospective study. SETTING: A medical-surgical intensive care unit in a Cancer-hospital. PATIENTS AND PARTICIPANTS: 26 consecutive patients undergoing a tracheotomy in neutropenic period, from 1987 to 1990. INTERVENTIONS: Tracheotomy, performed at the bedside or in operating room. MEASUREMENTS AND RESULTS: In all neutropenic patients undergoing a tracheotomy, the characteristics and duration of both neutropenia and mechanical ventilation have been recorded. Stomal bleeding and infection, and infectious pneumonias and alveolar haemorrhage have been carefully reviewed. Platelets were transfused in 23 of the 26 patients at the time of the procedure; no local haemorrhage was observed. Neither stomal nor pulmonary infections secondary to tracheotomy were noted. No respiratory worsening was attributable to the tracheotomy. Nineteen patients (73%) died in ICU, without direct link between tracheotomy and death. CONCLUSIONS: These findings suggest that a tracheotomy can be safely performed in neutropenic patients requiring mechanical ventilation.

Decision Making↗
PubMed1995

[Monoclonal gammopathies of undetermined significance in the elderly: apropos of 80 cases].

The authors reviewed the medical records of 80 patients with monoclonal gammopathy of undetermined significance who were examined at the hospital of Dijon between July 1990 and December 1992. The study included 43 males and 37 females with a mean age of 81.0 +/- 5.5 years. Type of M-component was IgG in 65% of the cases, IgA in 19% and IgM in 13.5%. A biclonal gammopathy was found in 2.5% of the cases. The follow-up duration was 24.6 +/- 10.8 months (range: 1-42 months). The survival probability of patients with monoclonal gammopathy of undetermined significance was 66.6% at 36 months compared with 75.6% in a control population. Lymphoplasmacytic disease developed in four patients (5%). There is a dramatic increase in monoclonal gammopathy with increasing age and the risk of malignant transformation must be continued whatever the age of patients. Further studies are required to determine routine follow-up in the elderly patient with monoclonal gammopathy of undetermined significance until the long term utility and cost/benefit ratio of screening techniques are known.

Aged↗
PubMed1995

A case-control study of aplastic anaemia: occupational exposures. The French Cooperative Group for Epidemiological Study of Aplastic Anaemia.

BACKGROUND: Based on the national register of new cases of aplastic anaemia (AA) begun in France in 1984, a case-control study was conducted to explore the aetiology of the disease. METHODS: Cases were all included in the French national register of AA. Two different groups of controls were derived with individual matching; one group from hospitalized patients in the same hospital; the other group from neighbours named by the case. A 15-year occupational history was collected through interview and then grouped into exposure categories by jobs done for one year or more. The study included 98 cases, 181 hospitalized controls, and 72 neighbours aged 18-70 years. RESULTS: No differences appeared between the cases and both groups of controls relative to any group of occupation investigated. However, a borderline non-significant small excess for exposure to pesticides was observed among the cases when compared to hospitalized controls. Whatever the control group, no association was found between AA and exposure to solvents, ionizing radiation, fuel, oils and grease. A positive relationship between exposure to glues and AA was observed, as well as a trend towards an increased risk after exposure to paints. CONCLUSIONS: This large-scale case-control study confirmed the vanishing role of previously known toxic substances in the aetiology of AA. However, a higher proportion of AA patients reported exposure to paints and to glues, a relationship which needs further investigation because of the diversity of compounds included in these products.

Adult↗
PubMed1995

Diagnostic value of serum IL-6 level in monoclonal gammopathies.

The serum level of IL-6 was reported to reflect disease severity in patients with multiple myeloma. We used a specific radioimmunoassay to measure the level of IL-6 in 239 serum samples in which a monoclonal gammopathy was identified for the first time. The same sample was used for the measurement of serum C reactive protein and serum albumin. Then, an inventory of clinical and biological features allowed us to classify these patients into five groups: monoclonal gammopathy of undetermined significance (MGUS:128), multiple myeloma (MM:66), Waldenström's macroglobulinaemia (WM:27), non-Hodgkin's lymphoma (NHL:11) and chronic lymphocytic leukaemia (CLL:7). The number of patients with serum IL-6 (S-IL-6) level > 0.335 ng/ml (upper limit in normal sera) was significantly higher in the MM group (35%; Confidence Interval (CI) 23.5-46.5) compared with the MGUS group (15%; CI 8.8-21.2). The distribution of S-IL-6 levels was also significantly different between the groups (Mann-Whitney test: P < 0.01). High S-IL-6 levels were measured in 5/11 patients with NHL and 9/27 patients with WM. The distribution of S-IL-6 levels in these groups was the same as that in MGUS or MM groups. In patients with MM, elevated S-IL-6 levels were associated with haemoglobin level < 100 g/l (P < 0.005), bone marrow plasmocytosis > 50% (P < 0.005) and stages II and III in the Durie & Salmon staging system (P < 0.005). The S-IL-6 level was also related to light chain component excretion in urine (P < 0.01) and M component serum level for IgA (P < 0.01). In patients with MGUS, the S-IL-6 level correlated with serum CRP level (P < 0.05), serum lactate dehydrogenase (P < 0.05) and serum ferritin (P < 0.01). We conclude that the S-IL-6 level is a marker of high tumour burden in multiple myeloma. However, S-IL-6 level can be increased in patients with MGUS in relation to inflammatory parameters. Therefore the S-IL-6 level does not demonstrate high predictive value for the diagnosis of MM in patients with newly identified monoclonal gammopathy.

Adult↗
PubMed1994

Survival benefit of repeat liver resections for recurrent colorectal metastases: 143 cases. Association Francaise de Chirurgie.

PURPOSE: Resection is the only chance for cure in patients with colorectal liver metastases (LM). Five-year survival rates are close to 25%. Unfortunately, recurrences occur in most patients. Some recurrent LM are technically resectable. The aim of this study was to determine the risks and benefits of repeat resections for recurrent LM. PATIENTS AND METHODS: Data from 130 patients who received 143 repeat liver resections for recurrent LM were collected. In 116 patients, only the liver was involved, while 14 had both liver and extrahepatic recurrences. RESULTS: In the first group, the operative mortality and morbidity rates were 0.9% and 24.7%, respectively. Two- and 3-year survival rates were 57% and 33%, respectively. Recurrences were observed in 66% of patients. Twelve patients underwent a third hepatectomy for recurrence. The mortality rate was nil, and the mean survival time was 12.5 months. In the group with liver and extrahepatic metastases, the operative mortality and morbidity rates were 0% and 25%. The mean survival time was 16 months. Eleven patients died and 13 had recurrences during the follow-up period. CONCLUSION: Some hepatic recurrences after surgical excision of colorectal metastases can be resected with a low operative risk and with a long-term survival rate similar to that obtained after first resections. This emphasizes the need for a careful follow-up after hepatectomy for colorectal metastases to detect resectable recurrences.

Adult↗
PubMed1993

Epidemiology of aplastic anemia in France: a case-control study. I. Medical history and medication use. The French Cooperative Group for Epidemiological Study of Aplastic Anemia.

Aplastic anemia (AA) is a rare, severe disease of mainly unknown origin. Numerous case history reports have incriminated drugs in the etiology of this disease. Because those reports were questionable, a case-control study was conducted in France between 1985 and 1988. Cases selected from the national register were eligible for inclusion when at least two blood lineages were depressed (hemoglobin < or = 10 g/100 mL and reticulocytes < or = 50 x 10(9)/L, granulocytes < or = 1.5 x 10(9)/L, platelets < or = 100 x 10(9)/L) and when the bone marrow biopsy was compatible with the disease. Using a standardized questionnaire, trained investigators interviewed one AA patient and two groups of controls (two hospitalized patients and one neighbor of the AA patient) matched for age, sex, and interviewer. One hundred forty-seven AA patients, 287 hospitalized controls, and 108 neighbors were interviewed. The occurrence of AA was analyzed by matched design with relation to medical history and drug use during the last 5 years, and specifically during the last year. Three times as many AA patients reported having suffered from clinical hepatitis during the last 6 months than either type of control. Similarly, a higher proportion of AA patients reported a history of chronic immune disorder, mainly rheumatoid arthritis (odds ratio of 6.8), and a previous use of gold salts and D-penicillamine in the 5 previous years (odds ratio of 4.9 for each drug). An excess of colchicine and allo/thiopurinol intake in the 5 previous years was observed among the AA patients (odds ratio equal to 4.1 and 3.6, respectively). These results for gold salts, D-penicillamine, and colchicine were confirmed when looking for drug use within the last year. A moderate risk was associated with acetaminophen or salicylate intake during the 5 previous years or during the last year (odds ratio between 1.8 and 2.0). The frequent use of salicylates within the last year was associated with a high risk of AA (odds ratio of 5.0). A high risk was also associated with indolic derivative intake but only when comparing AA patients to neighbor controls. No association could be evidenced with diclofenac intake, whatever the control group. Differences observed with recently published studies suggest that targeted studies on each category of drugs according to the treated pathologies should be initiated.

Adolescent↗
PubMed1993

Should vancomycin be used empirically in febrile patients with prolonged and profound neutropenia? Results of a randomized trial.

OBJECTIVES: We conducted a randomized trial with ceftazidine alone or associated with amikacin or vancomycin to investigate the efficacy of the daily 3 g dosage of ceftazidime and the efficacy of monotherapy with ceftazidime and to determine if vancomycin should be added empirically. METHODS: Patient inclusion criteria were: age over 10 years, therapeutically-induced neutropenia and fever for at least three hours above 38.5 degrees C in absence of a clear non-infectious aetiology. Patients were randomized into three groups: group C, ceftazidime alone 3 g/day; group CA, ceftazidime 3 g/day plus amikacin 15 mg/kg/day; or group C, ceftazidime 3 g/day plus vancomycin 1.5 g/day. RESULTS: Results from one hundred and two episodes of fever were analyzed. The underlying diseases were haematological malignancies (89 patients) and solid tumours (13 patients). The median duration of neutropenia (< 0.5 x 10(9) PMN/L) was 18 days and the minimum duration of 7 days. The main criterion for the analysis of efficacy was the onset of a major infectious event, i.e. death related to documented or suspected infection and any infectious event considered life-threatening or hindering future treatment of the underlying disease. Eight (22%) patients in group C developed major infectious events compared with four (13%) in group CA and none in group CV (p < 0.01). Major infectious events were mainly due to Gram-positive organisms, particularly Streptococcus species. CONCLUSION: We conclude that: 1) ceftazidime alone and in association with amikacin is effective in preventing Gram-negative major infectious events; and 2) vancomycin should not be added only when a Gram-positive infection is documented, but used empirically.

Adolescent↗
PubMed1992

Radioimmunoassay for the measurement of serum IL-6 and its correlation with tumour cell mass parameters in multiple myeloma.

Interleukin-6 (IL-6) was demonstrated to be a strong autocrine or paracrine plasmocytoma cell growth factor in humans. Using a bioassay, high serum IL-6 (S-IL-6) levels were correlated with disease severity in plasma cell dyscrasias. Since other cytokines could interfere with the bioassays, we developed a specific radioimmunoassay to study S-IL-6 levels in 102 patients with monoclonal gammopathy (MG). S-IL-6 level was studied by a double antibody radioimmunoassay using a rabbit polyclonal anti-IL-6 antibody and a human recombinant IL-6 as the standard. The lowest value of the standard significantly different from zero was found to be 78 pg/ml. Within-run and between-run precisions were characterized by a mean coefficient of variation of 3.72 and 5.5%, respectively. The mean analytical recovery was found to be 113% and the immunochemical identity of IL-6 standard and S-IL-6 was shown by dilution tests. IL-6 was detected in all tested sera. Sera from 66 healthy volunteers and 43 patients with acute leukemia or malignant lymphoma were tested as controls. In healthy subjects, S-IL-6 values were 294 +/- 86 pg/ml. MG were classified as multiple myeloma (MM), macroglobulinemia, and MG of undetermined significance (MGUS). The distribution of S-IL-6 levels in patients with MG was significantly higher than in healthy subjects but lower than in patients with acute leukemia or Hodgkin's lymphoma. Results obtained in 55 patients with MM were related to other biological parameters. S-IL-6 levels correlated with bone-marrow plasmacytosis (P less than .0005), serum-lactate dehydrogenase (S-LDH; P less than .005), serum beta 2 microglobulin (S -beta 2m; P less than .01), and serum calcium (S-Ca; P less than .025) and inversely correlated with haemoglobin (P less than .025). Our results indicate that 1) radioimmunoassay is suitable for the measurement of human IL-6 in serum; 2) high S-IL-6 levels are observed in a small number of patients with MG; and 3) S-IL-6 level correlates with tumour cell mass in patients with overt MM.

Bone Marrow↗
PubMed1992

High concentrations of intrathecal interleukin-6 in human bacterial and nonbacterial meningitis.

Interleukin-6 (IL-6) is multipotent cytokine that acts in a network of factors directing the inflammatory reaction of purulent bacterial meningitis (PBM). However, little is known about the role of IL-6 in aseptic or "viral" meningitis (AM). IL-6 was assayed by RIA in cerebrospinal fluid (CSF) and serum samples obtained from patients with AM (n = 65), PBM (n = 8), and lymphocytic bacterial meningitis (LBM, n = 11). Of patients with AM, 89% had detectable IL-6 in CSF, with high IL-6 titers (median, 2160 pg/mL; 95% confidence interval [CI], 1320-2540 pg/mL) compared with 100% in patients with PBM (median, 6575 pg/mL; 95% CI, 450-32,000 pg/mL) and 90.9% in patients with LBM (median, 875 pg/mL; 95% CI, 150-2180 pg/mL). There was a highly symmetrical correlation between IL-6 and the percentage of polymorphonuclear cells in CSF of patients with PBM (r = .97, P = .01) and AM (r = .49, P = .002). In conclusion, this study shows evidence that IL-6 is released into the meningeal space in aseptic meningitis and is correlated with the local acute inflammatory response.

Humans↗
PubMed1992

Prevalence of obesity: a comparative survey in France, the United Kingdom and the United States.

We investigated the differences in the prevalence of obesity between France, the United Kingdom and the United States in 1988. The analysis was made on a total sample of 5580 subjects, representative of the population aged 16-50 years in the three countries. The same questionnaire was used in all three countries. Body mass index (kg/m2) was used to assess corpulence. Significant differences in the prevalence of obesity were observed among the three countries: 7% of the population in France was obese, 9% in the UK and 15% in the USA (P less than 0.001). There was a strikingly high percentage of very obese women (more than 50% overweight) in the USA (8% of the population) as compared to the two European countries (2% in France and 3% in the UK). In all three countries, obesity was related to sex, age, level of education, marital status, physical exercise and smoking. An inverse association was found between obesity and alcohol consumption in the USA, but not in France nor in the UK. In men, prevalence of obesity remained significantly higher in the USA than in France or in the UK when adjusting for the obesity-related factors. In women, differences in prevalence of obesity between the three countries varied according to the level of exercise, income and alcohol consumption.

Adolescent↗
PubMed1992

HIV antibody testing in France: results of a national survey.

Data from a knowledge, attitudes, and behavior survey conducted at the end of 1988 suggest that 13% of the population in France, aged 16 to 50 years, had been tested for HIV antibodies. Geographical differences in testing were observed, with a greater number of respondents tested in the regions where AIDS is most prevalent. Important variations in the percentage of HIV antibody-tested persons were found in relation to age, education, and occupation, but not to gender. Multiple logistic regression analysis identified significant predictors of HIV antibody testing. Behavioral predictors were multiple partners (odds ratio = 2.4), anal intercourse (odds ratio = 1.8), and drug use. A positive relationship was demonstrated between HIV testing and condom use. These correlations could indicate that the opportunity for anonymous and free testing encourages high-risk individuals to be tested.

AIDS Serodiagnosis↗
PubMed1991

French intravenous drug users: knowledge and sexual behavior change.

In a population based survey conducted in France in 1988, 41 respondents reported present or past intravenous drug use. Controlling for age and gender, intravenous drug users (IDUs) engage in more high risk sexual behavior than the general population (sex with other IDUs, multiple partners), but they do not use condoms more frequently. They are five times more likely to have had an HIV test.

Acquired Immunodeficiency Syndrome↗