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Biomedical subjects

N Milpied

Publications and source records attributed to N Milpied.

179 records · Page 10Linked to original sources
PubMed1988

[Prophylactic systemic antibiotherapy with only ceftriaxone in neutropenic patients treated in a protected environment].

Prophylactic systemic antibiotherapy with ceftriaxone (CRO) alone was tested in aplastic patients receiving total gut decontamination and treated in protected environment. To enter the study, the patients had to be afebrile when their polymorphonuclear (PMN) count fell under 500/cumm. Seventy eight therapeutic aplasias (after allogeneic or autologous bone marrow transplant conditioning regimens or high dose chemotherapy) form the basis of this report. The median duration of aplasia was 19 D (11-93 D). Forty-three patients received during 51 aplasias one single injection of CRO per day as soon as PMN count was under 500/cumm. In 23 cases (45%) the patients remained afebrile until the end of aplasia. There were 3 Staphylococcus epidermidis bacteremias (6%), 3 bacteriologically documented fevers (6%) and 1 Cryptococcus septicemia. Twenty-nine of these aplasias were part of a randomized study between group A (prophylactic CRO) and group B (non prophylactic CRO: 27 cases). In group A, there were significantly more aplasias without fever (34.5% vs 4%), and less bacteremias (10% vs 48%). Fever appeared later in group A (mean 12.5 D vs 6 D). No death was recorded during the whole study. Thus, in protected environment, prophylactic systemic antibiotherapy could still lessen the risk of bacterial infections. The side effects and the cost of such a procedure appeared to be diminished by a monoantibiotherapy.

Adolescent↗
PubMed1987

[Preventive systemic antibiotherapy with ceftriaxone alone in neutropenic patients treated in a protected environment].

Prophylactic systemic antibiotic therapy with ceftriaxone alone was tested in aplastic patients receiving total gut decontamination and treated in a protected environment. Only patients who were afebrile when their polymorphonuclear (PMN) count fell below 500/cumm were admitted to the study. Seventy-eight episodes of therapeutic aplasia (consecutive to allogeneic or autologous bone marrow transplant conditioning regimens or to high dose chemotherapy) form the basis of this report. The median duration of aplasia was 19 days (range 11-93 days). Twenty patients received, during 22 episodes of aplasia, one single injection of ceftriaxone per day as soon as their PMN count was below 500/mm3. In 13 cases (59%) the patients remained afebrile until the end of aplasia, and no bacteriemia was detected. The second part of the study was randomized between group A (prophylactic ceftriaxone: 29 cases) and group B (no prophylactic ceftriaxone: 27 cases). Patients in group A had significantly more episodes of afebrile aplasia (34.5% vs 4%) and less bacteriemias (10% vs 48%) than those in group B. Also fever developed later in group A (mean: 12.5 vs 6 days). No death was recorded throughout the study. Thus, in a protected environment prophylactic systemic antibiotic therapy could still lessen the risk of bacterial infection. Using one single antibiotic seemed to reduce the side-effects and cost of the prophylactic treatment.

Adolescent↗
PubMed1986

Cutaneous immunological studies in diagnosis of acute graft-versus-host disease.

A comparative study of the healthy skin of patients who had undergone bone marrow grafting and not developed graft-versus-host disease (GVHD) and of patients with cutaneous lesions of acute GVHD has been carried out. The aim of this study was to assess the diagnostic value of cutaneous immunopathology in the diagnosis of acute GVHD. A double-labelling immunofluorescence technique was used with a panel of monoclonal antibodies. The results showed a lack of specificity for GVHD in the distribution of Langerhans cells, but confirmed the diagnostic value of HLA-DR staining of epidermal keratinocytes. Cellular polymorphism of the T cell infiltrate in the dermis was observed (T helpers 40% and T suppressors 20%). The expression of the 55-57 Kd keratin polypeptide and of bullous pemphigoid antigen showed modification during acute GVHD while that of pemphigus antigen remained unchanged.

Acute Disease↗
PubMed1983

[Lesions evoking Sweet's syndrome in acute leukemia: occurring during the stage of therapeutic aplasia].

Acute febrile neutrophilic dermatosis, so called Sweet's Syndrome is a distinct dermatological disease defined by constant clinical and histological features: Eruption of painful, tender, raised erythematous plaques of face and neck with fever. Dense dermal infiltration with mature neutrophil polymorphs. Sweet's Syndrome may occur during the course of chronic or acute haematological diseases such as chronic myelogenous leukemia or acute non lymphoblastic leukemia. In all cases, the counts of Neutrophil Polymorphs were normal or above normal limits. We report a case of Sweet's Syndrome occurring during the aplastic period induced by the treatment of an acute myelo monocytic leukemia, and discuss the responsibility of white blood cells transfusion in genesis of typical histological aspect.

Female↗
PubMed1982

[Eosinophilic fasciitis and Hodgkin's disease].

A case of eosinophilic fasciitis (EF) associated with Hodgkin disease is described. In eight previously published cases, EF was associated with immunologic diseases, such as autoimmune marrow aplasia. The relation between EF and Hodgkin disease should be studied by investigating the physiopathologic meaning of eosinophils in both conditions.

Aged↗
PubMedDate not supplied

[First-line treatment of severe myelomas of the young subject by high-dose melphalan].

Six patients (aged 39 to 55 years) with stage III myelomas were treated with IV high dose melphalan (HDM) 140 mg/m2. They had previously received only one or two courses of conventional chemotherapy. The extrahematological tolerance of the procedure was good. The duration of neutropenias (less than 500/mm3) was 14 to 24 days. Complete remission (CR) was obtained in 4 cases but one patient died in CR of invasive aspergillosis. In the other 3 cases, bone marrow was cryopreserved without ex vivo treatment and reinfused after a 2nd course of HDM. These patients remain in apparent CR 12, 20 and 34 months after the diagnosis although one of them had a pure meningeal relapse treated with a second autograft. These results suggest that CR can be obtained with HDM but at the expense of profound myelosuppression. Long term disease control can be obtained but the role of the 2nd course of HDM with autologous bone marrow transplantation warrants further study.

Adult↗
PubMedDate not supplied

Pharmacokinetics of high-dose melphalan in adults: influence of renal function.

BACKGROUND: The pharmacokinetics of melphalan were studied in 20 patients with multiple myeloma, primary amyloidosis or lymphoma after IV dose of 140 mg/m2 infused over 30 minutes (two patients were treated with a higher dose). MATERIALS AND METHODS: Six patients received melphalan alone, 8 received melphalan combined with total body irradiation, 2 received busulphan plus melphalan and 4 received the BEAM association (BCNU + etoposide + high dose aracytine + high dose melphalan). Creatinine clearance was measured immediately before the infusion of melphalan, and 9 blood samples were taken to monitor elimination kinetics. RESULTS: Pharmacokinetic parameters (CIT, Vdss, t1/2) and areas under the curve (AUC) were comparable to those obtained by Ardiet et al after rapid IV injection. For all patients, AUC, CIT, Vdss, t1/2 beta and MRT were significantly correlated with creatinine clearance; the different pharmacokinetic parameters calculated showed great interindividual variations. CONCLUSIONS: Renal insufficiency did not lead to a large decrease in melphalan clearance compared to interindividual variations in systemic clearance.

Adult↗