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P Thomas

Publications and source records attributed to P Thomas.

At least 37 records · Page 2Linked to original sources
PubMed2006

[Quality of life: attitudes and perspectives of doctors in a thoracic oncology regional care network].

BACKGROUND: The evaluation of health-related quality of life (HRQOL) of lung cancer patients is significant given their poor prognosis. Consequently, HRQOL is often currently assessed throughout clinical trials and sometimes in daily medical practice. The objective here was to determine physicians' perspectives on evaluating HRQOL. MATERIAL AND METHODS: The team carried out a prospective study of physicians belonging to a thoracic oncology network using an original questionnaire of 33 items. RESULTS: 102 physicians were questioned and 51 responded. Physicians' knowledge on HRQOL was frequently of a low level and incomplete, but most of them considered HRQOL as important HRQOL assessment in daily practice was often done intuitively. Many physicians noted that they lacked adequate time to explore and integrate all of the fields which should be covered by HRQOL in their clinical practice, but they felt overall that the HRQOL study improved doctor/patient communication and interaction. Physicians described an "ideal" HRQOL questionnaire as one containing 10-15 items within 6 domains (physical, psychological, general health, respiratory symptoms, family and social) and which could be completed in 5-8 minutes. In addition, such a questionnaire might integrate an opportunity for patients to isolate and identify items and issues that they consider to be most important to them. CONCLUSIONS: Physicians' will to consider and integrate the evaluation of HRQOL in the management of lung cancer patients is strong but meets some structural challenges (related to HRQOL assessment and interpretation of data) but also conjectural difficulties (with respect to a lack of knowledge). Training efforts are needed as well as the development of easier tools to facilitate the evaluation of HRQOL.

Adult↗
PubMed2005

Randomized multicentric phase II study of carboplatin/gemcitabine and cisplatin/vinorelbine in advanced non-small cell lung cancer GFPC 99-01 study (Groupe français de pneumo-cancérologie).

PURPOSE: To evaluate the efficacy and safety of gemcitabine and carboplatin in the treatment of previously untreated patients with advanced non-small cell lung cancer (NSCLC). METHODS: A randomized phase II study was conducted by the Groupe Français de Pneumo-Cancérologie (GFPC) in 15 centers. The patients were randomized in either arm A (GC): gemcitabine 1250 mg/m2 on days 1 and 8+carboplatin AUC 6 mg/(mLmin) on day 1; or in arm B (VP): vinorelbine 30 mg/m2 weekly+cisplatin 80 mg/m2 on day 1. Treatment cycles were repeated every 3 weeks. RESULTS: A total of 100 patients were randomized with stage IV or stage III NSCLC with malignant pleural effusion: 51 patients in arm A and 49 patients in arm B. A total of 190 cycles were administered in the GC arm and 172 cycles in the VP arm, with a median of four cycles per patient in each arm. The dose intensity was 84.9% for gemcitabine, 99.8% for carboplatin, 97.7% for cisplatin and 67.7% for vinorelbine. The objective response rates were 19.6% (95% CI, 9.8-33.1) for GC and 29.2% (95% CI, 17.0-44.1) for VP in an ITT analysis. The response duration was 169 days in arm A and 226 days in arm B. The TTP was similar with 140 days (GC) and 148 days (VP), respectively. Overall survival rates were 334 days in the GC combination and 304 days in the VP combination. Overall, the treatment was safe and toxicities observed were different in each arm: neutropenia was the most common toxicity in the VP treatment, whereas thrombocytopenia was more frequent in the GC combination. Anemia was similar in both arms. Non-haematologic toxicity was mild. One toxic death in arm A and three toxic deaths in arm B were observed. CONCLUSION: In terms of response rate, the gemcitabine-carboplatin combination was not efficient enough to allow further phase III study. Survival data are in the same range as the standard arm. This chemotherapy is feasible and may represent an alternative to a standard cisplatin-based regimen, allowing treatment in an outpatient setting.

Adult↗
PubMed2005

[Bronchial fistula postpneumonectomy: predictive factors].

OBJECTIVE: To determine predictive factors of bronchial fistula following pneumonectomy. PATIENTS AND METHODS: In 14 years (1989-2003), we collect 58 cases of bronchial fistula following 725 consecutive pneumonectomy in the service of thoracic surgery of the Sainte Marguerite Hospital in Marseilles. There were 53 cases (91.4%) of cancers and 5 cases (8.6%) of various pathology. The average age of the patients was of 61 +/- 10 years (range 24 to 80 years). The sex ratio M/F was 8.7. The software of regression SPSS (version11.5) was used to identify the factors risk of a bronchial fistula after a univariate and multivariate analysis. RESULTS: The prevalence of the bronchial fistula after a pneumonectomy was 8%.The preoperative factors which increased to a significant degree the incidence of the bronchial dent to the univariate analysis were the chronic smoking (P < 0.001), the existence of COPD (P = 0.001) and of a previous thoracic surgery (P = 0.01). Operational data like a right- side pulmonary resection (P < 0.001), the type of bronchial stup carried out (P = 0.03) as and an extended pneumonectomy to the auricule (P = 0.03) were significant risk factors. With the logistic regression the significant risk factors were the chronic smoking (P = 0.002), the existence of COPD (P = 0.003), a previous pulmonary surgery (P = 0.03) and the right - side of the pneumonectomy (P < 0.001). The indication of the pneumonectomy was retained neither by the univariate analysis, nor by the logistic regression significant risk factors. CONCLUSION: The predictive factors of a bronchial fistula after a pneumonectomy are dominated by respiratory co-morbidities. To prevent this complication, we insist on the stop of the tobacco, a better respiratory preparation and the acquisition of a protocol adapted of the bronchial stub after a pneumonectomy particularly on the right side.

Adult↗
PubMed2005

Oro-nasal fistula development and velopharyngeal insufficiency following primary cleft palate surgery--an audit of 148 children born between 1985 and 1997.

We present an audit of primary cleft palate surgery in our unit including rates of two important post-operative complications. Multidisciplinary audit clinics ran from March 1998 to April 2002 to follow up all local patients with a cleft lip or palate who had undergone primary palatal surgery in our unit. One hundred and forty eight patients were studied. Patient ages at follow-up ranged from 3 years and 10 months to 17 years and 4 months. Two surgeons performed the primary surgery. One hundred and twenty eight Wardill-Kilner and 20 Von Langenbeck repairs were performed. We found a 4.7% rate of oro-nasal fistula development requiring surgical closure, and a 26.4% rate of velopharyngeal insufficiency (VPI) requiring subsequent pharyngoplasty. We noted that the type of cleft involved affected the rate of VPI, 16% of patients with unilateral cleft lip and palate versus 29.2% of patients with a solitary cleft palate requiring secondary surgery. Outcome of surgery was determined by a 'Cleft Audit Protocol for Speech' (CAPS) speech therapy assessment at follow-up clinics. Only 14.9% of all patients assessed demonstrated any degree of hypernasality. Our results compare favourably with other recent studies including the Clinical Standards Advisory Group (CSAG) report into treatment of children with cleft lip and palate.

Adolescent↗
PubMed2005

Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation.

BACKGROUND: One-lung ventilation-related hypoxaemia (OLV-RH) can occur in patients with healthy lungs. In this case, PEEP frequently improves oxygenation. The aim of this study was to determine, in a healthy lung model of OLV, whether the increase in PEEP improved oxygenation and whether the mechanisms involved include both inspiratory lung recruitment and an end-expiratory lung volume increase. Since inhaled nitric oxide (iNO) may have a synergistic effect on oxygenation in the case of PEEP-induced recruitment, their association was also tested. METHODS: Twenty pigs were studied during open-chest, left OLV. Arterial blood gases and haemodynamic variables were measured at different levels of PEEP (0, 5, 10 and 15 cm H(2)O) applied in random order with or without iNO 4 p.p.m. Pressure-volume curves were measured at each level of PEEP. RESULTS: PEEP(5) and PEEP(10) improved Pa(O(2))/FI(O(2)) ratio (P<0.005) and shunt (P<0.005) regardless of the presence of iNO. PEEP(15) improved oxygenation and shunt only when it was associated with iNO (P<0.001). Whereas PEEP(5), PEEP(10) and PEEP(15) were associated with a significant increase in end-expiratory volume (P<0.001), only PEEP(5) and PEEP(10) were associated with continuous lung volume recruitment (P<0.01). Moreover, PEEP(15) induced a significant decrease in linear compliance (P<0.001). CONCLUSIONS: In a healthy porcine lung model of OLV-RH, moderate PEEP can improve oxygenation. This effect implies both expiratory and inspiratory pulmonary recruitment. Co-administration of 4 p.p.m. iNO was ineffective.

Animals↗
PubMed2005

The distributions of the duplicate oestrogen receptors ER-beta a and ER-beta b in the forebrain of the Atlantic croaker (Micropogonias undulatus): evidence for subfunctionalization after gene duplication.

Teleost fishes have three distinct oestrogen receptor (ER) subtypes: ER-alpha, ER-beta a (or ER-gamma) and ER-beta b. ER-beta a and ER-beta b arose from a duplication of an ancestral ER-beta gene early in the teleost lineage. Here, we describe the distribution of the three ER mRNAs in the hypothalamus and cerebellum of the Atlantic croaker to address two issues: the specific functions of multiple ERs in the neuroendocrine system and the evolution and fate of duplicated genes. ER-alpha was detected in nuclei of the preoptic area (POA) and hypothalamus previously shown to possess ER-alphas in teleosts. AcER-beta b, but not ER-beta a, labelling was detected in the magnocellular neurons of the POA, nucleus posterior tuberis, the nucleus recessus posterior and cerebellum. By contrast, acER-beta a, but not ER-beta b, was detected in the dorsal anterior parvocellular POA and suprachiasmatic nucleus. Both ER-betas were found in posterior parvocellular and ventral anterior POA nuclei, the ventral hypothalamus, and periventricular dorsal hypothalamus. The differences we observed in ER subtype mRNA distribution within well-characterized brain nuclei suggest that ER-beta a and ER-beta b have distinct functions in the neuroendocrine control of reproduction and behaviour, and provide evidence that the teleost ER-beta paralogues have partitioned functions of the ancestral ER-beta gene they shared with tetrapods.

Animals↗
PubMed2005

Cassini Imaging Science: initial results on Saturn's atmosphere.

The Cassini Imaging Science Subsystem (ISS) began observing Saturn in early February 2004. From analysis of cloud motions through early October 2004, we report vertical wind shear in Saturn's equatorial jet and a maximum wind speed of approximately 375 meters per second, a value that differs from both Hubble Space Telescope and Voyager values. We also report a particularly active narrow southern mid-latitude region in which dark ovals are observed both to merge with each other and to arise from the eruptions of large, bright storms. Bright storm eruptions are correlated with Saturn's electrostatic discharges, which are thought to originate from lightning.

Atmosphere↗
PubMed2005

Cassini Imaging Science: initial results on Saturn's rings and small satellites.

Images acquired of Saturn's rings and small moons by the Cassini Imaging Science Subsystem (ISS) during the first 9 months of Cassini operations at Saturn have produced many new findings. These include new saturnian moons; refined orbits of new and previously known moons; narrow diffuse rings in the F-ring region and embedded in gaps within the main rings; exceptionally fine-scale ring structure in moderate- to high-optical depth regions; new estimates for the masses of ring-region moons, as well as ring particle properties in the Cassini division, derived from the analysis of linear density waves; ring particle albedos in select ring regions; and never-before-seen phenomena within the rings.

Journal Article↗
PubMed2005

Filamin A mutations cause periventricular heterotopia with Ehlers-Danlos syndrome.

OBJECTIVE: To define the clinical, radiologic, and genetic features of periventricular heterotopia (PH) with Ehlers-Danlos syndrome (EDS). METHODS: Exonic sequencing and single stranded conformational polymorphism (SSCP) analysis was performed on affected individuals. Linkage analysis using microsatellite markers on the X-chromosome was performed on a single pedigree. Western blotting evaluated for loss of filamin A (FLNA) protein and Southern blotting assessed for any potential chromosome rearrangement in this region. RESULTS: The authors report two familial cases and nine additional sporadic cases of the EDS-variant form of PH, which is characterized by nodular brain heterotopia, joint hypermobility, and development of aortic dilatation in early adulthood. MRI typically demonstrated bilateral nodular PH, indistinguishable from PH due to FLNA mutations. Exonic sequencing or SSCP analyses of FLNA revealed a 2762 delG single base pair deletion in one affected female. Another affected female harbored a C116 single point mutation, resulting in an A39G change. A third affected female had a 4147 delG single base pair deletion. One pedigree with no detectable exonic mutation demonstrated positive linkage to the FLNA locus Xq28, an affected individual in this family also had no detectable FLNA protein, but no chromosomal rearrangement was detected. CONCLUSION: These results suggest that the Ehlers-Danlos variant of periventricular heterotopia (PH), in part, represents an overlapping syndrome with X-linked dominant PH due to filamin A mutations.

Adolescent↗
PubMed2005

Anal cytology: is there a role for reflex HPV DNA testing?

There is an increased incidence of anal squamous carcinoma and its precursor lesions (anal intraepithelial neoplasia [AIN]) among persons who engage in anal-receptive sex. Analogous to cervical cancer screening, anal Papanicplaou (Pap) smears currently are used to screen these high-risk populations. Human papilloma virus (HPV) has been implicated in anal carcinoma pathogenesis and this study was performed to assess the potential role of HPV DNA testing as an adjunct to anal cytology. We correlated cytological diagnoses and HPV DNA (Digene Hybrid Capture [HC II] assay) in anal specimens collected in SurePath liquid medium from 118 patients; 54.8% of cases diagnosed as atypical squamous cells of undetermined significance (ASC-US) and 87.8% diagnosed as low-grade squamous intraepithelial lesion (LSIL) or above tested positive for high- risk HPV DNA (B+). High-grade SIL (HSIL) was present in 31 of the 51 patients with follow-up. Although a cytological diagnosis of ASC-US or above was a reliable indicator for AIN, cytology frequently did not accurately predict the grade of SIL in subsequent biopsy. Our findings suggest that reflex HPV DNA testing would be helpful in triaging patients diagnosed with ASC-US. However, patients diagnosed with LSIL or above should go directly to ansocopic biopsy.

Adult↗
PubMed2005

[Allergic potential of titanium implants].

AIM: The aim of this investigation is to evaluate the allergic potential of titanium and titanium alloys for surgical implant applications. MATERIALS AND METHODS: Discs cut from rods supplied by five different titanium suppliers in several diameters were investigated. The samples were cp-Titanium as well as Ti6Al4 V and Ti6Al7Nb, 6 mm thick with a diameter of between 6 and 60 mm. The material was checked by optical spectral analysis. RESULTS: In all samples except iodidtitanium, a Nickel content of 0.012-0,034 wt% could be detected. CONCLUSION: The low nickel content in the implant material results from the production process. The nickel atoms are in solid solution in the titanium lattice. Nickel allergic patients may develop hypersensitivity reactions even due to this low nickel content. Hence, this reaction may be falsely attributed to the titanium material itself. Measurements of ion concentration in the body are helpful for quantifying the maximum content of nickel in titanium materials for surgical implant applications. In addition, technical questions related to the production of nickel free titanium materials for allergic patients have to be solved.

Biocompatible Materials↗
PubMed2005

[Metallurgical differentiation of cobalt-chromium alloys for implants].

BACKGROUND: Cobalt Chromium alloys are used in cemented total hip or knee arthroplasty as well as in metal-on-metal bearings in total hip arthroplasty. An increasing number of publications report about (allergic) reactions to wear particles of Cobalt Chromium alloys. Reactions to nickel are more frequent in comparison to Cobalt or Chromium particles. It is well known that different kinds of Cobalt Chromium alloys contain different amounts of alloying elements; nevertheless. The aim of the current work was to compare the different Cobalt Chromium alloys according to ASTM F or ISO standards in respect to the different alloying elements. MATERIAL AND METHODS: Co28Cr6Mo casting alloys according to ASTM F 75 or ISO 5832-4 as well as forging alloy types according to ASTM F 799 and ISO 5832 such as Co20Cr15W10Ni, Co35Ni20Cr, Fe40Co20Cr10Ni, Co20Cr20Ni, and Co28Cr6Mo were analyzed in respect to their element content of Co, Cr, Ni, Mo, Fe, W, and Mn. RESULTS: In 1935 the Cobalt based alloy "Vitallium" Co30Cr5Mo basically used in the aircraft industry was introduced into medicine. The chemical composition of this alloy based on Cobalt showed 30 wt.% Chromium and 5 wt.% Molybdenum. The differentiation using alloy names showed no Nickel information in single alloy names. CONCLUSION: The information given about different alloys can lead to an unprecise evaluation of histopathological findings in respect to alloys or alloying constituents. Therefore, implant manufacturers should give the exact information about the alloys used and adhere to European law, Euronorm 93/42/EWG.

Chromium Alloys↗
PubMed2005

[Clinical study and prognosis of 56 cases of vulvar intraepithelial neoplasia].

OBJECTIVE: To study main clinical characteristics of patients with vulvar intraepithelial neoplasia 3 (VIN3). To investigate the long-term outcome and risk factors associated with recurrence or progression to invasive carcinoma. PATIENTS AND METHODS: Retrospective study of 56 patients with VIN3 from January 1st 1995 to December 31st 2003. RESULTS: Lesions were unifocal for 30 patients (53.6%) whereas they were multifocal for 26 patients (46.4%). When the lesion was multifocal, women were younger than in the unifocal group (41.2+/-16.7 vs. 52.5+/-13.5 years, P<0.03). Clinical symptoms, disease characteristics and medical history were not different between the two groups. Clinical HPV infections were more frequent in the multifocal group (65.4 vs. 23.3%, P<0.01). The mean follow-up was 39 months. Nine patients (16.1%) had recurrence of VIN3. Progression to invasive carcinoma occurred in 4 patients (7.1%). Multifocal lesions, occult micro-invasive disease and positive margins were related to recurrence or progression to invasive carcinoma. However, age at diagnosis, HPV infection, lichen sclerosis, immunosuppression and initial treatment did not correlate with evolution. DISCUSSION AND CONCLUSION: Recurrence and progression to invasive carcinoma can occur during VIN3 evolution. Our results confirm previous reports and suggest that all patients need a long-term follow-up regardless of patients' age or clinical characteristics.

Adult↗
PubMed2005

Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes.

PURPOSE: Gemcitabine-platinum combination activity has been clearly established in a number of phase II studies. It has also been compared against other combinations in many phase III trials. It is generally believed that all such regimens have an equivalent impact on survival. This meta-analysis aims to quantify the treatment effect of gemcitabine plus a platinum agent in the treatment of advanced NSCLC and compare the combination to other regimens used globally. DESIGN: Data from a total of 4556 patients from 13 randomized trials investigating gemcitabine in combination with a platinum agent versus any other platinum-containing regimen were included in a meta-analysis of time-to-event outcomes. RESULTS: A significant reduction in overall mortality in favor of gemcitabine-platinum regimens was observed, hazard ratio (HR) 0.90 (95% CI: 0.84-0.96) with an absolute benefit at 1 year of 3.9%. Median survival was 9.0 months for the gemcitabine-platinum regimens and 8.2 months for the comparator regimens. Sub-group analysis of the first- and second-generation platinum-based comparator regimens also indicated a significant benefit for gemcitabine-platinum regimens, HR 0.84 (CI: 0.71-0.9985). Analysis of third-generation agent plus platinum regimens showed a non-significant trend favoring gemcitabine-platinum regimens, HR 0.93 (CI: 0.86-1.01). There was a significant decrease in the risk of disease progression in favor of gemcitabine-platinum regimens, HR 0.88 (CI: 0.82-0.93). An absolute benefit of 4.2% at 1 year was estimated. Median progression-free survival was 5.1 months for gemcitabine-platinum regimens compared with 4.4 months for the comparator regimens. Sub-group analysis indicated a statistically significant progression-free survival benefit for patients assigned to gemcitabine-platinum treatment compared to first- and second-generation platinum regimens, HR 0.85 (CI: 0.77-0.94), and third-generation agent plus platinum regimens, HR 0.89 (CI: 0.82-0.96).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

[Behavioral and psychological symptoms in dementia: description and management].

Behavioral and Psychological Symptoms in Dementia (BPSD) are, beside cognitive disorders, major features of Alzheimer's disease and related disorders. Diagnosis is important to enhance our knowledge of the pathophysiology of dementia and of their functional consequences for patients and caregivers. Pharmacological and non-pharmacological management of dementia depends to a large extent on the presence of BPSD. A committee of geriatricians, neurologists and psychiatrists specialized in dementia (THEMA 2) has promoted an epidemiological, diagnostic and therapeutic update in this field. This work was based on the BPSD Consensus Conference Report edited in 2000 by the International Psychogeriatric Association. This report was updated with the most recent literature reports, and was adapted to the French environment. This paper is a synthesis of this meeting, validated and corrected by the entire Thema 2 group.

Aged↗