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Biomedical subjects

R Tubiana

Publications and source records attributed to R Tubiana.

At least 19 recordsLinked to original sources
PubMed1996

Effects of lamivudine on replication of hepatitis B virus in HIV-infected men.

BACKGROUND: Therapy for hepatitis B virus (HBV) infection is still unsatisfactory, particularly in patients who are co-infected with the human immunodeficiency virus (HIV). Lamivudine, a retroviral inhibitor, has been shown to have activity against HBV replication in vitro, in animal models, and in studies of immunocompetent persons. OBJECTIVE: To assess the efficacy of lamivudine in inhibiting HBV replication during a 12-month period in patients with both HBV and HIV infection. DESIGN: Prospective, open study. SETTING: University hospital. PATIENTS: 40 consecutive patients (39 men and 1 woman) infected with both HIV and HBV. All had progressive HIV disease; were refractory to or unable to tolerate therapies other than lamivudine; and received lamlvudine, 600 mg/d or 600 mg/d followed by 300 mg/d, as therapy for HIV disease. MEASUREMENTS: Serum concentrations of HBV DNA were assessed every 2 months by using molecular hybridization. Polymerase chain reaction (PCR) for HBV DNA was done at baseline and was done at months 2, 6, and 12 only if the HBV DNA concentration was less than 5 pg/mL. RESULTS: Two groups were retrospectively identified at baseline: patients with high HBV replication (serum HBV DNA concentrations > 5 pg/mL) (n = 30) and patients with low HBV replication (serum HBV DNA concentrations < 5 pg/mL) (n = 10). After 12 months of treatment, 26 of 27 patients (96.3% [95% Cl, 81% to 99.9%]) who had had high HBV replication at baseline had serum HBV DNA concentrations less than 5 pg/mL. However, PCR could still detect HBV DNA in serum in 11.5% (Cl, 2% to 30%) of these patients. Among patients who had had low HBV replication at baseline, the results of PCR for serum HBV DNA became negative in the 6 patients who had had a positive result on PCR at baseline. No serious adverse events occurred during treatment. CONCLUSION: Although this study was not a randomized, blinded trial, it suggests that lamivudine is active against.

AIDS-Related Opportunistic Infections↗
PubMed1995

Hook-nail deformity. Surgical treatment with a homodigital advancement flap.

Sixteen patients presenting 18 hook-nail deformities have been treated by the advancement of a homodigital island flap. With an average follow-up of 31 months; Results were considered good or excellent in seven cases, fair in seven and poor in four. Six cases, although improved, had a marked recurrence of the deformity, six had a partial recurrence and six had almost no recurrence. Patient satisfaction was limited as the finger still had a short nail and a square shape.

Adult↗
PubMed1995

Evaluation of safety and efficacy of 3TC (lamivudine) in patients with asymptomatic or mildly symptomatic human immunodeficiency virus infection: a phase I/II study.

In a phase I/II study, 7 levels of 3TC therapy (from 0.5 to 20.0 mg/kg/day) were studied in 104 asymptomatic and mildly symptomatic human immunodeficiency virus-infected patients with CD4 cell counts < or = 400 x 10(6)/L. Mild and transient episodes of diarrhea, headache, fatigue, nausea, and abdominal pain were the most frequent events reported. No dose-limiting toxicities were observed. Small and transient increases in CD4 cell counts were detected during the first 4 weeks of treatment. These were followed by progressive declines during prolonged therapy. Sustained decreases in beta 2-microglobulin, neopterin, and p24 antigen levels were seen over the 52-week study. There was no consistent dose-response correlation for any surrogate marker. Penetration of 3TC into cerebrospinal fluid (CSF) was in the same range as reported for ddC and ddI; the mean CSF-to-serum ratio was 0.06. These findings indicate that 3TC exhibits an excellent safety profile and has antiretroviral activity at the dosages studied.

Adult↗
PubMed1995

Chemotherapy combined with zidovudine and GM-CSF in human immunodeficiency virus-related non-Hodgkin's lymphoma.

OBJECTIVE: The treatment of patients with non-Hodgkin's lymphoma related to the human immunodeficiency virus (HIV-NHL) is complicated by the underlying acquired immunodeficiency syndrome (AIDS). Patients without adverse prognostic factors (no AIDS prior to lymphoma, CD4+ lymphocyte counts greater than 100 x 10(6)/l and good performance status) can be cured of lymphoma and experience long-term survival. Our previous study with the intensive chemotherapy LNH84 regimen yielded a 63% complete response (CR) rate but median survival was only nine months, half of the patients died of AIDS and the other half of their lymphoma. We report here the results of a phase II study combining the same chemotherapy with zidovudine and GM-CSF. Our goal was to improve the treatment outcome over that of our previous study; GM-CSF was expected to decrease the hematological toxicity of chemotherapy and thus permit a dose intensity increase, while zidovudine was supposed to slow down the evolution of AIDS. DESIGN AND SETTING: A phase II non-randomized prospective clinical trial in 7 centres. PATIENTS AND METHODS: Thirty-two consecutive adult patients presenting HIV-NHL and performance status of less than three without active opportunistic infection underwent three cycles of doxorubicin 75 mg/m2, cyclophosphamide 1,200 mg/m2, vindesine 2 mg/m2 for two days, bleomycin 10 mg for two days and prednisolone 60 mg/m2 for five days (ACVB). Chemotherapy was associated with zidovudine (5 mg/kg/d) and GM-CSF (5 mu g/kg/d). The induction phase was followed by a four-month consolidation phase. RESULTS: CR and PR > 75% were observed in 56% of patients; 25% of the patients died during the induction phase. These results were analogous to those of the previous study (63% and 14%, respectively). Neither hematological tolerance nor dose intensity were improved. With a mean follow-up of 23.5 months, median survival was 6.7 months. The rate of non-NHL AIDS-related death during CR was not reduced (22% in our study vs. 16% in our previous one). CONCLUSIONS: GM-CSF failed to reduce significantly the cumulative hematological toxicity of chemotherapy and zidovudine. New antiviral agents without hematological toxicity would perhaps be useful in this setting.

Adolescent↗
PubMed1993

[Occupational arm ailments in musicians].

We began our specific interest in this subject in 1975 and to date have seen and treated over 600 musicians with functional problems of the upper limb. These are common problems affecting over one third of instrumental musicians. Every instrument may have its own specific repercussions. However certain factors may influence their onset: intensive practice; a technique requiring non-physiological positioning; a change in technique, instrument or habits; pre-existing trauma; psychological predisposition; inappropriate physique. The presentations are varied and the limits imprecise. Muscles, tendons, joints and nerves may be involved. The commonest, and easiest to cure are due to pain resulting from overuse syndromes cover a multitude of sins resulting from marked physical effort in excess of the normal physiological capacity of the body. Joint instability and degenerative disease pose their own specific problems. Peripheral nerve lesions can be related to overuse syndromes or to the adoption of non-physiological or harmful positions. The most difficult problems to deal with are those related to a loss of motor control when performing the same repetitive movement--functional dystonia. Their origin remains obscure with the major discussion revolving around either a neurological or organic aetiology. Our intensive experience of instrumentalists with these problems secondary to bad positioning or posture, has led us to propose a therapeutic regime based on structured re-education and relaxation. The great majority of sufferers overuse syndromes or functional dystonias have been able to resume their professional activities. It is clear that functional dystonias are curable if treatment is instituted early and that the lesions are not too long standing.

Arm Injuries↗
PubMed1991

Palmar subluxation of the carpus in rheumatoid disease: a radiological evaluation.

The authors present a radiological assessment of palmar subluxation of the carpus in rheumatoid disease. The radiological measurements have been taken with reference to the long axis of the radius, the radiological centres of the lunate and the capitate and expressing their reciprocal distances as a ratio which we have termed the radio-carpal and inter-carpal indices. Using a control group of a 100 serial radiographs of normal wrists it was possible to determine the normal indices and their normal range. A subsequent analysis of 100 rheumatoid wrists enabled them to accurately determine the degree of anterior carpal subluxation, and allowed this form of radio-carpal malalignment to be differentiated from other forms of carpal instability.

Adult↗
PubMed1991

[Development of the techniques of tendon transfers for radial paralysis].

The techniques of tendon transfer for radial palsy are continually evolving. The technique of R. Merle d'Aubigné partly inspired by that of Robert Jones clearly represented an advance, but a study of the results has shown several imperfections. The techniques of Brand, Tsuge, or Boyes more recently, have also brought improvements, but are not entirely satisfactory. A study of all the elements of tendon transfers schemes leads us to describe two basic schemes for tendon transfers either using F.C.U. or not, which can be adapted to the patient's particular needs. The essential point for success is the centralization of extensor carpi radialis longus at its insertion.

Hand↗
PubMed1990

Technique of dorsal synovectomy on the rheumatoid wrist.

Synovectomy is the basic operation on the rheumatoid wrist. Dorsal synovectomy of the wrist is never performed in isolation. It is always combined with extensor tenosynovectomy, synovectomy of the distal radio-ulnar joint, and surgical stabilization of the wrist. Early wrist synovectomy is ideally performed when the disease is largely confined to the soft tissues and where the overall alignment of the wrist is preserved. Careful reconstruction of the soft tissues following synovectomy is paramount in maintaining or restoring wrist stability. The satisfactory long term results of early wrist synovectomy have encouraged an expansion of the indications particularly to include the more advanced cases. In such cases additional bony surgery can be combined with the synovectomy to allow the realignment and stabilization of the wrist, so avoiding, in the majority of cases, the need for arthroplasty or wrist fusion.

Arthritis, Rheumatoid↗
PubMed1990

Carpal tunnel syndrome: some views on its management.

Despite its high incidence and its reputation for simplicity and efficacy, carpal tunnel release does not invariably produce good results and dissatisfied patients are not infrequently encountered. Unsatisfactory results are due to inaccurate diagnosis and, all too frequently, iatrogenic surgical complications. Surgical technique plays an important role in the achievement of good quality results. Various technical points are controversial and are here discussed: the incision, the division of the retinaculum, neurolysis, repair of the transverse carpal ligament and postoperative management. Our views on the management of recurrence, postoperative sequelae and complications are outlined.

Aged↗
PubMed1989

Restoration of wrist extension after paralysis.

Loss of active extension of the wrist is a major functional handicap for the affected patient. Restoration of wrist extension, primarily accomplished via tendon transfers, is a fundamental part of surgical treatment after paralysis. The anatomy and physiology of the wrist, the clinical aspects, the history, and restorative treatment of wrist extension after paralysis are discussed.

Humans↗
PubMed1989

[Repair of cutaneous tissue loss of the arm. Development of the principles and technics].

Few sectors of reconstructive surgery have evolved as quickly over the past few years as the use of skin flaps, especially those used to cover losses of substance in the upper limb. This development is due to the increasing concern of surgeons about: 1) ensuring selective coverage of higher quality (the teguments used for the hand must be supple, thin and sensitive); 2) having reliable techniques; 3) reducing operating times and the duration of treatment.

Arm↗
PubMed1988

Functional classification of the upper limb paralyses.

There are many classifications for paralyses of the upper limbs. In this article, the authors present a classification system which may be useful for the surgeon when analyzing the indications for reconstructive surgery. This classification system correlates the functional deficits that exist with nerve lesions at different levels, and thus helps the surgeon to establish a list of the deficits and of the functions to be restored. This functional balance should be used as a guide for surgical rehabilitation.

Arm↗