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Grave A, Blanc J, De Bari B, Pernot M, Boulbair F, Noirclerc M, Vienot A, Kim S, Borg C, Boustani J. Long-Term Disease Control After locoregional Pelvic Chemoradiation in Patients with Advanced Anal Squamous Cell Carcinoma. Front Oncol 2022; 12:918271. [PMID: 35936677 PMCID: PMC9354951 DOI: 10.3389/fonc.2022.918271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The incidence of metastatic squamous cell carcinoma of the anus (SCCA) is increasing. Even if systemic docetaxel, cisplatin, and 5-Fluorouracil (DCF) provide a high rate of long-term remission, the role of pelvic chemoradiation (CRT) is unknown in this setting. We reported the safety and efficacy of local CRT in patients with synchronous metastatic SCCA who achieved objective response after upfront DCF. Methods Patients included in Epitopes HPV01 or Epitopes HPV02 or SCARCE trials and treated with DCF followed by pelvic CRT were included. Concurrent chemotherapy was based on mitomycin (MMC) (10 mg/m² for two cycles) and fluoropyrimidine (capecitabine 825 mg/m² twice a day at each RT treatment day or two cycles of intra-venous 5FU 1000 mg/m² from day 1 to day 4). Primary endpoints were safety, local complete response rate, and local progression-free survival (PFS). Secondary endpoints were PFS, overall survival (OS), and metastasis-free survival (MFS). Results From 2013 to 2018, 16 patients received DCF followed by a complementary pelvic CRT for advanced SCCA. Median follow-up was 42 months [range, 11-71]. All patients received the complete radiation dose. Compliance to concurrent CT was poor. Overall, 13/15 of the patients (87%) had at least one grade 1-2 acute toxicity and 11/15 of the patients (73%) had at least one grade 3-4 toxicity. There was no treatment-related death. The most frequent grade 3-4 adverse effects were neutropenia (36%), dermatitis (40%), and anitis (47%). Eleven patients (73%) had at least one chronic grade 1 or 2 toxicity. One patient had a grade 4 chronic rectitis (7%). Complete local response rate was 81% at first evaluation and 62.5% at the end of the follow-up. Median local PFS was not reached and the 3-year local PFS was 77% (95%CI 76.8-77). Conclusions In patients with metastatic SCCA who had a significant objective response after upfront DCF, local CRT was feasible with high complete local response rate. The good local control rate, despite interruptions due to toxicities and low CT compliance, underline the role of pelvic RT. The high rate of toxicity prompts the need to adapt CRT regimen in the metastatic setting.
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Affiliation(s)
- Athénaïs Grave
- Department of Radiation Oncology, University Hospital of Besançon, Besançon, France
| | - Julie Blanc
- Department of Statistics, Centre Georges François Leclerc, Dijon, France
| | - Berardino De Bari
- Department of Radiation Oncology, Réseau hospitalier neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Mandy Pernot
- Department of Radiation Oncology, University Hospital of Besançon, Besançon, France
| | - Fatiha Boulbair
- Department of Radiation Oncology, Nord Franche-Comté Hospital, Montbéliard, France
| | - Monique Noirclerc
- Department of Radiation Oncology, Hasenrain Hospital, Mulhouse, France
| | - Angélique Vienot
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Jihane Boustani
- Department of Radiation Oncology, University Hospital of Besançon, Besançon, France
- *Correspondence: Jihane Boustani,
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Boustani J, Grave A, De Bari B, Mandy P, Boulbair F, Benhmida S, Noirclerc M, Monasterolo P, Kim S, Borg C. PO-1320 Pelvic chemoradiation after chemotherapy in patients with advanced anal squamous cell carcinoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Caron B, Reimund JM, Ben Abdelghani M, Sondag D, Noirclerc M, Duclos B, Kurtz JE, Nguimpi-Tambou M. Survival and Predictive Factors of Chemotherapy With FOLFIRINOX as First-Line Therapy in Metastatic Pancreatic Cancer: A Retrospective Multicentric Analysis. Pancreas 2021; 50:803-806. [PMID: 34347737 DOI: 10.1097/mpa.0000000000001837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The use of FOLFIRINOX (a combination of oxaliplatin, irinotecan, fluorouracil, and leucovorin) is one of the therapeutic standards in pancreatic adenocarcinoma. We analyzed progression-free survival (PFS) and overall survival (OS) and their predictive factors in patients treated with FOLFIRINOX as first-line therapy in metastatic pancreatic cancer. METHODS This multicenter retrospective analysis included patients treated with FOLFIRINOX between 2011 and 2015. The Kaplan-Meier method was used to estimate OS and PFS. The statistical comparison for survival was performed by the log-rank test. Predictive factors were estimated in multivariate analysis with the use of a Cox model. RESULTS One hundred and thirty-six patients were included (74 men, 62 women; median age, 62 years [range, 29-74 years]). The median PFS was 5.97 months (95% confidence interval, 4.4-6.63 months). The median OS was 8.93 months (95% confidence interval, 7.4-10.07 months). Prognostic factors in multivariate analysis were the use of granulocyte colony-stimulating factor, which appeared to be a good prognostic factor. Dose intensity of oxaliplatin (≥74.48%) and dose intensity of bolus of fluorouracil (>6.9%) appeared as pejorative factors. CONCLUSIONS In patients with metastatic pancreatic adenocarcinoma treated with FOLFIRINOX in first line, dose modifications at the onset of adverse effects and early use of granulocyte-colony stimulating factor seem to be associated with a better survival.
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Affiliation(s)
| | | | | | - Daniel Sondag
- Department of Gastroenterology, Emile Muller Hospital, Mulhouse
| | | | - Bernard Duclos
- From the Department of Gastroenterology, Hautepierre Hospital, Strasbourg, France
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Ohnleiter T, Piot L, Rogenmuser A, Noirclerc M, Hamlaoui R, Grandgirard A. [Management of a radiotherapy center during the COVID-19 outbreak: The experience of the Mulhouse hospital centre (France)]. Cancer Radiother 2020; 24:188-193. [PMID: 32334905 PMCID: PMC7164904 DOI: 10.1016/j.canrad.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022]
Abstract
L’épidémie de COVID-19 continue de croître de manière exponentielle dans notre pays. Si la majorité des formes sont bénignes, les patients atteints de cancer sont à risque de voir se développer une forme grave de la maladie. Les services de radiothérapie sont un lieu à potentiel de contamination en raison du nombre de patients traités et de personnels présents. Leur organisation pendant la période épidémique vise à assurer la continuité des soins tout en limitant le risque de décès dû à une contamination par le SARS-CoV-2 (virus responsable de la COVID-19). Dans le service de radiothérapie du groupe hospitalier de la région de Mulhouse et Sud-Alsace, cette organisation s’articule en cinq points : la protection des personnels médicaux et paramédicaux, la protection des patients en cours de traitement, la détection des patients suspects d’être atteints de COVID-19 et leur prise en charge, la réorganisation du circuit patient et les mesures concernant l’organisation du système qualité du service. Nos pistes de réflexion, débutée dès le début de l’épidémie dans notre département, nous permettent de préserver au maximum l’accès aux soins radiothérapiques en anticipant le risque de diffusion du virus. Grâce à des réunions bihebdomadaires, nous continuons à nous adapter à l’évolution épidémique dans notre service, en tenant compte de nos moyens matériels. La possibilité de réaliser des tests de diagnostic chez tous les patients suspects nous permettrait également d’affiner nos procédures.
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Affiliation(s)
- T Ohnleiter
- Service de radiothérapie, hôpital Émile-Muller, 20, avenue du Dr-René-Laennec, 68100 Mulhouse, France.
| | - L Piot
- Unité de physique médicale, hôpital Émile-Muller, 20, avenue du Dr-René-Laennec, 68100 Mulhouse, France
| | - A Rogenmuser
- Centre de coordination en cancérologie, hôpital Émile-Muller, 20, avenue du Dr-René-Laennec, 68100 Mulhouse, France
| | - M Noirclerc
- Service de radiothérapie, hôpital Émile-Muller, 20, avenue du Dr-René-Laennec, 68100 Mulhouse, France
| | - R Hamlaoui
- Service de radiothérapie, hôpital Émile-Muller, 20, avenue du Dr-René-Laennec, 68100 Mulhouse, France
| | - A Grandgirard
- Service de radiothérapie, hôpital Émile-Muller, 20, avenue du Dr-René-Laennec, 68100 Mulhouse, France
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Epailly E, Mattei M, Sebbag L, Kamar N, Guillemain R, Noirclerc M, Lelong B, Pattier S, Redonnet M, Sirinelli A. CNI Free Immunosuppression in Heart Transplant Patients Treated With Everolimus: Results of a Multicenter French Registry. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Dupuis O, Vie B, Lledo G, Hennequin C, Noirclerc M, Bennamoun M, Jacob JH. Preoperative treatment combining capecitabine with radiation therapy in rectal cancer: a GERCOR Phase II Study. Oncology 2008; 73:169-76. [PMID: 18418009 DOI: 10.1159/000127383] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 09/04/2007] [Indexed: 12/28/2022]
Abstract
OBJECTIVE(S) To assess efficacy and tolerability of preoperative capecitabine chemoradiation in rectal cancer. METHODS Patients received radiotherapy 45 Gy in 25 fractions over 5 weeks and capecitabine 825 mg/m(2) twice daily throughout radiotherapy. Surgery was performed 5-7 weeks after radiotherapy. The primary endpoint was pathological complete response, secondary endpoints were downstaging and tolerability. RESULTS Fifty-one patients were enrolled in a phase II study, median age 62 years (range 35-78). Sixty-three percent of tumours involved the lower third of the rectum, 45% were fixed. The median delivered radiotherapy dose was 44.8 Gy (range 39.6-45.0 Gy) over 33-49 days. The treatment-related grade 3 adverse events were diarrhoea (12%), skin reactions (8%) and asthenia (8%), with no grade 4 toxicity. Fifty patients underwent surgery (29 conservative) and 1 patient refused. The pathological complete response rate was 20% and a further 10% of patients had minimal residual disease. Additional tumour downstaging was seen in 28% of patients and the sphincter preservation rate was 58%. CONCLUSIONS Preoperative capecitabine chemoradiation is well tolerated and its efficacy supports further exploration, both as a single agent and as part of new therapeutic strategies.
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Abstract
We report an unusual case of primary cardiac epithelioid hemangioendothelioma (EHE) with atypical features, which was treated by orthoptic transplantation with a good outcome for 10 years despite recurrent pulmonary and nodal metastases. EHE is a rare vascular tumor that belongs to the group of malignant proliferations from the new World Health Organization classification of soft tissue tumors. EHE may harbor atypical features that confer a more aggressive course, albeit better than that of conventional angiosarcomas. Histological examination of the primary cardiac tumor revealed a proliferation of large epithelioid tumor cells presenting atypical features and a mitotic index of 3 mitoses per 10 high power fields. In contrast, pulmonary metastases exhibited typical features of EHE, and CD 34 and CD 31 immunostainings strongly stained cytoplasmic vascular lumen. In this report, we illustrate the potential aggressiveness of the atypical variant of EHE and suggest that transplantation might be considered as an alternative therapy in the treatment of EHE of the heart.
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Affiliation(s)
- N Moulai
- Department of Pathology, Grenoble, France
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Moulai N, Chavanon O, Guillou L, Noirclerc M, Blin D, Brambilla E, Lantuejoul S. Atypical primary epithelioid hemangioendothelioma of the heart. J Thorac Oncol 2006; 1:188-9. [PMID: 17409853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report an unusual case of primary cardiac epithelioid hemangioendothelioma (EHE) with atypical features, which was treated by orthoptic transplantation with a good outcome for 10 years despite recurrent pulmonary and nodal metastases. EHE is a rare vascular tumor that belongs to the group of malignant proliferations from the new World Health Organization classification of soft tissue tumors. EHE may harbor atypical features that confer a more aggressive course, albeit better than that of conventional angiosarcomas. Histological examination of the primary cardiac tumor revealed a proliferation of large epithelioid tumor cells presenting atypical features and a mitotic index of 3 mitoses per 10 high power fields. In contrast, pulmonary metastases exhibited typical features of EHE, and CD 34 and CD 31 immunostainings strongly stained cytoplasmic vascular lumen. In this report, we illustrate the potential aggressiveness of the atypical variant of EHE and suggest that transplantation might be considered as an alternative therapy in the treatment of EHE of the heart.
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Affiliation(s)
- N Moulai
- Department of Pathology, Grenoble, France
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André T, Noirclerc M, Hammel P, Meckenstock R, Landi B, Cattan S, Selle F, Codoul JF, Guerrier-Parmentier B, Mokhtar R, Louvet C. Phase II study of leucovorin, 5-fluorouracil and gemcitabine for locally advanced and metastatic pancreatic cancer (FOLFUGEM 2). ACTA ACUST UNITED AC 2004; 28:645-50. [PMID: 15646530 DOI: 10.1016/s0399-8320(04)95042-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM FOLFUGEM 1 (leucovorin 400 mg/m2 combined with 5-flurorouracil (FU) bolus 400 mg/m2 then 5-FU 2-3 g/m2/46 hours and gemcitabine 1000 mg/m2 in 30 min) in patients with locally-advanced and metastatic pancreatic adenocarcinoma appeared to be toxic (neutropenia and alopecia). The aims of this phase II multicentric study were to evaluate the response rate, clinical benefit and tolerance of a new scheme of combined leucovorin, 5-FU and gemcitabine (FOLFUGEM 2). PATIENTS AND METHODS FOLFUGEM 2 associated leucovorin 400 mg/m2 in 2 hours followed by 5-FU 1000 mg/m2 in 22 hours, then gemcitabine 800 mg/m2 (10 mg/m2/min) with cycles every 14 days. Gemcitabine dose could be increased (1000 then 1250 mg/m2) when NCI/CTC toxicity was < or = grade 2. RESULTS Fifty-eight patients were included (locally-advanced tumor: N = 13 and metastatic: N = 45). Among the 39 patients with measurable disease, 11 had partial response (28.2%, 95% confidence interval: 14-42%) and 11 had stable disease (28.2%). On an intent-to-treat analysis, the objective response rate was 19% (95% confidence interval: 9-29%). Clinical benefit rate was 46%. Median progression-free survival and median overall survival were 3.1 and 7.2 months, respectively. There were 13% grade 3-4 neutropenia and 36% complete alopecia. CONCLUSION FOLFUGEM 2 schema has an antitumoral effect in advanced pancreatic cancer and has an acceptable toxicity which appears to be less than that of FOLFUGEM 1.
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Dupuis O, Vié B, Lledo G, Hennequin C, Noirclerc M, Bennamoun M, Pavlovitch JM, Jacob JH. Capecitabine (X) chemoradiation (CRT) in the preoperative treatment of patients (pts) with rectal adenocarcinomas: A phase II GERCOR trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- O. Dupuis
- Clinique Victor Hugo, Le Mans, France; Centre F. Baclesse, Caen, France; Clinique St Jean, Lyon, France; Hopital St Louis, Paris, France; Centre Hospitalier, Mulhouse, France; Hopital Le Raincy, Montfermeil, France
| | - B. Vié
- Clinique Victor Hugo, Le Mans, France; Centre F. Baclesse, Caen, France; Clinique St Jean, Lyon, France; Hopital St Louis, Paris, France; Centre Hospitalier, Mulhouse, France; Hopital Le Raincy, Montfermeil, France
| | - G. Lledo
- Clinique Victor Hugo, Le Mans, France; Centre F. Baclesse, Caen, France; Clinique St Jean, Lyon, France; Hopital St Louis, Paris, France; Centre Hospitalier, Mulhouse, France; Hopital Le Raincy, Montfermeil, France
| | - C. Hennequin
- Clinique Victor Hugo, Le Mans, France; Centre F. Baclesse, Caen, France; Clinique St Jean, Lyon, France; Hopital St Louis, Paris, France; Centre Hospitalier, Mulhouse, France; Hopital Le Raincy, Montfermeil, France
| | - M. Noirclerc
- Clinique Victor Hugo, Le Mans, France; Centre F. Baclesse, Caen, France; Clinique St Jean, Lyon, France; Hopital St Louis, Paris, France; Centre Hospitalier, Mulhouse, France; Hopital Le Raincy, Montfermeil, France
| | - M. Bennamoun
- Clinique Victor Hugo, Le Mans, France; Centre F. Baclesse, Caen, France; Clinique St Jean, Lyon, France; Hopital St Louis, Paris, France; Centre Hospitalier, Mulhouse, France; Hopital Le Raincy, Montfermeil, France
| | - J. M. Pavlovitch
- Clinique Victor Hugo, Le Mans, France; Centre F. Baclesse, Caen, France; Clinique St Jean, Lyon, France; Hopital St Louis, Paris, France; Centre Hospitalier, Mulhouse, France; Hopital Le Raincy, Montfermeil, France
| | - J. H. Jacob
- Clinique Victor Hugo, Le Mans, France; Centre F. Baclesse, Caen, France; Clinique St Jean, Lyon, France; Hopital St Louis, Paris, France; Centre Hospitalier, Mulhouse, France; Hopital Le Raincy, Montfermeil, France
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Chavanon O, Durand M, Romain-Sorin V, Noirclerc M, Cracowski JL, Protar D, Abdennadher M, Blin D. [Does the time between preoperative interruption of aspirin intake and operation influence postoperative blood loss and transfusion requirement in coronary artery bypass graft?]. Ann Fr Anesth Reanim 2002; 21:458-63. [PMID: 12134590 DOI: 10.1016/s0750-7658(02)00656-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Impact of the interval between interruption of aspirin intake and surgery on postoperative bleeding and transfusion in coronary artery bypass graft (CABG), with extracorporeal circulation (ECC). STUDY DESIGN Retrospective study. PATIENTS AND METHODS Four hundred and twelve patients having undergone CABG were retrospectively reviewed. Three groups were evaluated according to the length of the interval defined above: Group I (< 3 days), Group II (3-7 days), Group III (> 7 days or without aspirin intake). Postoperative blood loss at 3rd, 6th, 12th, and 24th hour and transfusion requirements were assessed for the 3 groups. Aprotinin (low dose, 2 M KIU) was systematically included in the priming of the ECC circuit. RESULTS There were no significant differences among groups for weight, size, duration of ECC, and number of bypasses. No significant correlation was noted among the 3 groups for postoperative blood loss and transfusion. Multivariate analysis showed that factors associated to a higher risk of excessive bleeding were ECC duration and number of arterial grafts. Factors associated with a higher risk of transfusion were: emergency, minimum patient temperature during ECC, weight and preoperative haemoglobin level. Aspirine intake was not associated with an increase of bleeding or transfusion. CONCLUSION Our study showed that in our practice using systematic low dose of aprotinin when priming the ECC circuit, aspirin did not significantly increase bleeding or transfusion requirements in CABG with ECC, whatever the interval between interruption of aspirin intake and surgery. Consequently, in our practice, aspirin intake is interrupted on hospitalisation, one day before surgery.
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Affiliation(s)
- O Chavanon
- Service de chirurgie cardiaque, CHU Grenoble, 38043 Grenoble, France.
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Baguet JP, Mallion JM, Moreau-Gaudry A, Noirclerc M, Péoc'h M, Siché JP. Relationships between cardiovascular remodelling and the pulse pressure in never treated hypertension. J Hum Hypertens 2000; 14:23-30. [PMID: 10673727 DOI: 10.1038/sj.jhh.1000933] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of pulse pressure (PP) in cardiovascular remodelling was studied in 61 never treated hypertensive subjects who were selected on the criteria of ambulatory blood pressure (BP) monitoring (mean BP over 24 h: 147 +/- 14/96 +/- 10 mm Hg). Echocardiography and carotid ultrasonography were performed and the vascular images analysed using a specific automatic measuring program. Thirty percent of subjects had left ventricular hypertrophy (LVH). Left ventricular mass index (LVMI) was related to the clinic (r = 0.35) and ambulatory (r = 0.41 over 24 h, r = 0.38 daytime and r = 0.42 night-time) PP and to the systolic BP. PP was higher when there was LVH. Vascular thickening was found in 6.6% of subjects (carotid intima-media thickness (IMT) >/=1.0 mm). Among the BP parameters, IMT and cross-sectional area (CSA) were related only to the clinic PP (r = 0.27, r = 0.29 respectively) and to the ambulatory PP (over 24 h: r= 0.29, r = 0.28; daytime: r = 0.22, r = 0.23; night-time: r = 0.32, r = 0.30). In men, the relationship between CSA and PP (clinic and over 24 h) was independent of age. A total of 16.7% of subjects with LVH had intima-media thickening in contrast to 2.3% in the group without LVH. LVMI was related to the CSA (r = 0.37) and to the IMT (r = 0.31). However, after multivariate analysis taking into account the PP, relationships between IMT or CSA and LVMI disappeared. Our data showed that the PP was the most important BP parameter in the development of cardiac and arterial remodelling in hypertension. Journal of Human Hypertension (2000) 14, 23-30.
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Affiliation(s)
- J P Baguet
- Department of Cardiology and Internal Medicine, Grenoble University Hospital, France
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Baguet J, Mallion J, Moreau-Gaudry A, Noirclerc M, Péoc’h M, Siché J. Relación entre el remodelado cardiovascular y la presión de pulso en hipertensos no tratados. Hipertensión y Riesgo Vascular 2000. [DOI: 10.1016/s1889-1837(00)71089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Benchalal M, Salze P, Bombaron P, Bourderont D, Neidhardt AC, Maitre AM, Pignol JP, Lambert J, Baumann J, Sizaret O, Newinger G, Noirclerc M, Sabountchi M, Zipper JM, Prevot G. [Concurrent split-course chemotherapy and radiotherapy for unresectable stage III non-small cell lung cancer: preliminary results of a Phase II study]. Cancer Radiother 1999; 3:453-60. [PMID: 10630157 DOI: 10.1016/s1278-3218(00)88251-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE We initiated at Hospital de Mulhouse a prospective phase II study to assess a split-course concurrent radiochemotherapy in locally advanced non-small cell lung cancer. MATERIALS AND METHODS From March 1996 to December 1997, 28 patients were included in our study. All patients had a stage III cancer. The chemotherapy scheduled included vinorelbine (20 mg/m2/d, d1 and d5), cisplatin (20 mg/m2/d, from d1 to d5), and 5-Fluorouracil (350 mg/m2/d, from d1 to d5 by continuous infusion). The planned irradiation dose was 12.5 Gy per week with one daily fraction of 2.5 Gy from d1 to d5. Cycles were repeated every four weeks, for four cycles (50 Gy). Patients with a partial or complete response were proposed a fifth cycle. RESULTS Of the 28 patients of the study, only 27 were analysed; one patient had a metastatic disease at diagnosis. Major hematologic toxicity occurred in 26% of the patients. One to five cycles of chemoradiotherapy were administrated per patient (median: four). Four patients had received fewer than three cycles and their responses were not assessable. Of the 23 patients assessed, 12 responses (52%) were observed, three CR (13%) and nine PR (39%). Median follow-up was 14 months, and median survival 13.5 months. One- and two-year survival rates were respectively 63% and 14%. Local control rates was 11%, and 44% of the patients had a metastatic evolution. CONCLUSION Very preliminary results of this phase II study are disappointing, and quite inferior to the published results using chemoradiotherapy with conventional or hyperfractionated radiotherapy. Hematologic toxicity is restrictive. This type of chemoradiotherapy cannot be recommended.
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Affiliation(s)
- M Benchalal
- Service d'oncoradiothérapie de Mulhouse, hôpital du Hasenrain, France
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Chavanon O, Barbe C, Troccaz J, Carrat L, Ribuot C, Noirclerc M, Maitrasse B, Blin D. Accurate guidance for percutaneous access to a specific target in soft tissues: preclinical study of computer-assisted pericardiocentesis. J Laparoendosc Adv Surg Tech A 1999; 9:259-66. [PMID: 10414543 DOI: 10.1089/lap.1999.9.259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the field of percutaneous access to soft tissues, our project was to improve classical pericardiocentesis by performing accurate guidance to a selected target, according to a model of the pericardial effusion acquired through three-dimensional (3D) data recording. Required hardware is an echocardiographic device and a needle, both linked to a 3D localizer, and a computer. After acquiring echographic data, a modeling procedure allows definition of the optimal puncture strategy, taking into consideration the mobility of the heart, by determining a stable region, whatever the period of the cardiac cycle. A passive guidance system is then used to reach the planned target accurately, generally a site in the middle of the stable region. After validation on a dynamic phantom and a feasibility study in dogs, an accuracy and reliability analysis protocol was realized on pigs with experimental pericardial effusion. Ten consecutive successful punctures using various trajectories were performed on eight pigs. Nonbloody liquid was collected from pericardial effusions in the stable region (5 to 9 mm wide) within 10 to 15 minutes from echographic acquisition to drainage. Accuracy of at least 2.5 mm was demonstrated. This study demonstrates the feasibility of computer-assisted pericardiocentesis. Beyond the simple improvement of the current technique, this method could be a new way to reach the heart or a new tool for percutaneous access and image-guided puncture of soft tissues. Further investigation will be necessary before routine human application.
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Affiliation(s)
- O Chavanon
- Department of Cardiac Surgery, Grenoble University Hospital, Grenoble, France.
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16
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Abstract
BACKGROUND Mobilization of the gastroepiploic artery (GEA) often results in a vasospasm with reduction of early graft flow. In order to prevent or suppress this highly reactive artery's spasm, we have compared the effect of 4 vasodilators, used in external application to prepare the GEA graft, prior to myocardial revascularization. METHODS WE performed a double-blind clinical study to compare the effects of external application of vasodilators on gastroepiploic artery grafts. Fifty patients, whose gastroepiploic artery was used for coronary artery bypass grafting, were randomized into 5 groups of 10 patients. Gastroepiploic artery free flow and hemodynamic measurements were evaluated immediately after harvesting, before any pharmacological manipulation, and 10 minutes after the topical application of vasodilators, respectively: papaverine, linsidomine, nicardipine, glyceryl trinitrate, and normal saline solution. RESULTS A significant increase in free flow occurred in all groups except for the normal saline solution group with measurements from 26.1+/-3.6 mL/min to 26.4+/-6.5 mL/min; p = 0.9. The most important increase in flow before and after local application occurred with glyceryl trinitrate and papaverine: from 25.5+/-2 mL/min to 50+/-6.1 mL/min (p < or = 0.01) and from 36.8+/-3.2 mL/min to 62+/-7.8 mL/min (p < 0.01) respectively. Nicardipine and linsidomine produced a less significant increase in flow: from 33.1+/-3.6 mL/min to 47.7+/-8.9 mL/min (p < 0.05) and from 28+/-3.8 mL/min to 39.8+/-7.5 mL/min (p < 0.05) respectively. When comparing percentage of flow increase, glyceryl trinitrate appeared to be significantly more efficient than nicardipine and linsidomine (p < 0.01 versus both groups). Although papaverine was more efficient than nicardipine and linsidomine, it did not reach statistical significance. CONCLUSIONS During intraoperative preparation of the GEA graft, glyceryl trinitrate and papaverine to a lesser extent, used as topical vasodilators, appear to be more efficient in external application to increase the free flow of the GEA.
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Affiliation(s)
- O Chavanon
- Department of Cardiac Surgery, Grenoble University Hospital, France
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17
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Noirclerc M, Chavanon O, Borrel E, Bertrand B, Labat F, Broin P, Néron L, Hadjian O, Perez I, Blin D. [Primary cardiac sarcoma treated by orthoptic cardiac transplantation. Apropos of a case]. Arch Mal Coeur Vaiss 1997; 90:1539-43. [PMID: 9539829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors report a new case of cardiac sarcoma treated by cardiac transplantation. This treatment has been proposed for these malignant tumours of poor prognosis when simple excision is impossible, with variable results. This patient is in good general condition 20 months after transplantation. Transplantation is a therapeutic procedure which should be considered in malignant tumours limited to the heart.
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Affiliation(s)
- M Noirclerc
- Service de chirurgie cardiaque, CHRU Grenoble
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18
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Monti G, Magnan A, Fattal M, Rain B, Humbert M, Mege JL, Noirclerc M, Dartevelle P, Cerrina J, Simonneau G, Galanaud P, Emilie D. Intrapulmonary production of RANTES during rejection and CMV pneumonitis after lung transplantation. Transplantation 1996; 61:1757-62. [PMID: 8685956 DOI: 10.1097/00007890-199606270-00016] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
RANTES (regulated upon activation, normally T expressed and secreted) is a chemoattractant for macrophages, memory T lymphocytes, and eosinophils. We investigated whether intrapulmonary production of the chemokine RANTES contributes to the recruitment of immune cells during lung transplantation complications. RANTES concentration was measured in bronchoalveolar lavage (BAL) fluids using an ELISA assay. It was significantly higher during CMV pneumonitis (36.2 +/- l6 pg/ml, n=12, P=0.031) and allograft rejection (31.1 +/- 8.5 pg/ml, n=27, P=0.013) than in patients without complications (9.1 +/- 2.3 pg/ml, n=22). At least some of the RANTES was produced by lung macrophages: BAL macrophages cultured for 24 hr spontaneously released larger amount of RANTES during CMV pneumonitis (140 +/- 53 pg/ml, n=8, P=0.002) and allograft rejection (84 +/- 44 pg/ml, n=11, P=0.037) than in control patients (15.2 +/- 6.5 pg/ml, n=21). Moreover, macrophages in transbronchial biopsies were labeled by an anti-RANTES mAb. RANTES production by BAL macrophages was followed in 2 patients with CMV pneumonitis. It remained high as long as CMV-induced cytopathic effects or clinical symptoms were present, but it returned to baseline as the infection was controlled. These results suggest that the intrapulmonary production of the chemokine RANTES by activated macrophages contributes to the intrapulmonary accumulation of immune cells during complications of lung transplantation.
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Affiliation(s)
- G Monti
- INSERM U131, Institute Paris Sud sur les Cytokines, France
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19
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Hannoun-Levi JM, Rosello R, Simonian M, Cowen D, Noirclerc M, Alzieu C, Giovannini M, Resbeut M. 187 Endorectal ultrasonography in the treatement of anal canal carcinoma by interstitial brachytherapy. Radiother Oncol 1996. [DOI: 10.1016/0167-8140(96)87987-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Magnan A, Mege JL, Escallier JC, Brisse J, Capo C, Reynaud M, Thomas P, Meric B, Garbe L, Badier M, Viard L, Bongrand P, Giudicelli R, Metras D, Fuentes P, Vervloet D, Noirclerc M. Balance between alveolar macrophage IL-6 and TGF-beta in lung-transplant recipients. Marseille and Montréal Lung Transplantation Group. Am J Respir Crit Care Med 1996; 153:1431-6. [PMID: 8616577 DOI: 10.1164/ajrccm.153.4.8616577] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Acute inflammation in the lung is characterized by a phase of tissue injury followed by a phase of tissue repair. When the latter is excessive, fibrosis occurs. Alveolar macrophages (AM) can produce cytokines involved in both phases of acute lung inflammation, notably interleukin-6 (IL-6), involved in injury and transforming growth factor-beta (TGF-beta), mediating repair. We hypothesized that AM were activated in both phases, and studied IL-6 and TGF-beta production by AM during complications of lung transplantation, acute rejection (AR), and cytomegalovirus pneumonitis (CMVP). In addition, we analyzed these cytokines in bronchiolitis obliterans (BO), a fibrotic complication of lung transplantation linked to previous AR and CMVP. At the onset of AR and CMVP, IL-6 secretion increased, whereas AM TGF-beta content was increased, but not its secretion. In contrast, with time, IL-6 reached control value whereas TGF-beta secretion rose significantly. In BO, IL-6 was not oversecreted, but TGF-beta increased, notably before functional abnormalities occurred. These results show that during acute complications of lung transplantation, AM display an early activation with oversecretion of IL-6, which is involved in tissue injury, counterbalanced by a late activation in which TGF-beta predominates, mediating tissue repair. The results provide new insights into the pathogenesis of BO, which is linked to acute complications of lung transplantation through this biphasic AM activation.
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Affiliation(s)
- A Magnan
- Chest Medicine and Allergy Department, U INSERM 387, St.-Marguerite Hospital, Marseilles, France
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21
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Abstract
BACKGROUND This study examined our experience with bilateral single-lung transplantation in pediatric patients. METHODS Between 1988 and 1995, we have performed 32 double-lung transplantations in children. The first 10 were performed en bloc, the following 22 by bilateral single-lung transplantation. Indications for bilateral single-lung transplantation were cystic fibrosis in 16 patients, primitive obliterative bronchiolitis in 1, pulmonary artery hypertension in 1, and retransplantation in 4. Patients' ages ranged from 7 to 16 years (mean, 12 years). Four patients underwent a parenchymal reduction (lobectomy or bilobectomy). Bilateral single-lung transplantation was performed with a "clam-shell" incision, normothermic cardiopulmonary bypass, and a beating heart. RESULTS There was one postoperative death (heart failure in a retransplantation patient). Bleeding was moderate, and 4 patients had a bloodless procedure. Bronchial healing was satisfactory, with 3 patients receiving temporary left main bronchus stenting. There were two hospital deaths (recurrent cytomegalovirus infection in a retransplantation patient and multiorgan failure at 2 months) and seven late deaths, caused by infection (mostly cytomegalovirus), obliterative bronchiolitis, or both. Actuarial survival was 75% at 1 year, 56% at 2 years, and 36% at 3 years. CONCLUSIONS We conclude that bilateral single-lung transplantation appears to be an acceptable technique, even in small children. Bronchial healing is satisfactory, and no revascularization procedure appears necessary. Midterm and long-term results are comparable with those of heart-lung transplants, and in view of the current problems with organ donation, we think it is an adequate strategy in pediatric lung parenchymal disease.
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Affiliation(s)
- D Metras
- Unit of Cardio-Thoracic Surgery, La Timone Children's Hospital, Marseille, France
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22
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Robinson RJ, Shennib H, Noirclerc M. Slow-rate, high-pressure ventilation: a method of management of difficult transplant recipients during sequential double lung transplantation for cystic fibrosis. J Heart Lung Transplant 1994; 13:779-84. [PMID: 7803418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Single and double lung ventilation can be extremely difficult in patients with cystic fibrosis who require sequential double lung transplantation. This article reports the successful use of slow-rate, high-pressure ventilation in the management of two ventilator-dependent patients who would otherwise have needed to be supported by cardiopulmonary bypass.
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Affiliation(s)
- R J Robinson
- Joint Marseille-Montreal Lung Transplant Program, Marseille, France
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23
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Giudicelli R, Thomas P, Lonjon T, Ragni J, Morati N, Ottomani R, Fuentes PA, Shennib H, Noirclerc M. Video-assisted minithoracotomy versus muscle-sparing thoracotomy for performing lobectomy. Ann Thorac Surg 1994; 58:712-7; discussion 717-8. [PMID: 7944693 DOI: 10.1016/0003-4975(94)90732-3] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We prospectively analyzed the outcome of lobectomy in a cohort of 67 patients. Operative time, postoperative pain, pulmonary function, and early outcome were compared between the patients undergoing video-assisted techniques (n = 44) and those undergoing standard muscle-sparing procedures (n = 23). Pain was quantified daily throughout the first week using the visual analog scale. The forced expiratory volume in 1 second and the forced vital capacity were measured at days 2, 4, and 8 postoperatively. The operative time was significantly longer (p < 0.02) and the postoperative pain was significantly less (p < 0.006) in the group undergoing video-assisted procedures. Pain-related morbidity, the mean duration of air leaks, the duration of chest tube placement, and the hospital stay were all less in the video-assisted group, but the differences did not reach statistical significance. However, the impairment in pulmonary function and the overall morbidity were identical for the two groups. Based on our findings, we conclude that video-assisted minithoracotomy is a safe and reliable approach for performing lobectomies, and that the decreased postoperative pain associated with this minimally invasive approach does not result in preserved pulmonary function and significantly reduced morbidity when compared with a muscle-sparing thoracotomy.
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Affiliation(s)
- R Giudicelli
- Department of Thoracic Surgery and Lung Transplantation, Sainte-Marguerite University Hospital, Marseilles, France
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24
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Colt HG, Cammilleri S, Khelifa F, Dumon JF, Garbe L, Noirclerc M, Kaphan G. Comparison of SPECT lung perfusion with transbronchial lung biopsy after lung transplantation. Am J Respir Crit Care Med 1994; 150:515-20. [PMID: 8049839 DOI: 10.1164/ajrccm.150.2.8049839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The objective of this study was to evaluate the potential role for single photon-emission computed tomography (SPECT) using technetium 99m-macroaggregated albumin for diagnosing rejection in lung transplant patients. SPECT results were compared with those obtained from transbronchial biopsy (TBB) in patients undergoing bronchoscopy during routine surveillance and in cases of clinical, radiographic, or physiologic suspicion of lung rejection. This prospective, nonrandomized study was conducted by the Marseille Lung Transplant Group, Marseille University Hospitals South. It included 26 lung transplant recipients (19 double-lung, four single-lung, and three heart-lung). For each patient, SPECT lung perfusion was performed before TBB as part of routine surveillance protocol and when clinically indicated. Routine surveillance included TBB at 1, 3, 6, 9, and 12 months and every 6 months thereafter. SPECT was always performed within the 24 h preceding TBB. Whenever the SPECT was abnormal, biopsies were obtained from an area corresponding to a region of hypoperfusion. Results of the study were based on 79 paired SPECT and TBB obtained from 26 patients. Concordance between SPECT and biopsy occurred in 71 instances (89.9%). Among 25 cases of normal SPECT, TBB was normal in 24 and revealed subclinical lung rejection in one. Among 54 cases of abnormal SPECT, TBB was also abnormal in 47 (87.0%), with lung rejection being the abnormality in 23 (46%). For pairs performed as part of the routine surveillance protocol (61 pairs), clinically silent lung rejection was diagnosed in 16 (26.2%). SPECT was abnormal in 15 of 16 instances and normal in only one; this patient had minimal rejection that resolved without treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H G Colt
- Department of Thoracic Endoscopy, Pathology, University Hospitals South, Marseille, France
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25
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Resbeut M, Cowen D, Viens P, Noirclerc M, Perez T, Gouvernet J, Delpero JR, Gamerre M, Boubli L, Houvenaeghel G. Concomitant chemoradiation prior to surgery in the treatment of advanced cervical carcinoma. Gynecol Oncol 1994; 54:68-75. [PMID: 8020842 DOI: 10.1006/gyno.1994.1168] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In patients with locally advanced cervical cancer, most of the treatment failures occur within the pelvis. In an attempt to improve local control, 40 patients with bulky tumors (stage IB > 5 cm, stage IIB with distal parametrial invasion, and stage III-IVA) were treated between 1988 and 1992 with concurrent chemoradiation (CCR). The whole pelvis received a midplane dose of 45 Gy over 33 days. Daily radiation dose was 1.8 Gy, with twice-daily fractionation in the last 20 patients. Chemotherapy was administered on the 1st and 21st days of radiation therapy (RT) consisting of cisplatin (60 mg/m2), followed by 5-fluorouracil (600 mg/m2/day continuous i.v. infusion) over 96 hr (and decreased to 40 and 400 mg/m2, respectively, in the last 23 patients). CCR was first followed by a single intracavitary application and then by a parametrial boost in stage IIB-III patients and in stage IVA patients with disease reaching the pelvis side wall. Then surgery (colpohysterectomy with lymphadenectomy or pelvic exenteration) was performed in 35 patients. Median follow-up time was 2.6 years (0.6-5.6 years). Acute toxicity (WHO grade 3-4 diarrhea) in 13 patients led to 6 RT interruptions and 4 incomplete RTs. One patient died of a septic episode without leukopenia after completion of CCR. Five postexenteration complications required a second surgical procedure, of which one patient died with tumor and small bowel fistula. One patient developed small bowel late complication and another patient developed urinary late complications. No postoperative or late complications were observed in patients treated with twice-daily fractionation. Pelvic control was achieved in 32 of 40 patients (81 and 74% in stage IB-IIB and stage III-IVA, respectively). Sites of failure were the pelvis (6 cases), metastases (7 cases), and both (2 cases). Two-year survival and DFS rates were 61 and 66%, respectively, in stage IB-IIB and 77 and 65% in stage III-IVA. High SCC-TA4 values significantly worsened DFS rates. In patients with stage III-IVA tumors, additional surgery could be an important component of this treatment strategy and may be compatible with CCR using twice-daily fractionation radiotherapy. However, these results must be confirmed by a large-scale prospective study.
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Affiliation(s)
- M Resbeut
- Department of Radiotherapy, Institut Paoli Calmettes, Marseille, France
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26
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Ambrosi P, Noirclerc M, Wernert F, Bach S, Bernard PJ, Luccioni R. [Favorable outcome of severe right cardiac insufficiency after bipulmonary transplantation]. Arch Mal Coeur Vaiss 1994; 87:945-7. [PMID: 7702441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors report a long term success of bipulmonary transplantation in a 15 year old girl with cystic fibrosis and respiratory failure complicated by severe right heart failure. The operation did not cause any particular problems. After transplantation, the clinical signs of right ventricular failure and echocardiographic right ventricular dilatation regressed in less than one week. The right ventricular hypertrophy also regressed. Echocardiography shows no abnormality after 5 years' follow-up.
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Affiliation(s)
- P Ambrosi
- Service de cardiologie B, hôpital de La Timone, Marseille
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27
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Shennib H, Massard G, Reynaud M, Noirclerc M. Efficacy of OKT3 therapy for acute rejection in isolated lung transplantation. J Heart Lung Transplant 1994; 13:514-9. [PMID: 8061029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The purpose of this study was to evaluate the efficacy of muromonal-CD3 (Orthoclone OKT3) in the treatment of acute lung rejection. Criteria for its administration were (1) steroid-resistant acute rejection, (2) first-line therapy for grade III or higher acute rejection, and (3) second relapse after tapering off steroid treatment of acute rejection. During the period between May 1990 and May 1992, 41 patients had a total of 101 episodes of acute rejection. OKT3 (5 mg/kg for 7 to 10 days) was administered to 28 patients, of whom 19 responded (68%). Nine patients had either nonresponsive episodes or relapses immediately after completion of OKT3 therapy. Age, gender, cytomegalovirus status, underlying diseases, and type of procedure did not influence the outcome. Timing of OKT3 administration, however, was important; 16 (89%) of 18 patients responded to OKT3 therapy when administered during the first 6 months after transplantation, whereas 3 (30%) of 10 patients responded only beyond 6 months (p < 0.01). Infectious complications occurred after six treatments (21%), in which high-dose steroids were used concurrently (three Aspergillus, two Pseudomonas, and one cytomegalovirus pneumonia). Two patients also taking high-dose steroids had lymphoproliferative disorders. Three allergic reactions developed: one case of edema, one case of hypotension, and one case of arthralgia-myalgia syndrome. Serum antibody titers against OKT3 were persistently negative despite repeat (up to four times) therapy. We conclude that OKT3 is an effective and relatively safe therapy for steroid-resistant, high-grade, or relapsing acute lung rejection during the first 6 months. Antimicrobial prophylaxis must be considered when OKT3 is administered.
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Affiliation(s)
- H Shennib
- Joint Marseille-Montreal Lung Transplant Program, Quebec, Canada
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28
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Gaubert JY, Moulin G, Thomas P, Reynaud-Gaubert M, Noirclerc M, Bartoli JM. Anastomotic stenosis of the left pulmonary artery after lung transplantation: treatment by percutaneous placement of an endoprosthesis. AJR Am J Roentgenol 1993; 161:947-9. [PMID: 8273631 DOI: 10.2214/ajr.161.5.8273631] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Y Gaubert
- Department of Radiology, Timone Hospital, Marseille, France
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29
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Resbeut M, Noirclerc M, Viens P, d'Ercole C, Houvenaeghel G, Boubli L, Gamerre M, Delpéro JR. [Simultaneous radiotherapy and chemotherapy in the treatment of advanced cancer of the cervix uteri]. Bull Cancer 1993; 80:984-93. [PMID: 8081036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The pelvis is a major site of failure in patients with advanced carcinoma of the cervix. Attempting to improve local disease control, 40 patients were treated between February 1988 and July 1992 with concurrent chemoradiation (CCR). Thirty three patients (group A) with bulky cervical tumors (> 5 cm) received this CCR as the first part of their treatment (stages IB: 4; IIB with distal parametrial involvement: 14; IV: 15). CCR was followed by brachytherapy and a parametrial boost if indicated, then by surgery. CCR was also given, as a postoperative treatment, in seven patients (group B) with a bulky nodal involvement on a previous hysterectomy with lymphadenectomy performed for an early stage. CCR was a pelvic radiation therapy (RT): 45 Gy/25 F/33 d (two fractions per day in the last 14 patients) and a chemotherapy delivering: CDDP 60 mg/m2 on days 1 and 21, followed by 5-FU 600 mg/m2 i.v. continuous infusion for 96 hours (respectively 40 and 400 mg/m2 in the 16 last patients). Median follow-up is 35 months (range 10-63 m). Acute toxicities were grade 3-4 diarrhea in 16 patients and another patient died from a septic episode without leucopenia after CCR. Five post-operative complications required a second surgical procedure. Among these five patients, one died and two other developed small bowel late complications. No post-operative or late complication were observed in patients treated with a bi-fractionated RT. Sites of failure were: pelvic: four; metastases: five, both: three. Thirty months survival and DFS rates were 67.5% and 58.4% in the whole series and respectively 64% and 52.5% in stages IB-IIB patients and 63% and 59% in stage IV patients. Surgery is an important factor of the treatment and a CCR with a bi-fractionated RT allows such a surgical procedure. These encouraging results must be confirmed by a prospective study to determine whether a CCR is able to improve local control and survival.
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Affiliation(s)
- M Resbeut
- Service de radiothérapie, institut Paoli-Calmettes, Marseille, France
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30
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Ambrosi P, Chazalettes JP, Viard L, Raynaud M, Faugere G, Noirclerc M, Bernard PJ. [Left ventricular involvement in mucoviscidosis after 2 years of age]. Arch Fr Pediatr 1993; 50:653-6. [PMID: 8002738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The cardiac involvement in cystic fibrosis includes the rare cardiomyopathy seen in infants and changes in left ventricular performance in older children. POPULATION AND METHODS 67 patients, 6 to 34 months-old (mean: 16.7), 37 male and 30 female, with cystic fibrosis, were studied. Their Shwachman score was < 70. None showed any clinical manifestations of left ventricular insufficiency, but 6 patients had right ventricular insufficiency. Echocardiography was performed on 58 patients; it showed dilation of the right ventricle in 32 of them. Left ventricular perfusion was studied with thallium 201 tomoscintigraphy and left ventricular ejection fraction with 99mTc ventriculography. RESULTS The left ventricular ejection fraction was < 45% in 17 patients and scintigraphy showed hypofixation in 6 of them. In contrast, only 4 of the 50 patients with left ventricular ejection fraction > 45% had thallium hypofixation. CONCLUSIONS Resting perfusion abnormalities are more frequent in patients with a low left ventricular ejection fraction. These perfusion abnormalities suggest that myocardial fibrosis complicates the advanced stages of cystic fibrosis.
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Affiliation(s)
- P Ambrosi
- Service de Cardiologie Isotopique, Hôpital de la Timone, Marseille
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31
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Houvenaeghel G, Delpero JR, Rosello R, Resbeut M, Viens P, Jacquemier J, Noirclerc M, Guerinel G. Results of a prospective study with comparison of clinical, endosonographic, computed tomography, magnetic resonance imaging and pathologic staging of advanced gynecologic carcinoma and recurrence. Surg Gynecol Obstet 1993; 177:231-6. [PMID: 8356495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Between January 1988 and April 1991, 57 patients with advanced gynecologic carcinoma were preoperatively evaluated by gynecologic examination and endosonography (ESG) using general anesthesia. Abdominopelvic computed tomography (CT) was performed in 49 patients and magnetic resonance imaging (MRI) in 21 patients. There were 34 primary tumors and 23 instances of recurrence. Causes of gynecologic carcinoma were 38 carcinomas of the cervix uteri (26 primary and 12 recurrences), eight carcinomas of the ovary (four primary and four recurrences), three recurrences of carcinoma of the endometrium, five sarcomas of the uterus (one primary and four recurrences) and three primary carcinomas of the vagina. All of the patients were operated upon. This perspective study compares the data from clinical and imaging examinations to the data obtained from histologic examination of surgical sections. According to anterior or posterior tumor extension, the accuracy of clinical evaluation and preoperative imaging were studied for the posterior vesical wall and the vesicovaginal septum and the anterior rectal wall and the rectovaginal septum. Histologic examination revealed vesical involvement in 17 patients and of the involvement of vesicovaginal septum in 21 patients. The accuracy of the clinical examination, ESG, cystoscopy, CT and MRI was 83, 88, 87, 75 and 81 percent, respectively, for vesical extension. Cystoscopy was not taken into account for evaluation of extension to the vesicovaginal septum--accuracy was 80, 90, 67 and 86 percent for clinical examination, ESG, CT and MRI. Histologic examination showed involvement in the rectum in 14 patients and involvement in the rectovaginal septum in 19 patients. Rectoscopy was performed 13 times. The accuracy of clinical examination, ESG, CT and MRI was 91, 98, 89 and 71 percent, respectively, for extension to the anterior rectal wall. Rectoscopy was not taken into account for evaluation of extension to the rectovaginal septum--accuracy was 80, 96, 75 and 57 percent for clinical examination, ESG, CT and MRI. Endosonography would seem to be useful to complete examinations for regional extension of advanced gynecologic carcinomas. Its accuracy is superior to that of other examinations. Because it is performed using general anesthesia, there is no discomfort for the patient during this low cost procedure.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgery, Institut J. Paoli-I, Calmettes, Marseille, France
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Massard G, Shennib H, Metras D, Camboulives J, Viard L, Mulder DS, Tchervenkov CI, Morin JF, Giudicelli R, Noirclerc M. Double-lung transplantation in mechanically ventilated patients with cystic fibrosis. Ann Thorac Surg 1993; 55:1087-91; discussion 1091-2. [PMID: 8494415 DOI: 10.1016/0003-4975(93)90012-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Many lung transplant programs consider ventilator dependence as a contraindication for transplantation. Among 54 patients in whom bilateral lung transplantations for cystic fibrosis were performed by the Joint Marseille-Montreal Lung Transplant Program, 10 were ventilator dependent. Three of them died in the early postoperative period (30%): 2 as a result of cerebral anoxia and sepsis, 1 of Pseudomonas cepacia pneumonia. Two patients died at 15 and 19 months after transplantation of obliterative bronchiolitis and secondary bacterial pneumonitis. Another 2 patients in whom obliterative bronchiolitis developed underwent retransplantation with a heart-lung block; 1 of those was operated on at 12 months and is well at 29 months after his initial transplantation; the second was operated on at 34 months and died of primary graft failure. Three other patients are alive and well at 3, 11, and 14 months after transplantation. Actuarial survival at 1 year was 70%. The postoperative course and the infectious and rejection complications were no different from those in patients who underwent transplantation while spontaneously breathing. Obliterative bronchiolitis developed in 66% of patients at risk (2 of 6 patients surviving more than 6 months). We conclude that transplantation in mechanically ventilated patients with cystic fibrosis is not associated with an increase in morbidity or mortality after bilateral lung transplantation. Long-term survival, as in patients who undergo transplantation while spontaneously breathing, is limited by the development of obliterative bronchiolitis.
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Affiliation(s)
- G Massard
- Joint Marseille-Montreal Lung Transplant Program, Marseille, France
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33
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Massard G, Shennib H, Metras D, Giudicelli R, Fuentes P, Noirclerc M. [Lung transplantation. Contraindications and new indications]. Presse Med 1993; 22:538-42. [PMID: 8511081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The authors review the recent changes observed in the indications for lung transplantation. Several classical contra-indications have been alleviated or even cancelled. Chronic infection presenting as cystic fibrosis has become one of the first indications for lung replacement. Respirator-dependent patients are at an operative risk comparable to the overall results. Long-term corticosteroid therapy and pleural adhesions are no longer formal contraindications but should be approached with extreme caution. In recent years, single lung transplantation has been extended to diseases, such as emphysema and pulmonary hypertension, which were formerly indications for double-lung or heart-lung transplantation. The reasons for this include donor shortage and the better 1-year survival following single lung transplantation. The most recent development is paediatric lung transplantation. The legitimacy of redo transplantation is controversial.
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Affiliation(s)
- G Massard
- Service de Chirurgie thoracique, CHRU, Strasbourg
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Shennib H, Novick R, Mulder D, Menkis A, Morin JF, McKenzie N, Kaye M, Noirclerc M. Is lung retransplantation indicated? Report on four patients. Eur Respir J 1993; 6:354-7. [PMID: 8472825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
As more lung transplantations are performed, many patients will suffer graft failure and will be considered for retransplantation. This article reviews the case management reports of four patients who received lung or heart/lung retransplantation, with overall disappointing results. The pros and cons of lung retransplantation are discussed.
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Affiliation(s)
- H Shennib
- Joint Marseille-Montreal Lung Transplant Program, Marseille, France
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35
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Shennib H, Novick R, Mulder D, Menkis A, Morin JF, McKenzie N, Kaye M, Noirclerc M. Is lung retransplantation indicated? Report on four patients. Eur Respir J 1993. [DOI: 10.1183/09031936.93.06030354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As more lung transplantations are performed, many patients will suffer graft failure and will be considered for retransplantation. This article reviews the case management reports of four patients who received lung or heart/lung retransplantation, with overall disappointing results. The pros and cons of lung retransplantation are discussed.
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36
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Métras D, Shennib H, Kreitmann B, Camboulives J, Viard L, Carcassonne M, Giudicelli R, Noirclerc M. Double-lung transplantation in children: a report of 20 cases. The Joint Marseille-Montréal Lung Transplant Program. Ann Thorac Surg 1993; 55:352-6; discussion 357. [PMID: 8431040 DOI: 10.1016/0003-4975(93)90996-u] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In the last 3 1/2 years, we have performed 20 double-lung transplantations in children between 7 and 16 years old (mean age, 13 years). One patient had primitive bronchiolitis obliterans and the other 19, cystic fibrosis. Eight patients were operated on in an emergency situation, 7 of them requiring ventilator support before transplantation. The procedures were en bloc double-lung transplantation in the first 11 patients with separate bronchial anastomoses in 10, and sequential bilateral lung transplantation in the later 9 patients. There were no operative deaths. Two patients died in the hospital on postoperative days 37 and 73, and there were four late deaths, which were due to infection, rejection, and bronchiolitis obliterans. The acceptable incidence of airway complications, the improvement in lung function of survivors, and the acceptable midterm survival make double-lung transplantation an acceptable alternative to heart-lung transplantation in children. However, in very small children, heart-lung transplantation may be preferable because of the size of the airway anastomoses at risk.
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Affiliation(s)
- D Métras
- Hópital Ste. Marguerite, Marseille, France
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37
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Triglia JM, Belus JF, Dessi P, Noirclerc M, Cannoni M. [Rhinosinusal manifestations of cystic fibrosis]. Ann Otolaryngol Chir Cervicofac 1993; 110:98-102. [PMID: 8363304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The generalized disorders which characterize cystic fibrosis often involve the nose and paranasal sinuses and may frequently lead to the development of nasal polyps. A retrospective study of 78 patients with cystic fibrosis, 3 to 28 years old, was undertaken in order to determine the incidence of nasal involvement and to define an approach to the treatment of disabling recurrent nasal polyposis. 65% of these patients presented chronic symptoms such as rhinorrhea, nasal obstruction and disturbances of smell. Nasal polyps were found in 50% of patients and were more frequent in adults than in children. Clinical symptoms were directly related to the extent of polyp development which could be classified according to 3 groups. CT scans showed maxillary sinus involvement in almost all patients. The incidence and extent of ethmoidal sinus involvement on CT scans was correlated to the grade of polyp development. Medical treatment of polyposis failed in all cases. Polypectomy was always followed by recurrence. Intranasal ethmoidectomy seems to be an interesting alternative, since 73% of patients undergoing this procedure had clinical improvement.
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Affiliation(s)
- J M Triglia
- Département d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, Hôpital de la Timone, Marseille
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38
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Massard G, Badier M, Guillot C, Reynaud M, Thomas P, Giudicelli R, Noirclerc M. Lung size matching for double lung transplantation based on the submammary thoracic perimeter. Accuracy and functional results. The Joint Marseille-Montreal Lung Transplant Program. J Thorac Cardiovasc Surg 1993; 105:9-14. [PMID: 8419715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The present study evaluates the accuracy of submammary thoracic perimeter for lung size matching between donor and recipient and analyzes the influence of donor lung size discrepancies on functional outcome after double lung transplantation. The population is composed of 18 double lung graft recipients, 16 of whom had cystic fibrosis. The lung size match was assessed by comparison of predicted total lung capacity of donor and recipient: five patients were matched in a 10% confidence interval; four received smaller lungs, and nine received larger ones. The functional outcome was assessed with the spirometric values measured at 3 and 6 months after transplantation. The final functional result was not influenced by the lung size (r = 0.142 for total lung capacity; r = 0.372 for vital capacity; r = 0.378 for forced expiratory volume in 1 second). For larger lungs the final result tended to the recipient's predicted, whereas for smaller lungs, spirometry tended to the donor's predicted (r = 0.906 for total lung capacity; r = 0.875 for vital capacity; r = 0.874 for forced expiratory volume in 1 second). The thoracotomy effect, that is, restrictive syndrome at 3 months that resolves at 6 months, was not correlated with the lung size (r = 0.07 for total lung capacity; r = 0.436 for vital capacity). It is concluded that respiratory functional result is not affected by larger lungs; despite the wide range of error, the submammary thoracic perimeter appeared to be a satisfactory selection parameter in this group of patients.
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Affiliation(s)
- G Massard
- Service de Chirurgie Thoracique et Transplantations, Hôpital Sainte Marguerite, Marseille, France
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39
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Giudicelli R, Thomas P, Massard G, Reynaud M, Fuentes P, Noirclerc M. Tracheobronchial healing after lung and heart-lung transplantation. A critical review of 64 anastomoses. The Joint Marseille-Montréal Lung Transplant Program. Eur J Cardiothorac Surg 1993; 7:453-6. [PMID: 8217223 DOI: 10.1016/1010-7940(93)90273-e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The authors report on an analysis concerning the healing of tracheobronchial anastomoses after lung and heart-lung transplantation. The present study includes 64 anastomoses selected from a total of 80. Sixteen were excluded because of early postoperative death; none of these deaths was related to an airway complication. Bronchial healing was assessed with bronchoscopic follow-up; the aspect of the suture line was classified according to the grades of Couraud. The initial reference was the examination at 2 weeks postoperatively, which was compared to subsequent follow-ups. At the initial assessment, 42 anastomoses were grade I, 4 were grade II, and 18 were grade III. The subsequent anatomic result was satisfactory for 52 sutures (81%). The complications observed in the remaining patients were malacia in 2, stenosis treated with a stenting device in 4 and dehiscence in 6. The duration of ischemia and postoperative mechanical respiratory support, as well as the proximal or distal location of the anastomosis appeared to be of significant prognostic value.
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Affiliation(s)
- R Giudicelli
- Department of Thoracic Surgery, Hôpital Sainte Marguerite, Marseille, France
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40
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Shennib H, Adoumie R, Noirclerc M. Current status of lung transplantation for cystic fibrosis. Arch Intern Med 1992; 152:1585-8. [PMID: 1497391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lung transplantation has emerged as an acceptable option for the management of cystic fibrosis patients with endstage lung disease. Heart-lung transplantation and, more recently, double lung transplantation have been successfully performed in this group of patients. The choice of operation, so far, has been based on the surgeon's preference and experience as well as the cardiac function of the patient. Each of the procedures has advantages and disadvantages. This article reviews the current worldwide experience in lung transplantation for patients with cystic fibrosis and highlights the controversies involved in the selection of patients and procedure.
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Affiliation(s)
- H Shennib
- Joint Marseille-Montreal Lung Transplant Program, Montreal General Hospital, Quebec, Canada
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41
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Metras D, Kreitmann B, Shennib H, Noirclerc M. Lung transplantation in children. J Heart Lung Transplant 1992; 11:S282-5. [PMID: 1515450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- D Metras
- La Timone Children's Hospital, Marseille, France
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42
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Noirclerc M, Shennib H, Giudicelli R, Latter D, Metras D, Colt HG, Mulder D. Size matching in lung transplantation. J Heart Lung Transplant 1992; 11:S203-8. [PMID: 1515442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Volume concordance between donor lungs and the chest cavities of transplant recipients has important perioperative and postoperative implications. Between December 1987 and August 1991, 90 patients underwent lung transplantation in the Joint Marseilles-Montreal Lung Transplantation Program: 51 patients had double lung transplants, 19 patients had single lung transplants, and 20 patients had heart-lung transplants. There were 18 children (age range, 7 to 17 years) and 72 adults (age range, 18 to 58 years). Size matching was based on measurement of the submammary thoracic perimeter. Patient age (+/- 2 years) was also taken into consideration in children. Airway anastomoses were bronchial except for all heart-lung transplant patients and two double lung transplant patients, who had tracheal anastomoses. Occasional differences between donor and receiver bronchial diameters in children (greater donor size twice and smaller donor size once) required bronchoplasty in three instances. Healing was normal in these three instances, and no bronchial stenoses were noted. Performance of separate sutures rather than continuous running sutures on the cartilaginous anterior portion facilitated correction of airway diameter inequalities in adults. Excess volume was noted in three patients during closure of the thorax. In one patient, donor and recipient thoracic perimeters were similar. In two patients, however, donor size was greater by more than 20%. This was corrected by pneumoreduction with a surgical stapler. Lung size was decreased by 10% to 40% with use of this technique. Thoracic closure was facilitated and hemodynamic instability was thus corrected. No functional abnormalities were noted after surgery once the differences in lung size were corrected.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Noirclerc
- Department of Thoracic Surgery, Marseilles University Hospitals, France
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Shennib H, Noirclerc M, Ernst P, Metras D, Mulder DS, Giudicelli R, Lebel F, Dumon JF. Double-lung transplantation for cystic fibrosis. The Cystic Fibrosis Transplant Study Group. Ann Thorac Surg 1992; 54:27-31; discussion 31-2. [PMID: 1610249 DOI: 10.1016/0003-4975(92)91135-v] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
One hundred twenty cystic fibrosis patients were accepted for transplantation. Twenty-five patients underwent double-lung transplantation. Twenty-five patients died awaiting transplantation (20.6%). There were 13 female and 12 male patients. Their mean age was 28 years (range, 7 to 34 years), and mean percentage ideal body weight was 76% (range, 58.5% to 91.9%). Most patients were hypoxic and hypercarbic. Two patients underwent tracheal anastomosis, 15 had en bloc bronchial anastomoses, and 8 had sequential single-lung transplants. Operative mortality was 16%; all deaths were related to bleeding from extensive adhesions. Actuarial survival at 1 year was 64%. Rejection and infection were frequent during the first month and decreased thereafter. Airway complications occurred in 5 patients but were amenable to laser therapy and stenting. We conclude that double-lung transplantation is an acceptable modality for the treatment of cystic fibrosis patients with end-stage lung disease. It may be a better alternative to heart-lung transplantation considering the paucity of thoracic organ donors.
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Affiliation(s)
- H Shennib
- Thoracic Surgery Departments, Ste-Marguerite Hospital, Marseille, France
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44
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Zandotti C, de Lamballerie X, Viard L, Noirclerc M, de Micco P. Chimioprophylaxie par aciclovir et immunoglobulines et traitement des infections à cytomégalovirus chez l'enfant après transplantation bipulmonaire: à propos de 12 cas. Med Mal Infect 1992. [DOI: 10.1016/s0399-077x(05)80265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mancel-Grosso V, Bertault-Peres P, Barthelemy A, Chazalette JP, Durand A, Noirclerc M. Pharmacokinetics of cyclosporine A in bilateral lung transplantation candidates with cystic fibrosis. Transplant Proc 1990; 22:1706-7. [PMID: 2389438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- V Mancel-Grosso
- Laboratoire de pharmacocinétique Chu Timone, Marseille, France
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47
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Metras D, Noirclerc M, Vaillant A, Brunet CH, Kreitmann B. Double-lung transplant: the role of bilateral bronchial suture. Transplant Proc 1990; 22:1477-8. [PMID: 2389372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- D Metras
- Unit of Cardiac Surgery, CHU Timone-Children, Marseille, France
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48
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Metras D, Kreitmann B, Vaillant A, Noirclerc M, Benichou M, Habib G, Serradimigni A, Pannetier A, Couvely JP, Garbi O. [Heart and heart-lung transplantation. 3 years' experience in Timone CHU (Marseilles 1985-1988)]. Arch Mal Coeur Vaiss 1990; 83:209-15. [PMID: 2106856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Since December 1985, we have performed 38 transplantations: cardiac (CT) n: 31, cardiopulmonary (CPT) n: 1, or bipulmonary (BPT) n: 6. There were 31 male and 7 female patients, aged 7 to 62, mean 46. In the cardiac group, the cardiomyopathy was primitive in 13, ischemic in 16, valvular in 2. Five patients had undergone one or more previous operations. Three patients had a biventricular assist device (1,6 and 7 days before transplant) for acute cardiac failure. The indication of CPT or BPT was pulmonary artery hypertension (1), silicosis (1), cystic fibrosis (4). There were 4 post-operative deaths in the CT group (12.9%); failure of graft, low cardiac output, pulmonary artery hypertension by multiple pulmonary thrombosis, and 2 deaths in the CPT and BPT groups (28%). The mean post-operative hospital stay was one month. All patients with CT were treated by an initial maintenance bitherapy protocol (cyclosporine, steroids) and observed by myocardial biopsies and echocardiograms. In 40 per cent of the patients, Azathioprine was subsequently added. The patients had 2.1 rejection episode/patient/year, either spontaneously reversed of treated medically. There were two late deaths (2 and 7 months) by refractory rejection. 78 per cent of the patients were alive one year after transplant. All survivors have recovered a normal life, some of them with full-time work.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Metras
- Unité de chirurgie cardiaque, CHU Timone-Enfants, Marseille
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50
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Di Costanzo J, Sastre B, Choux R, Reynier JP, Noirclerc M, Cano N, Martin J. Experimental approach to prevention of catheter-related central venous thrombosis. JPEN J Parenter Enteral Nutr 1984; 8:293-7. [PMID: 6429367 DOI: 10.1177/0148607184008003293] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The role of catheter material in the formation of deep venous thrombosis during parenteral nutrition has been widely emphasized. Systematic venograms show central venous thrombosis in 20 to 33% of cases with polyethylene catheters and in 4% of cases with silicone catheters. Heparin infusion through the catheter diminishes but does not totally eliminate the risk of thrombosis. The aim of this study was to define the conditions under which the risk of thrombophlebitis was minimal. Four series of experiments were carried out, each on five rabbits. Catheters were inserted into the vena cava and, after 10 days, venograms were performed. The animals were then sacrificed, and the vena cava was macroscopically and microscopically studied. Plastic catheters were used in the first series, heparin-Benzalkonium-bonded plastic catheters in the second, silicone catheters in the third, and heparin-Benzalkonium-bonded silicone catheters in the fourth. The results revealed thrombosis of the vena cava and a fibrin sleeve around the catheters in series 1; thrombosis of the vena cava in series 2; a fibrin sleeve around the catheters in series 3; and neither thrombosis nor a fibrin sleeve in series 4. In conclusion, heparin-Benzalkonium-bonded silicone catheters appear to provide the best protection against thrombophlebitis by reducing the damage caused to the intima by the catheters and by slowing down platelet-aggregation around them.
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