B Acad Nat Med Paris
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High dose therapy with autologous stem cell transplantation (ASCT) has been extensively used in the past 15 years in multiple myeloma. The IFM 90 trial has shown that autologous bone marrow transplantation (BMT) is superior to conventional chemotherapy in terms of response rate, event free survival, overall survival. Several other randomized studies confirm that ASCT yields superior complete remission and event free survival rates. ⋯ Yet, allogeneic BMT is possibly the only curative therapy. Reports of CR achieved after infusion of donor lymphoid cells in patients relapsing after allogeneic BMT support the concept of a graft versus myeloma effect. Therefore, the objectives of current studies are to reduce transplant related mortality by using earlier BMT, better selection of patients, better graft-versus host prophylaxis or non myeloablative conditioning regimens.
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B Acad Nat Med Paris · Jan 2003
Comparative Study[Adverse drug effects observed at French admissions departments and emergency services (Prospective study of the National Educational Association for Teaching Therapeutics and proposals for preventive measures].
Various studies have shown that adverse drug events (ADE) are a substantial cause of hospital admissions. However, little is known about the incidence and severity of ADE resulting in hospital visits. To address this issue, we conducted a prospective survey in 10 primary care and emergency departments of French public hospitals. ⋯ The most frequently incriminated drug classes were (1) psychotropic agents, including anxiolytics and/or hypnotics, antidepressants and antipsychotics (n = 84, 20.5%), (2) diuretics (n = 48, 11.7%), (3) anticoagulants (n = 38, 9.3%), (4) other cardiovascular drugs (n = 63, 15.4%), and (5) analgesics, including non steroidal antiinflammatory agents (n = 57, 13.9%). The avoidability of ADE could be estimated by an external expert panel in 280 of the 328 cases. In 106 cases (37.9%), ADE was considered to be preventable because a contra-indication or a warning about drug use had not been respected.
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Thiomersal, also called thimerosal, is an ethyl mercury derivative used as a preservative to prevent bacterial contamination of multidose vaccine vials after they have been opened. Exposure to low doses of thiomersal has essentially been associated with hypersensitivity reactions. Nevertheless there is no evidence that allergy to thiomersal could be induced by thiomersal-containing vaccines. ⋯ To date, none of the epidemiological studies conducted in Europe and elsewhere support this assumption. Although any effort should be made to avoid useless exposure of vaccinees to a potentially toxic compound, it should be emphasized that 1) public communication on this issue has led to a decrease in the hepatitis B vaccination coverage of children born to HBs Ag positive mothers in the US; 2) this issue was not really relevant in France where until 2002, apart from two hepatitis B vaccines, all childhood vaccines were thiomersal-free, and 3) in developing countries using multidose vaccine vials, moving to thiomersal-free vaccines in unidose presentations would represent such an incremental cost that millions of children would no more have access to vaccination. Therefore the World Health Organisation still recommends the use of thiomersal-containing vaccines as part of the expanded programme of immunisation.
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B Acad Nat Med Paris · Jan 2003
Review[Spinal instrumentation, source of progress, but also revealing pitfalls].
The second half of the XXo century and especially the last 30 years have been the source of a great improvement for surgical treatment of spinal pathology essentially in 3 directions:--First, for the patient himself and his comfort by suppression for most of the cases of any post operative external support thanks to the rigidity, security and strength of segmental fixation given by the hooks, screws and rods systems, as well for posterior as anterior instrumentation. In addition, these new techniques allow the patient to return quickly to standing and walking activity and subsequently the surgery for adult people increased dramatically especially for all kind of degenerative diseases and more and more extended spinal deformities.--The second major improvement came from the real and new understanding of the 3 dimensions for all the physiology and pathology of the spine leading to practical applications for the design and surgical strategies for correction. The exploding expansion of the era of computer technology brought a lot of help in such understanding as well as for the development of spinal instrumentation.--Finally the impressive development of medical imaging with CT scan and less and less invasive techniques like MRI allow a much better vision of spinal cord and roots (a major concern for the spinal surgeon). ⋯ Finally it is evident that the first steps already done for spinal surgery avoiding fusion will extend.--For children and growing spine, the challenge is major, but with memory metal instruments, laser precise destruction of abnormal growing structures as well as posterior flexible instrumentation avoiding stripping of the periosteum and leaving integrity of the disc and facet joints function, improvements are also on the way.--For adult and degenerative spinal deformities and pain, the development of spinal arthroplasty already done for the disc replacement will improve as well as for the posterior joints units where artificial ligaments experience will be replaced by real artificial joints still on experiment. In conclusion, some general biological medical questions are still waiting for answers:--Neurology and erect posture--Growth and degeneration--Malignancy (comprehension and control)--Pain and suffering. And of course what is the fact of the genetics for all of these problems: plenty of work for the future.
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B Acad Nat Med Paris · Jan 2003
Review[Contribution of interventional radiology to the treatment of liver metastases of colorectal cancers (pre-operative portal embolization--percutaneous radiofrequency)].
Selective embolization of portal branches of some liver segments will induce hypertrophy of non embolized segments of the liver. This induced hypertrophy allows us to perform hepatectomy in patients with initially insufficient volume of future remnant liver (FRL). This technique aims at patients with initial FRL volume below 25% of total liver volume, and patient with initial FRL volume below 40% of total liver volume when a diffuse liver disease is present. ⋯ Spreading of this technique is at least partially explained by a relative high local efficacy (90% of small tumor targeted can be destroyed) and a low invasiveness. However, today no benefit in survival has been demonstrated for patients treated with radiofrequency ablation of liver tumors. Consequently, this technique should not be proposed for tumors that can be surgically resected.