Showing papers by "Anderson Loundou published in 2009"

Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation (RRA) with recombinant human TSH (rhTSH): a randomized controlled study.

Abstract: Summary Background Recombinant human TSH (rhTSH) has become the modality of choice for radioiodine remnant ablation (RRA) in low-risk thyroid cancer patients. Aims and methods The aims of the present prospective randomized study were to evaluate the impact of TSH stimulation procedure (hypothyroidism vs. rhTSH) on quality of life (QoL) of thyroid cancer patients undergoing RRA and to evaluate efficacy of both procedures. L-T4 was initiated in both groups after thyroidectomy. After randomization, L-T4 was discontinued in hypothyroid (hypo) group and continued in rhTSH group. A measure of 3·7 GBq of radioiodine was given to both groups. The functional assessment of chronic illness therapy-fatigue (FACIT-F) was administered from the early postoperative period to 9 months. Socio-demographic parameters, anxiety and depression scales were also evaluated (CES-D, BDI and Spielberger state-trait questionnaires). At 9 months, patients underwent an rhTSH stimulation test, diagnostic 131I whole body scan (dxWBS) and neck ultrasonography. Results A total of 74 patients were enrolled for the study. There was a significant decrease in QoL from baseline (t0) to t1 (RRA period) in the hypothyroid group with significant differences in FACIT-F TOI (P < 10−3), FACT-G total score (P = 0·005) and FACIT-F total score (P = 0·003). By contrast, QoL was preserved in the rhTSH group. In the multivariate analysis, FACIT-TOI changes were only affected by the modality of TSH stimulation performed for RRA. From 3 to 9 months, changes of QoL scales and subscales were no longer statistically different in both groups of patients. Based on serum rhTSH-stimulated Tg alone (Tg < 0·8 µg/l, BRAHMS Tg Kryptor), no difference in ablation success was observed between rhTSH and hypothyroidism groups, 91·7% and 97·1%, respectively. A higher rate of persistent thyroid remnants was observed in the rhTSH arm, although in most cases uptake was < 0·1% and of no clinical significance. Conclusions rhTSH preserves QoL of patients undergoing RRA with similar rates of ablation success compared to hypothyrodism. However, there is a wide heterogeneity in the clinical impact of hypothyroidism.

High expression of cathepsin B and plasminogen activator inhibitor type-1 are strong predictors of survival in glioblastomas

Abstract: In contrast to pilocytic astrocytomas (WHO grade I gliomas) that are circumscribed and cured by surgical resection, invasion is a hallmark of grades II-IV gliomas. Proteases play a major role in the invasion process and correlations between glioma grading, survival and protease expression have been demonstrated. In this study, we have chosen to study using different technical approaches (Q-RT-PCR, in situ hybridization and immunohistochemistry) the expression of five molecules involved in extracellular matrix degradation (cathepsin B, MMP2, MMP9, uPA and PAI-1) in glioblastomas in order to determine their prognostic impact among grade IV gliomas. Pilocytic astrocytomas were used as controls. Q-RT-PCR showed that transcripts of uPA, PAI-1, cathepsin B and MMP9 were significantly more expressed in glioblastomas (n = 52), in comparison to pilocytic astrocytomas (n = 17) (P = 0.049, P < 0.0001, P = 0.03 and P < 0.0001, respectively). On both univariate and multivariate analyses, cathepsin B and PAI-1 were strong predictors of overall survival among the group of glioblastomas (P < 0.0001 and P = 0.01, respectively). Immunohistochemical expression of cathepsin B further confirmed its prognostic value in an independent cohort of patients with glioblastoma. In situ hybridization showed that uPA is detected at the invasive edge of glioblastomas, whereas PAI-1 is more abundant in microvascular proliferation and pseudo-palisading cells than at the infiltrative edges. These results suggest that cathepsin B and PAI-1 are important biomarkers for the stratification of glioblastoma patients with respect to survival.

Height growth during adolescence and final height after haematopoietic SCT for childhood acute leukaemia: the impact of a conditioning regimen with BU or TBI.

Abstract: We compared the impact of a conditioning regimen with BU (n=16) or fractionated TBI (n=42) on height growth during adolescence and final height (FH), in 58 adults transplanted for acute leukaemia before adolescence (younger than 9 for girls and 11 for boys, and prepubertal). Heights were measured at three key periods, that is, transplantation, before adolescence, and FH, and compared using height standard deviation score (SDS) and cumulative change in SDS. The influence of the conditioning regimen was assessed using multiple linear regression and adjusting for gender, central nervous system irradiation, age and leukaemia status at transplant and type of transplantation. Overall mean height SDS was near normal at transplantation and before adolescence (0.2±0.1 and −0.2±0.1, respectively), but decreased to −1.6±0.1 at FH. There were significant differences between the TBI and BU groups when comparing FH SDS (−1.8±0.2 vs −0.8±0.2, P=0.001), mean change in height SDS from transplantation to FH (−2±0.1 vs −1.1±0.2, P=0.002) and mean change in height SDS during adolescence (−1.6±0.1 vs −0.7±0.2, P=0.003). We conclude that preparations involving BU, although less toxic than TBI-containing regimens, also have adverse effects on growth, predominantly during adolescence.

SCT for childhood acute leukaemia: the impact of a conditioning regimen with BU or TBI

Abstract: We compared the impact of a conditioning regimen with BU (n=16) or fractionated TBI (n=42) on height growth during adolescence and final height (FH), in 58 adults transplanted for acute leukaemia before adolescence (younger than 9 for girls and 11 for boys, and prepubertal). Heights were measured at three key periods, that is, transplantation, before adolescence, and FH, and compared using height standard deviation score (SDS) and cumulative change in SDS. The influence of the conditioning regimen was assessed using multiple linear regression and adjusting for gender, central nervous system irradiation, age and leukaemia status at transplant and type of transplantation. Overall mean height SDS was near normal at transplantation and before adolescence (0.2±0.1 and −0.2±0.1, respectively), but decreased to −1.6±0.1 at FH. There were significant differences between the TBI and BU groups when comparing FH SDS (−1.8±0.2 vs −0.8±0.2, P=0.001), mean change in height SDS from transplantation to FH (−2±0.1 vs −1.1±0.2, P=0.002) and mean change in height SDS during adolescence (−1.6±0.1 vs −0.7±0.2, P=0.003). We conclude that preparations involving BU, although less toxic than TBI-containing regimens, also have adverse effects on growth, predominantly during adolescence.

Pulmonary capillary blood flow and cardiac output measurement by partial carbon dioxide rebreathing in patients with acute respiratory distress syndrome receiving lung protective ventilation.

Abstract: Background Partial carbon dioxide rebreathing noninvasively measures the pulmonary capillary blood flow and estimates the cardiac output with the use of a predicted shunt value. It has been reported that the accuracy of the method is decreased in patients with high pulmonary shunt. The aim of this study was to investigate the agreement between partial rebreathing and thermodilution for the determination of pulmonary capillary blood flow and cardiac output in the setting of acute respiratory distress syndrome. Methods Twenty consecutive patients with the acute respiratory distress syndrome were enrolled. Ventilator settings include low tidal volume (6 ml x kg(-1)) and positive end-expiratory pressure + 2 cm H2O higher than the lower inflection point if present or 10 cm H2O if not. Seven pairs of cardiac output and pulmonary capillary blood flows were recorded every 20 min over a 2-h period. The authors determined bias, SD, limit of agreement (95% confidence interval) and percentage error. Results Bias and agreement for cardiac output measurement were 0.8 +/- 1.2 l x min(-1) (-2.1 to 3.7 l x min(-1)), and percentage error was 36%. Bias and agreement for pulmonary capillary blood flow measurement were -0.1 +/- 0.8 l x min(-1) (-2.1 to 1.9 l x min(-1)), and percentage error was 35%. Dead space, arteriovenous oxygen content difference, mean pulmonary arterial pressure, and baseline cardiac output were independently associated with differences between methods. Conclusions In patients with the acute respiratory distress syndrome, partial rebreathing cannot yet replace thermodilution for measuring pulmonary capillary blood flow or cardiac output. However, accuracy of the method is close to the boundary of clinical relevance.

Randomized trial of adjuvant chemotherapy (Cx) with cisplatin plus gemcitabine (CG) versus cisplatin plus docetaxel (CD) in patients (pts) with completely resected non-small cell lung cancer (NSCLC) with quality of life (QoL) as the primary objective

Abstract: 7532 Background: Adjuvant Cx with vinorelbine plus cisplatin (VC) improves survival of resected NSCLC but has an immediate negative impact on QoL (Bezjak, JCO 2008). In advanced stages NSCLC, GC and DC have comparable efficacy and might be superior to VC in QoL outcomes. This trial was designed to provide with data on other adjuvant Cx regimens for pts with resected NSCLC. Methods: Pts with stage IB to III resected (R0) NSCLC, without major postoperative complication, were eligible. Surgery has to be standardized. Cx consisted of cisplatin (75 mg/m2, D1) plus gemcitabine 1,250 mg/m2 (D1,8) or docetaxel (75 mg/m2 D1) for 3 cycles. The primary endpoint was QoL (EORTC QLQC30) and the trial was designed to detect a 10 points difference in QoL scores (α=0.05; power 80%). Relapse-free survival, overall survival (OS), safety profile and costs were the secondary endpoints. Results: 136 pts (median age: 57 yrs, 74% males, pTNM: 32% IB, 34% II, 34% III; histology: 55% ADC, 23% SCC) were included. 67 and 69 pts were...

Prognostic factor of recurrence for resected digestive endocrine tumors.

Abstract: BACKGROUND/AIMS The aim of the present study was to identify the factors of recurrence for digestive endocrine tumours resected with curative intent. METHODOLOGY 170 endocrine digestive tumours were reviewed from January 1997 to January 1997, Twenty eight patients were selected in this study. Localization of tumours were as follows: 14 duodenopancreatic (DP) and 14 Digestive (DT: 9 small bowel and 4 appendix). The following factors were investigated: primary site, hormonal clinical symptom, and differentiation. RESULTS Twenty eight patients (12 men) were selected. Median age was 48 (range, 23-79) yrs. All resection of metastasis were performed during the same procedure of primary tumour resection. There were 14 DT and 14 non functional DP tumours. For 28 patients, the only factor of recurrence was endocrine pancreatic tumour (p = 0.02). For non functional DP, the rate of recurrence was significantly dependent on histology and the expression of ki67 antigen and presence of metastasis. Survival free of disease for DT were: 100%,80% at 1, 5 yrs, and for DP they were 93%, 50%, 33% at 1, 3, 5 yrs, respectively. CONCLUSION The expression of the Ki67 antigen and differentiation seem to be good indicators for DP recurrence and may need an adjuvant treatment despite the R0 resection.