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Malamut G, Foulkes C, Fournier L, Hollande C, Berger A, Cellier C. Necrotizing pancreatitis complicated by oesophageal haemorrhage. Pancreatology 2013; 14:146-7. [PMID: 24650970 DOI: 10.1016/j.pan.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 11/17/2013] [Accepted: 12/12/2013] [Indexed: 12/11/2022]
Abstract
Bleeding is a rare complication of pancreatic pseudocyst. We describe an exceptional case of necrotizing pseudocyst with mediastinal extension providing cataclysmic oesophageal haemorrhage. The patient was successfully treated by adequate endoscopic, radiological and surgical management.
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Duhoux A, Fournier L, Gauvin L, Roberge P. What is the association between quality of treatment for depression and patient outcomes? A cohort study of adults consulting in primary care. J Affect Disord 2013; 151:265-74. [PMID: 23876194 DOI: 10.1016/j.jad.2013.05.097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 05/31/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The association between adequate treatment for a Major Depressive Episode (MDE) and improvements in depressive symptoms is not well established in naturalistic practice conditions. The main objective of this study was to examine the association between receiving at least one minimally adequate treatment for MDE (i.e. according to clinical guidelines) in the previous 12 months and evolution of depressive symptoms at 6- and 12-months. Associations with receiving pharmacotherapy and/or psychotherapy and the role of severity of depression were examined. METHODS This cohort study included 908 adults meeting criteria for previous-year MDE and consulting at one of 65 primary care clinics in Quebec, Canada. Multilevel analyses were performed. RESULTS Results show that (i) receiving at least one minimally adequate treatment for depression was associated with greater improvements in depression symptoms at 6 and at 12 months; (ii) adequate pharmacotherapy and adequate psychotherapy were both associated with greater improvements in depression symptoms, and (iii) the association between adequate treatment and improvement in depression symptoms varied as a function of severity of symptoms at the time of inclusion in the cohort with worse symptoms at the time of inclusion being associated with greater reductions at 6 and 12 months. LIMITATIONS Measures are self-reported. Participants were recruited at different stages over the course of their MDE. CONCLUSIONS This study shows that adequate treatment for depression is associated with improvements in depressive symptoms in naturalistic primary care practice conditions, but that those with more severe depressive symptoms are more likely to receive adequate treatment and improve across time.
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Audemard A, Bienvenu B, Magnier R, Fournier L, Galateau-Salle F, Silva NM. Clinical images: Bronchial stenosis in granulomatosis with polyangiitis (Wegener's). ACTA ACUST UNITED AC 2013; 65:3303. [PMID: 23983058 DOI: 10.1002/art.38120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Roberge P, Fournier L, Brouillet H, Benoit A. 085 Implementing a Knowledge Application Program for Anxiety and Depression in Community-Based Primary Mental Health Care: The Clinical Decision Support Component. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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80
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Roberge P, Fournier L, Brouillet H. P143 Projet Jalons: A Provincial Adaptation Of Clinical Practice Guidelines For Depression In Primary Care. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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81
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Fournier L. Tumour burden is an independent prognostic factor in metastatic renal cell carcinoma. BJU Int 2012; 110:1753-4. [DOI: 10.1111/j.1464-410x.2012.11525.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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82
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Ayllon J, Verkarre V, Scotté F, Fournier L, Corréas JM, Mejean A, Teghom C, Oudard S. Renal malacoplakia: Case report of a differential diagnosis for renal cell carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:38-40. [PMID: 23569483 PMCID: PMC3616183 DOI: 10.12659/ajcr.882596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 10/17/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Renal malacoplakia is a very rare chronic inflammatory disorder characterized by specific infiltration of tissue by inflammatory cells, and presents similar radiological characteristics to those of renal cell carcinoma. CASE REPORT A 54-year old woman, with a 37-year history of smoking, weight loss, anorexia, asthenia, and night sweats, was included in an antiangiogenesis clinical trial. Clinical signs of inflammation were apparent in the right lumbar region without functional limitations. Previous imagery identified a mass infiltrating the lower pole of the right kidney, extending to the psoas, perinephretic region and ganglia. Biological testing revealed inflammation and a urinary tract infection, treated with ciprofloxacin. Based on histology of a renal puncture biopsy, clear cell carcinoma with oxyphilic cells was suspected but not confirmed by immunohistochemistry. Urine analysis was positive for Escherichia Coli. Computed tomodensitometry revealed three masses (right kidney, between right psoas and the inferior vena cava, and right psoas) and a second puncture biopsy confirmed malacoplakia. After successful antibiotherapy, a right-sided nephrectomy was performed. The patient now shows no evidence of disease. CONCLUSIONS This case underscores the importance of excluding the differential diagnosis of renal malacoplakia before undertaking partial or total nephrectomy and/or initiating neoadjuvant treatment for renal cell carcinoma.
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de Bazelaire C, Calmon R, Thomassin I, Brunon C, Hamy AS, Fournier L, Balvay D, Espié M, Siauve N, Clément O, de Kerviler E, Cuénod CA. Accuracy of perfusion MRI with high spatial but low temporal resolution to assess invasive breast cancer response to neoadjuvant chemotherapy: a retrospective study. BMC Cancer 2011; 11:361. [PMID: 21854572 PMCID: PMC3173447 DOI: 10.1186/1471-2407-11-361] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 08/19/2011] [Indexed: 11/16/2022] Open
Abstract
Background To illustrate that Breast-MRI performed in high spatial resolution and low temporal resolution (1 minute) allows the measurement of kinetic parameters that can assess the final pathologic response to neoadjuvant chemotherapy in breast cancer. Methods Breast-MRI was performed in 24 women before and after treatment. Eight series of 1.11 minute-duration were acquired with a sub-millimeter spatial resolution. Transfer constant (Ktrans) and leakage space (Ve) were calculated using measured and theoretical Arterial Input Function (AIF). Changes in kinetic parameters after treatment obtained with both AIFs were compared with final pathologic response graded in non-responder (< 50% therapeutic effect), partial-responder (> 50% therapeutic effect) and complete responder. Accuracies to identify non-responders were compared with receiver operating characteristic curves. Results With measured-AIF, changes in kinetic parameters measured after treatment were in agreement with the final pathological response. Changes in Ve and Ktrans were significantly different between non-(N = 11), partial-(N = 7), and complete (N = 6) responders, (P = 0.0092 and P = 0.0398 respectively). A decrease in Ve of more than -72% and more than -84% for Ktrans resulted in 73% sensitivity for identifying non-responders (specificity 92% and 77% respectively). A decrease in Ve of more than -87% helped to identify complete responders (Sensitivity 89%, Specificity 83%). With theoretical-AIF, changes in kinetic parameters had lower accuracy. Conclusion There is a good agreement between pathological findings and changes in kinetic parameters obtained with breast-MRI in high spatial and low temporal resolution when measured-AIF is used. Further studies are necessary to confirm whether MRI contrast kinetic parameters can be used earlier as a response predictor to neoadjuvant chemotherapy.
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Hugonnet F, Fournier L, Medioni J, Smadja C, Hindié E, Huchet V, Itti E, Cuenod CA, Chatellier G, Oudard S, Faraggi M. Metastatic renal cell carcinoma: relationship between initial metastasis hypoxia, change after 1 month's sunitinib, and therapeutic response: an 18F-fluoromisonidazole PET/CT study. J Nucl Med 2011; 52:1048-55. [PMID: 21680694 DOI: 10.2967/jnumed.110.084517] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED The aims of this cohort study were to evaluate initial tumor hypoxia in metastatic renal cell carcinoma (mRCC) and its changes after sunitinib treatment, using (18)F-fluoromisonidazole PET/CT, and investigate the possible prognostic value of initial tumor hypoxia or its changes under sunitinib therapy. METHODS Antiangiogenic-naive patients with mRCC were prospectively enrolled in this cohort study. Before initiation of sunitinib, CT defined up to 10 targets that were assessed at 1 and 6 mo according to the response evaluation criteria in solid tumors (RECIST). Pretreatment target uptake of (18)F-fluoromisonidazole was compared with uptake at 1 mo. Targets were considered hypoxic when their maximal standard uptake value was above mean blood value + 2 SDs. Hypoxic volumes were also computed. Relationships between initial hypoxia status, initial degree of hypoxia, its change at 1 mo, and overall or progression-free survival (OS and PFS, respectively) were assessed by survival analysis. RESULTS Fifty-three patients were included. Median follow-up was 16.8 mo. (18)F-fluoromisonidazole uptake significantly decreased in initially hypoxic target metastases but did not change in others (-22%, P < 10(-4), vs. +1.5%, P = 0.77; P = 10(-3) between groups). Seventy-five percent of patients with hypoxic metastases were free of progressive disease at 4.8 mo (95% confidence interval, 2.99-11.83), compared with 11.3 mo (95% confidence interval, 3.08-36.9) for other patients (P = 0.02), whereas OS was not significantly different. Changes in tumor hypoxia were not related to PFS or OS. CONCLUSION Sunitinib reduced hypoxia in initially hypoxic RECIST target metastases but did not induce significant hypoxia in nonhypoxic RECIST target metastases. Patients with initially hypoxic targets have shorter PFS than others.
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Clément O, Faye N, Fournier L, Siauve N, Frija G. Rein et produits de contraste iodés et gadolinés. ACTA ACUST UNITED AC 2011; 92:291-8. [DOI: 10.1016/j.jradio.2011.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
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Faye N, Fournier L, Balvay D, Taillieu F, Cuenod CA, Siauve N, Clément O. Dynamic Contrast Enhanced Optical Imaging of Capillary Leakage. Technol Cancer Res Treat 2011; 10:49-57. [DOI: 10.7785/tcrt.2012.500179] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We studied in vivo the vascular permeability of two fluorescent contrast agents in three types of capillary, using a fibered confocal fluorescence microscopy system. Mice were imaged after injection of a macromolecular (albumin FITC 68,000 daltons) or low-molecular-weight contrast agent (FITC 389 daltons). We studied continuous capillaries in muscles (FITC n = 4, albumin FITC n = 6), fenestrated capillaries in mesenteries (FITC n = 8, albumin FITC n = 10), and discontinuous capillaries in xenografted tumors (FITC n = 2, albumin FITC n = 4). Signal intensity (SI) was measured in capillary and interstitial regions, and time-enhancement curves were drawn. Two-compartment models were constructed to determine quantitative microcirculation parameters. The arrival of the bolus of the two different contrast agents was observed in mesentery and muscle capillaries but not in tumor capillaries. Interstitial leakage of the low-molecular-weight contrast agent was observed almost instantaneously, whereas the macromolecular agent remained within the vessels. Signal intensity declined over the observation period, specifically in the tumor. No quantitative microcirculation parameters could be obtained with either of two bi compartmental models, owing to model instability. This study shows that the microcirculation can be reproducibly observed in different types of capillary in vivo with this fibered fluorescence imaging device. Further work is required to quantify microvascular parameters.
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Tam KBT, Lamarca B, Arany M, Cockrell K, Fournier L, Murphy S, Martin JN, Granger JP. Role of reactive oxygen species during hypertension in response to chronic antiangiogenic factor (sFlt-1) excess in pregnant rats. Am J Hypertens 2011; 24:110-3. [PMID: 20725052 DOI: 10.1038/ajh.2010.180] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Preeclampsia is associated with increased levels of reactive oxygen species (ROS) and the antiangiogenic factor, soluble fms-like tyrosine kinase-1 (sFlt-1). Moreover, recent studies have indicated that chronic sFlt-1 excess causes hypertension in pregnant animals. The purpose of this study was to evaluate the role of ROS in mediating sFlt-1-induced hypertension in the pregnant rat. METHODS Mean arterial pressure (MAP), and plasma sFlt-1 and tissue ROS levels were measured in the following groups: (i) pregnant controls; (ii) sFlt-1-treated pregnant rats; (iii) Tempol-treated pregnant rats; (iv) sFlt-1- and Tempol-treated pregnant rats. RESULTS MAP increased from 104 ± 2 mm Hg in pregnant control rats to 118 ± 3 mm Hg (P = 0.002) in sFlt-1-infused rats. Basal and nicotinamide adenine dinucleotide phosphate (NADPH)-stimulated levels of tissue ROS were increased in response to excess sFlt-1 during pregnancy. Pretreatment with Tempol attenuated oxidative stress and hypertension in response to sFlt-1. CONCLUSIONS ROS play an important role in mediating hypertension in response to chronic sFlt-1 excess during pregnancy.
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Nogue Kamdje A, Brasseur E, Fournier L, D'Orio V. [Hemolytic uremic syndrome with an atypical presentation]. REVUE MEDICALE DE LIEGE 2010; 65:676-680. [PMID: 21287762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The hemolytic uremic syndrome (HUS) is rare and of guarded prognosis in adults. It expresses a renal thrombotic microangiopathy. We report the case of a young patient whose clinical presentation and exploration make a diagnosis of HUS likely. The atypical presentation provides an opportunity not only to discuss all diagnostic elements based on recent pathophysiological hypotheses, but also to highlight recommendations for the management of this severe disease.
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Hugonnet F, Fournier L, Oudard S. Metastatic renal cell carcinoma (mRCC): Relationship between initial non-renal RECIST-target metastases hypoxia, change after 1 month of sunitinib, and therapeutic response: An 18F-MISO PET-CT study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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90
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Faye N, Dewachter P, Balvay D, Fournier L, Clément O. CMR2009: 6.02: Imaging in vivoduring anaphylactic shock. CONTRAST MEDIA & MOLECULAR IMAGING 2009. [DOI: 10.1002/cmmi.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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91
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Medioni J, Choueiri TK, Zinzindohoué F, Cho D, Fournier L, Oudard S. Response of renal cell carcinoma pancreatic metastasis to sunitinib treatment: a retrospective analysis. J Urol 2009; 181:2470-5; discussion 2475. [PMID: 19371877 DOI: 10.1016/j.juro.2009.02.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE Pancreatic metastasis accounts for 2% of metastatic renal cell carcinoma cases. Surgical management is typically recommended because of the limited value of immunotherapy as an effective treatment. Sunitinib recently showed clinical efficacy in patients with advanced renal cell carcinoma. We report a series of patients with pancreatic metastasis treated with sunitinib. MATERIALS AND METHODS We retrospectively studied a population of 15 adults with pancreatic metastasis of renal cell carcinoma at 1 center in France and at 2 in the United States who were treated with sunitinib between 2005 and 2007. Sunitinib monotherapy was given at a dose of 50 mg orally in 6-week cycles, consisting of 4 weeks of treatment followed by 2 weeks of rest. All clinical and radiological data were analyzed. RESULTS At a median followup of 20 months the overall tumor response using Response Evaluation Criteria in Solid Tumors was 34%. Median time to relapse was 20 months. Two deaths were noted and median survival was not attained. Responses in the pancreatic metastasis were seen in 28% of patients and were stable in 72%. The main grade 3 and 4 adverse events were diarrhea in 7% of cases and fatigue in 7%. Only grade 1 increased lipase was noted in 27% of patients and no increase in amylase was noted. CONCLUSIONS Sunitinib is effective in patients with pancreatic metastasis. This raises the question of whether patients with metastatic renal cell carcinoma limited to the pancreas may derive greater clinical benefit from anti-angiogenic agents, rather than from aggressive surgical resection. However, surgery remains the only potential cure in patients with isolated pancreatic metastasis.
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Thomassin-Naggara I, Daraï E, Cuenod CA, Fournier L, Toussaint I, Marsault C, Bazot M. Contribution of diffusion-weighted MR imaging for predicting benignity of complex adnexal masses. Eur Radiol 2009; 19:1544-52. [PMID: 19214523 DOI: 10.1007/s00330-009-1299-4] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 11/05/2008] [Accepted: 11/29/2008] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to prospectively assess the contribution of diffusion-weighted MR imaging (DWI) for characterizing complex adnexal masses. Seventy-seven women (22-87 years old) with complex adnexal masses (30 benign and 47 malignant) underwent MR imaging including DWI before surgery. Conventional morphological MR imaging criteria were recorded in addition to b(1,000) signal intensity and apparent diffusion coefficient (ADC) measurements of cystic and solid components. Positive likelihood ratios (PLR) were calculated for predicting benignity and malignancy. The most significant criteria for predicting benignity were low b(1,000) signal intensity within the solid component (PLR = 10.9), low T2 signal intensity within the solid component (PLR = 5.7), absence of solid portion (PLR = 3.1), absence of ascites or peritoneal implants (PLR = 2.3) and absence of papillary projections (PLR = 2.3). ADC measurements did not contribute to differentiating benign from malignant adnexal masses. All masses that displayed simultaneously low signal intensity within the solid component on T2-weighted and on b(1,000) diffusion-weighted images were benign. Alternatively, the presence of a solid component with intermediate T2 signal and high b(1,000) signal intensity was associated with a PLR of 4.5 for a malignant adnexal tumour. DWI signal intensity is an accurate tool for predicting benignity of complex adnexal masses.
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Nguyen Cong Duc E, Fournier L, Levecq C, Lesjean B, Grelier P, Tazi-Pain A. Local hydrodynamic investigation of the aeration in a submerged hollow fibre membranes cassette. J Memb Sci 2008. [DOI: 10.1016/j.memsci.2008.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fournier L, Thiam R, Medioni J, Trinquart L, Balvay D, Frija G, Oudard S, Cuenod CA. CMR 2007: 2.03: Can clinical DCE-CT using small molecular iodinated contrast agent detect and quantify the effect of anti-angiogenic drugs on metastatic renal cell carcinoma? CONTRAST MEDIA & MOLECULAR IMAGING 2007. [DOI: 10.1002/cmmi.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fournier L, Thiam R, Cuenod C, Medioni J, Trinquart L, Balvay D, Banu E, Balcaceres J, Frija G, Oudard S. Dynamic contrast-enhanced CT (DCE-CT) as an early biomarker of response in metastatic renal cell carcinoma (mRCC) under anti-angiogenic treatment. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14003 Background: Evaluation of treatment response for cancer relies on application of criteria based on size such RECIST. However, changes in size are often delayed and small. An accurate and early evaluation of tumor vascular characteristics would allow selection of patients (pts) who would most likely benefit of these therapies and early detection of treatment response to tailor therapy on an individual basis. Changes in tumor vascular parameters were quantified using dynamic contrast-enhanced computed tomography (DCE-CT) as a biomarker for tumor angiogenesis. Methods: A total of 44 mRCC pts were enrolled in an imaging study corollary of two phase III trials evaluating efficacy of anti-angiogenic drugs: sorafenib (N=9) vs. placebo (N=13), or sunitinib (N=17) vs. interferon (N=5). Perfusion CT acquisitions after injection of 80 ml of iodinated contrast agent were performed on a single “functional metastatic target” before treatment and every 6 weeks for follow-up. Microvascular parameters of the functional target were calculated using a dedicated software based on compartmental models: tumor blood flow (TBF) (ml/min/100g), tumor blood volume (TBV) (%), vascular permeability (VP) (ml/min/100g) and mean transit time (MTT) (s). These parameters were correlated to the best treatment response as evaluated by the size variation of the RECIST targets. Results: Among the 26 treated pts, there was a statistically significant drop in TBF and TBV as early as the first cycle of treatment (respectively -50%, p=0.03 and -51%, p<0.01) compared to pre-treatment, showing the biological effect of the drug on tumor vascularity. There was a significantly higher drop in TBF and TBV in pts who would be later classified as responders (N=16) vs. non-responders (N=10) after the first cycle of treatment (-66% vs. -6%, p=0.02; -60% vs. -26.5%, p=0.04). The changes in MTT and VP were not correlated to the best response. Conclusions: The functional imaging biomarkers TBF and TBV quantified by DCE-CT detect the biological effect of anti-angiogenic drugs on tumor vessels. TBF appears as very early predictor of mRCC response to anti-angiogenic drugs supporting the hypothesis that DCE-CT may constitute a surrogate biomarker of angiogenesis inhibition. No significant financial relationships to disclose.
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Medioni J, Arakelian N, Fournier L, Helley D, Thiam R, Banu E, Cuenod C, Oudard S. Relation between lactate dehydrogenase (LDH) during two first cycles in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib (SU). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14079 Background: LDH is a biomarker of cellular turn over. We evaluated LDH as a surrogate marker of tumor response and tumor necrosis during first cycles of SU. Methods: This is a single center study of immunorefractory patients with mRCC treated in second line with SU (50 mg, 4 weeks on, 2 weeks off). All patients performed CT scan and had serially measured tumor necrosis. Tumor response using the RECIST criteria was evaluated at the end of cycle 2 (C2). Tumor necrosis index was calculated at baseline, at the end of cycle 1 (C1) and C2 by measuring the percent area of the tumor with no enhancement after injection using an electronic calliper. LDH was measured at baseline (D1) and at the end (D28) of C1 and C2 using LD 200 kit on Synchron LX20 (Beckman Coulter). Relations between LDH and tumor response were studied using multivariate analysis of variance (MANOVA) with repeated measures and between LDH and tumor necrosis using Pearson correlation test. Results: Between Feb 2005 and Aug 2006, 56 patients were analyzed (75% men,), 91% Clear Cell Carcinoma. Mean age was 59 years (range: 30–81) and 62% has a performance status ECOG of 0. Median number of metastatic sites was 2 and mean hemoglobin level was 12.7 gr/dl. After C2, 12 (21%) partial responses, 35 (63%) stable diseases and 9 (16%) progressive diseases were noted. Results of LDH are summarized in the table . Mean LDH was statistically different between along time (p < 0.0001). LDH levels were statistically different between responders-stables and progressors patients (p = 0.004). There is a trend for a statistical relation between the index of necrosis and the tumor response measured by RECIST criteria (p = 0.08). No correlation was found between LDH and tumor necrosis. Conclusions: LDH level is higher in progressors compared to responders-stables patients. LDH level is not correlated to tumor necrosis measured by CT scan. [Table: see text] No significant financial relationships to disclose.
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Ferland A, Brassard P, Croteau S, Lemieux S, Bergeron J, Lacroix S, Fournier L, Poirier P. Impact of Beta-Blocker Treatment and the Nutritional Status on Glycemic Response During Exercise in Type 2 Diabetic Patients. CLIN INVEST MED 2007. [DOI: 10.25011/cim.v30i3.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background/Objective: More than 60% of type 2 diabetic individuals present with hypertension and have higher risk of cardiac complications. In addition to behavioural modifications, such as healthy food choices and regular physical activity, beta-blocker (BB) treatment may be considered in order to reduce morbidity and mortality especially following a cardiovascular event. However, this medication is generally associated with a deleterious impact on glucose metabolism. To assess the impact of a BB treatment on glucose response in type 2 diabetic patients exempt of cardiovascular complications.
Methods: Six sedentary men, treated with diet and/or a hypoglycemic agent performed four exercise sessions at 60% of their VO2 peak, in the fasted state or 2 hours after a standardized breakfast, with and without BB (Atenolol 100 mg id for five consecutive days). Blood samples were assayed during the resting period, at 15-minutes intervals during the exercise session and the recovery period.
Results: A reduction of blood glucose levels was observed following the exercise session performed in the postabsorptive state (41% and 37% reduction with and without BB treatment respectively; P < 0.01). One hour of exercise performed in the fasted state had minimal impact on glucose and insulin levels, with or without BB. BB treatment was not associated with increased baseline blood glucose or insulin levels in the fasted or the postabsorptive situation.
Conclusion: These results suggest that the nutritional status has a more important impact on plasma glucose and insulin modulation than short-term use of BB per se.
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Oudard S, Banu E, Vieillefond A, Fournier L, Priou F, Medioni J, Banu A, Duclos B, Rolland F, Escudier B, Arakelyan N, Culine S. Prospective multicenter phase II study of gemcitabine plus platinum salt for metastatic collecting duct carcinoma: results of a GETUG (Groupe d'Etudes des Tumeurs Uro-Génitales) study. J Urol 2007; 177:1698-702. [PMID: 17437788 DOI: 10.1016/j.juro.2007.01.063] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE Collecting duct carcinoma of the kidney is a rare and aggressive neoplasm of the distal collecting tubules for which there is no established treatment. Since the histology of collecting duct carcinoma is similar to that of urothelial carcinoma, the standard chemotherapy regimen defined by a gemcitabine and platinum salts combination was prospectively investigated in patients with metastatic collecting duct carcinoma. MATERIALS AND METHODS A total of 23 patients with metastatic collecting duct carcinoma with no prior systemic chemotherapy were treated with 1,250 mg/m(2) gemcitabine on days 1 and 8 plus 70 mg/m(2) cisplatin or carboplatin (AUC 5) in patients with renal insufficiency on day 1. The drugs were repeated every 21 days for 6 cycles according to toxicity and efficacy. The objective response rate was the primary end point. RESULTS There were 1 complete and 5 partial responses for an objective response rate of 26% (95% CI 8 to 44). Median progression-free and overall survival was 7.1 (95% CI 3 to 11.3) and 10.5 months (95% CI 3.8 to 17.1), respectively. Toxicity was mainly hematological with grade 3-4 neutropenia and thrombocytopenia in 52% and 43% of patients, respectively. The severity of granulocytopenia and the number of metastatic sites were associated with overall survival on univariate and multivariate analyses. CONCLUSIONS To our knowledge this is the first prospective, multicenter, phase II study showing that the platinum salts combination is an active and safe regimen as first line treatment in patients with metastatic collecting duct carcinoma. This platinum based chemotherapy should be considered the standard regimen in these patients.
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Martina MS, Fortin JP, Fournier L, Ménager C, Gazeau F, Clément O, Lesieur S. Magnetic targeting of rhodamine-labeled superparamagnetic liposomes to solid tumors: in vivo tracking by fibered confocal fluorescence microscopy. Mol Imaging 2007; 6:140-6. [PMID: 17445508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Polyethylene glycol (PEG)ylated and rhodamine-labeled liposomes loaded with maghemite nanocrystals provide a novel nanoscaled hybrid system for magnetic targeting to solid tumors in possible combination with double in vivo imaging by fluorescence microscopy and magnetic resonance imaging (MRI). Human prostate adenocarcinoma tumors implanted in mice were used as a system model. A magnetic field gradient was produced at the tumor level by external apposition of a magnet. Noninvasive fibered confocal fluorescence microscopy was successfully used to track the liposomes in vivo within organs and tumor blood vessels. Active targeting to the magnet-exposed tumors was clearly shown, in agreement with previous MRI studies. The liposomes were driven and accumulated within the microvasculature through a process that preserved vesicle structure and content.
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Martina MS, Fortin JP, Fournier L, Ménager C, Gazeau F, Clément O, Lesieur S. Magnetic Targeting of Rhodamine-Labeled Superparamagnetic Liposomes to Solid Tumors: In Vivo Tracking by Fibered Confocal Fluorescence Microscopy. Mol Imaging 2007. [DOI: 10.2310/7290.2007.00004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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