Time filter

Source Type

Beaussant Cohen S.,Center Hospitalo University Of Besancon | Fenneteau O.,Laboratoire dHematologie | Plouvier E.,Center Hospitalo University Of Besancon | Rohrlich P.-S.,Center Hospitalo University Of Besancon | And 14 more authors.
Orphanet Journal of Rare Diseases | Year: 2012

Background: WHIM syndrome (WS), a rare congenital neutropenia due to mutations of the CXCR4 chemokine receptor, is associated with Human Papillomavirus (HPV)-induced Warts, Hypogammaglobulinemia, bacterial Infections and Myelokathexis. The long term follow up of eight patients highlights the clinical heterogeneity of this disease as well as the main therapeutic approaches and remaining challenges in the light of the recent development of new CXCR4 inhibitors. Objective. This study aims to describe the natural history of WS based on a French cohort of 8 patients. Methods. We have reviewed the clinical, biological and immunological features of patients with WS enrolled into the French Severe Chronic Neutropenia Registry. Results: We identified four pedigrees with WS comprised of eight patients and one foetus. Estimated incidence for WS was of 0.23 per million births. Median age at the last visit was 29 years. Three pedigrees encompassing seven patients and the fetus displayed autosomal dominant heterozygous mutations of the CXCR4 gene, while one patient presented a wild-type CXCR4 gene. Two subjects exhibited congenital conotruncal heart malformations. In addition to neutropenia and myelokathexis, all patients presented deep monocytopenia and lymphopenia. Seven patients presented repeated bacterial Ears Nose Throat as well as severe bacterial infections that were curable with antibiotics. Four patients with late onset prophylaxis developed chronic obstructive pulmonary disease (COPD). Two patients reported atypical mycobacteria infections which in one case may have been responsible for one patient's death due to liver failure at the age of 40.6 years. HPV-related disease manifested in five subjects and progressed as invasive vulvar carcinoma with a fatal course in one patient at the age of 39.5 years. In addition, two patients developed T cell lymphoma skin cancer and basal cell carcinoma at the age of 38 and 65 years. Conclusions: Continuous prophylactic anti-infective measures, when started in early childhood, seem to effectively prevent further bacterial infections and the consequent development of COPD. Long-term follow up is needed to evaluate the effect of early anti-HPV targeted prophylaxis on the development of skin and genital warts. © 2012 Beaussant Cohen et al; licensee BioMed Central Ltd.


Sun X.S.,Jean Minjoz University Teaching Hospital | Sun X.S.,Center Hospitalier Belfort Montbeliard | Sun S.R.,Center Hospitalier Belfort Montbeliard | Guevara N.,University of Nice Sophia Antipolis | And 9 more authors.
Critical Reviews in Oncology/Hematology | Year: 2013

Background: The mainstay of treatment for differentiated thyroid carcinomas is surgery. There is hardly any room for radiation therapy in differentiated thyroid carcinomas. We aimed to update recommendations for RT in the context of histological variants, increased use of radioiodine and new irradiations techniques. Materials and methods: A search of the French and English literature was performed using thyroid carcinoma, radiation therapy, surgery, variants and radioiodine. Results: Papillary, follicular, Hürthle and medullary carcinomas represent about 80%, 11%, 3% and 4% of all thyroid carcinomas, respectively. Ten-year survival rates for patients with papillary, follicular and Hürthle cell carcinomas are 93%, 85%, and 76%, respectively. The occurrence of criteria such as older age (45 or 60 years-old), massive primary disease, extensive extracapsular spread and macroscopic iodine-negative components inconsistently indicate external beam irradiation (EBRT). The impact of EBRT on poorer-prognosis histological variants is an emerging issue. Noteworthy, the incidence of laryngeal and wound healing complications has been an important limitation to EBRT. However, intensity modulated radiation therapy (IMRT) offers clear dosimetric advantages on tumor coverage and organ sparing such as the larynx, thus reducing late toxicities to less than 5%. Iodine contrast agents should be avoided during 4-6 weeks before radioiodine. PET CT is increasingly used in iodine-negative tumors. Conclusion: There are elective indications for EBRT and IMRT has the potential to improve local control. © 2012 Elsevier Ireland Ltd.


Veauthier C.,Hanse Klinikum | Veauthier C.,Center Hospitalier Belfort Montbeliard | Gaede G.,Charité - Medical University of Berlin | Radbruch H.,Charité - Medical University of Berlin | And 3 more authors.
Clinical Neurology and Neurosurgery | Year: 2013

Objective In a previous polysomnographic cross-sectional study we found a significant relationship between sleep disorders and multiple sclerosis (MS) related fatigue. The purpose of this open follow-up observation was to compare the impact of treatment of sleep disorders on MS related fatigue measured with the Modified Fatigue Impact Scale (MFIS). Methods Non-randomized follow-up observation: treated versus untreated patients, subgroups according to compliance with sleep medical treatment recommendations (univariate, multivariate analysis, multiple logistic regression). 66 MS patients were followed after polysomnography, 49 patients with relevant sleep disorders and 17 without. Results Mean MFIS scores decreased from 41.2 to 26.2 (p = 0.025) in patients with good compliance (GC; n = 18), from 42.4 to 32.1 (p = 0.12) in patients with moderate compliance (MC; n = 12), and from 41.6 to 35.5 (p = 0.17) in non-compliant patients (NC; n = 17). Mean MFIS values increased in patients without sleep disorders from 22.9 to 25.4 (NSD; n = 12, p = 0.56). In multiple logistic regression, treatment of sleep disorders predicted decrease of MFIS-values (GC versus NSD odds ratio 13.4; p = 0.015; 95% confidence interval (CI) 1.7-107.2, MC versus NSD odds ratio 13.8; p = 0.028; 95% CI 1.3-143.3). Conclusions Sleep medical treatment may improve MS related fatigue when patients adhere to treatment recommendations. © 2013 Elsevier B.V.


Colombat P.,Service dHematologie et Therapie Cellulaire | Altmeyer A.,Center Hospitalier Belfort Montbeliard | Rodrigues M.,Association Pour lEnseignement et la Recherche des Internes en Oncologie | Rodrigues M.,University Pierre and Marie Curie | And 4 more authors.
Psycho-Oncologie | Year: 2011

The suffering of caregivers is often observed in haematology and oncology teams. A major Programme Hospitalier de Recherche Clinique was conducted in the north-west of France. Every oncology and haematology ward was contacted. On 64 wards we got 574 questionnaires within 53 different centres. Four major causes of aetiology have been identified, linked to the caregiver, to the speciality of oncohaematology, to the workload and to the organisation and team management. Our group (Afsos) has shown a relationship between participative management and quality of life at work of caregivers. This participative management is now mandatory in France for teams caring for palliative patients (measure 13a of HAS accreditation visit). The perspectives of the results are discussed. © 2011 Springer Verlag France.


Sun X.S.,Jean Minjoz University Teaching Hospital | Sun X.S.,Center Hospitalier Belfort Montbeliard | Sun S.R.,Center Hospitalier Belfort Montbeliard | Guevara N.,University of Nice Sophia Antipolis | And 12 more authors.
Critical Reviews in Oncology/Hematology | Year: 2013

Background: ATC represents 1-2% of all thyroid carcinomas. Median survival is poor (3-10 months). Our goal is to update recommendations for RT in the context of new irradiation techniques. Materials and methods: A search of the French and English literature was performed with terms: thyroid carcinoma, anaplastic, chemoradiation, radiation therapy and surgery. Level-based evidence remains limited in the absence of prospective studies and the small size of retrospective series of this rare tumor. Results: Surgery when possible should be as complete as possible but without mutilation given the 8-month median survival of ATC. It should be followed by systematic chemoradiation in ATC. Initiation of treatment is an emergency given fast tumor doubling time. The most promising results of chemoradiation to date have been shown in series of radiation therapy (+/- acceleration) combined with doxorubicin +/- taxanes or cisplatin. Adjuvant chemotherapy (doxorubicin, cisplatine and/or taxane-based) may also be recommended given the metastatic potential of ATC and warrants further investigations. Data on neoadjuvant chemotherapy are missing. Intensity modulated radiation therapy offers clear dosimetric advantages and has the potential to improve tumor and nodal (posterior neck, mediastinum) coverage, i.e., locoregional control while optimally sparing the spinal cord, larynx, parotids, trachea and esophagus. PET-CT and MRI may be used for RT planning. Conclusion: Chemoradiation with debulking surgery whenever possible is the mainstay of treatment of anaplastic thyroid carcinomas (ATC). EBRT using IMRT has the potential to improve local control. Taxane-doxorubicin concomitant chemoradiotherapy is worth further investigation. © 2012 Elsevier Ireland Ltd.


Martino D.,Plateforme Coordination Proximite Sante | Altmeyer A.,Center Hospitalier Belfort Montbeliard | Guyot H.,rue Paul Sabatier | Colombat P.,CHRU de Tours | Gofti-Laroche L.,Grenoble University Hospital Center
Oncologie | Year: 2014

This article focuses on the impact of cancer on the lives of sick people. A multidisciplinary workgroup, including doctors, psychologists, social workers and pharmacists, conducted research works on possible answers (legal and statutory assistance) and discussion on the limits of these. In conclusion of this work, a proposal for the improvement of the existing solutions is proposed. © Springer-Verlag 2014.


Monnier A.,Center Hospitalier Belfort Montbeliard
Cancer Management and Research | Year: 2010

The use of third-generation aromatase inhibitors (AIs), such as anastrozole and letrozole, as initial adjuvant hormonal therapy in postmenopausal women (PMW) with hormone receptor-positive (HR+) breast cancer offers a significant benefit over tamoxifen for reducing recurrence risk. Clinical studies, including the Arimidex Tamoxifen Alone or in Combination (ATAC) and the Breast International Group (BIG) 1-98 trials, have proven that both anastrozole and letrozole are, respectively, superior to tamoxifen in improving disease-free survival. Although differing in design, objectives, and follow-up time, these trials offer some insight into the comparative clinical efficacy of these two nonsteroidal AIs. In particular, results from BIG 1-98 show that letrozole significantly reduces early distant metastatic (DM) events, which constitute the majority of early recurrence events. Subsequently, there is a beneficial overall survival effect emerging in the trial, whereas survival is unchanged with anastrozole after 100 months of follow-up in ATAC. Significant differences in the potency of these two drugs, vis-à-vis their degree of aromatase inhibition, have been observed in comparative trials and show that letrozole causes a more complete suppression of estrogen levels than does anastrozole. Whether this difference in potency is relevant to reductions in DM events during adjuvant therapy remains unclear. The Femara Anastrozole Clinical Evaluation trial is addressing this issue in a more unequivocal manner by comparing initial adjuvant treatment with anastrozole or letrozole in a population of breast cancer patients at high risk of recurrence: PMW with HR+ disease and axillary lymph node involvement. © 2010 Monnier, publisher and licensee Dove Medical Press Ltd.


Montserrat M.,Center Hospitalier Belfort Montbeliard | Demoly-Pouret P.,Center Hospitalier Belfort Montbeliard | Winckfield B.,Center Hospitalier Belfort Montbeliard | Feissel M.,Center Hospitalier Belfort Montbeliard | And 3 more authors.
Pharmacien Hospitalier | Year: 2011

Objective: In the context of continuous improvements in quality of patient care, the pharmacy service performed a clinical audit on the daily feeding practices of the parenterally fed patients. The purpose of this study was to evaluate care and records of underfed inpatients in two french Hospitals. Materials and methods: Retrospective study was carried out on medical orders prescribed from July 1st to August 31st 2008. Three relevant criteria were evaluated: nutritional state, diagnosis-based information about nutritional state, and quality of patient care. Results: Thirty-nine patients were included, 43.6% were underfed and 43.6% presented a risk factor of malnutrition. In the overall admissions considerations, measurements of admission body weight hit 71.8%, usual body weight 7.7%, weight loss 23%, size 38.5% and calculation of Body Masse Index (BMI) hit 15.4%. With regards to the evaluation of efficiency, weekly body weight were recorded in 25.6% of medical charts, a food monitoring form had been taken into account in 41% of medical records, albumin dosage was achieved 87.2% and prealbumin dosage 10.2% of medical records. The clinical tolerance of parental nutrition involved clinical judgment based on hepatic data (79.5%), triglyceride data (69.2%) and cholesterol rate (7.7%). Conclusion: Evaluation of feeding practices revealed disappointing results. The nutritional care was not optimal in the BMH, mainly because the overall admissions considerations (weight and size at the first day of hospitalization) and the food monitoring form were rarely filled out. This evaluation allowed appropriate corrective actions (availability of appropriate tools and personnel training). Audits of the process and the corrective action plan after implementation will determine the overall effectiveness of the corrective actions taken. © 2011 Elsevier Masson SAS. All rights reserved.


De Conto C.,University of Franche Comte | De Conto C.,Center Hospitalier Belfort Montbeliard | Gschwind R.,University of Franche Comte | Martin E.,Center Hospitalier Belfort Montbeliard | Makovicka L.,University of Franche Comte
Physica Medica | Year: 2014

Dental prostheses made of high density material contribute to modify dose distribution in head and neck cancer treatment. Our objective is to quantify dose perturbation due to high density inhomogeneity with experimental measurements and Monte Carlo simulations. Firstly, measurements were carried in a phantom representing a human jaw with thermoluminescent detectors (GR200A) and EBT2 Gafchromic films in the vicinity of three samples: a healthy tooth, a tooth with amalgam and a Ni-Cr crown, irradiated in clinical configuration. Secondly, Monte Carlo simulations (BEAMnrc code) were assessed in an identical configuration. Experimental measurements and simulation results confirm the two well-known phenomena: firstly the passage from a low density medium to a high density medium induces backscattered electrons causing a dose increase at the interface, and secondly, the passage from a high density medium to a low density medium creates a dose decrease near the interface. So, the results show a 1.4% and 23.8% backscatter dose rise and attenuation after sample of 26.7% and 10.9% respectively for tooth with amalgam and crown compared to the healthy tooth. Although a tooth with amalgam has a density of about 12-13, the changes generated are not significant. However, the results for crown (density of 8) are very significant and the discordance observed may be due to calculation point size difference 0.8mm and 0.25mm respectively for TLD and Monte Carlo. The use of Monte Carlo simulations and experimental measurements provides objective evidence to evaluate treatment planning system results with metal dental prostheses. © 2013 Associazione Italiana di Fisica Medica.


PubMed | Center Hospitalier Belfort Montbeliard
Type: | Journal: Cancer management and research | Year: 2010

The use of third-generation aromatase inhibitors (AIs), such as anastrozole and letrozole, as initial adjuvant hormonal therapy in postmenopausal women (PMW) with hormone receptor-positive (HR+) breast cancer offers a significant benefit over tamoxifen for reducing recurrence risk. Clinical studies, including the Arimidex Tamoxifen Alone or in Combination (ATAC) and the Breast International Group (BIG) 1-98 trials, have proven that both anastrozole and letrozole are, respectively, superior to tamoxifen in improving disease-free survival. Although differing in design, objectives, and follow-up time, these trials offer some insight into the comparative clinical efficacy of these two nonsteroidal AIs. In particular, results from BIG 1-98 show that letrozole significantly reduces early distant metastatic (DM) events, which constitute the majority of early recurrence events. Subsequently, there is a beneficial overall survival effect emerging in the trial, whereas survival is unchanged with anastrozole after 100 months of follow-up in ATAC. Significant differences in the potency of these two drugs, vis--vis their degree of aromatase inhibition, have been observed in comparative trials and show that letrozole causes a more complete suppression of estrogen levels than does anastrozole. Whether this difference in potency is relevant to reductions in DM events during adjuvant therapy remains unclear. The Femara Anastrozole Clinical Evaluation trial is addressing this issue in a more unequivocal manner by comparing initial adjuvant treatment with anastrozole or letrozole in a population of breast cancer patients at high risk of recurrence: PMW with HR+ disease and axillary lymph node involvement.

Loading Center Hospitalier Belfort Montbeliard collaborators
Loading Center Hospitalier Belfort Montbeliard collaborators