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Murviel-lès-Montpellier, France

Bissonnette R.,Innovaderm Research | Girard C.,Hopital Saint Eloi | Haedersdal M.,Copenhagen University | Lear J.T.,Royal Infirmary | And 2 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2014

Background Patients with Gorlin syndrome develop multiple basal cell carcinomas (BCC), for which treatment is often difficult. Methylaminolevulinate- photodynamic therapy (MAL-PDT) is approved for the treatment of superficial and nodular BCCs in Canada and several European countries. Objectives To establish consensus recommendations for the use of MAL-PDT in patients with Gorlin syndrome. Methods The Gorlin consensus panel was comprised of 7 dermatologists who had treated a total of 83 patients with Gorlin syndrome using MAL-PDT. Consensus was developed based on the personal experience of the expert and results of literature review (on PUBMED using the keywords 'MAL' and 'PDT' and 'Gorlin' or 'naevoid basal cell carcinoma syndrome'). Results Consensus was reached among the experts and the literature review identified 9 relevant reports. The experts considered MAL-PDT a generally effective and safe therapy for treatment of BCC in Gorlin syndrome. For superficial BCC (sBCC), all sizes can be treated, and in nodular BCC (nBCC), better efficacy can be achieved in thinner lesions (<2 mm in thickness). MAL-PDT treatment schedule should be performed according to labelling although in individual cases, it may be adapted and performed on a monthly basis based on clinical assessment. Follow-up should be related to frequency of recurrence, and severity, number and location of lesions. Multiple lesions and large areas may be treated during the same session; however, adequate pain management should be considered. Conclusions MAL-PDT is safe and effective in patients with Gorlin syndrome. Utilization of these recommendations may improve efficacy and clearance rates in this population. © 2013 European Academy of Dermatology and Venereology.

Background & Aims: We aimed at determining the effect of maintenance therapy with ribavirin alone, after a year of combined peginterferon-alfa 2a (PegIFNα-2a) and ribavirin therapy, on viral response and liver histology after liver transplantation (LT). Methods: Hundred and one patients with recurrent HCV and a minimum of stage 1 fibrosis (METAVIR scoring), 1-5 years after LT, were enrolled. PegIFNα-2a and ribavirin were initiated at 90 μg/wk and 600 mg/d, respectively, then increased or adjusted as a function of tolerance. At 12 months, combination therapy was discontinued and patients were randomized to ribavirin or placebo for a further 12 months. Growth factor use was permitted. Results: At 18 months, a sustained virological response (SVR) was obtained in 47.9% of patients in Per Protocol (PP) analysis, and was higher in patients with genotype 2 or 3 than in patients with genotype 1 or 4, in patients with genotypes 1 + 4 receiving ciclosporine than in those receiving tacrolimus, in patients with worse renal function, in those having received EPO, in patients with lower weight, and in those with lower viral load at 3 months. Using logistic regression, only the early viral response, recipient weight and renal function were independently associated with better SVR. SVR, viral load, activity, and fibrosis scores were similar, at M18 and M30, in patients randomized to ribavirin, or to placebo. Conclusions: A PP SVR was achieved in 47.9% of patients with established recurrent hepatitis C after LT. Maintenance therapy with ribavirin alone does not improve the virological response or the histological parameters. © 2012 European Association for the Study of the Liver.

Farge D.,French Institute of Health and Medical Research | Bosquet L.,Institute National du Cancer | Kassab-Chahmi D.,Institute National du Cancer | Grange C.,Hopital Lyon Sud | And 4 more authors.
Critical Reviews in Oncology/Hematology | Year: 2010

Venous thromboembolism (VTE) is a major therapeutic issue in cancer patients. Advances in this field and heterogeneities in clinical practices prompted us to establish guidelines in the management of VTE in cancer patients according to the SOR (Standards, Options and Recommendations) methodology. A literature review of the studies published on this topic between 1999 and 2007 was performed. The guidelines were developed from the analysis of 38 out of 418 publications selected. They were peer-reviewed by 65 independent experts. The treatment of VTE in patients with cancer, including those with intracranial malignancies, should be based on low-molecular-weight heparins administered at therapeutic doses for at least 3 months. In the event of recurrent VTE, pulmonary embolism with hemodynamic failure or contra-indication to anticoagulant treatment, the indications and usages of vena cava filters and thrombolytic drugs should be the same as in non-cancer patients. © 2009 Dominique Farge. Published by Elsevier Ireland Ltd.

Payen J.-F.,British Petroleum | Chanques G.,Hopital Saint Eloi
Clinical Pulmonary Medicine | Year: 2012

Pain results from multiple sources in the intensive care unit (ICU) and is usually rated as moderate to severe in intensity. Painful experiences during the ICU stay can affect quality of life after discharge. Despite this, the assessment rates of pain in ICU remain below 40%, mainly because of the widespread use of sedatives (hypnotics) that hinder an adequate communication between patients and caregivers. There is, however, a current trend to question the systematic use of hypnotics in the ICU and to encourage the concept of sedation-based analgesia. Evidence is indeed accumulating about the impact of excessive use of hypnotics on patient outcome, especially prolonged duration of mechanical ventilation (MV) and increased length of ICU stay. In addition, we found that measuring pain levels in patients rendered nonverbal from of MV, and hypnotics resulted in more frequent sedation assessments, fewer hypnotics, and more care for procedural pain. After adjustments, these changes reduced the MV duration and length of ICU stay. These findings strongly argue in favor of the routine use of dedicated instruments to assess both pain and sedation. This can be achieved with the use of the visual analog scale, the verbal descriptor scale, and the 0 to 10 numeric rating scale in communicative patients. In noncommunicative patients, 2 pain behavior instruments have been validated: the behavioral pain scale and the critical-care pain observation tool. Overall, hypnotic drugs should be administrated in doses that allow pain assessment and adjustment of analgesics accordingly. This strategy may improve patient outcome. Copyright © 2012 by Lippincott Williams & Wilkins.

Thiolat A.,University of Paris 13 | Semerano L.,University of Paris 13 | Pers Y.M.,Montpellier University | Biton J.,University of Paris 13 | And 8 more authors.
Arthritis and Rheumatology | Year: 2014

Objective. The rationale for blocking interleukin-6 (IL-6) in rheumatoid arthritis (RA) lies chiefly in the proinflammatory effect of this cytokine. Few studies have evaluated the consequences of anti- IL-6 receptor (IL-6R) antibody treatment on Treg cells. This study was undertaken to elucidate the mechanism of action of anti-IL-6R antibody treatment by studying the effects on Treg cells in an experimental arthritis model and in patients with RA. Methods. Mice with collagen-induced arthritis (CIA) were treated with a mouse anti-IL-6R antibody (MR16-1), and changes in Treg, Th1, and Th17 cells were assessed at key time points during the course of the disease. Peripheral blood from 15 RA patients was collected on day 0 and after 3 months of tocilizumab treatment for flow cytometry analysis of Th17 and Treg cells. Results. In MR16-1-treated mice, Th17 cell frequencies were unchanged, whereas Treg cell frequencies were increased. The Treg cell phenotype showed marked changes, with an increase in the frequency of CD39+ Treg cells in the lymph nodes and spleen. Interestingly, similar CD39+ Treg cell expansion was observed in RA patients who were tocilizumab responders at 3 months, with no change in Th17 cell frequency. Moreover, fluorescence-activated cell-sorted CD39+ Treg cells from responder RA patients were functionally able to suppress the proliferation of conventional T cells. Conclusion. In both CIA and RA, the frequency of functionally suppressive CD39+ Treg cells is increased as a result of anti-IL-6R treatment, whereas Th17 cells are unaffected. The modification of Treg cell frequency and phenotype may be one of the mechanisms involved in the therapeutic effect of IL-6 blockade in RA. © 2014, American College of Rheumatology.

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