Prise en charge de 315 épisodes neutropéniques fébriles dans un centre anticancéreux

Management of febrile neutropenic patients is described in guidelines. Each cancer center can adapt these according to its local bacterial ecology. We present a retrospective study made in a cancer center from 2001 to 2003.     

Gem-(R)CHOP versus (R)CHOP: a randomized phase II study of gemcitabine combined with (R)CHOP in untreated aggressive non-Hodgkin's lymphoma--EORTC lymphoma group protocol 20021 (EudraCT number 2004-004635-54)

Background: Despite recent improvements, many patients with aggressive non‐Hodgkin’s lymphoma (NHL) ultimately succumb to their disease. Therefore, improvements in front‐line chemotherapy of aggressive NHL are needed. Gemcitabine is active in lymphoma. Methods: We performed a randomized phase II trial of the addition of gemcitabine to standard CHOP chemotherapy with or without rituximab [(R)CHOP]. The trial was also designed to determine the maximal tolerated dose (MTD) of gemcitabine in this combination. Patients with previously untreated aggressive NHL were randomized to receive either eight cycles of (R)CHOP given every 3 wk or (R)CHOP combined with gemcitabine [Gem‐(R)CHOP]. Results: Twenty‐five patients were enrolled in the trial before early closure. Twelve were randomized to Gem‐(R)CHOP and 13 to (R)CHOP. MTD of gemcitabine was 800 mg/m² given on days 1 and 8; dose‐limiting toxicity was hematologic. Five patients (42%) treated with Gem‐(R)CHOP achieved complete response in comparison with 10 (77%) treated with (R)CHOP. Median time to treatment failure was 1.5 yr for Gem‐(R)CHOP and 3.1 yr for (R)CHOP. Three patients receiving Gem‐(R)CHOP had serious pulmonary toxicity, when compared to none receiving (R)CHOP. One patient died of pneumonitis. Conclusions: In this group of patients, addition of gemcitabine did not seem to improve outcomes. Gem‐(R)CHOP in previously untreated patients with aggressive NHL occasionally results in severe, potentially fatal, pulmonary toxicity.     

mtDNA Deletion in an Iranian Infant with Pearson Marrow Syndrome

Background

Pearson syndrome (PS) is a rare multisystem mitochondrial disorder of hematopoietic system, characterized by refractory sideroblastic anemia, pancytopenia, exocrine pancreatic insufficiency, and variable neurologic, hepatic, renal, and endocrine failure.

Case Presentation

We describe a six-month-old female infant with Pearson marrow syndrome who presented with neurological manifestations. She had several episodes of seizures. Hematopoietic abnormalities were macrocytic anemia and neutropenia. Bone marrow aspiration revealed a cellular marrow with marked vacuolization of erythroid and myeloid precursors. Analysis of mtDNA in peripheral blood showed 8.5 kb deletion that was compatible with the diagnosis of PS.

Conclusion

PS should be considered in infants with neurologic diseases, in patients with cytopenias, and also in patients with acidosis or refractory anemia.     

Heart Hypertrophy During Pregnancy: A Better Functioning Heart?

During pregnancy, healthy women develop ventricular hypertrophy and diastolic dysfunction as a result of volume overload as well as increased stretch and force demand. Pregnancy also induces electrocardiogram disturbances such as longer QT-interval dispersion. Surprisingly, it was not until recently that the underlying molecular mechanisms or the role of sex hormones was addressed in this critical female reproductive stage. Recent work with the use of mouse and rat models show that the molecular signature of pregnancy-related hypertrophy differs from that of a pathologic form in that classic gene markers (e.g., myosin heavy chains [alpha and beta], atrial natriuretic peptide, phospholamban, and sarcoplasmic reticulum Ca(2+)-ATPase) remain unchanged. However, both types of hypertrophies have the commonality of a reduced expression of the Kv4.3 channel, a membrane protein that can prevent cardiac hypertrophy when overexpressed. Increased estrogen in late pregnancy may be a mechanism to induce Kv4.3 protein downregulation and increased activity of the stretch-activated c-Src kinase. Cellular/molecular mechanisms used to make a pregnant woman's heart work more efficiently and recover to normal cardiac function postpartum are beginning to emerge as cardioprotective natriuretic peptides- and NO-cGMP cascades get upregulated postpartum. This exciting initial work calls for more research in this underexplored area that should set the basis for better treatment of women during pregnancy.     

Single Implant Treatment in Healing versus Healed Sites of the Anterior Maxilla: A Clinical and Radiographic Evaluation

Purpose: The aim was to document the Nobelreplace tapered TiUnite® (Nobel Biocare, Göteborg, Sweden) implant system used by experienced clinicians in daily practice for replacing single maxillary anterior teeth and to compare the clinical and radiographic outcome between implants installed in healing sites (early implant placement) and fully healed sites (conventional implant placement) after on average two and a half years of function. Material and Methods: A cross‐sectional study in patients who had been treated by two periodontists and two prosthodontists in 2006 and 2007 was conducted. Surgical treatment involved standard flap elevation without releasing incisions and restorative procedures included cemented crowns in all patients. Only straightforward single implant treatments in healing sites (6–8 weeks following tooth extraction) and fully‐healed sites (≥6 months following tooth extraction) were considered with both neighboring teeth present and without the need for hard and/or soft tissue grafting. Clinical and radiographic analyses of all implants were performed by a blinded clinician who had not been involved in the treatment. Results: Forty‐nine of the 53 eligible single implants (22 early and 27 conventionally placed implants) in 44/48 patients were available for scrutiny. There was no significant difference in implant survival between early (95%) and conventionally (93%) installed implants (p = 1.000). Mean bone level to the implant‐abutment interface was 1.25 and 1.02 mm for early and conventional implant placement, respectively (p = .220). In spite of fairly low plaque levels (26%), overall peri‐implant bleeding was quite prevalent (36%). Mean peri‐implant probing depth was 3.3 mm. Five restorations had experienced technical complications. Conclusions: Single Nobelreplace tapered TiUnite® implants installed in healing as well as in healed sites of the anterior maxilla are predictable. Both strategies seem equally successful in terms of implant survival, bone remodeling, clinical response, and risk for complications.