Traitements actuels du lymphome folliculaire

in Revue Médicale Suisse (2009), 5

After diffuse large B-cell lymphoma, follicular lymphoma is the most frequent non-Hodgkin's lymphoma. It remains incurable, except for localized diseases. Advanced disease has to be treated only in the ... [more ▼]

After diffuse large B-cell lymphoma, follicular lymphoma is the most frequent non-Hodgkin's lymphoma. It remains incurable, except for localized diseases. Advanced disease has to be treated only in the presence of clinical and/or biology aggressiveness. These patients should be treated by rituximab (Mab-Thera) associated to polychemotherapy comprising cyclophosphamide, vincristine and prednisone. After this therapy, the benefit of rituximab in maintenance has to be confirmed. Autologous stem cell transplantation is also an interesting option. The other therapeutic options comprise radio-immunotherapy with 90Y ibritumomab tiuxetan (Zevalin) and bortezomib (Velcade). [less ▲]

Traitement de la maladie de Parkinson en 2009.

in Revue Médicale Suisse (2009), 5(214), 1650-5

The cause of Parkinson's disease remains unknown and no cure or prevention exists so far. Levodopa remains by far the most potent symptomatic therapy, but induces side-effects such as motor fluctuations ... [more ▼]

The cause of Parkinson's disease remains unknown and no cure or prevention exists so far. Levodopa remains by far the most potent symptomatic therapy, but induces side-effects such as motor fluctuations and abnormal movements, which can somewhat be counterbalanced by optimizing levodopa plasma levels or acting at receptors level with long half-life dopamine agonists. In severe cases, functional surgery with deep brain stimulation can be offered. Some non-dopaminergic symptoms like dementia, freezing, postural instability or dysautonomia do not respond to dopaminergic drugs and need special care. [less ▲]

Endoprotheses coronaires pharmaco-actives chez les patients diabetiques.

in Revue Médicale Suisse (2008), 4(168), 1806-10

In diabetic patients, the use of drug-eluting stents (paclitaxel-PES or sirolimus-SES) reduces the risk of restenosis as compared to bare-metal stents. However, the risk of (very) late thrombosis is ... [more ▼]

In diabetic patients, the use of drug-eluting stents (paclitaxel-PES or sirolimus-SES) reduces the risk of restenosis as compared to bare-metal stents. However, the risk of (very) late thrombosis is higher with drug-eluting stents than with bare-metal stents. All together, the incidence of major cardiovascular events is reduced with drug-eluting stents, mainly resulting from a diminution of revascularisation procedures rather than from a reduction in myocardial infarcts or cardiovascular deaths. Attempts to compare SES and PES gave discordant results in both randomised trials and registries. Efficacious antiplatelet therapy in the long run is mandatory in all diabetic patients treated with drug-eluting stents. [less ▲]

Indications cliniques de la radiotherapie metabolique dans les tymphomes.

in Revue Médicale Suisse (2008), 4(168), 1818-22

In their later stages low grade lymphoma are incurable. These lymphomas being radio-sensitive, a treatment of metabolic radioimmunotherapy, using monoclonal antibodies (anti-CD20) as the carrier has been ... [more ▼]

In their later stages low grade lymphoma are incurable. These lymphomas being radio-sensitive, a treatment of metabolic radioimmunotherapy, using monoclonal antibodies (anti-CD20) as the carrier has been developed. The aim of this treatment is to use these antibodies to target radiation to tumor tissues while limiting toxicity to normal cells. Ibritumomab tiuxetan (Zevalin) is currently prescribed for patients with relapsed or refractory low-grade follicular lymphoma after rituximab treatment. This outpatient treatment has a high level of overall response rate including complete response and that for a long period. The side effects are essentially hematological and reversible. In the near future many more indications should become apparent and Zevalin should become an important tool in the B-cell lymphoma (low and high grade). [less ▲]

Impact thérapeutique du dépistage de l’ischémie myocardique silencieuse chez le sujet diabétique de type 2

in Revue Médicale Suisse (2008), 168(4), 1800-1804

Coronary artery disease is the major cause of mortality of type 2 diabetic subjects. Its early diagnosis to prevent progression and clinical events has intuitive appeal. Somehow, rationale for screening ... [more ▼]

Coronary artery disease is the major cause of mortality of type 2 diabetic subjects. Its early diagnosis to prevent progression and clinical events has intuitive appeal. Somehow, rationale for screening has not been clearly established. Screening should not modify the medical therapy because diabetic subjects have to be treated in a secondary prevention strategy. We have no data from randomized trials concerning a better outcome after revascularization in this specific population. The question how to select the high risk population to be screened has no response by now. SPECT and stress echocardiography seem valuable for screening but not for risk stratification. A large randomized clinical trial is required to confirm the cost-utility ratio of such a screening. [less ▲]

Prise en charge du cancer pulmonaire non a petites cellules

in Revue Médicale Suisse (2007), 3(122), 1890-5

Surgery, chemotherapy, radiotherapy and "biological" treatment are differently used in the treatment of non small cell lung cancer. Surgery is the cornerstone of the stages I-II treatment; chemotherapy is ... [more ▼]

Surgery, chemotherapy, radiotherapy and "biological" treatment are differently used in the treatment of non small cell lung cancer. Surgery is the cornerstone of the stages I-II treatment; chemotherapy is dominant in the treatment of metastatic stage, but is more and more used in earlier stages. A large discussion is still open for advanced non metastatic stages, even if the association of the 3 major modalities is extensively studied. We discuss our position in this setting. [less ▲]

Existe-t-il une "memoire therapeutique" en prevention cardiovasculaire?

in Revue Médicale Suisse (2007), 3(122), 1864-61868-9

The prevention of type 2 diabetes and of cardiovascular diseases is a major public health objective. Obviously life-style changes play a major role in this strategy. The Finnish Prevention Study recently ... [more ▼]

The prevention of type 2 diabetes and of cardiovascular diseases is a major public health objective. Obviously life-style changes play a major role in this strategy. The Finnish Prevention Study recently demonstrated that the remarkable diabetes prevention observed after a 4-year lifestyle intervention is maintained after a further 3-year period of follow-up without prolongation of the active intervention. Such a reminiscent effect may also be observed in the prevention of cardiovascular diseases with various pharmacological interventions: an ACE inhibitor (HOPE), a statin (4S), a fibrate (Helsinki Heart Study) or an intensive insulin therapy in type I diabetic patients (DCCT-EDIC). These intriguing results argue for a long-term memory of previous therapeutic interventions in cardiovascular prevention. [less ▲]

Spondylodiscite compliquée d'un abcès du psoas

in Revue Médicale Suisse (2007), 3(101), 620-621

La prescription médicamenteuse chez la personne âgée: que devons-nous savoir?

in Revue Médicale Suisse (2006), 2(76), 1878-801882-3

Because of the increasing longevity of the population, a growing number of very old people are exposed to medications. Drug therapy in this population is difficult because of our lack of knowledge. The ... [more ▼]

Because of the increasing longevity of the population, a growing number of very old people are exposed to medications. Drug therapy in this population is difficult because of our lack of knowledge. The number of drugs administered is generally high and the prescription is often inappropriate. Changes in body composition, malnutrition and renal failure can cause drug accumulation and toxicity. However, hepatic metabolism via cytochrome P450 does not seem to be markedly influenced by oldness. Iatrogenic pathology is frequent in the elderly and may lead to hospitalisation and reduction in quality of life. Specific education of the medical care team should be promoted in order to tackle this important problem of public health. [less ▲]

Prevention cardiovasculaire par l'aspirine chez le patient diabetique: que nous apprend la medecine factuelle?

in Revue Médicale Suisse (2006), 2(76), 1904-8

Diabetes mellitus markedly increases the risk of cardiovascular diseases, with an especially elevated relative risk among women. Aspirin prescription is mandatory in secondary prevention, even if the ... [more ▼]

Diabetes mellitus markedly increases the risk of cardiovascular diseases, with an especially elevated relative risk among women. Aspirin prescription is mandatory in secondary prevention, even if the protection by aspirin appears less efficacious in diabetic than in non-diabetic patients. In primary prevention, available data are paradoxically rather scarce, but also suggest a less effective prevention when diabetes is present. Aspirin remains the first antiplatelet agent in the diabetic population in all international guidelines of cardiovascular prevention although a higher daily dose may be proposed in this subgroup of patients (160-300 mg rather than 75-100 mg). [less ▲]