[Action and tolerance of dothiepin hydrochloride (Prothiaden) in depressive states during the evolution of psychotic disorders]. / Activité et tolérance du chlorhydrate de dosulépine (Prothiaden) dans les états dépressifs survenant au cours de l'évolution d'une psychose.

During psychosis evolution, depressions occur frequently with a prevalence between 10% and 70% (average 25%-50%). Depression aggravates psychosis prognosis by increasing the risk of suicide, relapse and hospitalization. So antidepressant and neuroleptic treatments are often associated. Many studies with contradictory results were realized. Some concluded a favourable effect of this association, others considered this concomitant medication aggravates psychotic symptoms and adverse reactions. However this association appears to be efficient especially in deficitary or depressive forms of schizophrenia. The objective of this multicentre, non comparative, open study is to assess during 6 weeks the efficacy and tolerability of dothiepin in the treatment of depression occurring during the evolution of psychosis. The initial score on HDRS (17 items) had to be at least 18. 124 patients (40.7 years, 63.1% male) suffering from chronic psychosis associated with depressive syndrome were included in 29 hospital centres. According to DSM III-R criteria, 71.9% of patients were schizophrenic and 43% were suffering from major depressive illness. 16 patients (12.9%) stopped prematurely the treatment and side effects were reported for 8 of them. Any unexpected side effect occurred and pre-existing psychotic disorders reappeared for one patient. During the whole study, 63% of the population were treated with 75 mg as daily dosage of dothiepin. All concomitant treatments except antidepressant were authorized. 115 patients (95%) received at least one associated neuroleptic treatment and 54 patients (44.6%) a concomitant antiparkinsonian treatment. The significant decrease, between day 0 and day 45, of the global score on HDRS (from 23.78 to 8.48, p < 0.01), confirms the improvement of depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Flurbiprofen local action transcutaneous (LAT): clinical evaluation in the treatment of acute ankle sprains.

One hundred and thirty-one male and female outpatients, aged 18-70 yr, with acute pain in the ankle joint caused by a post-traumatic sprain, entered a multicentre, randomised, double-blind, parallel-group, study. The patients were assigned to a 40 mg flurbiprofen patch (n = 65) or a non-medicated (but otherwise identical) control (n = 66), 12-hourly over 7 days, and were assessed at entry and after 3 and 7 days treatment. On day 7, spontaneous pain (the prime efficacy parameter), as evaluated by the patient on a visual analogue scale in the physician's office, showed significant improvement in the 40 mg flurbiprofen patch group compared to control (change from baseline) (p = 0.039), a result corroborated by the evaluation of the periarticular oedema: a reduction of 77.4% was observed in the 40 mg flurbiprofen patch group, compared with 63.8% in the control group (p = 0.025). The other selected efficacy criteria showed changes with a trend in favour of the 40 mg flurbiprofen patch but without statistical significance. Two mild and local adverse events were reported by two flurbiprofen patch patients, but neither patients discontinued the treatment prematurely. Physicians and patients found the flurbiprofen patch to be efficacious and well tolerated. Compliance was excellent in both groups. The efficacy and tolerability of the 40 mg flurbiprofen patch are therefore confirmed in the treatment of acute ankle sprains.

[Long-term effects of splenectomy for immune thrombopenic purpura related to human immunodeficiency virus. A retrospective study from 2 groups, with and without splenectomy]. / Effets à long terme de la splénectomie pour purpura thrombopénique immunologique lié au virus de l'immunodéficience humaine. Etude rétrospective à partir de deux groupes, avec et sans splénectomie.

In order to evaluate the long-term effects of splenectomy in patients with human immunodeficiency virus-related immune thrombocytopenic purpura (ITP), we studied retrospectively two populations of patients: 21 had undergone splenectomy and 18 had not. At the time of diagnosis the first population had on average lower platelet counts than the second one. After a mean follow-up of 47 +/- 9 months the situation has been reversed: the population that underwent splenectomy had significantly higher platelet counts than that without splenectomy (190.600 +/- 55.300/mm3 versus 91.500 +/- 55.300/mm3, P less than 0.001). Moreover 76 percent of the patients with splenectomy versus 50 percent in the population without splenectomy were in complete remission of ITP at the last follow-up. It therefore seems that splenectomy had a statistically positive effect on platelet counts without worsening the immune status. Indeed, the clinical course towards AIDS was the same in both populations (35 percent in patients with splenectomy and 22 percent without, P = NS). Following splenectomy, the total blood lymphocytes count was increased, especially the CD8 population, while the CD4 count remains unchanged; these findings seem to be a common feature after splenectomy.

Long-term follow-up of 120 patients with AIDS-related Kaposi's sarcoma treated with interferon alpha-2a.

One hundred and twenty patients suffering from an AIDS-related Kaposi's sarcoma treated by 18 million units of recombinant alpha-2A-interferon daily were followed prospectively for a period of between one and six years. An overall complete response was observed in 35% of these patients; the figure was significantly higher in those who did not have a visceral localization or opportunistic infections. Total lymphocyte count, CD4 lymphocyte count, and CD4/CD8 ratio were significantly higher, and beta-2-microglobuline significantly lower, in the responders than in the non-responders. A multivariate analysis showed that localization of KS and CD4 count had independent predictive value, with an odds ratio of 35 for patients who had more than 300 CD4 cells at the onset of treatment versus those with less than 150. Patients whose initially negative p24 antigenemia remained negative during treatment had the highest frequency of complete response. Among patients with initially positive p24 antigenemia, those whose percentage decrease in antigenemia levels was greatest had a higher frequency of complete response. The cumulative probability of survival in responders was 62% at four years. These results demonstrate an anti-tumoral and anti-viral effect and prolonged survival in a group of patients whose initial immune parameters were relatively well preserved. However, these results do not permit us to conclude whether these well-responding patients were treated at the onset of illness, or whether their illness was naturally less evolutive.

Comparison of sporadic and hereditary forms of medullary thyroid carcinoma.

Between 1960 and 1988, 185 patients with medullary thyroid carcinoma (MTC) were followed at the Institut Gustave Roussy in France. The screening of the family members by calcitonin measurement (basal or after pentagastrin stimulation) has led to the characterization of 38 sporadic cases and 44 hereditary cases. Among the hereditary cases are seven families with MTC only and two families with multiple endocrine neoplasia type 2A (MEN 2A). MTC only cases and MEN 2B cases are present as apparently sporadic forms. Hereditary cases consisted of 26 females and 18 males; the male:female ratio was 21:17 in sporadic cases. Ten of the sporadic patients were deceased (mean age 46 years) compared to three of the hereditary cases (mean age 59 years). The age at diagnosis was 44 years for the sporadic patients and 35 years for the hereditary MTC only patients with clinical manifestations. Histologic data from the sporadic and hereditary patients showed that the tumor is mostly unilateral without C-cell hyperplasia in sporadic cases and bilateral with C-cell hyperplasia in hereditary cases. The location of tumors was quite variable among the sporadic cases and mostly localized to the middle part of the thyroid lobes in the hereditary cases. Our data suggest that the age at diagnosis is later in sporadic forms of MTC and that the age at diagnosis is later in the hereditary forms of MTC only compared to those with MEN 2A.