Analyse de la littérature et méta-analyse sur l’intérêt de la tomographie par émission (TEP) de positons au fluorodésoxyglucose (FDG) pour le diagnostic et l’évaluation de l’activité des vascularites ...des gros vaisseaux (maladie de Horton et Takayasu).
Recherche bibliographique via Medline, Cochrane Library et Embase des articles évaluant la TEP au FDG dans les vascularites des gros vaisseaux de 01/2000 à 12/2013. Critères d’inclusion : maladie de Horton (critères ACR) et maladie de Takayasu (ACR), définition du seuil de positivité de la TEP, et plus de quatre cas inclus. Sensibilité et spécificité de la TEP au FDG pour le diagnostic de vascularite étaient calculés pour chaque étude, puis poolés pour la méta-analyse.
Vingt et un études étaient inclues avec un total de 413 patients et 299 contrôles. Les sensibilités et spécificité poolées de la TEP au FDG pour le diagnostic de vascularite étaient à 0,77 (95 % CI, 0,69–0,83) et 0,95 (95 % CI, 0,92–0,95), respectivement. Quand seul les patients avec une maladie de Horton était considéré, la sensibilité diagnostique était augmenté à 0,90 (95 %CI, 0,79-0,96) et la spécificité à 0,98 (95 % CI, 0,94–0,99), avec une diminution du coefficient d’hétérogénéité (I-square). Les sensibilité et spécificité de la TEP au FDG pour l’évaluation de l’activité de la maladie de Takayasu étaient à 0,87 (95 % CI, 0,78–0,93) et 0,73 (95 % CI, 0,63–0,81), respectivement. L’analyse en sous-groupes utilisant les études avec une définition de l’activité selon NIH montrait une augmentation de la spécificité à 0,84 0,73 ;0,92, avec une diminution du coefficient d’hétérogénéité. Parmi les différents paramètres de définition de la TEP au FDG (subjectif, semi-quantitatif par rapport au foie, SUVmax), le paramètre le plus intéressant pour la définition d’une atteinte artérielle était l’hypermétabolisme artériel, supérieur au métabolisme physiologique du foie (indice semi-quantitatif).
La TEP au FDG est un outil intéressant pour le diagnostic, en particulier pour la maladie de Horton et l’évaluation de l’activité des vascularites des gros vaisseaux, en particulier la maladie de Takayasu. L’établissement de critères validés de définition de positivité de la TEP au FDG est nécessaire avant la mise en route de recommandations pour l’intérêt de cet examen dans les vascularites des gros vaisseaux.
Long-term results of high-dose therapy followed by autologous stem cell transplantation (HDT-ASCT) as the first-line treatment for patients with myeloma are still poorly reported. To gain further ...insight in the long-term benefits of first-line HDT-ASCT compared with conventional therapy in myeloma, we performed a meta-analysis of individual patient data. We selected randomized trials evaluating HDT-ASCT in patients with previously untreated myeloma from 1990 to 1998, all with a median follow-up of 5 years or more. Individual data of the 3 selected trials were obtained from the study authors. Outcomes were survival, treatment-related mortality, and time without symptoms of disease or toxicity of treatment (TWiST). Five hundred seventy-five patients were analyzed, including 435 deaths (104 months of median follow-up). Compared with conventional therapy and adjusting for prognostic covariates, HDT-ASCT did not significantly prolong long-term survival (stratified hazard ratio, 0.887; 95% confidence interval, 0.735-1.072). This was not modified by accounting for heterogeneity in baseline risks, in treatment of relapse, or in outcomes across trials. There was no evidence of interaction between treatment effect on survival and presentation features. In contrast, a mean gain of 14.5 months (95% confidence interval, 9.9-19.1 mo) in TWiST was observed in the HDT-ASCT group compared with conventional therapy. In conclusion, we showed only a trend toward a long-term survival benefit of HDT-ASCT over conventional therapy for first-line treatment of myeloma. However, HDT-ASCT clearly delayed time to relapse, with a resulting 14.5 months benefit in mean TWiST.
A causal relationship has been established between hyperglycemia and cardiovascular diseases, but no threshold has been retained to determine a 'glycemia-associated' cardiovascular risk. Carotid ...intima-media thickness (CIMT) is an independent predictor for cardiovascular events. High blood pressure is a major determinant of CIMT.
To determine the influence of fasting glycemia on CIMT in hypertensive patients with either normal fasting glucose, impaired fasting glucose (IFG) or type 2 diabetes (DM-2).
We included 158 essential hypertensive patients with either normal fasting glucose (n=74), IFG (n=24) or DM-2 (n=60) in a cross-sectional study. Common carotid IMT was measured with a high resolution echotracking system.
CIMT of DM-2 patients was significantly higher than that of IFG and normal fasting glucose patients (809 +/- 180, 697 +/- 151 and 689 +/- 134 microm, respectively; analysis of variance (ANOVA) P <0.0001). In multivariate analysis in normal fasting glucose patients, local pulse pressure and age were the major determinants of CIMT, whereas glycemia was not. In IFG and DM-2 patients, fasting glycemia was strongly associated with CIMT, explaining 21 and 18% of its variance, respectively. Particularly, in IFG patients, an increase in 1 mmol/l glycemia was associated with a 165 microm increase in CIMT. In hyperglycemic patients, with either IFG or DM-2, age was an important determinant of CIMT, whereas local pulse pressure was not.
These data suggest that glycemia is a major independent determinant of CIMT in hypertensive hyperglycemic patients, not only in DM-2 patients but also at the earlier stage of IFG, offsetting the mechanical role of local pulse pressure.
From January 1995 to June 1998, 136 new cases of non-Hodgkin lymphomas (NHLs) were seen in our center which serves all the French Basque Country (300000 inhabitants). The crude and standardized ...incidence rates were respectively 13.2 and 7.6 cases/100000/year. The distribution of histologic subtypes according to the REAL classification showed a good correlation with the previous published data. Eleven patients (8%) were HIV-positive and two (1.4%) were HCV carriers. Hence, in our region, contrary to Italy, there is no evidence of relationship between HCV and NHLs.
The correlation between the incidence of GVHD and the number of infused CD34 super(+) cells remains controversial for PBSC transplantation after a reduced-intensity-conditioning (RIC) regimen. We ...evaluated 99 patients transplanted with an HLA-identical sibling after the same RIC (2-Gy-TBI/fludarabine). Donor and recipient characteristics, donor's blood G-CSF-mobilized CD34 super(+) cell count, and number of infused CD34 super(+) and CD3 super(+) cells were analyzed as risk factors for acute and chronic GVHD There was a trend for an increased incidence of extensive chronic GVHD in the quartile of patients receiving more than 10 10 super(6) CD34 super(+) cells/kg (P=0.05). Interestingly, the number of donor's blood CD34 super(+) cells at day 5 of G-CSF mobilization was closely associated with the incidence of extensive chronic GVHD, that is, 48% (95% CI: 28-68) at 24-months in the quartile of patients whose donors had the highest CD34 super(+) cell counts versus 24.3% (95% CI: 14-34) in the other patients (P=0.007). In multivariate analysis, the only factor correlating with extensive chronic GVHD (cGVHD) was the donor's blood CD34 super(+) cell count after G-CSF (HR 2.49; 95% CI: 1.16-5.35, P=0.019). This study shows that the incidence of cGVHD is more strongly associated with the donor's ability to mobilize CD34 super(+) cells than with the number of infused CD34 super(+) cells.
The correlation between the incidence of GVHD and the number of infused CD34.sup.+ cells remains controversial for PBSC transplantation after a reduced-intensity-conditioning (RIC) regimen. We ...evaluated 99 patients transplanted with an HLA-identical sibling after the same RIC (2-Gy-TBI/fludarabine). Donor and recipient characteristics, donor's blood G-CSF-mobilized CD34.sup.+ cell count, and number of infused CD34.sup.+ and CD3.sup.+ cells were analyzed as risk factors for acute and chronic GVHD There was a trend for an increased incidence of extensive chronic GVHD in the quartile of patients receiving more than 10 x 10.sup.6 CD34.sup.+ cells/kg (P = 0.05). Interestingly, the number of donor's blood CD34.sup.+ cells at day 5 of G-CSF mobilization was closely associated with the incidence of extensive chronic GVHD, that is, 48% (95% CI: 28-68) at 24-months in the quartile of patients whose donors had the highest CD34.sup.+ cell counts versus 24.3% (95% CI: 14-34) in the other patients (P = 0.007). In multivariate analysis, the only factor correlating with extensive chronic GVHD (cGVHD) was the donor's blood CD34.sup.+ cell count after G-CSF (HR 2.49;95% CI: 1.16-5.35, P = 0.019). This study shows that the incidence of cGVHD is more strongly associated with the donor's ability to mobilize CD34.sup.+ cells than with the number of infused CD34.sup.+ cells. Bone Marrow Transplantation (2012) 47, 1564-1568; doi: 10.1038/bmt.2012.75; published online 21 May 2012 Keywords: PBSC transplantation; GVHD; CD34.sup.+ cell; non-myeloablative conditioning regimen; stem cell mobilization
Abstract Objectives To compare bone-patellar tendon-bone autografts with hamstring autografts for reconstruction of the anterior cruciate ligament. Data sources Medline, WebSPIRS, Science Citation ...Index, Current Contents databases, and Cochrane Central Register of Controlled Trials. Review methods All randomised controlled trials reporting one or more outcome related to stability (instrumented measurement of knee laxity, Lachman test, or pivot shift test) and morbidity (anterior knee pain, kneeling test, loss of extension, or graft failure). Study quality was assessed by using a 5 point scale. Random effect models were used to pool the data. Heterogeneity in the effect of treatment was tested on the basis of study quality, randomisation status, and number of tendon strands used. Results 24 trials of 18 cohorts (1512 patients) met the inclusion criteria. Study quality was poor for nine studies and fair for nine studies. The weighted mean difference of the instrumented measurement of knee laxity was 0.36 (95% confidence interval 0.01 to 0.71; P = 0.04). Relative risk of a positive Lachman test was 1.22 (1.01 to 1.47; P = 0.04), of anterior knee pain 0.57 (0.44 to 0.74; P < 0.0001), of a positive kneeling test 0.26 (0.14 to 0.48; P < 0.0001), and of loss of extension 0.52 (0.34 to 0.80; P = 0.003). Other results were not significant. Conclusion Morbidity was lower for hamstring autografts than for patellar tendon autografts. Evidence that patellar tendon autografts offer better stability was weak. The poor quality of the studies calls into question the robustness of the analyses.
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