Search

Objectives Establish recommendations for the management of UTIs in MS patients. Background Urinary tract infections (UTIs) are common during multiple sclerosis (MS) and are one of the most common comorbidities potentially responsible for deaths from urinary sepsis. Methods The recommendations attempt to answer three main questions about UTIs and MS. The French Group for Recommendations in MS (France4MS) did a systematic review of articles from PubMed and universities databases (01/1980–12/2019). The RAND/UCLA appropriateness method, which has been developed to synthesize the scientific literature and expert opinions on health care topics, was used for reaching a formal agreement. 26 MS experts worked on the full-text review and a group of 70 multidisciplinary health care specialists validated the final evaluation of summarized evidences. Results UTIs are not associated with an increased risk of relapse and permanent worsening of disability. Only febrile UTIs worsen transient disability through the Uhthoff phenomenon. Some immunosuppressive treatments increase the risk of UTIs in MS patients and require special attention especially in case of hypogammaglobulinemia. Experts recommend to treat UTIs in patients with MS, according to recommendations of the general population. Prevention of recurrent UTIs requires stabilization of the neurogenic bladder. In some cases, weekly oral cycling antibiotics can be proposed after specialist advice. Asymptomatic bacteriuria should not be screened for or treated systematically except in special cases (pregnancy and invasive urological procedures). Conclusion Physicians and patients should be aware of the updated recommendations for UTis and MS.

Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

In Xenopus and zebrafish gastrulae, PAPC attenuates planar cell polarity signaling and controls formation of an adhesive, yet flexible, contact at the ectoderm–mesoderm boundary., Cleft-like boundaries represent a type of cell sorting boundary characterized by the presence of a physical gap between tissues. We studied the cleft-like ectoderm–mesoderm boundary in Xenopus laevis and zebrafish gastrulae. We identified the transcription factor Snail1 as being essential for tissue separation, showed that its expression in the mesoderm depends on noncanonical Wnt signaling, and demonstrated that it enables paraxial protocadherin (PAPC) to promote tissue separation through two novel functions. First, PAPC attenuates planar cell polarity signaling at the ectoderm–mesoderm boundary to lower cell adhesion and facilitate cleft formation. Second, PAPC controls formation of a distinct type of adhesive contact between mesoderm and ectoderm cells that shows properties of a cleft-like boundary at the single-cell level. It consists of short stretches of adherens junction–like contacts inserted between intermediate-sized contacts and large intercellular gaps. These roles of PAPC constitute a self/non–self-recognition mechanism that determines the site of boundary formation at the interface between PAPC-expressing and -nonexpressing cells.

Objective: To review trials evaluating the efficacy and safety of Vaxchora, a reformulated, single-dose, oral, lyophilized Vibrio cholerae CVD 103-HgR vaccine for the prevention of travel-related cholera caused by V cholerae serogroup O1. Data Sources: A literature search was conducted using MEDLINE (1946 to January week 3, 2017) and EMBASE (1996 to 2017 week 3). Keywords included oral cholera vaccine, single-dose, Vaxchora, and CVD 103-HgR. Limits included human, clinical trials published in English since 2010. ClinicalTrials.gov was used as a source for unpublished data. Additional data sources were obtained through bibliographic review of selected articles. Study Selection and Data Extraction: Studies that addressed the safety and efficacy of Vaxchora, the reformulated, single-dose oral CVD 103-HgR cholera vaccine, were selected for analysis. Data Synthesis: Approval of Vaxchora, was based on efficacy of the vaccine in human trials demonstrating 90.3% protection among those challenged with V cholerae 10 days after vaccination and in immunogenicity studies with 90% systemic vibriocidal antibody conversion at 6 months after a single-dose of vaccine. Tolerability was acceptable, with the most common adverse effects reported to be fatigue, headache, and abdominal pain. Conclusion: Vaxchora is the only FDA-approved, single-dose oral vaccine for the prevention of cholera caused by V cholerae serogroup O1 in adult travelers from the United States going to cholera-affected areas. Safety and efficacy has not been established in children, immunocompromised persons, and pregnant or breastfeeding women or those living in cholera-endemic areas.

Gastrulation involves of a series of coordinated cell movements to organize the germ layers and establish the major body axes of the embryo. One gastrulation movement is epiboly, which involves the thinning and spreading of a multilayered cell sheet. Epiboly plays a prominent role in zebrafish gastrulation and studies of zebrafish epiboly have provided insights into basic cellular properties and mechanisms of morphogenesis that are widely used in animal development. Although considerable progress has been made in identifying molecules that are required for epiboly, we still understand very little about how these factors cooperate to drive the process. Here, we review work on the molecular and cellular basis of zebrafish epiboly in order to identify unifying themes and to highlight some of the current open questions.

47 patients with stages IIIB and IV Hodgkin's disease underwent laparotomy with splenectomy as restaging procedure after first-line chemotherapy (CT) which included 4 cycles of CT ABV/IMEP/PCAV/ABV. After surgical restaging (SR), all patients were scheduled to receive 2 additional cycles IMEP/PCAV followed by TNI 20 Gy and patients with residual clinical abnormality or positive restaging surgery received a 20 Gy boost to these areas. 11 patients (23.4%) were found to have active disease in the spleen (10 patients) and/or the lymph nodes (3 patients) after SR. In the spleen, foci of active disease had a size in millimeters and confirm the limits of clinical restaging. According to the response to CT, 5 of the 35 patients (14%) clinically restaged as good responders had active disease; 6 of the 12 patients (50%) clinically restaged as poor responders had active disease. SR is of interest in selected patients with slowly responding disease to determine the indication of an extended field RT for responding patients and salvage therapy for patients resistant to CT.

Management of patients with acute severe liver failure is a major clinical challenge. We need to understand better normal and abnormal liver physiology, develop methods of assessing the degree of liver dysfunction, standardize methods of intervention and develop rational procedures to support the acutely failing liver until it either recovers or is replaced. Investigators have attempted to support animals and patients with liver insufficiency, utilizing various extracorporeal support systems including cross-circulation, whole liver blood perfusion, hemadsorption, hemodialysis, plasma exchange, total body wash-out, use of microsomal enzymes bound to artificial carriers and other. None of these therapeutic modalities succeeded in gaining wide clinical acceptance. Charcoal hemoperfusion has been used to treat severe acute liver failure with mixed results. Although there is clear experimental evidence that the technique has some beneficial effects, a controlled prospective clinical study failed to demonstrate significant clinical advantages. Other methods which relied primarily upon blood detoxification, showed limited success as well. Thus it appears that, at least for now, whole organ transplantation remains the only method with clinically-proven efficacy for treating severe acute liver failure. In attempting to develop systems for temporarily supporting patients until an organ becomes available for transplantation and because of the complexity and vast number of metabolic and other physiologic functions provided by the liver, it was felt that to provide effective ex vivo liver support, either utilization of whole organ perfusion or construction of a liver support system utilizing intact, viable, functioning isolated liver cells will be needed.

The influence of HAART on the survival of patients with AIDS-related lymphoma (ARL) was evaluated. A retrospective analysis of 73 HIV-1-infected patients with proven ARL diagnosed between 1992 and 2000 was conducted. Patients received uniformly the same chemotherapy regimen according to CD4 cell counts at NHL diagnosis:, patients with CD4 cells below or above 100 cells x 10(6)/liter received CHOP or ACVBP regimens, respectively. Event-free survival (EFS) and survival were estimated by the Kaplan-Meir method and a Cox model was used to evaluate the effect of different variables on survival. At diagnosis of ARL, the median age was 37 years and 22 patients (30%) had prior AIDS-defining events. Median CD4 cell count was 99 x 10(6)/liter. The median follow-up was 60 months. Ann Arbor stage 3-4 was noted in 60 patients (82%) and bone marrow or meningeal involvement was present in 13 (17%) and 12 (16%) patients, respectively. Two groups were identified: group 1 (n = 38) included patients who had never received HAART and group 2 (n = 35) included those who received HAART either before the diagnosis or following ARL. There was no statistical significant differences in lymphoma extensive stage, presence of B symptoms, meningeal involvement, CD4 cell count at diagnosis, prior AIDS events, or chemotherapy regimens between the two groups. Median survival (MS) of the whole cohort of patients was 8 months. Estimated EFS was significantly higher (30 months) in group 2 compared to group 1 (6.1 months) (p = 0.03). In the multivariate Cox model HAART has an independent significant effect on EFS (p = 0.0085). No influence on outcome was found for other variables except for prior AIDS and bone marrow involvement. HAART has significantly improved the survival and EFS in patients with ARL, independently of chemotherapy regimen.

Resume L’objectif de ce travail etait de tester 1) l’effet de la qualite des donnees medico-administratives sur la comparaison des taux de mortalite hospitaliere ajustes, et 2) l’effet de l’adjonction de variables cliniques d’ajustement au systeme d’information medico-administratif sur la qualite de la prediction. L’etude a porte sur deux pathologies, l’ischemie myocardique aigue et l’insuffisance cardiaque congestive, prises en charge dans des services de cardiologie medicale. Les donnees analysees sont issues de la base de donnees PMSI de l’annee 1998 des hopitaux de l’Assistance publique–hopitaux de Paris. Les variables d’ajustement supplementaires non disponibles dans les donnees PMSI ont ete definies par un groupe de cardiologues. Les resultats mettent en evidence une sous-estimation importante de la comorbidite dans le recueil fait par les cliniciens, en particulier pour les comorbidites qui n’interviennent pas dans le groupage PMSI, mais qui permettent la description du terrain morbide des patients. Par ailleurs, malgre un taux de changement de GHM de 15 % apres recodage, la variation moyenne de points ISA (apres–avant recodage) n’est pas significativement differente de zero. Si les modeles de prediction de mortalite sont plus robustes apres recodage et adjonction de variables supplementaires, il y a peu d’impact de ces facteurs en termes de comparaison des taux de mortalite standardises (SMR).

L’objectif de cette etude etait de mettre en evidence l’heterogeneite des profils medicaux des patients pris en charge en unites de soins de longue duree (SLD), et de rechercher les facteurs de morbidite associes a une lourdeur de prise en charge medicale et soignante. La typologie, effectuee sur une population de 600 patients de SLD, met en evidence deux types de patients, l’un caracterise par peu ou pas de pathologies graves, l’autre, representant pres du tiers de l’effectif, correspondant a des patients avec une polypathologie grave et une forte lourdeur medicale et soignante. Les facteurs associes a la lourdeur de prise en charge sont des pathologies severes telles l’insuffisance cardiaque ou respiratoire evoluees. Le modele predictif de la lourdeur de prise en charge pourra etre utilise pour mesurer l’adequation entre l’etat de ces patients et leur structures optimales de prises en charge.

Background. The standard Q-TWiST approach defines a series of health states and weights each state’s duration according to its quality of life (QOL) to calculate quality-adjusted lifetimes. However, a fixed weight may not adequately reflect time variations in QOL. Methods. To account for measurements derived from irregular visits and informative missing data, the authors estimated the mean QOL profile using a mixed-effect growth curve model for the response, combined with a logistic regression model for the drop-out process. Results. Using data from a clinical study of lymphoma patients, the authors demonstrated better readaptation to normal life for patients younger than 30. Sensitivity analyses and computer simulations demonstrated that modeling the drop-out probability as a function of the QOL measurements is necessary if conditioning by health state is not possible. Conclusion. Our model-based approach is useful to analyze studies with incomplete QOL data, especially when approximate QOL assessment by...

Epiboly, the thinning and spreading of one tissue over another, is a widely employed morphogenetic movement that is essential for the development of many organisms. In the zebrafish embryo, epiboly describes the coordinated vegetal movement of the deep cells, enveloping layer (EVL) and yolk syncytial layer (YSL) to engulf the yolk cell. Recently, we showed that the large GTPase Dynamin plays a fundamental role in epiboly in the early zebrafish embryo. Because Dynamin plays a well-described role in vesicle scission during endocytosis, we predicted that Dynamin might regulate epiboly through participating in bulk removal of the yolk cell membrane ahead of the advancing margin, a proposed part of the epiboly motor. Unexpectedly, we found that Dynamin function was dispensable in the yolk cell and instead, it was required to maintain the epithelial integrity of the EVL during epiboly. Here, we present a model describing the maintenance of EVL integrity, which is required for the proper generation and transmission of tension during epiboly. Furthermore, we discuss the role of Dynamin-mediated regulation of ezrin-radixin-moesin (ERM) family proteins in the maintenance of epithelial integrity.

Epiboly, the first morphogenetic cell movement that occurs in the zebrafish embryo, is the process by which the blastoderm thins and spreads to engulf the yolk cell. This process requires the concerted actions of the deep cells, the enveloping layer (EVL) and the extra-embryonic yolk syncytial layer (YSL). The EVL is mechanically coupled to the YSL which acts as an epiboly motor, generating the force necessary to draw the blastoderm towards the vegetal pole though actomyosin flow and contraction of the actomyosin ring. However, it has been proposed that the endocytic removal of yolk cell membrane just ahead of the advancing blastoderm may also play a role. To assess the contribution of yolk cell endocytosis in driving epiboly movements, we used a combination of drug- and dominant-negative-based approaches to inhibit Dynamin, a large GTPase with a well-characterized role in vesicle scission. We show that Dynamin-dependent endocytosis in the yolk cell is dispensable for epiboly of the blastoderm. However, global inhibition of Dynamin function revealed that Dynamin plays a fundamental role within the blastoderm during epiboly, where it maintains epithelial integrity and the transmission of tension across the EVL. The epithelial defects were associated with disrupted tight junctions and a striking reduction of cortically localized phosphorylated ezrin/radixin/moesin (P-ERM), key regulators of epithelial integrity in other systems. Furthermore, we show that Dynamin maintains EVL and promotes epiboly progression by antagonizing Rho A activity.

The effects on long-term outcome in childhood acute lymphoblastic leukaemia (ALL) of the duration and the intensity of maintenance chemotherapy need to be assessed reliably. With this objective the Childhood ALL Collaborative Group coordinated a worldwide overview of all randomised trials that began before 1987.Individual patient data were sought for about 3900 children in trials of longer vs shorter maintenance (eg, 3 vs 2 years), 3700 in trials of intensive "reinduction" chemotherapy during maintenance, and 4400 in trials of various other questions, including 1300 in trials of pulses of vincristine and prednisone (VP) during maintenance. Analyses were of survival in first remission, overall survival, and cause-specific mortality.Deaths during remission were increased by longer maintenance (2.7 percent vs 1.2 percent), VP pulses (4.0 vs 3.2 percent), and intensive reinduction (4.8 percent vs 3.3 percent), but these increases were counterbalanced by reductions in relapses. Total events (relapse or death) were significantly reduced by longer maintenance (23.3 percent vs 27.6 percent), VP pulses (31.2 percent vs 40.4 percent) and intensive reinduction (27.8 percent vs 35.8 percent) (each 2p0.001). Many of those who relapsed were successfully re-treated, however, and only for intensive reinduction was overall survival significantly improved (18.5 percent vs 22.3 percent; 2p=0.01).Intensive reinduction chemotherapy in these trials produced an absolute improvement of about 4 percent in long-term survival; if the extra deaths in remission had been avoided, this would have been a 5 percent benefit. Further improvements in survival seem more likely to be obtained with intensive treatment than with longer low-level maintenance.

Forty-eight mothers and their 5.5-month-olds participated in a series of face-to-face interactions consisting of a Normal plus three still-face (SF) periods where mothers could touch their infants (SF with touch). The primary objective was to determine whether young infants are sensitive to subtle changes in maternal touch. Variations in infants' affective and attentional responses were revealed as a function of the different periods; infants smiled more when mothers were requested to maximize their smiling using touch alone, and gaze shifted from mothers' faces in the Normal period to their hands in the SF with touch periods. Results imply that: (1) infants are sensitive to subtle changes in their mothers' touching, (2) mothers are effective in using touch to elicit specific infant responses, (3) touch-only interactions are positive, as reflected in infants' gaze and affective displays, (4) mothers use consistent types of touch when touching specific areas of their infants' bodies during brief interactions.

Background: Severe liver failure is associated with high mortality. Orthotopic liver transplantation (OLT) is the only effective therapeutic modality; there is a need for a ‘bridge’ system to support patients until an organ becomes available. Methods: A bioartificial liver (BAL) was used to treat 10 patients with severe liver failure. A plasmapheresis system was used to pump patient plasma through a module with porcine hepatocytes. Each treatment lasted 6-7 h. Results: All patients tolerated the procedures(s) well. Eight patients underwent OLT following BAL treatment(s). There were two late deaths after recovery from liver failure. Five patients with increased intracranial pressure (ICP) and decerebration had ICP normalization, increased cerebral perfusion pressure and full neurologic recovery after OLT. There was improvement in the level of encephalopathy and a significant decrease in serum ammonia after BAL treatment(s). Conclusions: BAL treatment is safe and beneficial and can be successfully used as a...

Despite recent advances in medical supportive therapy, patients with severe fulminant hepatic failure (FHF) have mortality rate approaching 90%. Investigators have attempted to improve survival by using various extracorporeal liver support systems loaded with sorbents and liver tissue preparations. None of them succeeded in gaining clinical acceptance and orthotopic liver transplantation (OLT) remains a primary therapeutic option for patients with FHF. In this study, authors discuss the systems which utilize isolated hepatocytes. Most of these devices were tested in vitro and in animals with chemically and surgically induced liver failure. In some studies, signficant levels of detoxification and liver functions were achieved. The authors describe their own hepatocyte-based artificial liver (BAL). It is based on plasma perfusion through a hollow-fiber module seeded with matrix-anchored porcine hepatocytes. The BAL was used 14 times to treat 9 patients with acute liver failure. On 10 occasions, a charcoal column was included in the plasma circuit. Each treatment lasted 7 +/- 1 h. All procedures were tolerated well and 8 patients (including 6 patients with FHF) underwent OLT. Five patients with increased intracranial pressure (ICP) and evidence of decerebration had normalization of ICP and enjoyed full neurologic recovery after OLT. Laboratory data showed evidence for bilirubin conjugation, decrease in blood ammonia, maintenance of low lactic acid levels, and increase in the ration between the branched chain and aromatic amino acids. No allergic reactions to xenogeneic hepatocytes were observed. The authors conclude that BAL treatment with porcine hepatocytes appears to be safe and can help maintain patients alive and neurologically intact until a liver becomes available for transplantation. (c) 1994 John Wiley & Sons, Inc.

A 56-year-old woman displayed a condition of alternating unilateral lachrymation while she was undergoing psychotherapy. Although she was aware of this condition only since her marriage, hypnotic age regression revealed its existence in childhood, together with mutism and a catatonic trance-like state. Further investigation revealed the connection of this symptom with her family constellation and the reappearance of the unilateral crying as an adult. In this paper we review the neurophysiology of lachrymation, discuss the hypnosis sessions, discuss the symptom as a psychosomatic condition and as a dissociative phenomenon, and present a case report of her background.

The chest radiographs of 252 patients with aggressive non-Hodgkin's lymphoma, prospectively treated according to one of three protocols of combination chemotherapy, were reviewed to determine the incidence and prognostic significance of mediastinal abnormalities following treatment. Residual mediastinal masses were defined as any abnormality, greater than 2 cm in diameter, that had initially responded to chemotherapy and then remained stable in size for at least three months after its maximal response, together with the disappearance of all other clinical and biological signs of active lymphoma. At the end of treatment, 21 (8%) patients had some residual mediastinal abnormality. The predominant histological pattern was the diffuse large cell subtype (p less than 0.001). Disease free survival and overall survival for these patients were similar to those observed among patients in complete remission without a persisting radiological mass after treatment. We conclude that mediastinal residual masses after completion of treatment for aggressive lymphoma are frequent and do not indicate a poorer prognosis. Such patients can be observed clinically without any need for additional chemotherapy or radiotherapy.

The classic calpain system has been implicated in regulating a variety of cellular processes including cell adhesion, migration, and intracellular signaling; however, little is known regarding the function of this system in vivo. Two heterodimeric Ca(2+)-dependent cysteine proteases, mu-calpain (CAPN1) and m-calpain (CAPN2), and the endogenous inhibitor calpastatin (CAST) comprise the classic/ubiquitous calpain system in mammals. Recently, knockout of two murine classic calpain genes, Capn2 and Capn4/Capns1, revealed that components of the classic system are indispensable for preimplantation development. We identified four classic calpain catalytic subunit genes (capn1a, 1b, 2a, 2b), two regulatory subunit genes (capns1a, 1b), and calpastatin (cast) from the zebrafish. Our data suggest that the components of the classic mammalian system are both conserved and expanded in the teleost lineage. In contrast to the classic/ubiquitous mammalian system, zebrafish calpain system genes acquire unique, tissue-specific patterns of expression within the first 2 days of development.

From 1981 to 1984 a randomized clinical trial was conducted to evaluate the role of doxorubicin in low grade malignancy non-Hodgkin's lymphoma (NHL). One hundred and thirteen patients were treated by an induction regimen including cyclophosphamide 400 mg/m2 day 1 and 8, vincristine 1.4 mg/m2 day 1 and 8, procarbazine 80 mg/m2 day 1 to 14, prednisone 60 mg/m2 day 1 to 5 (PCOP regimen) randomly associated to doxorubicin: 20 mg/m2 day 1 and 8 (PACOP regimen). Maintenance therapy consisted of 12 monthly courses of chlorambucil 10 mg/m2 for 5 days or association of cyclophosphamide 300 mg/m2 for 3 days, vincristine 1.4 mg/m2 day 1 and prednisone 60 mg/m2 for 5 days. Complete response (CR) was obtained in 51 patients (45 per cent), in 30 patients after induction regimen and in 21 patients after maintenance therapy, without difference according to regimens. Bone marrow involvement (p = 0.02) and number of involved nodal sites (p = 0.001) were found to influence probability of achieving CR. The median time to progression was estimated to 39 months without difference between regimens. Median overall survival is not reached with a median follow-up of 53 months. Multivariate regression analysis permits observation of negative influence on survival of three parameters: initial bone marrow involvement, age over 50 years and incomplete response to treatment. The initial adjunction of doxorubicin did not seem to influence the appearance of histologic progression.

Enterococcus faecalis , a member of the natural microbiota of animal and human intestinal tracts, is also present as a natural contaminant in a variety of fermented foods. Over the last decade, E. faecalis has emerged as a major cause of nosocomial infections. We investigated the genetic diversity in 30 clinical and food isolates, including strains V583 and MMH594, in order to determine whether clinical and food isolates could be distinguished. Data were obtained using comparative genomic hybridization and specific PCR with a total of 202 probes of E. faecalis , selected using the available V583 genome sequence and part of the MMH594 pathogenicity island. The cognate genes encoded mainly exported proteins. Hybridization data were analyzed by a two-component mixture model that estimates the probability of any given gene to be either present or absent in the strains. A total of 78 genes were found to be variable, as they were absent in at least one isolate. Most of the variable genes were clustered in regions that, in the published V583 sequence, related to prophages or mobile genetic elements. The variable genes were distributed in three main groups: (i) genes equally distributed between clinical and dairy food isolates, (ii) genes absent from dairy food-related isolates, and (iii) genes present in MMH594 and V583 strains only. Further analysis of the distribution of the last gene group in 70 other isolates confirmed that six of the probed genes were always absent in dairy food-related isolates, whereas they were detected in clinical and/or commensal isolates. Two of them corresponded to prophages that were not detected in the cognate isolates, thus possibly extending the number of genes absent from dairy food isolates. Genes specifically detected in clinical isolates may prove valuable for the development of new risk assessment markers for food safety studies and for identification of new factors that may contribute to host colonization or infection.

The Standard Mortality Ratio (SMR), comparing the observed in-hospital mortality to the predicted, may measure the intensive care units (ICU) performance.Multicentric retrospective national study.A probability model using a severity score such SAPS II calculated the predicted mortality rate. A national French study has been undertaken to compare the SMR of ICUs and looked for explanation.One hundred six units, 34 were medical (32%), 18 surgical (17%) and 57 medical/surgical (51%) participated to the study. Forty-six ICUs (43%) were located in teaching hospitals. The SMR of the 87,099 stays was 0.84 (0.82-0.85). The SMR of ICUs varied from 0.41 to 1.55. Ten units had a SMR0.85, which suggested a low performance. They had more stays for cardiovascular failures, as compared with others. The best units (SMR0.82) had more stays for drug overdose. The SMR increased with the number of organ failures, from 0.47 with zero failure to 1.11 with 4 or more organ failures. The stays with cardiovascular failure, either unique or associated, had a higher SMR. The 7935 stays with a drug overdose had a SMR of 0.12 (0.10-0.14), which suggested a bad calibration of the model in theses cases.The case mix must be taken in account when comparing the ICUs performance by the mean of SMR, particularly when the units admitted a lot of drug overdoses.

Research and 'common knowledge' has for many years accepted that education and feedback supplied to individuals during and immediately after workplace health assessments provides valuable information to workers about their health. Further, if more relevant and detailed information could be supplied then awareness and preventative action may increase proportionately. This research carried out with a rural Australian population has shown that preventative action did not increase in proportion to a corresponding increase in the amount and variety of information provided in connection with hearing health status. Two research groups underwent hearing tests, both with pure tone audiometry (PTA) while the second group also underwent otoacoustic emission (OAE) testing. Test results were presented to the subjects at the conclusion of their test session. An analysis of questionnaire responses at six week and twelve months follow up showed that more information did not result in increased preventative action. Barriers seem to exist such that individuals feel that they are not able to effectively act to reduce overall noise exposure. While self-efficacy initially increased, it declined to close to its initial value over the longer period. Other measures such as perceived susceptibility to hearing loss and the benefits of exposure reduction significantly increased and remained at the same increased level after twelve months. So, while overall awareness of noise and the risks of exposure were increased after both types of hearing test there was no increased hearing health benefit due to additional testing and hearing information.

Hospital units report on their inpatient care activity by writing yearly activity reports, which are used by their Medical Information Department (MID) to develop standardized summaries for communication to healthcare authorities. The data are categorized by uniform patient groups and used to describe inpatient care activity and to guide resource allocation. The objective of this study was to evaluate the completeness of activity reports from intensive care units (ICUs) in France.Activity reports sent in 1998 and 1999 by French ICUs participating in the study were collected using dedicated abstracting software supplied to the relevant MIDs. Completeness of data in the activity reports was evaluated, with special attention to the SAPSII score, Omega rating of ICU procedures according to the Classification of Medical Procedures, and primary and secondary diagnoses.The 106 ICUs that volunteered for the study reported data on 107,652-hospital stays. Mean age and SAPSII were 55 +/- 21 years and 35 +/- 21 years, respectively. Mean ICU and hospital lengths of stay were 6.2 +/- 12.4 and 16.1 +/- 21.6 days, respectively. Mean ICU and hospital mortality rates were 15% and 19%. The SAPSII and Omega procedures were reported for 81% and 80% of stays, respectively. The SAPSII and Omega procedures were calculated or coded in 94% (100/106) and 96% (102/106) of ICUs, respectively. Mean number of Omega procedures was 4.3+/-3.9. However, only 5% (5/106) of ICUs entered the SAPSII for every stay, and 21% (22/106) of ICUs failed to enter the SAPSII for over 20% of stays. Similarly, 53% (56/106) of ICUs rated no more than five Omega procedures on average per stay. The primary diagnosis was reported for all stays, and the mean number of secondary diagnoses was 3.5 +/- 3.8. In 80% (86/106) of ICUs, no more than five secondary diagnoses were coded on average per stay.The analysis of this national database shows that data communicated to the MIDs and therefore to the healthcare authorities, are incomplete regarding SAPSII, ICU procedures, treatment intensity, and diagnoses. This may lead to the underestimation of ICU activity and resource needs, particularly if the SAPSII and selected procedures identified as markers for high-intensity critical care are used in the future.

The objective of this study was to highlight the heterogeneous nature of the medical profiles of patients living in long term care units (LCU) and to present the morbidity factors associated with-the weight and burden of ensuring long term medical care and treatment. Typology analysis, performed on a group of 600 LCU patients, highlights two types of patients: one who is characterised by having few or no serious diseases, and the other (representing nearly one-third of the sample population) corresponding to patients with serious poly-pathologies and requiring a high level of medical attention and nursing care. Factors associated with a higher level of care are diseases such as those related to cardiac or respiratory deficiencies. This predictive model for the burden of care could be used to measure the suitability between the state of the patients and the their optimum structures for care.

The French protocol LALA 87 was designed to compare three different postinduction strategies in adult acute lymphocytic leukemia (ALL): chemotherapy, autologous transplantation, and allogeneic transplantation. This trial demonstrated a significant superiority of allogeneic bone marrow transplantation (BMT) in high-risk ALL patients. Similarly, there was a trend in favor of autologous BMT over chemotherapy in those same patients. Allogeneic BMT was not superior to autologous BMT or chemotherapy in less aggressive leukemia (standard-risk ALL). Further improvements are warranted in the treatment of adult ALL. The authors' current ongoing study is stratifying patients to allocate them to regimens with risk-adapted treatment intensity.

Incidence of central nervous system (CNS) recurrence in patients with aggressive non-Hodgkin's lymphoma who did not receive meningeal prophylaxis is about 5%. Controversy remains regarding risk factors associated with such an event preventing a rational approach of prophylactic strategies.We analyzed a cohort of 974 patients with aggressive lymphoma in complete remission (CR). All the patients received a CNS prophylaxis consisting of intrathecal injections and intravenous high-dose methotrexate. The risk repartition on the basis of the international prognostic index (IPI) of these 974 CR-patients was low (L): 41%, low-intermediate (LI): 27%, high-intermediate (HI): 19%, high (H): 13%.The incidence of isolated CNS relapse was 1.6%. In a first multivariate logistic regression analysis an increased LDH (P = 0.05, RR = 5) and the presence of more than one extranodal site (P = 0.05, RR = 3) were identified as independent risk factors for isolated CNS relapse. Another multivariate analysis incorporating IPI as a unique parameter showed that only IPI remained significantly associated with a higher risk of CNS relapse (L-LI: 0.6% vs. HI H: 4.1%, P = 0.002; RR = 7).Prophylaxis notably reduces the risk of CNS recurrence in the higher risk patients. By contrast, we propose the deletion of prophylactic intrathecal injections in the lower risk patients.

Despite high-dose therapy and ASCT some patients with aggressive HD fail to achieve long-term survival.Forty-three patients with induction failure (n = 19) or very unfavorable (UF) relapse (n = 24) from HD were included in a multicentric study of tandem ASCT. They planned to receive two course of IVA75 with GCSF and blood stem cell collection. ASCT1 was conditioned with CBV + mitoxantrone (30 mg/m2) and ASCT2 (cytarabine 6 g/m2 melphalan 140 mg/m2 and total body irradiation at 12 Gy or busulfan 16 (n = 4) than 12 mg/kg). After salvage therapy, response50% was observed in 63% of the patients (six patients were included for refractory relapse). Four patients had no ASCT for disease progression; seven patients had only ASCT1 (disease progression, n = 3) and thirty-two patients (74%) received the two ASCT.Hematologic recovery was normal after ASCT1 but delayed platelet recovery was observed after ASCT2 with busulfan in the conditioning regimen. Two VOD with one fatal occurred with busulfan at 16 mg/kg and one hemorrhagic cystic, no further grade 4 toxicity was observed with the reduced doses of busulfan (12 mg/kg). After ASCT2, 83% of these UF patients were in remission and 20% relapsed within the first year. On an intent-to-treat analysis, 22 of 43 patients are in continuous CR (including 8 patients with induction failure). For the whole population (n = 43) and for patients receiving the two ASCT (n = 32), the two-year survival from the date of progression were respectively at 65% and at 74%.Double ASCT is feasible in very UF relapse from HD and may lead to some prolonged remission.

To evaluate the prevalence and outcome of the acute respiratory distress syndrome (ARDS) among patients requiring mechanical ventilation.A prospective, multi-institutional, initial cohort study including 28-day follow-up.Thirty-six French intensive care units (ICUs) from a working group of the French Intensive Care Society (SRLF).All the patients entering the ICUs during a 14-day period were screened prospectively. Hypoxemic patients, defined as having a PaO(2)/FIO(2) ratio (P/F) of 300 mmHg or less and receiving mechanical ventilation, were classified into three groups, according to the Consensus Conference on ARDS: group 1 refers to ARDS (P/F: 200 mmHg or less and bilateral infiltrates on the chest X-ray); group 2 to acute lung injury (ALI) without having criteria for ARDS (200P/F/= 300 mmHg and bilateral infiltrates) and group 3 to patients with P/F of 300 mmHg or less but having exclusion criteria from the previous groups.Nine hundred seventy-six patients entered the ICUs during the study period, 43 % of them being mechanically ventilated and 213 (22 %) meeting the criteria for one of the three groups. Among all the ICU admissions, ARDS, ALI and group 3 patients amounted, respectively, to 6.9 % (67), 1.8 % (17) and 13.3 % (129) of the patients, and represented 31.5 %, 8.1 % and 60.2 % of the hypoxemic, ventilated patients. The overall mortality rate was 41 % and was significantly higher in ARDS patients than in the others (60 % vs 31 % p0.01). In group 3, 42 patients had P/F less than 200 mmHg associated with unilateral lung injury; mortality was significantly lower (40.5 %) than in the ARDS group. In the whole group of hypoxemic, ventilated patients, septic shock and severity indices but not oxygenation indices were significantly associated with mortality, while the association with immunosuppression revealed only a trend (p = 0.06).In this survey we found that very few patients fulfilled the ALI non-ARDS criteria and that the mortality of the group with ARDS was high.

Objectifs Connaitre le projet de l’imagerie electronique de l’AP-HP. Points cles La realisation d’un PACS ‘partage’ au sein de l’assistance publique des hopitaux de paris. La base centrale des index images permettant de synchroniser les systemes « independents » sans replication des donnees. Resume Le projet « imagerie electronique » de l’Assistance Publique – Hopitaux de Paris se deroule depuis 2005 en plusieurs phases successives« transversales » a l’ensemble des hopitaux de l’AP-HP. Vingt solutions identiques de stockage des images medicales (une par hopital MCO) ont ete installees pendant la premiere phase. La deuxieme phase comprend simultanement la connexion des hopitaux SSR et la realisation d’une interface avec le dossier clinique permettant aux cliniciens d’acceder aux images stockees. Enfin la creation d’une base centrale d’index synchronisee de toutes les zones de stockage (sans aucune replication des donnees images) a ete realisee. Le systeme en place permet en 2008 le stockage « en ligne » en format DICOM lossless de toute la production d’imagerie de l’AP-HP pendant une periode minimale de 5 ans et l’acces pour un utilisateur autorise a un examen d’imagerie de l’AP-HP quelque soit son lieu de production.

Angiogenesis has an important role in the progression of solid tumors. Therefore, we measured the blood levels (ELISA) of angiogenic factors [basic fibroblast growth factor (bFGF), hepatocyte growth factor/scatter factor, and vascular endothelial growth factor (VEGF)] and soluble adhesion molecules [E-selectin, intercellular adhesion molecule (ICAM-1), platelet endothelial cell adhesion molecule-1, and vascular cell adhesion molecule-1] in 76 consecutive patients with untreated renal cell carcinoma and 41 healthy controls to evaluate their prognostic value. The serum levels of bFGF, hepatocyte growth factor, and VEGF were significantly higher in patients with renal cancer than they were in healthy subjects. bFGF and VEGF values were significantly higher in patients with disseminated cancer (N+ and/or M+) than they were in those with undisseminated (M-N-) cancer: median = 27 pg/ml, range = 5-118, n = 15 versus median = 8 pg/ml, range = 1-149, n = 61 (P = 10(-4)) for bFGF; and median = 883 pg/ml, range = 200-2317, n = 15 versus median = 278 pg/ml, range = 0-1704, n = 61 (P = 0.006) for VEGF. The blood levels of ICAM-1 and vascular cell adhesion molecule-1 were significantly higher, and the levels of E-selectin and platelet endothelial cell adhesion molecule-1 were significantly lower in patients with renal cancer than they were in controls. Plasma ICAM-1 was higher in metastatic patients (M+) than they were in nonmetastatic (M-) patients: median = 687 ng/ml, range = 294-1091, n = 12 versus median = 408 ng/ml, range = 217-1375, n = 64 (P = 10(-4)). ICAM-1 and bFGF blood values were correlated with the size of the primary tumor. The interleukin 6 and tumor necrosis factor-alpha (TNF-alpha) values of these patients have been previously published and are included in the survival analysis. Univariate analysis showed that bFGF, ICAM-1, interleukin 6, and TNF-alpha, before treatment, were prognostic factors. In multivariate analysis for proportional hazard regression, only TNF-alpha was an independent prognostic indicator, with a normal plasma TNF-alpha being highly predictive for a good prognosis in patients with untreated renal cell carcinoma.

The purpose of this study was to, assess the efficacy of glycosylated recombinant human granulocyte colony-stimulating factor (lenograstim) in the prevention of neutropenia and infection in patients receiving dose-intensive chemotherapy for non-Hodgkin's lymphoma (NHL). A second objective was to determine clinical predicators of delay to cytotoxic chemotherapy administration. One hundred-sixty two patients with intermediate- or high-grade NHL and at least one poor prognostic factor received a total of 4 cycles of the LNH-84-regimen every 2 weeks, with an open randomization to treatment with anthracyclines. Patients were randomized to receive subcutaneous lenograstim 5 micrograms/kg/day (n = 82) or placebo (n = 80) from day 6 to day 13 of each cycle. The incidence of severe neutropenia (absolute neutrophil count (ANC)0.5 x 10(9)/L) was reduced in the lenograstim group compared with placebo (52% vs 75%). A significant reduction (p0.001) in the median duration of ANC0.5 x 10(9)/L was also observed in patients treated with lenograstim during each cycle of chemotherapy (0-1 day vs 2-4 days in placebo recipients). Fever occurred in 66 patients in each treatment group. Thirty-four percent of placebo recipients had documented infections during ANC1.0 x 10(9)/L compared with 18.5% of lenograstim-treated patients (p0.05). Infections ofor = 2 severity were significantly less frequent (p = 0.001) among lenograstim recipients compared with placebo (25 vs 49). The most common adverse events among lenograstim recipients were headache, mild bone pain and injection site reactions. Although lenograstim significantly increased (p = 0.0001) relative dose intensity compared with placebo (93% vs 80%), no difference in CR rate (67% vs 71%) or 3-year survival (63% vs 55%) was observed. The results of this study suggest that patients treated with a chemotherapy regimen that induces severe neutropenia can benefit from treatment with lenograstim. Furthermore, lenograstim permits treatment to be delivered at full dose intensity at 2 week intervals, even in patients with bone marrow involvement, and may permit further dose escalation of the chemotherapeutic regimen used.

Dose-intensive treatment followed by ABMT is currently used in different approaches to treat breast cancer patients. An active non cross-resistant regimen combining cyclophosphamide (C), mitoxantrone (M) and melphalan (A) (CMA), was developed as the conditioning regimen before ABMT. The purpose of this phase II study was to evaluate this protocol and the duration of its effect in metastatic patients, who responded to chemotherapy. Criteria for inclusion included histologically documented breast cancer, age55 years and the first detection of measurable metastatic lesions. Following first-line chemotherapy in responding patients, histologically negative bone marrow was collected and cryopreserved. Then, intensification with cyclophosphamide (120 mg/kg), mitoxantrone (60 mg/m2), and melphalan (140 mg/m2) was followed by ABMT. Sixty-one metastatic breast cancer patients with a mean age of 40 years were included. Sites of measurable metastases included: liver 24, lung 14, central nervous system four, pleura three, skin six, and chest wall six, nodes eight and bone marrow one. Nineteen patients had lesions in two or more sites, and 22 had bone involvement. The response of 60 patients could be evaluated: before ABMT 31 were in clinical complete response (CR), 22 in partial response50% (PR), and seven had new progression. After ABMT, 36 patients were in CR, 16 in PR, one progressed and one was stable. Seven (11.5%) toxic deaths occurred. Mean time for hematological recovery was 32.5 days, without hematopoietic growth factors. Median survival was 33 +/- 9.4 months from the start of therapy, and 25.7 +/- 4.6 months from the date of ABMT. Median event-free survival was 20 months from the start of therapy, and 13 +/- 2 months from ABMT. With a median follow-up of 51 months, probability of actuarial survival, measured from the beginning of initial chemotherapy, was 36%, and event-free survival was 18%. In metastatic breast cancer responding to chemotherapy, high-dose consolidation with CMA and ABMT resulted in a median survival of 33 months. These results lay the ground work for evaluation in a randomized trial in metastatic breast cancer.

Resume Le mode de financement des etablissements de sante va devenir mixte : Une partie est directement liee a l’activite, l’autre partie correspond a une dotation dans le cadre d’une mission d’interet general. 1- Le financement lie a l’activite repose sur trois types de recettes : - des recettes induites par des sejours de patients dans les centres hospitaliers. Ainsi, l’hopital ou la clinique peut etre beneficiaire ou deficitaire. - des recettes qui decoulent de prestations (consultations, prestations externes, urgences) et qui donnent lieu a l’octroi de forfaits annuels. - enfin le paiement par la tutelle des innovations, des medicaments, ainsi que de divers dispositifs medicaux. 2- Le deuxieme mode de financement est la dotation par deux enveloppes : l’une correspond a l’activite d’enseignement et de recherche. Les criteres d’attribution doivent etre definis en 2005 ou 2006. L’autre decoule de projets de contractualisation entre l’etablissement et la tutelle. Consequences pour l’imagerie medicale : A partir de l’evaluation des couts par GHM en fonction de la DMS, une evaluation des couts de l’imagerie par GHM a ete faite tenant compte du cout de chaque examen et du nombre d’examens prescrits. Il s’avere donc possible d’etablir des comparaisons par rapport a la moyenne nationale. Chaque responsable de pole medical ou chirurgical aura donc son budget clinique et medico-technique. On peut ainsi envisager l’etablissement de contrat avec l’imagerie visant a optimiser la productivite. Une bonne productivite doit permettre une diminution des durees de sejour par le raccourcissement des delais de rendez-vous des examens d’imagerie pour les malades hospitalises. L’ouverture des poles d’imagerie aux consultants externes ne s’envisage que dans la mesure ou la productivite pour les malades hospitalises est suffisante.

One hundred and seventy three clinical isolates of mannitol fermenter staphylococci, including 120 S. aureus (38% methicillin resistant) and 53 coagulase negative staphylococci were assayed for direct detection of S. aureus on colonies. Three new rapid slide agglutination tests were compared: Pastorex Staph Plus, Slidex Staph Kit and Staph aureus. Each one detects fibrinogen receptor and protein A. According to the addition of monoclonal antibodies, Pastorex Staph plus is intended to detect capsular antigens 5 and 8, and Slidex Staph kit to detect a surface glycopolysaccharide. Sensitivities of these tests were equal, Pastorex Staph plus 95%, Slidex Staph kit 94.2%, Staph aureus 95.8%. Among meticillin-resistant S. aureus, sensitivities reached 91.3%, 87% and 91.3% respectively. Specificities over coagulase negative staphylococci which gave conclusive results were 92.5%, 90.2% and 90.4% respectively. The validity of these results was checked over 100 staphylococcal primary isolates of medical samples in April 1994. Over 62 S. aureus (29% methicillin-resistant) Pastorex Staph plus and Staph aureus sensitivities were 96.8% and 98.4% respectively and specificities were 94.6% and 91.9% over 37 coagulase negative staphylococci which gave conclusive results. Staph aureus test sensitivity is at least equivalent to second generation tests as well in primary cultures as in subcultures The best specifity is achieved with Pastorex Staph plus, which contains latex particles without red blood cells.

If complete remission (CR) is now obtained in close to 80% of cases, with intensified induction chemotherapy [1, 2, 3], in adult acute lymphoblastic leukemia (ALL) preventive treatments of relapse is still controversial and subject of much debate. Several approaches may be used in post remission: chemotherapy, allogenic bone marrow transplantation (BMT) or autologous bone marrow transplantation [4,5,6].

In order to assess the eventual prognostic significance of early response to chemotherapy in adult acute lymphoblastic leukemia (ALL), we recommended to perform a bone marrow aspiration at day 15 after the beginning of the induction, in the last two French multicentric trials: AALL85 and AALL87.

Interferon alfa and cytotoxic drugs have synergistic effects in patients with non-Hodgkin's lymphoma. In 1986, we designed a clinical trial to evaluate the benefit of concomitant administration of recombinant interferon alfa with a regimen containing doxorubicin in patients with follicular non-Hodgkin's lymphoma.The trial involved 242 patients with advanced low-grade follicular non-Hodgkin's lymphoma selected on the basis of clinical, radiographic, and biologic criteria. All patients were treated with a regimen consisting of cyclophosphamide, doxorubicin, teniposide, and prednisone (CHVP), given monthly for six cycles and then every two months for one year. After randomization, 123 patients also received interferon alfa-2b at a dosage of 5 million units three times weekly for 18 months. The remaining 119 patients received chemotherapy alone.As compared with the patients treated with CHVP only, the patients treated with CHVP plus interferon alfa had a higher overall rate of response (85 percent vs. 69 percent, P = 0.006), a longer median event-free survival (34 months vs. 19 months, P0.001), and a higher rate of survival at 3 years (86 percent vs. 69 percent, P = 0.02). Granulocyte toxicity was greater in the patients treated with CHVP plus interferon alfa than in those treated with CHVP alone. There were no treatment-related deaths. Interferon alfa had to be stopped because of toxic effects (fatigue and hepatitis) in 13 patients (11 percent).The addition of interferon alfa to a regimen containing doxorubicin increased the rate of response, event-free survival, and overall survival in patients with advanced follicular non-Hodgkin's lymphoma, without serious toxicity, although some patients were unable to tolerate the side effects.

To evaluate the effects of chemotherapy dose intensity (DI) on outcome in patients with aggressive lymphoma, the received relative DI (received RDI) is usually calculated using Hryniuk's model. We applied this model to a selected patient subgroup included in the LNH87 protocol (LNH87-2 protocol), who had been treated with the ACVB induction regimen.Patients aged55 who had at least one of the following prognostic factors: performance status (PS)or = 2, number of extranodal sitesor = 2, tumor burdenor = 10 cm, bone marrow or central nervous system involvement, and Burkitt's or lymphoblastic histologic subtype, were included in this study. Actual DI was calculated using the definition of DI as mg/m2/week previously described by Hryniuk.Eighty-seven of the 311 patients included in the study (28%) presented a RDI below 70% of the theoretical DI. We demonstrated a decreased response rate (65% vs. 79%, p = 0.01) and shorter overall 2-year survival (61% vs. 72%, p = 0.02) in patients receiving a DI70%. This difference was still significant when the multiparametric analysis was used (p = 0.004).Results obtained when this model was applied to aggressive lymphoma patients included in the LNH-87 protocol led to the demonstration of a strong relationship between received RDI and survival.

An increased risk of high-grade non-Hodgkin's lymphoma is observed in patients who are seropositive for human immunodeficiency virus (HIV). Treatment of such patients is complicated by their underlying acquired immunodeficiency syndrome (AIDS). Intensive strategies such as those used in non-HIV-related lymphoma may be poorly tolerated. However, patients without severe AIDS may derive significant benefits from such an approach. In a prospective multicenter study, treatment outcomes were assessed in 141 cases of HIV-seropositive lymphomas submitted to aggressive chemotherapy.Adult patients with lymphoma with a performance status less than 3 and no active opportunistic infection were consecutively treated with three cycles of doxorubicin 75 mg/m2, cyclophosphamide 1,200 mg/m2, vindesine 2 mg/m2 for 2 days, bleomycin 10 mg for 2 days, and prednisolone 60 mg/m2 for 5 days (ACVB). This treatment was followed by a consolidation phase of high-dose methotrexate plus leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH84). Central nervous system prophylaxis with intrathecal methotrexate was routinely used. Zidovudine maintenance therapy was started after chemotherapy. Ninety-three patients had high-grade lymphomas (59 Burkitt's type) and 48 had intermediate-grade lymphomas. Disseminated stage III-IV was present in 86 patients, meningeal involvement in 29, and bone marrow infiltration in 30; 62 patients had more than 2 extranodal localizations. Lactate dehydrogenase levels were above the normal value in 95 cases. The median CD4-positive lymphocyte count was 227 x 10(6)/L.Eighty-nine patients (63%) achieved complete remission (CR) and 19 (13%) partial remission, whereas 13 did not respond and 20 (14%) died during the course of ACVB, 8 of them from progressive disease. With a median follow-up of 28 months, median survival and disease-free survival were 9 and 16 months, respectively. Median survival for nonresponders was 5 months; 23 patients died of opportunistic infections while in persistent CR. In multivariate analysis, four factors were strongly associated with shorter survival: (1) CD4 count less than 100 x 10(6)/L, (2) performance status greater than 1, (3) immunoblastic lymphoma, and (4) prior AIDS. In the absence of all risk factors, the probability of survival at 2 years was 50%.In a selected group of HIV-related lymphomas, intensive chemotherapy with LNH84 is feasible and yields a high CR rate. Survival is short due to death from HIV-related infections; however, in a subgroup of patients without adverse prognostic factors, long-term remission was observed.