[Palifermin in the preventive treatment of oral mucositis in autograft patients: data on efficacy and tolerance following marketing approval]. / Le palifermin dans le traitement préventif de la mucite buccale chez les patients autogreffés: données d'efficacité et de tolérance après autorisation de mise sur le marché

BACKGROUND: Few data are available on the efficacy of and tolerance to palifermin in the preventive treatment of oral mucositis in autograft patients treated with conditioning protocols usually used in France. METHODS: Our retrospective study bears on the first five candidates for autograft who benefited from prophylactic treatment with palifermin (60 microg/kg/day) between December 2005 and March 2006. RESULTS: Despite the prophylactic treatment, 3 patients developed severe oral mucositis. Moreover, in 3 patients, palifermin was found to be responsible for the onset of severe toxidermia, which required, in 2 cases, interruption of the treatment. CONCLUSION: These results need to be confirmed by a larger study that would also make it possible to evaluate the impact of palifermin on morbi-mortality in autograft patients in France, and to determine the safety profile of this drug.

[Good clinical practices and inpatient antibiotics: optimization of fluoroquinolone switch therapy]. / Bon usage des antibiotiques: optimisation du relais per os des fluoroquinolones.

OBJECTIVE: Intravenous-to-oral switch therapy is strongly recommended in the medical literature. The aim of this study was to assess how we can improve fluoroquinolone switch therapy. METHODS: In this comparative prospective study, we analyzed 243 intravenous ciprofloxacin treatments and assessed the impact of promoting a switch to oral step-down therapy. RESULTS: This study found that switches from intravenous to oral therapy increased, mainly in medical wards, and led to significant savings in direct costs. DISCUSSION: Promoting switch therapy has improved clinical practices in antibiotic use and led to lower direct and probably indirect drug-related costs. CONCLUSION: Our findings will help define the role of switch therapy in improving clinical practices in inpatient antibiotic use.

Coronary thrombectomy, technical comparison of two systems on a laboratory bench: the impact of bends, angles and thrombus age.

AIMS: Despite the results of recent randomised studies, the systematic use of aspiration techniques in ST-elevation myocardial infarction has not been included in the new guidelines. To date, there have been very few bench tests of the different systems and the aim of our study was to test two catheters on different models of arteries with thrombi at six and 12 hours. METHODS AND RESULTS: The test apparatus consisted of 3 mm diameter glass tubes of 150 mm in length. The thrombi were left for either six or 12 hours and ten models of tubes were used: straight, with a single bend and with two bends. Two types of catheters were tested: the Export® aspiration catheter (EAC) and the Proxis® embolic protection system (PES). The main assessment criterion was total thrombectomy. Total thrombectomy was achieved in only 55.3% of the tests and no difference appeared between the two systems. Total thrombectomy was achieved more frequently with 6-hour thrombi than with 12-hour thrombi for the two techniques, 62.5% vs. 42.5% (p = 0.018) and 67.5% vs. 48.7% (p = 0.025) for EAC and PES catheter, respectively. In contrast, total thrombectomy was more frequent in straight tubes and in tubes with a single bend than in tubes with double bends, respectively for EAC (64% vs. 44.8%, p = 0.028) and for PES (85.9% vs. 35.4%, p < 0.001). CONCLUSIONS: The use of thrombectomy in the invasive management of acute coronary syndromes is growing. Our work on a "laboratory bench" reveals important technical differences. In consequence, in clinical practice, we speculate that the catheter system must be chosen according to both the artery anatomy and the delay between chest pain and PCI.

[Economic impact of transarterial chemoembolization with drug eluting beads in the treatment of hepatocellular carcinoma]. / Impact économique de la chimioembolisation avec microsphères chargées dans le traitement du carcinome hépatocellulaire.

Transarterial chemoembolization (TACE) is the standard treatment in patients with unresectable non-metastatic hepatocellular carcinoma (HCC). New drug eluting beads aim at improving efficacy of TACE in retaining as long as possible the anticancer drug within the tumor. Our monocentric study compares direct hospital medical costs, according to two different methods, for a first course of conventional TACE and for a first course of TACE using drug eluting beads in 30 patients with HCC. The average cost of a first course of conventional TACE valued by the analytic accounting system is 4 332 € versus 3 577 € for a first course of TACE using drug eluting beads. The average cost of a first course of conventional TACE valued by the official tariffs from the new French Diagnosis Related Group prospective payment system is 4 507 € (+175 €) versus 2 852 € (-725 €) for a first course of TACE using drug eluting beads. Our study shows that a first TACE using drug eluting beads, valued by the official tariffs from the new French Diagnosis Related Group prospective payment system, is significantly (p  =  0.006) less expensive than a first conventional TACE.