A História da Alimentação: balizas historiográficas

Os M. pretenderam traçar um quadro da História da Alimentação, não como um novo ramo epistemológico da disciplina, mas como um campo em desenvolvimento de práticas e atividades especializadas, incluindo pesquisa, formação, publicações, associações, encontros acadêmicos, etc. Um breve relato das condições em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biológica, a econômica, a social, a cultural e a filosófica!, assim como da identificação das contribuições mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histórica, foi ela organizada segundo critérios morfológicos. A seguir, alguns tópicos importantes mereceram tratamento à parte: a fome, o alimento e o domínio religioso, as descobertas européias e a difusão mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rápido balanço crítico da historiografia brasileira sobre o tema

Nouvelle prise en charge des patients âgés atteints d hémopathie maligne (Place du médecin généraliste dans l évaluation gériatrique pré-thérapeutique dans le service d Hématologie de l Hôpital d Instruction des Armées Percy )

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Greffe de sang placentaire à conditionnement atténué (optimisation de l immunosuppression pré-greffe par irradiation corporelle totale 4 grays)

PARIS7-Xavier Bichat (751182101) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Exploration des performances physiques après traitement pour hémopathie maligne

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Postremission treatment of elderly patients with acute myeloid leukemia in first complete remission after intensive induction chemotherapy: results of the multicenter randomized Acute Leukemia French Association (ALFA) 9803 trial.

International audienceIn elderly patients with acute myeloid leukemia (AML) treated intensively, no best postremission strategy has emerged yet. This clinical trial enrolled 416 patients with AML aged 65 years or older who were considered eligible for standard intensive chemotherapy, with a first randomization comparing idarubicin with daunorubicin for all treatment sequences. After induction, an ambulatory postremission strategy based on 6 consolidation cycles administered monthly in outpatients was randomly compared with an intensive strategy with a single intensive consolidation course similar to induction. Complete remission (CR) rate was 57% with 10% induction deaths, and estimated overall survival was 27% at 2 years and 12% at 4 years, without notable differences between anthracycline arms. Among the 236 patients who reached CR, 164 (69%) were randomized for the postremission comparison. In these patients, the multivariate odds ratio in favor of the ambulatory arm was 1.51 for disease-free survival (P.05) and 1.59 for overall survival from CR (P.04). Despite repeated courses of chemotherapy associated with a longer time under treatment, the ambulatory arm was associated with significantly shorter rehospitalization duration and lower red blood cell unit and platelet transfusion requirements than observed in the intensive arm. In conclusion, more prolonged ambulatory treatment should be preferred to intensive chemotherapy as postremission therapy in elderly patients with AML reaching CR after standard intensive remission induction

Hematopoietic Recovery using Multi-Cytokine Therapy in 8 Patients Presenting Radiation-Induced Myelosuppression after Radiological Accidents

International audienceTreatment of accidental radiation-induced myelosuppressionis primarily based on supportive care and requiresspecific treatment based on hematopoietic growth factorsinjection or hematopoietic cell transplantation for the mostsevere cases. The cytokines used consisted of pegylatederythropoietin (darbepoetin alfa) 500 IU once per week,pegylated G-CSF (pegfilgrastim) 6 mg 3 2 once, stem cellfactor 20 lg.kg–1 for five days, and romiplostim (TPO analog)10 lg.kg1 once per week, with different combinationsdepending on the accidents. As the stem cell factor did nothave regulatory approval for clinical use in France, theFrench regulatory authorities (ANSM, formerly, AFSSAPS)approved their compassionate use as an investigational drug‘‘on a case-by-case basis’’. According to the evolution andclinical characteristics, each patient’s treatment was adoptedon an individual basis. Daily blood count allows initiating GCSFand SCF delivery when granulocyte ,1,000/mm3, TPOdelivery when platelets ,50,000/mm3, and EPO when Hb,80g/L. The length of each treatment was based on blood cellrecovery criteria. The concept of ‘‘stimulation strategy’’ islinked to each patient’s residual hematopoiesis, which variesamong them, depending on the radiation exposure’s characteristicsand heterogeneity. This paper reports the medicalmanagement of 8 overexposed patients to ionizing radiation.The recovery of bone marrow function after myelosuppressionwas accelerated using growth factors, optimized bymultiple-line combinations. Particularly in the event ofprolonged exposure to ionizing radiation in dose ranges inducing severe myelosuppression (in the order of 5 to 8 Gy),with no indication of hematopoietic stem cell transplantation

Infectious complications in adult acute myeloid leukemia: analysis of the Acute Leukemia French Association-9802 prospective multicenter clinical trial.

International audienceInfections are a major complication in patients with acute myeloid leukemia undergoing intensive chemotherapy. They remain a major cause of therapy-associated morbidity and mortality, and represent a frequent cause of treatment withdrawal. An analysis of the medical charts of 459 younger adults included in the multicenter Acute Leukemia French Association (ALFA)-9802 trial showed that 1369 febrile episodes occurred among the 459 registered patients, including fever without identifiable source (23%) and clinically or microbiologically documented infections (77%). Bloodstream infections occurred in 314 episodes, including 129 documented episodes with Gram-positive and 96 with Gram-negative pathogens. Pulmonary infection was diagnosed in 144/1054 documented infectious episodes (14%). Invasive fungal infection was probable or proven in 116 patients. In all, 15 patients died of infection-associated complications, of whom seven died during early induction therapy, one during salvage therapy and seven during consolidation therapy. Better supportive care strategies may improve overall survival in patients undergoing chemotherapy for acute myeloid leukemia