Quel suivi thérapeutique pharmacologique pour le Mycophénolate mofétil dans les greffes rénales ?

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

[Evidence-based Therapeutic Drug Monitoring for Saquinavir].

International audienceThe human immunodeficiency virus (HIV) protease inhibitor saquinavir displays a large inter-individual variability in its pharmacokinetic parameters, related to a low absorption rate and an important hepatic metabolism. Based on literature, is the saquinavir therapeutic drug monitoring relevant? In naïve HIV-infected patients, the probability of achieving an undetectable HIV viral load at W48 was significantly associated with a saquinavir plasma trough concentration >100 ng/mL. Two studies in HIV-infected pre-treated patients reported that the genotypic inhibitory quotient was a predictive factor of virologic response with a threshold value around 40 ng/mL/mutation. Concerning the exposure-toxicity relationship, the risk of occurrence of grade 3-4 abdominal pains was more frequently associated with high concentrations of saquinavir, but without threshold value determination. Several studies, one of which was randomized, have reported the interest of saquinavir therapeutic drug monitoring to optimize the virologic response. Therefore, the level of evidence of the interest of saquinavir therapeutic drug monitoring is "recommended"

La reconstruction de la cavité buccale (microchirurgie et perspectives en microdialyse)

BESANCON-BU Médecine pharmacie (250562102) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Impact des concentrations plasmatiques et du suivi thérapeutique pharmacologique de la ribavirine sur la réponse virologique soutenue des patients traités pour hépatite C chronique

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

HISTAMINE ET ARYTHMIES DE REPERFUSION (UNE ETUDE PAR MICRODIALYSE SUR COEURS ISOLES DE RAT (DES BIOL. MED.))

BESANCON-BU Médecine pharmacie (250562102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La sécurité et l'efficacité des produits dermo-cosmétiques (la réalité et la législation internationale)

Dans la civilisation d'aujourd'hui, l'usage de produits dermo-cosmétiques (PDC) par l'Homme est un besoin quotidien indispensable. La plupart des personnes, surtout les femmes, sont des consommatrices actives des PDC, à cause du culte de l'apparence physique et la civilisation du " look ". Lors de l'achat d'un PDC, le consommateur s'intéresse essentiellement à deux critères très importants selon lui : il tient compte de l'efficacité du PDC et de sa sécurité à court et à long terme. - L'objectif de notre travail de thèse était de protéger les consommateurs en assurant l'efficacité des PDC, et surtout éviter les risques de toxicités aiguës et chroniques. Ce travail est divisé en trois parties : [1] Une comparaison entre différentes techniques de quantification du microrelief cutané (in vitro et in vivo) pour vérifier la sensibilité des méthodes contrôlant l'efficacité des PDC. [2] Études de la pénétration cutanée des molécules suspectes utilisées en cosmétique (les parabènes), incorporées dans une lotion commercialisée en pharmacie. Notre objectif était de déterminer les quantités des parabènes qui traversent l'épiderme et le derme et joignent la circulation générale. [3] Établir une comparaison entre les législations des PDC d'aujourd'hui et l'état réel de leurs utilisations par les consommateurs.Nowadays, the use of dermo-cosmetic products by human beings is essential. Many persons, especially women, use frequently cosmetics due to the cult of physical appearance and the importance of the look. A consumer is interested in two criteria when buying a cosmetic product : the efficacy of the product and its security during short or long periods. - The aim of our work was to protect the consumer by proposing methods to assure effective and safe cosmetics. This work is divided in three parts : [1] A comparison between different techniques of skin relief quantification (in vitro and in vivo) : we have verified the sensibility of some methods used in the evaluation of cosmetics efficacy. [2] A percutaneous study : we have evaluated the cutaneous passage, across epidermis-dermis layers of risky molecules : parabens. [3] A comparison between intemational legislations and real use of cosmetics by consumers nowadays.BESANCON-BU Médecine pharmacie (250562102) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

[Monitoring free flaps with cutaneous microdialysis: preliminary study in oral cavity reconstruction]

International audienceINTRODUCTION: Postoperative monitoring of free flaps with microdialysis allows early diagnosis of anastomotic complications. Feasibi-lity studies are required to examine flap accessibility for oral cavity reconstruction. CASES: We present our preliminary findings in two patients who underwent radial free flap reconstruction of the floor of the mouth. For the first patient, a microprobe was used to monitor the flap for 45 hours. In the second case, an abdominal microprobe served as a control in healthy skin with another probe located in the cutaneous flap for 4 days. Flap monitoring, starting from the recovery room, was successful with easy manipulations for the nurse. Correlation between the monitoring curves and the clinical aspect of the flap was excellent. DISCUSSION: The microprobe should be short (1 cm), and carefully anchored. Naso-gastric feeding is required during monitoring. A close correlation has been found between glucose level and systolic pressure. The use of a comparative microprobe in healthy abdominal skin is helpful in learning to use the dialysis curves

Niveau de preuve du suivi thérapeutique pharmacologique de l’étoposide administré par voie orale

L’étoposide administré par voie orale présente une forte variabilité inter- et intra-individuelle. Des relations convaincantes ont été observées entre la toxicité hématologique et les expositions, pour lesquelles l’aire sous la courbe des formes totales apparaît être la plus pertinente en pratique. Un certain nombre d’arguments plaident en faveur du suivi thérapeutique de l’étoposide : cinétique linéaire, stratégies de prélèvements limités, réduction des variabilités lors des études concentration contrôlées. C’est la raison pour laquelle ce suivi peut-être estimé comme recommandé ou éventuellement utile. Des études complémentaires, intégrant des modèles permettant d’obtenir des paramètres pharmacocinétiques individuels (modèles bayésiens), sont cependant nécessaires pour définitivement établir l’intérêt de suivi thérapeutique pharmacologique

[Microdialysis of cutaneous free flaps to monitor results of maxillofacial surgery]

International audienceThe development of in vivo microdialysis has made it possible to monitor cutaneous free flaps in maxillo-facial surgery. A microprobe inserted in the free flap dermis collects a microdialysate enabling measurement of dermal metabolites such as glucose, lactate, pyruvate, or glycerol. The monitoring curves are predictive of ischemia-related tissue injury. Hourly measurements provide a reliable method for early diagnosis of venous or arterial thrombosis. Revision surgery can then be undertaken if needed to repair microanastomoses before clinical alteration. This technique has been compared with validated flaps monitoring systems such as temperature probe, transcutaneous oxygen tension monitoring, and laser Doppler flowmetry. Microdialysis has several advantages: objective measurements, different curves for venous and arterial thrombosis, early diagnosis. Accessibility to oral cavity or pharyngeal flaps requires careful clinical analysis (microprobe fixation, anatomy and choice of flap)

In the shadow of the wrinkle: experimental models.

International audienceResearch on aging has run for decades, and knowledge on the biologic process of skin chronological and photoaging is still increasing thanks to read across results generated between human, animal, and in vitro studies. However, wrinkles should not be considered to result only from the aging process. There are few reports on specific wrinkle histological features compared to the surrounding skin, and there is thus a need in really wrinkling skin animal and in vitro models. UV-irradiated Hr mouse is a good model because it develops wrinkles. Nevertheless, as mouse skin is somehow different from human skin, the innovative model of wrinkling human skin xenograft on SCID mice seems to be really promising. Concerning in vitro and ex vivo models, although there have been considerable advances in reconstructing realistic aged skins, there is still a lack of in vitro wrinkling skin model, and unfortunately, this gap will probably be difficult to fill