[Tolerance and feasibility of adjuvant treatment of stage II malignant melanoma with high-dose interferon-alpha]. / Tolérance et faisabilité du traitement adjuvant du mélanome malin stade II par interféron alpha à fortes doses.

BACKGROUND: The use of high-dose interferon alpha as adjuvant therapy has been shown for the first time to improve recurrence-free and overall survival in stage II malignant melanoma. The aim of our work was to evaluate the toxicity of this therapeutic scheme during a 1-year period in 13 patients with malignant melanoma. PATIENTS AND METHODS: Thirteen patients, mean age 56 years, with stage II melanoma were included. Interferon alpha was administered at the dose of 20 MU per m2 body surface area five days per week for four weeks during the induction phase and at the dose of 10 MU subcutaneously three times a week for 48 weeks in the maintenance phase. Patients underwent clinical assessment daily and had blood tests twice a week during the induction phase. Weekly blood tests and monthly examinations were then performed during the maintenance phase. Clinical and biological toxicity was evaluated in accordance with the WHO scores. Grade 3 toxicity led to a 30 p. 100 dose reduction and treatment was interrupted in case of grade 4 toxicity. RESULTS: A flu-like syndrome (grade 1-2) and digestive disorders, nausea, anorexia related to dysgeusia or dry mouth were observed in most of the patients during the induction phase and persisted in 30% of the patients during the maintenance phase. Six patients developed a state of depression (grade 2-3) which persisted during the maintenance phase, inciting us to prescribe an antidepressor regimen for all our patients. One patient developed major reversible alopecia at dose reduction. Nine patients had grade 1 or grade 2 neutropenia and four had grade 3 neutropenia. Seven patients developed grade 1-2 thrombocytopenia, six had elevated transaminase levels (grade 1-2) and two moderately elevated CPK. CONCLUSION: At the end of the induction phase of interferon alpha therapy in 13 patients with malignant melanoma, 8/13 had received 100 p. 100 of the theoretical dose and 11/13 had received 80 p. 100. At the end of the treatment protocol, 5/10 patients had received 100 p. 100 of the theoretical dose and 8/10 more than 80 p. 100. The proposed protocol appears to be feasible without major risk. Rigorous clinical and biological surveillance is mandatory.

An epidemiological study of a Schistosoma intercalatum focus in south-east Gabon.

A Schistosoma intercalatum focus in south-east Gabon was studied between July 1989 and July 1990. Among the 356 permanent residents in the village, 354 provided stool specimens and 101 (28.5%) were excreting eggs (geometric mean of egg density = 101.4 eggs/g, with a range of 1-3200). The pattern of prevalence and intensity of infection with age showed the curve usually found in schistosomiasis, i.e. increasing during the first 2 decades of life and then gradually decreasing. The analysis by stepwise logistic regression of factors shown to be important in determining infection in other schistosomiasis clearly demonstrated the significant and independent effects of both age and water contact on infection by S. intercalatum. These similarities with other schistosomal infections could indicate that similar immune mechanisms were operating. Urine from 284 subjects, of whom 90 were egg excreters, was tested for circulating antigen by enzyme-linked immunosorbent assay using a Schistosoma genus-specific monoclonal antibody (Sm 10.27.12). The test was positive for 90 subjects but only 35 of these were egg excreters. Although S. intercalatum is usually considered of low pathogenicity in man, this study showed a relationship between egg excretion and both splenomegaly and lower haemoglobin levels, even after taking into account the confounding presence of Plasmodium falciparum.

[Value of the use of a stereotaxic framework in the selective thermocoagulation of Gasser's ganglion]. / Intérêt de l'utilisation d'un cadre "stéréotaxique" dans la thermocoagulation sélective du ganglion de Gasser

Impressed by some inconvenients of the presently used method of ocagulation of the gasserian ganglion, authors bring forth the arguments that have led them to modify the "freehand" technique by making use of Rosomoff's cordotomy framework that fastens electrode and patients's head.