Estimation of glomerular filtration rate in cancer patients with abnormal body composition and relation with carboplatin toxicity.

PURPOSE: Carboplatin clearance is correlated with glomerular filtration rate (GFR) and usually estimated with creatinine clearance using Cockcroft-Gault (CG) formula. Because plasma creatinine level is highly correlated with muscle mass, we hypothesized that an abnormal body composition with a low lean body mass (LBM) percentage [(LBM/weight) × 100] may result in inadequate carboplatin dosing. Serum cystatin C is an alternative marker of GFR, not affected by muscle mass. We aimed to investigate the influence of total LBM and LBM percentage on GFR calculation, using creatinine (CrCl) or cystatin C (GFRcysC-creat) in cancer patients. METHODS: Pretreatment serum creatinine and cystatin C were prospectively measured in consecutive patients. CrCl (CG formula), GFRcysC-creat (CKD-EPI creatinine-cystatin equation), and LBM (CT scan) were calculated. Severe thrombocytopenia post-carboplatin were analyzed. RESULTS: In 131 patients without renal insufficiency, LBM was correlated with creatinine (r = 0.30, p < 0.005) but not with cystatin C (r = -0.07, p = 0.43). In patients with the lowest LBM percentage, the CrCl was significantly higher than GFRcysC-creat indicating an overestimation of GFR with creatinine (p = 0.0004). In 24 patients treated with carboplatin AUC 5 (mg/ml min) ± paclitaxel, the risk of severe thrombocytopenia was associated with lower LBM percentage (p = 0.0002) and higher CrCl/GFRcysC-creat ratio (p = 0.006). By ROC analysis, the CrCl/GFRcysC-creat ratio threshold predicting severe thrombocytopenia was 1.23. CONCLUSIONS: A low LBM percentage increases the risk of inadequate GFR calculation by CG formula, and carboplatin overdosage with severe thrombocytopenia. High CrCl/GFRcysC-creat ratio allows the identification of these patients.

An immunomodulation strategy targeted towards immunocompetent cells or cytokines in inflammatory bowel diseases (IBD).

Many immunological abnormalities have been described in inflammatory bowel diseases (IBD). Even though, no clear cut primary defects have yet been described, some therapeutic trials have targeted either immunocompetent cells or overproduction of cytokines. Preliminary results have shown that antisense oligonucleotides (anti-ICAM), anti-cytokine antibodies (anti-TNF) or recombinant human cytokines (IL-10 or IL-11) are effective in some patients with Crohn's disease refractory to steroids. However, these data need to be confirmed and the potential side effects of these treatments must be further considered. These drugs need to be more precisely defined in particular compared to corticotherapy. Finally, data from immunomodulation strategies should help us understand the aetiology of abnormal immune responses in Crohn's disease (CD) and ulcerative colitis (UC).

[Bone complications from chronic etretinate intoxication in children]. / Complications osseuses de l'intoxication chronique par l'étrétinate chez l'enfant.

Clinical, roentgenographic and biologic features of etretinate bone toxicity in a 13-year-old girl with pachyonychia congenita syndrome are reported. Etretinate is a synthetic derivative of vitamin A that infrequently induces bone and joint abnormalities in children. The following manifestations can be observed: cortical hyperostosis, pain, calcification of tendons, thinning of long bones, demineralization, premature closure of epiphyses, or abnormal remodelling. Onset of these anomalies is often delayed since etretinate has a long half-life. Mechanisms are unknown. We advocate use of the minimum effective dosage and regular monitoring of patients.

[Separation of the distal humeral epiphysis in young children. Radiologic features]. / Décollements épiphysaires du coude chez le jeune enfant. Aspects radiologiques.

Separation of the distal humeral epiphysis is infrequent in young children. Diagnosis is difficult since the entire condylar region is almost completely composed of cartilage. Marked sequelae occur if the diagnosis is not promptly made and arthrography is required to evaluate the extent of lesions. Two cases in children aged 2 1/2 years and one day are reported.

[Fractures of the lateral condyle of the elbow in children. Radiologic aspects]. / Les fractures du condyle externe du coude chez l'enfant. Aspects radiologiques.

Fractures of the lateral condyle of the humerus classified as type IV in Salter schema are difficult to diagnose when the capitellum is not ossified. Therefore it is necessary to know exactly the radiological lines which are constructed from the humerus and the radius to the capitellum. Diagnosis is also difficult when the ossification center of the capitellum humeri is only slightly displaced. The epiphyseal fracture line which is always visible at surgery can be missed on X-Ray when ossification has not yet appeared. Laminograms are necessary in some cases to be sure that the fracture is displaced. Displaced fractures are always treated by open reduction.

[Junctional syndrome responsible for prostatic urethral dilatation: a new pathological entity?]. / Syndrome jonctionnel responsable d'ectasie de l'urètre prostatique: nouvelle entité pathologique?

The authors report two observations of monstrous ectasia of the prostatic urethra, in boys age 12, without any previous pathological history; discovered on at the time of major dysuria previous urinary troubles with chronic retention of 500 cl and 1.250 l respectively. In the absence of any organic obstacle, etiology relieves functional troubles. If functional explorations show a normal or hypertensive detrusor, then they discuss the possibility of vesico-sphincter dyssynergia or an obvious hypertension of the striated sphincter. From this moment onwards, purely intrinsic urethral functional trouble is plausible, all the more because the recovery was assured by treatments directed only at the urinary canal. In the first case, after surgical treatment owing to complex lesions (plastic reduction of the urethral ectasia preserving the posterior wall and respecting the striated sphincter) combined with diverticulectomies with urethral reimplantations), the patient recovered complete vesical waste removal at once, with normalisation of the flowmeter in six months. In the second case, a simpler treatment (sub-montanal urethrotomy of the principle) allowed a normalisation period of 10 months with complete vesical waste removal. The functional results are maintained after a period of nine and two years respectively. The integrity of the striated sphincter controlled post-operatively by the operatory gesture on the urinary canal and confronts the authors in the idea of intrinsic urethral pathology, although electronic microscopic examination may not have shown achalasia.

[Renocolonic fistula complicating vesicorenal reflux and xanthogranulomatous pyelonephritis in a 20-month-old child]. / Fistule réno-colique compliquant un reflux vésico-rénal et une pyélonéphrite xanthogranulomateuse chez un enfant de 20 mois.

A case of vesico-renal reflux with xanthogranulomatous pyelonephritis complicated with a renocolic fistula in a 20 months old child is reported. Imaging in this case was crucial for the diagnosis and the work up; it included ASP, renal ultrasound, UIV retrograde cystography and CT. The treatment consisted in a right ureteronephrectomy after fistula's section.

[Aerodigestive papillomatosis in an infant]. / Papillomatose aéro-digestive chez un nourrisson.

A case of juvenile papillomatosis involving the supra glottic area of the larynx and the esophagus in a 10 months old infant is reported. The patient was treated by multiple Laser CO2 resections of papillomas and received autogenous vaccine. He is now 5 years; he is well and apparently free of disease for the last two years. Radiography of the larynx and esophagogram were crucial for the initial diagnosis and the followup of this child.

[Tillaux's fracture]. / La fracture de Tillaux.

Tillaux fracture or fracture of the antero-lateral portion of the distal tibia has a vertical fracture line either at the middle of the epiphysis or close to the external malleolus. It is seen around 13-14 years. Distance from the fracture line to the external malleolus depends of the degree of closure of the epiphyseal plate. When the medial aspect of the physis is open, the fracture line is more medial. The location of the fracture line in the epiphysis therefore depends on the maturity of the physis as shown by closure of its medial portion. Tomography is frequently necessary to see the fracture line and mainly to appreciate the fracture gap. If the gap is less than two millimeters non operative treatment with plaster cast is sufficient.

[Esophageal communication with a totally sequestrated hypoplastic right lung]. / Communication oesophagienne avec un poumon droit hypoplasique totalement séquestré.

Pulmonary sequestrations involving communication with the digestive tractus are known as bronchopulmonary foregut malformations. The authors add a peculiar case report: there was an hypoplastic right lung with a total sequestration from the bronchial tree and communicating with esophagus. This was fed from the pulmonary vasculature without collateral artery formation. The pulmonary vein was normal. Association with a facial dysmorphia and an occipital meningocele is also of interest. The radiological diagnosis is based on the pulmonary X-Ray and the oesophagogram.

[Idiopathic laryngotracheobronchial calcifications in children. Apropos of 2 cases]. / Les calcifications laryngo-trachéo-bronchiques idiopathiques chez l'enfant. A propos de deux observations.

Calcifications of cartilage in the larynx, trachea and bronchi are rare in children. Two cases reported and listed with 5 similar cases of the literature. Such calcifications are generally discovered in young children and congenital stridor is commonly associated with. Calcifications of bronchi are not present in every case. The blood calcium is normal. Laryngoscopic examination shows in two cases a laryngeal stiffness. The prognosis is good. In two cases, one of the parents of under 40 years old, also had calcifications of the trachea and of the bronchi.

[Rare localizations of digestive adenocarcinoma in children. Apropos of 2 cases]. / Localisations rares d'adénocarcinome digestif chez l'enfant. A propos de deux cas.

The authors report two cases of adenocarcinoma of the digestive system in children both of which were located in unusual sites. A child of 9 years old had an adenocarcinoma of the small bowel and a boy of 16 years who was known to have a long-standing hiatus hernia developed an adenocarcinoma of the oesophagus. In children these tumors have some characteristic features. They develop on a preexisting lesion. Evolution is rapid. From the pathological point of view, anaplasic and colloide patterns are frequent.

Blood group antigens on fetal red cells obtained by umbilical vein puncture under ultrasound guidance: a rapid hemagglutination test to check for contamination with maternal blood.

Seventy-two fetal blood samples obtained by umbilical vein puncture under ultrasound guidance for prenatal diagnosis and monitoring purposes were tested for the expression of 38 blood group antigens. The gestational age at sampling ranged from 18 to 34 wk with 76% of fetuses between 20 and 25 wk. Compared to adult red blood cells, the following antigens showed either abnormally decreased frequency, or significantly reduced expression: A, B, A1, H, Lua, Lub, Lea, Leb, P1, P, and I. Selected anti-I and anti-i cold agglutinins, active at room temperature, were used at appropriate dilution, in a rapid slide or spin test to check for possible mixture of the sample with maternal blood and were shown to detect contaminations up to 5%. The test has proved particularly helpful for immediate and in process assessment of foetal origin of the sampled blood.

Pulmonary sequestrations of the upper lobe in children: three presentations.

Pulmonary sequestrations are congenital abnormalities where nonfunctioning lung tissue receives its vascular supply from the systemic circulation (thoracic or abdominal aorta). It is necessary to establish the diagnosis in childhood when the lesions are uncomplicated. The authors present three cases of sequestration of the apex (2 extralobar and 1 atypical) with the main clinical and radiological features. Sequestrations in the upper lobe are rare, and the usual site is the left lower lobe. Plain x-rays show a dense opacity, sometimes air-filled and sometimes with an air-fluid level: angiography is currently the best mean for definitive diagnosis; however, computed tomography will probably be very useful in the future. Differential diagnosis includes tumours of the superior mediastinum (neurogenic tumours, digestive duplication, bronchogenic cysts, pheochromocytoma and hydatid cysts).