[Para-aortic lymph node staging in grade IB2 and above cervical cancers: Comparison of 18FDG PET-CT with para-aortic lymphadenectomy, using data from the Côte d'Or gynaecological cancer registry from 2003 to 2016]. / Stadification ganglionnaire lombo-aortique dans les cancers du col de stade supérieur ou égal à IB2: comparaison des performances du PETscan au 18FDG et du curage lombo-aortique à partir des données du registre des cancers gynécologiques de Côte d'Or de 2003 à 2016.

INTRODUCTION: Current guidelines (ASCO, ESTRO, and ESGO) recommend para-aortic lymphadenectomy (PAL) for lymph node staging in patients with a negative initial PET-CT in locally advanced cervical cancer (LACC), with the aim to determine the radiation fields for radiochemotherapy. The main goal of this study was to compare overall survival (OS) in two groups, which differed according to the para-aortic lymph node staging technique used: imaging alone versus imaging and PAL. Secondary objectives were to determine recurrence-free survival (RFS), the proportion of false negatives on PET-CT, and surgery-related complications. METHODS: We conducted a retrospective, observational study on data from the Côte d'Or gynaecological cancer registry collected from 2003 to 2016, and compared two groups of LACC with different techniques for staging para-aortic lymph nodes: PET-CT alone (iN group) (n=99) and PET-CT associated with PAL (pN group) (n=35) for a total of 134 patients. RESULTS: OS (HR=1.04 (95% CI: 0.53-2.03); P=0.9) and RFS (HR=0.65 (95% CI: 0.29-1.45); P=0.29) were similar in both groups. There were 11.4% of false negatives in PET-CT, and 2.9% of patients who underwent PAL experienced complications. The staging method, iN or pN, had no impact on the time to the implementation of concomitant radiochemotherapy. CONCLUSION: For lymph node staging in LACC, PAL after a PET-CT as compared with PET-CT staging alone, had no significant impact on OS or RFS.

[Adult respiratory distress symptom during Plasmodium falciparum malaria]. / Syndrome de détresse respiratoire de l'adulte compliquant un accès palustre à Plasmodium falciparum.

INTRODUCTION: We present a typical case of adult respiratory distress syndrome (ARDS) occurring during infection with Plasmodium falciparum, in a nonimmune adult. The patient recovered after treatment. CASE: A 63-year-old man who had traveled in Kenya without malaria prophylaxis came to the hospital after 72 hours of fever on his return. On admission, the blood smear revealed severe P. falciparum parasitemia (45%), thrombopenia (4000/mm3), disseminated intravascular coagulation, and hepatic dysfunction. He was treated with intravenous quinine, and the initial course was favorable. On day 4, his parasitemia resolved, but he developed dyspnea with hypoxemia and required mechanical ventilation. Chest radiography showed bilateral diffuse infiltrate. Low central venous and pulmonary artery occlusion pressure confirmed ARDS. Bacteriological testing remained negative. Secondary course was favorable: he was extubated on day 10 and discharged on day 13. DISCUSSION: During the first five days of treatment for severe or multisystemic P. falciparum malaria, patients have a substantial risk of ARDS. This case illustrates the principal predisposing factors: severe parasitemia, hypoalbuminemia and fluid overload; hypoglycemia and lactic acidosis are also common. CONCLUSION: Physicians caring for patients with malaria must anticipate the possible onset of complications, including ARDS.