Real-world patient- and caregiver-reported outcomes in advanced breast cancer.

Background: Advanced breast cancer (abc) represents a substantial burden for patients and caregivers. In the present study, we aimed to estimate quality of life (qol), utility, productivity loss, pain, health care resource utilization, and costs for patients with abc, and qol, utility, and productivity loss for their caregivers. Methods: This multicentre prospective non-interventional study was conducted in Canada. Eligible participants were postmenopausal women with estrogen receptor-positive, her2-negative unresectable abc and their caregivers. Validated questionnaires were used to measure qol, utility, productivity loss, and pain. Patients and caregivers were classified into 4 health states typically used in oncology economic modelling: first-line progression-free (1l-pf), first-line progressive disease (1l-pd), second- or subsequent-line progression-free (≥2l-pf), and second- or subsequent-line progressive disease (≥2l-pd). Results: Most patients and caregivers accepted to participate, with total recruitment of 202 patients and 78 caregivers. Compared with patients in pf, patients in pd had lower mean qol scores (52.9 ± 29.9 for 1l-pd vs. 68.2 ± 23.2 for 1l-pf, and 54.0 ± 23.6 for ≥2l-pd vs. 66.0 ± 22.1 for ≥2l-pf), lower mean utility values (0.64 ± 0.22 for 1l-pd vs. 0.73 ± 0.20 for 1l-pf, and 0.65 ± 0.25 for ≥2l-pd vs. 0.74 ± 0.18 for ≥2l-pf), and greater productivity loss (39.4 ± 27.7 for 1l-pd vs. 27.5 ± 30.1 for 1l-pf, and 37.6 ± 29.2 for ≥2l-pd vs. 32.0 ± 29.0 for ≥2l-pf). Compared with caregivers of patients in pf, caregivers of patients in pd had lower qol scores and utility values, and greater productivity loss. Conclusions: Study results indicate that, for patients and caregivers, pd health states are associated with a deterioration of qol and utility and a decrease in productivity in both 1l and ≥2l.

Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma.

PURPOSE: Morbidity associated with wound complications may translate into disability and quality-of-life disadvantages for patients treated with radiotherapy (RT) for soft tissue sarcoma (STS) of the extremities. Functional outcome and health status of extremity STS patients randomized in a phase III trial comparing preoperative versus postoperative RT is described. PATIENTS AND METHODS: One hundred ninety patients with extremity STS were randomized after stratification by tumor size dichotomized at 10 cm. Function and quality of life were measured by the Musculoskeletal Tumor Society Rating Scale (MSTS), the Toronto Extremity Salvage Score (TESS), and the Short Form-36 (SF-36) at randomization, 6 weeks, and 3, 6, 12, and 24 months after surgery. RESULTS: One hundred eighty-five patients had function data. Patients treated with postoperative RT had better function with higher MSTS (25.8 v 21.3, P <.01), TESS (69.8 v 60.6, P =.01), and SF-36 bodily pain (67.7 v 58.5, P =.03) scores at 6 weeks after surgery. There were no differences at later time points. Scores on the physical function, role-physical, and general health subscales of the SF-36 were significantly lower than Canadian normative data at all time points. After treatment arm was controlled for, MSTS change scores were predicted by a lower-extremity tumor, a large resection specimen, and motor nerve sacrifice; TESS change scores were predicted by lower-extremity tumor and prior incomplete excision. When wound complication was included in the model, patients with complications had lower MSTS and TESS scores in the first 2 years after treatment. CONCLUSION: The timing of RT has minimal impact on the function of STS patients in the first year after surgery. Tumor characteristics and wound complications have a detrimental effect on patient function.

Development of a robust calibration model for nonlinear in-line process data

A comparative study involving a global linear method (partial least squares), a local linear method (locally weighted regression), and a nonlinear method (neural networks) has been performed in order to implement a calibration model on an industrial process. The models were designed to predict the water content in a reactor during a distillation process, using in-line measurements from a near-infrared analyzer. Curved effects due to changes in temperature and variations between the different batches make the problem particularly challenging. The influence of spectral range selection and data preprocessing has been studied. With each calibration method, specific procedures have been applied to promote model robustness. In particular, the use of a monitoring set with neural networks does not always prevent overfitting. Therefore, we developed a model selection criterion based on the determination of the median of monitoring error over replicate trials. The back-propagation neural network models selected were found to outperform the other methods on independent test data.

Renal and adrenal gland localization of chronic myelomonocytic leukemia presenting as a kidney tumor.

Chronic myelomonocytic leukemia (CMML) is a myelodysplastic syndrome (MDS) characterized by prominent monocytosis and an increase in bone marrow monocyte precursors in addition to dyshaematopoietic features (1). Extrahaematological manifestations including cutaneous, neurologic, and rheumatic symptoms have been recorded in association with CMML. Here, we report the first observation of renal, adrenal and perirenal involvement in CMML which presented as a kidney tumor.

[Schizophrenia, special approach and continuity of care : The first episode program of Hôtel-Dieu Hospital in Lévis, Québec.]. / Schizophrénie, approche spécialisée et continuité de soins. Le programme spécifique d'intervention Premier-Episode de l'Hôtel-Dieu de Lévis.

Schizophrenia is a complex illness with an evolutive character. Based on a conceptual framework of cognitive orientation, the specific intervention program First Episode of Hôtel-Dieu in Lévis includes a complete and standardized assessment to an individualized and family plan. Different methods of treatment acording to an individualized approach (psyhco-education, psychotherapy) as well as group therapy (psychological intervention at the cognitive level or Brenner's Integrated psychological therapy) are then proposed. Psycho-education intervention for families is also offered. Structures and different steps described here, harmonize with those already in place before the program's creation thus offering a continuity in care. The underlying conceptual framework and the different methods of functioning of the program are also presented.

Digital necrosis and lupus-like syndrome preceding ovarian carcinoma.

Since 1967, about 40 cases of digital necrosis associated with neoplasia have been reported. We report a new case of digital necrosis associated with an ovarian carcinoma and with a lupus-like syndrome. Immunologic cross-reactivity to tumoral antigen could explain the lupus-like syndrome.

Short-term impact of the European Consensus Conference on the use of selective decontamination of the digestive tract with antibiotics in ICU patients.

Because it remained controversial, the use of selective digestive decontamination (SDD) in patients in the intensive care unit (ICU) was chosen as the topic of the first European Consensus Conference in Intensive Care Medicine (ECCICM) in December, 1991. The Consensus Bureau decided to assess the impact of this conference 2 years afterwards. For this purpose, a questionnaire was sent to the members of the European Society of Intensive Care Medicine, the Societé de Réanimation de Langue Française and the Societé Française d'Anesthesie et Réanimation before the conference. The recommendations following the conference discouraged the systematic use of SDD in ventilated patients and urged the monitoring of bacterial resistance and adapting antibiotics to epidemiology of the units. Two years after the conference, the same questionnaire was sent to those physicians who had responded to the first one. Eighteen percent used SDD for all ventilated patients and 17% remain users after 2 years. Among the occasional (32%) or continual (17%) users of SDD, the regimens used were mostly intravenous cefotaxime (60% of systemic antibiotics) and a topical combination of polymixin E, tobramycin, and amphotericin B (62% of overall topical combinations). The antibiotics used were unchanged after 2 years in almost all cases. In conclusion, the short-term impact of the Consensus Conference on SDD in ICU patients has been poor. This may be related to the continuing insufficiency of strong, definite data regarding the impact of this technique upon mortality and the theoretical risk of resistance to antibiotics, thus allowing physicians to stick to their policies until there is new evidence.

Effect of hyperthermia on cisplatin sensitivity in human glioma and ovarian carcinoma cell lines resistant and sensitive to cisplatin treatment.

Two pairs of human tumour-cell lines consisting of a cisplatin sensitive and resistant line from glioma and ovarian carcinoma were tested to determine the effect of hyperthermia on cisplatin sensitization. Both cisplatin resistant lines were more sensitive to 42 degrees C heating than their cisplatin sensitive counterparts. The cisplatin response was dependent on cell growth phase, with plateau phase cells more sensitive than exponentially growing cells. The difference in cisplatin response between resistant and sensitive lines was also growth phase dependent and was opposite for the two cell line pairs. Hyperthermia caused about the same thermal sensitization in the plateau phase cisplatin sensitive cell lines and in the resistant lines but this too was growth-phase dependent. In exponentially growing cells hyperthermia-cisplatin sensitization was greater in the sensitive cell lines. Hyperthermia at 42 degrees C did not completely overcome cisplatin resistance but could be useful as a sensitizer in cisplatin resistant tumour cells.

[Lung disease induced by isotretinoin]. / Pneumopathie induite par l'isotrétinoïne.

A young man without any past history of note had taken isotretinoin for disfiguring acne before the summer season. He presented with a severe bilateral pneumonia, associated with dyspnoea two months after the start of treatment. On the pulmonary radiography there was a bilateral ground glass appearance which was worse on the right. The elevated level of eosinophils (54% in 564,000 cells/ml) in the alveolar lavage lead to a diagnosis of allergic pneumonia. The rapidly favourable outcome following the cessation of the medication and with the addition of corticosteroids seemed to us a supplementary argument in favour of a diagnosis of eosinophilic pneumonia, due to isotretinoin which seemed the primary initiating factor.

[Visceral form of human anthrax imported from Africa]. / Forme viscérale de charbon humain importée d'Afrique.

Widespread vaccination has largely eliminated anthrax in Europe (the last case was reported in France in 1972) but the disease remains endemic in many developing countries. The usual cutaneous presentation (malignant pustules) is much more familiar than the various visceral manifestations including digestive tract, pulmonary or meningeal signs. We report a case of a 33-year-old immigrant living in France who was hospitalized for asthenia, dyspnoea, mucopurulant expectoration and moderate diarrhoea 3 days after a 3-month stay in Senegal and Gambia. The temperature was 39 degrees C at admission and blood pressure 110/70 mmHg. Crepitants were heard at the base of the right lung and the rest of the physical examination was normal. Blood was drawn for culture. Laboratory tests and the chest X-ray led to the diagnosis of pneumopathy and a treatment of amoxicillin and clavulanic acid was given with oxygenotherapy. The patient's temperature returned to normal but over the next 48 hours the dyspnoea worsened together with the black diarrhoea. The abdomen was painful. There were no skin lesions. The chest X-ray revealed an extension of the bilateral pulmonary images and bilateral pleural effusion. Laboratory tests revealed thrombopenia (platelet count 38,000/mm3) hyperleukocytosis (WBC 48,000/mm3) and haemolysis (Hb 4 milligrams). The diagnosis was made on the basis of the initial blood cultures which were positive for Bacillus anthracis. All other samples were negative, including HIV serology. Despite adapted antibiotic therapy (penicillin G, 8MU/day, was initiated on day 2), multiple organ failure occurred with septic shock and pulmonary oedema. The patient died in the intensive care unit on day 7. Fatal outcome due to anthrax is described in 25% of the visceral forms but reaches 100% in cases of septicaemia. The haemolysis observed in this case is not mentioned in the classical descriptions of anthrax. When treating septic syndromes in patients who have returned from endemic zones, clinicians should entertain the diagnosis of anthrax since the risk of fatal outcome is increased greatly in case of delayed diagnosis.

Multiresistant corynebacteria in bacteriuria: a comparative study of the role of Corynebacterium group D2 and Corynebacterium jeikeium.

During an 11-month prospective study, urine cultures were performed on 5685 samples obtained in three hospital units. The use of a selective medium improved the recovery of antibiotic-multiresistant corynebacteria (AMC): 703 isolates (12.4%) compared with 88 isolates (1.6%) on sheep blood agar. Corynebacterium group D2 (CGD2) was isolated in 80.5% of urines yielding greater than or equal to 10(5) AMC ml-1 whereas Corynebacterium jeikeium represented 80.2% of isolates with less than 10(5) AMC ml-1. Among 16 patients with greater than or equal to 10(5) ml-1 C. jeikeium none had signs of urinary tract infection. In contrast, among 56 patients with greater than or equal to 10(5) CGD2, 40 (71%) had abnormal urinary sediment (mainly apatite or struvite crystals) and 29 (52%) had clinical signs of urinary tract infections sometimes complicated by lithiasis (seven cases) and alkaline-encrusted cystitis (two cases).

Transient expression of an intermediate filament-associated protein (IFAPa-400) during in vivo and in vitro differentiation of chick embryonic cells derived from neuroectoderm.

The expression of an intermediate filament (IF) associated protein (IFAPa-400) and IF proteins was investigated during chick neurogenesis. Using immunoblots and indirect immunofluorescence we have found that IFAPa-400 was strongly expressed during the early events of nervous tissue ontogenesis and disappeared thereafter. IFAPa-400 was elevated in the brain and retina until ED 10 and until hatching in the cerebellum. This protein was shown to be transiently expressed in the Müller glia of the developing retina. In the brain, IFAPa-400 decreased as development proceeded in a way similar to vimentin but the latter remained elevated in the retina and the cerebellum radial glia (Müller and Bergmann cells). In all tissues examined, GFAP was detected long after the disappearance of IFAPa-400. In dorsal root ganglion cell cultures, IFAPa-400 and vimentin were absent from mature neurons but were coexpressed into supportive cells. In trunk neural crest cell cultures, IFAPa-400 and vimentin were present in all cells after one day but IFAPa-400 became undetectable after a few days of culture in differentiated melanocytes and catecholaminergic neurons. The transient expression of this giant cytoskeletal protein in non-differentiated cells deriving from the neuroectoderm could reflect a structural change which precedes overt cytodifferentiation.

Ultralow doses of vasopressin in the management of diabetes insipidus.

Management of postoperative diabetes insipidus (DI) frequently requires intermittent treatment with multiple subcutaneous injections of pituitrin or vasopressin, in doses averaging 20 IU/24 h. Use of a syringe pump for a continuous infusion of ultralow doses of pituitrin produced uniform, constant, and sustained reduction of urinary output, thus facilitating regular fluid replacement. Twelve patients with postoperative DI received iv pituitrin at a dose of 1.6 +/- 0.26 mIU/kg X h (1 to 2 IU/24 h). The antidiuretic effect began at the third hour of treatment, peaked by the sixth hour (diuresis of 37 ml/h, specific gravity of 1.018 +/- 0.002), and was sustained throughout infusion. Polyuria recurred 3 h after the infusion was discontinued; this rapid reversibility is highly advantageous when excessive fluid intake causes overhydration. Pressor effects were not observed during the treatment period.

[Hypovolemic shock caused by increased capillary permeability associated with monoclonal gammopathy. New case and review of the literature]. / Choc hypovolémique par augmentation de la perméabilité capillaire associé à une gammapathie monoclonale. Nouvelle observation et revue de la littérature.

The authors report another case of hypovolaemic shock due to increased capillary permeability and review previous reports in the medical literature. It is a rare condition with all patients presenting hypovolaemic shock of sudden onset with varying degrees of hypoproteinaemia and increased haematocrit. A monoclonal globulin peak is usually observed on serum electrophoresis during and between episodes of shock. The pathological role of this globulin in the increased capillary permeability has not been established.