The addition of cisplatin to cyclophosphamide-doxorubicin-etoposide combination chemotherapy in the treatment of patients with small cell lung carcinoma: A randomized study of 457 patients. "Petites Cellules" Group.

BACKGROUND: To assess whether the addition of cisplatin (100 mg/m(2) administered intravenously on Day 1) to CDE (cyclophosphamide [1000 mg/m(2) on Day 1], doxorubicin [45 mg/m(2) on Day 1], and etoposide [150 mg/m(2) on Days 1 and 2] combination is useful in the treatment of patients with small cell lung carcinoma (SCLC). METHODS: In a multicenter clinical trial, 457 patients were randomized from May 1988 to March 1993 to receive either CDE (n = 228) or cisplatin-CDE (PCDE, n = 229) chemotherapy every 4 weeks for 6 cycles. As patients with limited SCLC were included in a concomitant trial assessing thoracic radiotherapy, the current study mainly included patients with extensive stage (79%) or limited stage disease and a contraindication for thoracic radiotherapy. RESULTS: The objective response rate was higher in the cisplatin-CDE group (72%) than in the CDE group (53%) (P = 0.0001). The median overall survival was similar for the groups that received CDE (266 days) and PCDE (271 days) (P = 0.93, log rank test). A higher fatal neutropenia rate was observed in the PCDE group (n = 23) than in the CDE group (n = 4) (P < 0.001, log rank test), mainly for patients with extensive disease (n = 26; P = 0.015, log rank test). CONCLUSIONS: The addition of cisplatin to a CDE regimen is toxic to patients with extensive SCLC and does not improve overall survival. The PCDE combination must be avoided for patients with extensive SCLC; CDE or cisplatin-etoposide combinations remain standard chemotherapy for these patients. The PCDE combination associated with granulocyte-colony stimulating factors could only be assessed in patients with good prognoses.

[Mycobacterium xenopi infection in emphysematous bulla. Apropos of 4 cases operated on]. / Infection à Mycobacterium xenopi dans des bulles d'emphysème. A propos de 4 cas opérés.

The authors presented their observations of four patients who were operated on for a supra-infection of emphysematous bullae by Mycobacterium xenopi. In two cases the patients were operated on without a diagnosis and excision of the right upper lobe assured their cure. The other patient underwent a decortication and ultimately relapsed. The fourth had a bilateral apical infection and underwent bilateral excision. A survey of the literature leads one to think that pulmonary infections with a Mycobacterium xenopi occur in emphysematous bullae more often than is generally thought. The unreliability of the results of antituberculous drugs, the complications of treatment and the risks of recurrence after treatment are well known. Controlled surgical excision of the lesions, which is most often followed by a definitive cure, always merits consideration as part of the therapeutic arsenal.

[Acute mitral endocarditis in a 4-month-old infant]. / Endocardite aiguë mitrale chez un nourrisson de 4 mois.

The authors report a case of bacterial endocarditis from unidentified bacteria, responsible for a rupture of chordae of the mitral valve in a 4 month-old infant with a previously normal heart. Bidimensional echocardiography led to diagnosis. The importance of the mitral loss thus created made a mitral plasty necessary with cardiopulmonary by-pass at age 2 years. Ultrasonographic data were then confirmed. Postoperative result was excellent. The features of acute bacterial endocarditis in infancy are reviewed.

[Pulmonary arteriovenous aneurysm]. / Anévrysme artério-veineux pulmonaire.

A case of large arteriovenous aneurysm in the right upper lobe of a 27-year old man is reported. The pulmonary angioma was responsible for a 30% shunt with hypoxia and polycythaemia but was only discovered while looking for the origin of a cerebral abscess. A few weeks after surgical treatment of the cerebral abscess, the right upper lobe was excised with immediate correction of the hypoxia. This case shows that pulmonary angiomas can sometimes be revealed by neurological complications, and that visceral angiomas should not remain undiagnosed. They should be considered as part of a Rendu-Osler disease, the familial character of which may contribute to an early diagnosis.