[Intrahospital mortality during acute exacerbations of COPD. Study EABPCO-CPHG of the College of the Lung specialists of General hospitals (CPHG)]. / Mortalité intrahospitalière au cours des exacerbations aiguës de BPCO. Etude EABPCO-CPHG du Collège des pneumologues des hôpitaux généraux (CPHG).

INTRODUCTION: The objective of the present study was to determine the in-hospital mortality rate in the EAPCO-CPHG cohort and to identify risk factors. METHODS: All patients with COPD acute exacerbation admitted to the pneumology department of 68 French general hospitals between October 2006 and June 2007 were included in the EABPCO-CPHG cohort. RESULTS: At discharge, vital status was known for 1817 patients. Forty-five patients died during their hospital stay, i.e., an in-hospital mortality rate of 2.5%. Mutivariate analysis identified age (OR=1.07 [1.03-1.11]), grade greater than 2 dyspnea in stable state (OR=3.77 [1.68-8.57]), and number of clinical signs of severity during the acute exacerbation (OR=1.36 [1.11-1.55]) as independent risk factors for in-hospital mortality. CONCLUSIONS: In-hospital mortality in patients admitted to a pneumology department of a general hospital is quite low. Simple clinical criteria allow easy identification of at-risk patients and should enable management to be improved.

[Characteristics and management of acute exacerbations of COPD in hospital. EABPCO-CPHG study by the college of general hospital respiratory physicians]. / Caractéristiques et prise en charge des exacerbations aiguës de BPCO hospitalisées. Etude EABPCO-CPHG du Collège des pneumologues des hôpitaux généraux.

INTRODUCTION: A cohort was formed to explore the evolution of COPD patients treated in general hospitals for acute exacerbations (AE). The present article describes and compares patient characteristics according to whether COPD was diagnosed before the AE or not. METHODS: Data were analyzed for 1,824 patients admitted between October 2006 and June 2007 to 68 departments of respiratory medicine. RESULTS: Population characteristics were: male, 77%; mean age, 70.3+/-11.3 years; current smokers, 33%; baseline grade 3-4 dyspnoea, 47%; FEV1

Sequential two-line strategy for stage IV non-small-cell lung cancer: docetaxel-cisplatin versus vinorelbine-cisplatin followed by cross-over to single-agent docetaxel or vinorelbine at progression: final results of a randomised phase II study.

BACKGROUND: This phase II trial compared docetaxel-cisplatin (DC) with vinorelbine-cisplatin (VC), both as first-line therapy followed by cross-over at progression to single-agent vinorelbine or docetaxel in advanced non-small-cell lung cancer (NSCLC). METHODS: Overall, 115 patients received DC (docetaxel 75 mg/m(2) and cisplatin 100 mg/m(2) both on day 1, every 3 weeks, arm A1) and 118 VC (vinorelbine 30 mg/m(2)/week on days 1 and 8 and cisplatin 100 mg/m(2) on day 1, every 3 weeks, arm B1) for six cycles, and subsequently maintained by monotherapy with docetaxel (A1) or vinorelbine (B1) with cross-over on disease progression to vinorelbine 30 mg/m(2) days 1 and 8 (A2), or docetaxel 100 mg/m(2), day 1, both every 3 weeks (B2). The primary end point was overall response rate (ORR). RESULTS: Patient characteristics were balanced; median follow-up was 8.8 months. First-line response rate was 33.9% with DC and 26.3% with VC (P=0.20). In arms A1 and B1, respectively: duration of response was similar (8.2 versus 8.4 months); median time to progression was 5 months in both; median survival was 8 versus 9 months (P=0.38); 1-, 2- and 3-year survival was 36% versus 35%, 17% versus 10% and 13% versus 6% (P not significant). However, with a low number of long-term survivors, statistical significance was not reached. Overall, almost half of the patients crossed over to second-line therapy; there were no response with vinorelbine and 6 (11.2%) partial responses with docetaxel. Considering the safety profile, the occurrence of febrile neutropenia was 9.6% with DC and 26.3% with VC. Treatment-related mortality was 2.5% with DC and 8.5% with VC. CONCLUSIONS: The trend in favour of the DC arm in ORR, even though statistical significance was not reached, is consistent with previous reports. This study suggests an activity of first-line DC in advanced NSCLC, and that second-line vinorelbine does not provide additional clinical benefit. As already shown in other studies, the use of DC in first-line should provide a better percentage of long-term survivors, despite the absence of efficacy of the second-line in our study.

Standard combination versus alternating chemotherapy in small cell lung cancer: a randomised clinical trial including 394 patients. 'Petites Cellules' Group.

PURPOSE: to compare standard and alternating administration of chemotherapy combinations in small cell lung cancer (SCLC) patients. MATERIAL AND METHODS: in a multicenter clinical trial, 394 previously untreated SCLC patients were randomised to receive, every 4 weeks, eight courses of either a standard regimen with CCNU, cyclophosphamide, adriamycin (CCA) and VP16 or an alternating regimen (CCA regimen alternating with cisplatin-vindesine-VP16). RESULTS: overall response rate was higher in the standard group (78%) than in the alternating group (64%) (P = 0.0001). Complete response rate was also higher in the standard group (32%) than in the alternating group (18%) (P = 0.004). The median survival in the overall SCLC population was 306 days in the standard group and 272 days in the alternating group (P = 0.08). In limited SCLC patients, median survival was higher in the standard group (421 days) than in the alternating group (328 days) (P = 0.01). Grade III/IV haematological toxicity was lower in patients in the alternating group (25 versus 47%) (P < 0.001). CONCLUSION: the standard regimen was better than the alternating regimen for patients with limited forms of SCLC. The alternating regimen, associated with better haematological safety and ensuring a fairly similar survival, may be considered in patients with extensive SCLC. Pleiomorphic resistance mechanisms to chemotherapy make it difficult to define a non-cross-resistant chemotherapy regimen.

Subcutaneous heparin treatment increases survival in small cell lung cancer. "Petites Cellules" Group.

BACKGROUND: A positive influence of anticoagulant treatment in small cell lung cancer (SCLC) has been suggested by experimental and clinical data. METHODS: In a multicenter clinical trial, 277 patients with SCLC were randomized either to receive or not to receive subcutaneous heparin injections for 5 weeks at effective doses, which were monitored by blood coagulation tests. All patients received one of the two chemotherapy regimens studied in this trial, for eight courses in the case of patients with complete or partial response, and subsequently were randomized to receive delayed thoracic radiotherapy after these eight courses. RESULTS: In comparison to the 139 patients who did not receive heparin, the 138 patients who received anticoagulant treatment obtained better complete response rates (37% vs. 23%, P = 0.004), better median survival (317 days vs. 261 days, P = 0.01), and better survival rates at 1, 2, and 3 years (40% vs. 30%, 11% vs. 9% and 9% vs. 6%, respectively). At subgroups analysis, the results on survival were obtained for limited forms (P = 0.03) but not for extensive diseases (P = 0.31). No important bleeding or thrombocytopenia was related to heparin treatment. CONCLUSIONS: These results confirm the value of anticoagulant treatment in SCLC, already suspected for warfarin and now proven for heparin, but the modes of administration and the biologic explanations for this activity still warrant further investigation.

[Ureteral stenosis caused by pelvic actinomycosis]. / Sténose urétérale par actinomycose pelvienne.

The authors report a case of pelvic actinomycosis causing ureteral obstruction in a 30-year-old woman. An intra-uterine device being in place for 6 years is considered as the main cause. The treatment, which included a laparotomy for abscess drainage, an indwelling double pigtail ureteral stent and a 9 month antibiotherapy led to recovery after an initial relapse.

[Malignant fibrous histiocytoma of soft tissue: atypical presentations. Value of combined surgery and chemotherapy]. / Histioctome fibreux malin des tissus mous: présentations atypiques. Intérêt de l'association chirurgie-chimiothérapie.

The authors report five cases of malignant fibrous histiocytoma of the soft tissues, some of them with atypical presentation (necrotizing tumor, hypereosinophilic syndrome, dermatomyositis). This is the first case of polymyositis associated with malignant fibrous histiocytoma. The tumor occurs between the fifth and the seventh decade, principally as a mass on the proximal lower limb. Local recurrence and metastasis occurs in 50% of patients. Prognosis is dependent on both the surgical possibilities and the characteristics of the tumor (site, size, histologic grade). Surgery alone is inadequate. Adjuvant chemotherapy improves the 5-year survival.

[Orf: recontamination 8 months after the original infection. Review of the literature apropos of a case]. / Orf: recontamination huit mois après l'infection originelle. Revue de la littérature à propos d'une observation.

Frequent in France among domesticated sheep and goats, contagious pustular dermatitis of the sheep is called Orf when it occurs in man. The authors present a case of recontamination in a woman farmer of the Cher department (Central France), who had been bottle-feeding lambs affected with the zoonosis. This 71-year old woman developed papules, then papulopustules on the ulnar aspect of her hands and wrists (fig. 1). Within a few days, these lesions were 1.5 to 2 cm in diameter and surrounded with a severe inflammatory reaction. Two weeks later, the pustules became encrusted. Electron microscopy of a fragment of lesion demonstrated the virus. Cure was observed after 3 weeks. Eight months later, however, lesions identical with the previous ones appeared on the 4th finger and on the median aspect of the right wrist, corresponding to excoriations caused by nibbling from the lambs. The eruption was accompanied with fever which persisted for one month. In this patient's farm, the disease was present for the first time and affected only 2-month old lambs in the form of numerous papulo-pustules located on the lips and later covered by hard and thick scabs. These lesions were also found on the tongue and palate of some animals (fig. 5), preventing them from taking any food. Vaccination resulted in rapid and dramatic regression of the enzootie. From a more general point of view, the clinical features and epidemiology of the disease are described comparatively in animals and man. The differential diagnosis is dealt with at the end of the article. The literature on the subject is reviewed (151 references).

[Doxapram in stable obstructive chronic respiratory insufficiency. A prospective study on 15 cases (author's transl)]. / Le doxapram dans l'insuffisance respiratoire chronique obstructive stable. Etude prospective portant sur 15 cas.

The oral form of Doxapram, a respiratory analeptic drug with central action, was tested prospectively and successively, the subject being his own control, in 15 patients with stable obstructive chronic respiratory insufficiency (OCRI), but not infected and with a high PaCO2. The efficiency of the product was judged notable nine times, medium four times; only twice was its action judged inefficient. Retrospectively, it was not possible to define the group OCRI with high PaCO2, responding or not to the oral form of Doxapram. In these conditions, the utility of prescribing this molecule is subjected to the control of gasometric efficiency before and after absorption. The frequent efficiency of the product leads to the consideration of a regular use in some obstructive chronic respiratory insufficiency.