Breast Cancer Index predicts pathological complete response and eligibility for breast conserving surgery in breast cancer patients treated with neoadjuvant chemotherapy.

BACKGROUND: The aim of neoadjuvant chemotherapy is to increase the likelihood of successful breast conservation surgery (BCS). Accurate identification of BCS candidates is a diagnostic challenge. Breast Cancer Index (BCI) predicts recurrence risk in estrogen receptor+lymph node-breast cancer. Performance of BCI to predict chemosensitivity based on pathological complete response (pCR) and BCS was assessed. METHODS: Real-time RT-PCR BCI assay was conducted using tumor samples from 150 breast cancer patients treated with neoadjuvant chemotherapy. Logistical regression and c-index were used to assess predictive strength and additive accuracy of BCI beyond clinicopathologic factors. RESULTS: BCI classified 42% of patients as low, 35% as intermediate and 23% as high risk. Low BCI risk group had 98.4% negative predictive value (NPV) for pCR and 86% NPV for BCS. High versus low BCI group had a 34 and 5.8 greater likelihood of achieving pCR and BCS, respectively (P=0.0055; P=0.0022). BCI increased c-index for pCR (0.875-0.924; P=0.017) and BCS prediction (0.788-0.843; P=0.027) beyond clinicopathologic factors. CONCLUSIONS: BCI significantly predicted pCR and BCS beyond clinicopathologic factors. High NPVs indicate that BCI could be a useful tool to identify breast cancer patients who are not eligible for neoadjuvant chemotherapy. These results suggest that BCI could be used to assess both chemosensitivity and eligibility for BCS.

Recurrent subcutaneous infection due to Scopulariopsis brevicaulis in a liver transplant recipient.

We describe a case of recurrent Scopulariopsis brevicaulis subcutaneous infection, which occurred 6 years after the patient underwent liver transplantation. Combined surgery and long-term oral therapy with terbinafine resulted in a favorable outcome, although this is not the rule in the previously reported S. brevicaulis infections in immunocompromised patients.

[Treatment with rilmenidine 1 mg per day: time-lag to maximum response. A multicenter ambulatory study. Le Groupe Français d'étude Multicentrique d'Hyperium]. / Traitement par la rilmenidine à 1 mg par jour: délai d'obtention de la réponse maximale. Etude multicentrique en ambulatoire. Le Groupe Français d'étude Multicentrique d'Hyperium.

Forty-four placebo-resistant patients (mean age: 59.2 +/- 2.1 years; mean weight: 70.14 +/- 1.95 kg: mean supine diastolic pressure: 101.6 +/- 0.70 mmHg) were treated during 8 weeks (D0-D56) with a single 1 mg tablet of rilmenidine taken every morning. The patients were seen at intervals of 14 days until their diastolic pressure returned to a normal value of 90 mmHg. Once this goal was achieved, they were not seen again until D56. The actuarial survival curve enabled us to evaluate, at a given moment, the cumulative number of normalized patients and the accuracy of this evaluation (confidence interval). After two weeks of rilmenidine treatment, 66 percent of the patients were normalized. The cumulative proportion of normalized patients increased with time, from 80 percent at D28 to 85 percent at D42 and 98 percent at D56. Confidence intervals were relatively small. Although these results were much better than those obtained in previous studies of this drug, our study shows that blood pressure was rapidly normalized in the majority of hypertensive patients by a daily 1 mg dose of rilmenidine and that doubling this dosage after two weeks of treatment is not necessarily justified, since the percentage of normalized patients increases up to 98 percent after eight weeks of treatment. The small number of adverse effects and the good patient's compliance with treatment (evaluated by tablet counts and rilmenidine plasma level values) testify that this drug respects the quality of life.

[Effectiveness of trimetazidine in stable effort angina due to chronic coronary insufficiency. A double-blind versus placebo study]. / Efficacité de la trimétazidine dans l'angor d'effort stable de l'insuffisant coronarien chronique. Etude à double insu contre placebo.

The antianginal activity of trimetazidine (Vastarel 20 mg) was evaluated in a double blind study versus placebo. The 54 subjects of the survey were males, of mean age 55.2 +/- 1.4 years in the trimetazidine group and 55.5 +/- 1.8 years in the placebo group, suffering from stable angina. The stability of angina was tested by two exercise tests carried out at the beginning and at the end of a two-week preselection period under placebo. Three tablets daily of either trimetazidine or placebo were given at random for two weeks. At the end of that time, a third exercise test was carried out. The clinical results showed a significant reduction (P less than 0.001) in the number of weekly attacks from 8.1 +/- 0.3 to 2.9 +/- 0.5 under trimetazidine and from 7.6 +/- 0.2 to 4.9 +/- 0.5 under placebo. Moreover, nitroglycerin consumption over a week decreased from 9.1 +/- 0.6 to 3.1 +/- 0.5 tablets under trimetazidine and from 7.9 +/- 0.3 to 5.4 +/- 0.6 tablets under placebo. The difference was significant (P less than 0.001). The global evaluation of the exercise tests showed a significant difference in favor of trimetazidine: 19 patients out of 27 improved under trimetazidine, as compared to 11 out of 27 under placebo. The total workload-capacity after treatment was increased by 62.1% under trimetazidine, and by 24.7% under placebo (P = 0.007). The rate-pressure product diminished by 12% with trimetazidine and by 4% with the placebo. Nevertheless, the interaction was not significant (P = 0.079). This study made it possible to evaluate the significant reduction of stress attacks frequency and nitroglycerin consumption under trimetazidine versus placebo. This clinical improvement was assessed by ergometric parameters.

[Strongyloidiasis: a clinical, biological and epidemiological study of 350 cases (author's transl)]. / Anguillulose: analyse clinique, biologique et épidémiologique de 350 observations.

The authors report on a series of 350 cases of strongyloidiasis. The patients had come from the French West Indies or from Africa and had been living in France for less than five years. Stool examinations were performed systematically or on account of eosinophilia, which was often pronounced (400-1500 per cubic millimetre). Although 44 patients offered favourable conditions for the worms to multiply, no death was recorded. The relevant published data are discussed.

International multicentre study of indapamide in the treatment of essential arterial hypertension.

A total of 1600 patients with essential arterial hypertension was recruited from 10 countries, and treated with indapamide according to a common protocol. 703 subjects who completed the protocol were analysed, from whom 644 were followed for 3 months, and the remainder (all from Belgium) up to 10 months. The group of 644 showed a highly significant drop in erect and supine blood pressures after one month, and this was maintained after 3 months treatment. The percentage of responders (normalization of diastolic pressure, or drop of at least 30 mmHg) was 64% after 3 months. The Belgian group maintained their reductions in pressure at 6 and 10 months. Serum potassium showed a modest drop, but remained within normal limits: other biochemical values were virtually unchanged. Some side effects were noted, but none was serious. It is concluded that indapamide is a first line treatment for essential arterial hypertension.

Outbreak of trichinosis near Paris.

A localised outbreak of trichinosis occurred in January 1976 in the southern suburbs of Paris. A total fo 125 cases was recorded including 30 children. The prominent symptoms were oedema of the face or eyelids, fever, and myalgia; diarrhoea was unusual and constipation common. An increased blood eosinophil count and raised serum concentrations of muscular enzymes strongly indicated trichinosis. This diagnosis was confirmed later immunologically. The parasite was found in only three out of 32 muscle biopsy specimens but this investigation was made relatively early in the disease. No deaths occurred. In all cases clinical recovery was fast and serum antibody titres were maximum during the first month and decreased slowly. The disease was milder and the recovery faster in children than adults. Epidemiological study suggested that horse meat was responsible for the infection, though no meat could be examined.

[Trichinosis: review of the epidemic in the south suburbs of Paris in January, 1976 (apropos of 125 cases)]. / Trichinose: bilan de l'épidémie de janvier 1976 dans la banlieue sud de Paris (à propos de 125 cas).

The authors report the results of the trichinosis epidemic which occurred in the southern suburbs of Paris in January 1976. 125 patients from a total of 65 families were affected. The major signs: oedema of the face and eyelids, fever and myalgia, were commonly found. There were even laboratory abnormalities with eosinophilia, increase in muscle enzymes and positive specific serology. The course over a period of months was very favourable. There were no deaths. The most severe symptoms rapidly regressed. Only myalgia and headache, and above all fatugie, persisted for 3 to 4 months, in the adults. The biological course was marked by the disappearance in one month of the majority of the disturbances seen in the acute phase, apart from the eosinophilia and serological findings which remained pathological after one year in a number of cases. The particular aetiology, due to horsemeat, may be explained by modern industrial rearing techniques and the complexity of current commercial circuits.