ABSTRACT
The plathypnea orthodeoxia syndrome is a rare condition that is characterized by dyspnea and hypoxia that occurs in the upright position and improves with recumbency. The diagnostic is often made tardively and requires the combination of two components: a mechanical one (for example a patent foramen ovale) and a kinetic one (for example COPD). This combination contributes to the blood flow through the communication. The treatment consists of closing the veno-arterial communication (in the case of a patent foramen ovale, the closing of the inter-atrial septum) (Knapper et al, 2014). In the present article, we describe two severe hypoxemic patients suffering from this syndrome. Both cases were associated with an acute pulmonary disease. A review of the literature is performed.
Subject(s)
Dyspnea/etiology , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/diagnosis , Hypoxia/etiology , Aged , Dyspnea/diagnosis , Female , Humans , Hypoxia/diagnosis , SyndromeABSTRACT
INTRODUCTION: Second primary lung cancer (SPLC) is generally of poor prognosis in patients presenting with head and neck cancer. METHODS: Between January 2000 and June 2008, 39 patients with head and neck squamous-cell carcinoma (HNSCC) patients diagnosed with SPLC were included. RESULTS: Fourteen SPLC were classified as synchronous and 25 as metachronous. SPLC and HNSCC staging correlated (P=0.0496). Patients with metachronous tumor showed longer median overall survival than those with synchronous tumor (92.9 months versus 15.7 months; Hazard ratio (HR), 0.323; 95% CI, 0.042-0.559; P=0.0045). In the subgroup of 11 patients with SPLC diagnosed more than 5 years after HNSCC, prognosis was better (128.1 versus 29.7 months; HR, 0.288; 95% CI, 0.053-0.353; P<0.0001). DISCUSSION: In the present study, in contrast to the literature, improved prognosis and survival were found in the subgroup in which SPLC developed more than 12 months after initial HNSCC diagnosis, and even more specifically in that in which SPLC developed more than 5 years after initial HNSCC diagnosis. CONCLUSION: SPLC in HNSCC is generally described as unequivocally aggressive and of poor prognosis. Metachronous SPLC, however, especially when diagnosed more than 5 years after HNSCC, was clearly associated with better prognosis.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Lung Neoplasms/diagnosis , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Second Primary/diagnosis , Otorhinolaryngologic Neoplasms/diagnosis , Adult , Aged , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Neoplasms, Multiple Primary/mortality , Neoplasms, Multiple Primary/pathology , Neoplasms, Second Primary/mortality , Neoplasms, Second Primary/pathology , Otorhinolaryngologic Neoplasms/mortality , Otorhinolaryngologic Neoplasms/pathology , Prognosis , Proportional Hazards Models , Retrospective Studies , Survival RateSubject(s)
Cholesterol, LDL/metabolism , Inflammation/therapy , Oxygen Inhalation Therapy/methods , Oxygen/metabolism , Peroxidase/metabolism , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/therapy , Humans , Interleukin-8/blood , Oxidative Stress , Transforming Growth Factor beta/blood , Treatment OutcomeABSTRACT
The present study was conducted to determine whether it is justifiable to adapt treatment to age in patients with non-small-cell lung cancer (NSCLC). All NSCLC patients treated at the Institut Jules Bordet who were 75 years old or over were prospectively entered in our database. Patients were divided into those who were "eligible" and those who were "ineligible" for clinical trials according to the standard criteria used by the ELCWP. The 604 consecutive patients treated for NSCLC between March 1995 and August 2001 included 60 (9.9%) aged 75 years or over. Their principal characteristics were as follows: median age 78 years (75-93); male-to-female ratio 45/15; stages I/II/III/IV in 16/1/23/18 cases (in 2 cases complete work-up was refused by the patient); squamous/glandular/other histology in 23/24/13 cases; the median performance status was 70 (30-100). Except for their age, 37 patients met the eligibility criteria for the ELCWP standard treatment study protocol in progress during the study period. Twenty-five (67.6%) of these patients received an adequate treatment according to the stage of the disease, and 5 (13.5%) refused conventional therapy and received less aggressive treatment or none at all. For 7 (18.9%) patients, an adapted treatment was chosen solely on the basis of their age. For patients with disease in stages I-III who underwent adequate treatment survival rates were equivalent to the results found in the literature, with median survival times of 770 days and 262 days for those with stage I-II and those with stage III disease, respectively. Survival rates for patients with stage IV disease ranged from 10 days to 17 months. NSCLC patients 75 years of age or more without significant co-morbidities can probably be treated in the same way as younger people with similar survival rates if their disease is in stages I-III. Because the number of patients was too small, our data do not allow us to provide meaningful conclusions for stage IV disease.
