Two cases of cutaneous drug eruption associated with temozolomide therapy for glioblastoma.

Glioblastoma is the most common form of primary brain cancer. Its treatment involves surgery, radiotherapy, and chemotherapy with temozolomide (tmz), which is an oral alkylating agent. To the best of our knowledge, few dermatologic side effects of tmz have been described. We report two cases of cutaneous drug eruption caused by tmz during and after radiochemotherapy treatment. In the first case, all tests were negative, but the clinical history and the time of onset supported an allergy to tmz. In the second case, an allergy to tmz was proved by a positive lymphocyte activation test. In this context, our study is one of a very few trying to determine dermatologic side effects by applicable tests used in routine practice.

[The Lady Windermere syndrome: clinical and bacteriological data and progress in seven cases]. / Le syndrome de Lady Windermere : données cliniques, bactériologiques et évolutives.

Described by Reich and Johnson in 1992 [2], the Lady Windermere syndrome occurs exclusively in non-smoking women over the age of 60 years, without significant pre-existing pulmonary disease. It comprises bronchial dilatation, typically in the middle lobe and lingula, together with secondary infection by atypical mycobacteria (Mycobacterium avium in the first cases). Among the 17 cases of atypical mycobacterial infection that we have seen in the past 14 years, there were seven cases of this syndrome. It was associated with cough, sputum, sometimes haemoptysis, febrile episodes and deterioration of general health. The diagnostic criteria and treatment were defined by the American Thoracic Society. The pathophysiological hypothesis proposed by Reich and Johnson was that voluntary suppression of the cough led to congestion of the bronchi and secondary infection with atypical mycobacteria. Currently it is thought more likely that the following factors are involved: progressive increase in dilatation of small bronchi, delayed diagnosis, morphological abnormalities of the thorax, hormonal factors, immune deficiency, genetic neutrophil dysfunction, and even heterozygous forms of cystic fibrosis.

Use of both CD63 up regulation and IgE down regulation for the flow cytometric analysis of allergen induced basophil activation. Definition of an activation index.

OBJECTIVE AND DESIGN: The aim of this study was to compare the use of a late (CD63) and an early (IgE) marker of basophil activation in the flow cytometric diagnosis of beta-lactam induced allergic hypersensitivity reactions. SUBJECTS: Twelve patients who had had a clear cut betalactam induced immediate reaction and 16 controls were selected, as well as 11 patients who had had an immediate reaction to bee or wasp stings. METHODS: Leukocyte suspensions were incubated with allergen dilutions as well as 2 positive controls (anti-IgE and NFormyl- Methionyl-Leucyl-Phenylalanine (fMLP)). Basophils were labelled with an anti-IgE FITC (fluorescein isothiocyanate) and an anti-CD63 PE (phycoerythrin). Results were expressed as percentage CD63 expression and index calculated according to a specific algorithm including the two activation markers. RESULTS: Significant CD63 expression (>5 %) was observed in 3/12 cases for the beta-lactam sensitized population, in 0/16 cases for the controls and in 11/11 cases for the venom sensitized population. A significant index (determined by a ROC analysis) was observed in 11/12 beta-lactam sensitized patients and in 0/16 controls. CONCLUSION: These results show that IgE (an early activation marker) is more sensitive than CD63 (a later activation marker) in the diagnosis of beta-lactam allergy.

[Smoking cessation in the pregnant woman: descriptive study in Limousin]. / Sevrage tabagique chez la femme enceinte : étude descriptive en Limousin.

OBJECTIVE: Among obstetricians and midwives, estimate the percentage of smokers, appraise the proportion of medical professionals who mention the subject of nicotine addiction to their pregnant patients, and assess the quality of the information delivered to patients as well as their own experience in the field of tobacology. PATIENTS AND METHODS: Between February and March 2002, 188 postal questionnaires were sent to obstetricians and gynecologists, midwives and midwife students of public hospitals in Limousin and private clinics in Limoges. RESULTS: The response rate was 75,5% (142 answers) and the median age was 37 years old (20-59). 43,6% of the respondents were current smokers. Patients' smoking habits would be asked for and the risks of tobacco smoking would be explained by the majority of praticians and midwives. Minimal counsel to be given was known and given by 34,4% of gynecologists an 26,5% of midwives. Smoking cessation counselling was never proposed by 62% of gynecologists and 79% of midwives. Seventy per cent of them did not have any specific training in the field of tobacology during their studies. DISCUSSION AND CONCLUSION: There seems to be a deficiency in smoking cessation help for pregnant women in Limousin. Specifics programs and trainings for obstetricians, gynecologists, as well as midwives should be organized.

[Investigation of allergic reactions to platinum salts]. / Exploration d'une allergie aux sels de platine.

INTRODUCTION: We report two cases occurring in 2004 of patients being treated for pleural mesothelioma with a combination of cisplatin or carboplatin and pemetrexed. Investigation by skin tests and flow cytometry confirmed the clinical diagnosis in both cases. CASE REPORTS: Case 1: a man of 62 developed, after 12 courses of cisplatin-pemetrexed, an anaphylactic reaction 5 minutes after the infusion of cisplatin. Treatment was withdrawn permanently. Case 2: a man of 66 developed, after 7 courses of cisplatin-pemetrexed, an anaphylactic reaction within the first minute of the infusion of cisplatin. Subsequently, in March 2004, he received pemetrexed alone without any problems. In August 2004 he was prescribed carboplatin-pemetrexed. Within 5 minutes he developed urticaria, pruritus and abdominal pain. He was treated later with pemetrexed alone with no problems. CONCLUSION: Hypersensitivity to platinum salts usually occurs after several courses of treatment. Skin tests and flow cytometry are a simple, concordant, and reliable way of confirming the diagnosis.

Aspirin and non steroidal anti-inflammatory drugs hypersensitivity review (2002-2004).

According to physician, Aspirin and NSAIDS hypersensitivity are causing three major problems: how to make the diagnosis? Which treatment are to he given to these patients? What kind of anti-inflammatory drugs are to be prescribed? For these last three years, several articles regarding these matters were being published.

[Respiratory effects of risperidone? A prospective study]. / Effets respiratoires de la rispéridone? Etude prospective.

Risperidone is an atypical neuroleptic which has been incriminated as a cause of respiratory symptoms. The purpose of this prospective study was to assess over a three-month period the respiratory status of patients free of allergic or respiratory disease treated with risperidone. Thirty-nine patients were enrolled. Twenty dropped out. One patient developed cough very likely related to risperidone but with no change in function. Bronchial hyperreactivity developed in two other patients who had no clinical symptom or sign of respiratory disorder. Despite the small number of patients in this study, risperidone would appear to have secondary respiratory effects. The high frequency of bronchial hyperreactivity observed in patients at inclusin and the nearly constant co-prescription of other psychiatric drugs suggests a potential combination effect (notably with selective seritonin reuptake inhibitors).

[Clinical and biological surveillance after the cessation of Hymenoptera venom desensitization]. / Surveillance clinique et biologique après arrêt de la désensibilisation aux venins d'hyménoptères.

107 patients have discontinued Hymenoptera venom immunotherapy between 1988 and 2000. 31 have been seen again with intradermal tests with IgEs, and 81 responded to a questionnaire. Intradermal reactions and IgEs decrease together significantly during immunotherapy and then persist at low level during three years. Beyond, the number of patients is insufficient. 32 patients were stung by the same Hymenoptera and not had any systemic reaction. However, five have beta blockers, three have IEC and half of the patients don't take precautions to avoid Hymenoptera.

[Respiratory allergy and domestic animals]. / Allergie respiratoire et animaux domestiques.

Pets must be considered allergy factors. They are not advised for atopic families. However some recent publications suggest a protective effect of cat and dog exposure in the first year of life. The origin of this protective effect is not known.

Carboplatin-etoposide combination in small cell lung cancer patients older than 70 years: a phase II trial.

BACKGROUND: No standard treatment is defined for elderly patients with small cell lung cancer (SCLC). Carboplatin and etoposide are highly active agents against SCLC. In this study, we evaluated the activity and toxicity of a combination of these two agents. PATIENTS AND METHODS: Thirty-four untreated patients with limited or extensive SCLC and median age of 73.9 years entered the study. Chemotherapy consisted of carboplatin i.v. on day 1 (AUC 5 using Calvert's formula) and etoposide 100 mg/m(2) given orally on days 1-5, every 4 weeks, and thoracic irradiation was given to limited disease patients after chemotherapy. RESULTS: The overall response rates was 59% (95% CI: 43-76). The median survival for all patients was 37 weeks (range 3-76 weeks). The toxicity was mainly haematological with grade 3-4 neutropenia in 59% of courses, febrile neutropenia in 15% of courses, and toxic death in 9% of patients. CONCLUSION: The results of this regimen are disappointing with worse response and survival, and more haematological toxicity than expected and previously reported, despite the use of Calvert's formula. Possible explanations are the use of etoposide per os rather than i.v., the frequent comorbidities of older patients and the inclusion of patients with poor prognosis factors.

[Pseudoneoplastic forms of bronchiolitis obliterans with organizing pneumopathy (BOOP)]. / Formes pseudo-néoplasiques des BOOP.

Chronic obstructive bronchiolitis with organizing lung disease is an anatomoradioclinical entity characterized by nonspecific inflammation associated with recurrent migratory minimally dense alveolar opacities on the chest x-ray poorly responsive to corticosteroid therapy. Excepting this typical presentation, other clinical forms may occur. We report the cases of two patients with an exceptional localized presentation raising the differential diagnosis of lung cancer.

[Pulmonary infection caused by Fusobacterium nucleatum]. / Infection pulmonaire à Fusobacterium nucleatum.

Thoracic infection by anaerobes are uncommon diseases and often presents difficulty in diagnosis. We report a case of thoracic infection due to Fusobacterium Nucleatum. A 60-year old man presented a lesion infiltrating from the lung to the thoracic wall. Fusobacterium Nucleatum was isolated on pus collected. Treatment by penicillin, metronidazole combined with surgical drainage was highly effective.

[Aerosol administration of a replication defective recombinant adenovirus expressing normal human cDNA-CFTR in the respiratory tractus in patients with cystic fibrosis]. / Administration par aérosol d'un adénovirus recombinant déficient pour la réplication contenant cADN-CFTR humain normal dans le tractus respiratoire de patients atteints de mucoviscidose.

At present it is conceivable to think that gene therapy represents a way to treat or even prevent the respiratory manifestations of cystic fibrosis. Consistent to such a concept, there is sufficient evidence that Ad-CFTR, a recombinant replication-deficient adenovirus expressing the human cystic fibrosis transmembrane conductance regulator cDNA, can vectorize the expression of a functional CFTR (cystic fibrosis transmembrane conductance regulator) to the nasal and airway epithelia. The clinical protocol was designed to assess the safety of single escalating doses of a replication defective adenovirus expressing the cystic fibrosis transmembrane conductance regulator gene (Ad-CFTR) when administered to the tracheobronchial portion of the airways and whether biological efficacy of CFTR delivery could be demonstrated. Six cystic fibrosis patients received nasal instillation and subsequent aerosol (Optineb, Air Liquide, Paris, France) administration of Ad-CFTR the following day. Doses (pfu) applied to the nose were 10(5) (patients SG and PB), 10(7) (patients FP and EP) and 4 x 10(8) (patients DS and FG), while aerosolised doses were 10(7) (patients SG and PB), 10(8) (patients FP and EP) and 5.4 x 10(8) (patients DS and FG), respectively. No acute toxic effects, no increase in the titer of anti-adenovirus antibodies and no spreading or shedding of Ad-CFTR were detected. In one patient Ad-CFTR DNA was found in the urine and blood two days after aerosolisation. Ad-CFTR DNA was detected in nasal and bronchial brush samples, in BAL, in saliva and tonsils 21, 8, 14 and 4 days post virus administration, respectively. Ad-CFTR mRNA (RT-PCR on bronchial cells) and CFTR protein (immunochemistry on nasal and bronchial cells) were detected up to 14 days following Ad-CFTR administration. These results show that the nebulisation of Ad-CFTR is a possible approach for treating the respiratory manifestation of cystic fibrosis.

[Pneumopathy induced by pirindopril. A case report]. / Pneumopathie induite par le pirindopril. A propos d'un cas.

Cough is known to be the major respiratory side effect of treatment with angiotensin converting enzyme inhibitors (ACEI). Recently, ACEI have been implicated in drug-induced lung disease. We report a new case of diffuse pneumonitis which occurred during treatment with ACEI. A 73-year-old man was admitted for cough, dyspnea at rest, fever and weight loss. The patient had been treated with the ACEI pirindopril during 6 months for systemic hypertension. Chest radiographs showed reticular infiltrates in the upper lung fields. A CT scan confirmed the infiltrates and showed pleural thickening and airspace opacities. White blood cell counts showed 15,700/mm3 leucocytes with 940 eosinophils/mm3. Transbronchial biopsy was consistent with infiltration of the lung with eosinophils. There was no evidence for another etiology. Once the drug was withdrawn, clinical and radiological abnormalities improved but steroids were required to control symptoms. This report suggests that pirindopril, as captopril, can induce the picture of drug-induced pulmonary disease.