[Lung neuroendocrine large cell carcinoma in young women. An unusual presentation]. / Cancer neuroendocrine à grandes cellules de la femme jeune : une présentation inhabituelle.

INTRODUCTION: Lung neuroendocrine large cell carcinoma is a rare tumor with a poor prognosis. There are very few guidelines for treating this cancer but a better knowledge of its markers could improve the treatment and the prognosis. OBSERVATIONS: We report two patients who presented initially with an early stage carcinoid tumor treated with surgery. Both patients had further new neuroendocrine disease diagnosed because of intermittent carcinoid syndrome, predominantly occurring at the same time as menstruation. They were then diagnosed with metastatic lung neuroendocrine large cell carcinoma and treated with first-line cisplatin-etoposide and second-line octreotide with estrogen plus progestin. They both had a good prognosis with no disease progression to date. CONCLUSIONS: The clinical characteristics of these cases raise several questions about the pathophysiology of lung neuroendocrine large cell carcinoma and may suggest potential new treatment options. The unusual clinical presentation and good prognosis may be explained either by the second-line treatment choice or by potential molecular or hormonal biomarkers. There is a need to investigate these potential biomarkers further since they could be new therapeutic targets.

[Lung neuroendocrine large-cell carcinoma in young women - An unusual presentation]. / Cancer neuroendocrine à grandes cellules de la femme jeune : une présentation inhabituelle.

INTRODUCTION: Lung neuroendocrine large-cell carcinoma (LNELCC) is a rare tumour with a poor prognosis. There are very few guidelines for LNELCC treatment but a better knowledge of its biology could improve the treatment and prognosis of this malignancy. OBSERVATIONS: We present the cases of 2 patients who presented initially with early stage carcinoid tumours treated with surgery. Both patients had further new neuroendocrine disease diagnosed because of intermittent carcinoid syndrome, predominantly occurring at the same time as menstruation. They were then diagnosed with metastatic LNELCC. They were treated with first-line cisplatin-etoposide and second-line octreotide based on the protocol used for treatment of gastro-intestinal neuroendocrine tumours. They both had a good prognosis with no disease progression to date. CONCLUSIONS: The clinical characteristics of these cases raise several questions about the pathophysiology of LNELCC and may suggest potential new treatment options. The unusual clinical presentation and good prognosis may be explained either by the second-line treatment choice or by potential molecular or hormonal biomarkers. There is a need to investigate these potential biomarkers further since they could be new therapeutic targets.

[Impact of a targeted educational intervention on respiratory syncytial virus bronchiolitis prevention in full-term and preterm infants]. / Optimisation de la prévention de la bronchiolite à VRS chez les nouveaux-nés à risque et les prématurés : mesure de l'impact d'une intervention éducative ciblée.

OBJECTIVES: Palivizumab, a humanized monoclonal antibody directed against respiratory syncytial virus (RSV), is the only existent immunoprophylaxis therapy for prevention of serious lower respiratory tract disease caused by RSV in infants (up to 2 years of age), particularly in those who meet high-risk criteria (preterm infants and/or those with bronchopulmonary or congenital heart disease). In our region, the monthly injections are not given at the hospital but by private pediatricians during the epidemic season. We aimed to assess the influence of an educational and personalized support of preterm infants treated with Palivizumab on patient compliance during the last season. METHODS: A three-level educational intervention was conducted: the parents were advised in the neonatology units, then at the hospital pharmacy where the treatment was delivered, and finally by their referent pediatrician. We evaluated the impact of this intervention by measuring patient compliance, defined by two criteria, and by measuring the rate of rehospitalization for RSV bronchiolitis. We compared these results to those of the previous season (2011-2012) in which no interventional program was conducted. RESULTS: Compliance was better in the group of patients followed (2012-2013); 59.7% of them received all the palivizumab doses, while only 32.9% of the infants not followed received all doses. The number of injections given at appropriate intervals remained stable between the two groups and no significant difference was found in the rate of RSV bronchiolitis rehospitalizations. CONCLUSION: This educational intervention program, coordinated by doctors and pharmacists, is associated with improved treatment compliance in high-risk of RSV bronchiolitis infants. To optimize such a care program, we have planned to set up and then evaluate a call center procedure involving extensive counseling for parents and reminder telephone calls.

[Liver involvement in hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease). Report of one case and review of the literature]. / Atteinte hépatique au cours de la maladie de Rendu-Osler. A propos d'un cas et revue de la littérature.

INTRODUCTION: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular dysplasia; mutations in at least three genes (ENG, ACVRL1 et MADH4), which are components of transforming growth factor (TGF)-beta, may lead to the clinical picture of HHT. HHT is a multisystemic angiodysplasia, resulting in multiple vascular malformations, involving notably the liver. EXEGESIS: We report the case of a patient with anicteric cholestasis, revealing HHT. Abdominal CT-scan revealed hepatic artery dilation and multiple arteriovenous fistula. At 2-year follow-up, the patient exhibited liver involvement-associated high output cardiac insufficiency. CONCLUSION: Liver involvement is frequent in HHT, occurring in 8-31% of patients; it may lead to life-threatening complications, such as high output cardiac failure, portal hypertension or severe cholangitis. Abdominal Doppler ultrasonography is a non-invasive accurate method, suitable for first-line imaging of the liver in patients with HHT; it should be done in all patients, in order to detect HHT-related hepatic vascular malformations.