Biomedical subjects
Publications and source records attributed to F Vaylet.
Technological progress and numerous published studies allow to estimate the best place of the 18F-fluorodeoxyglucose positron emission tomography, a real functional metabolic imagery, in the clinical and therapeutic strategy of non small cell lung cancers.
"Whole body" FDG-PET usually covers the body from the base of the skull to the upper third of the thighs, arms in abduction. Thus, the upper part of the head and the lower limbs are not included in the acquisition field. We report the cases of three patients with non-small-cell lung cancer who developed secondary distal localizations beyond the acquisition field of "whole body" FDG-PET. Lung cancer is known to favor hematogenic dissemination, raising the possibility of early distal metastasis. A pretherapeutic PET scan which includes the extremities can be useful to search for distal extension. These true whole body scans are time consuming and can thus limit machine availability. Furthermore, the diagnostic yield of this type of examination may be low since it can be estimated that about 1% of patients will develop isolated distal metastases (3 out of 293 patients in our series initially treated for non-metastatic non-small-cell lung cancer). In the current context of technical availability, systematic inclusion of the lower limbs in the PET scan acquisition field would not appear warranted for the initial work-up of patients with non-small-cell lung cancer. However, clinicians must be aware that distal metastases (brain, lower limbs) may not be detected.
In France, American pulmonary histoplasmosis is an imported deep mycosis, caused by inhalation of Histoplasma capsulatum. Clinical and radiological features of this exotic disease are multiple, simulating tuberculosis or cancer. We report two cases of American histoplasmosis with pseudo-tumoral form, in immunocompetent subjects working in Venezuela, with a multinodular pulmonary presentation.
BACKGROUND: Because of the expected high performances of scintigraphic scans with [18F]-fluorodeoxyglucose (FDG) not only in diagnostics and but also in therapeutic impact, especially in thoracic oncology, there are a lot of French nuclear medicine departments which will soon be equipped with a positron emission tomograph (PET). MATERIAL AND METHODS: The Nuclear Medicine Department of the Hôpital d'Instructions des Armées du Val-de-Grâce, Paris, led a retrospective study among physicians interested in 338 FDG-PET exams performed between may 2000 and march 2002 in order to compare its own results with international literature concerning four indications for lung cancer: pulmonary nodule or mass malignancy diagnostic, lung carcinoma extension evaluation, therapeutic efficiency, recurrence suspicion. RESULTS: There seems to be no divergence, regarding limitation induced by the not exhaustive analysis of the retrospective study: more than every two FDG-PET exam highly influenced the effective therapy. CONCLUSION: That is why clinical FDG-PET has to be widely developed to investigate lung cancer.
INTRODUCTION: Smoke inhalation and respiratory complications are still the major causes of mortality in severely burned patients. STATE OF THE ART: The diagnosis is suspected clinically on the basis of history and physical examination and can be confirmed bronchoscopically. Respiratory failure in burned patients occurs through a number of associated mechanisms. Pneumonitis and adult respiratory distress syndrome (ARDS) are common early complications. New pulmonary treatments and advances in ventilation have reduced the incidence of both barotrauma and infectious complications. Tracheal stenosis can occur as a late complication of prolonged mechanical ventilation. PERSPECTIVES: Clinical and experimental studies have shown that damage to the mucosal barrier and the release of inflammatory mediators are the most important pathophysiological events following smoke inhalation. Manipulation of the inflammatory response following inhalation may be a treatment option in the distant future. CONCLUSION: Inhalation injury occurring in burned patients can produce severe respiratory and systemic complications.
BACKGROUND: Taxotere (docetaxel) at the dose of 75 mg/m(2) every 3 weeks is a standard therapy for pretreated non-small-cell lung cancer (NSCLC). The aim of this study was to evaluate the safety profile of two schedules of docetaxel administration (every 3 weeks versus weekly) in patients with pretreated NSCLC. PATIENTS AND METHODS: From February 2000 to February 2001, 125 patients with locally advanced or metastatic NSCLC were randomised after failure of a previous platinum-based regimen to receive either docetaxel 75 mg/m(2) administered every 3 weeks (Dq3w) or docetaxel 40 mg/m(2) given weekly for 6 weeks followed by 2 weeks of rest (Dqw). Safety evaluations focused on grade 3-4 neutropenia, febrile neutropenia, nausea-vomiting and asthenia. RESULTS: Patients' characteristics were well balanced between arms. The most common National Cancer Institute Common Toxicity Criteria (NCI-CTC) grade 3-4 toxicity was neutropenia, which occurred in 48.4% of Dq3w patients versus 15.9% of Dqw patients (P=0.001). In addition, febrile neutropenia were observed in 6.5% of patients in Dq3w versus 0% in Dqw. Grade 3-4 asthenia was more frequent in Dqw. Other non-haematological toxicities were very rare. Regarding efficacy, there was a trend towards a better disease control rate in Dq3w: 32.2% versus 25.4% in Dqw. Median time to progression and survival were rather similar in both arms, respectively: 2.1 months (range 2-3.2) and 5.8 months (range 4.0-7.0) in Dq3w and 1.8 months (range 1.6-2.3) and 5.5 months (range 3.7-6.6) in Dqw. CONCLUSIONS: While both schedules had a favourable safety profile, a significant lower rate of severe neutropenia was observed in the weekly arm. Both regimens had similar efficacy. The weekly regimen could be considered as a good alternative for patients at risk of severe neutropenia.
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18FDG-PET scanning enables the imaging of metabolic activity giving an assessment of the local extent of thoracic malignancies as well as an indication of the presence of nodal or metastatic spread. This enables more accurate staging and has revolutionised the management of lung cancer. National and international guidelines describe the role of this technique.
Laryngeal tuberculosis is exceptional and identification in this localization can reveal clinically unrecognized pulmonary tuberculosis. We report two cases illustrating this situation. The pseudo-tumor aspect observed at endoscopy may be wrongly suggestive of neoplasia. Bacteriological examination provides the diagnosis. New methods of genomic diagnosis (Gen-Probe) and culture now allow particularly rapid diagnosis. Outcome is always favorable with standard anti-tuberculosis treatment.
We report the case of a 77-Year-old immunocompetent woman who required intensive care for acute dyspnea revealing complete atelectasia of the left lung related to an aspergillus mycelium plug blocking the principal bronchus. The clinical course was favorable after deobstruction by thermocoagulation and oral itraconazole given for six Months. The patient was free of parenchymatous or endobronchial sequelae. Adjuvant oral corticoid therapy was given temporarily during the second Month of treatment when signs of transition towards allergic aspergillosis developed. Four Months after discontinuing the antifungal treatment, the patient developed a new episode of acute dyspnea caused by atelectasia limited to the right lower lobe. Treatment by itraconazole was resumed and continued as long-term therapy. No recurrence has been observed for eighteen Months. The diagnostic and therapeutic problems raised by Aspergillus fumigatus are well known in the immunocompromised subject, but can also be encountered in the immunocompetent subject.
Long carrier flights favor thromboembolism. The risk is well known to the general public but is probably really very low. The risk is however pertinent due to the volume of air travel in the world. Sitting in the same position for a long time induced venous stasis which is the principal factor favoring thrombosis in travelers, irrespective of the means of transportation. Long carrier flights also expose passengers to specific factors related to air travel: coagulation disorders and alterations of the endothelium related to hypobarism, hypoxia and low hygrometry in the cabin. Presence of pathogenic thrombophilia is not a constant factor. The prevention of venous thrombosis in air travelers calls upon simple measures: abundant hydration, avoiding use of alcohol and tobacco, walking and dorsal flexion of the feet. The only preventive option with proven efficacy is the use of elastic contention which reduces the risk of thromboembolic events. There is no consensus concerning the use of drugs proposed by certain authors; prudence should be the rule. All passengers should become aware of the risk of thromboembolism related to sitting in the same position for a long time.
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BACKGROUND: The survival benefit associated with first-line chemotherapy in advanced lung cancer led to the need for second-line chemotherapy. Docetaxel (Taxotere) has proven efficacy in both settings. This study evaluated the safety and efficacy of two doses of docetaxel in patients with non-small-cell lung cancer who had failed first-line platinum-based chemotherapy. PATIENTS AND METHODS: In total, 182 patients from 24 French centres were randomised and treated with either docetaxel 75 mg/m(2) (arm A) or 100 mg/m(2) (arm B) every 3 weeks. Baseline characteristics were well balanced, except more patients in arm A had metastatic disease (91.4% versus 78.7%) and therefore the median number of sites involved for arm A was three compared with two for arm B. RESULTS: Median time to treatment failure was 1.34 months [95% confidence interval (CI) 1.28-1.64] for arm A and 1.64 months (95% CI 1.34-2.62) for arm B. Median overall survival was 4.7 months (95% CI 3.8-5.9) for arm A versus 6.7 months (95% CI 4.8-7.1) for arm B. According to a blinded expert panel, disease control was achieved in 35 (43.8%) patients in arm A and 39 (49.4%) patients in arm B. More patients in arm B experienced grade 3-4 neutropenia (B: 72.7% versus A: 44.0%), asthenia (B: 20.2% versus A: 10.8%) and infection (B: 6.7% versus A: 2.2%). Three treatment-related deaths were reported in each arm. CONCLUSIONS: The optimal docetaxel dosage in this second-line setting is 75 mg/m(2), as it has a more favourable safety profile and on balance a similar efficacy to the 100 mg/m(2) dose.
In pulmonary oncology, positron emission tomography provides metabolic imaging with a sensitivity and specificity of around 90%. Such results are of particular interest in the diagnosis of the benigness or malignancy of a pulmonary nodule, for the staging and the follow-up of lung cancers. Studies are ongoing to assess its interest in the appreciation of the prognosis and response to chemo- and radiotherapy.
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Approximately 50,000 implantable sites are prepared each year in France because of the undeniable advantage for the treatment of patients requiring long-duration intravenous infusions. The benefits of this technique must not overshadow the mechanical risks inherent in their installation and complications related to their use: infections, thromboembolic events. Clear, precise, and adapted treatment protocols must be established and rigorously implemented by the healthcare team. Information notes for the patients concerning the risks involved and warning signs must be written in order to be able to institute appropriate treatment rapidly.
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