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World Breastfeeding Week is held every year from 1-7 August to promote breastfeeding as a way to make infants around the world healthier. In French Guiana, caregivers work within a network to support this approach with young mothers, as evidenced by a midwife who has worked for several years on site, particularly in remote prevention and health centres and at the Kourou Hospital Centre., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

High shore intertidal ectotherms must withstand temperatures which are already close, at or beyond their upper physiological thermal tolerance. Their behaviour can provide a relief under heat stress, and increase their survival through thermoregulation. Here, we used infrared imaging to reveal the thermoregulatory behavioural strategies used by the snail Littorina saxatilis (Olivi) on different microhabitats of a high shore boulder field in Finistère (western France) in summer. On our study site, substrate temperature is frequently greater than L. saxatilis upper physiological thermal limits, especially on sun exposed microhabitats. To maintain body temperatures within their thermal tolerance window, withdrawn snails adopted a flat posture, or elevated their shells and kept appended to the rock on the outer lip of their aperture with dried mucous (standing posture). These thermal regulatory behaviours lowered snail body temperatures on average by 1-2°C. Aggregation behaviour had no thermoregulatory effect on L. saxatilis in the present study. The occupation of biogenic microhabitats (barnacles) was associated with a 1°C decrease in body temperatures. Barnacles and microhabitats that experienced low sun exposure, low thermal fluctuations and low thermal maxima, could buffer the heat extremes encountered at high shore level especially on sun exposed microhabitats., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Understanding the physiological abilities of organisms to cope with heat stress is critical for predictions of species' distributions in response to climate change. We investigated physiological responses (respiration and heart beat rate) of the ectotherm limpet Patella vulgata to heat stress events during emersion and the role of seasonal and microclimatic acclimatization for individual thermal tolerance limits. Individuals were collected from 5 microhabitats characterized by different exposure to solar radiation in the high intertidal zone of a semi-exposed rocky shore in winter and summer of 2014. Upper thermal tolerance limits (heat coma temperatures - HCTs, and heart rate Arrhenius break temperatures - ABTs) were determined for individuals from each microhabitat in both seasons under laboratory conditions. While we found a clear seasonal acclimatization, i.e., higher HCTs and ABTs in summer than in winter, we did not find evidence for microhabitat-specific responses that would suggest microclimatic acclimatization. However, operative limpet temperatures derived from in-situ temperature measurements suggest that individuals from sun exposed microhabitats have a much narrower thermal safety margins than those from less exposed surfaces or within crevices. Microhabitat specific thermal safety margins caused by high thermal heterogeneity at small spatial scales and the lack of short term acclimatization will likely shape small scale distribution patterns of intertidal species in response to the predicted increase in the frequency and intensity of heat waves., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The effects of ocean acidification alone or in combination with warming on coral metabolism have been extensively investigated, whereas none of these studies consider that most coral reefs near shore are already impacted by other natural anthropogenic inputs such as metal pollution. It is likely that projected ocean acidification levels will aggravate coral reef health. We first investigated how ocean acidification interacts with one near shore locally abundant metal on the physiology of two major reef-building corals: Stylophora pistillata and Acropora muricata. Two pH levels (pHT 8.02; pCO2 366 μatm and pHT 7.75; pCO2 1140 μatm) and two cobalt concentrations (natural, 0.03 μg L-1 and polluted, 0.2 μg L-1) were tested during five weeks in aquaria. We found that, for both species, cobalt input decreased significantly their growth rates by 28% while it stimulated their photosystem II, with higher values of rETRmax (relative Electron Transport Rate). Elevated pCO2 levels acted differently on the coral rETRmax values and did not affect their growth rates. No consistent interaction was found between pCO2 levels and cobalt concentrations. We also measured in situ the effect of higher cobalt concentrations (1.06 ± 0.16 μg L-1) on A. muricata using benthic chamber experiments. At this elevated concentration, cobalt decreased simultaneously coral growth and photosynthetic rates, indicating that the toxic threshold for this pollutant has been reached for both host cells and zooxanthellae. Our results from both aquaria and in situ experiments, suggest that these coral species are not particularly sensitive to high pCO2 conditions but they are to ecologically relevant cobalt concentrations. Our study reveals that some reefs may be yet subjected to deleterious pollution levels, and even if no interaction between pCO2 levels and cobalt concentration has been found, it is likely that coral metabolism will be weakened if they are subjected to additional threats such as temperature increase, other heavy metals, and eutrophication.

Bivalve larvae and hydrographic parameters were sampled over a range of spatio-temporal scales in a deep atoll lagoon. Bivalve larvae abundances were very high throughout the year: 18,550 m(-3) in average. Larvae were (i) concentrated at mid-depth with nocturnal ascent and diurnal descent, (ii) heterogeneously dispersed at the lagoon scale, (iii) subject to day-to-day variation in abundance and (iv) transferred between different parts of the lagoon providing evidence of intra-lagoonal connectivity. The primacy of physical factors was seen on large spatial scale with the diluting effect of water renewal and transfers by hydrodynamics. On smaller spatial scale, the primacy of biological processes was recognised, with larval swimming activity leading to dial vertical migration correlated with food concentration. Variations in larval abundance were driven by bivalve reproductive activity correlated with meteorological conditions (i.e. windy periods). Finally, relationship between bivalve larvae patterns and pearl oyster (Pinctada margaritifera) settlement structuring is discussed., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Understanding the relationship between growth and temperature will aid in the evaluation of thermal stress and threats to ectotherms in the context of anticipated climate changes. Most Pecten maximus scallops living at high latitudes in the northern hemisphere have a larger maximum body size than individuals further south, a common pattern among many ectotherms. We investigated differences in daily shell growth among scallop populations along the Northeast Atlantic coast from Spain to Norway. This study design allowed us to address precisely whether the asymptotic size observed along a latitudinal gradient, mainly defined by a temperature gradient, results from differences in annual or daily growth rates, or a difference in the length of the growing season. We found that low annual growth rates in northern populations are not due to low daily growth values, but to the smaller number of days available each year to achieve growth compared to the south. We documented a decrease in the annual number of growth days with age regardless of latitude. However, despite initially lower annual growth performances in terms of growing season length and growth rate, differences in asymptotic size as a function of latitude resulted from persistent annual growth performances in the north and sharp declines in the south. Our measurements of daily growth rates throughout life in a long-lived ectothermic species provide new insight into spatio-temporal variations in growth dynamics and growing season length that cannot be accounted for by classical growth models that only address asymptotic size and annual growth rate.

The elemental mercury evasion from non-impacted natural areas is of significant importance in the global Hg cycle due to their large spatial coverage. Intertidal areas represent a dynamic environment promoting the transformations of Hg species and their subsequent redistribution. A major challenge remains in providing reliable data on Hg species variability and fluxes under typical transient tidal conditions found in such environment. Field experiments were thus carried out to allow the assessment and comparison of the magnitude of the gaseous Hg fluxes at the three interfaces, sediment-water, sediment-atmosphere and water-atmosphere of a mesotidal temperate lagoon (Arcachon Bay, Aquitaine, France) over three distinct seasonal conditions. The fluxes between the sediment-water and the sediment-atmosphere interfaces were directly evaluated with field flux chambers, respectively static or dynamic. Water-atmosphere fluxes were evaluated from ambient concentrations using a gas exchange model. The fluxes at the sediment-water interface ranged from -5.0 to 5.1 ng m(-2) h(-1) and appeared mainly controlled by diffusion. The occurrence of macrophytic covers (i.e.Zostera noltii sp.) enhanced the fluxes under light radiations. The first direct measurements of sediment-atmosphere fluxes are reported here. The exchanges were more intense and variable than the two other interfaces, ranging between -78 and 40 ng m(-2) h(-1) and were mostly driven by the overlying atmospheric Hg concentrations and superficial sediment temperature. The exchanges between the water column and the atmosphere, computed as a function of wind speed and gaseous mercury saturation ranged from 0.4 to 14.5 ng m(-2) h(-1). The flux intensities recorded over the intertidal sediments periodically exposed to the atmosphere were roughly 2 to 3 times higher than the fluxes of the other interfaces. The evasion of elemental mercury from emerged intertidal sediments is probably a significant pathway for Hg evasion in such tidal environments exhibiting background contamination level.

Objective: To report the rules and the activity of the institutional review board of the French college of obstetricians and gynecologists (Comité d'éthique de la recherche en obstétrique et gynécologie [CEROG]) created in 2008. The submission requirements are also described., Methods: Retrospective study., Results: The Ethical Review Committee [institutional review board of the French college of obstetricians and gynecologists (CNGOF)] CEROG have examined 65 project studies in 2008. The median number of submitted studies was 5.5 per month (IQR: 3.75-6.25). The origins of the submission were as follows: tertiary care university hospitals (n=63, 97 %), Inserm (n=1), INRA (n=1). Researches were found to be in conformity with the French laws and regulations, to conform to generally accepted scientific principles and medical research ethical standards in 44 cases (68 %). In 13 cases (20 %), the study has been forwarded to the Persons Protection Committee (PPC) since it concerned biomedical research or "usual care research" (soin courant). In six cases (9 %), the investigators have not responded to IRB suggestions. In two cases (3 %), the information form has been judged unsatisfactory., Conclusion: The CEROG is the first national IRB in obstetrics and gynecology. This new committee clarifies IRB submission procedure in France concerning non-interventional studies in the field of obstetrics and gynecology., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Fluxes of dissolved inorganic carbon and oxygen at the water-sediment interface were measured at eight coral reef stations (Indian Ocean) in summer and winter. The dark fluxes provided the community respiratory quotient (CRQ = dissolved inorganic carbon release / oxygen uptake) and the diurnal fluxes corrected from the dark fluxes gave the community photosynthetic quotient (CPQ = oxygen gross release / dissolved inorganic carbon gross uptake). The CRQ and the winter CPQ were not significantly different from 1. Summer CPQ (0.79; SD 0.02) was significantly lower than 1 due to the combined effect of the daily evolution of the community respiration and the discrepancy between the daily evolution in community oxygen respiration and community carbon respiration. These results highlight the importance of measuring simultaneously the benthic community production and respiration for long term integrated data sets, instead of the traditional daily or seasonal budget calculations from limited measures of community respiration.

Previous studies of contracting muscle with low loading and partial vascular occlusion demonstrated hypertrophy and strength adaptations similar to and exceeding those observed with traditional moderate to high resistance (Shinohara M, Kouzaki M, Yoshihisa T, and Fukunaga T. Eur J Physiol 77: 189-191, 1998; Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, and Ishii N. J Appl Physiol 88: 2097-2106, 2000; Takarada Y, Sato Y, and Ishii N. Eur J Physiol 86: 308-314, 2002). The purpose of the study was to determine the anabolic and catabolic hormone responses to light resistance exercise combined with partial vascular occlusion. Three experimental conditions of light resistance with partial occlusion (LRO), moderate resistance with no occlusion (MR), and partial occlusion without exercise (OO) were performed by eight healthy subjects [mean 21 yr (SD 1.8)]. Three sets of single-arm biceps curls and single-leg calf presses were completed to failure with 1-min interset rest periods. Workloads of 30 and 70% one repetition maximum for each exercise were lifted for the LRO and MR trials, respectively. Blood samples were taken preexercise, postexercise, and 15 min postexercise for each experimental condition. Lactate increased significantly in the LRO and MR trials and was not significantly different from each other at any time point. Growth hormone (GH) increased significantly by fourfold from pre- to postexercise in the LRO session but did not change significantly during this time period in the MR and OO trials (8.3 +/- 2.3 vs. 2.1 +/- 1.2 and 2.6 +/- 0.94 microg/l; respectively, P < 0.05). There were no changes in resting total testosterone [T; mean 15.7 +/- 1.6 (SE) nmol/l], free testosterone (FT; 54.1 +/- 4.5 pmol/l), or cortisol (267.6 +/- 22 nmol/l) across all trials and times. In conclusion, with similar lactate responses, light exercise combined with partial vascular occlusion elicits a greater GH response than moderate exercise without occlusion but does not affect T, FT, or cortisol.

Shell disease in the abalone Haliotis tuberculata L. is characterized by a conchiolin deposit on the inner surface of the shell. The gross clinical signs appear similar to the Brown Ring Disease (BRD) of clams. BRD has been extensively described in clams and is known to be responsible for severe mortalities and the collapse of the clam aquaculture industry in western France. In the clam, it was found to be caused by the infection of the mantle by Vibrio tapetis. Brown protein deposits have been observed in various abalone species around the world; some of these have been associated with a fungal infection in New Zealand, but the ones described here are similar to bacterial infections observed in clams. Larger animals appeared to be more affected by the disease, and a positive correlation of the number of successive infections found in the shells with the level of infestation of the shell by borers suggests that boring polychaetes and sponges may be vectors of the disease, or that the parasite infestation may increase the susceptibility of the animal to this infection. There is no evidence, however, that this infection causes mortality in abalone.

Purpose: To evaluate whether preoperative chemotherapy (PCT) could improve survival in resectable stage I (except T1N0), II, and IIIA non-small-cell lung cancer (NSCLC)., Patients and Methods: A randomized trial compared PCT to primary surgery (PRS). PCT consisted of two cycles of mitomycin (6 mg/m(2), day 1), ifosfamide (1.5 g/m(2), days 1 to 3) and cisplatin (30 mg/m(2), days 1 to 3), and two additional postoperative cycles for responding patients. In both arms, patients with pT3 or pN2 disease received thoracic radiotherapy., Results: Three hundred fifty-five eligible patients were randomized. Overall response to PCT was 64%. There were two preoperative toxic deaths. Postoperative mortality was 6.7% in the PCT arm and 4.5% in the PRS arm (P =.38). Median survival was 37 months (95% confidence interval [CI], 26.7 to 48.3) for PCT and 26.0 months (95% CI, 19.8 to 33.6) for PRS (P =.15). Survival differences between both arms increased from 3.8% (95% CI, 1.3% to 25.1%) at 1 year to 8.6% (95% CI, 2.64% to 24.4%) at 4 years. A quantitative interaction between N status and treatment was observed, with benefit confined to N0 to N1 disease (relative risk [RR], 0.68; 95% CI, 0.49 to 0.96; P =.027). After a nonsignificant excess of deaths during treatment, the effect of PCT was significantly favorable on survival (RR, 0.74; 95% CI, 0.56 to 0.99; P =.044). Disease-free survival time was significantly longer in the PCT arm (P =.033)., Conclusion: Although impressive differences in median, 3-year, and 4-year survival were observed, they were not statistically significant, except for stage I and II disease.

The incidence of chronic respiratory failure is underestimated in Martinique. The aim of our retrospective study was to determine local particularities. Between December 1991 and December 1995, 128 patients (55% men, mean age 60 years, range 18-89 years) were hospitalized in our pneumology unit to receive a respiratory device (oxygen concentrator, respirator, continuous positive pressure generator). The high percentage of continuous positive pressure generators contrasted with the low number of oxygen concentrators prescribed indicating that obstructive disease is relatively less common due to the absence of widespread smoking habits. Sleep apnea syndrome (SAS) was particularly frequent in women (44% of the SAS patients). 10% of the SAS patients had perturbed blood gases unexplained by an associated bronchopathy. SAS in obese, hypertensive, diabetic women in Martinique is a public health problem and should be assessed by a prospective study. We observed that home care was particularly difficult for the most severely diseased patients, especially those with a tracheotomy, due to the lack of a management structure.

Optimal dosage for chemotherapy administered to patients on chronic hemodialysis remains a difficult question. We report the case of a patient with chronic renal failure on hemodialysis for 9 years who was treated for small-cell lung cancer. The chemotherapy protocol combined carboplatin and etoposide at doses adapted to creatinine clearance. Tumor regression was observed after 6 cycles without major intolerance.

Previous studies have suggested the utility of D-Dimer ELISA assays in eliminating a diagnosis of pulmonary embolism (PE). Our objectives were to evaluate the performance of a new, rapid, quantitative, and automated Liatest D-Dimer Assay in patients with suspected PE. Three hundred eighty-six consecutive patients referred to our institution between March 1992 and December 1996 for clinically suspected PE, with recent clinical signs not exceeding 1 wk, were included in this study. Diagnosis of PE was based on clinical evaluation, radionuclide lung imaging, lower limb examination, and, when required, pulmonary angiography. D-Dimer performances, for both Liatest D-Dimer and standard D-Dimer ELISA (Asserachrom DDi), assays, were assessed at the end of the study. Among the 386 patients tested, 146 (37.8%) were classified as PE-positive. Liatest D-Dimer assay had a 100% sensitivity (95% confidence interval, 97 to 100%) and a negative predictive value of 100% (95% confidence interval, 94 to 100%). A normal result, below the cutoff of 500 ng/ml, occurred in 83 of the 386 (21%) patients. There was a strong agreement between Liatest D-Dimer and Asserachrom DDi analyses. These findings suggest that this rapid, quantitative, and automated D-Dimer assay provides a useful diagnostic tool for the clinician with regard to exclusion of PE.

In previous studies, enzyme-linked immunosorbent assays (ELISA) for plasma D-dimer analysis have demonstrated high sensitivity, suggesting their potential usefulness in excluding deep venous thrombosis (DVT). We evaluated the usefulness of a new D-dimer test (Liatest D-dimer) for suspected DVT in a prospective study of patients admitted to the hospital because of recent (not exceeding 1 week before admission) clinical signs. Contrast venography or compression ultrasonography or both were performed within 24 hours of admission. A new quantitative determination of D-dimer concentration using a suspension of microlatex particles coated with specific antibodies was tested. A standard plasma D-dimer ELISA measurement was also performed. Of 464 patients, 276 had a proven DVT (distal, 74; proximal, 202). For a cutoff level of 400 ng/mL, sensitivity of the Liatest method in the diagnosis of overall DVT was 94.6% (95% confidence interval, 92.0%-97.0%), and the specificity was 35% (95% confidence interval, 28%-42%). The sensitivity and negative predictive value were 98.5% and 95.6%, respectively, in the diagnosis of proximal DVT, but only 83.8% and 84.6%, respectively, in the diagnosis of distal DVT. This new rapid Liatest D-dimer assay seems to be highly sensitive and could replace the ELISA method in excluding patients with proximal DVT. Both methods provide lower sensitivity for distal DVT.

Asthma, as a chronic condition, alters individual's day-to-day life in functional, emotional and social domains. There has been a recent upsurge of interest in the assessment of quality of life in asthmatic patients. Indeed, there is growing evidence that conventional outcomes of asthma (symptoms assessments, functional measures...) although important, may not detect all the changes experienced by patients. Quality-of-life instruments target two distinct properties. First, discriminative instruments are needed to distinguish between individuals or groups of patients. Second, an evaluative instrument is required to detect such changes in an individual or group of patients, as occur in clinical trials. There are now a number of quality-of-life instruments, with strong measurement properties, that can be used in clinical trials.

The Asthma Quality of Life Questionnaire (AQLQ) is a well-validated instrument. Our objectives were to explore the cross-sectional validity of the French version, using usual outcomes of asthma, as well as assessment of knowledge of asthma, self-management and compliance. A self-administered version of the AQLQ was given to 124 consecutive patients recruited from two out-patient clinics and an emergency room in order to reflect a wide range of asthma severity. The other outcomes of asthma measured were the FEV1, patient-perceived asthma severity using a visual analogue scale, compliance, knowledge of asthma condition and self-management autonomy. Correlations were predicted before analysis ( r > 0.5, strong correlation, ++ r = 0.35-0.5, moderate correlation and + r = 0.20-0.35, fair correlation). The AQLQ scores correlated moderately to strongly with asthma severity and fairly with the pulmonary function results. Of the behavioural outcomes assessed, only knowledge of asthma correlated fairly with the AQLQ scores, as expected. This study of the French version of the AQLQ, while showing similar cross-sectional correlations with functional assessment and asthma severity to those observed with the original English version, suggested in addition a positive association between quality of life and knowledge of asthma.

Objective: To compare oral anticoagulant treatment (fluindione) started on either the 1st or the 10th day of a low-molecular-weight heparin (enoxaparin) treatment for deep vein thrombosis confirmed by venography., Design: An open, multicenter, randomized study in two parallel treatment groups., Interventions: All patients received enoxaparin, 1 mg/kg s.c. twice daily, and oral fluindione, 20 mg once daily, either beginning on day 1 or on day 10 of the enoxaparin treatment. Enoxaparin was discontinued once the international normalized ratio under fluindione was stable between 2.0 and 3.0 over 2 days. Fluindione treatment was maintained during a 3-month follow-up period., Outcome Measurements: Specific examinations (venography and/or V/Q lung scanning and/or angiography) were performed only in the event of a clinically suspected recurrence of venous thromboembolism during the 3-month follow-up period. All cases were blindly assessed by an independent Reading Committee., Results: A clinically suspected venous thromboembolism was confirmed by objective tests in 1 of 223 patients (group of delayed introduction of fluindione; n = 111). Equivalence was demonstrated between the two treatment schedules (p < 0.0001) for a maximal difference of 10% (90% confidence interval: -2.42 to 0.58). The mean duration of hospitalization was significantly reduced (p = 0.0001) in the group with early introduction of fluindione. The incidence of hemorrhage was comparable between the two treatment groups., Conclusion: Early and delayed introduction of oral anticoagulant treatment in association with subcutaneous enoxaparin in patients with deep vein thrombosis was shown to be equivalent in preventing the recurrence of venous thromboembolism. In patients with early introduction of oral anticoagulant, hospitalization was significantly reduced.

Since a high tissue penetration of dirithromycin (D) has been assessed in early studies, the aims of this study were to determine D concentrations in bronchial mucosa and secretions in patients suffering from an acute exacerbation of chronic bronchitis (AECB), to compare intra-individual bronchial mucosa and secretion concentrations and to relate bronchial concentrations of D and clinical efficacy. The main inclusion criteria were comprised of (1) AECB, defined by the presence of an increase in dyspnea, sputum production and change in sputum purulence, and (2) clinical indication of fiberoptic bronchoscopy allowing performance of bronchial biopsies. All patients were treated with a 500-mg once-daily D dose for 5 days. Patients were randomly divided into three groups, according to sampling times (24, 48 and 72 h after the last dose). Tissue concentration analyses were performed by one blinded microbiologist (microbiological agar diffusion assay). The results showed: (1) 37 out of the 46 patients (80.4%) had a favorable response to treatment at the time of fiberoptic bronchoscopy (14 cured, 23 improved); (2) bronchial mucosa concentrations were high in all groups, and (3) mean values at 24, 48 and 72 h after the last dose were respectively 6.51 +/- 1.44, 6. 61 +/- 2.7, 5.67 +/- 1.02 mg.kg-1; no statistical difference was observed between the groups. In bronchial secretions collected simultaneously, concentrations were lower, i.e. 1.26 +/- 0.3, 0.61 +/- 0.12, 0.84 +/- 0.12. Significant associations were observed between bronchial mucosa and secretion concentrations (r = 0.71, p = 0.0001), and between clinical response and bronchial concentrations (p = 0.03, Kruskall-Wallis test). In conclusion, these results may confirm the clinical significance of tissue concentrations measured in bronchial tissues of patients with AECB.

We describe a 28-year-old subject employed as a roofer in a construction company since the age of 19, who developed work-related symptoms of a cough, shortness of breath, wheezing, rhinitis and headaches. A description of a usual day at work suggested that the symptoms worsened while he was sawing corrugated fiber cement. Baseline spirometry was normal, and there was a mild bronchial hyperresponsiveness to carbachol. A skin patch test to chromium was negative. A specific inhalation challenge showed a boderline fall in forced expiratory volume in 1 s (FEV1) after exposure to fiber cement dust. Exposure to nebulization of potassium dichromate (K2Cr2O7), at 0.1 mg.ml-1 for 30 min, was followed by an immediate fall by 20% FEV1. Simultaneously, a significant increase in bronchial hyperresponsiveness was demonstrated.

A Phase I trial of carboplatin therapy was performed on patients with locally advanced non-small cell lung cancer who had been previously treated with cisplatin, mitomycin and a vinca aklaloïd. This was administered as a daily bolus infusion or as a continuous infusion for 6 weeks with concurrent daily thoracic radiation. All patients had to be objective responders or to show no change after chemotherapy. The carboplatin was started at 10 mg/m2 per day, and increased to 15 mg/m2 per day and 20 mg/m2 per day, if treatment was feasible in successive cohorts of at least six patients. The radiation therapy consisted of 62-66 Gray on the tumor and the ipsilateral mediastinal nodes, 50 Gray on the mediastinum and 40-45 Gray on the supraclavicular lymph nodes. Twenty-nine patients took part in this study. Thrombocytopenia was the principal dose-limiting toxicity, with 15 mg/m2 per day of bolus or continuous infusion. Other toxicities included a fall in haemoglobin level, a fall in white-blood cell count, nausea and vomiting. The median survival time was 12 months, but the response rate cannot be determined among patients selected on the basis of response to chemotherapy. The recommended Phase II dose for patients previously treated with cisplatin containing chemotherapy, is 10 mg/m2 per day of either a bolus or continuous infusion.

Background: The value of a risk factor analysis in the presence of a clinically suspected deep venous thrombosis (DVT) has been assessed mainly in inpatient populations. The aim of this prospective study was to evaluate the potential association between DVT and acquired circumstances suspected as risk factors, in a cohort of outpatients with a clinically suspected DVT., Methods: Consecutive outpatients referred for a clinically suspected DVT, with recent clinical signs, not exceeding 1 week, were included. Before venography, all patients were interviewed by a trained physician to detect the presence of risk factors., Results: From March 1992 to February 1994, 277 patients were included; venography was positive in 162 (58.4%). Five independent variables were significantly associated with the occurrence of DVT; in a multivariate analysis, 64.7% of patients were correctly classified; odds ratios for having DVT in the presence of these underlying conditions were respectively: 1.75 for age over 65 years, 1.68 for prior history of venous thromboembolism, 1.69 for high risk circumstances (any type of surgery or leg trauma within the past 3 months), 5.59 for malignancy, and 2.56 for varicose veins., Conclusions: In outpatients referred for a clinically suspected DVT, recognition of associated conditions might increase the certainty of the diagnosis.

As previous studies have suggested an association between obstructive sleep apnea syndrome (OSA) and ischaemic heart disease, the aim of the present study was to evaluate the frequency of clinically relevant OSA in this selected population. From September 1992 to April 1993, 136 patients referred to the Cardiology Unit for suspected angina pectoris were asked to participate in the study. The main inclusion criterion was a stable coronary heart disease, diagnosed by angiography. A sleep questionnaire was administered by a trained physician. Patients who experienced one of the following symptoms: association of body mass index (-weight/height2) above 27.5 and heavy snoring, breathing stops, or daytime hypersomnolence, were selected for a nocturnal oxygen saturation recording. The occurrence of at least one desaturation, defined as a 4% fall from baseline, led to a full night-time polysomnography. One hundred and eight patients (78 males), satisfied the entry criteria. A pulse oximetry was performed in 15, and three patients experienced a significant desaturation. Finally, one patient satisfied the criteria of OSA. The estimated proportion of OSA amounted to 0.92%, in accordance with the prevalence of OSA described in the general population. Clinically relevant OSA does not appear to be more frequent in patients suffering from stable coronary heart disease. Systematic sleep investigations in such patients do not appear to be useful in daily clinical practice.

Hyperventilation syndrome is a frequent, but poorly understood clinical entity. The clinical expression is a rich combination of respiratory, cardiac and neurological signs which can simulate various organic diseases. Hypocapnia remains the primum movens for most authors although the relationship with psychiatric situations, in particular in anxious patients, is increasingly emphasized. The diagnosis is currently based on the elimination of diseases associated with hyperventilation, then on Nijmegen's questionnaire and is confirmed by the reproduction of the same clinical picture in a voluntary hyperventilation test. Respiratory function tests offer little information. Treatment is based on combining rehabilitation therapy focused on the diaphragm and on relaxation. Specialized care may be needed in psychiatric patients.

We report a case of plastic bronchitis occurring in a 58 year-old man free from underlying pulmonary disease. Relief of symptoms was observed under steroid therapy (1 mg/kg), but relapse occurred as treatment being tapered. Such evolution is in accordance with recent published data.

This study was designed to assess the risk of associated pulmonary embolism according to the level of deep venous thrombosis. From March 1992 to March 1994, 328 patients were referred to medical units for suspected deep venous thrombosis, with recent clinical signs, less than a week. Each patient underwent contrast venography and/or duplex ultrasounds of lower extremities, ventilation and perfusion lung scan within 48 hours and angiography in case of low or intermediate pulmonary embolism probability. Diagnosis of deep venous thrombosis was confirmed in 155 patients; location was distal in 41, proximal in 114; an associated pulmonary embolism was found in 66 patients (10 with distal, 56 with proximal deep venous thrombosis); odds ratio was 2.99 (95% Cl: 1.2-3.13). Significantly higher risk of associated pulmonary embolism when deep venous thrombosis involves proximal veins is confirmed, but as many as 10 out of 41 patients with distal thrombosis also had an associated embolism. Management of both distal and proximal deep venous thromboses appears identical.

A rare small-cell carcinoma of the trachea was observed in a 27 year-old man. Treatment included chemotherapy and radiotherapy as for bronchogenic small cell carcinomas. This treatment regimen led to complete but temporary remission. The patient died 4 months after the end of the treatment due to multiple cerebral metastases.

Purpose: The purpose of the study was to assess the possible benefit of the combination vinorelbine (NVB)-cisplatin (DDP) in comparison with NVB alone in advanced non-small cell lung cancer (NSCLC), not treated previously. It also involved confirmation of the efficacy of vinorelbine as monotherapy., Patients and Methods: In this phase III trial, 231 eligible patients were stratified by centre and randomized to receive either NVB alone, 30 mg/m2/week or the combination of NVB 30 mg/m2/week and DDP 80 mg/m2/3 weeks. Patients were to be treated for a minimum of 6 weeks, with the first response assessment performed 9 weeks after the beginning of treatment., Results: The two groups differed in terms of objective response rates (16% and 43%, respectively, p = 0.0001) and median time to progression (10 weeks and 20 weeks, p = 0.0001). However, the difference was not significant for median survival time (32 weeks, 33 weeks, p = 0.48). The addition of DDP resulted in an increase in toxicity, in particular renal, hematologic, neurologic and emetic. This toxicity led to treatment discontinuation in 8% and 21% of patients, respectively. Respectively 3% and 13% of patients stopped treatment early during objective response (toxicity or refusal)., Conclusions: The NVB-DDP combination increased objective response rates and time to progression in comparison with NVB alone, but did not influence the survival of patients. The activity of NVB in the treatment of advanced NSCLC was confirmed.

We report a case of small cell lung cancer in a 17 year-old man. He was admitted to our unit suffering from a two month history of pain left shoulder. Chest X-rays showed a large round mass in the left upper lobe. The chest CT scan revealed a tumor with evidence of first left rib involvement. Histological examination, after surgical biopsy revealed small cell carcinoma, confirmed by two independent pathological physicians. Small cell lung carcinoma is very rare in the under 20 year age group and we compare this case with other types of lung cancer in young patients described in the literature.

Rhabdomyosarcoma is a malignant tumour generally observed in children or adolescents; thoracic localization is rare. The authors report a case of embryonary rhabdomyosarcoma of the thoracic wall in a 36-year-old subject. Pathology examination of surgical specimens confirmed the diagnosis. Treatment included surgical exeresis together with pre- and post-operative chemotherapy combining doxorubicine (40 mg/m2/cycle), ifosfamide (6 g/m2/cycle) and dacarbazine (900 mg/m2/cycle). Local recurrence, requiring radiotherapy, was observed a few months later and led to the patient's death after a 9-month clinical course.

We report the case of an asymptomatic 51-year-old man, presenting with chest X-ray abnormalities consisting in multiple pulmonary nodules; the diagnosis of mesenchymal cystic hamartoma of the lung was made by an open lung biopsy, revealing both nodules of mesenchymal cells and cysts with a lining of normal or metaplastic epithelium. Clinical and pathological characteristics of this rare entity are reviewed.

Formoterol aerosol, a long-acting new beta 2-mimetic was administered over a year at a dose of 12 micrograms twice daily, to 62 chronic obstructive bronchitics of mean age 66 +/- 6 years and of whom the basal VEMS was at 12,801 +/- 0.59. Clinical tolerance of the product was good with undesirable effects in 13 patients, the most frequent being shaking. No untoward effect was seen on systolic or diastolic arterial pressure, or the heart rate over successive visits at 1, 3, 6, 9 months and one year. Electrocardiographic surveillance found in only four patients electrical abnormalities that may be due to Formoterol, these were patients without previous cardiac problems but of advanced mean age. Functionally, a significant improvement of basal VEMS was noticed from the 6th month. The VEMS improved significantly after administration of 12 micrograms on successive visits, without tachyphylactic signs. Well tolerated, with functional benefits, Formoterol is a promising product amongst the long-acting beta 2-mimetics. Its usefulness and limitations in the basic treatment of these chronic bronchopathies remains to be defined.

We report the results of a combined of chemotherapy with CDDP and 5 FU repeated every 3 weeks in sixteen men (age range 31-73 years) with brain metastases. CT was performed after 2, 4 and 6 cycles to assess efficiency. Response was considered complete when no lesion was found on the CT scan and partial when the lesion shrunk to least half its the total volume. After two cycles, the response rate was 8/16 (50%). Treatment toxicity was mild with only one case of severe but reversible myelotoxicity (grade III). CDDP and 5 FU combined chemotherapy can be a useful treatment for brain metastasis of lung carcinoma.

Chemotherapy is not a common treatment for cerebral metastases. The authors report results of combination chemotherapy with cisplatin (CDDP) and fluorouracil (5-FU). Sixteen men (age range 31-73 years) with brain metastases were treated with CDDP 20 mg/m2/day in continuous infusion for 5 days (d 1-5) and 5-FU 1 g/m2/day in continuous infusion for 4 days (d 1-4), and the treatment schedule repeated every 3 weeks. A brain computerized tomography after 2, 4 and 6 cycles was performed to assess efficacy. It was considered that complete response was achieved if no lesion was found on the CT scan, and partial response if at least half of the total volume had decreased. After 2 cycles, the response rate was therefore 8/16 (50%). Treatment toxicity was very mild with only 1 case of severe but reversible myelotoxicity (grade III). It is concluded that chemotherapy combination with CDDP and 5-FU is a useful treatment for brain metastasis of lung carcinoma.

The gene of cystic fibrosis is localised on the long arm of chromosome 7. DNA probes placed close to the gene enable a study of restriction polymorphism to follow the transmission of the gene in index families. It is now possible to counsel those families, who already have an affected child, with an early antenatal diagnosis at ten weeks after the last period. In our personal experience, based on a study of the genotype of 48 families, 70% were informative when they were studied by two probes corresponding to the local pJ3.11 and met. When the latter probes Km19-XV2c were studied concurrently useful information was achieved in 96%. DNA analysis non enables the detection of the chromosome carrying the deleterious gene in practically every family where there is a child suffering from the disease.

Lymphocytes forming E rosettes, active E, autologous and EA antibodies were studied in 66 subjects (56 men, 10 women, mean age 59, range: 40-85 years) who presented with lung cancer classified on the TMN scale in stages I and II: 19; stage III: 20; stage IV: 27. In comparison to the controls, there was a significant reduction (p less than 0.01) in E, autologous and EA rosettes in the patients. A reduction in E active rosettes (compared to controls) was noted for stage IV cases (p less than 0.01) and rose with the stage. The formation of rosettes was reduced in 50 squamous carcinomas compared to 12 anaplastic carcinomas for E rosettes (p less than 0.01) and E active (p less than 0.02). If one compares the actuarial survival curves of 37 patients with E act rosettes greater than or equal to 23% and of 29 with a level of less than 23%, the mean survival for all stages combined was 14.1 months in the first group and 8.2 months in the second group. Associated with an extension of the tumour, the immunological system has a role in determining outcome and lymphocytes forming active E rosettes appear to be the subpopulation most closely correlated with survival.

Eleven patients with bronchial epidermoid carcinoma and undergoing treatment with cis-D.D.P. (II) were kept under electrophysiological and clinical surveillance. No other neurotoxic medication was added. The total dose of cis-D.D.P. was 300 mg/m2 over a period of three months: namely, three courses of 100 mg/m2 distributed over 5 days. Following the pretreatment check-up, the patients were divided into two groups: those without any electrophysiological abnormality (group A), and those without clinical abnormality but with a delayed latency H of the Hoffmann Reflex (group B). Patients in group A showed a slowing down of the motor nerve conduction velocity of the Median and Peroneal Nerves after a course of 100 mg, without accompanying worsening of the conduction velocity after 300 mg/m2, and prolongation of the distal latency of the sensory Median Nerve after 300 mg/m2; in group B, no significant change of electrophysiological clinical features were noted. In the two groups a non-significant reduction in amplitude of evoked responses were noted. These findings are more consistent with an axonal injury than with functional myelin injury. The authors review the existing literature and discuss the physiopathologic mechanisms of cis-D.D.P. peripheral neuropathies.