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Objective: To describe a fast, simple method to acquire pressure-volume curves of the respiratory system and to compare this with a classic method in terms of reliability of the data and speed. Design: Acquisition of pressure-volume curves by low flow inflation technique (P-Vlf) versus the occlusion technique (P-Vst) using the standard equipment of a Cesar ventilator. Setting: General ICU – Aix en Provence Hospital. Patients: Ten sedated, curarized patients undergoing mechanical ventilation. Interventions: P-Vlf curves were acquired by setting the ventilator parameters at f = 5 c./min, duty time Ti/Ttot = 80 %, VT = 1100 ml, pause time = 0. The pressure and volume data were collected directly on the ventilator screen. P-Vst curves were acquired using an airway occlusion technique. The pressures obtained for the same inflation volumes and times necessary for performance of the two techniques were compared. Results: The time needed to acquire a P-Vlf curve was 3 min versus 38 min for P-Vst curve. Concordance analysis between the two methods showed a 95 % confidence interval of (–0.5 cm H2O, + 1.8 cm H2O) for pressure. Conclusions: P-Vlf curves are close to P-Vst curves, are much less time-consuming, easy to acquire with Cesar ventilator equipment, and may be used in clinical routine to assess the elastic properties of the respiratory system.

Despite health public problems arised by metastatic breast cancer, specific studies remain rare, and especially when concerning second line chemotherapy. Today, these studies seem essential to allow the clinician, facing the choice between different treatments, to make the best decision. Two recent treatments, docetaxel and paclitaxel, administered every 3 weeks, were compared to the referenced treatment: vinorelbine administered every week. The study aims at evaluating these 3 therapeutic options on second line treatment of metastatic breast cancer. For each of these 3 strategies, our end points were: (1) the duration of progression free survival; (2) the quality adjusted on progression free survival; (3) the cost including the intrinsic cost of chemotherapy as well as the cost of treatment-related and disease-related complications, due to toxicity. Savings obtained with the treatment by delaying relapse were subtracted from expenditure. We used a Markov model to describe the patient's evolution after the administration of the compared treatments. The evaluation concerns the period from the beginning of second line chemotherapy to death. Only direct medical costs were taken into account. Non medical costs and indirect costs were excluded. For each clinical state, resources utilisation was estimated by a retrospective multicentric analysis of 153 medical records of metastatic breast cancer, treated on second line. Resources valuation of hospital costs were based on a national survey on the cost of medical services per DRGs. Quality of life was estimated by a group of nurses in oncology, using the feeling thermometer and standard gamble technics. Incremental cost utility ratios were calculated. Docetaxel reduces the time spent in progression, decreases the number of complications due to progressive disease and thereby provides better quality of life. It provides a benefit of 57 disease- and discomfort-free days, compared to vinorelbine and 22 days compared to paclitaxel. Docetaxel may be thought of as a self-financing strategy as a result of savings in hospital admissions, providing net saving of French Francs (FF) 6,800 in 1993 prices, compared with expenditure associated with vinorelbine treatment and FF 700 compared with the equivalent figures for paclitaxel. A sensitivity analysis confirms the robustness of those results.

IgG synthesis within the central nervous system is the expression of a local pathologic immune reaction. Its detection is of great importance in a large number of neurologic diseases, especially multiple sclerosis (MS). The results obtained from the study of 115 neurologic patients (52 patients with MS and 63 patients with other neurologic diseases) using three different mathematic formulas (Tourtellotte's formula, the index of Tibbling and coworkers, and Schuller and Sagar's formula) are presented and statistically analyzed. Despite their obvious differences, the results from these three formulas are in accordance in 76% of the patients observed. The clinical correlations of these formulas are discussed; none of them allows a specific diagnosis of MS. The formula of Schuller and Sagar seems the most sensitive, detecting local central nervous system IgG synthesis in 79% of patients with MS, compared with 54% of patients with MS utilizing the index of Tibbling and coworkers and 50% of patients with MS utilizing Tourtellotte's formula. No correlation was established between serum and cerebrospinal fluid albumin concentrations, nor between serum albumin and IgG levels in cerebrospinal fluid. Thus, no evidence exists to support the inclusion of variations in serum albumin levels in the calculation of intrathecal IgG synthesis. Furthermore, Schuller and Sagar's formula allows classification of neuroimmunologic diseases and the evaluation of antibody-specific activity (ASA) in locally produced IgG. The comparison of intrathecal IgG ASA with serum IgG ASA, which reflects local and general immunity, respectively, seems potentially important.

This case of recurrent migratory superficial phlebitis is reported because of the highly unusual nature of the lesion observed. The picture was dominated by periphlebitis with inflammatory granuloma, giant cells and elastophagia. When the condition had been present for sixteen months, an aortic arch syndrome developed in an inflammatory context. In this light, various auto-immunological etiologies were considered, among them Takayashu's arteritis of which, in the author's opinion, this would be the first case to be combined with venopathy.