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Mediastinal liposarcomas (LPS) are rare tumours. We report a case of primary myxoid LPS in a 22-year-old woman suffering from cough, dyspnoea on exercise and asthenia for 3 weeks. Thoracic MRI showed a large tumour on the right side. After neoadjuvant chemotherapy, a complete resection was performed, followed by adjuvant thoracic irradiation. Eighteen months after the diagnosis, no sign of recurrence was detected. Mediastinal LPS include a heterogeneous group of bulky tumours, the progression of which depends on the histological type. The prognosis is dominated by the operability of the tumour. Adjuvant therapies are not established.

Purpose The objective of this randomised phase II study was to evaluate the impact in terms of response and toxicities of induction or consolidation chemotherapy respectively before or after concurrent chemoradiotherapy in unresectable stage III non-small-cell lung cancer. Patients and methods In the induction arm, patients received induction chemotherapy with cisplatin (80 mg/m 2 ) and paclitaxel (200 mg/m 2 ) on days 1 and 29 followed by a concurrent chemoradiotherapy (66 Gy in 33 fractions, cisplatin 80 mg/m 2 days 1, 29 and 57, vinorelbine 15 mg/m 2 days 1, 8, 29, 36, 57 and 64). In consolidation arm, the same concurrent chemoradiotherapy began on day 1 followed by two cycles of cisplatin and paclitaxel. Results One hundred twenty seven patients were randomised. The intent to treat response rates in induction and consolidation arms were 58% and 56% respectively. Median survival was 19.6 months in induction arm and 16.3 months in consolidation arm and 4-year survival rates were 21% and 30% respectively. Haematologic and non-haematologic toxicities were similar in both arms, except grade 3/4 oesophagitis, more frequent in consolidation arm than in induction arm (17% versus 10%). Conclusion Cisplatin-based chemotherapy as induction or consolidation with concurrent chemoradiotherapy can be administrated safely. Response rates were similar in both arms with a trend in favour for consolidation arm for long-term survival.

Resume Introduction Lors de leurs demonstrations, les cracheurs de feu utilisent le plus souvent le kerdane, produit derive du petrole. L’inhalation accidentelle du kerdane est a l’origine de manifestations respiratoires decrites sous le nom de pneumopathie des “cracheurs de feu”. Observations Nous rapportons 8 cas de pneumopathie des cracheurs de feu. Les caracteristiques cliniques, radiologiques et evolutives, ont ete comparees aux 44 cas decrits dans la litterature francophone et anglo-saxonne. La presentation etait stereotypee : survenue chez un adulte jeune et inexperimente; une phase initiale immediate, caracterisee par une toux et des troubles digestifs; apres une phase de latence, apparition d’une symptomatologie respiratoire pseudo-infectieuse s’associant frequemment a des manifestations extra-respiratoires le plus souvent digestives; une evolution clinique et radiologique habituellement favorable, rarement compliquee par la formation de pneumatoceles ou la survenue d’un pneumothorax. Conclusion Le diagnostic des pneumopathies des cracheurs de feu repose sur l’anamnese et sur un ensemble clinique et radiologique tres caracteristique. Le traitement est symptomatique. La prevention repose sur une diffusion de l’information concernant les risques lies a l’exercice de cracheur de feu.

The shrinking lung syndrome (SLS) is a rare complication of systemic lupus erythematosus.A 69-year-old man presented with exertional dyspnoea, muscle weakness, and weight loss of 15kg in 6months. Pulmonary function tests revealed a restrictive lung disorder, with a dramatic decrease in maximal inspiratory pressure (17% of theoretical value), and alveolar hypoventilation (pH 7.43; PaCOThe interesting features of this case report consist of: 1) the presentation of the SLS as an alveolar hypoventilation with a fatal outcome, 2) the presentation of systemic lupus as SLS.

Resume Les auteurs rapportent l'observation d'un patient âge de 49 ans qui presente depuis trois ans des episodes de balanite a repetition dont le bilan etiologique est jusqu'alors reste negatif. Le prick-test et l'intradermoreaction a Candida albicans sont tous deux tres positifs, et le RAST met en evidence des IgE seriques specifiques pour cette levure. L'anamnese, les resultats des tests cutanes, la survenue de reactions syndromiques apres la realisation de l'intradermoreaction a Candida albicans ou de certaines injections d'extrait allergenique, et l'evolution favorable du tableau clinique avec le suivi d'une desensibilisation specifique, permettent d'evoquer le diagnostic de balanite recidivante en rapport avec une allergie IgE-dependante a Candida albicans. Cette observation presente le double interet d'attirer l'attention quant a l'existence eventuelle d'une allergie immediate IgE-dependante a Candida albicans, dont le role est evoque par certains auteurs dans la survenue de vulvo-vaginites recidivantes, et de discuter un nouveau diagnostic etiologique en matiere de balanites a repetition. Elle souligne par ailleurs l'efficacite potentielle de l'immunotherapie specifique conduite avec un extrait de Candida albicans.

resume Dans notre travail, nous avons etudie l'interet diagnostique et pronostique du tissue polypeptide antigen (TPA) et de l'antigene carcinoembryonnaire (ACE) en pathologie pleurale, compare au diagnostic cytologique. Les dosages pleuraux de ces marqueurs tumoraux ont ete realises chez 76 patients repartis en trois groupes : 31 patients avec une pleuresie benigne, 25 patients avec une pleuresie maligne et 20 patients avec une pleuresie d'origine indeterminee. L'analyse en courbe ROC met en evidence un leger avantage du TPA pleural sur l'ACE bien que cette superiorite ne soit pas statistiquement significative. La specificite des deux marqueurs est excellente, la sensibilite comparable a celle retrouvee par d'autres auteurs. De plus, les taux eleves des marqueurs retrouves chez des patients du groupe indetermine a cytologie negative ont permis de reclasser ces patients dans le groupe ≪ pleuresie tumorale ≫ et montrent donc l'interet d'associer le dosage des marqueurs a l'examen cytologique d'un liquide pleural dans le bilan de pleuresie.

Resume Les proteines du latex constituent un melange polyallergenique dont la composition est variable en fonction de parametres botaniques, techniques et immunologiques. Malgre des resultats parfois discordants, les tres nombreuses etudes portant sur l'identification des allergenes montrent le role de l'heveine et de son precurseur la proheveine, du facteur d'elongation du latex et des β glucosidases. L'existence d'allergenes croises avec d'autres vegetaux de familles botaniques parfois tres eloignees, en particulier les fruits, rend compte de la conservation interespeces de motifs proteiques tres voisins. Parmi ces allergenes croises, le lysozyme parait etre un panallergene vegetal, appartenant au groupe des proteines de stress.

Mediastinal liposarcomas (LPS) are rare tumours. We report a case of primary myxoid LPS in a 22-year-old woman suffering from cough, dyspnoea on exercise and asthenia for 3 weeks. Thoracic MRI showed a large tumour on the right side. After neoadjuvant chemotherapy, a complete resection was performed, followed by adjuvant thoracic irradiation. Eighteen months after the diagnosis, no sign of recurrence was detected. Mediastinal LPS include a heterogeneous group of bulky tumours, the progression of which depends on the histological type. The prognosis is dominated by the operability of the tumour. Adjuvant therapies are not established.

Distributed Intelligent Systems (DIS) are, among other characteristics, geographically dispersed. A DIS will function properly and fulfill the tasks it has to perform only if the use of dispersed resources, processes and communications is correctly coordinated, that is if the system is appropriately managed. An approach is introduced to take into account this management aspect at an early stage of the design. The aim is to animate a DIS which has been defined statically with CUBE TOOL in order to get an assessment of its dynamical behavior before any implementation. Colored Petri Nets are used to model the system and to reduce the complexity of its representation by folding together identical substructures.

Resume Une observation de purpura vasculaire apres injection de dalteparine au cours d'un cancer bronchique complique de phlebite est rapportee. Le purpura cedait apres arret de la dalteparine, alors qu'aucune autre cause de purpura n'etait mise en evidence. L'intradermo-reaction a la dalteparine positive evoquait un mecanisme d'hypersensibilite, mecanisme conforte par la notion d'une prescription anterieure a la toxidermie de la dalteparine. Un heparinoide de synthese, le lomoparan, put etre substitue a la dalteparine sans intolerance. Cette observation, tres rarement decrite, souligne la necessite d'une surveillance accrue des heparines de bas poids moleculaire. Ces molecules, de plus en plus prescrites dans la maladie thromboembolique, sont pourant a l'origine d'hemorragies et d'effets secondaires immunoallergiques, surtout des thrombopenies mais aussi des toxidermies, comme celle decrite dans notre observation. Les heparinoides de synthese pourraient constituer une alternative therapeutique.

Drug-induced erythema multiforme is reported with many antimicrobial and antipyretic medications. We present one patient who experienced erythema multiforme and urticaria after administration of pyrazinamide for treatment of cutaneous tuberculosis. The side-effects of pyrazinamide include hepatic or dermatologic disorders, but erythema multiforme has not yet, to our knowledge, been described. Clinical features and discontinuation and reintroduction of the drug led us to consider pyrazinamide the cause of the erythema multiforme, but allergologic studies remained negative, except for the presence of circulating immune complexes. The mechanism of this eruption remains obscure, and definite withdrawal of pyrazinamide seems to be the best therapeutic choice.

Resume Les cystites allergiques demeurent une pathologie controversee et sont tout au moins exceptionnelles. Parfois un allergene alimentaire est implique. Les auteurs rapportent deux observations de cystites hematuriques qui ont pu etre rattachees a une allergie alimentaire. Dans les deux observations, une sensibilisation aux trophallergenes est prouvee (le lait de vache pour la premiere, le blanc d'œuf et les crustaces pour la seconde). Le diagnostic de cystite par allergie alimentaire est retenu sur l'evolution des symptomes apres plus d'un an de recul sous regimes d'exclusion et de reintroduction. L'apport therapeutique des nouveaux antihistaminiques et du cromoglycate disodique est discute.

PURPOSE: To evaluate the efficacy and safety of paclitaxel and carboplatin in the treatment of previously untreated patients with metastatic small-cell lung cancer (SCLC). PATIENTS AND METHODS: Eligible patients were aged 18 to 75 years with an Eastern Cooperative Oncology Group (ECOG) score ≤ 2 and life expectancy ≥ 12 weeks. Paclitaxel (200 mg/m2) was infused over 3 hours, before carboplatin (area under the curve [AUC] 6; Calvert formula) infused over 1 hour, once every 3 weeks for six cycles maximum. Prednisolone, dexchlorpheniramine, and ranitidine were standard premedication. Response to treatment was assessed every two cycles, and nonresponding patients were withdrawn from the trial to receive standard chemotherapy. RESULTS: Of the 50 patients entering the study, 48 and 46 patients were assessable for toxicity and response, respectively. The overall response rate was 65%, with complete responses in three patients. Five patients had stable disease (11%) and 11 patients experienced progressive disease (24%). Median survival was 38 weeks, and median duration of response was 20 weeks. One-year survival was 22.5%. For a total of 232 cycles, grade 3 and 4 toxicity was 33% for neutropenia, 3.5% for thrombocytopenia, and 4% for anemia. Four patients had neutropenic fever (one toxic death). Nonhematologic toxicity was mainly grade 1 and 2 paresthesia (21% of patients); grade 3 myalgia/arthralgia was observed in 6.5% of patients. CONCLUSION: First-line chemotherapy with paclitaxel and carboplatin in metastatic SCLC achieved a response rate and survival similar to standard regimens. With 1-day administration and a tolerable toxicity profile, this combination merits further investigation.

Satisfaction des attentes ; Satisfaction Objectif .– La relation entre les attentes des patients avant arthroplastie totale de hanche (ATH) et la satisfaction postoperatoire est mal comprise. L’objectif de ce travail etait d’evaluer les facteurs associes a la satisfaction globale et a la satisfaction des attentes 1 an apres ATH. Methodes.– Dans une precedente etude [1], les attentes de 132 patients en attente d’ATH et de leurs chirurgiens respectifs etaient evaluees par le « Hospital for Special Surgery Total Hip Replacement Expectations Survey » (THR survey). Un an apres l’intervention, 123 patients repondaient a un questionnaire sur la satisfaction de leurs attentes (THR survey), leur satisfaction globale, leur fonction (Womac) et leur qualite de vie (SF-12). Des analyses uniet multivariees etaient realisees pour evaluer les determinants de la satisfaction globale et de la satisfaction des attentes. Resultats.– Les attentes des chirurgiens etaient plus realistes que celles des patients concernant la persistance de douleurs nocturnes et le besoin d’aide a la marche. Les patients et les chirurgiens avaient des attentes trop optimistes concernant la reprise des activites sportives et professionnelles, l’amelioration des activites sexuelles, la possibilite de se chausser ou de se couper les ongles de pied. Chez les patients satisfaits (n = 113), la composante psychologique du SF12 preoperatoire etait plus elevee, et les attentes des chirurgiens plus optimistes. La satisfaction des attentes etait le seul facteur associe de facon significative a la satisfaction globale (OR ajuste 1,08, IC a 95% [1,04 ; 1,12]). La satisfaction des attentes pouvait etre predite en preoperatoire par un âge peu eleve (coefficient de regression –0,55 [–0,88 ; –0,21]), un meilleur etat psychologique (0,56 [0,14 ; 0,99]) et unemeilleure fonction (–0,96 [–1,82 ; –0,1]). Apres la chirurgie, la recuperation fonctionnelle etait le seul determinant de la satisfaction des attentes (–2,10 [–2,79 ; –1,42]). Discussion.– Quelles ques soient les attentes des patients avant ATH, seule leur satisfaction determine la satisfaction globale 1 an apres l’intervention. Les chirurgiens, dont les attentes paraissent realistes, pourraient mieux communiquer avec les patients de facon a moderer leurs attentes concernant certaines activites. Reference [1] Jourdan C, et al. Comparison of patient and surgeon expectations of total hip arthroplasty. PLoS One 2012;7(1):e30195.

Carcinoid tumour of the thymus is a rare neuroendocrine tumour particularly at an advanced age. The authors report a case of a mediastinal mass in a man aged 85, the mass had remained asymptomatic for a long time. It was decided to achieve a diagnosis because the tumour was causing local compression: a mediastinal needle biopsy under computerised tomographic control confirmed that this was a carcinoid tumour and a study of the biopsy material using an electron microscope showed neurosecretory granules. A sternotomy enabled the tumour to be excised but a post-operative Pseudomonas pneumonia led to the death of the patient. This case underlines the diagnostic place of mediastinal needle biopsy in the presence of a mediastinal tumour. The technique can be carried out under computerised tomography or ultrasonography and this can be associated with a study of the biopsy specimen using electron microscopy which enables the diagnosis to be made before any therapeutic decisions. The treatment of choice of a carcinoid tumour of the thymus is surgery which confirms the tumour limits and also its thymic origin. Tumour excision can be completed using radiotherapy or even chemotherapy.

We report two cases of soybean-lecithin-induced asthma in bakers. The patients experienced clinical symptoms in relation to an occupational exposure to this additive. Skin tests were positive with soybean lecithin, RAST showed a sensitization to soybean, and bronchial challenge tests were positive for a dilution of 10(-3) with this allergen. The same tests remained negative among healthy and asthmatic controls. Soybean lecithin, a common additive in bakery, must be added to the list of numerous aeroallergens involved in baker's asthma.

This study concerns 45 patients group one suffering from broncho-pulmonary cancer, the diagnosis was obtained by bronchial biopsies or by transparietal puncture using a scanner: there were 35 non-small cell bronchial carcinomas (CNPC) and 10 small cell bronchial cancers (CPC). The control patients (99 patients) were divided up as follows: 44 pleuro-pulmonary infections (group two) and 55 with respiratory failure of various causes other than infectious episodes (group three). In group one the level for TPA was positive in 30 cases (the threshold value was 90 units per litre), 9 for CA 19.9, 7 for ACE and 9 for NSE. The overall sensitivity was thus better for TPA. There was no correlation between TPA and type of tumour histology nor between the different markers. Their association did not improve the sensitivity. The NSE however, remained the most sensitive test for the diagnosis of CPC with six positive tests out of ten. In the control population, the specificity of TPA (66%) was less than that of ACE (100%) or of CA 19.9 (94%) and the false positives were significantly more numerous in group two: 21 patients had a positive test compared to only 12 in group three. Finally we noticed an increase in the level of TPA contrary to other markers, as a function of the extent of the disease from the carcinoma (CNPC unique). The TPA is thus the most sensitive and it turns out to be better reflector to the extent of the tumour disease than either ACE, CA 19.9 or NSE but this applies uniquely to non-small cell carcinoma.

Dissemination has often occurred before the diagnosis of bronchopulmonary cancer. Pancreatic metastases are exceptional and are very rarely the revealing manifestation. The authors report a case of a tumour of the pancreas which led to the discover of an bronchogenic epidermoid carcinoma. The relationship between these two tumours lead to the proposed hypothesis of pancreatic metastasis of a bronchogenic carcinoma. Although this situation is rare, the preoperative work-up for bronchogenic carcinoma should include computed tomography of the pancreas if the abdominal echography does not allow complete visualization of the pancreas in cases with suggestive digestive disorders. If a tumour is observed in the pancreas, scan-guided needle biopsy should be performed to enable the histological examination.

Bronchial carcinoma in situ is an intra-epithelial proliferation of tumour which does not cross the basement membrane and is asymptomatic. The evidence for this cancer often rests on a biopsy carried out on a bronchus which may show simple inflammation or may even be normal. We report a new observation on a bronchial carcinoma in situ which was completely ablated after a bronchial biopsy. However surgery remains the first form of treatment for bronchial cancer. If the patient is inoperable, endobroncho-cryotherapy, radiotherapy or phototherapy may be tried but tumour recurrence remains a possibility.

Occupational allergy to enzyme detergents had almost disappeared by the use of preventive measures, both individually and in industries. The occurrence of 8 new cases of asthma in a detergent factory has led to a prospective clinical and aetiological enquiry. Although there was no documentation using the specific provocation test or by measuring respiratory function whilst at work, the occupational character of this asthma seemed possible after taking a history. Sensitization to the enzymes used (Savinase, Maxatase and Biozym P 300 S) was shown by skin tests (8 positive to all the enzymes) and the level of specific IgE to Rast (8 times greater than class 3 for Savinase and Maxitase) and for HBDT for Maxatase and Biozym P 300 S (greater than 50% in 8 patients). From another stand point the incomplete application of preventive measures within the factory did not seem to totally explain the origin of this sensitization. In fact, it was the study of the morphology of the enzyme grains, which had been introduced into the factory which helped us to explain the mechanism. In effect it was the capsules of the grain which were fissured and thus allowed allergen contact. The replacement of these grains whose envelope was intact, led to the disappearance of the symptoms and confirmed our hypothesis. There remains a continuing risk from occupational sensitization to asthma and it is suggested that there is continued collaboration between the medical profession and industry.

Twelve inoperable lung cancer patients were treated with a combination chemotherapy of cisplatinum (CDDP) and etoposide (VP16), as a continuous infusion for 5 days, every 21 days, and with a daily oral administration of GaCl3. Dosages of CDDP and VP16 were adapted in order to obtain an area under the curve (AUC) of 80,000 micrograms l-1.h for plasma total platinum and of 200 mumol.l-1 h for plasma VP16 during each 120 h infusion. GaCl3 was given at the dosage of 400 mg/24h from the time of diagnosis at least until the evaluation after 3 courses of chemotherapy. An objective response was observed in 5 non small cell (NSCLC) lung cancer patients (group 1) and 3 small cell (SCLC) lung cancer patients (group 2). In the other 4 patients with a NSCLC no partial response was noted (group 3). No significant difference in area under the curve (AUC) was noted between the 3 groups, either for plasma total platinum (group 1 = 89,598 +/- 20,843 micrograms l-1.h; group 2 = 88,081 +/- 15,431 micrograms l-1.h; group 3 = 83,820 +/- 13,455 micrograms l-1.h), or for VP16 (group 1 = 227 +/- 41 mumol.l-1 h; group 2 = 217 +/- 29 mumol.l-1.h and group 3 = 211 +/- 30 mumol.l-1.h). The maximal plasma Ga concentrations were 244 +/- 34 micrograms/l in group 1, 112 +/- 57 micrograms/l in group 3 (p less than 0.005) and 243 +/- 132 micrograms/l in group 2. It was then decided to increase the dose of GaCl3 in the further non-responding patients. In 6 responders, 3 additional courses of this combination chemotherapy could have been given without major toxicity, allowing a much more important decrease in the tumor volume in 4 of them. This schedule of treatment should permit the chemotherapy to continue for longer than 6 courses, in order to improve the survival time.