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Recurrent respiratory papillomatosis (RRP) is a currently incurable benign neoplasm caused by human papilloma virus (HPV) infection. It usually reduces voice, respiratory, and general quality of life, and is sometimes life-threatening. Patients usually need repeated operations. The use of adjuvant bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A, has been described in several case reports, with a good efficacy and safety profile. We report the cases of five patients with aggressive RRP who were treated with adjuvant systemic bevacizumab in a single Belgian tertiary center. A complete response was achieved in four patients after a median of 4.5 months, and a partial response in one. In all cases, the number of surgeries was drastically reduced, and quality of life improved. Toxicity was easily managed. Systemic bevacizumab seems to be an effective and safe adjuvant treatment for aggressive RRP.

Une situation vécue a interpelé des étudiants en médecine. Un patient âgé de 54 ans, atteint du syndrome de Down, arrive au service des urgences avec une altération de l’état général et une suspicion de pneumonie ; il a présenté récemment un épisode de rectorragies et des douleurs abdominales. Quelle est l’attitude diagnostique la plus adéquate ? A partir de sources scientifiques, éthiques et juridiques, nous apportons une vision nouvelle quant à l’approche de ce type de situation., A situation that happened in a hospital questioned medical students. A 54 years old patient, with Down’s syndrome, came to the emergencies department with a change of the general state, a suspicion of pneumonia and a recent episode of rectal bleeding and abdominal pain. What is the more suitable diagnostic procedure? On the basis of the scientific, ethical and legal aspects, we bring a new vision for the approach of this kind of situation.

Background Rheumatoid arthritis (RA) is a chronic, inflammatory disease with joint destruction and permanent disability. Biologic agents offer a better outcome when disease is not adequately controlled by DMARDs. Nevertheless, many concerns still exist about the safety of biologics compared to classical DMARDs treatment. Objectives The purpose of the study was to test the hypothesis that adverse events (AEs), including severe infections and malignancies, are more common in patients receiving biologics than in those treated with DMARDs. Methods This study included data from 1143 patients followed in our outpatient academic clinic for whom each severe infection and malignancy was identified. Relative risks were then calculated by comparing the rates of these events. Sub-categories of adverse events were created to clarify what type of infection and/or cancer were observed. Finally, an estimate of survival by Kaplan-Meier method was calculated for these two major adverse events. The experimental group, including patients who were treated with biological agent at any time and the control group, patients who have never taken any biological agent, were compared across these survival curves. Results We included 1143 patients (74% female, mean age of 51.3 (14.2) years, 75% treated with corticosteroids and 7% with diabetes), 604 (53%) were exposed to biologics and 539 (47%) controls. There were 226 severe infection in the biological group with an IR of 4.89 events/100 patient years (IRR=2.1 95% CI 1.7 to 2.5) as compared with 168 and 2.35 events/100 PY with DMARDs only. In the biological group, increase risk was observed for skin, musculoskeletal, pulmonary, urinary, mycobacterial and herpes zoster infection. The relative risk associated with the use of biological agents in the treatment of rheumatoid arthritis for the development of malignancy was 1.0 (confidence interval 95%: 0.7-1.4) without any significant differences among type of cancer. Survival rates are presented in