RESUMO
INTRODUCTION: Comparison by sex and presenting features between 2000 and 2010 of the characteristics of new cases of non-small-cell lung cancer (NSCLC). METHODS: Observational KBP-2010-CPHG study similar to KBP-2000-CPHG. Both studies were promoted by the French College of General Hospital Respiratory Physicians (CPHG). KBP-2010-CPHG collected data for 6083 NSCLC diagnosed between January 1st and December 31st, 2010, and followed in the respiratory departments of 119 French general hospitals. RESULTS: In 2010, 24.4 % of the patients were women (16 % in 2000, p<0.0001). Compared to men, women were more commonly non-smokers (34.2 vs 4.7 %) or lighter consumers (37.2 vs 43.7 pack per years) (p<0.0001). Their tumours (mostly adenocarcinoma: 64.6 vs 48.7 %, p<0.0001) were more frequently diagnosed at stage IV (62.4 vs 56.9 %, p=0.0008). EGFR mutation research was more frequently performed (48.5 vs 31.0 %, p<0.0001) and positive (20.6 vs 5.2 %, p<0.0001) in women than men. Their treatment more frequently included targeted therapy (13.4 vs 5.7 %, p<0.0001). Compared to 2000, the percentage of non-smokers increased in men (4.7 vs 2.5 %, p<0.0001) while remaining stable in women (36.1 vs 34.2 %, p=0.32). The percentage of adenocarcinomas increased, particularly in men (48.7 vs 31.5 %, p<0.0001). CONCLUSIONS: The percentage of women with NSCLC has increased in 10years in France. In 2010, the main gender differences persist, but have decreased with the increasing proportion of non-smokers and adenocarcinomas in men. Various hypotheses to explain these changes are discussed.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Neoplasias Pulmonares/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/terapia , Feminino , França/epidemiologia , Hospitais Gerais , Humanos , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Terapia Neoadjuvante/estatística & dados numéricos , Fatores SexuaisAssuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Desoxicitidina/análogos & derivados , Desoxicitidina/efeitos adversos , Hemorragia/induzido quimicamente , Pneumopatias/induzido quimicamente , Alvéolos Pulmonares/efeitos dos fármacos , Idoso , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Carcinoma de Células Grandes/tratamento farmacológico , Evolução Fatal , Hemorragia/diagnóstico , Hemorragia/tratamento farmacológico , Humanos , Pneumopatias/diagnóstico , Pneumopatias/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Esteroides , GencitabinaRESUMO
While outpatient management for chronic neurological diseases is well-established, the impact of inpatient neurological examination in emergency room and university hospital remain largely underestimated. We prospectively studied the role of the neurologist in patient management, in a primary care university hospital. Over a period of 12 months, we prospectively recorded the demographics of patients requiring examination in the emergency room, the initial suspected neurological diagnosis of the emergency room, the final diagnosis of the neurology team, and the patients' outcomes. For each patient, the time between admission, the call and the neurological examination were recorded. Neurological examinations were performed in 2220 patients in whom 75.6 p.100 were performed in the emergency room. These latter patients corresponded to 14 p.100 of all patients admitted in the emergency room. Of examined patients, 52 p.100 were male and mean age was 56.9 +/- 21 years. The time between admission and examination was 32 min. (+/- 36 min), irrespective of the day of the week, and depended on the suspected diagnosis: shorter in stroke and status epilepticus (p<0.05), and longer in loss of consciousness and vertigo (p<0.01). Forty-four percent of the examinations took place in the evening and night. The reasons for examinations were: stroke (28.3 p.100), epilepsy (17.7 p.100), headaches (8.4 p.100), loss of consciousness (7.9 p.100), cognitive dysfunctions (4.1 p.100), neuropathies (4 p.100) and miscellaneous (8.1 p.100). Neurological examinations modified neurological diagnosis and treatment in more than 86 p.100 of the patients. Following neurological examination, 17.2 p.100 of the patients were able to go home, while the rest were admitted to the stroke unit (27.2 p.100), the general neurological unit (27.3 p.100) or in other departments (28.3 p.100), of which intensive care unit (5.3 p.100) or neurosurgery (5.9 p.100). Emergency neurologic examination improves neurological diagnosis and has a positive impact both on treatment and, more globally, in patient management.
Assuntos
Emergências , Pacientes Internados , Exame Neurológico , Consultores , Serviço Hospitalar de Emergência/estatística & dados numéricos , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , França , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estado Epiléptico/diagnóstico , Estado Epiléptico/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Inconsciência/epidemiologiaRESUMO
Normobaric oxygen toxicity is well described in all animal species. However susceptibility to oxygen exposure is highly variable according to age, species and strains. Similarly in humans, prolonged high oxygen exposure is reported to induce cough, shortness of breath, decrease vital capacity and increase alveolo-capillary permeability. The toxic FIO2 threshold (length of exposure and level) is still debated. In patients with previous lung injury, this threshold is even more difficult to delineate as pathologic pulmonary lesions might result from hyperoxia or primary lung insult. Oxygen free-radicals play a key role in the pathophysiology of oxygen toxicity. Oxygen resistance or tolerance is obtained with intraperitoneal, intravenous and intratracheal endotoxin or cytokines administration. Previous exposure to high oxygen concentration is also reported to increase survival rate and decrease pulmonary lesions in animal models. Protection may rely on antioxidant enzymes synthesis, nitric oxide production, neutrophils recruitment and modulation of alveolar macrophages activity. In humans, oxygen tolerance might be suspected through several clinical studies reporting favorable outcome after long term-oxygen exposure. Better knowledge of the risks of prolonged high oxygen exposure is important to re-evaluate the goals of mechanical ventilation (FIO2, SaO2, PEEP) and/or to develop treatments to prevent oxygen toxicity (surfactant, antioxidant enzymes).
Assuntos
Hiperóxia/fisiopatologia , Oxigênio/toxicidade , Animais , Humanos , Especificidade da EspécieRESUMO
PURPOSE: We initiated at Hospital de Mulhouse a prospective phase II study to assess a split-course concurrent radiochemotherapy in locally advanced non-small cell lung cancer. MATERIALS AND METHODS: From March 1996 to December 1997, 28 patients were included in our study. All patients had a stage III cancer. The chemotherapy scheduled included vinorelbine (20 mg/m2/d, d1 and d5), cisplatin (20 mg/m2/d, from d1 to d5), and 5-Fluorouracil (350 mg/m2/d, from d1 to d5 by continuous infusion). The planned irradiation dose was 12.5 Gy per week with one daily fraction of 2.5 Gy from d1 to d5. Cycles were repeated every four weeks, for four cycles (50 Gy). Patients with a partial or complete response were proposed a fifth cycle. RESULTS: Of the 28 patients of the study, only 27 were analysed; one patient had a metastatic disease at diagnosis. Major hematologic toxicity occurred in 26% of the patients. One to five cycles of chemoradiotherapy were administrated per patient (median: four). Four patients had received fewer than three cycles and their responses were not assessable. Of the 23 patients assessed, 12 responses (52%) were observed, three CR (13%) and nine PR (39%). Median follow-up was 14 months, and median survival 13.5 months. One- and two-year survival rates were respectively 63% and 14%. Local control rates was 11%, and 44% of the patients had a metastatic evolution. CONCLUSION: Very preliminary results of this phase II study are disappointing, and quite inferior to the published results using chemoradiotherapy with conventional or hyperfractionated radiotherapy. Hematologic toxicity is restrictive. This type of chemoradiotherapy cannot be recommended.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/administração & dosagem , Terapia Combinada , Fracionamento da Dose de Radiação , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Vimblastina/administração & dosagem , Vimblastina/análogos & derivados , VinorelbinaRESUMO
The volumetric ventilator Eole 2 NA has been adapted to work as an anaesthesia machine with low flow or closed system. This modified device is very easy to use in exceptional situations: because of its strength and reliability; its favorable quality/price ratio; versatile electrical supply: mains (220 volts) or 24 D.C.V. from internal battery (2 hours autonomy) or external battery (8 hours autonomy); gas economy: less than 1 L.min-1 of fresh gas flow, whether O2/N2O = 0.5 L.min-1 of each gas or 1 L.min-1 delivered by an oxygen concentrator. Clinical trials are discussed.
Assuntos
Anestesia por Inalação/instrumentação , Ventiladores Mecânicos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/análise , Dióxido de Carbono/análise , Humanos , Óxido Nitroso/administração & dosagem , Óxido Nitroso/análiseRESUMO
A practical versatile anaesthesia device is described. An electrical pump provides room air to carry anaesthetic vapours. O2 can also be added if desired. Energy is supplied either by built-in batteries (12 volts = autonomy 6 hours) or external electric mains (12-30 volts or 220 alternative volts). The optimal recommended anaesthetic circuit is the Modified D Mapleson Circuit for economy in oxygen and anaesthetic vapours (for an adult only 6 l are needed). A non-rebreathing circuit can also be used: so draw-over ventilation or the use of an auto-inflating bag are possible when no electric power is available. If mechanically controlled ventilation is necessary, a specific ventilator can be adapted. This apparatus has already been manufactured and is very practical on the battle field or in developing countries.
Assuntos
Anestesiologia/instrumentação , Acidentes , Países em Desenvolvimento , Humanos , GuerraRESUMO
When the inside pressure of mouldable mattress is lowered isotropic deformation can be harmful for spinal cord. The axial force is measured placing stress gauge in a metallic manikin and in corpse (T2-L1), then on the cephalic top of volunteers. When soles and head are included in an usual mattress, during the retraction stress values raise up to 484 N at 262 mbar for manikin, to 150 N at 315 mbar for corpse, to 102 N at 310 mbar for cephalic top of the volunteers. In comparison, a prototype was tested. Results were improved on metallic models but not on human corpses or volunteers. This test allowed us a better understanding of the mechanism of the stress. It is possible to propose precautionary measures during patient immobilization (to provide a space between soles, head and mattress) and to build a new stressless mattress.
Assuntos
Leitos , Medula Espinal/fisiologia , Fenômenos Biomecânicos , Humanos , Imobilização , Modelos Anatômicos , Traumatismo Múltiplo/terapia , Transporte de PacientesRESUMO
Three series of cultured Wistar rat heart cells (10 treated and 10 controls x 3) were examined with a laser contraction-meter in a special chamber for anoxia to determine whether cytidine diphosphate choline (CDPC), a membrane phospholipid precursor, can protect against total oxygen deprivation. Heart rate and force of contraction (inotropism) were monitored during a 40-minute period of hypoxia. CDPC in a concentration of 142 micrograms/ml-1 was added to the culture medium only during the anoxia period in series I, during the 3 days of culture in series II, and during the 3 days of culture and the 40-minute hypoxia period in series III. In series I, inotropism decreased by 21% versus 55% in control group (P less than 0.05). In series II, inotropism decreased by 25% versus 43% in control group (P less than 0.05). In series III, inotropism decreased by 22% versus 44% in control group (P less than 0.05). Compared with control cells, cells treated with CDPC during anoxia maintained a significantly greater inotropic state. The effect is greatest if the cells are weak, as in series I. CDPC may be a useful component of the cardioplegic mixture during cardiopulmonary bypass and in the treatment of myocardial ischemia.
Assuntos
Hipóxia Celular/efeitos dos fármacos , Citidina Difosfato Colina/farmacologia , Miocárdio/citologia , Animais , Células Cultivadas , Meios de Cultura , Contração Miocárdica/efeitos dos fármacos , Ratos , Ratos EndogâmicosRESUMO
Criteria of quality of gases and vapours supply, ventilator, patient's circle circuit and monitoring devices are recalled to help the anesthetist to choose his anesthesia machine. Advantages of compact or modular apparatus are discussed. Four, now wellknown, anesthesia machines (modulus II+, Siemens 900 D+SAC985, Roche Kontron 4300 and Engstrom Elsa) were analysed in clinical controlled ventilation and in simulated spontaneous ventilation to study the imposed work of breathing. Results are discussed with regard to safety rules and to ergonomics, bearing in mind their respective prices. Comparison is made with an original "bisontin" prototype.
Assuntos
Anestesia por Inalação/instrumentação , Monitorização Intraoperatória , Ventiladores Mecânicos , Custos e Análise de Custo , HumanosRESUMO
Non invasive blood pressure (NBP) measures are currently used in anesthesiology. The accuracy of this oscillometric technic has been tested with healthy patients, but not often with a wide pattern of pathology. The aim of this study is to point out the reliability of NBP during vascular surgery with patients suffering from arterial disease and atherosclerosis. It compares outcome with simultaneous catheter arterial blood pressure measurement (template technic). In this conditions, oscillometric method underestimates the systolic pressure value, and overestimates the diastolic one. The higher the level of arterial pressure is, the larger is the difference between this methods. It is clear that the automatic oscillometric technic is not so reliable if hypertension or atherosclerosis disease occurs. In order to improve this technic, automatic measures must take in account the degrees of arterial rigidity in its outcome.
Assuntos
Determinação da Pressão Arterial/instrumentação , Automação , Determinação da Pressão Arterial/métodos , Erros de Diagnóstico , Falha de Equipamento , Humanos , Monitorização Fisiológica , OscilometriaRESUMO
A prototype of high frequency jet ventilator is compared with a classic device: Gambro Soxijet ventilator. The advantages of the prototype are: no need of pressured medical gas; warming and saturated moisture of the gas. A powerful compressor (2 M3.H-1 flow--3 bar pressure) draws up the moistened and warmed gases and injects them into a double pneumatic capacity. The first capacity is pressure limited by a relief valve (3 bar). Exhausted gases flow back to the pump. A miniature pressure regulator, placed between the two capacities, rules the driving pressure. Gas mixture is injected through a solenoid valve controlled by an electronic twin-timer. Results of both devices are similar. However, our prototype seems to be very convenient for developing countries where medical gases under high pressure are not often available.
Assuntos
Ventilação em Jatos de Alta Frequência/instrumentação , Países em Desenvolvimento , Desenho de Equipamento , HumanosRESUMO
The choice of ethyl violet as a pH indicator in soda lime is not the best. Color change happens too late because pH alteration of the surface of soda lime is slower than in the core of the canister. Clinical and comparative measurement of wall temperature of two in series canisters is a good precaution. If the down stream canister is warmer than the upstream one, you must change the latter.
Assuntos
Anestesia com Circuito Fechado/métodos , Compostos de Cálcio , Óxidos , Hidróxido de Sódio/normas , Humanos , Concentração de Íons de Hidrogênio , Corantes de RosanilinaRESUMO
UNLABELLED: After induction with vecuronium, etomidate and then isoflurane or enflurane, nitrous oxide, useful at the beginning of tympanoplasty is washed out before the end of operation. So barotrauma on the graft is avoided. In the expectation of analgesia insufficiency, alfentanil is infused intravenously all over the operation period following two modes: constant flow mode (1.25 micrograms.kg-1.min-1) after a bolus (25 micrograms.kg-1): 33 patients; decreasing hyperbolic flow mode (H): cumulative dose = 10.8 x t0.5 (where t = minutes of infusion) = 47 patients. In this mode, plasma concentration is measured by 12 patients. RESULTS: the mean plasmatic level of alfentanil is steady during the 120 minutes duration of anaesthesia: standard deviation is higher than 30%. After high quality anaesthesia in both technics, recovery time was shorter with H mode than with constant flow one (extubation time = 46 +/- 31 min. versus 92 +/- 54 min). H. mode seems to be safer. Though, individual reactivity, drug interaction and genetic polymorphism must make us cautious! Two patients presented apnea 20 and 60 minutes after an efficient awakening.
Assuntos
Alfentanil/administração & dosagem , Analgesia/métodos , Óxido Nitroso/administração & dosagem , Timpanoplastia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-IdadeRESUMO
Two new vaporizers for isoflurane were tested and verified with very low flows: Ohmeda Tec 5 and Penlon PPV Sigma vaporizers. This work completes a previous one [1]. The Ohmeda Tec 5 appeared to be quite reliable. The Penlon vaporizer gave pretty good results too. However a gas flow with vibratory component can affect the result by decreasing dramatically the concentration of inhaled isoflurane.
Assuntos
Anestesia por Inalação/instrumentação , Isoflurano , Nebulizadores e Vaporizadores , Estudos de Avaliação como AssuntoRESUMO
The velocity of ATP hydrolysis, catalyzed by purified F1ATPase from Micrococcus luteus, was decelerated on decreasing the temperature. At 13 degrees C one reaction cycle is completed after 20 s. Hydrolysis was triggered upon rapid mixing of the enzyme with ATP. During the first reaction cycle, succeeding structural alterations of the F1ATPase were traced by time resolved X-ray scattering. The scattering spectra obtained from consecutive intervals of 1 s, revealed the F1ATPase to pass a conformational state exhibiting an expanded (6%) molecular shape. The expanded state was observed between 45% and 65% of the time required to complete the reaction cycle. This points out a conformational pulsation during ATP hydrolysis.
Assuntos
Trifosfato de Adenosina/metabolismo , ATPases Translocadoras de Prótons/metabolismo , Hidrólise , Cinética , Micrococcus/enzimologia , Conformação Proteica , ATPases Translocadoras de Prótons/química , Raios XRESUMO
A new apparatus for anaesthesia has been developed for disaster situations. A turbine pushes room air through a halothane vaporizer to a modified D. Mapleson system. A battery provides an autonomy of two hours with an air flow of 5 liters per minute. Electrical current used is 220 volts external or 12 volts. Oxygen can be added during inductions and when there is imbalance in the hemodynamic or respiratory function. One series of 20 patients successfully underwent this procedure. Oxygen monitoring was performed with percutaneous PO2, SaO2, FiO2. Only one patient with cardiac disease needed oxygen adjonction (2 l.min-1) to raise his SaO2 level above 95%. Thus it is possible to have the optimum FiO2 with the lowest amount of halothane and oxygen.
Assuntos
Ar , Anestesia por Inalação/métodos , Halotano , Anestesia por Inalação/instrumentação , Monitorização Transcutânea dos Gases Sanguíneos , Emergências , HumanosRESUMO
There is a high incidence of dysrhytmias in the operating room and I.C.U. Calling again diagnosis criteria using common leads of the E.E.G. leads to suggest a treatment approach taking the main effect of non cardiac factors in account, before the use of antiarrhythmic drugs. The Puech classification takes many data into consideration: electrophysiological properties, cardiac disease and trigger mechanism of dysrythmias. So, it is a better practice in a dysrythmia therapy to examine all these characteristics in order to choose an adjusted treatment.
Assuntos
Anestesia Geral/efeitos adversos , Arritmias Cardíacas/etiologia , Cuidados Críticos , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Eletrocardiografia , Humanos , Hiperpotassemia/etiologia , Hipopotassemia/etiologia , Monitorização IntraoperatóriaRESUMO
The C.B. users offered for a few years a way for putting-out the distress on the highway. There were 2,000 in Besançon and surroundings in 1982. Today they are becoming no existent. Since then a new system of alarm run is born with 150 buses, 178 kilometers of net-travel and a sweep frequency of 10 min from 6h30 a.m., to 8h p.m, and of 30 min until 12h p.m. The 250 "C.T.B." drivers assume a regular surveillance of the urban and suburban highways. A standard message in used between the C.T.B. (Besançon Company of Buses.) regulation and Samu 25, regulation which allows to fix circumstances, place of road accident and inventory of casualties: 27 emergency calls are received in 1987, 50 in 1988. It might be possible to use other private or public radiotelephonic network.