Voriconazole for chronic pulmonary aspergillosis: a prospective multicenter trial.

Early evidence suggests the efficacy of voriconazole for chronic pulmonary aspergillosis (CPA). We conducted a prospective, open, multicenter trial to evaluate the efficacy and safety of voriconazole for proven CPA in minimally or non-immunocompromised patients. Patients had CPA confirmed by chest computed tomography (CT) and/or endoscopy, positive Aspergillus culture from a respiratory sample, and positive serologic test for Aspergillus precipitins. Patients received voriconazole (200 mg twice daily) for a period of 6-12 months and were followed for 6 months after the end of therapy (EOT). The primary endpoint was global success at 6 months, defined as complete or partial (≥50 % improvement) radiological response and mycological eradication. Forty-one patients with confirmed CPA were enrolled. All patients had A. fumigatus as the etiologic agent. By EOT, five patients had died from comorbidities and seven had discontinued voriconazole due to toxicity. The global success rate at 6 months was 13/41 (32 %): 10/19 (53 %) for chronic necrotizing aspergillosis and 3/22 (14 %) for chronic cavitary aspergillosis (p = 0.01). The respective success rates at EOT were 58 and 32 %. Clinical symptoms and quality of life also improved during treatment. Voriconazole is effective for CPA, with acceptable toxicity. The response rate is higher and obtained more rapidly in necrotizing than cavitary forms.

[A bronchial mucous gland adenoma resected by endoscopic procedure]. / Un adénome des glandes muqueuses bronchiques réséqué par voie endoscopique.

INTRODUCTION: Surgical resection is usually performed for the treatment of endobronchial tumors. This case describes the use of endoscopic resection as an initial treatment, allowing to spare lung parenchyma. CASE REPORT: A patient was admitted to the emergency unit with right lower lobe pneumonia. A thoracic CT-scan and subsequent bronchoscopy revealed an intrabronchial tumor between the right main and intermediate bronchus. Biopsies were non-diagnostic and a PET-scanner did not find any abnormalities. Surgical resection was initially proposed but would have required a right upper lobectomy. The patient had stage 2 (moderate) chronic obstructive pulmonary disease (GOLD classification). Because of this, we decided to perform an endoscopic resection to obtain further histology and hopefully achieve total removal. Under conscious sedation, the resection by argon plasma coagulation with a flexible bronchoscope was realized without any complication. The histological diagnosis was a bronchial mucous gland adenoma. CONCLUSION: This case emphasizes the role of multidisciplinary discussion when considering suitability of local resection of tumors by an endobronchial procedure rather than a surgical resection.

Corneal graft rejection in a patient treated with nivolumab for primary lung cancer.

We report the case of a 58-year-old woman treated with nivolumab for an unresectable squamous non-small cell lung cancer, after first-line cisplatin and gemcitabine combination chemotherapy. This woman had a history of left corneal graft. After 9 cycles of nivolumab, the patient described decreased visual acuity in the left eye with watering and conjunctival erythema. Ophthalmological examination revealed chronic corneal graft rejection. The patient was then treated with an intravenous bolus of corticosteroids (500mg of methylprednisolone) for 3 days, followed by oral prednisone for 4 weeks and subconjunctival corticosteroid injections every 48h, while treatment with nivolumab was discontinued. No clinical benefit was observed 4 weeks later and the corneal graft became totally unfunctional despite of the therapy. We hypothesise that the treatment was started too late. To our knowledge, this is the first reported case of corneal graft rejection related to nivolumab.

Chronic pain of vascular origin caused by a parietopulmonary fistula of the thoracic wall.

We describe the case history of a patient who suffered from dorsal thoracic nonpenetrating trauma after a fall, with rupture of the aortic isthmus treated by thoracotomy. Arteriovenous fistula between the thoracic wall and the lung, with hypervascularization of the left thoracic wall, was revealed by atypical chronic thoracic pain and a murmur. This case demonstrates that chronic thoracic pain of vascular origin must be considered.

Simultaneous discovery of bilateral intralobar and extralobar pulmonary sequestrations.

We describe the rare case of bilateral bronchopulmonary sequestrations, one intralobar and one extralobar, in a 22-year-old man. The coexistence of two forms of separated sequestrations with a common vascularization support the theory that intralobar as well as extralobar sequestrations are congenital malformations.

[Contribution of flow cytometry in the prognostic evaluation of non-small-cell lung cancers. Review of the literature]. / Apport de la cytométrie en flux dans l'évaluation du pronostic des cancers bronchiques non à petites cellules. Revue de la littérature.

The flow-cytometry (FCM) is a method of quickly determining the desoxyribonucleic acid (DNA) content of tumoral cells. This provides us with two results: the DNA-ploidy which characterizes quantitatively the DNA, and the percentage of cells in DNA synthesis phase (%S). The contribution of FCM in evaluation of the prognosis of non-small cell lung cancer remains disputable. The absence of standardization between laboratories makes it difficult to compare the different studies to define the place of FCM analysis. However, for epidermoid carcinomas, the most actively studied, a DNA diploidy and a weak %S have a favourable impact on survival. No conclusion can be drawn from the studies on adenocarcinomas. Large cell carcinomas have never been studied in an isolated manner, due to the lack of numbers.

[Prognostic value of flow cytometry in squamous cell bronchogenic cancer. A retrospective study of 61 cases]. / Valeur pronostique de la cytométrie en flux dans les cancers bronchiques épidermoïdes. Etude rétrospective à propos de 61 cas.

To assess the prognostic value of flow cytometric analysis, 61 cases of operated squamous cell lung carcinoma were studied in terms of desoxyribonucleic acid (DNA) nuclear content and percentage of cells in DNA synthesis phase (% S). These parameters were determined on a fresh surgical sample. The S % was obtained in 25 cases. DNA index (DI) and % S were compared with survival and usual clinicopathologic characteristics for the prediction of survival. DNA content classified as DNA-diploid and DNA-aneuploid is not a prognostic factor for survival. DI higher than 2 seems to be predictive but needs confirmation. The % S and multiploidy are not predictive factors for survival.

[Prognostic evaluation of small cell lung carcinoma by flow cytometry. A retrospective study from bronchial brushing samples]. / Evaluation pronostique du carcinome bronchique à petites cellules par cytométrie en flux. Etude rétrospective à partir de prélèvements par brossage bronchique.

The authors determined the desoxyribonucleic acid (DNA) content of 45 small-cell lung cancers, by flow-cytometry (FC), from bronchial brushings to asses the prognostic meaning of the DNA index, the percentage of cells in DNA synthesis phase (% S) and the ploidy. Moreover, the value of this tumorous cells brushing was assessed for Flow-cytometric analysis. Bronchial brushing offers some advantages opposite to biopsies, but the low quantity of collected cells reduces the number of tumors analysable by FC. The output is low (39%) for determination of DNA index, and moreover low (22%) for determination of % S. In regard to the flow-cytometry analysis, the DNA content does not show any significant difference of survival where as the % S is related to survival, but it seems to be paradoxical in this study. Indeed, patients with small-cell lung cancer associated to high cells' percentage in DNA synthesis phase have the longest survival.

[Anorexia associated with bronchial cancer]. / Anorexie au cours du cancer bronchique.

Anorexia is a frequent complaint in patients suffering from bronchial cancer. It is linked to multiple factors, organic, biological and psychological. The treatment of anorexia implies an involvement with all these factors. If it persists, it may be improved by corticosteroids or by derivatives of progesterone independently of the control of the tumour process.

[Relieving the obstruction caused by malignant tracheobronchial tumors under flexible endoscopy]. / La désobstruction des tumeurs malignes de l'arbre trachéo-bronchique sous endoscopie souple.

OBJECTIVES: We evaluate the feasibility and the efficiency of electrosurgery in the treatment of the symptomatic malignant tracheobronchial tree obstructions (MTTO) when it is used with flexible fiberoptic bronchoscopy without general anesthesia. METHODS: The aim of electrosurgery was to restore the permeability of the tracheobronchial tree to suppress symptoms. The operation lasted no more than 60 minutes, and a second operation was performed 8 days later if symptoms persisted. The patients received local anesthesia and light sedation (midazolm). PATIENTS: 28 patients have been treated from june 1995 to june 1996 for following symptoms: dyspnea (22 cases), cough (1 case), dyspnea and cough (5 cases). All patients had malignant disease palliatively treated. RESULTS: The protocol has failed in one case, needing general anesthesia. 27 patients have had one session, 6 a second one week later. After the first session, dyspnea was improved in 22/27 cases (81.5%) and cough in 5/6 cases (83%). After the second session, dyspnea was globally improved in 26/27 cases (96%), without change for cough. CONCLUSION: Electrosurgery is a feasible and safe treatment which can implement immediately without general anesthesia, in MTTO. Its result are highly effective on dyspnea but less on cough, with reproducible effects and a well-tolerated procedure. Further investigations need to compare the different techniques.

[Benign clear cell tumor ("sugar tumor"). An unusual cause of intrapulmonary coin lesion]. / Tumeur bénigne à cellules claires ("tumeur sucre"). Une cause rare d'opacité ronde intrapulmonaire.

The authors report a case of a 25 years old woman in whom a coin lesion was fortuitously discovered. Initial investigations were negative and an exploratory thoracotomy was performed which enabled a benign clear cell tumour of the lung to be found (sugar tumour). This rare benign tumour whose cellular origin remains indeterminate is in general discovered in a fortuitous manner after a chest x-ray has been performed showing a round peripheral opacity. The diagnosis is confirmed following the excision of the tumour, complementary examinations are not helpful.

[Evolvements in the presentation of primary bronchial adenocarcinomas observed in a pneumology service over an 11-year period]. / Evolution de la présentation des adénocarcinomes bronchiques primitifs observés dans un service de pneumologie pendant 11 ans.

The evolution of the clinical presentation, endoscopy and radiology in a consecutive series of 121 cases of primary bronchial adenocarcinoma has been studied in a retrospective manner over a period of 11 years. The mean age was 60 +/- 12 and 16.5% of the patients were women. The frequency of smoking and the quantity smoked in packed years was significantly higher in men than in women. The frequency of the presenting signs and the endoscopic features did not change over the period. On the other hand, the peripheral and mediastinal-hilar forms were more frequent from 1990 in a significant manner so that the hilar form became rarer. The result seems to confirm an increase in the frequency of a new radio-clinical expression of primary bronchial adenocarcinoma. These mediastinal-hilar adenocarcinomas do not have specific characteristics but are associated with a higher mortality.

[Endodermal pulmonary tumor resembling a fetal lung]. / Tumeur pulmonaire endodermique ressemblant au poumon foetal.

We report a case of a 56-year-old man who developed a flu-like syndrome associated with weight loss. Chest X-ray revealed a homogeneous round lesion of the lung with sharply defined margins in the central lobe. At pathology, the tumor was found to be an endodermal pulmonary tumor resembling a fetal lung. This uncommon tumor is generally a fortuitous chest X-ray finding seen as a rounded peripheral opacity. Diagnosis is based on pathology examination of the surgical specimen. Complementary investigations are not contributory. Unlike blastoma, a differential diagnosis, prognosis is generally good.

[Surgical vein reconstruction in patients with tumor invasiveness of the superior caval system. Retrospective study of 7 cases]. / Reconstruction veineuse chirurgicale devant un envahissement tumoral du système cave supérieur. Etude rétrospective de 7 cas.

We studied retrospectively all patients who underwent vascular reconstruction after tumor invasion of the superior vena cava in order to assess the surgical procedure. Seven patients were operated including 5 with compression of the superior vena cava. Compression regressed within 24 hours without recurrence. Reconstruction had no effect on morbidity and mortality. One patient is still alive after a 5 year follow-up. Invasion of the superior vena cava is not a contraindication for resection of a tumor localized in the thorax and may contribute to cure as it improved patient comfort in all cases.

[Can outcome of varicella pneumonia be predicted in a non-immunosuppressed patient?]. / Peut-on prévoir l'évolution d'une pneumopathie varicelleuse chez un sujet non-immunodéprimé?

Varicella rarely occurs in the adult but can cause multi-organ complications. The most frequent (15 to 30% involve varicella pneumonia of unpredictable outcome. In the healthy adult, outcome can be favourable in 5 days or inversely lead to respiratory distress and death in 10 to 20% of the cases. An analysis of the published cases does not reveal any factor predicting unfavourable outcome. A register of varicella pneumonia would help identify potential predictive factors.

[Phase II trial evaluating the effect of megestrol acetate-prednisolone combination in the treatment of anorexia during the palliative-care phase of lung cancer]. / Essai de phase II évaluant l'effet d'une association acétate de mégestrol et prednisolone dans le traitement de l'anorexie au cours du cancer bronchique en phase palliative.

OBJECTIVES: Anorexia is one of the most frequent complaints in patients who have reached the palliative-care phase of lung cancer. Megestrol acetate (or medroxyprogesterone acetate) and corticosteroids have been used with success, but the effect of their combination remains unknown. We conducted a phase II trial to assess the impact of combination therapy. PATIENTS AND METHODS: Patients with lung cancer given palliative care and who developed anorexia with or without weight loss were given 320 mg/d megestrol acetate in 2 doses and 40 mg/d prednisolone in one dose in the morning for 1 month. The principal outcome criterion was anorexia assessed on a visual analog scale prior to treatment and then at day 15 and day 30. Variation in daily calorie intake and weight were also recorded. We used an Armitage sequential plan to determine the number of inclusions necessary and the preference method (closed schema) to evaluate the principal outcome criterion. RESULTS: Inclusions were stopped after the eighth patient (giving p<0.05) as we observed a significant improvement in patient appetite. Daily calorie intake improved significantly (p<0.0001), by 39.18% the first 15 days and 16.57% more the next 15 days. Body weight improved significantly by 5.4% in one month (p=0.5). No treatment-related complication occurred during the study period or during the six consecutive months. CONCLUSIONS: The megestrol acetate-prednisolone combination was found to improve anorexia in patients with lung cancer in the palliative-care phase and allowed a significant improvement in calorie intake and body weight.

[Angiosarcoma of the thoracic wall revealed by hemothorax]. / Angiosarcome de la paroi thoracique révélé par un hémothorax.

Angiosarcoma is an uncommon tumor accounting for approximately 1% of all soft tissue tumors which, themselves account for 0.7% of all malignant tumors. Thoracic parietal localizations are reported exceptionally and prognosis is poor. We report the case of a 79-year-old woman who developed an angiosarcoma of the thoracic wall. The inaugural symptom was a hemothorax. Besides the localization, this case was particularly exceptional since the patient has remained asymptomatic three years after treatment by wide resection followed by radiotherapy.