RESUMO
BACKGROUND AND OBJECTIVE: Omalizumab is a human anti-IgE antibody approved for the treatment of severe allergic asthma (SAA). However, its effectiveness in SAA associated with chronic rhinosinusitis with nasal polyposis (CRSNP+) is less well documented. Objective: The aim of this study was to evaluate the real-life effectiveness of omalizumab in patients with SAA and CRSNP+ who tolerated and did not tolerate aspirin. METHODS: We performed a retrospective, observational, multicenter, real-life study of patients with SAA and CRSNP+ treated with omalizumab for 6 months. Asthma outcome parameters (symptoms, number of salbutamol rescues/wk, number of moderate/severe exacerbations, Asthma Control Test score, and lung function), sinonasal outcome parameters (symptoms, number of episodes of acute rhinosinusitis, sinus computed tomography images, nasal polyps endoscopy score), and serum eosinophil levels were analyzed 6 months before and after treatment with omalizumab. RESULTS: Twenty-four adult patients were included (9 with documented aspirin intolerance). All respiratory parameters were significantly improved by the treatment. In parallel, a significant improvement was observed in sinonasal clinical outcomes and sinus computed tomography images, with no major effect on the nasal polyps endoscopy score. The serum eosinophil count decreased significantly after 6 months of treatment with omalizumab. CONCLUSION: Treatment of SAA with omalizumab improves the outcome of associated CRSNP+, thus supporting the concept of a "one airway disease".
Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Pólipos Nasais/tratamento farmacológico , Omalizumab/uso terapêutico , Rinite Alérgica/tratamento farmacológico , Adulto , Eosinófilos/patologia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Antagonistas dos Receptores CCR5/uso terapêutico , Linfócitos T CD4-Positivos/imunologia , Infecções por HIV/tratamento farmacológico , HIV-1/fisiologia , Maraviroc/uso terapêutico , Sarcoidose/tratamento farmacológico , Adulto , Linfócitos T CD4-Positivos/efeitos dos fármacos , Humanos , Masculino , Resultado do TratamentoRESUMO
INTRODUCTION: Allergic asthma has variable characteristics depending on the region of occurrence. Management is often organized without easy access to a specialized pneumo-allergological evaluation. OBJECTIVES: PRIMARY: To characterize allergic asthma in patients followed at the Nancy University Hospital. SECONDARY: To estimate the impact at 12 months of the proposed specialized management. METHOD: Retrospective study including allergic asthmatic adults conducted between 01/01/2016 and 31/12/2018. Parameters studied (aside from descriptive parameters): asthma control score ACQ-7 (Asthma Control Questionnaire) and lung function at inclusion and at one year. RESULTS: One hundred and fifteen patients were included (age 42±16 years, women 63%, non-smokers 70%). Even though asthma symptoms arose at 19±18 years, the specialized consultation was performed 21±17.5 years later. Frequent sensitizations involved house dust mites (49%), cat dander (43%), grasses (43%). Patients tended to underestimate the frequency of their allergies (mites 36% P=0.011, pollens 36% P=0.001, pet dander 42% P=0.003, molds 80% P=0.007). At 1-year follow-up both the ACQ-7 score (1.3±1.3 vs. 0.8±0.9; P=0.007) and the forced expiratory volume per second (81.3±20.8% vs. 86.2±21.9%; P=0.002) had improved. CONCLUSION: The specificities of allergic asthmatics followed up in Nancy: late age of asthma onset of asthma and specialized consultation; predominant sensitization to cat dander and Betulaceae pollens; underestimation of allergies by the patient. Specialized care seems to important in the management of allergic asthma. While access to specialized care remains problematic, it could be facilitated by the creation of dedicated networks.
Assuntos
Asma , Hipersensibilidade , Humanos , Feminino , Estudos Retrospectivos , Asma/epidemiologia , Asma/terapia , Hipersensibilidade/diagnóstico , Hipersensibilidade/epidemiologia , Hipersensibilidade/terapia , Alérgenos , FungosRESUMO
INTRODUCTION: We illustrate the diagnostic method for chronic nasal dysfunction by an observation in which the clinical history was compared to preoperative responses on the DyNaChron self-administered questionnaire, with ENT interpretation of the sinonasal CT scan preceding and guiding nasal endoscopy. CASE REPORT: The initial suspicion of rhinitis medicamentosa was transformed by the radiological and endoscopic findings of chronic respiratory rhinitis signs. Prick tests showing sensitivity to dust mites then suggested an allergic origin of the mucosal inflammation, which affected neither the olfactory nose nor the paranasal sinuses. A septal deviation hampering visualization of the right ethmoidal reliefs completed the clinical picture. Inferior turbinate hypertrophy secondary to allergic inflammation could have been aggravated by prolonged daily use of nasal vasoconstrictors. Failure of medical treatment combining nasal lavage, topical corticosteroids and an attempt at weaning led to effective medical and surgical management combining septoplasty, bilateral inferior turbinoplasty, continuation of topical corticosteroids and initiation of allergen immunotherapy. In addition to complete relief of nasal obstruction and abandonment of nasal vasoconstrictors, improved sense of smell completed the restoration of nasal comfort. DISCUSSION: It is helpful to conceive the nose as being anatomically and pathophysiologically a triple organ and to evaluate therapy in terms of improvement in each symptom.
Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/diagnóstico , Rinite/etiologia , Rinite/terapia , Sinusite/complicações , Pólipos Nasais/complicações , Pólipos Nasais/diagnóstico , Pólipos Nasais/terapia , Descongestionantes Nasais/uso terapêutico , Endoscopia , Corticosteroides/uso terapêutico , Inflamação/complicações , Doença CrônicaRESUMO
Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.
Assuntos
Neoplasias Pulmonares/diagnóstico , Abandono do Hábito de Fumar , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , França/epidemiologia , Humanos , Neoplasias Pulmonares/epidemiologia , Programas de Rastreamento/métodos , Mortalidade , Fumantes/estatística & dados numéricos , Fumar/epidemiologia , Fumar/terapia , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricosRESUMO
INTRODUCTION: Skeletal-related events (SRE) are common in patients with bone metastatic lung cancer and have a negative impact on quality of life and survival. The objective of this study is to identify predictive factors for SRE occurrence among this population. METHODS: We conducted a 3-year retrospective study including 100 lung cancer patients with bone metastasis. RESULTS: Eighty-two patients presented at least one SRE (69.5% at baseline). The median occurrence for SRE was 4.5 months and severe bone pain was the most common SRE (56%). The alkaline phosphatase serum level>120IU/L (hazard ratio [sHR]=2.8; 95% confidence interval (CI) [1.5-5.4]; P=0.002) and calcemia>2.6mmol/L ([sHR]=9.7; 95% CI [5.1-18.4]; P<0.001) were identified as risk factors for SRE occurrence while the presence of an initial SRE was associated with a decrease of this risk ([sHR]=0.2; 95% CI [0.1-0.4]; P<0.001). CONCLUSION: The elevated alkaline phosphatase serum level and hypercalcemia are risk factors for SRE occurrence in bone metastatic lung cancer patients and should be used as biomarkers to adapt current medical practice for these patients.
Assuntos
Neoplasias Ósseas/etiologia , Neoplasias Ósseas/secundário , Carcinoma Broncogênico/patologia , Neoplasias Pulmonares/patologia , Idoso , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/epidemiologia , Carcinoma Broncogênico/diagnóstico , Carcinoma Broncogênico/epidemiologia , Carcinoma Broncogênico/terapia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Comorbidade , Feminino , França/epidemiologia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
INTRODUCTION: Occupational asthma is a disease where the pathophysiological characteristics of asthma are linked to repeated exposure to a sensitizing agent present in the workspace. Assessment of patients with severe asthma to identify and manage comorbidities improves asthma control and is recommended in international guidelines on the management of severe asthma. CASE REPORT: We report the case of a 49-year-old patient, nonsmoker, without atopy, who had severe work-related asthma due to exposure to isocyanates, which was uncontrolled despite the avoidance of the occupational exposure and maximal medical treatment. A systematic assessment for possible comorbidities revealed gastroesophageal reflux and obstructive sleep apnea syndrome. The specific management of these two comorbidities led to an improvement of asthma control with a reduction in the number of exacerbations, a reduced burden of treatment and a resumption of employment. CONCLUSIONS: As with all cases of severe asthma, the assessment of comorbidities must be systematic in the presence of an occupational asthma which persists after the cessation of the occupational exposure. The management of these comorbidities can lead to an improvement in asthma control and severity.
Assuntos
Asma Ocupacional/induzido quimicamente , Asma Ocupacional/complicações , Refluxo Gastroesofágico/complicações , Isocianatos/toxicidade , Apneia Obstrutiva do Sono/complicações , Asma Ocupacional/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Humanos , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/complicações , Hipersensibilidade Imediata/diagnóstico , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnósticoRESUMO
Anaplastic lymphoma kinase (ALK) rearrangement is a therapeutically targetable oncogenic driver found in 5% of patients with non-small-cell lung cancer (NSCLC). The objective of this paper is to synthesise current knowledge on ALK rearrangement and its impact on the management of advanced NSCLC. Several inhibitors of the tyrosine kinase of ALK (crizotinib, ceritinib, alectinib) have been approved as first line therapies in patients with advanced ALK positive NSCLC, which are associated with a better median progression-free survival than conventional chemotherapy. Unfortunately, the emergence of drug resistance leads to tumor progression. In patients with oligoprogressive disease if local ablative therapy can be effected, continuing with the same ALK tyrosine kinase inhibitor is one option. In patients with progression, clinicians may consider switching to another therapy. Rebiopsy of the tumor or liquid biopsy could be attempted to identify the mechanisms of resistance and to customize ALK-target therapy. The emergence of crizotinib drug resistance has prompted the development of next generation drugs including ceritinb, alectinib, brigatinib and lorlatinib. The ability to quickly develop targeted therapies against specific oncogenic drivers will require close co-operation between pathologists, pulmonologists and oncologists in the future to keep pace with drug discoveries and to define optimal therapeutic strategies.
Assuntos
Quinase do Linfoma Anaplásico/genética , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Oncologia/métodos , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Progressão da Doença , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Resistencia a Medicamentos Antineoplásicos/genética , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Oncologia/tendências , Terapia de Alvo Molecular/métodos , Terapia de Alvo Molecular/tendências , Estadiamento de Neoplasias , Inibidores de Proteínas Quinases/uso terapêuticoRESUMO
Doege-Potter syndrome is a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia secondary to a solitary fibrous tumor. These tumors are rare and usually asymptomatic. The syndrome of hypoglycemia is seen in less than 5% of the cases, and the associated tumors are large with a high mitotic rate. The cause of hypoglycemia is related to insulin-like growth factors produced by these tumors called "big" IGF-2. Several biological tests can demonstrate the increase of "big" IGF-2 plasma levels confirming the diagnosis of non-islet cell tumor induced hypoglycemia. The diagnosis is suggested by imaging but diagnostic confirmation is provided by the surgery, which remains the treatment of choice. Resection in many cases is the cure leading to hypoglycemia resolution. Recurrences and malignant transformations are possible which imposes a long-term monitoring. We report a case with relapsed malignant pleural fibrous tumor for which the pathophysiological mechanism of hypoglycemia could be documented as a paraneoplastic syndrome.
Assuntos
Hipoglicemia/etiologia , Síndromes Paraneoplásicas/etiologia , Neoplasias Pleurais/complicações , Sarcoma/complicações , Idoso , Documentação , Humanos , Hipoglicemia/sangue , Hipoglicemia/patologia , Fator de Crescimento Insulin-Like II/metabolismo , Masculino , Prontuários Médicos , Síndromes Paraneoplásicas/sangue , Síndromes Paraneoplásicas/patologia , Neoplasias Pleurais/sangue , Neoplasias Pleurais/patologia , Sarcoma/metabolismo , Sarcoma/patologiaRESUMO
PURPOSE: Prophylactic radiotherapy to prevent procedure-tracts metastases from malignant pleural mesothelioma remains controversial and clinical practice varies. The purpose was to assess the efficacy of local radiotherapy in a single fraction of 10Gy in preventing malignant seeding at intervention pleural site in patients with malignant pleural mesothelioma. MATERIAL AND METHODS: This is a retrospective cohort study, including patients with histological confirmed malignant pleural mesothelioma treated by prophylactic irradiation to prevent interventional site metastases with a unique fraction of 10Gy with 6 to 18MeV, from January 1990 to December 2013 in the institut de cancérologie de Lorraine (Nancy, France). RESULTS: Ninety-one patients were treated by irradiation in intervention site, involving 120 intervention pleural sites, 91 thoracoscopies, 17 thoracotomies with chest drain and 12 CT or ultrasound guided needle biopsies. The median follow-up was 7 months (interquartile between 3 and 15 months). The overall survival was 43.5% at 12 months. The local progression free survival was 43.7% at 12 month. The incidence of local recurrence was 8% at 12 months. The median interval from radiotherapy to local recurrence was 4 months (2; 32). No grade II or higher toxicity was observed. CONCLUSION: Irradiation of pleural intervention sites with a single fraction of 10Gy is effective, well tolerated, simple, fast and cost effective.
Assuntos
Neoplasias Pulmonares/cirurgia , Mesotelioma/cirurgia , Inoculação de Neoplasia , Neoplasias Pleurais/cirurgia , Doses de Radiação , Prevenção Secundária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , França , Humanos , Masculino , Mesotelioma Maligno , Pessoa de Meia-Idade , Metástase Neoplásica/prevenção & controle , Estudos RetrospectivosRESUMO
INTRODUCTION: The prevalence of chemotherapy-induced anemia in lung cancer is estimated at about 80%. STATE OF ART: There are currently no specific recommendations for the management of chemotherapy-induced anemia in lung cancer. In this paper, we propose a synthesis of currently existing data in the literature on the management of chemotherapy-induced anemia in general, supplemented with specific data about the efficacy and safety of erythropoietic therapy in lung cancer. PERSPECTIVES: Better management of chemotherapy-induced anemia improves patient's quality of life and reduces red blood cell transfusion requirement. In the meantime, in respect to currently missing data, thoracic oncologists should develop specific recommendations for the management of chemotherapy-induced anemia in lung cancer, with specific studies in this domain. CONCLUSIONS: Since the prevalence of chemotherapy-induced anemia in patients with lung cancer is high and has a significant impact on these patients quality of life, a specific prospective management should be implemented as early as possible.
Assuntos
Anemia/terapia , Antineoplásicos/efeitos adversos , Transfusão de Sangue , Hematínicos/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Anemia/induzido quimicamente , Medicamentos Biossimilares/uso terapêutico , Ensaios Clínicos como Assunto , Terapia Combinada , Gerenciamento Clínico , Transfusão de Eritrócitos , Fadiga/etiologia , Hematínicos/administração & dosagem , Hematínicos/efeitos adversos , Hemoglobinas/análise , Humanos , Ferro/uso terapêutico , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/radioterapia , Guias de Prática Clínica como Assunto , Qualidade de Vida , Radioterapia/efeitos adversos , Proteínas Recombinantes/uso terapêuticoRESUMO
INTRODUCTION: The inadequate secretion of ß-human chorionic gonadotropin (ß-HCG) during non-small cell lung cancer (NSCLC) is rare and quite ignored. The dosage of ß-HCG is probably not systematically realized in women who are in age of pregnancy and who need chemotherapy (CT) despite the descriptions of cases of prescription of CT against lung cancer in women who were pregnant. The incidence of NSCLC cancer is increasing and the risk to prescribe a CT in a woman who is pregnant is also increasing. CASES REPORTS: We describe the cases of two women and one man who had an augmentation of the ß-HCG plasmatic level before the prescription of CT against lung cancer. In women, the differential diagnostic between inadequate secretion of ß-HCG and pregnancy has been a problem. CONCLUSION: The inadequate secretion of ß-HCG during NSCLC is probably not so rare. The dosage of this hormone before each infusion of CT should be systematic to avoid the realization of CT during pregnancy. This raises the question of the method for differential diagnostic between pregnancy and inadequate secretion of ß-HCG in young women who suffer from NSCLC, especially when a small level of ß-HCG is measured.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Gonadotropina Coriônica Humana Subunidade beta/metabolismo , Neoplasias Pulmonares/diagnóstico , Síndromes Endócrinas Paraneoplásicas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Pulmonares/metabolismo , Masculino , Pessoa de Meia-Idade , Síndromes Endócrinas Paraneoplásicas/metabolismo , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnósticoRESUMO
Hypersensitivity pneumonitis (HP) occurred after organic antigens inhalation at home is rare and the diagnosis is very often difficult. We report the case of a 55-year male patient with allergic asthma since childhood, well controlled with inhaled corticosteroids, twice hospitalized for respiratory distresses. The patient presented fever (39°C), dry cough, rapidly progressive dyspnea, chest pain and crackles. Blood gas analysis found a hypoxemia of 52 mmHg, and CT-scan showed ground glass images in the upper lobes. Respiratory function tests showed severe obstructive syndrome and a decrease of diffusion test. HP was suspected because the symptoms were triggered by domestic environmental. The Medical Indoor Environment Councelor (MIEC) visited the patient's house and camper and performed air and dust samples. Moldy walnuts were found in the camper. The identification of microorganisms present in the air and on the surfaces in the camper was used for serum precipitins research by double diffusion (DD) and electrosyneresis (E) methods. From the 14 antigens tested, serological tests were considered significant for mesophilic Streptomyces (five arcs DD, six arcs E) and Penicillium chrysogenum (one arc DD, four arcs E). After removal from the camper of the objects suspected to be contaminated, the patient's symptoms regressed. This is a typical case of domestic HP to mesophilic Streptomyces and P. chrysogenum. The MIEC's intervention was useful in both diagnosis and treatment.