Two cases of cutaneous drug eruption associated with temozolomide therapy for glioblastoma.

Glioblastoma is the most common form of primary brain cancer. Its treatment involves surgery, radiotherapy, and chemotherapy with temozolomide (tmz), which is an oral alkylating agent. To the best of our knowledge, few dermatologic side effects of tmz have been described. We report two cases of cutaneous drug eruption caused by tmz during and after radiochemotherapy treatment. In the first case, all tests were negative, but the clinical history and the time of onset supported an allergy to tmz. In the second case, an allergy to tmz was proved by a positive lymphocyte activation test. In this context, our study is one of a very few trying to determine dermatologic side effects by applicable tests used in routine practice.

Phorbol myristate acetate: a mitogen selective for a T-lymphocyte subpopulation.

Phorbol myristate acetate (pma) is a potent mitogen for human peripheral blood lymphocytes (PBL) comparable to phytohemagglutinin (PHA) in potency. Inactivation of PHA-responsive lymphocytes by 5'-bromodeoxyuridine and light treatment left the PMA response intact and nice versa. Experiments separating lymphocytes by rosetting with sheep erythrocytes (SRBC) demonstrated that the PMA-responsive lymphocytes segregate with those that have a high affinity for SRBC to a greater than PHA- or concanavalin A (Con A)-responsive cells. These results indicate that a PMA-responsive population in human peripheral blood resides within the T-lymphocyte population and appears to have a high affinity for SRBC and to be distinct from that responding to PHA and Con A. PMA may be useful clinically to assay the size and function of the high affinity or "active" rosette population.

[Smoking cessation in the pregnant woman: descriptive study in Limousin]. / Sevrage tabagique chez la femme enceinte : étude descriptive en Limousin.

OBJECTIVE: Among obstetricians and midwives, estimate the percentage of smokers, appraise the proportion of medical professionals who mention the subject of nicotine addiction to their pregnant patients, and assess the quality of the information delivered to patients as well as their own experience in the field of tobacology. PATIENTS AND METHODS: Between February and March 2002, 188 postal questionnaires were sent to obstetricians and gynecologists, midwives and midwife students of public hospitals in Limousin and private clinics in Limoges. RESULTS: The response rate was 75,5% (142 answers) and the median age was 37 years old (20-59). 43,6% of the respondents were current smokers. Patients' smoking habits would be asked for and the risks of tobacco smoking would be explained by the majority of praticians and midwives. Minimal counsel to be given was known and given by 34,4% of gynecologists an 26,5% of midwives. Smoking cessation counselling was never proposed by 62% of gynecologists and 79% of midwives. Seventy per cent of them did not have any specific training in the field of tobacology during their studies. DISCUSSION AND CONCLUSION: There seems to be a deficiency in smoking cessation help for pregnant women in Limousin. Specifics programs and trainings for obstetricians, gynecologists, as well as midwives should be organized.

[Investigation of allergic reactions to platinum salts]. / Exploration d'une allergie aux sels de platine.

INTRODUCTION: We report two cases occurring in 2004 of patients being treated for pleural mesothelioma with a combination of cisplatin or carboplatin and pemetrexed. Investigation by skin tests and flow cytometry confirmed the clinical diagnosis in both cases. CASE REPORTS: Case 1: a man of 62 developed, after 12 courses of cisplatin-pemetrexed, an anaphylactic reaction 5 minutes after the infusion of cisplatin. Treatment was withdrawn permanently. Case 2: a man of 66 developed, after 7 courses of cisplatin-pemetrexed, an anaphylactic reaction within the first minute of the infusion of cisplatin. Subsequently, in March 2004, he received pemetrexed alone without any problems. In August 2004 he was prescribed carboplatin-pemetrexed. Within 5 minutes he developed urticaria, pruritus and abdominal pain. He was treated later with pemetrexed alone with no problems. CONCLUSION: Hypersensitivity to platinum salts usually occurs after several courses of treatment. Skin tests and flow cytometry are a simple, concordant, and reliable way of confirming the diagnosis.

Aspirin and non steroidal anti-inflammatory drugs hypersensitivity review (2002-2004).

According to physician, Aspirin and NSAIDS hypersensitivity are causing three major problems: how to make the diagnosis? Which treatment are to he given to these patients? What kind of anti-inflammatory drugs are to be prescribed? For these last three years, several articles regarding these matters were being published.

Consistency of routine measurements of CD4+, CD8+ peripheral blood lymphocytes.

In order to evaluate the reliability of CD4 and CD8 T lymphocyte counts in large scale studies, a quality control study was performed in 12 French laboratories. CD4 and CD8 counts, assessed by various haematological and immunological techniques, were compared in order to assess possible differences between the laboratories and the techniques used. Our data showed that (a) the consistency of CD4 measurements was satisfactory since the between-laboratory coefficient of variation for absolute CD4 cell numbers above 200/mm3 was around 15% instead of 5-10% for all laboratories but one; (b) the major sources of variability arose from the use of automatic devices in the two-step measurement procedure: immunophenotyping and haematological counting. These data suggest that multicentre assays of CD4 and CD8 counts result in some increase in their variability. Nevertheless the results of large multicentric trials can be extrapolated with confidence in the routine care of HIV+ patients. Together, the results justified the involvement of several experienced laboratories in a clinical trial of HIV-related disease.

Carboplatin-etoposide combination in small cell lung cancer patients older than 70 years: a phase II trial.

BACKGROUND: No standard treatment is defined for elderly patients with small cell lung cancer (SCLC). Carboplatin and etoposide are highly active agents against SCLC. In this study, we evaluated the activity and toxicity of a combination of these two agents. PATIENTS AND METHODS: Thirty-four untreated patients with limited or extensive SCLC and median age of 73.9 years entered the study. Chemotherapy consisted of carboplatin i.v. on day 1 (AUC 5 using Calvert's formula) and etoposide 100 mg/m(2) given orally on days 1-5, every 4 weeks, and thoracic irradiation was given to limited disease patients after chemotherapy. RESULTS: The overall response rates was 59% (95% CI: 43-76). The median survival for all patients was 37 weeks (range 3-76 weeks). The toxicity was mainly haematological with grade 3-4 neutropenia in 59% of courses, febrile neutropenia in 15% of courses, and toxic death in 9% of patients. CONCLUSION: The results of this regimen are disappointing with worse response and survival, and more haematological toxicity than expected and previously reported, despite the use of Calvert's formula. Possible explanations are the use of etoposide per os rather than i.v., the frequent comorbidities of older patients and the inclusion of patients with poor prognosis factors.

Fetal liver transplantation: biology and clinical results.

Over the last 18 years, we have developed the transplantation of fetal liver cells to treat severe immunodeficiencies, hematological disorders and inborn errors of metabolism. Post-natally, this treatment is successful in two-third of patients and it is therefore very valuable, especially when there is no perfectly matched donor for a bone marrow transplant. Since 1988 we have carried out these fetal liver transplants (FLTs) in utero, immediately after prenatal diagnosis. Engraftment and reconstitution have been obtained, and several advantages appear to be associated with in utero FLT: increased probability of graft take, ideal isolation of the patient (in the maternal uterus) and optimal environment for the differentiation of the transplanted fetal liver cells (in the fetal host).

Soluble interleukin-2 receptor (S IL-2R) in renal and pancreatic transplantation.

The monitoring of plasma soluble interleukin-2 receptor (S IL-2R) concentrations has been proposed in organ transplantation, especially to detect early manifestations of rejection. In organ transplantation, immune activation occurs in various circumstances such as rejections and infections. We performed S IL-2R determination 3 times a week in the sera of 106 patients undergoing kidney and/or pancreas transplantation. In kidney transplantation, S IL-2R was increased before the transplant. It also increased under prophylactic and especially under curative anti-rejection OKT3 or ATG therapy. In 90% cases, S IL-2R increased 2 to 4 days before creatininemia rise. In the other 10% cases, no correlation could be found with any clinical status modification. S IL-2R concentrations never increased in isolated acute tubular necrosis or in cyclosporine A (CsA) nephrotoxicity. In pancreas transplantation, the correlation between S IL-2R concentrations and possible pancreas rejection, was very poor. During cytomegalovirus (CMV) infection, only 50% patients with clinical CMV manifestations had high concentrations of S IL-2R. During Dihydroxy Propoxy Methyl Guanine (DPHG = Ganciclovir) treatment, S IL-2R still increased at the beginning, then it decreased progressively when therapy was efficient on CMV infection. The monitoring of S IL-2R concentrations may be useful in the weeks following organ transplantation provided that results are interpreted in the context of clinical and other laboratory findings, particularly with the renal function status and creatininemia.

Immunogenetics and immunopathology of human primary membranous glomerulonephritis: HLA-A, B, DR antigens; functional activity of splenic macrophage Fc-receptors and peripheral blood T-lymphocyte subpopulations.

In most of our patients with idiopathic membranous nephritis (MGN), we have studied the HLA-A, B, DR phenotype, the clearance of anti Rhesus D coated-51 Cr-labeled-autologous erythrocytes, and the peripheral blood T-lymphocyte subpopulations as ascertained by monoclonal antibodies (OKT3, OKT4, OKT8). The frequency of HLA-B8 antigen is 57.14% in 28 primary MGN versus 14.4% in 104 local controls (Pc less than 0.00018). The frequency of HLA-DR3 antigen is 65.38% in 26 primary MGN patients versus 20.27% in 74 local control individuals (Pc less than 0.00008). The half-life of sensitized erythrocytes is 37.30 +/- 9.55 min in 10 controls, 1963 min and 1601 min in 2 splenectomized controls, 12 min in a patient with hypersplenism, and 67.05 +/- 69.64 min in 18 idiopathic MGN patients respectively. The half-life is significantly prolonged in 6 out of 18 MGN patients. This prolongation correlates with exacerbation of the disease while normal values are obtained with remission. The OKT3 positive subpopulation (total T-lymphocytes) is 63.77 +/- 10.37% in 31 controls versus 53.74 +/- 13.81% in 22 MGN (P less than 0.002). The OKT4 positive subpopulation (helper T-cells) is 37.90 +/- 8.21% in controls versus 32.79 +/- 10.89% in MGN (P less than 0.03). The OKT8 positive subpopulation (suppressor T-cells) is 21.60 +/- 5.28% versus 20.03 +/- 5.76% respectively. The OKT4/OKT8 ratio is 1.85 +/- 0.58 in controls versus 1.74 +/- 0.69 in MGN. During exacerbation, the T-lymphocyte subset fractions are normal, whereas OKT3 and OKT4 are decreased during remission. MGN is a strongly HLA-linked disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Respiratory allergy and domestic animals]. / Allergie respiratoire et animaux domestiques.

Pets must be considered allergy factors. They are not advised for atopic families. However some recent publications suggest a protective effect of cat and dog exposure in the first year of life. The origin of this protective effect is not known.

[Clinical and biological surveillance after the cessation of Hymenoptera venom desensitization]. / Surveillance clinique et biologique après arrêt de la désensibilisation aux venins d'hyménoptères.

107 patients have discontinued Hymenoptera venom immunotherapy between 1988 and 2000. 31 have been seen again with intradermal tests with IgEs, and 81 responded to a questionnaire. Intradermal reactions and IgEs decrease together significantly during immunotherapy and then persist at low level during three years. Beyond, the number of patients is insufficient. 32 patients were stung by the same Hymenoptera and not had any systemic reaction. However, five have beta blockers, three have IEC and half of the patients don't take precautions to avoid Hymenoptera.

[Lymphocyte subpopulations of the blood and cerebrospinal fluid in acute polyradiculoneuritis. Study of 14 cases using monoclonal antibodies]. / Sous-populations lymphocytaires du sang et du liquide céphalo-rachidien dans les polyradiculonévrites aiguës. Etude de 14 cas pour les anticorps monoclonaux.

The T lymphocytes in blood and CSF of 14 patients with acute polyradiculoneuritis were studied using the OKT series of monoclonal antibodies. Results were compared with findings in two control groups. Three patients with cytomegalovirus infection showed elevation of circulating OKT 8. A significant increase in the mean ratio OKT 4/OKT 8 was noted in all other cases, corresponding in 4 of the 11 patients to a reduction in number of OKT 8 lymphocytes. The CSF was normal in 3 of the 14 cases.

[Pneumopathy induced by pirindopril. A case report]. / Pneumopathie induite par le pirindopril. A propos d'un cas.

Cough is known to be the major respiratory side effect of treatment with angiotensin converting enzyme inhibitors (ACEI). Recently, ACEI have been implicated in drug-induced lung disease. We report a new case of diffuse pneumonitis which occurred during treatment with ACEI. A 73-year-old man was admitted for cough, dyspnea at rest, fever and weight loss. The patient had been treated with the ACEI pirindopril during 6 months for systemic hypertension. Chest radiographs showed reticular infiltrates in the upper lung fields. A CT scan confirmed the infiltrates and showed pleural thickening and airspace opacities. White blood cell counts showed 15,700/mm3 leucocytes with 940 eosinophils/mm3. Transbronchial biopsy was consistent with infiltration of the lung with eosinophils. There was no evidence for another etiology. Once the drug was withdrawn, clinical and radiological abnormalities improved but steroids were required to control symptoms. This report suggests that pirindopril, as captopril, can induce the picture of drug-induced pulmonary disease.

[Pulmonary infection caused by Fusobacterium nucleatum]. / Infection pulmonaire à Fusobacterium nucleatum.

Thoracic infection by anaerobes are uncommon diseases and often presents difficulty in diagnosis. We report a case of thoracic infection due to Fusobacterium Nucleatum. A 60-year old man presented a lesion infiltrating from the lung to the thoracic wall. Fusobacterium Nucleatum was isolated on pus collected. Treatment by penicillin, metronidazole combined with surgical drainage was highly effective.

[Pseudoneoplastic forms of bronchiolitis obliterans with organizing pneumopathy (BOOP)]. / Formes pseudo-néoplasiques des BOOP.

Chronic obstructive bronchiolitis with organizing lung disease is an anatomoradioclinical entity characterized by nonspecific inflammation associated with recurrent migratory minimally dense alveolar opacities on the chest x-ray poorly responsive to corticosteroid therapy. Excepting this typical presentation, other clinical forms may occur. We report the cases of two patients with an exceptional localized presentation raising the differential diagnosis of lung cancer.

[Post-traumatic pulmonary hematomas. Apropos of 2 cases]. / Hématomes pulmonaires post-traumatiques. A propos de deux observations.

Post-traumatic pulmonary hematoma presents clinically as a hemorrhagic collection within a newly-formed cavity in the lung parenchyma. Its frequency is probably underestimated in view of the importance of the associated lesions. The most frequent clinical sign is hemoptysis. The chest radiograph, as well as the CT scan, shows a clearly defined round image. As a rule, there is a favorable outcome with slow resorption over several weeks, with a restoration of the integrity of the pulmonary parenchyma, which justifies simple observation, with an absence of any therapeutic intervention.

[Respiratory effects of risperidone? A prospective study]. / Effets respiratoires de la rispéridone? Etude prospective.

Risperidone is an atypical neuroleptic which has been incriminated as a cause of respiratory symptoms. The purpose of this prospective study was to assess over a three-month period the respiratory status of patients free of allergic or respiratory disease treated with risperidone. Thirty-nine patients were enrolled. Twenty dropped out. One patient developed cough very likely related to risperidone but with no change in function. Bronchial hyperreactivity developed in two other patients who had no clinical symptom or sign of respiratory disorder. Despite the small number of patients in this study, risperidone would appear to have secondary respiratory effects. The high frequency of bronchial hyperreactivity observed in patients at inclusin and the nearly constant co-prescription of other psychiatric drugs suggests a potential combination effect (notably with selective seritonin reuptake inhibitors).

[The Lady Windermere syndrome: clinical and bacteriological data and progress in seven cases]. / Le syndrome de Lady Windermere : données cliniques, bactériologiques et évolutives.

Described by Reich and Johnson in 1992 [2], the Lady Windermere syndrome occurs exclusively in non-smoking women over the age of 60 years, without significant pre-existing pulmonary disease. It comprises bronchial dilatation, typically in the middle lobe and lingula, together with secondary infection by atypical mycobacteria (Mycobacterium avium in the first cases). Among the 17 cases of atypical mycobacterial infection that we have seen in the past 14 years, there were seven cases of this syndrome. It was associated with cough, sputum, sometimes haemoptysis, febrile episodes and deterioration of general health. The diagnostic criteria and treatment were defined by the American Thoracic Society. The pathophysiological hypothesis proposed by Reich and Johnson was that voluntary suppression of the cough led to congestion of the bronchi and secondary infection with atypical mycobacteria. Currently it is thought more likely that the following factors are involved: progressive increase in dilatation of small bronchi, delayed diagnosis, morphological abnormalities of the thorax, hormonal factors, immune deficiency, genetic neutrophil dysfunction, and even heterozygous forms of cystic fibrosis.