[Indication of sclerotherapy in the treatment of ischiatic pressure sore: about 13 cases]. / Indication de la sclérothérapie dans le traitement de l'escarre ischiatique. À propos de 13 cas.

INTRODUCTION: Ischiatic pressure sore is a common pathology of the paraplegic patient. Usually treated after medical therapy, with fasciocutaneous or musculocutaneous local flaps, despite this treatment the recurrence rate is high. Sclerotherapy, injection of pure ethanol in the cavity of the pressure sore could be an interesting solution in the armentarium of the plastic surgeon in some indications. PATIENTS AND METHODS: Sclerotherapy was used for 13 patients in the plastic surgery department to treat ischiatic pressure sores with a cavity, beneath the defect. RESULTS: The mean length of stay was 24 days. The ischiatic pressure sore was completely healed with no skin defect or cavity for nine patients (65%). For two patients, there was a delay of healing of the skin defect but no cavity beneath. There were two early recurrences of the pressure sore. They were treated by sclerotherapy with a complete recovery in 2 months with simple hydrocolloid dressings. The mean post op follow-up was 14,6 months (4 to 24). Only one recurrence was observed after 12 months. CONCLUSION: The injection of pure ethanol in the cavity of specifics ischiatics pressure sores is a simple, fast and effective technique with a good and stable long term wound healing. The mean length of stay is shorter and the recurrence rate is equivalent to other techniques.

[Smoking during pregnancy and smoking clinics]. / Tabac, grossesse et consultations de tabacologie.

OBJECTIVES: France has the highest rate in Europe for smoking during pregnancy, the first cause of preterm birth. PATIENTS AND METHODS: We aimed to study the accessibility of smoking clinics for pregnant women in Picardy. A woman simulated by phone a request for a visit. RESULTS: Smoking cessation visits are poorly publicized. The mean delay for a visit is nine days (range: 2-42). Only eight centers out of 21 could reduce the delay when it was stressed that the request was for a pregnant woman, reducing the delay to seven days (range: 1-16). None of the centres has checked for this condition. DISCUSSION AND CONCLUSION: Smoking is a major burden. Inconsistencies in the French healthcare system are reviewed. Professionals' involvement in smoking cessation programs must be improved, however consistency in the support from health care authorities is needed.

Masitinib, a c-kit/PDGF receptor tyrosine kinase inhibitor, improves disease control in severe corticosteroid-dependent asthmatics.

BACKGROUND: Masitinib is a tyrosine kinase inhibitor targeting stem cell factor receptor (c-kit) and platelet-derived growth factor (PDGF) receptor, which are expressed on several cell types including mast cells and bronchial structural cells, respectively. We hypothesized that c-kit and PDGF receptor inhibition may decrease bronchial inflammation and interfere with airway remodeling, which are crucial features of severe asthma. OBJECTIVES: The primary endpoint was the percent change from baseline in oral corticosteroids after 16 weeks of treatment. Change in asthma control (asthma control questionnaire), exacerbation rate, pulmonary function tests, rescue medication requirement and safety were secondary endpoints. METHODS: A 16-week randomized, dose-ranging (3, 4.5, and 6 mg/kg/day), placebo-controlled study was undertaken in 44 patients with severe corticosteroid-dependent asthma who remained poorly controlled despite optimal asthma management. RESULTS: At 16 weeks of treatment, a comparable reduction in oral corticosteroids was achieved with masitinib and placebo (median reduction of -78% and -57% in the masitinib and placebo arms, respectively). Despite this similar reduction, the Asthma Control Questionnaire score was significantly better in the masitinib arm as compared to placebo with a reduction by 0.99 unit at week 16 (P < 0.001) vs 0.43 unit in the placebo arm. Masitinib therapy was associated with more transient skin rash and edema. CONCLUSIONS: Masitinib, a c-kit and PDGF-receptor tyrosine kinase inhibitor, may represent an innovative avenue of treatment in corticosteroid-dependent asthma. These preliminary results warrant further long-term clinical studies in severe asthma

[Five year survival for lung cancer patients managed in general hospitals]. / Survie à cinq ans des cancers bronchiques primitifs dans les centres hospitaliers généraux.

INTRODUCTION: In 2000 the College of Pulmonologists of General Hospitals undertook an epidemiological study (KBP-2000-CPHG) enrolling all new cases of histologically confirmed lung cancer managed in general hospitals. This paper reports the five year survival in these cases. METHODS: Vital status was available for 5447 out of 5667 patients included in the original study. The effect of different prognostic factors on mortality was assessed. RESULTS: At 5 years 567 patients (10.4%) were still alive. Median survival for the 4880 (89.6%) deceased patients was 7 months. Univariate analysis identified age, smoking history, performance status, histological type and disease stage (TMN classification) as determinants of survival. For non-small cell lung cancer (n=4885) multivariate analysis identified five predictive factors for mortality - age, gender histological type, performance status and stage. CONCLUSIONS: Five year survival in lung cancer continues to be poor. As the risk factors for poor outcome at the time of diagnosis are not modifiable and pending the results of screening studies reduction in mortality must rest on primary prevention.

[Hemosiderotic fibrohistiocytic lipomatous lesion: a new entity you must remind]. / Tumeurs fibrolipomateuses hémosidérotiques: une nouvelle entité à ne pas méconnaître.

Fatty tissues lesions are the most frequent of both benign (lipoma) and malignant tumor (liposarcoma) of soft tissues in the adult. We here describe the case of female patient having a fatty tissue mass of the ankle corresponding to an hemosiderotic fibrohistiocytic lipomatous lesion (HFHLL). This very rare tumour of recent description is specific of the ankle/foot area of the middle age women. These lesions are always benign and frequently recur following incomplete resection. This tumor may have invasive local growth and metastases have not been described so far. We describe the anatomopathologist's key points of their diagnostic. We discuss the main differentials diagnosis and treatment.

How should nasal symptoms be investigated in asthma? A comparison of radiologic and endoscopic findings.

BACKGROUND: To improve asthma control, the management of rhinosinusitis often leads the physician to perform sinonasal imaging and/or nasal endoscopy, but their respective contributions are still insufficiently understood. OBJECTIVE: To evaluate the potential contribution of a symptoms questionnaire, sinus radiography (SR) and computed tomography (CT) scan to the diagnosis of nasal diseases in asthmatic patients when compared with ENT examination. METHODS: A total of 124 patients completed a questionnaire on nasal symptoms administered by the chest physician. Then, they underwent ENT examination. On the same day, SR and CT scans were performed independently. RESULTS: Patients (80.3%) had nasal symptoms during the month preceding the consultation. The ENT examination was normal in 8.1% (n = 10) and revealed rhinitis in 57.3% (n = 71), rhinosinusitis in 14.5% (n = 18) and nasal polyposis in 20.2% (n = 25). For rhinitis, the negative predictive value of bilateral nasal obstruction was 87.8%. Both SR and CT had low sensitivity and specificity. For rhinosinusitis, the negative predictive value of nasal symptoms varied from 85.4 to 95.2%. Sinus CT was at least as accurate as SR for the diagnosis of rhinosinusitis. In a multivariate analysis, only the CT scan (score > or =12) appeared to be significantly associated with the diagnosis of nasal polyposis. CONCLUSION: In asthmatic patients, physicians need to enquire systematically about the existence of nasal symptoms by using this simple questionnaire which is sensitive for rhinitis, and has good negative predictive value for excluding rhinosinusitis and nasal polyposis.

[Value of thoracoscopy]. / Intérêt de la thoracoscopie.

Formerly used in active tuberculosis to divide pleuro-pulmonary adhesions and to complete therapeutic pneumothorax, thoracoscopy has now become the object of renewed interest. By introducing, after pneumoserosa and usually through the axilla, a fine trocar into the chest, the whole thoracic cavity, including parietal pleura, diaphragm, lung and lung fissures, mediastinum and pericardium, can be explored. This technique, performed under local rather than general anaesthesia or under neuroleptanalgesia, is innocuous, fairly cheap and effective. In addition, the patient is immobilized for only 4 or 5 days on average and surgery, which is much heavier, can be avoided in many cases. Thoracoscopy nowadays is mostly used: (1) to determine the cause of a chronic pleurisy unexplained after 3-4 weeks (positive results: 95-97% for cancer, 92% for tuberculosis); (2) to dry up pleural effusions by talc and drainage (satisfactory results in 90% of the cases); (3) to establish the pathophysiological diagnosis of spontaneous pneumothorax (bullae, blebs, adhesions, fistulae), to treat it with talc and with coagulation of small "bullae", or to decide in favour of surgery; (4) to perform lung biopsies which clinch the diagnosis in 95-97% of cases of diffuse interstitial pneumonia. The same technique is also used methodically and efficiently for optic and electronic microscopy, bacteriological or mycological examination, immunofluorescence, hormone receptor detection and study of organic particles or minerals. Thoracoscopy lies half-way between pure medical practice and surgery and deserves to be widely used again by pneumologists, provided they learn to master its technique by regular, assiduous and sufficient practice. Pneumologists do not become thoracoscopists at a moment's notice; it is a skill which must be included in their training.