Estimation of glomerular filtration rate in cancer patients with abnormal body composition and relation with carboplatin toxicity.

PURPOSE: Carboplatin clearance is correlated with glomerular filtration rate (GFR) and usually estimated with creatinine clearance using Cockcroft-Gault (CG) formula. Because plasma creatinine level is highly correlated with muscle mass, we hypothesized that an abnormal body composition with a low lean body mass (LBM) percentage [(LBM/weight) × 100] may result in inadequate carboplatin dosing. Serum cystatin C is an alternative marker of GFR, not affected by muscle mass. We aimed to investigate the influence of total LBM and LBM percentage on GFR calculation, using creatinine (CrCl) or cystatin C (GFRcysC-creat) in cancer patients. METHODS: Pretreatment serum creatinine and cystatin C were prospectively measured in consecutive patients. CrCl (CG formula), GFRcysC-creat (CKD-EPI creatinine-cystatin equation), and LBM (CT scan) were calculated. Severe thrombocytopenia post-carboplatin were analyzed. RESULTS: In 131 patients without renal insufficiency, LBM was correlated with creatinine (r = 0.30, p < 0.005) but not with cystatin C (r = -0.07, p = 0.43). In patients with the lowest LBM percentage, the CrCl was significantly higher than GFRcysC-creat indicating an overestimation of GFR with creatinine (p = 0.0004). In 24 patients treated with carboplatin AUC 5 (mg/ml min) ± paclitaxel, the risk of severe thrombocytopenia was associated with lower LBM percentage (p = 0.0002) and higher CrCl/GFRcysC-creat ratio (p = 0.006). By ROC analysis, the CrCl/GFRcysC-creat ratio threshold predicting severe thrombocytopenia was 1.23. CONCLUSIONS: A low LBM percentage increases the risk of inadequate GFR calculation by CG formula, and carboplatin overdosage with severe thrombocytopenia. High CrCl/GFRcysC-creat ratio allows the identification of these patients.

An immunomodulation strategy targeted towards immunocompetent cells or cytokines in inflammatory bowel diseases (IBD).

Many immunological abnormalities have been described in inflammatory bowel diseases (IBD). Even though, no clear cut primary defects have yet been described, some therapeutic trials have targeted either immunocompetent cells or overproduction of cytokines. Preliminary results have shown that antisense oligonucleotides (anti-ICAM), anti-cytokine antibodies (anti-TNF) or recombinant human cytokines (IL-10 or IL-11) are effective in some patients with Crohn's disease refractory to steroids. However, these data need to be confirmed and the potential side effects of these treatments must be further considered. These drugs need to be more precisely defined in particular compared to corticotherapy. Finally, data from immunomodulation strategies should help us understand the aetiology of abnormal immune responses in Crohn's disease (CD) and ulcerative colitis (UC).

[Fractures of the lateral condyle of the elbow in children. Radiologic aspects]. / Les fractures du condyle externe du coude chez l'enfant. Aspects radiologiques.

Fractures of the lateral condyle of the humerus classified as type IV in Salter schema are difficult to diagnose when the capitellum is not ossified. Therefore it is necessary to know exactly the radiological lines which are constructed from the humerus and the radius to the capitellum. Diagnosis is also difficult when the ossification center of the capitellum humeri is only slightly displaced. The epiphyseal fracture line which is always visible at surgery can be missed on X-Ray when ossification has not yet appeared. Laminograms are necessary in some cases to be sure that the fracture is displaced. Displaced fractures are always treated by open reduction.

[Renocolonic fistula complicating vesicorenal reflux and xanthogranulomatous pyelonephritis in a 20-month-old child]. / Fistule réno-colique compliquant un reflux vésico-rénal et une pyélonéphrite xanthogranulomateuse chez un enfant de 20 mois.

A case of vesico-renal reflux with xanthogranulomatous pyelonephritis complicated with a renocolic fistula in a 20 months old child is reported. Imaging in this case was crucial for the diagnosis and the work up; it included ASP, renal ultrasound, UIV retrograde cystography and CT. The treatment consisted in a right ureteronephrectomy after fistula's section.

[Aerodigestive papillomatosis in an infant]. / Papillomatose aéro-digestive chez un nourrisson.

A case of juvenile papillomatosis involving the supra glottic area of the larynx and the esophagus in a 10 months old infant is reported. The patient was treated by multiple Laser CO2 resections of papillomas and received autogenous vaccine. He is now 5 years; he is well and apparently free of disease for the last two years. Radiography of the larynx and esophagogram were crucial for the initial diagnosis and the followup of this child.

[Esophageal communication with a totally sequestrated hypoplastic right lung]. / Communication oesophagienne avec un poumon droit hypoplasique totalement séquestré.

Pulmonary sequestrations involving communication with the digestive tractus are known as bronchopulmonary foregut malformations. The authors add a peculiar case report: there was an hypoplastic right lung with a total sequestration from the bronchial tree and communicating with esophagus. This was fed from the pulmonary vasculature without collateral artery formation. The pulmonary vein was normal. Association with a facial dysmorphia and an occipital meningocele is also of interest. The radiological diagnosis is based on the pulmonary X-Ray and the oesophagogram.

[Idiopathic laryngotracheobronchial calcifications in children. Apropos of 2 cases]. / Les calcifications laryngo-trachéo-bronchiques idiopathiques chez l'enfant. A propos de deux observations.

Calcifications of cartilage in the larynx, trachea and bronchi are rare in children. Two cases reported and listed with 5 similar cases of the literature. Such calcifications are generally discovered in young children and congenital stridor is commonly associated with. Calcifications of bronchi are not present in every case. The blood calcium is normal. Laryngoscopic examination shows in two cases a laryngeal stiffness. The prognosis is good. In two cases, one of the parents of under 40 years old, also had calcifications of the trachea and of the bronchi.

[Rare localizations of digestive adenocarcinoma in children. Apropos of 2 cases]. / Localisations rares d'adénocarcinome digestif chez l'enfant. A propos de deux cas.

The authors report two cases of adenocarcinoma of the digestive system in children both of which were located in unusual sites. A child of 9 years old had an adenocarcinoma of the small bowel and a boy of 16 years who was known to have a long-standing hiatus hernia developed an adenocarcinoma of the oesophagus. In children these tumors have some characteristic features. They develop on a preexisting lesion. Evolution is rapid. From the pathological point of view, anaplasic and colloide patterns are frequent.

Pulmonary sequestrations of the upper lobe in children: three presentations.

Pulmonary sequestrations are congenital abnormalities where nonfunctioning lung tissue receives its vascular supply from the systemic circulation (thoracic or abdominal aorta). It is necessary to establish the diagnosis in childhood when the lesions are uncomplicated. The authors present three cases of sequestration of the apex (2 extralobar and 1 atypical) with the main clinical and radiological features. Sequestrations in the upper lobe are rare, and the usual site is the left lower lobe. Plain x-rays show a dense opacity, sometimes air-filled and sometimes with an air-fluid level: angiography is currently the best mean for definitive diagnosis; however, computed tomography will probably be very useful in the future. Differential diagnosis includes tumours of the superior mediastinum (neurogenic tumours, digestive duplication, bronchogenic cysts, pheochromocytoma and hydatid cysts).

[A case of vertebral chondroblastoma]. / A propos d'une observation de chondroblastome vertébral.

The authors have observed a case of cervical chondroblastoma in a child aged nine years. Clinically there was a mediastinal syndrome, with pulmonary tract infection. Resection was achieved in two stages. One year later a local recurrence was treated by a third resection, followed by radiotherapy. Three years later there was no sign of recurrence. A review of the literature summarises the difficulties of diagnosis.

[Hepatic calcification in children. Review apropos of 4 personal cases]. / Les calcifications hépatiques chez l'enfant. Revue à propos de quatre observations personnelles.

The authors describe the main patterns of the calcifications of the liver and present the different causes which are numerous. Value of the radiological procedures, mainly ultrasound and computer tomography is emphasized. They are necessary for the diagnosis of the type of calcifications and of the disease of the patient.

[Course of diaphyseal dysplasia. Camurati-Engelmann disease followed for 14 years]. / Evolution d'une dysplasie diaphysaire. Maladie de Camurati-Engelmann suivie sur 14 ans.

The authors report a case of a child with Camurati-Engelmann disease de Camurati-Engelmann followed-up for 14 years. The diagnosis was made at the age of 5 years, with a typical picture. During the course of the disease, certain discordant facts emerged with, in particular, the appearance of osteoporotic lesions in the pelvis, metaphyses, epiphyses and skull. This led to the possibility of other diagnoses being envisaged but none could be made definitely. Furthermore, the osteoporotic lesions could not be explained by corticosteroid therapy which was taken in too irregular a manner. Is there a borderline disease within the broad definition of diaphyseal dysplasia?

[Congenital giant diverticuli of the bladder. Apropos of 3 cases]. / Diverticules congénitaux géants de la vessie. A propos de 3 observations.

The giant congenital vesical diverticulum of the bladder is very uncommon; three observations are described. The clinic symptomatology is ruled by acute retention of urine and by dysuria. The I.V.P. always shows the important reverberation on the renal cavities. In two cases the diagnosis has been done thanks to the cystography. Concerning the third child both clinic and paraclinic symptoms inclined to favour the diagnosis of an abdominal cystic hygroma but the surgical procedure showed it was a bilateral vesical diverticulum. The surgical treatment is made up of endo and latero-vesical diverticulectomy with reimplantation of the homolateral ureter which is always implanted in the posterior pouch. With its clinical, anatomical and physiopathological aspects, the giant congenital diverticulum of the bladder must be differentiated with the little diverticulum.

[Benign pheochromocytoma and metaphyseal bone lesions in childhood]. / Phéochromocytomes bénins et lésions osseuses métaphysaires chez l'enfant.

The authors report a 5 year-old child in whom lesions of the inferior metaphyses of the femur and superior metaphyses of the tibia were observed after successive pheochromocytomas. The aspect of the lesions, their improvement after surgical treatment of the tumors, the data in the literature and histologic findings suggest that a bone ischemia was induced by impaired microcirculation with infarction of the metaphyses.