15-Lipoxygenase promotes resolution of inflammation in lymphedema by controlling Treg cell function through IFN-ß.

Lymphedema (LD) is characterized by the accumulation of interstitial fluid, lipids and inflammatory cell infiltrate in the limb. Here, we find that LD tissues from women who developed LD after breast cancer exhibit an inflamed gene expression profile. Lipidomic analysis reveals decrease in specialized pro-resolving mediators (SPM) generated by the 15-lipoxygenase (15-LO) in LD. In mice, the loss of SPM is associated with an increase in apoptotic regulatory T (Treg) cell number. In addition, the selective depletion of 15-LO in the lymphatic endothelium induces an aggravation of LD that can be rescued by Treg cell adoptive transfer or ALOX15-expressing lentivector injections. Mechanistically, exogenous injections of the pro-resolving cytokine IFN-ß restores both 15-LO expression and Treg cell number in a mouse model of LD. These results provide evidence that lymphatic 15-LO may represent a therapeutic target for LD by serving as a mediator of Treg cell populations to resolve inflammation.

[Comparison of mortality of lung cancer resections in France to other European countries]. / Comparaison de la mortalité des résections pulmonaires en France aux autres pays Européens.

BACKGROUND: France is characterized by the dispersion of its technical surgical platforms, and it seemed interesting for us to obtain information on quality of care compared to other European countries, which often have different organizations and practices. The objective of the study was to compare the 30-day mortality of patients operated on for bronchial cancer in France with that of other European countries. METHOD: We conducted a literature review on practices in different European countries. The terms used for the selection were: lung cancer surgery, 30-day mortality in different hospitals in European countries. RESULTS: We selected 9 articles corresponding to 9 European countries. The correlation coefficient between the number of lung resections per year and the population of the country was 0.967. The linear regression model between number of annual lung resections and population showed that except for Great Britain, most of the countries were close to the linear regression line. Germany and France had a mortality rate of 2.887% and 2.937% respectively, whereas the average is 2.13%. Following sensitivity analysis, the mortality rates for Germany and France remained higher than the average. CONCLUSION: France is among the European countries with the highest postoperative mortality rates. These results should induce surgical teams to adopt quality-of-care measures focusing on outcome analysis.

Duration of anticoagulation for upper extremity deep vein thrombosis associated with cancer and central venous catheter: Outcome of a cohort study.

INTRODUCTION: In cancer patients with catheter-associated upper extremity deep vein thrombosis, 3 months of anticoagulation is recommended. The main objective of this study was to compare the incidence of thrombosis recurrence in these patients in case of continuation or discontinuation of anticoagulation, at the end of 3 months and after catheter has been removed. The secondary objectives were the incidence of major bleeding and death. MATERIAL AND METHODS: We conducted a retrospective cohort study including patients with a cancer and a catheter-associated upper extremity deep vein thrombosis. RESULTS: About 60 patients included, 44 stopped anticoagulation after the first 3 months and 16 continued it. The median time between catheter insertion and deep vein thrombosis was 26±83 days. Three recurrences occurred during the one-year follow-up: 2 in the group who stopped anticoagulation, with a cumulative incidence at 1 year of 4,8% (95%IC 1.2-18.1) and 1 in the group who continued anticoagulation, with a cumulative incidence at 1 year of 14.3% (95%IC 2.1-66.6). No major bleeding event occurred in anticoagulation discontinued group. The group who stopped anticoagulation was significantly associated with a lower risk of death (HR 0.21-95%IC 0.09-0.48, P<0.001). CONCLUSION: The risk of recurrence in cancer patients with a catheter-associated upper extremity deep vein thrombosis was low and statistically comparable between the group who stopped anticoagulation and the group who continued it. These results suggest that anticoagulation after the first 3 months deserves to be considered when catheter is removed.

Management of upper extremity deep vein thrombosis in Occitanie: practice assessment.

BACKGROUND: The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing. Its management is sometimes complex and difficult due to its complications and the lack of strong recommendations. The aim was to describe the practice of vascular physicians in Occitanie region in the management of upper extremity deep vein thrombosis. MATERIAL AND METHODS: We used a descriptive observational study in the form of a declarative survey by means of a questionnaire from April to May 2019 among vascular physicians. RESULTS: Of the 142 physicians contacted, 84 responded, with a reply rate of 59.1%. The majority of physicians introduced low-molecular-weight heparin treatment (60.71%) and 29.76% direct oral anticoagulation after a diagnosis of UEDVT. Three months of anticoagulation was chosen by 69% of physicians against 27.4% for a duration of 6 months. Diagnostic work-up included biological risk factors, chest and/or cervical radiography and ultrasonography with dynamic maneuvers. Three quarters of doctors recommended venous compression. A control ultrasonography was performed for 67.86% of patients at one month and at the end of treatment. After the acute phase, 63% of physicians introduced direct oral anticoagulation and 11% recommended venous revascularization. DISCUSSION AND CONCLUSIONS: The mobilization of vascular physicians reflects their interest for this pathology. The management of UEDVT requires specific studies to address therapeutic modalities, the duration of anticoagulation or the place of venous compression in the acute phase.

[Pathological findings of visible and non-visible tumors on multiparametric magnetic resonance imaging (MRI) prior to radical prostatectomy]. / Caractéristiques anatomopathologiques des tumeurs apparentes et non apparentes en IRM multiparamétrique de la prostate avant prostatectomie totale.

INTRODUCTION: As urologists are questioned about the overtreatment of localized prostate cancer, multiparametric MRI can diagnose significant prostate cancer thanks to targeted biopsies. However, some tumors cannot be detected by MRI. What are the pathological characteristics of those tumors? MATERIALS AND METHODS: We have selected 144 consecutive patients treated with radical prostatectomy for clinically localized prostate cancer diagnosed on systematic and targeted biopsies (Koelis®) according to multiparametric MRI findings. On MRI, each suspicious area was graded according to the PI-RADS score v1.0. On radical prostatectomy specimen, tumor foci with a Gleason score greater than 3+3 and/or a tumor volume greater than 0,5cm3 were considered significant. The grade-four tumoral volume was calculated by multiplying the tumoral volume by grade 4 tumoral percentage. RESULTS: Two hundred and seventy seven tumors were identified. A hundred and thirty nine were non-visible on MRI. They had a significantly lower volume (0.15cm3 versus 1.45cm3, P<0.0001) and a Gleason score significantly lower (P<0.0001) than apparent tumors. 17.3% of non-apparent tumors were significant. Moreover, the grade-four tumoral volume of significant non-apparent tumors was significantly lower than that of significant apparent tumors (0.11cm3 versus 0.66cm3, P<0.0001). CONCLUSION: Non-apparent prostate tumors on multiparametric MRI have a Gleason score, a tumor volume - and consequently - a grade 4 tumor volume significantly lower than apparent tumors. LEVEL OF PROOF: 4.

[Venous thromboembolic disease: Comparison of management practices in France, Italy and Spain]. / Comparaison en France, en Italie et en Espagne des modalités de prise en charge de la maladie thromboembolique veineuse.

BACKGROUND: Many national and international guidelines have been established for venous thromboembolic disease (VTE). Homogeneous management practices could be expected in the different European countries. To verify this hypothesis, we compared practices in France, Italy and Spain. METHOD: We used data from the international RIETE registry to compare VTE management between France, Italy and Spain. RESULTS: From 2001 January to 2011 January, patients were consecutively included in France (n=1548), Italy (n=2083) and Spain (29,824). All patients received anticoagulant treatment. Low molecular-weight heparin (LMWH) was the most frequently used drug as initial therapy in all three countries, but unfractionated heparin (UFH) was more frequently used in France and Italy than in Spain. In France, the proportion of patients receiving LMWH was lower than the proportion of patients with active cancer (cancer 22.5 %, long-term treatment with LMWH 17.4 %). A vena cava filter was significantly more frequently used in France (5.5 % in France, 3.2 % in Italy and 2 % in Spain, P<0.0001). High bleeding risk because of surgery with recent thromboembolic disease was the most frequent indication in France and Italy for vena cava filter placement (36.4 %, and 31.3 %, respectively). CONCLUSION: Despite the publication of national and international guidelines, VTE management differs among the three major European countries included in the RIETE registry, France, Italy and Spain.

[Multidisciplinarity, education, and training in pediatric oncology-hematology]. / Multidisciplinarité et formation des spécialistes à l'oncologie et à l'hématologie maligne pédiatrique.

INTRODUCTION: According to the European Society of Pediatric Oncology (SIOPE) standard of care guidelines, high-quality care of children and adolescents with cancer needs to be delivered by well-trained multidisciplinary teams in specialist centers working with designated shared-care local centers in a so-called hub-and-spoke model. The Diplôme Inter-Universitaire d'Oncologie Pédiatrique (DIUOP) is the only European training program in pediatric oncology in French for all physicians involved in care of patients with pediatric malignancies. In agreement with the SIOPE syllabus, the DIUOP is composed of training courses (120h), on-site practical training in a specialist center, and a research project to be defended before an examining board. METHOD: All graduates received a questionnaire to describe their current professional position. A comprehensive PubMed analysis retrieved all papers published form DIUOP research projects. RESULTS: From 2000 to 2011, 290 physicians were trained: 242 pediatricians, 21 surgeons, and 19 radiation therapists. Eight had another specialty including imaging, hematology, and pathology. Ninety-two were initially trained outside of France: 50% in Europe (mainly in Italy, Belgium, and Switzerland), 42% in Africa and the Middle East, and 8% in South America. Of the 266 graduates, 74% answered the questionnaire, and 90% of them take care of children and adolescents with cancer. Sixty-nine articles, i.e., one out of four research projects, were published in 34 journals with a median impact factor of 3.5 (0-22.6), 85% in English. CONCLUSION: DIUOP is the only French-speaking European education program providing a high-quality, professionalizing, and comprehensive multidisciplinary training program for French and international specialists taking care of children and adolescents with cancer.

[Ultrasound screening of abdominal aortic aneurysm: Lessons from Vesale 2013]. / Dépistage échographique de l'anévrisme de l'aorte abdominale - les enseignements de Vésale 2013.

Although aneurysm of the abdominal infra-renal aorta (AAA) meets criteria warranting B mode ultrasound screening, the advantages of mass screening versus selective targeted opportunistic screening remain a subject of debate. In France, the French Society of Vascular Medicine (SFMV) and the Health Authority (HAS) published recommendations for targeted opportunistic screening in 2006 and 2013 respectively. The SFMV held a mainstream communication day on November 21, 2013 in France involving participants from metropolitan France and overseas departments that led to a proposal for free AAA ultrasound screening: the Vesalius operation. Being a consumer operation, the selection criteria were limited to age (men and women between 60 and 75 years); the age limit was lowered to 50 years in case of direct family history of AAA. More than 7000 people (as many women as men) were screened in 83 centers with a 1.70% prevalence of AAA in the age-based target population (3.12% for men, 0.27% for women). The median diameter of detected AAA was 33 mm (range 20 to 74 mm). The prevalence of AAA was 1.7% in this population. Vesalius data are consistent with those of the literature both in terms of prevalence and for cardiovascular risk factors with the important role of smoking. Lessons from Vesalius to take into consideration are: screening is warranted in men 60 years and over, especially smokers, and in female smokers. Screening beyond 75 years should be discussed. Given the importance of screening, the SFMV set up a year of national screening for AAA (Vesalius operation 2014/2015) in order to increase public and physician awareness about AAA detection, therapeutic management, and monitoring. AAA is a serious, common, disease that kills 6000 people each year. The goal of screening is cost-effective reduction in the death toll.

[Prevalence and risk factors of peripheral arterial disease in an outpatient screening campaign]. / Évaluation de la prévalence et des facteurs de risque de l'artériopathie oblitérante des membres inférieurs dans le cadre d'une campagne de dépistage ambulatoire.

BACKGROUND: Peripheral arterial disease (PAD) is an important predictor of cardiovascular disease with major medico-economic consequences. However, systematic screening of asymptomatic patients free from history of cardiovascular disease is debated. OBJECTIVE: Determining the prevalence, risk factors for PAD in a population of outpatients at intermediate or high-risk of cardiovascular disease, free from history of cardiovascular disease to assess the potential impact of PAD screening in such groups of patients. METHODS: Multicenter 1-day screening program of PAD conducted from 2008 to 2010 in a population defined by diabetes plus age greater than 50 years, positive active smoking status, or age greater than 70 years. PAD was defined as an ankle-brachial index (ABI) less than 0.9 measured as follows: lowest systolic ankle pressure divided by highest systolic arm pressure. RESULTS: Ten thousand six hundred and fourteen patients fulfilled study inclusion criteria: 16.7% (n = 1774) exhibited an ABI less than 0.9 and 3.8% (n = 407) an ABI less than 0.7. ABI greater than 1.3 was found in 7.7% of patients (n = 818). Age greater than 70 years, male gender, active smoking status, hypertension and diabetes (treated) were independent risk factors for PAD. CONCLUSION: Primary prevention outpatient screening of a population with intermediate or high cardiovascular risk can identify numerous patients with PAD. The medical impact in terms of cardiovascular mortality and morbidity of such a screening needs to be assessed.

[Medication errors in anaesthesia: a review of reports from the French Health Products Agency]. / Erreurs médicamenteuses en anesthésie : bilan et analyse des signalements reçus à l'Afssaps.

BACKGROUND: The purpose of this study was to assess medication errors and risks of medication errors during anaesthetic practice reported at the French Health Products Agency (Afssaps) from 2005 to 2010. STUDY DESIGN: Descriptive study. METHODS: The data are issued of "Medication errors and risks of medication errors" file which group together all cases received by the Medication Errors Unit at Afssaps since 2005. RESULTS: A total of 263 cases were observed by the Medication Errors Unit at Afssaps. Among them, 159 cases were risks of medication errors, 76 cases were patent medication errors and 28 were near misses. Among the 76 cases of patent medication errors, out of which 47 cases were appreciated with adverse reaction and 35 cases were classified as serious. Adverse events were classified as haemodynamic, respiratory and neurologic events. Most of the errors occurred during administration (65%), followed by dispensing errors (14%), storage errors (15%) or preparation errors (4%). Sixty-nine percent of cases of wrong drug errors were found, followed by 26% of errors of strength, 3% of incorrect route of administration errors and 2% of patient errors. In most of cases, similarity in packaging was underlined (n=83). CONCLUSION: This study showed that the majority of medication errors and risks of medication errors during anaesthetic practice, underline similarity in packaging. Results highlighted the importance of vial labeling presentation (readability and mention understanding) in anaesthetic practice.

Phase III trial comparing paclitaxel poliglumex vs docetaxel in the second-line treatment of non-small-cell lung cancer.

Paclitaxel poliglumex (PPX), a macromolecule drug conjugate linking paclitaxel to polyglutamic acid, reduces systemic exposure to peak concentrations of free paclitaxel. Patients with non-small-cell lung cancer (NSCLC) who had received one prior platinum-based chemotherapy received 175 or 210 mg m(-2) PPX or 75 mg m(-2) docetaxel. The study enrolled 849 previously treated NSCLC patients with advanced disease. Median survival (6.9 months in both arms, hazard ratio=1.09, P=0.257), 1-year survival (PPX=25%, docetaxel=29%, P=0.134), and time to progression (PPX=2 months, docetaxel=2.6 months, P=0.075) were similar between treatment arms. Paclitaxel poliglumex was associated with significantly less grade 3 or 4 neutropenia (P<0.001) and febrile neutropenia (P=0.006). Grade 3 or 4 neuropathy (P<0.001) was more common in the PPX arm. Patients receiving PPX had less alopecia and did not receive routine premedications. More patients discontinued due to adverse events in the PPX arm compared to the docetaxel arm (34 vs 16%, P<0.001). Paclitaxel poliglumex and docetaxel produced similar survival results but had different toxicity profiles. Compared with docetaxel, PPX had less febrile neutropenia and less alopecia, shorter infusion times, and elimination of routine use of medications to prevent hypersensitivity reactions. Paclitaxel poliglumex at a dose of 210 mg m(-2) resulted in increased neurotoxicity compared with docetaxel.

[Medical treatment of patients with clinical peripheral arterial disease at hospital discharge: compliance with the French guidelines and changing practices (COPART I registry)]. / Traitement médical du patient atteint d'artériopathie athéroscléreuse des membres inférieurs symptomatique à sa sortie de l'hôpital: adéquation aux recommandations et évolution des pratiques dans le temps (registre COPART I).

INTRODUCTION: Peripheral arterial disease (PAD) is a frequent and serious condition with a risk of mortality comparable to that of certain cancers. However, in France, the literature on this medical condition is scarce and data on management, incidence of complications and prognosis are lacking. PURPOSES: The COPART I registry, set up in June 2004, in the Vascular Medicine Department of the University Hospital of Toulouse, France, constitutes an observational database on hospitalized patients with PAD, in order to evaluate management, follow-up and prognosis of the patients. The aim of the present work is to compare medical prescriptions at hospital discharge, with the recent guidelines of the French High Authority of Health. METHODS: All consecutive patients with PAD, hospitalized in the Vascular Medicine Department of the University of Toulouse, between June 1, 2004 and July 31, 2006 were included. Only surviving patients were analysed. RESULTS: Four hundred patients were included in the study. As expected, the majority were male (70%). Common cardiovascular risk factors were: arterial hypertension (66.7%), dyslipidemia (58.9%), diabetes (42.9%), and smoking (27.4%). Three patients out of 10 had claudication intermittens, nearly two out of 10 patients complained of persistent pain, and four out of 10 patients had Leriche and Fontaine stage IV arteriopathy. At hospital discharge, 86.9% of the patients were taking at least one antiplatelet treatment, 71.2% a statin, 54% a renin-angiotensin-system inhibitor. Nearly 66% of the patients (65.8%) received at least one antiplatelet agent and a statin. Nearly 50% of the patients (49.4%) had the three drugs recommended by the French High Authority of Health. We observed a change in prescription practices for statins (+30%), as well as for prescription of evidence-based tri-therapy (+29%) between 2004 and 2006. CONCLUSION: Treatments prescribed at hospital discharge of patient with PAD included in the COPART I registry are in compliance with the French High Authority of Health guidelines concerning antiplatelet drugs and statins. Inhibitors of the renin-angiotensin system seem insufficiently used. However, favorable trends in medical practices between 2004 and 2006 have been observed.

[Fewer lung complications following inspiratory muscle training in patients undergoing coronary bypass surgery: a randomized trial]. / Minder longcomplicaties door ademspiertraining bij patiënten die een coronaire bypassoperatie moeten ondergaan: een gerandomiseerde trial.

OBJECTIVE: The aim of this study was to evaluate the prophylactic efficacy of preoperative physiotherapy, including inspiratory muscle training (IMT), on the incidence of postoperative pulmonary complications (PPCs) in high-risk patients scheduled for elective coronary artery bypass grafting (CABG). DESIGN: Randomized controlled clinical trial (www.controlled-trials. com/isrctn17691887). METHOD: Of 655 patients referred to a university medical centre in The Netherlands for elective CABG, 299 met the criteria for being at high risk of developing PPCs. A total of 279 were enrolled and monitored up to discharge from hospital. Patients were randomly assigned to receive either preoperative IMT (n=140) or usual care (n=139). Both groups received the same postoperative treatment. RESULTS: Both groups were comparable at baseline. Before CABG, 2 control group patients and 1 IMT group patient died. After CABG surgery, PPCs were present in 25 (18%) of 139 patients in the IMT group and 48 (35%) of 137 patients in the control group (OR: 0.52; 95% CI: 0.30-0.92). Pneumonia occurred in 9 (6.5%) of 139 patients in the IMT group and in 22 (16.1%) of 137 patients in the usual care group (OR: 0.40; 95% CI: 0.19-0.84). Mean duration of postoperative hospitalization was 7 (range 5-41) days in the IMT group versus 8 (range 6-70) days in the usual care group (Mann-Whitney test; Z: -2.42; p = 0.015). CONCLUSION: Preoperative physiotherapy, including IMT, statistically significantly reduced the incidence ofPPCs and the duration ofpostoperative hospitalization in patients at high risk of developing a pulmonary complication on undergoing CABG.

[Favourable long-term results using the unmodified maze procedure in patients with medication-refractory or nearly refractory atrial fibrillation; experience from 1993/'04]. / Gunstige langetermijnresultaten van de originele 'maze'-operatie voor patiënten met medicamenteus moeilijk of niet te behandelen boezemfibrilleren; ervaringen van 1993/'04.

OBJECTIVE: To assess the short- and long-term results following the unmodified maze procedure in patients with medication-refractory or nearly refractory atrial fibrillation. DESIGN: Retrospective. METHODS: We retrospectively collected and analysed preoperatively in-hospital and follow-up data from patients with atrial fibrillation with or without structural heart disease who underwent the unmodified maze procedure in the St. Antonius hospital, Nieuwegein, the Netherlands. RESULTS: In the 11-year period 1993-2004, 203 patients underwent the procedure: 139 underwent the maze procedure only and 64 underwent combined surgery for concomitant atrial fibrillation and structural heart disease. There were no in-hospital deaths. During a mean follow-up period of 4 years, 2 ofthe 203 patients died from cardiac causes; both had undergone combined surgery. With a mean follow-up period of 4 years, the rate of atrial fibrillation-free survival was 90% in patients with lone atrial fibrillation and 70% in patients with concomitant atrial fibrillation. For patients who had no recurrent atrial fibrillation 1 year after surgery, the risk of recurrence after 4 years was small (odds ratio: 9.56). Risk factors for recurrence included a large left atrium and a long duration of atrial fibrillation (more than 5 years). CONCLUSION: The maze procedure was a successful surgical intervention for patients with atrial fibrillation, both in the short and long term. This procedure can be considered when medication and electrical cardioversion are ineffective.

Feasibility of preoperative inspiratory muscle training in patients undergoing coronary artery bypass surgery with a high risk of postoperative pulmonary complications: a randomized controlled pilot study.

OBJECTIVE: To determine in a pilot study the feasibility and effects of preoperative inspiratory muscle training in patients at high risk of postoperative pulmonary complications who were scheduled for coronary artery bypass graft surgery. DESIGN: Single-blind, randomized controlled pilot study. SETTING: University Medical Centre Utrecht, the Netherlands. SUBJECTS: Twenty-six patients at high risk of postoperative pulmonary complications were selected. INTERVENTION: The intervention group (N = 14) received 2-4 weeks of preoperative inspiratory muscle training on top of the usual care received by the patients in the control group. MAIN MEASURES: Primary outcome variables of feasibility were the occurrence of adverse events, and patient satisfaction and motivation. Secondary outcome variables were postoperative pulmonary complications and length of hospital stay. RESULTS: The feasibility of inspiratory muscle training was good and no adverse events were observed. Treatment satisfaction and motivation, scored on 10-point scales, were 7.9 (+/- 0.7) and 8.2 (+/- 1.0), respectively. Postoperative atelectasis occurred in significantly fewer patients in the intervention group than in the control group (kappa(2)(DF1) = 3.85; P = 0.05): Length of hospital stay was 7.93 (+/- 1.94) days in the intervention group and 9.92 (+/- 5.78) days in the control group (P = 0.24). CONCLUSION: Inspiratory muscle training for 2-4 weeks before coronary artery bypass graft surgery was well tolerated by patients at risk of postoperative pulmonary complications and prevented the occurrence of atelectasis in these patients. A larger randomized clinical trial is warranted.

Sequential two-line strategy for stage IV non-small-cell lung cancer: docetaxel-cisplatin versus vinorelbine-cisplatin followed by cross-over to single-agent docetaxel or vinorelbine at progression: final results of a randomised phase II study.

BACKGROUND: This phase II trial compared docetaxel-cisplatin (DC) with vinorelbine-cisplatin (VC), both as first-line therapy followed by cross-over at progression to single-agent vinorelbine or docetaxel in advanced non-small-cell lung cancer (NSCLC). METHODS: Overall, 115 patients received DC (docetaxel 75 mg/m(2) and cisplatin 100 mg/m(2) both on day 1, every 3 weeks, arm A1) and 118 VC (vinorelbine 30 mg/m(2)/week on days 1 and 8 and cisplatin 100 mg/m(2) on day 1, every 3 weeks, arm B1) for six cycles, and subsequently maintained by monotherapy with docetaxel (A1) or vinorelbine (B1) with cross-over on disease progression to vinorelbine 30 mg/m(2) days 1 and 8 (A2), or docetaxel 100 mg/m(2), day 1, both every 3 weeks (B2). The primary end point was overall response rate (ORR). RESULTS: Patient characteristics were balanced; median follow-up was 8.8 months. First-line response rate was 33.9% with DC and 26.3% with VC (P=0.20). In arms A1 and B1, respectively: duration of response was similar (8.2 versus 8.4 months); median time to progression was 5 months in both; median survival was 8 versus 9 months (P=0.38); 1-, 2- and 3-year survival was 36% versus 35%, 17% versus 10% and 13% versus 6% (P not significant). However, with a low number of long-term survivors, statistical significance was not reached. Overall, almost half of the patients crossed over to second-line therapy; there were no response with vinorelbine and 6 (11.2%) partial responses with docetaxel. Considering the safety profile, the occurrence of febrile neutropenia was 9.6% with DC and 26.3% with VC. Treatment-related mortality was 2.5% with DC and 8.5% with VC. CONCLUSIONS: The trend in favour of the DC arm in ORR, even though statistical significance was not reached, is consistent with previous reports. This study suggests an activity of first-line DC in advanced NSCLC, and that second-line vinorelbine does not provide additional clinical benefit. As already shown in other studies, the use of DC in first-line should provide a better percentage of long-term survivors, despite the absence of efficacy of the second-line in our study.

[Plantar venous thrombosis and anticardiolipin antibody syndrome. Case report]. / Thrombose veineuse plantaire interne et anticorps anticardiolipine. Cas clinique.

We report a case of isolated plantar venous thrombosis in a young female with no recent history of surgery or trauma who complained of spontaneous left talalgia. She was treated with aspirin for a lupus anticoagulant. The diagnosis was established on the basis of color duplex ultrasonography. The patient was given long-term oral anticoagulants in accordance with international recommendations. Veins other than the usually examined regions, such as plantar veins, should be explored in patients with a known thrombophilic condition who present spontaneous talalgia. Presence of an isolated plantar venous thrombus in a patient with no known coagulation abnormality is suggestive of thrombophilic disease.