[Treatment of primary disease (breast, non-small cell lung and prostate cancers) with irradiation in case of de novo metastatic cancer]. / Traitement de la maladie primitive (cancers du sein, du poumon non à petites cellules et de la prostate), par irradiation, au stade d'emblée métastatique.

The basis of treatment of primary disease in case of metastatic cancer at diagnosis is based on the knowledge of the natural history of the disease, the biology of the primary tumour and its metastases, advances in modern radiotherapy techniques (modulated intensity, stereotactic radiotherapy) in order to improve the survival of patients with advanced disease. The clinical concept of oligometastatic disease at diagnosis has repositioned the interest of local treatment for primitive disease because these patients have a slower evolutionary profile than metastatic disease extended from the outset. This article reviews the indication of radiotherapy as a local treatment for primary cancer in a de novo metastatic diagnosed disease in the case of breast cancer, non-small cell lung cancer and prostate cancer.

[Oropharyngeal candidiasis and radiotherapy]. / Candidose oropharyngée et radiothérapie.

The oropharyngeal candidiasis is a common condition in cancer patients treated by irradiation, during and after their treatment. For example, almost 70% of patients treated with chemoradiation for head and neck cancer are colonized, and 40% of symptomatic patients have an oropharyngeal candidiasis. Furthermore, we noticed an increase in non-albicans Candida strains, which are present in almost 50% of samples. Cancer treatments, especially radiation therapy, and comorbidities are risk factors of oropharyngeal candidiasis. Oropharyngeal candidiasis has substantial effects on quality of life, and may limit treatment. Epidemiologic data, physiopathology, clinical diagnosis criteria, consequences and treatment of oropharyngeal candidiasis will be discussed in this article.

[Sciatic foramina radiculalgia. Apropos of 16 cases]. / Les radiculalgies sciatiques foraminales. A propos de seize observations.

Over a period of six years, the authors have seen sixteen cases of foraminal sciatica with an L5 topography which possesses the following unusual clinical features: long history of back pain with a grumbling course and without any acute episodes, progressive sciatica without any predisposing factors, paresthesiae particularly on standing with normal amipaque saccoradiculography and unresponsive to medical treatment. The operative finding in all of these patients was a disc compression in the intervertebral foramen (hernia, disc residue or softened disc), which was frequently associated with factors reducing the calibre of the foramen: abnormal position of the root and lowering of the pedicular roof caused by lumbosacral disc degeneration. This multi-factorial compression therefore required, depending on the case, curettage of the disc or a localized annulectomy combined with a facettectomy. The long term results of the operation can be considered to be favourable, in view of the long history of root pain (an average of 4 years) which largely explains the incomplete nature of the post-operative success.

[Fasting and postprandial blood glucose in subjects with crural pain and sciatica]. / La glycémie à jeun et post-prandiale chez les sujets atteints de cruralgie et de sciatique.

The search for diabetes in a patient with crural neuralgia is well established practice. The prevalence of diabetes in the general population is not known, and studies attempting to demonstrate a relationship between diabetes and radiculopathies have been inconclusive. In the present study, fasting and postprandial blood glucose determinations, as well as 14 other parameters, were analyzed in 88 patients with classical sciatica, 27 with crural neuralgia, and 42 with only back pain. Multidimensional statistical analysis revealed that patients with crural neuralgia were older than those with classical sciatica or only back pain, and that there were no differences in blood glucose regulation. The concept that diabetes is found more frequently in patients with crural neuralgia should be revised, since age appears to be the only factor responsible for changes in glucose regulation.

[Conversion of fast insulin intensive therapy to lispro insulin in type I diabetes. Pharmacoeconomic analysis of cost-effectiveness]. / Conversión de la terapia intensiva con insulina rápida a insulina lispro en la diabetes tipo 1. Análisis farmacoeconómico de coste-efectividad.

In order to analyze the initial cost-effectiveness of transfer to two treatments with insulin lispro in type 1 diabetes, a pharmaco-economic study was conducted for nine months. After an educational reinforcement, a group of 30 C-peptide-negative patients (31.8 +/- 11.5 years [mean +/- SD], time since diagnosis of diabetes of 9.2 +/- 7.1 years, and on intensive therapy for 5.3 +/- 3.1 years) initiated a 3-month basal period with their usual therapy (preprandial rapid insulin and nocturnal NPH). Patients were then randomly assigned to one of the two groups, changing rapid insulin to either lispro (L1) or lispro combined with 15% to 20% NPH insulin (L2). Cross-over was made 3 months after the first treatment. Efficacy and safety were established by the assessment of HbA1c, self-monitoring blood glucose and hypoglycemia rates. Therapy cost was measured by systematic examination of the injection devices and wastage of insulin. The mean prescribed and actually consumed doses for R, L1, L2 groups were 52.9, 57.1, 55.2 U and 60.3, 64.1, 63 U per day, respectively (p < 0.001). The average of postprandial peak glucose (9.7, 8.4, 8.3 mM; p < 0.001) and HbA1c (7.6%, 7.2%, 7.1%; p < 0.01) were significantly lower after L1 or L2 lispro therapy. Although no statistical differences in overall hypoglycemia rates were observed, fewer nocturnal episodes were detected (0.72, 0.37, 0.41 events/month). The mean daily cost for regular insulin treatment was lower (186.8, 241.8; 215.7 pts and 53.7 pts per day. Efficacy and safety for two MIT regimens containing lispro were similar in the short run. Nevertheless, the preprandial use of the fast-acting insulin analog lispro in combination with a 15%-20% intermediate-acting NPH seemed to be more cost-effective than the premeal lispro therapy alone.

[ADA criteria undervalues the impact of diabetes in a high-risk Spanish population]. / Los criterios de la ADA infravaloran el impacto de la diabetes en la población española de más alto riesgo.

OBJECTIVE: The main aim was to investigate the prevalence of abnormal glucose homeostasis (impaired fasting glucose, impaired glucose tolerance and undiagnosed diabetes) on high-risk Spanish population. The second, to determine the prevalence and usefulness of classical risk factors for diabetes screening according WHO and ADA criteria and to evaluate the potential effect of different stepwise strategies. DESIGN AND SETTING: Cross-sectional, multicentric, selective screening study carried out in primary health care which involved 9 health care centres and 1 diabetes unit (230,000 inhabitants). PATIENTS: Individuals aged > 40 years, non pregnant with at least one major risk factor for diabetes: BMI > or = 30 kg/m2, a first degree relative with diabetes, previous abnormality of glucose tolerance or the use of oral hyperglycaemic drugs for a long time. MEASUREMENTS: Database including sex, age and risk factors. Diagnoses were based on measurement of fasting plasma glucose (FPG) followed by a 2h-plasma glucose (2hPG) using a 75 gr. oral glucose tolerance test (OGTT). Positive predictive value (PPV) and odds ratio were calculated for each risk factor. The FPG concentration which maximised the sensitivity and specificity with respect to the 2hPG was established by means of the ROC-curves (receiver operator characteristics). MAIN RESULTS: 580 individuals were evaluated, 250 males (43.1%), mean age 58.1 +/- 10.7 years and BMI 31.2 +/- 5.2 kg/m2. A total of 132 (22.7%) individuals presented diabetes according the WHO criteria, 79 (13.6%) according ADA and only 53 (9.1%) according both sets of criteria. FPG > or = 126 mg/dl (7 mM) predicted a diabetic 2hPG with high specificity (94.2%) but a very low sensitivity (40.2%). If that cut-point was used alone for early screening half the diabetics with normal FPG but with a diabetic 2hPG would not have been diagnosed. According the WHO criteria PPV for classical risk factors oscillated between 23.4-29.1% and were significantly higher than those obtained according ADA criteria (11.6-18.3%; p < 0.01). CONCLUSIONS: The OGTT is still the cornerstone for diabetes screening thus the FPG predictive value greatly decreases the 2hPG predictive value. ADA criteria undervalues the diabetes impact mainly on high-risk population.