Serum level of interleukin 6 as a prognosis factor in metastatic renal cell carcinoma.

Interleukin (IL) 6 was measured in the serum of 138 patients with metastatic renal carcinoma before the initiation of IL-2 treatment. IL-6 was detectable in 66 patients with renal cancer (48%) and in only 8 of 70 normal adults (11%). Serum C reactive protein (CRP) and IL-6 levels are correlated, suggesting that IL-6 is involved in CRP increase in these patients. The interval between diagnosis of the primary tumor and metastasis was shorter in patients with a detectable serum IL-6 and/or serum CRP level greater than 50 mg/liter. Serum IL-6 and CRP levels were higher in subgroups of patients previously defined as having a poor life expectancy according to the Eastern Cooperative Oncology Group criteria. Pretreatment concentrations of IL-6 and CRP were higher in patients who experienced progressive disease after IL-2 treatment. Patients with detectable IL-6 had a shorter survival from the beginning of IL-2 treatment than patients without circulating IL-6 (median, 8 versus 16 months). Similarly, the median survival from the beginning of IL-2 therapy of patients with CRP levels greater than 50 mg/liter was 6 months, compared to 16 months in those with CRP levels below this threshold. None of the 21 patients with serum IL-6 concentrations greater than 300 pg/ml achieved response to any of the three IL-2 regimens. This subgroup has a median survival of 5 months after IL-2 treatment and consisted of 15% of the patients in our series. These results indicate that serum IL-6 and CRP levels are adverse prognosis factors in patients with metastatic renal cell carcinoma. Serum IL-6 level could help in the selection or stratification of the patients in future IL-2 trials.

Brachial plexus compression by an iatrogenic arteriovenous fistula.

A case of left brachial plexus compression by an iatrogenic arteriovenous fistula was treated by detachable balloon technique with immediate relief of pain. Good results on paresia were obtained in a few weeks.

[Long-term follow-up of 88 patients with Paget's disease treated by discontinuous courses of low-dose disodium etidronate]. / Suivi au long cours de 88 pagétiques traités par l'étidronate disodique en cures discontinues à faible posologie.

987 patients with Paget's disease were treated with disodium etidronate at an oral dose of 5 mg/kg/d and followed up for an average of 5.2 years: each course of treatment lasted 6 months and was repeated once or several times. 76 per cent of the patients with symptoms had improved by the end of the follow up period, and 85 per cent of the asymptomatic patients showed none of the complications that might have been expected preventive treatment with etidronate not been undertaken. The course of the disease deteriorated in 28% of the patients between start and finish of the study, but the result was sometimes incomplete or in some doubt. For patients receiving treatment, the annual incidence of coxarthropathy was 1 per cent. In patients with medullary involvement, indicated by spasmodic paraparesis during the initial assessment, oral disodium etidronate always had a curative effect. In patients with cranial involvement, the condition worsened fairly frequently, with hypoacusis arising or deteriorating in 29 per cent of the patients. Twenty three fractures occurred, including 8 in pagetic bone, with an incidence of respectively 5 and 1.7 per cent patient-years: the risk of fracture did not seem to be increased when etidronate was used at a low dose. Among the side effects observed, there was a delayed increase in bone pain in 12.5 per cent of the patients, the symptoms generally resolving except in one case where a fracture occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

[Spinal osteoblastoma. Report of 8 cases]. / L'ostéoblastome rachidien. A propos de huit observations.

The authors studied the special features of the vertebral location of this benign tumour of osteoblastic origin in eight cases of spinal osteoblastoma. Clinically, neurological complications are frequently present and scolioses may arise and persist after treatment; radiologically, new imaging techniques enable the limits of the tumour to be assessed with greater accuracy with respect to the neighbouring bone and their relationship to the components of the vertebral canal; surgically, there are difficulties specific to this location raised by the proximity of nervous components, and also by the vertebral destabilization entailed by the considerable bone involvement. Anatomicopathological diagnosis remains difficult, particularly in the case of osteoid osteoma.