[Satisfaction survey of Serbian oncologists after experience in French hospitals]. / Enquête de satisfaction des cancérologues serbes en stage d'observation en France.

UNLABELLED: Serbian oncologists benefited of a short training in French structures as observer between 2003 and 2007. To this day, there has been yet no study on the professional feedback of this kind of training for foreigner doctors. Our aim was to evaluate the satisfaction of the participants and thereafter to analyse their needs. MATERIAL AND METHODS: Survey by auto questionnaires sent to the participants oncologists. RESULTS: On 60 oncologists, 40 answered. On all the oncologists interviewed, 90% thought that the knowledge was easily accessible and is still useful. Sixty per cent said they introduced new protocols; 92.3% wished they could have another training. Compared to their own practise in Serbia, 97% think there is a employee in charge of administrative questions that set the doctors free to do something else. DISCUSSION: To optimise these training's, basic knowledge of French and well-targeted expectations are essential. To improve professional practise of oncologists, the answers go to a best internal communication and the establishment of a politic of education for doctors and the rest of the personal in oncology services.

Contribution of the initial features of systemic lupus erythematosus to the clinical evolution and survival of a cohort of Mediterranean patients.

BACKGROUND: Systemic lupus erythematosus has a wide spectrum of immunological and clinical manifestations. Its course is characterised by exacerbations which may result in mortality or morbidity to vital organs/systems. OBJECTIVE: To determine clear and early prognostic markers to avoid further complications. METHODS: 245 adult patients diagnosed between January 1978 and March 2001 were studied. Clinical manifestations and laboratory findings both at onset and during the clinical course were collected. The number, type, and severity of the flares were also noted. Statistical analyses between disease features at onset, subsequent flares, and mortality were performed. RESULTS: 239 patients entered the study. Their mean age at onset was 30 years. The mean time between onset and diagnosis was 36 months and the mean evolution time was 114 months. 205 patients developed 915 flares; 205 (22.4%) of these flares were major flares, and affected 110 patients. Cardiac, neurological, or renal affection at onset were associated with a higher probability of developing cardiac (p=0.022), neurological (p<0.001), and renal (p<0.001) exacerbations, respectively, during the evolution. Lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) were predictors of stroke (aCL, p=0.000; LA, p=0.001). Age at diagnosis (p=0.003) and valvular disease at onset (p=0.008) were independent predictors of low survival. CONCLUSIONS: Renal, cardiac, or neurological involvement and the presence of LA or aCL positivity at onset were predictors of renal, cardiac, or neurological flares, respectively. Age and valvular involvement at onset were found to be independent adverse outcome predictors for low survival.

Thalidomide in the treatment of cutaneous lupus refractory to conventional therapy.

OBJECTIVE: We describe a prospective treatment study of thalidomide in a series of 22 patients with cutaneous lupus refractory to other treatments. METHODS: From 1992 to 1998, 22 patients with cutaneous lupus (9 with discoid lupus erythematosus, 7 with subacute cutaneous lupus, 4 with profundus lupus, 2 with nonspecific rash) were treated with thalidomide. Initial treatment was started at 100 mg daily. If the cutaneous lesions vanished, the dose was lowered to 50-25 mg daily as a maintenance therapy and it was considered a complete remission. If the lesions improved but remained, this was considered a partial response and treatment was continued until the lesions were not further modified. Periodically, adverse effects were evaluated. RESULTS: Three patients discontinued treatment because of side effects such as vertigo, persistent drowsiness, or paresthesia. Rash improved in 16/19 patients (84%). Complete remission occurred in 12/16 (75%). In 9 (65%) the rash resolved, but recurred 4-16 weeks after withdrawal of thalidomide; when it was used again, they improved. Partial response was achieved in 4/16 (25%) patients. No response occurred in 3/19 (16%). Many patients noted improvement within 2 weeks after starting thalidomide and maximum benefit was achieved within 3 months. Five of the 14 women had amenorrhea during the treatment with thalidomide. CONCLUSION: Thalidomide is effective in the treatment of cutaneous lupus refractory to other treatments. However, only some patients had a remission; the remainder relapsed when treatment was withdrawn, or required low doses of thalidomide to preserve inactive lesions. Amenorrhea was observed as a new secondary effect of thalidomide.

[Seasonal evolution of the biogeochemical cycle in the southwest lagoon of New Caledonia. Application of a compartmental model]. / Evolution saisonnière du cycle biogéochimique dans le lagon sud-ouest de Nouvelle-Calédonie. Application d'un modèle compartimental.

A biogeochemical box model describing the south-west lagoon of New-Caledonia was developed in order to simulate the seasonal cycle of carbon and nitrogen. We used fluxes generated by a 3D hydrodynamic model to simulate horizontal exchanges between boxes and added freshwater influxes as nitrogen sources from the land. Average residence time proved to be less than 11 days for the lagoon as a whole. Standard simulations showed baseline values of chlorophyll a between 0.2 and 0.4 microgram.L-1. Influences of freshwater influxes proved to be significant (increases up to 1 microgram.L-1) only in shallow areas protected from wind exposure and during short periods of heavy rainfall (tropical depressions). Tropical climatic events have reduced impact in space and time and long-term simulations over decades with increased nutrient inputs did not show any significant process of eutrophication. Hydrodynamics seemed to be one of the major control factors with respect to organic matter cycling in the lagoon.

Rhodococcus equi pneumonia in patients infected with the human immunodeficiency virus. Report of 2 cases and review of the literature.

Rhodococcus equi is a cause of lung infection in immunosuppressed hosts. Since the start of the HIV epidemic, 76 cases of R. equi lung infection (MEDLINE 1985-96) affecting this population have been described. We report 2 additional cases and review the clinical data, radiological findings, treatment and outcome of these 78 patients. The mean age of these patients was 33 y; 69 were male. 71 met the criteria for AIDS (CDC 1993). Fever and cough were the presenting complaints in the majority of patients (84.3%). A single cavitary lung lesion in the upper lobes was the most common radiological finding (57.7%), although multiple cavitations, alveolar infiltrates and pleural effusion were also found. Treatment usually was based on synergistic antibiotic combinations for a long period of time determined on an individual basis. Surgery was performed only in 11 patients. Death attributable directly to R. equi infection is low (15.4%), however only half of the patients (53.8%) were completely cured. We conclude that R. equi infection should be strongly considered in any HIV patient who presents with cavitary lesions in the lung, especially if mycobacteria are not identified. Treatment must be based on synergistic antibiotic combinations, and surgery relegated to cases of chronic single cavitary lesions not responding to antibiotics.