[Evaluation of the COPD Assessment Test in patients with stable COPD]. / Évaluation du COPD Assessment Test (CAT) chez des patients BPCO en état stable.

INTRODUCTION: The COPD Assessment Test (CAT) is a new simple tool developed for assessing health-related quality of life in patients with COPD. The characteristics of the score derived from the CAT as a function of various parameters of evaluation of the severity of COPD remain to be described. METHODS: The CAT was submitted prospectively to 213 consecutive stable ambulatory COPD patients assessed in a tertiary care hospital. The discriminative value of the CAT was analysed as well as its association with various parameters of interest. RESULTS: The progressive increase in the CAT score with the severity of the disease as assessed by the GOLD stages and the BODE index, as well as the level of dyspnoea, demonstrates the discriminative capacity of the CAT. In multivariate analysis, only the RV/TLC (residual volume/total lung capacity) and the 6-minute walk distance were significantly associated with the CAT score, explaining only 27 % of its variability. The inclusion of dyspnoea in the model explained 42 % of the CAT score variability, only dyspnoea and the RV/TLC ratio being significantly associated. CONCLUSION: The CAT has good discriminative characteristics that are similar to more complex tools designed to assess health-related quality of life in patients with COPD.

Interest of (18)F-FDG PET-CT scanning for staging and management of merkel cell carcinoma: a retrospective study of 15 patients.

BACKGROUND: The additional benefit of 18FDG-Positron Emission Tomography-Computed Tomography (FDG PET-CT) compared with conventional imaging is still a controversial issue in MCC. OBJECTIVES: This study was designed to evaluate the ability of FDG PET-CT to detect secondary lesions clinically inconspicuous and not shown by conventional imaging. METHODS: Clinical records of 15 MCC patients were retrospectively reviewed to investigate the specific interest of FDG PET-CT compared with X-computed tomography (CT). The main endpoint was the ability of FDG PET-CT to detect secondary lesions and the possible resulting changes in disease staging and management compared with pre-FDG PET-CT data including clinical examination, sentinel lymph node biopsy (SLNB), and diagnostic CT. RESULTS: FDG PET-CT was relevant with a single false negative result and led to significant changes in disease staging and management in 46% of patients compared with clinical examination alone. However, additional secondary lesions not detected by CT were evidenced during follow-up in a single patient with an already known metastatic disease, data which did not result in any change in staging and treatment. Sensitivity, specificity, positive predictive value and negative predictive value were respectively 0.66, 1, 1 and 0.8 for SLNB, 0.89, 1, 1 and 0.93 for CT and 0.89, 1, 1 and 0.93 for FDG PET-CT. No additional neoplasm was detected by FDG PET-CT. CONCLUSION: Although FDG PET-CT is of questionable value in MCC management when used in parallel with CT, it may be considered as a valuable option as a single whole-body survey procedure.

[Unusual axillary apocrine carcinoma of the skin: histological diagnostic difficulties]. / Carcinome apocrine cutané axillaire inhabituel : difficultés diagnostiques histologiques.

BACKGROUND: Apocrine carcinoma of the skin (ACS) is a rare adnexal neoplasm presenting as an indurated slow-growing dermal or subcutaneous plaque that often occurs in the axilla. Histological distinction between ACS and cutaneous metastases of breast carcinoma may be difficult. OBSERVATION: A 64-year-old man presented with a slowly growing left axillary mass, which he had noticed for 2 years, without any other functional or clinical symptoms. Histological examination of the skin biopsy showed dermal invasion with atypical cells in an "Indian file" pattern. The pattern of the tumour and immunohistochemical staining suggested a diagnosis of breast carcinoma metastasis. However, the history of a slow-growing tumour and negative initial testing for a primary adenocarcinoma supported the hypothesis of ACS. DISCUSSION: A 100 cases of ACS have been reported in the literature with the main site being the axillary area. The differential diagnostic between axillary ACS and metastasis of lobular breast carcinoma has been discussed recently. Diagnosis may be difficult since the pattern of the tumour can be misleading and immunomarkers are not always specific. CONCLUSION: We report a new case of axillary ACS histologically mimicking lobular breast carcinoma metastasis.

[Multiple Bowen disease of the lower limbs in elderly women: a rare clinical subset involving therapeutic difficulties]. / Maladies de Bowen multiples des membres inférieurs chez les femmes âgées : une forme clinique particulière et de traitement difficile.

BACKGROUND: Cutaneous Bowen's disease (CBD) is a form of intraepithelial squamous cell carcinoma that usually presents as a solitary lesion. We report four similar cases of a peculiar and well-delimited clinical subset of multiple Bowen's disease seen in the lower limbs in elderly women and associated with specific therapeutic problems. OBSERVATIONS: Four women aged over 70 years presented with multiple CBD limited to the lower limbs associated with squamous cell and superficial basal cell carcinomas along with actinic keratosis. No significant aetiological factors were present apart from chronic sun exposure other than one case possibly involving immunodeficiency. The four patients were treated using photodynamic therapy, and partial clinical response and good tolerance were observed. DISCUSSION: These four cases share numerous clinical similarities: elderly women, markers of chronic sun exposure, lack of other aetiological factors such as arsenic or irradiation, localization of the lesions (multiple and/or continuous layer pattern, restricted to the lower limbs in all cases) and a chronic course. The frequency of this subset is probably underestimated due to absence of biopsies or to inconclusive histology reports. Photodynamic therapy yields valuable results with a good efficacy/safety ratio compared to imiquimod or 5-fluorouracil. However, while this treatment could be considered a first-line option in multiple CBD, its therapeutic value requires more detailed evaluation.

[Thoracic hyperinflation and COPD. Beyond respiratory mechanics and dyspnea]. / Distension thoracique et BPCO, au-delà de la mécanique respiratoire et de la dyspnée.

INTRODUCTION: The interactions between thoracic hyperinflation and respiratory mechanics, as well as their importance in the development of dyspnoea, are now well understood. We discuss here other aspects of thoracic hyperinflation that are relevant in the context of COPD. BACKGROUND: Both clinical examination and imaging have a limited role in the detection of thoracic hyperinflation for which respiratory function tests remain the gold standard. Imaging, however, has led us to a better understanding of how the chest wall accommodates for hyperinflation, which mainly affects the diaphragm, particularly its vertical portion. More recently the adverse effects of hyperinflation on both pulmonary and systemic haemodynamics and life expectancy have been highlighted. VIEWPOINTS AND CONCLUSIONS: Thoracic hyperinflation affecting patients with COPD has important consequences that extend far beyond the framework of respiratory mechanics. In the future the importance of hyperinflation as a determinant of the prognosis should be confirmed and the most relevant parameter, in this context, defined. The potential links between thoracic hyperinflation and systemic inflammation should also be clarified.

Skeletal muscle force and functional exercise tolerance before and after lung transplantation: a cohort study.

We investigated the impact of lung transplantation and outpatient pulmonary rehabilitation after lung transplantation on skeletal muscle function and exercise tolerance. Skeletal muscle force (Quadriceps force, QF), exercise tolerance (six minute walking distance, 6MWD) and lung function were assessed in 36 patients before and after lung transplantation. Seventeen male and 19 female patients (age 57 +/- 4) showed skeletal muscle weakness before the transplantation. A further 32 +/- 21% reduction was seen 1.2 (interquartile range 0.9 to 2.0) months after LTX. The number of days on the intensive care unit was significantly related to the observed deterioration in muscle force after LTX. At this time point 6MWD was comparable to pre-LTX. Rehabilitation started 37 (IQR 29 to 61) days after LTX. 6MWD and QF improved significantly (140 +/- 91 m, and 35 +/- 48%, respectively; p < 0.05) with rehabilitation. QF remained below pre-LTX values. The evolution of the 6MWD with the transplantation and the subsequent rehabilitation was less in female compared to male subjects. We conclude that muscle strength deteriorates after lung transplantation, particularly in patients with long ICU stay. Outpatient pulmonary rehabilitation is feasible after lung transplantation and leads to recovery of skeletal muscle function. In female patients this recovery is significantly less compared to male recipients.

[Secretory immunity of the airways]. / Immunité sécrétoire des voies respiratoires.

INTRODUCTION: Continuous exposure of the respiratory tract to inhaled particles and microbes implies the presence of effective defence mechanisms at a bronchial and alveolar level. STATE OF ART: Among the mechanisms involved secretory mucosal immunity contributes considerably to the defence of the bronchial tree. This immunity depends essentially on the active trans-epithelial transport of IgA involved in both innate non-specific and acquired specific immunity. Recently an IgA receptor has been identified on the surface of phagocytes including alveolar macrophages, establishing a link between alveolar and bronchial defences. PERSPECTIVES: The respiratory mucosa represents a crucial interface between the host and its environment, and should provide in the future a new target for the development of diagnostic and therapeutic tools. CONCLUSIONS: Beyond its function as an anatomical barrier the bronchial epithelium possesses a secretory activity that is essential for the protection of the lung. Despite a better understanding of mucosal immunity this secretory activity and in particular the part played by IgA remains to be elucidated.

Unnatural enantiomers of 5-azacytidine analogues: syntheses and enzymatic properties.

2'-Deoxy-beta-L-5-azacytidine(L-Decitabine), beta-L-5-azacytidine, and derivatives were stereospecifically prepared starting from L-ribose or L-xylose. D- and L-enantiomers of 2'-deoxy-beta-5-azacytidine were weak substrates of human recombinant deoxycytidine kinase (dCK), whereas both enantiomers of beta-5-azacytidine or the L-xylo-analogues were not substrates of the enzyme. None of the reported derivatives of beta-L-5-azacytidine was a substrate of human recombinant cytidine deaminase (CDA).

Maedi-visna virus, a model for in vitro testing of potential anti-HIV drugs.

A series of beta-D- and beta-L-cytidine analogues were evaluated for their inhibitory effect on the replication of maedi-visna virus (MVV) strains KV1772 and MV1514 cultured on sheep choroid plexus cells and the sheep chondrocyte cell line G81092, respectively. Eleven cytidine analogues were selected for the anti-viral test. Five of them belong to the family of the 2',3'-dideoxycytidine analogues, well known for their activity against human immunodeficiency virus (HIV). The others, all newly synthesized, were potential anti-viral and/or anti-leukemic agents. None of the compounds under study had a toxic effect in both anti-viral assay systems up to a 300 microM concentration. Based on the cytopathic effects (CPE), the virus replication was completely inhibited by the five 2',3'-dideoxycytidine analogues at a concentration of 50 microM, whereas the others six newly synthesized compounds induced titre reductions of 4-5 log units. The effective concentration causing 50% reduction of CPE (EC50) was of 5 microM for the five 2',3'-dideooxycytidine analogues and for beta-L-XyloFc, whereas the value of 50 microM was found for the b-L-XyloC and the four 5-azacytidine compounds tested. All these data reveal a good correlation between inhibition of MVV replication by several nucleoside cytidine analogues and their reported anti-HIV activity.