[Hospitalization facilities required for quality care of lung cancer patients]. / Les modes d'hospitalisation nécessaires pour une prise en charge de qualité en oncologie thoracique.

The purpose of this study was to determine whether good-quality care for patients with lung cancer can be delivered without a full hospitalization unit. Our study included all consecutive untreated lung cancer patients admitted over a two-year period. The following criteria were analyzed retrospectively: residence, age, sex, histology, staging, treatments, administrative data during the first 6 months of treatment, place of death, and duration of last stay before death in the unit. Two hundred six patients were recorded. Twenty-eight percent of the patients had stage IIIB disease and 61% stage IV disease. The first treatment included: surgery (12%), chemotherapy (80%). During the first six months, the median number of hospitalizations was 8 and the median number of full hospitalization days was 17 compared with 6 days for one-day stays. The median duration of the first stay was 5 days whereas the duration of the last one was 3 days. During the first year, 71% of the patients dies: 36% in our unit (47% of them were inpatients for more than 6 days during their last stay). Diagnosis, initial treatment, management of treatment complications and supportive care are not compatible with weekly hospitalization. Full hospitalization is mandatory for good-quality care in a referral cancer unit.

[Hospital information systems ineffectiveness in costing ambulatory chemotherapy in pulmonary oncology]. / Insuffisance de la valorisation PMSI de la chimiothérapie ambulatoire en oncologie pulmonaire.

The real cost of medical consumption was compared with the proportion of medication consumption of (the) GHM n(o) 681 (homogeneous group of patients, chemotherapy for cancer in day care) in the French case mix system (PMSI). For those patients in our thoracic oncology unit (Sainte-Marguerite Hospital, Marseille, France), the real medication cost was calculated from prices paid by the hospital, then compared to the expected expenditures for the medication consumption of the GHM 681, i.e. 678 French francs (24.1% of the 225 ISA points (synthetic activity index)). Over a period of 2 months in 1998, 87 patients (mean age 63 +/- 11) had 194 chemotherapy sessions in day care, with multi-drug therapy in 38 cases. Vinorelbine or gemcitabine represented 81% of the single drug chemotherapy. In 84% of the single drug and 76% of the multi-drug chemotherapy, the real cost of medication consumption was above the allocated budget. The mean cost for single drug chemotherapy was 1722 FF and 2920 FF for multi-drug chemotherapy. The budget allocated by the PMSI shows a deficit in the most cases. To avoid a restriction in the use of some drugs, it appears that the French system of budget evaluation needs to be improved.

[Panhypopituitarism secondary to pituitary metastases]. / Panhypopituitarisme secondaire à une métastase hypophysaire.

BACKGROUND: Hypophyseal metastatic localizations are uncommon and rarely the first expression of a primary cancer. We report an exceptional case revealed by panhypopituitarism and diabetes insipidis. CASE REPORT: Brain MRI visualized an intra- and suprasellar tumoral formation found to be a cribiform adenocarcinoma. The primary tumor could not be identified. Despite radiotherapy, surgery and chemotherapy combining carboplatin and etoposide, the tumor progressed with the development of cervical and mediastinal nodes. The patient died one year after onset of the clinical signs. DISCUSSION: Diagnosis of hypophyseal metastasis is mainly based on indirect evidence: rapid course, invasion of neighboring structures. Optimal management of these rare tumors remains to be determined.

[A case report of bronchial cysticercosis]. / Un cas de localisation bronchique de la cysticercose.

Cysticercosus cellulosae is usually located in muscles, subcutaneous tissues, brain and eyes. The authors reported a rare case of bronchial cysticercosis in a 20-year-old man. The only clinical signs were hemoptysis. Bronchial fibroscopy allowed to have a visual field of the cysticercus lesion. This parasitological tumor was removed by surgical resection. The diagnosis was confirmed by histological examination. A drug therapy by praziquantel completed the treatment.