Impact of previous head and neck cancer on postoperative complications after surgical resection for lung cancer: a case-control study.

BACKGROUND: Head and neck cancer (HNC) and lung cancer are often linked because of common risk factors. We aimed to assess the risk of postoperative complications in patients with previous HNC undergoing thoracic surgery for lung cancer. METHODS: Patients with previous HNC undergoing surgery for lung cancer were included in this retrospective, monocentric, case-control study. All patients were matched for age, sex, FEV1, smoking history, and year of surgery with lung cancer patients without previous HNC. Major postoperative complication was defined as at least one of the following during the first 30 days post lung resection (LR): death, shock, need for mechanical ventilation, and pneumonia. RESULTS: From January 2006 to May 2012, 65 patients with previous HNC underwent LR. Fifty-nine of these patients were included and matched with 120 control patients without HNC. Major complications occurred in 25 [42.4% (95% CI, 29.4-55.4%)] vs. 19 [15.8% (95% CI, 9.2-22.5%)] patients in the HNC and non-HNC groups, respectively (P<0.001). Among the complications, pneumonia occurred in 19 (32.2%) vs. 12 (10%) (P=0.01), and death occurred in 5 (8.5%) vs. 2 (1.7%) patients in the HNC and non-HNC groups, respectively (P=0.04). The following factors were identified by multivariate analysis to be independently associated with postoperative complications: previous HNC [odds ratio (OR) =4.24; (95% CI, 1.84-9.74)], male gender [OR =8.99; (95% CI, 1.05-76.78)], cumulative smoking [OR =1.02 per unit; (95% CI, 1.01-1.04)] and elevated Charlson score [OR =1.45; (95% CI, 1.07-1.96)]. CONCLUSIONS: Previous HNC is a major independent risk factor for serious postoperative complications after LR for lung cancer. Postoperative pneumonia (POP) is the most frequent complication.

A clinical decision-making algorithm for penicillin allergy.

BACKGROUND: About 10% of subjects report suspected penicillin allergy, but 85-90% of these patients are not truly allergic and could safely receive beta-lactam antibiotics Objective: To design and validate a clinical decision-making algorithm, based on anamnesis (chronology, severity, and duration of the suspected allergic reactions) and reaching a 100% sensitivity and negative predictive value, to assess allergy risk related to a penicillin prescription in general practise. STUDY DESIGN AND METHODS: All patients were included prospectively and explorated based on ENDA/EAACI recommendations. Results of penicillin allergy work-up (gold standard) were compared with results of the algorithm. RESULTS: Allergological work-up diagnosed penicillin hypersensitivity in 41/259 patients (15.8%) [95% CI: 11.5-20.3]. Three of these patients were diagnosed as having immediate-type hypersensitivity to penicillin, but had been misdiagnosed as low risk patients using the clinical algorithm. Thus, the sensitivity and negative predictive value of the algorithm were 92.7% [95% CI: 80.1-98.5] and 96.3% [95% CI: 89.6-99.2], respectively, and the probability that a patient with true penicillin allergy had been misclassified was 3.7% [95% CI: 0.8-10.4]. CONCLUSIONS: Although the risk of misclassification is low, we cannot recommend the use of this algorithm in general practice. However, the algorithm can be useful in emergency situations in hospital settings. Key messages True penicillin allergy is considerably lower than alleged penicillin allergy (15.8%; 41 of the 259 patients with suspected penicillin allergy). A clinical algorithm based on the patient's clinical history of the supposed allergic event to penicillin misclassified 3/41 (3.7%) truly allergic patients.

Predicting the long-term course of asthma in wheezing infants is still a challenge.

Background. In recurrent wheezing infants, it is important to identify those likely to remain asthmatic in order to propose appropriate long-term management. Objective. To establish predictive factors for persistent asthma at adolescence in a population of recurrent wheezing infants. Methods. Retrospective study of 227 infants. Inclusion criteria were age under 36 months, a history of at least three wheezing episodes assessed via a doctor-led ISAAC questionnaire and a standardized allergy testing programme. At 13 years, active asthma was assessed by questionnaire. Results. Risk factors for asthma persisting into adolescence were allergic sensitization to multiple airborne allergens (OR 4.6, CI-95% (1.9-11.2) P = 0.001), initial atopic dermatitis (OR 3.4, CI-95% (1.9-6.3) P < 0.001), severe recurrent wheezing (OR 2.3, CI-95% (1.3-4.2) P = 0.007), and hypereosinophilia ≥470/mm(3) (OR 2.2, CI-95% (1.07-4.7) P = 0.033). Conclusion. While it is still difficult to predict the long-term course of asthma, atopy remains the major risk factor for persistent asthma.