Correlation between lung function tests and peak oxygen consumption in post-TB lung disease.

BACKGROUND: After TB treatment, many patients have post-TB lung disease (PTLD), associated with increased mortality and morbidity. Nevertheless, relationships between lung function testing and exercise capacity in people with PTLD are poorly understood.METHODS: This single-centre study investigated the association between lung function testing and peak oxygen consumption (VO2peak) and percentage-predicted VO2peak (VO2peak (%pred)) in adults with PTLD investigated for surgery.RESULTS: Eighty-two patients (52 males, 30 females) with a mean age of 43.2 years (SD 11.3) were included. Spirometric values of forced vital capacity (FVC) percentage predicted (%pred) and forced expiratory volume in 1 sec (FEV1) %pred suggested significant correlations with VO2peak (%pred) (P < 0.001 and P < 0.001), whereas FEV1/FVC did not. Diffusing capacity for carbon monoxide (DLCO) %pred also correlated significantly with VO2peak (%pred) (P = 0.002). However, the magnitude of all significant correlation coefficients were weak. No significant correlations for any plethysmographic values with VO2peak (%pred) could be robustly concluded. Correlations with VO2peak (ml/kg/min) for most physiological variables were less robust than for VO2peak (%pred).CONCLUSIONS: Although statistically significant, the correlations between any measure of lung function and VO2peak or VO2peak (%pred) were weak, with only FVC correlation coefficient surpassing 0.50.

Living with food allergy: What this means for children.

Health-related knowledge, skills and attitudes that translate to behaviours are important foundations for healthy living. However, deficiencies in any one of these factors have the potential to impact quality of life. This study investigates how Australian children perceive and manage their food allergy as they transition through childhood onto adolescence. To measure this, children aged 12 years and under completed an online survey [under 8 years and 8-12 years] on knowledge, skills and attitudes. Although recruitment involved advertisements to over 700 Australian pre-schools, 44 allergy specialists and multiple representations to the patient support group, Allergy & Anaphylaxis Australia, completion relied on parental notification and/or guidance. Of the 139 participants recruited, 114 commenced the survey with 65 participants under 8 years (58%) and 49 between 8 and 12 years. Results showed participants recognised different ways to keep safe with children under 8 years (N = 65) 100% cognisant of the need to check with 'Mum/Dad' or teachers if they could safely eat food as well as the importance of not swapping lunches, while there was a slight change in compliance for those aged 8-12 years as three (6.1%, n = 3/49) children did not see the necessity of asking an adult/teacher if a food item was safe to eat. Older children were also less likely to tell friends about their food allergy even if they thought they were having an allergic reaction, despite children under 8 years more likely to feel different to friends (38%, n = 24/64) compared to those aged 8-12 years (31%, n = 14/45). Although both groups disliked parents' fussing, for children under 8 years, there was a strong association between this and 'feeling different to friends'. Results from this study highlight the importance of normalising food allergy at home and in the community, so children are confident in telling others about their food allergy.

Position statement for adult and paediatric spirometry in South Africa: 2022 update.

Spirometry is required as part of the comprehensive evaluation of both adult and paediatric individuals with suspected or confirmed respiratory diseases and occupational assessments. It is used in the categorisation of impairment, grading of severity, assessment of potential progression and response to interventions. Guidelines for spirometry in South Africa are required to improve the quality, standardisation and usefulness in local respiratory practice. The broad principles of spirometry have remained largely unchanged from previous versions of the South African Spirometry Guidelines; however, minor adjustments have been incorporated from more comprehensive international guidelines, including adoption of the Global Lung Function Initiative 2012 (GLI 2012) spirometry reference equations for the South African population. All equipment should have proof of validation regarding resolution and consistency of the system. Daily calibration must be performed, and equipment quality control processes adhered to. It is important to have standard operating procedures to ensure consistency and quality and, additionally, strict infection control as highlighted during the COVID-19 pandemic. Adequate spirometry relies on a competent, trained operator, accurate equipment, standardised operating procedures, quality control and patient co-operation. All manoeuvres must be performed strictly according to guidelines, and strict quality assurance methods should be in place, including acceptability criteria (for any given effort) and repeatability (between efforts). Results must be categorised and graded according to current guidelines, taking into consideration the indication for the test.

Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function.

BACKGROUND: Persistent respiratory symptoms and lung function deficits are common after patients with TB. We aimed to define the burden of post-TB lung disease (PTLD) and assess associations between symptoms and impairment in two high TB incidence communities.METHODS: This was a cross-sectional survey of adults in Cape Town, South Africa who completed TB treatment 1-5 years previously. Questionnaires, spirometry and 6-minute walking distance (6MWD) were used to assess relationships between outcome measures and associated factors.RESULTS: Of the 145 participants recruited (mean age: 42 years, range: 18-75; 55 [38%] women), 55 (38%) had airflow obstruction and 84 (58%) had low forced vital capacity (FVC); the mean 6MWD was 463 m (range: 240-723). Respiratory symptoms were common: chronic cough (n = 27, 19%), wheeze (n = 61, 42%) and dyspnoea (modified MRC dyspnoea score 3 or 4: n = 36, 25%). There was poor correlation between FVC or obstruction and 6MWD. Only low body mass index showed consistent association with outcomes on multivariable analyses. Only 19 (13%) participants had a diagnosis of respiratory disease, and 16 (11%) currently received inhalers.CONCLUSION: There was substantial burden of symptoms and physiological impairment in this "cured" population, but poor correlation between objective outcome measures, highlighting deficits in our understanding of PTLD.

Complementary and alternative medicine and the search for knowledge by conventional health care practitioners.

The use of complementary and alternative medicines (CAM) is growing rapidly within the western world and the nexus with conventional health care services is expanding. Many nurses and other conventional health care providers are not only using CAM themselves but see many of their clients using these medicines and therapies. The attitudes to CAM can influence client satisfaction and client use of different therapies and many practitioners of conventional health care are seeking education and information to enhance their knowledge and use of CAM. This paper reflects on the attitudes to CAM and the education needs and services in the field of CAM as identified by western health care providers, in particular nurses.

The utility of hand-held mobile spirometer technology in a resource-constrained setting.

BACKGROUND: Mobile phone-linked spirometry technology has been designed specifically for evaluating lung function at primary care level. The Air-Smart Spirometer is the first mobile spirometer accepted in Europe for the screening of patients with chronic respiratory diseases. OBJECTIVES: To prospectively assess the accuracy of the device in measuring forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in a South African population, and to investigate the ability of the device to detect obstructive ventilatory impairment. METHODS: A total of 200 participants were randomly assigned to perform spirometry with either the mobile spirometer connected to a smartphone or the desktop spirometer first, followed by the other. The FEV1/FVC ratio as well as the absolute FEV1 and FVC measurements were compared, using each participant as their own control. A Pearson correlation and Bland-Altman analysis were performed to measure the agreement between the two devices. We defined obstructive ventilatory impairment as FEV1/FVC <0.7 measured by desktop spirometry in order to calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the Air-Smart Spirometer. RESULTS: There was a strong correlation between the absolute FEV1 and FVC values and FEV1/FVC ratio measured with the mobile Air-Smart Spirometer and more conventional pulmonary function testing, with r=0.951, r=0.955 and r=0.898, respectively. The Air-Smart Spirometer had a sensitivity of 97.6%, specificity of 74.4%, PPV of 73.0% and NPV of 97.8% for obstructive ventilatory impairment. CONCLUSIONS: The mobile Air-Smart Spirometer compared well with conventional spirometry, making it an attractive and potentially affordable tool for screening purposes in a primary care setting. Moreover, it had a high sensitivity and NPV for obstructive ventilatory impairment.

6-Hydroxymelatonin protects against quinolinic-acid-induced oxidative neurotoxicity in the rat hippocampus.

Melatonin, a naturally occurring chemical mediator, although assigned a diverse range of functions, has attracted interest because of its ability to function as a free radical scavenger. Its major hepatic metabolite and photoproduct, 6-hydroxymelatonin (6-OHM), also shares this property. Since singlet oxygen and quinolinic acid (QUIN) are critically involved in the pathology of neurotoxicity, the objective of this study was to investigate the ability of 6-OHM to scavenge singlet oxygen and evaluate its ability to scavenge superoxide anions and reduce QUIN-induced neurotoxicity in the hippocampus in-vivo. The results show that 6-OHM is an efficient inhibitor of singlet oxygen formation as indicated by the rate constants and quantum yields reported for 6-OHM and zinc phthalocyanine (ZnPc), respectively. 6-OHM, appears to reduce QUIN-induced superoxide anion generation in the hippocampus, which provides some evidence of the neuroprotective effects of 6-OHM.

Polyaspartamides as water-soluble drug carriers. Part 1: Antineoplastic activity of ferrocene-containing polyaspartamide conjugates.

BACKGROUND: Numerous detrimental side effects and/or lack of water-solubility of anticancer drugs often prove dose-limiting in chemotherapy. Water-soluble polymeric drug carriers may overcome/minimise many of these limitations. MATERIALS AND METHODS: Aspartic acid polymers to which ferrocene-containing antineoplastic agents are covalently bound, were tested for cytotoxicity against murine EMT-6 cancer cells. Cell survival was measured by means of the colorometric 3-(4,5-dimethylthiazol-2-yl)-diphenyltertrazolium bromide assay. RESULTS: The 90% lethal dosage of pure 3-ferrocenylbutanoic acid is 452 microg/mL LD90 for the polymeric derivative, expressed in terms of 3-ferrocenylbutanoic acid content, is only 65 microg/ml. A polymer structural effect in drug activity was evident: longer side chains linking drugs to polymer backbones enhanced drug activity. Drug activity is also enhanced if drug modifications (to enable drug anchoring) resulted in a lower ferrocenyl reduction potential. CONCLUSIONS: The effectivity of antineoplastic drugs may be enhanced by covalently anchoring them on suitable biodegradable water-soluble polymeric drug carriers.

[Sarcomas of the bone and soft tissue: general observations]. / Sarcomes des os et des tissus mous: généralités.

The term sarcomas regroups a large variety of malignant tumors originating from the mesenchymal tissues, which represent only 1% of cancers, with a higher relative frequency in children. Whether bone or soft tissue tumors, their preeminent general evolutive characteristics are a high local aggressiveness and a high frequency of hematogenic metastatic diffusion, with a predilection for pulmonary involvement. An improved knowledge of the natural history of sarcomas has led to a better definition of multidisciplinary therapeutical protocols for each particular disease.

[An intensive course for general practitioners in a university hospital for oncology. Evaluation of a 5-year experience]. / Stage intensif pour des médecins généralistes en service hospitalo-universitaire de cancérologie. Bilan d'une expérience de 5 ans.

For 5 years, 121 general practitioners (GP) had a one-week course of continuing medical education, organized by the League against cancer, by groups of five, in oncology university services. A few years later they were asked, through a postal questionnaire, about their appreciation of this course and its consequences on their practice. Seventy six (55%) answers indicate that, except for two GP, such a course was considered as very valuable. They think it was useful to improve their clinical expertise and to reduce radiological and biological investigations. Their relations with patients, families and oncologists had been improved. They hope such an experiment will continue. Limits and difficulties of this experiment are briefly underlined.

[Treatment of locally extensive soft tissue sarcomas. Value of intra-arterial chemotherapy (author's transl)]. / Traitement des sarcomes des tissus mous localement évolués. Intérêt de la chimiothérapie d'induction par voie intra-artérielle.

Between 1964 and 1978, 21 patients with locally extensive soft tissue sarcoma received intal-arterial regional chemotherapy (IAC), combined with radiotherapy. Some patients were also submitted to conservative surgery. Although there were three serious accidents, one of which was lethal, the tolerance was considered acceptable. Tumor regression of more than 50 per cent was observed in 9 of the 21 patients after chemotherapy. Overall, the addition of IAC to radiation therapy gave satisfactory local control. Recurrent local disease occurred in only four patients. On the basis of these results IAC can be considered as an important element of combined treatment methods to achieve local control in locally extensive soft tissue sarcomas, which are generally not very responsive to systemic chemotherapy.

[Perception of cancer by general practitioners. Development over 15 years]. / Perception du cancer chez les médecins généralistes. Evolution sur 15 ans.

Fifteen years after two surveys among general practitioners in the Southwest of France, concerning their attitudes towards cancer patients, a new survey was made using the same questions. In the spring of 1991, 731 general practitioners in Gironde were asked by a written questionnaire sent by mail: 261 answers (36%) forming a fair sample, were analyzed. Though incidence of cancer in physician's practice is low, these patients represent an important burden. Difficulties in coping with these patients during relapse or at the end of life are mainly psychological in relation to the importance of moral burden and the time spent. These psychological difficulties have increased during the past 15 years whereas technical medical problems have decreased. According to 80% general practitioners, cancer patients know their diagnosis. This knowledge is independent of practitioner's age and the working place, and it does not alter the difficulties for practitioner.

[Evaluation of a clinical course in an oncology department during the second cycle of medical education. A 12-year study by questionnaire among 321 students]. / Evaluation d'un stage hospitalier en cancérologie au cours du deuxième cycle des études médcales. Enquête par questionnaire chez 321 étudiants en 12 ans.

The comprehensive cancer center in the Southwest of France, Bergonié Institute hosts medical students in 4th-6th year of their studies, for 4-month courses. This course was evaluated at its end by a questionnaire, during two periods of 6 years: 1983-88. 161 students; 1990-95, 160 students. Due to the policy of the Bordeaux University, these students were significantly younger during the second period: 48.4% in 4th year vs 25.8% in the first period (P = 0.00024). The main reasons for choosing this hospital were to meet cancer patients (54.8%), to improve knowledge in oncology (49.7%) or to see a variety of diseases, unlike in other specialty services (20.8%). At the end of the course, the main investigation in oncology appeared to be pathology (40.8%), radiology (38.2%) or blood cell counts (14.5%). Their training was highly (2+) or very highly (3+) rated by 67.9% of the students in theoretical matters, by 66% in clinical practice and by 92.5% in behavior. The best-learned fields were relations with patients (67.4%), treatments (24.5%) and clinical examination (23.5%). Students declare to have been negatively impressed by failures and deaths (34.7%), patients in poor condition (24.7%) or treatments poorly tolerated or not efficient enough (12.2%). They declare to have been well impressed by cooperation of caregivers (26.5%), comprehensive care (22.7%), teachers' efforts (22.1%), patient-caregiver relations (21.%) and courageous patients (18.1%). Finally students' presence during consultation is useful to see outpatients in good condition or cured patients. Between the first and the second period, there is a significant decrease of clinical training and a trend in favor of improved treatment and better prognosis. Thus this hospital appears mainly useful for training in patient-doctor relations and in clinical practice in a variety of diseases. Efforts have to be made to further improve clinical training. Such an investigation should be pursued to check the students' training periodically. This will allow the adaptation and improvement of the teaching, in accordance with changes in patients' conditions and treatments.

[Long-term clinical course after second laparotomy in ovarian cancer]. / Evolution à long terme après seconde laparotomie dans les cancers ovariens.

A series of thirty consecutive epithelial ovarian cancer patients were reviewed after long-term follow-up (more than 5 y) since their second-look operation (SLO). All patients had advanced tumors (stages IIb-IV). Primary chemotherapy consisted of a cisplatin-associated regimen. For all patients adjuvant treatment had been planned after completion of the SLO. Mean follow-up after SLO was 68 months (47-103 months). Tumor status at SLO divided the patients in 2 subgroups: Group A = 13 patients (43%), with no evidence of histologically proved disease at time of operation (NED); Group B = 17 patients (57%), with macroscopic persistence of tumor. Survival was significantly better in the first group than in the second (77% at 5 yr vs less than 25%). Recurrence rate in the NED group was 7.7% (1 recurrence at 32 months). Eight of 17 patients with gross tumor at SLO underwent satisfactory resection. However, recurrence rate was high (75%) and survival rate was low (25% at 5 yrs). This result was not significantly better than that of patients with no optimal resection at SLO (9 patients, survival 22%). Second effort resection at SLO does not seem to be beneficial in these patients after partial failure of initial chemotherapy with cisplatin. The usefulness of systematic second look operations is discussed. Controlled randomized trials should be made to determine the exact role of SLO in ovarian cancer treatment.

[Is there a place for 2nd look laparotomy in the treatment of ovarian cancers?]. / Que reste-t-il de la laparotomie de deuxième vue dans le traitement des cancers de l'ovaire?

The charts of 147 patients with advanced ovarian cancers responding completely (CR) or partially (PR > 50%) to a primary cisplatin-based chemotherapy are reviewed. All fulfilled our criterias to undergo second-look laparotomy. One hundred patients (group A) underwent second-look laparotomy and 47 patients (group B) other features of control: laparoscopy 37 patients, clinical control ten patients. Apart metastatic spread more frequent in group B (A vs B = 10 vs 32%) and tumor grade 1 more frequent in group B (A vs B = 33 vs 49%), the two groups were well balanced concerning tumor characteristics and treatment features. All patients had received a complementary treatment after the second-look procedures. With a median follow-up of 86 months in group A and 104 months in group B, no difference was found in overall nor in recurrence-free survival. Within group A, 34 patients had achieved pathologic proved complete remission. Their 5-year survival was 73% with an incidence of recurrence of 32%. Second-look laparotomy was found an invasive technique with a 15% operative morbidity. Its therapeutic apport seems absent and the diagnostic role limited to indication of radiotherapy in CR patients. Second-look laparotomies should be reserved to trials evaluating its proper place but should not be used systematically to assess tumor response to chemotherapy. The good 5-year survival of the CR mi group suggest the beneficial impact of complementary treatment, but prospective trials are needed to evaluate the place of this treatment.

[Prognostic significance of isolated local recurrences in breast cancer following mastectomy and axillary node excision. Apropos of 77 recurrences in 2362 patients]. / Signification pronostique des récidives locorégionales isolées dans les cancers du sein après mastectomie et curage axillaire. A propos de 77 récidives chez 2 362 patientes.

During the years 1958-1984, 2 362 patients presenting with breast carcinoma were treated at the Fondation Bergonié by modified radical mastectomy and followed or not by radiotherapy or adjuvant chemotherapy. A retrospective analysis of this series showed that 77 patients (3.3%) presented an isolated locoregional recurrence as the first sign of treatment failure. A chest wall recurrence alone was noted in 47 patients, while 30 presented an involvement of the lymph nodes, sometimes associated with chest wall disease. The prognosis' factors of isolated locoregional recurrence, studied by multidimensional analysis by Cox's model are by decreasing order the disease free interval and the Scarf and Bloom's histologic grade. The median survival is 29 months after isolated locoregional recurrence and the survival curve is very similar to that of patients with isolated bone metastatic recurrences (median survival of 26 months) and slightly better than the median survival of patients with non osseous metastasis (median survival of 16 months).

[Primary choriocarcinoma of the stomach. Immunohistochemistry study of a case and review of the literature]. / Choriocarcinome primitif de l'estomac. Etude immunohistochimique d'un cas et revue de la littérature.

A rare tumor, primary choriocarcinoma of the stomach occurred in a 68 year-old man. Histologic examination of the tumor revealed two components, choriocarcinoma and adenocarcinoma. The liver metastasis displayed only choriocarcinoma, the lymph nodes metastasis only adenocarcinoma. The diagnosis was confirmed by demonstration of beta HcG in serum and urines by radioimmunoassay and within syncytiotrophoblast cells by immunoperoxidase staining. A review of the literature is done. The pathogenesis is discussed with hypothesis that this tumor represents a form of retro-differentiation of a preexisting carcinoma. However, this diagnosis will only be certain when a metastasis of a non gestational, non gonadal choriocarcinoma will be eliminated.

[Histological changes after chemotherapy of soft tissue sarcomas in the adult]. / Modifications histologiques après chimiothérapie des sarcomes des tissus mous de l'adulte.

The variations of histologic patterns inside the primary tumor have been studied in 15 patients with locally advanced soft tissue sarcomas who were given induction (neo adjuvant) chemotherapy. Increase of tumor necrosis and decrease of tumor cellularity were the predominant aspects identified. The mitosis count tend to be lower, while the nuclear atypies and the number of giant malignant cells tend to increase. In 2 cases, a better tumor differentiation, attributable to the induction chemotherapy was noted. In 10/15 cases, it was concluded to a tumoricidal effect of the chemotherapy. According to tumor grade, 6 among 10 patients with grade III tumor presented a histological response (greater than 50 p. cent of tumor destruction) while none among 5 lesions of grade I or II exhibited a response of such a level. So, the histological study allows an evaluation of the response to chemotherapy which usefully completes the clinical appreciation, and that may be useful for the selection of postoperative adjuvant treatment, as it is in osteosarcomas.

[Curietherapy-surgery for epidermoid carcinomas of the uterine cervix T1]. / Curiethérapie-chirurgie pour les carcinomes épidermoïdes du col T1.

Between 1975 and 1985, we have treated 157 patients with carcinoma of the cervix T1. The size of the tumor was always equal or less than 30 mm. Our patient underwent Cesium 137 brachytherapy with Fletchers applicators followed by a modified radical hysterectomy and pelvic lymphadenectomy 4 to 6 weeks later. Intracavitary brachytherapy was performed within three days (low dose rate 0.8-1 Gy/h). The median 60 Gy Isodose was: 65 mm height, 58 mm width and 29 mm thickness. At surgical time we mentioned that vaginal cut out was 2-3 cm and pelvic lymphadenectomy limited to external iliac nodes. The 5 and 10 disease Free Survival was respectively 91.6 and 89.4%. We observed 14 relapses, five were distant metastases only. The tumor size and pelvic node involvement were the main prognostic factors in our data. The sterilization of the cervix wasn't of prognostic value. Complications occurred in 22 patients, 2 (1.3%) were severe urinary injury.