Management and outcome of metastatic melanoma during pregnancy.

BACKGROUND: Although metastatic melanoma occurrence during pregnancy challenges the physician in several ways, only a few studies have been published. OBJECTIVES: Our aim was to investigate therapeutic management together with maternal and fetal outcomes in pregnant women with advanced melanoma. METHODS: A French national retrospective study was conducted in 34 departments of Dermatology or Oncology. All patients with American Joint Committee on Cancer (AJCC) stage III/IV melanoma diagnosed during pregnancy were included. Data regarding melanoma history, pregnancy, treatment, delivery, maternal and infant outcomes were collected. RESULTS: Twenty-two women were included: 10 AJCC stage III and 12 stage IV. Abortion was performed in three patients. Therapeutic abstention during pregnancy was observed in three cases, 14 patients underwent surgery, four patients received chemotherapy and one patient was treated with brain radiotherapy alone. The median gestational age was 36 weeks amenorrhoea. Neither neonatal metastases nor deformities were observed. Placenta metastases were found in one case. Among 18 newborns, 17 are currently alive (median follow up, 17 months); one died of sudden infant death. The 2-year maternal survival rates were 56% (stage III) and 17% (stage IV). CONCLUSIONS: Faced with metastatic melanoma, a majority of women chose to continue with pregnancy, giving birth, based on our samples, to healthy, frequently premature infants. Except during the first trimester of pregnancy, conventional melanoma treatment was applied. No serious side effect was reported, except one case of miscarriage after surgery. Mortality rates do not suggest a worsened prognosis due to pregnancy but larger prospective controlled studies are necessary to assess this specific point.

Concentration and mobilization of Cd, Cu, Pb and Zn by meiofauna populations living in harbour sediment: their role in the heavy metal flux from sediment to food web.

The bioavailability of Cd, Cu, Pb and Zn was assessed in different harbours of the Atlantic coast (France). The responses of the two dominant meiobenthic groups (nematodes and copepods) to a heavy metal contamination gradient measured in similar subtidal sediments were observed in field surveys. Heavy metal concentrations were measured in nematodes and copepods. Nematodes have higher Cd, Cu, Pb and Zn transfer factors than copepods or other benthic species. The flux of heavy metal through nematodes was estimated and appears to be important compared to plankton in the process of heavy metal transfer to benthic or pelagic food webs.

Bioaccumulation and toxicity of four dissolved metals in Paracentrotus lividus sea-urchin embryo.

The bioaccumulation of four metals (Cd, Cu, Pb, Zn) dissolved in water was assessed measuring the concentrations recorded within sea-urchin larvae (Paracentrotus lividus, Lmk.) after a 48-h exposure period. Concurrently, the frequencies of abnormalities were evaluated at the 48-h pluteus stage to check the actual toxicity of such contaminants with regards to larval development. Maximum metal concentrations in the larvae reached 43.8 +/- 6.7 micrograms Cd g-1 dry weight (d.w.), 1269 +/- 392 micrograms Cu g-1 d.w., 3106 +/- 679 micrograms Pb g-1 d.w., 534 +/- 62 micrograms Zn g-1 d.w. Bioconcentration factors (BCFs) reached very high values for Pb (maximum value: 16,282 +/- 973) and indicated that the concentrations of Pb and Cd were directly related to the water concentration at least in the range of concentrations tested. Zn appeared to be partially regulated above a certain threshold concentration (between 5 and 25 micrograms l-1). Cu was accumulated with an active uptake at least below lethal threshold level (100 micrograms l-1). Nevertheless, above these thresholds, high mortality of embryos prevent any interpretation of Zn and Cu bioconcentration factors. Concurrent studies carried out on embryotoxicity confirmed the high toxicity of Cu towards sea-urchin pluteus larvae and highlighted the different behaviour of Cd. The internal Cd concentrations were directly related to the external ones, comparable to other non-essential metals, but Cd had little toxic effect on the initial larval development.

[Anemia caused by iron deficiency and pagophagia. Apropos of a case]. / Anémie par carence en fer et pagophagie. A propos d'un cas.

The authors report a case of a 17 year old young man, who entered our hospital for a severe iron lack anemia reported to ice cubes ingestion (Pagophagia). Such cases are reported in the literature. Usually, Pagophagia is a compulsive eating (Pica) caused by iron deficiency. Pagophagia could improve non hematologic symptoms of iron deficiency such as stomatitis and glossitis.

[Ocular metastasis demonstrated a carcinoma of the thyroid gland (author's transl)]. / Métastase oculaire révélatrice d'un microcarcinome du corps thyroïde.

Report of a case of choroidal metastasis. Enucleation was performed because of the clinical aspect of a primitive tumor. Histopathologic stains revealed a vesicular adenocarcinoma, may be of the thyroid gland. Total thyroidectomy was performed and demonstrated a vesicular microcancer (1/10e mm diameter).

[Negative results of a randomized therapeutic trial of nonspecific immunotherapy in primary, surgically-treated non-small cell bronchial cancer]. / Résultats négatifs d'un essai thérapeutique randomisé d'immunothérapie non spécifique dans le cancer bronchique primitif non microcellulaire opéré.

Between March 1978 and May 1981, 219 patients suffering from non-small cell primary bronchial carcinoma underwent surgical excision which was intended to be curative. Three weeks later the patients were randomised into two groups: 1. A control group, with no other treatment following excision (110 patients). 2. A non-specific immunotherapy group (109 patients). The immunostimulant used was an aqueous suspension of heat killed mycobacterium smegmatis administered subcutaneously once a month. The trial was analysed on December 1, 1982. There were 117 recurrences and 112 deceased. There was no significant difference as regard survival without relapse or overall survival; all causes of death were included.

[Prognostic factors in operated non-small cell cancer of the lung. Study from a randomized therapeutic trial]. / Facteurs pronostiques du cancer du poumon opéré non à petites cellules: étude à partir d'un essai thérapeutique randomisé.

This article presents the results of a prognostic study of primary resected lung cancer (non-small cell). The data result from a randomised clinical trial of immunotherapy with a non-specific adjuvant; the follow-up was between four to seven years. Thirty-five clinical, biological and anatomo-pathological parameters were gathered at the time of inclusion in the trial. The response criteria used were survival without recurrence and total survival. A multivariate analysis using the Cox's model was carried out for each criterion. At the reference date of the 1st April 1985, 125 relapses and 132 deaths were counted amongst 219 patients; there was only one patient lost to follow-up and only 39 missing data were observed. The negative therapeutic results of the immunotherapy used were confirmed by this new intermediate analysis. The rate of survival without recurrence at 5 years was 43% and the overall survival at five years was 42%. The use of Cox's model to show the prognostic information at the 5% level for survival without recurrence could be summarised by five factors: main staging (the prognostic factor), leucocytosis, the cutaneous reaction to proteus, Karnofsky index and presence of physical signs. For stages I and II the outcome was identical and no factor was predictive at the 5% level. For stage III the cutaneous reaction to proteus and leucocytosis were prognostic. For overall survival, the prognostic information at the 5% level could be summarised by five factors: staging (main prognostic factor), leucocytosis, Karnofsky index, presence of physical signs and lymphocytosis. For stages I and II whose outcome was identical only Karnofsky index and lymphocytosis were predictive at the 5% level.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary interstitial pneumopathies].

Primitive interstitial pneumopathies are only a temporary classification. They seem to be due to an evolution for the worse of a "diffuse alveolar damage" of unknown origin. Evolution towards pulmonary fibrosis and respiratory insufficiency is their common risk. Etiopathogenic hypotheses would favour the immunological etiology. A diagnosis of primitive interstitial pneumopathy is reached by elmination when no known cause can be found. Liebow's classification remains valuable for pathology but is debatable where anatomo-clinical correlations, etiological hypotheses and the eventual effect of treatment are concerned. Today these primitive forms still represent 40% of the interstitial lung diseases, the causes of which are progressively discovered.

[Pleuro-pulmonary infections : importance of anaerobic bacteria and therapeutic consequences (author's transl)]. / Suppurations pleuro-pulmonaires : importance des germes anaérobies et conséquences thérapeutiques.

A prospective study of bacteriology and therapeutic outcome in 14 cases of pleuro-pulmonary infections is reported. Bacteriologic results are based on transtracheal aspirates and empyema fluid. Appropriate anaerobic bacteriologic methods were employed. Anaerobic bacteria were recovered from 11 patients, and were the only pathogens isolated in 6 patients. Patients were treated by penicillin G. This was judged satisfactory in all cases, although 1 patient died from pneumococcal septicemia few hours after his admission to the hospital. The results indicate that with reliable specimen (pleural fluidand transtracheal aspirates) and optimal anaerobic culture methods, bacteriologic diagnosis can be established. Since anaerobes play a key role in most cases of pleuro-pulmonary infections, penicillin G is the prefered initial drug.

Six vs twelve cycles for complete responders to chemotherapy in small cell lung cancer: definitive results of a randomized clinical trial. The "Petites Cellules" Group.

Of 320 patients with small cell lung cancer (SCLC) entered into a clinical trial of chemotherapy between January 1983 and September 1985, 106 patients achieved a complete response. The induction chemotherapy used was lomustine 60 mg.m-2 p.o., cyclophosphamide 1 g.m-2 i.v., doxorubicin 45 mg.m-2 i.v. and etoposide 150 mg.m-2 i.v., every four weeks. Lomustine was only given for the first three cycles. Seventy nine of the 106 patients still in complete response after six chemotherapy cycles were subsequently randomized to receive either six more cycles or no more treatment until relapse. In this group of 79 patients, a difference was shown from the time of inclusion between the 51 patients with limited disease and the 28 patients with disseminated disease, with overall median survivals of 395 and 165 days, respectively, (p = 0.0002). No difference was shown between the two treatment groups: the median survival was 332 days from the time of second randomization with a two year survival rate of 28% for the patients randomized to receive six more cycles and 246 days and 22% for those randomized to receive no more treatment (add 147 days to obtain overall median survival). Continuing chemotherapy for more than six cycles to patients in complete response did not improve survival.

[Double paraneoplastic syndrome and anaplastic carcinoma of the lung. ADH and ACTH levels in the tumoral tissue (author's transl)]. / Double syndrome paranéoplasique au cours d'un carcinome anaplasique du poumon. Dosage de l'ADH et de l'ACTH dans le tissu tumoral.

A double paraneoplasic syndrome with hypersecretion of ADH and ACTH revealed the presence of a small cell bronchial cancer in a man aged 62 years. Water and electrolyte anomalies due to the hypersecretions were of such a degree that an occlusive syndrome occurred. Very high levels of ADH and ACTH were found in the tumoral tissue. The measurement of these levels is rarely conducted at the present time but was able to define the mechanism of abnormal secretion of these two hormones in this case.

The bacteriology of cavitating pulmonary infections and empysema. Studies of transtracheal aspirates and pleural fluid.

A prospective study of bacteriology in 14 cases of cavitating pulmonary infections and empyema is reported. Bacteriologic results were based on transtracheal aspirates or pleural fluid. Appropriate anaerobic bacteriologic methods were employed. Anaerobic bacteria were recovered in 11 patients (79%); they were the only pathogens isolated in 6 patients. The predominant species were Fusobacterium nucleatum, Bacteroides melaninogenicus, Bacteroides fragilis and Peptostreptococcus. Aerobic bacteria were present in 7 patients. The results indicate that anaerobes play a key role in most cases of cavitating pulmonary infections and empyema, and that proper culture of adequat specimens will generally establish the bacteriological diagnosis.

[Comparative efficiency of rigid broncoscopy and fibroscopy in proximal bronchial neoplasms]. / Rentabilité comparée de la bronchoscopie rigide et de la fibroscopie dans les cancers bronchiques proximaux.

The authors report 2 comparable series of 200 bronchoscopies and 200 fibroscopies on 400 cases whose endoscopic pictures suggested a bronchial neoplasia. The histopathological results were similar in both series.

Adjuvant immunotherapy with nonviable Mycobacterium smegmatis in resected primary lung carcinoma. A randomized clinical trial of 219 patients.

Two hundred and nineteen patients with resected lung carcinoma were randomized 3 weeks after surgery between two treatment arms: a control group (110 cases) and an immunotherapy group (109 cases). The immunostimulant was a nonviable saprophytic mycobacterium, M. smegmatis, given monthly by subcutaneous injection in four sites. The two groups were equivalent in terms of prognostic factors, including a nonsignificant difference favoring the control group based on the N (node) classification. This interim analysis was carried out on June 1, 1981. Treatment comparison by the log-rank test did not show any significant differences between these two groups in regards to disease-free interval and overall survival. There was no significant difference between the two groups after stratification of the comparison according to the N classification or adjustment with a subset of eight prognostic parameters through the Cox model. The initially expected difference (20% 1-year survival) will probably not be achieved, given these interim results, but patients will continue to be treated and followed-up according to the protocol as to allow further evaluation of this nonspecific immunotherapy.

Inhaled corticosteroids and Churg-Strauss syndrome: a report of five cases.

Churg-Strauss syndrome is an eosinophil-associated, small vessel granulomatous vasculitis, characterized by late onset asthma, upper airways disease, eosinophilia, and clinical manifestations of systemic vasculitis. Several cases of Churg-Strauss syndrome have been recognized in patients treated with cysteinyl leukotriene-receptor antagonists and weaned off systemic corticosteroids. These cases have led to a general warning on the possible development of Churg-Strauss syndrome after taking cysteinyl leukotriene-receptor antagonists. The authors report five cases of Churg-Strauss syndrome in severe steroid dependent asthmatics in whom inhaled corticosteroids allowed systemic corticosteroid withdrawal. It is concluded that physicians should monitor patients carefully when severe asthma is controlled with any substance allowing withdrawal from (or even avoidance) of systemic corticosteroids. Case-control studies should identify more precisely the risk factors of Churg-Strauss syndrome.