[Pemetrexed-induced cutaneous sclerosis of the lower limbs]. / Œdèmes inflammatoires et scléreux des membres inférieurs sous pémétrexed.

BACKGROUND: Pemetrexed is an antifolate used to treat intrathoracic cancers. We report a rare case of cutaneous toxicity of pemetrexed with inflammatory cutaneous sclerosis of the lower limbs. PATIENTS AND METHODS: A 63-year-old man diagnosed with metastatic adenocarcinoma of the lung was treated with pemetrexed. Fourteen months after undergoing this chemotherapy, he developed inflammatory and fibrotic edema of the lower limbs with functional consequences on knee bending. Cardiac, renal, hepatic, thrombotic and infectious causes were ruled out. Pemetrexed was suspended and partial remission was obtained using super-potent topical corticosteroids. With the approval of the oncologist, nivolumab was introduced as a follow-on therapy after pemetrexed. DISCUSSION: Often misdiagnosed by physicians, this form of toxicity due to pemetrexed is rare but classically described. To limit cutaneous side effects, dexamethasone may be proposed the day before, the same day as and the day after the infusion. Suspension of chemotherapy is not routine but depends on the risk-benefit ratio of the functional impact of the dermatosis and on the therapeutic alternatives available for the cancer.

[Prematurity and low birth weight: effects of active and passive smoking during pregnancy]. / Prématurité et petit poids àla naissance: les effets du tabagisme actif et passif durant la grossesse.

Among the risk factors inevitably associated with low birthweights and premature births, tobacco remains the factor most often cited. From 1997 to 1998, a study was conducted in a Quebec City hospital centre in order to determine the prevalence of smoking among pregnant women as well as their exposure to passive smoking at home and at work. The percentage of women who smoke before pregnancy is 40.2%, while that of women who smoke during pregnancy is 37.3%. The analysis of characteristics of pregnant women who smoke and do not smoke shows strong variations according to age, education, matrimonial status and income. The relative risk linked to smoking is 1.54 for premature birth and 2.21 for low birthweight.