[Prolongation of anti vitamin K treatment for 18 months versus placebo after 6 months treatment of a first episode of ideopathic pulmonary embolism: a mutlicentre, randomised double blind trail. The PADIS-EP Trial]. / Prolongation d'un traitement par antivitamine K pendant dix-huit mois versus placebo au décours d'un premier épisode d'embolie pulmonaire idiopathique traité six mois: un essai randomisé multicentrique en double aveugle. Essai "PADIS-EP".

BACKGROUND: After stopping a 3 to 6 months course of oral anticoagulation for a first episode of idiopathic venous thromboembolism (VTE), the risk of recurrent VTE is high (10% per year). In this setting, international guidelines recommend at least 6 months treatment. However, this recommendation is not satisfactory for the following reasons: (1) no randomized trial has compared 6 months to extended duration (2 years) anticoagulation; and (2), even though the frequency of recurrent VTE is similar after pulmonary embolism (PE) and deep vein thrombosis (DVT), the fatality rate of recurrent VTE after PE is higher than that after DVT. METHODS: A French multicentre double blind randomized trial. The main objective is to demonstrate, after a first episode of symptomatic idiopathic PE treated for 6 months using a vitamin K antagonist, that extended anticoagulation for 18 months (INR between 2 and 3) is associated with an increased benefit / risk ratio (recurrent VTE and severe anticoagulant-related bleeding) compared to placebo. The double blind evaluation is ensured using by active warfarin and placebo, and blinded INR. The protocol was approved by the ethics board of the Brest Hospital on the 7th of March 2006. For an alpha risk of 5% and a beta risk of 20%, the estimated sample size is 374 patients. EXPECTED RESULTS: This study has the potential to: (1) demonstrate that the benefit / risk ratio of extended anticoagulation for 18 months is higher than that observed with placebo in patients with a first episode of idiopathic PE initially treated for 6 months, during and after the treatment period; and (2) to validate or invalidate the contribution of isotope lung scans, lower limb Doppler ultrasound and D-Dimer at 6 months of treatment as predictors of recurrent VTE (medico-economic analysis included).

[Activity and safety of fenspiride in bronchial hyperexudation (author's transl)]. / Efficacité-tolérance du fenspiride dans les hyper-exsudations bronchiques.

This clinical trial of fenspiride (injectable and sustained-release 80 mg tablet) was carried out on patients selected because their bronchopathy was of a hypersecretory type. Interesting results were observed in 20 out of 37 cases, but they were often delayed. This group of patients included a high proportion of patients with major hypersecretion; the efficacy of fenspiride is often evident, (in 8 out of 11 cases) but it is unpredictable individually. It can be concluded from this trial that a long term treatment with fenspiride, well tolerated, can usefully be tried in patients with predominant signs of bronchial hyperexudation.

[Successive bilateral adrenal phaeochromocytoma. One case (author's transl)]. / Phéochromocytomes surrénaliens bilatéraux successifs. Une observation.

A patient underwent surgery for the first time at the age of ten years for a right-sided adrenal phaeochromocytoma. She underwent a second operation at the age of 27 years, for a contro-lateral localisation. Phaeochromocytomas are rare in the child. They are frequently bilateral, multiple and situated extra-adrenally. They fall within the context of Sipple's syndrome more rarely than in the adult. Treatment of these bilateral forms requires bilateral adrenalectomy in one or two stages, followed by substitute hormone therapy.

[Extensive Wegener's granulomatosis: treatment with immunodepressants and complicated by pulmonary aspergillosis (author's transl)]. / Maladie de Wegener extensive sous immunodépresseurs et compliquée d' aspergillose pulmonaire.

The case reported is of Wegener's granulomatosis which responded only temporarily to immunodepressant treatment and complicated by pulmonary aspergillosis. This combination poses a diagnostic since the respiratory manifestation of the two conditions may be confused, and a therapeutic problem because of contradictions in the drugs indicated.