RESUMEN
The real need for extensive staging at the time of diagnosis is discussed in regard to small cell lung carcinoma. We performed a decisional retrospective analysis on a series of 182 patients, based on three staging steps: the first step included physical examination and routine biologic tests. The second step consisted of liver ultrasonography and needle aspiration of any clinically detectable tumor mass, and the third step included bone marrow examination, radionuclide bone scan, thoracic, abdominal, and brain CT scan. A stepwise multivariate logistic regression performed on 11 variables considered in the first step shows that a four-parameter model can predict the spread of the disease (limited or extensive): weight loss, performance status, and elevated LDH or alkaline phosphatase levels. Limited disease can be predicted in two ways: (1) elevated LDH with normal alkaline phosphatases, no weight loss, and good performance status, or (2) normal LDH and alkaline phosphatases. In this series, 28 percent of patients can be predicted as having extensive disease and can be treated with chemotherapy alone without chest irradiation. After the second step, the probability of disease being extensive is only 25 percent, and only 84 (46.15 percent) patients would need to undergo the third step of staging procedures (brain CT scan, bone marrow aspiration and biopsy, radionuclide bone scan) with this method. We conclude that a multistep approach represents a simple staging method and offers the advantage of harmlessness and lower costs for patients not to be evaluated in prospective clinical trials.
Asunto(s)
Carcinoma de Células Pequeñas/patología , Neoplasias Pulmonares/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Pequeñas/epidemiología , Carcinoma de Células Pequeñas/terapia , Terapia Combinada , Intervalos de Confianza , Técnicas de Apoyo para la Decisión , Francia/epidemiología , Humanos , Modelos Logísticos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/terapia , Métodos , Estadificación de Neoplasias , Pronóstico , Dosificación Radioterapéutica , Estudios RetrospectivosRESUMEN
In tuberculous meningitis there is a disturbance of control involving hyponatraemia and increased urinary elimination of antidiuretic hormone resulting in hypersecretion of vasopressin. This inappropriate secretion of antidiuretic hormone should not be confused with the Schwartz-Bartter syndrome, which is reserved for paraneoplastic syndromes. The pathophysiology remains poorly understood but its recognition in cases of lymphocytic meningitis is improved as the correct diagnosis has precise therapeutic implications.
Asunto(s)
Síndrome de Secreción Inadecuada de ADH/orina , Tuberculosis Meníngea/orina , Vasopresinas/orina , Anciano , Femenino , Humanos , Hiponatremia/orina , Masculino , Persona de Mediana EdadRESUMEN
The cardiotoxicity of 5 fluoro-uracil is currently recognised. We report here a new case in which an effort test and a Methergin test were carried out in the hours following the episode and at a later date. With normal coronary arteriography the evidence is in favour of coronary artery spasm which is the usual mechanism for this type of toxicity.
Asunto(s)
Vasoespasmo Coronario/inducido químicamente , Fluorouracilo/efectos adversos , Vasoespasmo Coronario/fisiopatología , Electrocardiografía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
In order to gather information on the management of primary lung cancer in France, 70 hospital teams answered a questionnaire aimed at defining the current systematic attitudes concerning local lesions, assessment of extension, paraclinical examinations, respiratory function tests and therapeutic strategies and modalities.
Asunto(s)
Neoplasias de los Bronquios/terapia , Neoplasias de los Bronquios/patología , Neoplasias de los Bronquios/fisiopatología , Instituciones Oncológicas , Francia , Humanos , Estadificación de Neoplasias , Encuestas y Cuestionarios , Tomografía Computarizada por Rayos XRESUMEN
Acute lymphoblastic leukaemia of B-cell phenotype (B-ALL) is uncommon. We studied eight cases of B-ALL, investigating the clinical characteristics as well as the biological features. Cytology revealed a typical L3 profile in most cases, but in one case the morphological diagnosis was L2 and morphometric analysis indicated that the blasts in B-ALL were larger than in other ALLs. Cytogenetic study detected the typical translocations (8; 14) and (8; 22) in most of the cases. Abnormalities of the long arm of the chromosome 1 were found in four cases and a major aneuploidy was observed in one case. Cell-cycle analysis showed a high degree of proliferation with, in all cases, a small fraction of cells in G1 with low protein content (corresponding to early G1). All these biological characteristics must be related to the poor prognosis of this disease.
Asunto(s)
Leucemia Linfoide/patología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Linfocitos B , Ciclo Celular , Niño , Humanos , Cariotipificación , Leucemia Linfoide/complicaciones , Leucemia Linfoide/genética , Leucocitosis/etiología , Persona de Mediana Edad , Trombocitopenia/etiología , Translocación GenéticaRESUMEN
We studied the clinical and radiological features of pulmonary metastases present in 4 out of 22 patients with medullary carcinoma of thyroid. Two patients presented with common metastases: macronodules in one, and micronodules in the other one. The other two patients presented initially with reticulonodular perihilar lesions on chest X-ray, leading to the diagnosis of sarcoidosis in both of them. The observation of such pulmonary metastases is original: initially latent, they progress very slowly, and they correspond to a lymphangitic spread of the tumour with amyloid deposition in peribronchovascular structures without alveolar involvement, as shown in one of our cases with pathologic study.