Durée de traitement des tuberculoses extrapulmonaires : six mois ou plus ? Analyse de la base de données TB-INFO

Purpose

The recommended duration of pulmonary tuberculosis therapy is 6 months. For extrapulmonary tuberculosis, treatment duration depends on tuberculosis involvement and HIV status. The objective of this study was to describe the main characteristics of a cohort of extrapulmonary tuberculosis patients, to compare patients with a 6-month treatment to those with more than a 6-month treatment, and to analyze the compliance of medical centres with recommended duration of treatment.

Methods

A retrospective cohort study of 210 patients with extrapulmonary tuberculosis was carried from January 1999 to December 2006 in two hospitals in the north-east of Paris. These patients were treated with quadruple therapy during two months, followed by dual therapy during 4 months (n = 77) or more (n = 66). The characteristics of each group were compared by uni- and multivariate analysis. The primary endpoint was the rate of relapse or treatment failure at 24-month follow-up after treatment completion.

Results

No relapse was observed after 24 months of follow-up after the end of treatment in the two groups. In univariate analysis, patients with lymph node tuberculosis were more often treated for 6 months than at other sites of tuberculosis (respectively 61% versus 40.9%; P = 0.02); the decision of treatment duration was related to medical practices (79.2% treated 6 months in one hospital versus 20.7% in the other, P < 0.001); patients living in private residence were more often treated during 6 months than patients living in residence (24.2% versus 10.3%, P = 0.042). In multivariate analysis, only hospital (P = 0.046), sex (P = 0.007) and private residence were significantly different in each group.

Conclusion

A period of 6 months seems to be sufficient to treat extrapulmonary tuberculosis (except for neuromeningeal localization).     

Le facteur de croissance des nerfs : un nouveau médiateur de l’inflammation ?

Nerve growth factor (NGF), in addition to its essential activity on nerve growth and survival, has recently been shown to function as an important inflammatory mediator. As evidenced from animal studies, NGF may contribute to the development of airway hyperresponsiveness and to an increased sensory and sympathetic innervation in the lung. A variety of cell sources have been studied and shown to synthetise and secrete NGF. NGF also has a profound effect in the development of pulmonary inflammation and asthma-related symptoms. NGF seems to be important in inflammation and should be described as a future potential target in airway inflammation, especially in asthma.     

Syndrome paranéoplasique hypercalcémie–hyperleucocytose au cours des carcinomes épidermoïdes cutanés. À propos de deux observations

Introduction

We report two cases of hypercalcemia–hyperleucocytosis paraneoplastic syndrome complicating cutaneous squamous cell carcinoma.

Case reports

The first patient, a 50-year-old man, suffering for hidradenitis suppurativa for the past 20 years, was admitted for squamous cell carcinoma. Laboratory findings showed marked hypercalcemia and hyperleucocytosis. PTHrP serum level was increased. Bone scintigraphy was normal. There was evidence of pulmonary metastasis. Despite treatment the patient died of agranulocytosis. The second patient was a 60-year-old man who presented with several months enlarging left axillary tumour. He has been treated by surgery for a squamous cell carcinoma of the left hand, 6 months ago. Serum calcium and white cell bloods count were elevated. The diagnosis of metastatic lymph node of cutaneous squamous cell carcinoma was confirmed. There was evidence of pulmonary metastasis. Despite chemotherapy the patient died rapidly.

Conclusion

Hypercalcemia–hyperleucocytosis paraneoplastic syndrome is rarely described during the course of cutaneous squamous cell carcinoma. This syndrome seems to be related to hormones or cytokines secretion by the neoplasic cells including PTHrP and G-CSF. Some authors ascribe it a poor prognostic significance.     

Surveillance des cancers coliques opérés à visée curative : faut-il revoir les recommandations de la conférence de consensus ?

Colorectal cancer is one of the most common human malignancies. Surgical resection remains the primary treatment but cancer recurrences (locoregional or distant) are associated with a poor prognosis. Follow-up is of particular importance in the three-years after surgery and various strategies have been purposed in the surveillance of patients after curative resection for colorectal cancer. The objective is to diagnose a recurrence at the earliest possible stage, enabling a second curative treatment. Optimal strategy for follow-up remains controversial. Results from randomized trials comparing low intensity programs and intensive programs of colorectal cancer surveillance are insufficient to recommend a follow-up strategy. To update recommendations for surveillance of colorectal cancer, larger prospective randomized studies are required.     

Quel est l’intérêt de rechercher un hypogonadisme chez un patient présentant des ulcères de jambe récidivant depuis l’âge de 20 ans ?

Androgen replacement therapy has been reported to have a beneficial effect in patients with Klinefelter's syndrome or perforating plantar ulcers. We report the case of a 55-year-old man with a 35-year history of leg ulcers and venous insufficiency. His leg ulcers healed 4 months after a management scheme including vascular rehabilitation (intermittent pressure therapy, ankle mobilization, multiple layer compression bands on the lower limbs), skin grafts and foam sclerotherapy of the great saphenous vein. The ulcers recurred 1 month later. This recurrence and the unusually young age for development of venous leg ulcers led to a search for a rare cause. The diagnosis of anterior pituitary failure was established. Sclerotherapy and androgen replacement therapy led to complete healing without recurrence at the 1-year follow-up visit. A link between androgen deficiency and fibrinolysis, protein synthesis deficiency, inflammation and trophicity is well documented in the literature. A search for hypogonadism may be useful in young patients presenting a longstanding history of leg ulcers or in patients with suspected andropause irrespective of age.     

Radiothérapie externe et photothérapie dynamique des cancers de l’œsophage : une association dangereuse ?

A 60-year-old man presented an oesophageal transmural necrosis fistulised in the trachea following curative photodynamic therapy (PDT) for a superficial recurrence of an oesophageal carcinoma, initially treated by radiochemotherapy. Two stents, a tracheal and an oesophageal one, were placed. Eight months later the patient is in complete remission with only mild swallowing problems. This complication, although unusual, has already been described by other teams with the association of radiochemotherapy and PDT. The present case study suggests that illumination dose should be lowered in this indication.     

Caracterización bibliométrica y temática de los grupos de investigación de Archivos de Bronconeumología (2003–2007)

Introduction

Scientific cooperation is essential for the advance of biomedical research. Scientists set up informal groups to work together on common issues, who are the main units in the research funding system. Bibliometric and Social Network Analysis methods allow informal groups in scientific papers to be identified and characterised. The objective of the study is to identify research groups in Archivos de Bronconeumología between 2003 and 2007 period with the aim of characterizing their scientific collaboration patterns and research areas.

Methods

Co-authorships, institutional collaboration relationships and the main research areas of papers published in Archivos de Bronconeumología have been identified. Co-authorship networks and institutional collaboration networks have been constructed by using Pajek software tool.

Results

A total of 41 research groups involving 171 investigators have been identified. The Collaboration Index for articles was 5.59 and the Transcience Index was 73.11%. There was institutional collaboration in 60.33% of papers. The collaboration between institutions of the same region prevails (41.03%), followed by collaborations between departments, services or units of the same institution (39.74%), inter-regional collaboration (14,97%) and international collaboration (6.83%). A total of 83.03% of articles were cited. The main research areas covered by groups were chronic obstructive pulmonary disease, asthma, lung neoplasm, bronchogenic carcinoma, smoking and pulmonary embolism.

Conclusions

The scientific production of a large number of Respiratory System Spanish research groups is published in Archivos de Bronconeumología. A notable collaboration and citation rate has been observed. Nevertheless, it is still essential to encourage inter-regional and international collaboration.     

Le traitement endovasculaire des lésions urgentes de l’aorte thoracique descendante est-il possible dans un centre ne disposant pas de circulation extracorporelle ?

OBJECTIVE: To determine whether access to extra-corporal circulation (ECC) is necessary to treat acute descending thoracic aorta disease. METHOD: From January 2004 to May 2006, 16 patients underwent endovascular stent-graft repair of the descending thoracic aorta, among them 13 (81%) were treated in an emergency setting (nine men, mean age: 75.4 years, range 30-94 years). The indication was traumatic aortic rupture (n=3, 23%), complicated acute type B dissection (n=4; 31%), symptomatic or ruptured thoracic aortic aneurysm (n=4; 31%), aorto-esophageal fistula (n=1; 7,5%) and aortic intramural haematoma (n=1; 7,5%). Computed tomography showed hemomediastin and/or hemothorax in five patients (38%). Transesophageal echocardiography and angiography were performed in two (15%) and one patients respectively. Cerebrospinal fluid drainage was performed for two patients (15%). RESULTS: Endovascular repair was successfully completed in 92.3% of cases. The 30-day mortality was 7.5% (n=1). There was one case (7.5%) of delayed paraplegia. Follow-up ranged between two and 24 months (mean 10.2), no rupture occurred. Three type I endoleaks were detected and only two were treated. Two none related additional mortalities were observed. None of these patients has needed ECC. CONCLUSION: The unavailability of ECC does not seem to be a compromising factor in the management of thoracic aorta disease, however a good experience in endovascular techniques is required.