转移性恶性黑素瘤患者对达卡巴嗪发生超敏反应(法语)

Background.Dacarbazine(DTIC)is the first-line chemotherapy for metastatic malignant melanoma without cerebral metastasis.Its clinical and hematological safety is usually good.Hypersensitivity in hepatic failure patients is the most serious side effect described.Patients and methods.This was a retrospective study of the prevalence of hypersensitivity in patients treated with DTIC for metastatic melanoma between 11/01/2002 and 10/31/2003.Hypersensitivity was diagnosed in the event of fever,hypereosinophilia(>500/mm3)with or without liver dysfunction(> twice pre-therapeutic values).Clinical data,DTIC administration modalities,number of courses and clinical and laboratory safety data were recorded.Results.Twenty patients were included,11 women and 9 men of median age 58.6 years(22-82 years)with multiple metastases in all cases.DTIC was the first-line treatment for 19 patients,being administered for 4 days to 10 patients and for 1 day to the other 10 patients,depending on their overall health status.Five hypersensitivity-like manifestations were observed,all in the 4-day treatment group.In 3 patients,fever and hypereosinophilia were seen without liver dysfunction at D3 of the second course of treatment.In 2 patients,treatment was stopped after the second course because of disease progression.In the third patient,4 courses were given with recurrence of symptoms,although the latter were controlled during the fifth course with corticosteroids and antihistamines given 15 minutes before the start of treatment.Two patients experienced severe forms of hypersensitivity with fever,hypereosinophilia,liver dysfunction(cytolysis and cholestasis)and delayed medullar aplasia,after the first and second course respectively.In one patient,bone marrow examination showed a block at the promyelocytic stage consistent with a toxic etiology.Treatment with DTIC was stopped,and all signs regressed with symptomatic treatment.Discussion.Hypersensitivity with DTIC seems to be frequent,being observed in 20%of our patients,with early onset(after the first or second course)and absence of dose-dependence.We describe for the first time two cases of medullar aplasia occurring in association with DTIC hypersensitivity.During phase I studies,the hematologic toxicity of DTIC was moderate,rarely affecting red cells,and was observed with higher doses than those used in metastatic malignant melanoma.We suggest that this aplasia forms part of the signs of hypersensitivity because of the bone marrow morphology,the existence of anemia and concomitant resolution with all the others signs of hypersensitivity.Conclusion.Laboratory monitoring(NFS,liver enzymes)is thus justified,particularly after the first and second courses of DTIC.In case of fever and hypereosinophilia without liver dysfunction,DTIC may be continued together with symptomatic treatment.In the event of hepatic dysfunction,and of course severe hematological disorders,potentially fatal complications can occur and treatment must be stopped.

炎症性肠病与早产

The present study investigates pregnancy outcome in women with IBD and examines the effect of pregnancy on the severity of IBD. Method: A case-control study comparing deliveries by mothers with IBD between January 1988 and January 2005 was performed. For every birth by a mother with IBD, four births by non- IBD mothers were randomly selected and adjusted for ethnicity and year of delivery. Result: During the study period there were 48 deliveries to patients with Crohn’ s disease and 79 deliveries to patients with ulcerative colitis. Higher rates of preterm delivery ( < 37 weeks) were found among patients with IBD as compared to the controls (odds ratios (OR) = 2.2; 95% confidence interval (CI) = 1.3- 3.8). This association remained significant after adjustment for labor induction and multiple gestations, using the Mantel-Haenszel technique (weighted OR = 2.1; 95% CI 1.3- 3.5 and weighted OR = 2.0; 95% CI 1.2- 3.5; P = 0.012; respectively). In addition, these patients had higher rates of fertility treatments (OR = 2.2; 95% CI = 1.1- 4.4). Using a multivariate analysis, controlling for maternal age and fertility treatments, preterm delivery was seen to be significantly associated with IBD (adjusted OR = 2.0; 95% CI = 1.2- 3.5). Perinatal outcomes, such as perinatal mortality, low Apgar scores, and congenital malformations, were comparable to the outcomes in the control group. Conclusion: Maternal IBD is an independent risk factor for preterm delivery. IBD is not associated with adverse perinatal outcome.

妊娠合并贫血是发生低出生体重及早产的独立危险因素

Objective: The present study was designed to investigate the outcome of pregnancy and delivery in patients with anemia. Methods: A retrospective population-based study comparing all singleton pregnancies of patients with and without anemia was performed. Deliveries occurred during the years 1988-2002 in the Soroka University Medical Center. Maternal anemia was defined as hemoglobin concentration lower than 10 g/dl during pregnancy. Patients with hemoglobinopathies such as thalassemia were excluded from the analysis. Multiple logistic regression models were performed to control for confounders. Results: During the study period there were 153,396 deliveries, of which 13,204 (8.6%) occurred in patients with anemia. In a multivariable analysis, the following conditions were significantly associated with maternal anemia: placental abruption, placenta previa, labor induction, previous cesarean section (CS), non-vertex presentation and Bedouin ethnicity. Higher rates of preterm deliveries (< 37 weeks gestation) and low birthweight (< 2500 g) were found among patients with anemia as compared to the non-anemic women (10.7%versus 9.0%, p < 0.001 and 10.5%versus 9.4%, p < 0.001; respectively). Higher rates of CS were found among anemic women (20.4%versus 10.3%; p < 0.001). The significant association between anemia and low birthweight persisted after adjusting for gender, ethnicity and gestational age, using a multivariable analysis (OR = 1.1; 95%CI 1.0-1.2, p = 0.02). Two multivariable logistic regression models, with preterm delivery (< 37 weeks gestation) and low birthweight (< 2500 g) as the outcome variables, were constructed in order to control for possible confounders such as ethnicity, maternal age, placental problems, mode of delivery and non-vertex presentation. Maternal anemia was an independent risk factor for both, preterm delivery (OR = 1.2; 95%CI 1.1-1.2, p < 0.001) and low birthweight (OR = 1.1; 95%CI 1.1-1.2, p = 0.001). Conclusion: Maternal anemia influences birthweight and preterm delivery, but in our population, is not associated with adverse perinatal outcome.

肩难产相关决定因素的人群研究

Objective: The study was aimed to define obstetric factors associated with shoulder dystocia. Methods: A population-based study comparing all singleton, vertex, term deliveries with shoulder dystocia with deliveries without shoulder dystocia was performed. Statistical analysis was done using multiple logistic regression analysis. Results: Shoulder dystocia complicated 0.2%(n=245) of all deliveries included in the study(n=107965). Independent risk factors for shoulder dystocia in a multivariable analysis were birth-weight ≥4000 g(OR=24.3; 95%CI 18.5-31.8), vacuum delivery(OR=5.7, 95%CI 3.4-9.5), diabetes mellitus(OR=1.7, 95%CI 1.2-2.5) and lack of prenatal care(OR=1.5, 95%CI 1.1-2.3). A significant linear association was found between birth-weight and shoulder dystocia, using the Mantel-Haenszel procedure. Pregnancies complicated with shoulder dystocia had higher rates of third-degree perineal tears as compared to the comparison group (0.8%versus 0.1%; P < 0.001). Similarly, perinatal mortality was higher among newborns delivered after shoulder dystocia as compared to the comparison group(3.7%versus 0.5%; OR=7.4, 95%CI 3.5-14.9, P< 0.001). In addition, these newborns had higher rates of Apgar scores lower than 7 at 1 and 5 min as compared to newborns delivered without shoulder dystocia(29.7%versus 3.0%; OR=13.8, 95%CI 10.3-18.4, P< 0.001 and 2.1%versus 0.3%; OR=7.2, 95%CI 2.8-18.1, P< 0.001, respectively). Combining risk factors such as large for gestational age, diabetes mellitus and vacuum delivery increased the risk for shoulder dystocia to 6.8%(OR=32.6, 95%CI 10.1-105.8, P< 0.001). Conclusions: Independent factors associated with shoulder dystocia were birth-weight ≥4000 g, vacuum delivery, diabetes mellitus and lack of prenatal care.

静脉滴注免疫球蛋白治疗天疱疮(法语)

Introduction. The interest of intravenous immunoglobulins (IgIV) in the treatment of pemphigus is discussed. Pemphigus is not a recognized indication for this treatment by the CEDIT (French Committee for the assessment and diffusion of technological innovations). The aim of this study was to assess the efficacy of IgIV in the treatment of severe corticosteroid-dependant or resistant pemphigus. Material and methods. A retrospective study using a standardized questionnaire was conducted in the various departments of dermatology among the "Groupe Bulles"of the French Society of Dermatology. The study collected the following information from 12 patients suffering from pemphigus and treated with IgIV: 1) general demographical data; 2) characteristics of the pemphigus; 3)different treatments applied, and 4) efficacy and side effects of treatments. Results. Among the 12 patients studied at the end of treatment with IgIV, 8 were in complete remission (1 fleetingly for 2 months and 1 preceding initiation of IgIV), and 2 were improved (1 temporarily for 4 months). A reduction in corticosteroid therapy was possible in 75 p. 100 of cases (9 patients). During treatment with IgIV, immunosuppressors were combined with oral corticosteroids in 3 cases. It was possible to reduce their dose 1 one case and to stop them in another case. No major side effect related to treatment with IgIV was observed. Six months and one year after the treat-ment, complete remission rates were respectively 6/10 and 5/8. One patient relapsed more than one year after the end of IgIV treatment. Conclusions. Although very expensive, treatment with IgIV appears of interest in the treatment of severe corticosteroid-dependant or resistant pemphigus. Moreover tolerance is excellent. The results of our study warrant confirmation in a prospective study.