The risk of thrombo-embolic events is increased in patients with germ-cell tumours and can be predicted by serum lactate dehydrogenase and body surface area

The aim of this study was to evaluate the risk of thrombo-embolic events (TEE) in patients with germ-cell tumours (GCT) who receive cisplatin-based chemotherapy, to compare this risk to that of a matched control group of non-GCT cancer patients, and to identify risk factors of TEE. The rate of TEE during the 6 months following the initiation of chemotherapy was assessed in 100 consecutive patients with GCT and in 100 controls with various neoplasms who were matched on sex and age, and who received first-line cisplatin-based chemotherapy during the same period of time at Institut Gustave Roussy, Villejuif, France. Data were subsequently tested on a validation group of 77 GCT patients treated in Lyon, France. A total of 19 patients (19%) (95% confidence interval (CI): 13–28) and six patients (6%) (95% CI: 3–13) had a TEE in the GCT group and the non-GCT control group, respectively (relative risk (RR): 3.4; P<0.01). Three patients from the GCT group died of pulmonary embolism. In multivariate analysis, two factors had independent predictive value for TEE: a high body surface area (>1.9 m2) (RR: 5 (1.8–13.9)) and an elevated serum lactate dehydrogenase (LDH) (RR: 6.4 (2.3–18.2)). Patients with no risk factor (n=26) and those with at least one risk factor (n=71) had a probability of having a TEE of 4% (95% CI: 1–19) and 26% (95% CI: 17–37), respectively. In the GCT validation set, 10 (13%) patients had a TEE; patients with no risk factor and those with at least one risk factor had a probability of having a TEE of 0 and 17% (95% CI: 10–29), respectively. Patients with GCT are at a higher risk for TEE than patients with non-GCT cancer while on cisplatin-based chemotherapy. This risk can be accurately predicted by serum LDH and body surface area. This predictive index may help to study prospectively the impact of thromboprophylaxis in GCT patients

Dépistage, prise en charge et suivi des personnes potentiellement surexposées à l’arsenic inorganique du fait de leur lieu de résidence

International audienceBackground and objectives. - The French national authority for health (Haute Autorite de sante: HAS) and the French clinical toxicology society (Societe de toxicologie clinique: STC) received a formal request from the French ministry for heath to elaborate recommendations for the screening of environmental overexposure to inorganic arsenic (iAs), for the medical management of overexposed patients and for the medical surveillance of exposed population.Methods. - The method used for the elaboration was the Clinical practice guidelines method recommended by HAS in this situation (HAS, 2010).Results. - The recommendations are presented in the present article. They concern: a) identification of those sites with a high risk of iAs overexposure for the residents (using bioaccessible concentrations in soils); the target population for Asi overexposure screening and screening modalities (using measurement of iAs and its metabolites in urine); b) the biomonitoring indications and modalities for overexposed individuals; c) the fraction of the population with iAs environmental exposure which should be the target for the detection and the diagnosis of complications, and the modalities of these operations; d) the treatment and prevention of iAs environmental overexposure. (C) 2020 Elsevier Masson SAS. All rights reserved.RésuméContexte et objectifsÀ la demande de la Direction générale de la santé, la Haute Autorité de santé (HAS), en partenariat avec la Société de toxicologie clinique (STC) et avec la collaboration de la Société française de médecine du travail (SFMT), la Société française de santé publique (SFSP), la Société française de toxicologie analytique (SFTA) et la Société francophone de santé-environnement (SFSE) a élaboré des recommandations pour le dépistage des surexpositions environnementales à l’arsenic inorganique (Asi) et la prise en charge des populations concernées.MéthodeLa méthode d’élaboration utilisée est celle des Recommandations pour la pratique clinique (RPC) de la HAS (HAS, 2010).RésultatsLes recommandations élaborées identifient : les sites susceptibles d’entraîner des surexpositions environnementales, à partir de la concentration d’Asi dans leur sol ; la fraction des résidents qui constitue la population cible du dépistage ; les modalités de ce dépistage qui utilise le dosage de l’Asi et de ses métabolites dans les urines. En fonction des résultats du primo-dépistage, elles précisent les indications et le déroulement de la surveillance biométrologique. Elles indiquent la fraction de la population exposée qui constitue la cible de la recherche de complications de la surexposition environnementale à l’Asi. Elles précisent les modalités de cette recherche. Enfin, elles proposent des mesures pour le traitement et la prévention des contaminations par l’Asi de l’environnement