Intérêts des scores prédictifs de survie dans la prise en charge des patients atteints de cancer bonchique primitif non à petites cellules stades III-B et IV

Le cancer bronchique non à petites cellules (CBNPC) localement avancé ou métastatique est une maladie fréquente et grave, pour lequel un traitement spécifique est désormais proposé, quand l état général le permet. Les molécules dites de troisième génération et les thérapies ciblées ont permis une amélioration du pronostic de ces malades. Dans les essais thérapeutiques récents, la médiane de survie est d environ un an et le taux de survie à deux ans, d environ 12 %. La possibilité d une longue survie n est donc pas négligeable. Nous présentons ici les résultats d une étude rétrospective comparative de type cas-témoins concernant les longs survivants du service de pneumologie de l hôpital Ambroise Paré à Boulogne, dont le principal objectif est l évaluation, en pratique courante, de l intérêt des scores prédictifs de survie élaborés par F. Blanchon et T. Hoang. Huit patients ont été inclus dans chaque groupe. Aucune différence significative n a été observée en ce qui concerne certaines données cliniques et biologiques. L intérêt en pratique clinique des scores prédictifs de survie paraît limité. Dans le groupe des longs survivants, 4 patients ont répondu au gefitinib, de manière parfois prolongée, suggérant qu au delà des caractéristiques initiales du patient, la réponse au traitement est indispensable pour une longue survie.Locally advanced or metastatic non -small lung cancer (NSCLC) is a frequent and serious disease, for which a specific treatment is proposed, when the general status allows it. The third generation molecules and the targeted therapies allowed an prognosis improvement. In the recents therapeutic trials, the median survival is about one year the survival rate at two years is about 12 %. A long survival is also possible. We presents here the results of a comparative retrospective case-control study concerning the long survivors in the pneumology department in the Ambroise Pare medical hospital in Boulogne, France. The main objective is the evaluation, in current practice, of the survival predictive scores interest, which was elaborated by F. Blanchon and T. Hoang. Eight patients were included in every group. No significant difference was observed as regards certain clinical and biological data. The survival predictive scores interest in the clinical practice seems limited. In the long survivors group, we observed an improvement in 4 patients with gefitinib, in a sometimes prolonged way, suggesting that beyond the patients initial characteristics, the treatment response is indispensable for a long survival.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Atteinte pulmonaire dans la maladie de Rendu-Osler

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Apport de l'étude cytologique de l'aspiration bronchique prélevée au cours d'une endoscopie dans le diagnostic des carcinomes bronchiques

PARIS5-BU Méd.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Characterization of ion and fluid transport in human bronchioles.

The regulation of the volume and composition of airway surface liquid is achieved through epithelial ion transport processes. In humans, these processes have been characterized in proximal but not distal airways. Segments of human bronchioles were dissected from surgically removed lung pieces. The transmural potential difference of microperfused bronchioles was inhibited by luminal exposure to amiloride and increased when exposed to the Cl secretagogues forskolin and ATP in the presence of amiloride. Human bronchiolar epithelial cells were cultured on permeable supports and studied in Ussing chambers. They generated a short circuit current (Isc) that decreased in response to amiloride and increased in response to forskolin and to ATP in the presence of amiloride. In low-Cl Kreb's Ringer bicarbonate, the baseline Isc and amiloride-induced decrease in Isc were not different, whereas the forskolin- and ATP-induced increases in Isc were smaller. Fluid transport measurement in excised bronchioles revealed a basal absorptive flow that was reduced by amiloride, whereas forskolin and ATP combined induced a secretory flow in the presence of amiloride. We conclude that human bronchioles actively absorb Na and fluid in unstimulated conditions and are capable of active Cl and fluid secretion when exposed to forskolin and to ATP

Impact of pulmonary arteriovenous malformations on respiratory-related quality of life in patients with hereditary haemorrhagic telangiectasia.

Fifteen to fifty percent of patients with hereditary haemorrhagic telangiectasia have pulmonary arteriovenous malformations. The objective of this study was to measure the effect of the presence of pulmonary arteriovenous malformations and of their embolisation on respiratory-related quality of life (QoL). We prospectively recruited patients with a diagnosis of hereditary haemorrhagic telangiectasia based on the Curaçao criteria and/or the identification of a pathogenic mutation. Respiratory-related quality of life was measured using the Saint George's Respiratory Questionnaire (SGRQ). Patients who underwent embolisation of pulmonary arteriovenous malformations completed the questionnaire before and 6-12 mo after the procedure. The 56 participants were divided into three groups: no pulmonary arteriovenous malformation (group A, n = 10), small pulmonary arteriovenous malformations not accessible to embolotherapy (group B, n = 19), and large pulmonary arteriovenous malformations accessible to embolotherapy (group C, n = 27). The SGRQ score was significantly higher in group C compared to the other groups, indicating a worse respiratory-specific QoL. There was no significant difference between groups A and B. Among the 17 patients who underwent an embolisation, the SGRQ score decreased significantly after the procedure, to a value similar to that in patients without pulmonary arteriovenous malformation. Our results indicate that the presence of large but not small pulmonary arteriovenous malformations negatively affects the respiratory-related quality of life and that embolisation of pulmonary arteriovenous malformations normalizes the respiratory-related quality of life