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IFCT study administering 7.5 mg/kg Bevacizumab plus chemotherapy after chemotherapy induction did not improve outcomes in extensive SCLC patients. Background This randomized phase II–III trial sought to evaluate the efficacy and safety of adding bevacizumab (Bev) following induction chemotherapy (CT) in extensive small-cell lung cancer (SCLC). Patients and methods Enrolled SCLC patients received two induction cycles of CT. Responders were randomly assigned 1:1 to receive four additional cycles of CT alone or CT plus Bev (7.5 mg/kg), followed by single-agent Bev until progression or unacceptable toxicity. The primary end point was the percentage of patients for whom disease remained controlled (still in response) at the fourth cycle. Results In total, 147 patients were enrolled. Partial response was observed in 103 patients, 74 of whom were eligible for Bev and randomly assigned to the CT alone group (n = 37) or the CT plus Bev group (n = 37). Response assessment at the end of the fourth cycle showed that disease control did not differ between the two groups (89.2% versus 91.9% of patients remaining responders in CT alone versus CT plus Bev, respectively; Fisher's exact test: P = 1.00). Progression-free survival (PFS) since randomization did not significantly differ, with a median PFS of 5.5 months [95% confidence interval (CI) 4.9% to 6.0%] versus 5.3 months (95% CI 4.8% to 5.8%) in the CT alone and CT plus Bev groups, respectively [hazard ratio (HR) for CT alone: 1.1; 95% CI 0.7% to 1.7%; unadjusted P = 0.82]. Grade ≥2 hypertension and grade ≥3 thrombotic events were observed in 40% and 11% of patients, respectively, in the CT plus Bev group. Serum vascular endothelial growth factor (VEGF) and soluble VEGF receptor titrations failed to identify predictive biomarkers. Conclusion Administering 7.5 mg/kg Bev after induction did not improve outcome in extensive SCLC patients.

Introduction L’echographie thoracique est indispensable a la pratique du pneumologue, ameliorant diagnostic et securite des gestes pleuraux mais aussi le diagnostic de pathologies pleurales, pulmonaires et parietales. Ainsi les biopsies echoguidees de lesions echovisibles sont rapides et sures et d’une sensibilite diagnostique equivalente aux ponctions sous scanner. Nous rapportons ici notre experience. Methodes Etude retrospective descriptive bicentrique portant sur 209 patients ayant eu une biopsie echoguidee dans les services de pneumologie du CH de Saint Omer ( n = 126) et du CHI de Creteil ( n = 83). Le site des lesions, la rentabilite diagnostique et les complications ont ete notes. Resultats La lesion biopsiee etait pulmonaire chez 134, pleuro-parietale chez 49, mediastinale chez 12, ganglionnaire (cervicale, sus-claviculaire ou axillaire) chez 12 ou des parties molles extra-thoraciques chez 2. Un diagnostic histologique definitif a ete obtenu chez 188 patients sur les 209 (90 %), 90 % pour les lesions pulmonaires, 91 % pour les lesions mediatisnales, 84 % pour les lesions pleuro-parietales, 100 % pour les adenopathies et les metastases extra-thoraciques. Les complications, au nombre de 10 (4,7 %), ont necessite une intervention specifique et une hospitalisation dans 2 cas (1 %). Il s’agissait de 5 PNT dont 1 a necessite un drainage, de 3 hemoptysies dont une a necessite une embolisation arterielle bronchique et de 2 hematomes de paroi. Conclusion La biopsie echoguidee est une technique simple, non irradiante facilement accessible au pneumologue avec une rentabilite diagnostique elevee au prix d’un faible taux de complication le plus souvent de resolution spontanee.

To assess the usefulness of electron microscopy of the aqueous cells when confronted with the clinical association of rhegmatogenous retinal detachment after trauma, high intraocular pressure (IOP) and aqueous cells.We report a clinical history of a 50-years-old man who had ocular trauma with perforation in 1944, intraocular lens for traumatic cataract in 1988, Yag capsulotomy in 1993 and retinal detachment with oral dialysis, high IOP and aqueous cells in anterior chamber in 1995. During the surgical therapy we performed an anterior chamber puncture to analyse the aqueous cells. An electron microscopic study was performed on 0.2 ml of aqueous humor mixed in the same volume of 2.5% glutaraldehyde and fixed with 1% osmium acid.Electron microscopic ultrastructural study of the aqueous cells showed numerous photoreceptor outer segments, some of them appearing degenerated.The combination of rhegmatogenous retinal detachment with tears near the ora serrata, high IOP and aqueous cells in the anterior chamber should lead the physician to do an anterior chamber puncture and analyse the aqueous cells structure. The combination of those three clinical signs associated with the photoreceptor outer segments in the anterior chamber allowed to diagnose the Schwartz-Matsuo syndrome.

Evaluation of cyclosporin-A in prevention of immune reaction in high-risk penetrating keratoplasties.Cyclosporin A was given to 45 corneal allograft recipients, 5 mg/kg/j (cyclosporinemy between 100 and 150 ng/l), for three months following surgery. 45 controls have undergone penetrating keratoplasty during the same period. Mean follow-up was respectively 431 days and 402 days. Survival was analysed according to Kaplan-Meier's method, and then using Cox model.The significant predictive factors were the number of neovascularized quadrants, and the graft diameter. No significant effect of cyclosporin is evidenced. Side effects are marginal.Three hypothesis may explain the absence of prognosis improvement in the Cyclosporin A treated group: insufficient dose or duration of treatment, individual risk factors that prevents correct pairing, or corneal-specific immunological mechanisms.

A 39 year old female with severe respiratory insufficiency by bronchiectasis is treated by assisted ventilation at home. Indication is discussed.