We report a case of acute respiratory distress syndrome (ARDS) in a 37-year-old man. Hypoxemia was refractory despite conventional treatment of ARDS, but the evolution was satisfactory after corticosteroid therapy. Biological data and the clinical evolution led us to the diagnosis of Churg-Strauss syndrome. This case incites us to reiterate that after having eliminating the usual causes of ARDS, the assumption of a systemic disease should be considered in order to begin the appropriate treatment as rapidly as possible.

C.A. SiegristA child with recurrent infections represents a challenge to the pediatrician who must identify, among a large number of repeatedly infected but nevertheless healthy children whose parents need to be reassured, the rare cases of potentially severe immune deficiency. This can be most successfully achieved through the measurement of IgA, IgG, and antibody titers to vaccine (tetanus, diphtheria, Haemophilus influenzae B) and exposure (pneumococcus) antigens. The presence of normal antibody responses makes it possible to rule out underlying immune deficiency in a sensitive and specific manner. Conversely, abnormally weak antibody responses identify the children who have to be referred without delay for further investigation of a potential immune defect. This article indicates for which pediatric patients an immunodeficiency screening should be considered, and how to analyze its results.

Parce que la scintigraphie est peu spécifique et trop sensible, deux marqueurs biochimiques du remodelage osseux, la désoxypyridinoline (DPYR) et le télopeptide C terminal du collagène de type I (CTX) ont été évalués au sein d'une population de patients avec un cancer bronchique dans le but de diagnostiquer, de façon précoce, les métastases osseuses.La population sans métastase montre une augmentation significative versus la population normale pour l'excrétion urinaire de la DPYR et le CTX. Au sein de la population avec métastase osseuse, l'augmentation des concentrations excrétées de DPYR et CTX est plus importante que celle de la population sans métastase ; cette augmentation est significative versus la population normale avec p < 0,0001 pour la DPYR et p < 0,0001 pour le CTX. Les valeurs seuil établies à partir des courbes ROC au sein de cette population sont pour la DPYR = 9.4 nmol mmol−1 de créatinine et pour le CTX = 429 μg mmol−1 de créatinine. Ces marqueurs doivent être utilisés avec prudence chez les femmes ménopausées.

This report describes a case of paraneoplastic neurological syndrome associating a subacute sensory neuronopathy and an intestinal pseudo-obstruction in a 64-year old man with a small cell lung cancer. Various paraneoplastic neurological syndromes have been described in association with small cell lung cancer. In our patient anti-Hu antibodies were identified by indirect immunohistochemistry and western-blot analysis. This antibody constitutes an informative tool in assessing the paraneoplastic origin of neurologic symptoms when the etiological inquiry is negative. Its positivity is important in promoting the search for an underlying malignancy and should lead to repeat investigations if the first investigations are normal.

We report a 72 patients trial, who had surgical treatments for non small cell lung cancer, stage II (T1N1, T2N1). In our retrospective study, the overall 5-years survival is 44%, with a 24-month median survival. 45% of the patients have recurrence mainly due to distant metastasis. State II appears to be an heterogeneous group. As shown in other studies, the presence of hilar nodes (N1H) seems to be linked with a pejorative outcome. In our series, the survival associated with Lobar N1 (N1L) disease is the same as the survival of Hilar N1 disease, but the initial sites of recurrence differ. The interest of a postchirurgical treatment is controversial. The postoperative radiotherapy reduces the local recurrence without increasing the survival. The chemotherapy treatment is debatable and several studies are under way. We reviewed the different causes of death. The appearance of second cancer in the cured patients is very frequent.

We report the case of a patient, 62-year-old, with a non small cell lung cancer treated by right pneumonectomy followed by chemo and radiotherapy. After surgery appeared a refractory hypoxemia increasing with supine position. Cardiac catheterism showed a right left shunt by reopening of the "foramen ovale". We have performed foramen's occlusion by endovascular method with prothetic material with good result until the death, 14 months later, by neoplasic evolution.

We report a 72 patients trial, who had surgical treatments for non small cell lung cancel; stage II (T1N1, T2N1). In our retrospective study, the overall 5-years survival is 44%, with a 24-month median survival. 45% of the patients have recurrence mainly due To distant metastasis. Stage II appears to be an heterogeneous group. As shown in other studies, the presence of hilar nodes (N1H) seems to be linked with a pejorative outcome. In our serie, the survival associated with Lobar N1 (N1L) disease is the same as the survival of Hilar N1 disease, but the initial sites of recurrence differ. The interest of a postchirurgical treatment is controversial. The post operative radiotherapy reduces the local recurrence without increasing the survival. The chemotherapy treatment is debatable and several studies are under way. We reviewed the different causes of death. The appearance of second cancer in the cured patients is very frequent.

This report describes a case of paraneoplastic neurological syndrome associating a subacute sensory neuronopathy and an intestinal pseudo-obstruction in a 64-year old man with a small cell lung cancer. Various paraneoplastic neurological syndromes have been described in association with small cell lung cancer. In our patient anti-Hu antibodies were identified by indirect immunohistochemistry and western-blot analysis. This antibody constitutes an informative tool in assessing the paraneoplastic origin of neurologic symptoms when the etiological inquiry is negative. Its positivity is important in promoting the search for an underlying malignancy and should lead to repeat investigations if the first investigations are normal.

Long-term low-dose methotrexate (MTX) has a proven beneficial effect in patients with rheumatoid arthritis; the main drawback being the risk of interstitial pneumonia. Although estimations have varied, in our recent prospective analysis we observed 4 cases among 124 receiving MTX for rheumatological disorders, i.e. a risk rate of 3.2% Age, sex, disease duration, administration route and daily or cumulative dose do not appear to affect risk, but recent work suggest that renal failure, concomitent use of nonsteroid anti-inflammatory drugs, smoking, past pulmonary history or radiographic anomalies as well as recent withdrawal of corticosteroids are risk factors. Pulmonary function tests can be used to detect acute disorders and regular testing has been proposed to help predicted pulmonary complications in patients receiving long-term MTX. Unfortunately, minimal variations observed to date, for example in forced vital capacity or expiratory volume, do not appear to occur prior to clinical manifestations and may be due to normal aging processes or the pathological effect of the rheumatoid disease itself. In addition, due to the proven efficacy of MTX, randomized trials against a control group not given MTX would be ethically unacceptable. We are thus still unable to predict development of secondary pulmonary complications to long-term low-dose MTX. We therefore recommend testing pulmonary function at treatment onset to establish a reference for subsequent tests performed in case of clinical manifestations during MTX therapy. Patients should be counselled to consult in case of pulmonary symptoms in order to allow diagnosis as early as possible. The most recent data also would suggest that MTX may induce infraclinical alterations of pulmonary function although their significance remains to be clarified.

Cases of cancer have been reported in patients with primary humoral immunodeficiency syndromes, mainly non-Hodgkin's lymphoma and gastric adenocarcinoma. Two cases of Hodgkin's disease complicating IgA and IgG subclass deficiency are reported. This association is probably more than mere coincidence. A review of the literature is presented.

We report the cases of two males who presented with spontaneous complete unilateral pneumothorax with ipisilateral liquid effusion. Neither had a history of previous respiratory disease. In both cases chest tube drainage resulted in recurrence of pneumothorax with chronic illness requiring surgical exploration. The surgery revealed a malignant pleural mesothelioma by histological examination. Thus, spontaneous pneumothorax, particularly with abondant effusion can be a revealing symptom of malignant pleural mesothelioma.

Bronchogenic carcinoma is the most frequent carcinoma of men and affect more often old patients. Medical oncologists and pneumologists don't treat or treat with less intensive therapies patients older than 70 or 75 years compared with younger patients. That behaviour is not based on scientific criterias. The majority of the published studies are in fact retrospective with a lot of biases (especially selection of patients). It doesn't seem that nephrotoxicity is greater in older patients with cisplatinum but the neurological, digestive and medullary toxicities are more important in older than in younger patients.

La frequence du cancer bronchique augmente avec l'âge. Face a ce fait, les medecins decident le plus souvent de ne pas traiter ou du moins de ne pas appliquer les memes traitements chez les sujets âges de plus de 70 ou 75 ans par rapport aux sujets jeunes. Cette attitude ne repose pas sur des criteres scientifiques solides. En effet, la plupart des etudes sont retrospectives et biaisees sur les criteres de selection des patients. Il ne semble pas que l'age soit un facteur predisposant a une nephrotoxicite accrue du cisplatine. L'âge, en revanche, semble favoriser la toxicite neurologique, digestive et medullaire de la chimiotherapie. Les cancers a petites cellules du poumon doivent etre traites quel que soit leur age grâce a des chimiotherapies « adaptees », avec de l'etoposide seul ou associe a du carboplatine. Quant au cancer non a petites cellules, des etudes prospectives doivent etre entreprises pour repondre a la question de l'utilite d'une chimiotherapie chez le sujet âge. Les decisions therapeutiques doivent etre prises en tenant compte du benefice attendu, de l'esperance de vie encore notable meme a 80 ans (6,9 ans) et du desir du patient.

STUDY OBJECTIVE Acute interstitial pneumonitis is the main pulmonary side effect during methotrexate (MTX) treatment for rheumatoid arthritis. The aim of the study was to determine the following: (1) the incidence of MTX-induced pneumonitis during low-dose long-term MTX treatment for chronic arthritis; (2) whether periodic pulmonary function tests were useful for detecting MTX pneumonitis before clinical symptoms; and (3) whether any subclinical abnormality of pulmonary function was present in asymptomatic patients receiving MTX treatment. DESIGN Pulmonary function tests, including diffusing capacity for carbon monoxide (DCO) measurements, were performed in 124 patients receiving low-dose MTX for rheumatologic diseases at the time of initiating treatment, and then at 3 months, 6 months, and at 6-month intervals thereafter. Mean duration of treatment was 23 months. RESULTS MTX treatment was interrupted in six patients for acute onset of clinical symptoms; criteria for diagnosis of MTX pneumonitis were fullfilled in four cases (incidence: 3.2%); no risk factor could be identified. No significant decrease in pulmonary function parameters could be observed before the onset of clinical symptoms of MTX pneumonitis, and this adverse effect could not be predicted by periodic function tests. A statistically significant decrease was found in FVC (-2.2%, p=0.04), FEV1 (-5.0%, p<0.001), and diffusing capacity per alveolar volume, DCO/VA (-4.8%, p=0.03), but not DCO (-1.3%, p>0.05), in the 118 other asymptomatic patients during MTX treatment. CONCLUSION We found minor subclinical alterations in pulmonary function in asymptomatic patients receiving low-dose long-term MTX treatment, but periodic pulmonary function tests did not allow us to detect MTX-induced pneumonitis before clinical symptoms. Therefore, we recommend that these tests should not be systematically performed while patients are receiving treatment.

Bronchogenic carcinoma is the most frequent carcinoma of men and affect more often old patients. Medical oncologists and pneumologists don't treat or treat with less intensive therapies patients older than 70 or 75 years compared with younger patients. That behaviour is not based on scientific criterias. The majority of the published studies are in fact retrospective with a lot of biases (especially selection of patients). It doesn't seem that nephrotoxicity is greater in older patients with cisplatinum but the neurological, digestive and medullary toxicities are more important in older than in younger patients.Small cell lung cancers have to be treated ill all patients irrespective of the age, with adapted chemotherapy (etoposide alone or in association with carboplatine). Prospective clinical trials with quality of life's studies have to be done in non small cell lung cancer in patients older than 70 years in attempt to assess the utility of chemotherapy.Therapeutic decisions have to take in consideration benefice, life expectancy still important at 80 years (6,9 years) and patient's willingness.