Intention de changement de comportement lors de la campagne de santé publique Vas-Y au Québec

PurposeThe present study examined associations between intention of youth to change their health behaviours and the messages of a media campaign held in Québec from 2004 to 2008, designed to increase awareness on active living and healthy eating's health benefits.MethodsSix hundred and three parent-youth dyads from primary and secondary schools participated to this cross-sectional survey by questionnaire at the end of the campaign. The intention to behaviour change in youth aged 10–16 years and their parents, their respective perceptions of the campaign's messages and their exposition to the campaign according to their school level were analyzed.ResultsSeventy-eight percent of youth heard about the campaign. One third of those having indicated that they knew the messages aimed at changing one or two behaviours. Youth from primary school vs. high school (P = 0.008) and those with a positive perception of messages (P < 0.001) were youths with the highest intention to change their behaviour.ConclusionThe high level of awareness reached in such a short period suggests that campaigns with motivating messages can be used to influence attitudes and intentions to adopt healthy eating and active living.     

Impacto de los factores de riesgo en la eficacia y complicaciones de la biopsia hepática percutánea ecoguiada de lesiones ocupantes de espacio

IntroductionUltrasound-guided percutaneous liver biopsy is considered the technique of choice for the histological diagnosis of space-occupying lesions, given its high level of safety and diagnostic performance. However, since it is an invasive diagnostic procedure, complications can occur. Various clinical and radiological parameters have been analyzed as factors related with the efficacy of the technique or with its complications; however, the results have been contradictory. Thus, we aimed to evaluate the impact of various risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy in the diagnosis of space-occupying lesions in ordinary clinical practice.Material and methodsThis retrospective observational study included all patients who underwent real-time ultrasound-guided percutaneous biopsies of space-occupying liver lesions with the free-hand technique between December 2012 and February 2018 in the diagnostic imaging department at the Hospital Clínico Universitario de Santiago de Compostela. We analyzed the following risk factors: location of the lesion in upper liver segments (II, IVa, VII, or VIII); proximity to the liver capsule, distance from the skin > 100 mm, interposition of osseus or vascular structures, inability to go through healthy parenchyma, and lack of patient cooperation during the procedure. Efficacy was analyzed in terms of the number of cylinders obtained and the percentage of adequate biopsies; safety was analyzed in terms of the percentage of complications, which were classified as major or minor.ResultsWe included 295 biopsies in 278 patients (median age, 69 years; 64.1% male; 44.7% had prior neoplasms). In 61.4%, the biopsy was indicated for the initial diagnosis; 82.4% of biopsies were done in hospitalized patients, and 65% of the lesions were located in the right liver lobe.The median number of cylinders obtained was 3 (range 1-6); 91.2% of the biopsies were adequate and 92.2% were considered clinically useful. These percentages did not differ significantly according to the presence of risk factors. Complications occurred in 10 (3.4%) patients. Complications were considered major in 3 (0.9%) patients (2 (0.6%) bleeding complications and 1 (0.3%) infectious complication) and minor in 7 (2.4%). The percentage of complications was significantly higher in patients who did not cooperate during the procedure (p=0.04).ConclusionsUltrasound-guided percutaneous liver biopsy is an efficacious and safe technique for the histological diagnosis of space-occupying liver lesions. Our results confirm the increased rate of complications when patients fail to cooperate during the procedure.     

Estudio de las enfermedades de las trompas de Falopio mediante resonancia magnética

Knowledge about fallopian tube disease is essential in the assessment of the pelvis in female patients. Primary and secondary changes in the tubes vary widely, regardless of whether associated changes in the ovaries are present. Ultrasonography is the initial technique in the study of adnexal disease because it is very sensitive and widely available; however, MRI is also very useful in this context because its high tissue resolution and anatomic detail make it more specific. The morphologic findings and the characteristics of the contents of the tubes on MRI enable a more accurate diagnosis or limit the differential diagnosis, helping to ensure that the most appropriate treatment is provided in each case.     

Fracture de fatigue de l'humérus. À propos de trois cas

Three cases of stress fractures of the humeral shaft are reported. The first, a complete spiroid fracture, was observed after a rope climbing exercise following an intensive training period. The two others, radiologically not so spectacular, occurred during the first weeks of this training. The three fractures represent the three different clinical stages. Intensive training and repetitive stress won over an otherwise wonderfully adapted bone structure. Treatment remains orthopaedic, even in the case of the spiroid fracture, with a perfect functional result.     

Effet de l'instruction sur la régulation de la raideur des membres inférieurs lors de sauts de contre-haut

Goal. – We tested in this study the possibility of influencing leg stiffness through instructions on the knee flexion in drop jump (30 and 60 cm).Method. – Twelve basket players were instructed to jump with three different instructions: 1) “jump as high as you can”; 2) jump high with a larger knee flexion at touch-down and 3) jump high with a smaller knee flexion at touch-down. The ground reaction force were measured with an AMTI force plate (500 Hz). The kinematics of the jump was recorded using two digital cameras (50 Hz).Results. – The results show that the ground reaction force pattern depended more on the instruction than on the height of the box. The active peak decreased from 6 times the body weight (BW) to 2.9 times BW. Bending the knee appears to be an efficient strategy to increase the leg stiffness [R =0.86; P <0.05].Conclusion. – The instructions high knee flexion decreases the leg stiffness. The same vertical jump performance could be achieved with different values of stiffness. The maximum knee flexion does not modify the vertical performance.     

Extravasación de medios de contraste intravenosos en el sitio de la punción: Protocolo de actuación

The incidence of contrast medium extravasation at the venipuncture site has increased with the generalized use of automatic injectors. Most extravasations only cause slight edema and erythema. Nevertheless, in some cases extravasation can result in severe skin lesions or even in compartment syndrome. Lesions caused by extravasation usually resolve spontaneously with conservative treatment. Although the complications of extravasation are well known, institutional protocols are normally lacking and the criteria for taking action and the type of treatment, whether based on the literature or personal preferences, tend to vary. In this article, we review the incidence, risk factors, clinical manifestations, and options for preventing and treating contrast medium extravasation in soft tissues. Finally, we present the protocol we use to manage extravasation at our hospital.     

Optimización de los protocolos y del uso de contrastes en tomografía computarizada de los equipos de tomografía por emisión de positrones

The introduction of PET/CT scanners in clinical practice in 1998 has improved care for oncologic patients throughout the clinical pathway, from the initial diagnosis of disease through the evaluation of the response to treatment to screening for possible recurrence. The CT component of a PET/CT study is used to correct the attenuation of PET studies; CT also provides anatomic information about the distribution of the radiotracer. CT is especially useful in situations where PET alone can lead to false positives and false negatives, and CT thereby improves the diagnostic performance of PET. The use of intravenous or oral contrast agents and optimal CT protocols have improved the detection and characterization of lesions. However, there are circumstances in which the systematic use of contrast agents is not justified. The standard acquisition in PET/CT scanners is the whole body protocol, but this can lead to artifacts due to the position of patients and respiratory movements between the CT and PET acquisitions. This article discusses these aspects from a constructive perspective with the aim of maximizing the diagnostic potential of PET/CT and providing better care for patients.     

Cribado poblacional de cáncer de mama. Certezas,controversias y perspectivas de futuro

Population-based breast cancer screening programs based on mammography must maintain a high level of quality, so the results must be constantly monitored. Although most authors consider that these programs have decreased the mortality due to breast cancer by about 30%, others claim that the mortality has decreased by only about 12% due to errors in the randomization of patients, because the rate of advanced tumors has hardly decreased and because adjuvant treatment also improves survival. Other criticisms focus on overdiagnosis and overtreatment. We believe that despite the unquestionable value of mammographic screening, we should be open to certain changes such as the stratification of patients by their level of risk and the introduction of complementary techniques like tomosynthesis, ultrasonography, and magnetic resonance imaging in selected cases.     

Síndrome de Cockett o de May-Thurner o síndrome de compresión de la vena ilíaca

Iliac vein compression syndrome (also known as May-Thurner syndrome or Cockett's syndrome) is a rare clinical entity in which the left common iliac vein is compressed when it passes between the right common iliac artery and the spine. The sustained compression and trauma caused by the pulsatile force of the artery on the vein damage the intima and lead to the formation of membranes or bands in the vascular lumen that hinder or obstruct the flow of blood in the vein, favoring thrombus formation. The current treatment strategy of choice is endovascular vein patch angioplasty and stenting with the aim of improving the caliber of the lumen and enabling normal venous drainage. We present two cases of May-Thurner syndrome and review the clinical and CT findings.