Accuracy of nasopharyngeal carcinoma staging by magnetic resonance imaging

To audit the accuracy of magnetic resonance (MR) staging of nasopharyngeal carcinoma (NPC) in daily reporting, the MR images of 101 adult patients with newly diagnosed NPC reported between December 1996 and February 2002 were reviewed retrospectively. Based on the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) TNM staging criteria (1997), the tumour staging obtained from the MR reports and the MR films was compared by two experienced head and neck radiologists. The number of patients being upstaged, downstaged or unchanged was noted. In all stages, the NPC staging obtained from the MR reports revealed 18 (17.8%) understaged, eight (7.9%) overstaged and 75 (74.2%) the same stage when compared to the staging obtained from the MR films based on the AJCC/UICC criteria. The percentage of patients being understaged or overstaged, in decreasing order of frequency, were stages II, III, IV and I. Magnetic resonance of NPC should be reported by radiologists who are not only familiar with the pathology of this condition and its pattern of spread but who should also base their reports on the AICC/UICC staging criteria. The necessity to improve our MR staging accuracy is largely because it determines the type of therapy to be given and this has to be appropriate and adequate for a successful treatment.     

Genetic analysis of cystic fibrosis in Denmark. Implications for genetic counselling, carrier diagnosis and prenatal diagnosis

Cystic fibrosis is the most common, severe, inherited disease in the Caucasian population. As a consequence, the demand for genetic counselling of patients with cystic fibrosis and their families is large. In Denmark the incidence of cystic fibrosis is 1:4700, which is quite low compared to other European countries. We have investigated 268 Danish cystic fibrosis patients with respect to DNA markers (haplotypes) and the most common mutation delta F508. The delta F508 mutation is found on 88% of all cystic fibrosis chromosomes, the highest frequency reported so far. This had had an important impact on genetic counselling, prenatal diagnosis and eventually population screening. In the Danish population 78% of all couples at risk will be informative for delta F508 and will be identifiable by simple screening methods.     

Ollier's disease and juvenile ovarian granulosa tumor

The authors report one case of Ollier's disease in a 12 year-old girl in whom the occurrence of an ascites revealed a secretant juvenile granulosa cell tumor some years later. The tumor was right-sided, homolateral to the hemicorporal side involved by enchondromatosis. Five other cases of this association were previously reported. Attention is drawn not only to the risk of chondrosarcomatous change but also to the possible recurrence of ovarian tumor in the year following ovariectomy.     

L'échelle de l'atmosphère dans les services psychiatriques (EAS)

Résumé Ce travail présente l'étude d'une traduction en français (EAS) du Ward Atmosphere Scale (WAS C) de MOOS (1974). Le questionnaire (100 items, 10 catégories) permet d'évaluer le consensus entre patients et membres du personnel concernant le climat social dans des services psychiatriques. Après un bref aperpu de l'élaboration du WAS C, du contenu, de l'administration et du dépouillement de l'EAS, les auteurs rapportent les résultats d'une étude d'application de l'EAS dans 12 services. Des comparaisons de normes, des mesures de fidélité (test-retest), homogénéité (consistance interne, corrélations item-catégorie), validité interne (corrélations inter-catégories) et validité externe (différenciation de divers types de services, associations entre certaines perceptions des services par les patients et succès ou échec de leur réadaptation) semblent confirmer la qualité de l'instrument et sa traduction.

---

Summary The use of a French translation (EAS) of MOOS's Ward Atmosphere Scale (WAS C) is reported. This questionnaire (100 items, 10 categories) allows the assessment of consensus between patients and staff members characterizing social climate on psychiatric wards. The elaboration of the WAS C is briefly described, as well as content, administration and evaluation of the EAS. The results obtained within 12 psychiatric wards are reported and measures of reliability (test-retest), homogeneity (internal consistency, item-category correlations) and internal (inter-category correlations) and external validity (differentiation of various types of wards, specific associations between patients' perceptions and success or failure of their readaptation) are given. These appear to confirm the quality of the instrument and its French translation.

---

---

Dir. Prof. Dr. L. Ciompi

---

Dir. Prof. Dr. Ch. Müller     

Carcinoid tumors of the appendix in children

 We report ten cases of carcinoid tumor of the appendix observed in children from 1988 to 1996. The patients included six females and four males with an average age of 13 years at presentation. They were admitted after complaining of pain in the lower abdominal quadrant. In eight children who presented with symptoms of acute appendicitis, the tumor was located at the tip of the appendix. Diagnosis was performed after appendicectomy (AE) and pathologic examination, which revealed a tumor slightly under 1 cm in size. Two other children were admitted with clinical signs of peritonitis due to larger tumors measuring more than 2 cm on the base of the appendix. One patient underwent a cecectomy, the other a right hemicolectomy. For all patients follow-up was 3 years, and all recovered fully. According to these findings and a review of the literature, we suggest conservative surgical procedures in children. More than 70% of these tumors are localized at the tip of the appendix and represent an incidental pathologic finding during AE; AE alone is curative. Patients with a bulky tumor of the appendicular base measuring 2 cm and invading the serosa and mesoappendix without metastases may be treated with a cecectomy; ileocecal resection may be indicated in cases where the tumor has infiltrated tissue beyond the cecum with localized metastases and in patients with incomplete gross resection. Right hemicolectomy is questionable in this age group and restricted to rare conditions. Accepted: 24 August 2000     

The influence of familial and hereditary factors on the prognosis of breast cancer

Background: Family history is a well recognized risk factor for breast cancer, but its impact in terms of breast cancer survival is uncertain. The recent identification of breast cancer predisposing genes has provided new clinical insights in this field.Design: English literature identified through Medline between 1976 and February 1999 was reviewed including search terms: breast cancer, survival, prognosis, family history, genetics, BRCA1, BRCA2, and related articles.Results: Publications were divided into three categories.Family history-based studies: eighteen articles were reviewed. Four studies showed a statistically significant better survival in patients with a family history of breast cancer, and two studies demonstrated a significantly worse prognosis in this context. The remaining articles showed no significant difference. Linkage studies: Two studies based on linkage to BRCA1 found that overall survival was better in linked families. A third one concluded to a worse outcome in BRCA2-linked tumors. Mutation-based studies: 10 studies looking at the association between germ-line mutations in BRCA1/BRCA2 and clinical outcomes were reviewed. Eight articles reported no significant difference in outcome, whereas two studies showed a worse outcome in patients with mutations.Conclusions: Conflicting data exist as to whether the prognosis of familial or hereditary breast cancer differs from that of sporadic cases. Some of the discrepancies may be explained by methodological differences or biases. However, no studies showed a survival advantage for BRCA1mutation carriers. This seems to indicate that BRCA1-related breast cancer is not associated with a survival advantage, and that in fact, certain BRCA1 germline mutations confer a worse prognosis. However, to adequately answer this question, more efficient molecular tools to identify all the genetic changes responsible for breast cancer predisposition, and large cohort studies to evaluate their clinical consequences, are needed.     

Performance of dental implants after staged sinus floor elevation procedures: 5-year results of a prospective study in partially edentulous patients

Objectives: The aim of this prospective study was to evaluate the 5‐year performance and success rate of titanium screw‐type implants with the titanium plasma spray (TPS) or the sand‐blasted, large grit, acid‐etched (SLA) surface inserted in a two‐stage sinus floor elevation (SFE) procedure in the posterior maxilla. Material and methods: A total of 59 delayed SFEs were performed in 56 patients between January 1997 and December 2001, using a composite graft with autogenous bone chips combined with deproteinized bovine bone mineral (DBBM) or synthetic porous β‐tricalcium phosphate (β‐TCP). After a healing period averaging 7.75 months, 111 dental implants were inserted. After an additional 8–14‐week healing period, all implants were functionally loaded with cemented crowns or fixed partial dentures. The patients were recalled at 12 and 60 months for clinical and radiographic examination. Results: One patient developed an acute infection in the right maxillary sinus after SFE and did not undergo implant therapy. Two of the 111 inserted implants had to be removed because of a developing atypical facial pain, and 11 implants were lost to follow‐up and were considered drop‐outs. The remaining 98 implants showed favorable clinical and radiographic findings at the 5‐year examination. The peri‐implant soft tissues were stable over time; the mean probing depths and mean attachment levels did not change during the follow‐up period. The measurement of the bone crest levels (DIB values) indicated stability as well. Based on strict success criteria, all 98 implants were considered successfully integrated, resulting in a 5‐year success rate of 98% (for TPS implants 89%, for SLA implants 100%). Conclusion: This prospective study assessing the performance of dental implants inserted after SFE demonstrated that titanium implants can achieve and maintain successful tissue integration with high predictability for at least 5 years of follow‐up in carefully selected patients.     

What patients and carers want to know: an exploration of information and resource needs in adult mental health services

OBJECTIVE: The objectives of this study were to: (i) obtain baseline data on the extent of carer involvement across a representative sample of hospital and community patients within an integrated area health service; and (ii) examine perspectives on discharge planning and community care among patients and their carers to identify information and resources they consider important. METHOD: Over a 4-month period, inpatients before discharge and patients accessing community mental health services participated in face-to-face interviews. Information was collected about carer involvement and, with the patient's consent, the identified carer was sent a similar survey to determine demographics and information needs. This resulted in a representative sample of patients and carers accessing inpatient and community settings across a metropolitan mental health service. Support needs and carer burden were also assessed but are not reported here. RESULTS: A total of 407 interviews were completed, 207 in inpatient settings and 200 in the community. An inpatient response rate of 70% and a community response rate of 75% was achieved. Across both settings, 67% of patients identified a carer and a carer response rate of 28% was then obtained. We found carers and patients have different priorities regarding the information they want and information is often not provided to carers. Furthermore, patients were more confident in their ability to manage their mental health in the community than carers. CONCLUSIONS: This study yielded important baseline data about the number of patients who have a carer. We were also able to determine that routine clinical information provided to patients and carers is inadequate from their perspective. It is anticipated that this initiative will assist ongoing service planning and improve partnerships with patients and their carers.     

African tick-bite fever: four cases among Swiss travelers returning from South Africa

BACKGROUND: African tick-bite fever (ATBF) is a recently described disease belonging to the spotted fever group. It is caused by Rickettsia africae, and cases are mainly diagnosed in travelers returning from sub-Saharan Africa. METHODS: We report four cases of ATBF among Swiss travelers returning from a 1-month trip in rural South Africa. Diagnosis was made on the basis of clinical, epidemiologic and serologic findings that we describe in detail. Serology was performed using microimmunofluorescence (MIF) assay 2 weeks, 6 weeks and 14 months after the commencement of symptoms. RESULTS: All patients developed the typical eschar and a rash; two had a local lymphadenopathy and one a lymphangitic reaction. Two patients developed transient neuropsychiatric symptoms such as headache, irritability and depressed mood. All four patients had rises in both IgM and IgG classes of anti-R. africae antibodies. After 1 year, only two patients still had measurable circulating antibodies. Cross-reactions with R. conorii were noted. Three patients were cured after a short course of doxycycline; one required 15 days of treatment. CONCLUSIONS: ATBF is a benign disease increasingly being diagnosed in travelers. After ruling out malaria, ATBF diagnosis relies upon a detailed travel history and the classical findings of influenza-like symptoms, fever, one or more necrotic eschars, and rash. Serologic tests usually help to confirm the diagnosis. Neuropsychiatric symptoms specifically associated with ATBF are reported here for the first time.