Dysplastic naevus in non-familial melanoma. A clinicopathological study of 101 cases

In 101 patients with non-familial cutaneous melanoma (CM), melanocytic naevi were counted and classified according to clinical criteria. Only 8% of the patients had very atypical naevi. These atypical naevi were few in number and only one patient exhibited dysplastic naevus syndrome. An histological study was undertaken on the hypothesis that, in a given individual, if the most clinically atypical naevus is not histologically dysplastic it is unlikely that any of the others are. The most clinically atypical naevus in each patient was biopsied. Estimated in this way the prevalence of dysplastic naevi in patients with non-familial CM was only 18%. Comparison of patients with and without dysplastic naevi did not suggest that they constituted two different subsets. An attempt to correlate clinical diagnosis and histological features in this group of patients showed that the diagnosis of dysplastic naevi on the basis of clinical criteria alone is difficult and not reliable.     

Unusual presentation of ulnar artery aneurysm and dissection with associated anomalous radial artery: appearances on multi-detector row CT angiography

We present a case of ulnar artery aneurysm and dissection associated with a congenitally hypoplastic ipsilateral radial artery. We postulate that the aetiology is due to increased blood flow through the ulnar artery as a consequence of the radial artery anomaly, therefore making the ulnar artery more vulnerable to aneurysm formation and traumatic damage. This might represent a variant of the hypothenar hammer syndrome with associated ulnar artery dissection and recurrent distal embolisation manifesting as Raynaud’s phenomenon. Forearm arterial injuries, treatment and the importance of upper limb arterial anatomical variations are also discussed. To our knowledge, this is the first reported case of its type diagnosed by multi-detector row computed tomography angiography.     

Improving attitudes towards children with disabilities in a school context: a cluster randomized intervention study

Aim Although inclusive education of disabled children is now an accepted practice, it is often challenged by negative peer attitudes. We undertook an interventional study aimed at improving students’ attitudes towards their disabled peers. Method The participants were students from the 7th grade of twelve paired schools (1509 students from 62 classes; age 12–13y), randomly allocated to an intervention group (205 males, 285 females) or a control group (132 males, 165 females). The intervention consisted of a mandatory comprehensive educational project on disability. The Chedoke‐McMaster Attitudes Towards Children with Handicaps Scale (CATCH) was used to assess children’s attitudes before (T0) and after (T1) intervention. The hierarchical structure of the data was taken into account by adjusting standard deviations and using linear multilevel models. Results Seven hundred and eighty‐four students had at least one score on the three domains (cognitive, affective, behavioural) of the CATCH at T0 and T1. The final scores were higher than baseline scores (total scores, intervention group: baseline score 25.6 (SD=5.4), final score 26.8 (5.9), p<0.001; Control group: baseline 25.2 (5.4), final 26.0 (5.7), p<0.009) with no significant difference between the intervention and control groups. Individual score changes over time were associated with baseline score (p<0.001 for total and all sub‐scores). Lower improvement in attitudes was found in students from schools with special units for their peers with cognitive impairment for total (p=0.013), affective (p<0.001), and behavioural (p=0.001) scores, while higher improvement existed for the cognitive domain (p=0.029). Interpretation Although we found no effect of our intervention, we found an improvement in attitudes in the intervention and control groups that could be a result of the nature of the scales and questionnaires the students had to complete before the intervention.     

儿童外伤后大脑氧合作用与损伤严重程度及预后的相关性

介绍:创伤是儿童最常见的死亡原因。它容易导致弥漫性原发性脑损伤,且可由于继发性病变(比如:缺氧、低血压)而加重脑损伤。标准的监护包括:颅内压(ICP)、大脑灌注压的监测,但二者均不能反映大脑真实的氧合作用[氧输送(DO2)]情况。本研究探讨脑组织氧气定向重点治疗指南的优点。     

How can health services effectively meet the health needs of homeless people?

BACKGROUND: Homelessness affects many people in contemporary society with consequences for individuals and the wider community. Homeless people experience poorer levels of general physical and mental health than the general population and there is a substantial international evidence base which documents multiple morbidity. Despite this, they often have problems in obtaining suitable health care. AIM: To critically examine the international literature pertaining to the health care of homeless people and discuss the effectiveness of treatment interventions. DESIGN OF STUDY: Review and synthesis of current evidence. METHOD: Medline (1966-2003), EMBASE (1980-2003), PsycINFO (1985-2003), CINAHL (1982-2003), Web of Science (1981-2003) and the Cochrane Library (Evidence Based Health) databases were reviewed using key terms relating to homelessness, intervention studies, drug misuse, alcohol misuse and mental health. The review was not limited to publications in English. It included searching the internet using key terms, and grey literature was also accessed through discussion with experts. RESULTS: Internationally, there are differing models and services aimed at providing health care for homeless people. Effective interventions for drug dependence include adequate oral opiate maintenance therapy, hepatitis A, B and tetanus immunisation, safer injecting advice and access to needle exchange programmes. There is emerging evidence for the effectiveness of supervised injecting rooms for homeless injecting drug users and for the peer distribution of take home naloxone in reducing drug-related deaths. There is some evidence that assertive outreach programmes for those with mental ill health, supportive programmes to aid those with motivation to address alcohol dependence and informal programmes to promote sexual health can lead to lasting health gain. CONCLUSIONS: As multiple morbidity is common among homeless people, accessible and available primary health care is a pre-requisite for effective health interventions. This requires addressing barriers to provision and multi-agency working so that homeless people can access the full range of health and social care services. There are examples of best practice in the treatment and retention of homeless people in health and social care and such models can inform future provision.     

Absence of breast cancer cells in a single-day peripheral blood progenitor cell collection after priming with cyclophosphamide and granulocyte-macrophage colony-stimulating factor

The effect of priming on occult tumor cell involvement of peripheral blood (PB) and PB progenitor cell (PBPC) collections is poorly characterized. Using sensitive immunocytochemistry (ICC) and tumor clonogenic assays (TCA) specific for epithelial-derived tumor cells, hematopoietic specimens were analyzed for PBPC and occult tumor cell involvement in 28 patients with chemotherapy-sensitive stage IIIB or IV breast cancer. Before PBPC priming, tumor was detected by ICC in PB of 1 of 23 (4%) patients and in bone marrow (BM) harvests of 4 of 27 (15%) patients. Fifteen days after cyclophosphamide and granulocyte- macrophage colony-stimulating factor (GM-CSF) priming, 2 of 28 (7%) patients had ICC-positive PBPC collections. The median amplification of CD34+ PBPC during this time was over 19-fold (range, < 1 to 199). One patient had pretreatment tumor involvement of both PB and BM. One patient grew tumor colonies in TCA; the PB and BM were ICC- and TCA- positive, but the PBPC collection was ICC-positive and TCA-negative. After cytoreduction with conventional-dose chemotherapy, patients with advanced breast cancer and histologically negative BM biopsy specimens have rare tumor cell involvement of PB and BM. Despite effective PBPC priming with cyclophosphamide and GM-CSF, clonogenic breast cancer cells were not found in the PBPC collection performed on day 15.     

Environmental risk factors for oesophageal cancer in Malawi: A case-control study

Aim

There is a high burden of oesophageal cancer in Malawi with dismal outcomes. It is not known whether environmental factors are associated with oesophageal cancer. Without knowing this critical information, prevention interventions are not possible. The purpose of this analysis was to explore environmental factors associated with oesophageal cancer in the Malawian context.

Methods

A hospital-based case-control study of the association between environmental risk factors and oesophageal cancer was conducted at Kamuzu Central Hospital in Lilongwe, Malawi and Queen Elizabeth Central Hospital in Blantyre, Malawi. Ninety-six persons with squamous cell carcinoma and 180 controls were enrolled and analyzed. These two groups were compared for a range of environmental risk factors, using logistic regression models. Unadjusted and adjusted odds ratios and 95% confidence intervals (CI) were calculated.

Results

Firewood cooking, cigarette smoking, and use of white maize flour all had strong associations with squamous cell carcinoma of the oesophagus, with adjusted odds ratios of 12.6 (95% CI: 4.2–37.7), 5.4 (95% CI: 2.0–15.2) and 6.6 (95% CI: 2.3–19.3), respectively.

Conclusions

Several modifiable risk factors were found to be strongly associated with squamous cell carcinoma. Research is needed to confirm these associations and then determine how to intervene on these modifiable risk factors in the Malawian context.     

Use of oral rehydration therapy in the treatment of childhood diarrhoea in Douala,Cameroon

Introduction

The use of oral rehydration solutions in our context remains limited. This study was conducted to analyze the rate of this use in Douala, Cameroon and thereby determine the factors associated with it.

Method

A cross-sectional survey was administered to parents of children aged five years and younger during a six-month study period. The studied variables focused on the socio-demographic data of the population, data on diarrhoea and its severity, data on oral rehydration salts (ORS), and data related to other interventions for diarrhoea. The chi-square test was used to qualify associations between variables, with the significance level being set at 5%.

Results

Overall, 672 people agreed to participate in the study. Among them, 418 (62.2%) correctly defined diarrhoea. When their children develop diarrhoea, the majority of the parents (348, 51.8%) reported seeking hospital assistance before any intervention, while 225 parents (33.5%) preferred the use of ORS first. Four hundred seventy-five parents (70.7%) had heard of ORS and among them 313 (65.9%) had actually given ORS to their children as treatment during these children''s most recent episodes of diarrhoea. Of the parents who had given their children ORS, 217 (69.3%) knew how to prepare it, and 122 (39.0%) knew how to administer it. One hundred thirty-five parents (20.1%) had administered metronidazole to treat their children''s diarrhoea. The age of the children, the parents'' level of education, and the number of children in the household significantly influenced the use or non-use of ORS (respectively, p < 0.001, p = 0.003 and p < 0.0001). Rehydration was correctly identified by 234 parents (34.8%) as the purpose of administering ORS.

Conclusion

The knowledge and the use of ORS in diarrhoea by the study sample was insufficient. The role of ORS was poorly known. Awareness campaigns can be carried out in order to improve the use of this effective intervention for diarrhoea.