Travellers to high UV-index countries: sun-exposure behaviour in 7822 French adults

BACKGROUND: Travel health information includes warning on sun exposure, particularly for fair-skinned individuals travelling to tropical countries. METHOD: A self-completed questionnaire on sun exposure behaviour was sent to the 12,741 French adults enrolled in the SU.VI.MAX cohort. Among the 7822 participants, 196 (110 women and 86 men) declared at least one visit to a high UV-index country over the past year for more than 1 month, subsequently referred to as long-term travellers. The remaining 7626 participants (non-travellers) accounted for 4862 women and 2764 men. RESULTS: Women travellers declared more frequently skin exposure to the sun over the past year, practised tanning in high UV-index areas more than 2h daily, experienced intensive sun exposure than non-travellers. Moreover, they asserted that basking in the sun is very important. Comparable results were found in men. The use of sun protection products was similar in travellers and non-travellers, but women tended to use sunscreen products more often, more regularly and with a higher sun protection factor (SPF) than men. CONCLUSIONS: Specific health education campaigns and pre-travel advice aiming to reduce sun exposure and to improve protective measures against ultraviolet (UV) radiation should be addressed to travellers to countries with high UV-index.     

Coronary revascularization in end-stage renal disease

Advanced coronary artery disease and acute cardiac events are the most common causes of death in patients with end-stage renal disease. Because of their heightened risk, end-stage renal disease patients are frequently referred for coronary revascularization. However, these patients are almost always excluded from trials examining various innovations in medical and revascularization interventions for cardiovascular conditions. Extrapolation of trial conclusions regarding dialysis patients can be misleading because the risk-benefit ratios of various interventions in this patient population can be markedly different. Thus, clinical decisions regarding the need for (and type of) coronary revascularization are based on retrospective outcome analyses from various databases. This article reviews the data available in the literature on the morbidity, mortality, and outcomes of dialysis patients undergoing surgical or percutaneous revascularization, particularly with the addition of drug-eluting stents to the available therapeutic options.     

Closed-loop small-bowel obstruction: diagnostic patterns by multidetector computed tomography

ABSTRACT: Multidetector computed tomography is a highly accurate method in evaluating high-grade intestinal obstruction. Closed-loop obstruction is a relatively uncommon subcategory of small-bowel obstruction; however, it is associated with a high risk of vascular impairment and is, therefore, important to diagnose accurately. Closed-loop obstruction is often caused by conditions such as internal hernias, congenital bands, postoperative adhesions, and malrotation. The purpose of this article is to review the imaging features of closed-loop bowel obstruction and various underlying conditions. Special emphasis will be placed on the technique of multidetector computed tomography and its role in diagnosing this entity.     

Giant cell tumor complicating Paget disease of long bone

Giant cell tumor (GCT) is a rare complication of Paget disease of bone. It usually occurs in the skull or pelvic bones of patients with long-standing polyostotic disease. This report describes a 62-year-old patient who presented with monostotic Paget disease of the distal femur complicated by GCT. He had a 2-year history of discomfort and pain in his left knee. Conventional plain films and MRI demonstrated the characteristic bone changes of Paget disease and an associated lytic lesion involving the epiphyseal and metaphyseal regions of the distal femur. A diagnostic curettage showed the characteristic histopathologic features of Paget disease and GCT. There was no evidence of malignancy. The clinicopathologic features of this rare lesion are described and correlated with a review of the literature.     

Transurethral Resection of Bladder Tumor (TUR-BT) then Concomitant Radiation and Cisplatin Followed by Adjuvant Gemcitabine and Cisplatin in Muscle Invasive Transitional Cell Carcinoma (TCC) of the Urinary Bladder

Purpose: To evaluate the efficacy, safety, and tolerance of bladder preservation trimodality protocol combining maximal transurethral resection of bladder tumor (TURBT) with concomitant chemoradiation (CCRT) followed by adjuvant chemotherapy in patients with muscle invasive transitional cell carcinoma (TCC) of the bladder. Patients and Methods: Between January 2004 and May 2006, 40 patients with invasive TCC (T2-T4a) presented to the Radiation Oncology and Urosurgery departments - Ain Shams University hospitals and were enrolled in this prospective phase II study. Patients were treated using concurrent cisplatin and 45Gy radiotherapy (induction phase) after maximal TUR-BT. Patients were reevaluated 2 weeks after induction CCRT, by cystoscopy, repeated biopsy and urine cytology. Those with complete pathologic response (CR) received consolidation CCRT to 64.8Gy. Patients with less than CR were advised to undergo radical cystectomy (RC). Four cycles of adjuvant gemcitabine 1250mg/m2 on days 1 and 8 and cisplatin 70mg/m2 on day 1, repeated every 3 weeks, were given following definitive therapy. Results: Twenty-four patients achieved CR after initial 45Gy CCRT, 22 of them received additional consolidation CCRT. Eight of 14 patients who did not achieve CR after induction CCRT underwent RC. A total of 30 patients (75%) received adjuvant chemotherapy. Twenty percent (20%) and 13.7% of patients experienced at least one severe (grade 3) toxicity during induction and consolidation phase of CCRT, respectively, mainly neutropenia, cystitis, proctatitis and nausea and vomiting, while 46% experienced at least one severe (grade 3 or 4) toxicity during adjuvant chemotherapy, mainly neutropenia (32%), thrombocytopenia (11%) and nausea and vomiting (29%). Local and/or regional failure was recorded in 40% of patients and distant metastasis was reported in 25%. Eighteen patients (45%) retained functioning and healthy urinary bladder at the end of follow-up. The 2-year actuarial survival and progression free survival (PFS) were 67% (95% CI 52.2%-82.7%) and 58% (95% CI 42.3%-74.0%), respectively. There was significantly better 2 year survival for patients having complete TUR-BT before CCRT. Conclusion: Trimodality approach is a reasonable and safe alternative to RC with manageable toxicities. Longer follow-up with a larger number of patients is necessary to assess its impact on overall and disease-free survival. Key Words: Bladder cancer , Chemoradiotherapy , Cisplatin , Gemcitabine.     

Renal Doppler indices in diabetic children with insulin resistance syndrome

Ghaffar SAE, Kaffas KE, Hegazy R, Mostafa M. Renal Doppler indices in diabetic children with insulin resistance syndrome. End‐stage renal failure is still a leading cause of mortality among type 1 diabetes patients. Insulin resistance plays a larger role in type 1 diabetes disease process than is commonly recognized. Detection of diabetic nephropathy as early as possible currently offers the best chance of delaying or possibly preventing progression to end‐stage disease. Renal resistive index (RI) and pulsatility index (PI), measured using renal Doppler ultrasonography, reflect intrarenal vascular resistance. The present work aimed at examining renal Doppler indices (RI and PI) in type 1 diabetic children and their relation to features of insulin resistance and other established parameters of early diabetic nephropathy as microalbuminuria. One hundred diabetic children with a mean age of 13.4 ± 2.9 yr and an average diabetes duration of (7.2 ± 2.5 yr) were included. Thirty healthy children served as controls. All renal Doppler indices were significantly higher in children with type 1 diabetes mellitus (p ≤ 0.01). The worst parameters were observed in children diagnosed with insulin resistance syndrome (IRS) (38%), hypertensive (12%), and obese (4%) children. Resisitive index showed a significant correlation to blood pressure (r = 0.2, p = 0.04), waist–hip ratio (r = 0.5, p = 0.02), insulin dose (r = 0.2, p = 0.02) and estimated glucose disposal rate (r = ?0.5, p = 0.01). No correlation was noted to microalbuminuria, HbA1c, or duration of diabetes. The present work concluded that renal Doppler indices are worse in diabetic children and particularly those with IRS. These children appear to be at graver risk for diabetic nephropathy. In these patients adding renal Doppler assessment to their work up, might diagnose diabetic nephropathy at a prealbuminuric stage.     

Life cycle and attacks of ectoparasites on ruminants during the year in Central Europe: recommendations for treatment with insecticides (e.g., Butox®)

The occurrence of ectoparasites on ruminants throughout the yearly seasons was compiled from the literature and from our own experiments that were based on ultraviolet trap catches during the years 2007–2009. The data were listed in tables, which also contained details on the life cycles of flies, mosquitoes, tabanids, midges, simuliids, louse flies, mallophaga, sucking lice, etc. The breeding sites of those ectoparasites were described as well as their potential activity as vector of agents of diseases. Considering the places for overwintering, proposals were made when insecticidal products such as Butox® pour-on should be used in order to obtain good rearing results.     

Adverse maternal and neonatal outcome of prolonged course of magnesium sulfate tocolysis

BACKGROUND: Magnesium sulfate continues to be widely used as a tocolytic agent despite a paucity of evidence supporting its use. Many practitioners use prolonged courses of magnesium sulfate, sometimes for months. This study was conducted to determine maternal and neonatal outcome of patients exposed to prolonged tocolytic magnesium sulfate. METHODS: A retrospective review of maternal and neonatal charts (1995-2003) of pregnancies that received tocolytic magnesium sulfate. Cases who received magnesium sulfate >48 h (n=78) were compared to controls who received it < or =48 h (n=77) for maternal side effects and neonatal outcome. RESULTS: Cases were more likely to be nulliparous (55.1% versus 37.7%, p=0.044), multiple gestations (33.3% versus 10.4%, p=0.001), and of lower gestational age (29.0+/-3.9 versus 30.5+/-3.8 weeks, p=0.017) compared to controls. The median magnesium sulfate infused was 154 (78-5,500) versus 54 (8-86) g (p<0.001) and the highest maternal magnesium level was 6.5+/-1.7 versus 5.6+/-1.9 mg/dl (p=0.002) in cases and controls, respectively. Cases were more likely to have > or =1 adverse side effect (30.8% versus 15.6%, p=0.045). The median neonatal magnesium level was significantly higher in cases (3.3 (1.4-7.2) versus 2.6 (1.1-5.2) mg/dl, p=0.016); however, neonatal mortality and other neonatal morbidity rates were similar in both groups. Abnormal bone mineralization was encountered in 3 neonates (cases). CONCLUSIONS: Maternal morbidity rate is higher with prolonged intake of tocolytic magnesium sulfate compared to < or =48-h regimen. Despite similar neonatal morbidity and mortality rates, bone demineralization in the neonates may be encountered.