Place des gamma-caméras portables en cancérologie mammaire

Non-palpable breast cancers are more and more frequent. Their surgical management requires the excision of the tumor and sentinel lymph node (SLN) needing a technical preoperative organization combining preoperative identification of the tumor by wire guide and injection of a radioactive tracer for the identification of SLN. The implementation of this minimally invasive surgery is sometimes paradoxically complicated due to the presurgical organization requiring several medical teams. It is for this reason that hand-held gamma-cameras have been developed, used either preoperatively or during surgery to replace lymphoscintigraphy but also as a help to excision of the tumor after radioisotope injection. The objective of this study was to evaluate the interest of the main hand-held gamma-cameras used in breast cancer.     

Peer Reviewed: Awareness, Treatment, and Control of Hypertension and Hypercholesterolemia Among Insured Residents of New York City, 2004

Introduction

Health care access and sociodemographic characteristics may influence chronic disease management even among adults who have health insurance. The objective of this study was to examine awareness, treatment, and control of hypertension and hypercholesterolemia, by health care access and sociodemographic characteristics, among insured adults in New York City.

Methods

Using data from the 2004 New York City Health and Nutrition Examination Survey, we investigated inequalities in the diagnosis and management of hypertension and hypercholesterolemia among insured adults aged 20 to 64 years (n = 1,334). We assessed differences in insurance type (public, private) and routine place of care (yes, no), by sociodemographic characteristics.

Results

One in 10 participants with hypertension and 3 in 10 with hypercholesterolemia were unaware and untreated. Having a routine place of care was associated with treatment and control of hypertension and with awareness, treatment, and control of hypercholesterolemia, after adjusting for insurance type, age, sex, race/ethnicity, foreign birth, income, and education. Differences in systolic blood pressure and total cholesterol between people with versus without a routine place of care were 2 to 3 times the difference found between people with public versus private insurance. Few differences were associated with sociodemographic characteristics after adjusting for routine place of care and insurance type; however, male sex, younger age, Asian race, and foreign birth with short-term US residence reduced the odds of having a routine place of care. Neither income nor education predicted having a routine place of care.

Conclusion

Sociodemographic characteristics may influence chronic disease management among the insured through health care access factors such as having a routine place of care.     

Seroprevalence of herpes simplex virus type 2 and characteristics associated with undiagnosed infection: New York City, 2004

BACKGROUND: Herpes simplex virus type 2 (HSV-2) infection is associated with substantial morbidity and increased risk for human immunodeficiency virus acquisition. We describe HSV-2 seroprevalence in adult New Yorkers, and examine the relationship between select characteristics, infection, and diagnosis. METHODS: HSV-2 seroprevalence and risk factors were measured using the 2004 New York City Health and Nutrition Examination Survey, a population-based cross-sectional survey of adults. HSV-2 seroprevalence and corresponding 95% confidence intervals were computed for select characteristics. Associations between proposed risk factors and HSV-2 infection and diagnosis were estimated using unadjusted and adjusted odds ratios. RESULTS: Nearly 28% of adults were infected with HSV-2; 88.4% of HSV-2 positive persons were undiagnosed. Black women had the highest seroprevalence (59.7%) of any sex or race/ethnicity group. Women, non-Hispanic blacks, and Hispanics (vs. non-Hispanic whites), and men who have sex with men were at greater odds of HSV-2 infection. Among HSV-2 infected individuals, non-Hispanic blacks (vs. non-Hispanic whites), uncircumcised men, and those with no routine place of care were less likely to be diagnosed. CONCLUSIONS: HSV-2 is highly prevalent and largely undiagnosed in New York City; seroprevalence varies by subgroup. Targeted HSV-2 screening, counseling and treatment may help reduce transmission of HSV-2 and human immunodeficiency virus.     

Pediatric narrative oncology: interprofessional training to promote empathy, build teams, and prevent burnout

The aim of this study was to test the feasibility and effectiveness of providing narrative training to a mixed group of doctors, nurses, social workers, and child life therapists on a pediatric oncology service for the purpose of promoting empathy, building teams, and preventing burnout. All staff members were invited to attend a weekly narrative training seminar for 6 weeks. During these seminars, participants wrote about their attachment to patients, their emotional responses to patients and families, and their attempts to imagine clinical situations from the perspectives of patients and family members; participants then read aloud their narratives to one another during a facilitated discussion. Baseline and post-intervention assessments used the Interpersonal Reactivity Index (IRI) and the Stressor Scale for Pediatric Oncology Nurses (SSPON), and a focus group was convened to assess qualitative outcomes at the study's conclusion. Nineteen staff members who consented and participated in the training completed all baseline and postintervention measures.THE IRI subset of Perspective Taking improved at a statistically significant level (P = 0.029), and the Empathic Concern subset trended toward significant improvement (P= 0.056). Reported stress levels on the SSPON increased at varying rates over the course of the study. Focus group reports indicated that teamwork and resilience improved in the 6 weeks of the seminar. A narrative training approach aimed at an inter-disciplinary group of healthcare professionals has promise as a means to address some of the most difficult aspects of pediatric oncology care facing clinicians.     

Postoperative inhalation treatment after paranasal sinus interventions. A placebo-controlled, double-blind and randomized study]

A placebo-controlled, double-blind study with Ems brine inhalations as postoperative treatment after endoscopic endonasal sinus surgery was conducted on 30 patients. After informed consent had been obtained, the patients were treated with either Ems brine or saline solution (200 ml) 3 times a day for 10 days. The parameters measured were rhinomanometry, X-ray films of the sinuses, endoscopy, saccharin clearance and a subjective evaluation by the physician and by the patient based on a visual analogue scale. The difficulty of choosing parameters for assessing the treatment was that comparable clinical studies and a single predictive parameter were not available. The bacteriological test and the saccharin clearance test were not significantly different between the two groups. Recovery, swelling, crusting, bleeding and signs of inflammation, opacity on sinus X-ray films, and nasal flow as measured by rhinomanometry were all significantly better in the group inhaling brine solution (P less than 0.05).     

Giant juvenile xanthogranuloma of the tongue.

Juvenile xanthogranulomas (JXGs) are rare, benign, fibrohistiocytic lesions. They usually appear as one or more cutaneous papules on the head, neck, or trunk in infants. Twelve cases of oral JXGs have been reported, four of which involved the tongue. We present a 6-year-old girl with a large tongue mass diagnosed as JXG after an excisional biopsy. Histological and immunohistochemical staining results are presented. This is the first reported case of a giant oral JXG. A review of the literature on these unusual lesions is presented, along with discussion of their differential diagnosis and key aspects of the patient's evaluation, management, and pathological diagnosis.     

MPLV: a retrovirus complex inducing an acute myeloproliferative leukemic disorder in adult mice

A novel murine retrovirus complex was derived from the in vivo passage of a molecularly cloned Friend ecotropic helper virus. The virus isolate, myeloproliferative leukemia virus (MPLV), causes an acute (2-3 weeks) and generalized myeloproliferative disorder in adult mice. All strains of mice examined, including the C57BL/6J strain, developed the acute syndrome. This syndrome is characterized by a rapid hepatosplenomegaly, no thymus or lymph node involvement, granulocytosis, thrombocytosis, and erythroblastosis leading to polycythemia. The most prominent feature at the terminal phase of the disease is a granulocytic hyperplasia. The MPLV isolate replicates in vitro on NIH 3T3 fibroblasts but does not induce foci of transformed cells. Thus, MPLV exhibits unique biological properties that distinguish it either from the Friend virus complexes or from acutely transforming sarcomatogenic murine retrovirus which also induced a rapid splenomegaly.