[Haemothorax revealing thoracic endometriosis]. / Hémothorax spontané révélant une endométriose pleurale.

INTRODUCTION: Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. Manifestations of TE include pneumothorax and haemothorax. Treatment is based on surgical and hormonal therapy that aims at eradicating existing endometrial thoracic plaques and to prevent reseeding from pelvic endometriosis. CASE REPORT: We report the case of a 36 year-old young woman presenting thoracic endometriosis revealed by a recurring spontaneous, large and isolated right haemothorax. Diagnosis, pathogeny and treatment are discussed. CONCLUSION: Thoracic endometriosis needs to be considered as a cause of haemothorax in women of childbearing age.

Base excess and lactate as prognostic indicators for patients treated by extra corporeal life support after out hospital cardiac arrest due to acute coronary syndrome.

OBJECTIVE: To examine whether values of arterial base excess or lactate taken 3 h after starting ECLS indicate poor prognosis and if this can be used as a screening tool to follow Extra Corporeal Life Support after Out Hospital Cardiac Arrest due to acute coronary syndrome. DESIGN: Single Centre retrospective observational study. SETTING: University teaching hospital general adult intensive care unit. PATIENTS: 15 consecutive patients admitted to the intensive care unit after refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support. INTERVENTIONS: Arterial base excess and lactate concentrations were measured immediately after starting ECLS and every 3 h after. RESULTS: Both base excess and arterial lactate measured 3 h after starting ECLS effectively predict multi-organ failure occurrence and mortality in the following 21 h (area under the curve on receiver operating characteristic analysis of 0.97, 0.95 respectively). The best predictive values were obtained with a base excess level measured 3 h after starting ECLS of less than -10 mmol/l and lactate concentrations greater than 12 mmol/l. The combination of these two markers measured 3 h after starting ECLS predicted multiorgan failure occurrence and mortality in the following 21 h with a sensitivity of 70% and a specificity of 100%. CONCLUSIONS: Combination of base excess and lactate, measured 3 h after starting ECLS, can be used to predict multiorgan failure occurrence and mortality in the following 21 h in patients admitted to an intensive care unit for refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support. These parameters can be obtained simply and rapidly and help in the decision process to continue ECLS for refractory CA.

Impact of anatomical location of lower limb venous thrombus on the risk of subsequent cancer.

After a proximal deep-vein thrombosis (P-DVT), the risk of diagnosis of a previously unsuspected cancer is high. Isolated distal DVT (iD-DVT; i.e. infra-popliteal DVT without pulmonary embolism [PE]) and isolated superficial-vein thrombosis (iSVT; i.e. without concomitant DVT and PE) are at least as frequent as P-DVT but their association with subsequent cancer is uncertain. We exploited data from the OPTIMEV prospective, observational, multicentre study to i) compare the risk of subsequent cancer three years after a first objectively confirmed iSVT, iD-DVT and iP-DVT in patients without a prior history of cancer or of venous thromboembolism, ii) assess predictors of subsequent cancer in cases of iD-DVT. The overall cumulative rates of cancer among the 304 patients with iSVT, 536 patients with iD-DVT, and 327 patients with iP-DVT were similar (3.4% 95% confidence interval [1.8-6.2], 3.9% [2.5-5.9] and 3.9% [2.3-6.8], respectively), regardless of whether the index venous thromboembolic event was unprovoked or associated with a major transient risk factor. Neither anatomical (muscular vs deep-calf DVT) nor ultrasound scan characteristics (number of thrombosed veins, clot diameter under compression) seemed strongly associated with the risk of cancer in cases of iD-DVT. In patients managed in routine practice, all the different clinical expressions of lower limb venous thromboembolism are associated with a similar risk of subsequent cancer. From a clinical practice point of view, this suggests that cancer screening, without discussing the necessity, or not, of such screening, should not differ between a deep-proximal, deep-distal or superficial location of thrombosis.

[Impact on parents of cerebral palsy in children: a literature review]. / Impact sur les parents de la paralysie cérébrale chez l'enfant : revue de la littérature.

Cerebral palsy is the commonest cause of motor impairment in childhood. Parents of children with this particular neurodevelopmental disorder face many problems encountered by disabled children's parents. The aim of the present paper is to report the current knowledge on this parental impact, highlighting consensus and disagreement. A literature search was conducted using the key words "Cerebral palsy" and "Parents/Father/Mother" and "Adapt/Adjust/Cost/Economic/Impact/Well-being" in the Medline and PsycInfo databases searching for articles published between 1989 and 2009. Seven parental impact dimensions were distinguished: time spent, occupational restrictions, social relationships, family relationships, psychological well-being, physical health, and financial burden. Of 40 selected references, the studies were mostly cross-sectional, although longitudinal surveys highlighted the causal relationship between factors. Despite various methodologies, this review confirms that parents of CP children have greater risk of experiencing a sense of burden than parents of typically normally developing children. Time spent caring for the child appears to be an important factor that depends on the child's autonomy. The 7 impact dimensions seem to be related to each other and to child's and caregiver's characteristics. The severity of motor impairment is not unanimously viewed as a worsening factor: however, the child's behavioral problems influence the impact experienced by the parents. The level of intellectual impairment also has a negative influence on family relationships and on the parent's psychological well-being. The child's developmental stage seems to be related to the level of parental impact, but there is no agreement on the dimensions involved. We also observed that the mother and father do not experience this situation in the same way, probably because of the role played by each one in the family. The current literature lacks data on caregiver characteristics, identifying families at risk of burden, and the environmental context that would allow for a less negative impact on parents. In addition, the tools measuring the impact lack standardization. No questionnaire covering all 7 dimensions exists, but useful validated questionnaires for different dimensions were identified. We consider that the caregiver's occupation and physical health needs further research. The current knowledge is insufficient for proposing an overall model taking all the dimensions into account. Research is needed before a complete model of the CP child's impact on parents can be tested in view of providing guidelines to professionals for identifying families with a risk of maladaptation and suggesting solutions to decrease the negative impact.

[ABO-RH1 grouping and red blood cell antibody screening: error analysis in the French external quality assessment in 2006]. / Groupes sanguins et recherche des anticorps antiérythrocytaires: analyse d'erreurs au contrôle national de qualité en 2006.

Further to a survey set up in 2006 over 2600 laboratories by the French agency for health product safety (AFSSAPS), seven ABO grouping errors and 53 negative answers to red blood cell antibody screening with a serum containing anti-RH1 antibody, have been found. A questionnaire sent to the involved laboratories revealed non-analytical errors already met in previous cases. Besides, the analytical stage has also induced red blood cell antibody screening errors due to a wrong serum collection by the automat. Here are displayed the analysis of the questionnaire results and proposed corrections.

[National external quality assessment in auto-immunity: auto-antibodies against thyroid constituents]. / Contrôle national de qualité en auto-immunité: anticorps anti-thyroïdiens.

The French Health Products Safety Agency organized in 2005, for the scheme of the national external quality assessment, a survey on antibodies against thyroid constituents which included for the first time the quantitative assay. The purpose of this survey was to assess the quality of the different methods of these assays. The overall qualitative results are satisfactory. However, this survey pointed out a lower performance for immunodot which appeared to have been misused. Concerning the titer of antibodies, results show a broad dispersion between reagents. This confirms the lack of a real standardisation despite of the existence of the international MRC standards.

[Red blood cell antibody screening: error analysis in a french interlaboratory comparison program survey]. / Recherche des anticorps antiérythrocytaires: analyse d'erreurs au Contrôle national de qualité

The French quality control is organized by the French Health Products Safety Agency. In 2005, the immuno-haematology testing control included the screening of an anti KEL 1 antibody. 17 out of 2639 laboratories (0,64%) answered 'negative screening'. All laboratories received a questionnaire in order to understand the failure. In this paper the authors present the detailed laboratories' responses and failure explanations.

[National external quality assessment in auto-immunity: autoantibodies detected on liver, kidney and stomach tissues]. / Contrôle national de qualité en auto-immunité: anticorps anti-tissus non spécifiques d'organe.

In 2003, for the scheme of the French national external quality assessment, Afssaps organized for the first time a survey on auto-antibodies detected on liver, kidney and stomach tissues. This survey had two purposes: first to make an inventory of the methodology applied by the medical laboratories and secondly to assess the quality of the results. The survey sample contained M2 anti-mitochondrial antibodies. Overall results are satisfactory. Concerning the titer of antibodies, a broad dispersion of results was observed (12% of titers were upper than the expected titer). Delivered information to the participants, at the end of the survey, should improve analytical procedures applied by the biologists. An effort of standardization by using titrated internal controls would be suitable.

Impact of external quality assessment on antinuclear antibody detection performance.

Our objective was to evaluate performance of the clinical laboratories for the detection of antinuclear antibodies (ANA) by using indirect immunofluorescence method (IIF), in France. A national external quality assessment (EQA) on ANA detection was organized by the French health products safety agency once a year since 1998. Between 606 to 687 laboratories together with six university reference laboratories experienced in performing tests in autoimmunity participated in the six-year consecutive survey. Each laboratory had to answer to methodological procedures and give coded responses. Variability in IIF methodological procedure was observed. Use of inappropriate microscope magnifications for reading slides or nonconventional cutoff dilution of serum were pointed out to concerned laboratories. Concerning ANA measurement, the rate of good responses ranged from 92.7% to 99.5% of the laboratories when the samples contained ANA. A wide dispersion of ANA titers obtained on a same sample was repeatly observed every year. Misinterpretation of particular fluorescence pattern was noticed. On ANA negative sample, the rate of good responses was 94.3%. In conclusion, ANA detection in routine practice is far from being standardized. However, EQA may have an impact on ANA detection performance when it is conducted on several consecutive year surveys, by providing advice for participating laboratories to limit inter laboratory variations related to methodological procedures.

[Monoclonal immunoglobulin: national external quality assessment and diagnostic reasoning]. / Immunoglobuline monoclonale: contrôle national de qualité et démarche diagnostique.

In 2003, for the scheme of the French national external quality assessment, Afssaps sent to medical laboratories a sample for which two analyses could be carried out: the electrophoresis of proteins and the characterization for monoclonal immunoglobulin. The purpose of this new approach was to make it possible to the laboratories to transpose their usual diagnostic reasoning. This survey recalled to the biologists that it is necessary to check the sensitivity of the test of electrophoresis of proteins used in first intention and to use advisedly the anti-serums anti-free chains. Moreover this operation reinforced the educational aspect of the external quality assessment, pointing out the importance to ensure the coherence of the results of these two analyses carried out with a same diagnostic aim.

[Good practices for the study of hemoglobin]. / Bonnes pratiques de l'étude de l'hémoglobine.

Hemoglobinopathies have become a significant national health problem in France. The biologists have a pivotal role in the genetic diagnoses. Although sickle cell disease (SCD) is the most frequent abnormality found: not less than 200 new cases are observed each year at birth, many other globin gene variations are found in the various ethnic groups. Since 1995 a neonatal sickle cell screening program has been established for at risk newborns. This programme is supported by the "Association française de dépistage et prévention des handicaps de l'enfant" (AFDPHE). The characterization of hemoglobin genetic variations requires a comprehensive set of laboratory techniques for which we specify here main clinical and technical recommendations.

Biological control of the snail intermediate hosts of Schistosoma mansoni in Martinique, French West Indies.

In Martinique water-cress beds constituted the last transmission sites for schistosomiasis. The competitor snail, Melanoides tuberculata, was introduced at the beginning of 1983 to a group of water-cress beds and eliminated the snail hosts, Biomphalaria glabrata and B. straminea, in less than two years. Following this first success, M. tuberculata was introduced to the other groups of beds which were inventoried at the beginning of the eighties. At the present time, B. glabrata and B. straminea have totally disappeared from eight sites and only a few individuals have been recorded from 12 sites. The two remaining water-cress beds have dried up and were abandoned.

Biological control of Biomphalaria glabrata and B. straminea by the competitor snail Thiara tuberculata in a transmission site of schistosomiasis in Martinique, French West Indies.

In Martinique, intestinal schistosomiasis was discovered at the beginning of this century. The intermediate host snail, Biomphalaria glabrata, was considered in the past as a common species in the different habitats of the island, but during the last decade it has been found only in water-cress beds. Several of these water-cress cultures contained mixed populations of B. glabrata and B. straminea. Moreover, these habitats also constituted transmission sites for Schistosoma mansoni infection. In 1979 the thiarid snail Thiara ( = Melanoides) tuberculata was discovered in Madame river, Fort-de-France, and in the following years at other sites. In 1983 a programme of biological control using this snail was started in two groups of water-cress beds. In 1981-1982 the study site, Roxelane valley, sheltered important populations of B. glabrata (45-256 individuals/m2) and of B. straminea (2-30 ind./m2). In January 1983 the competitor T. tuberculata was introduced into the two groups of water-cress beds (1.3 and 1.7 ind./m2 respectively) and during subsequent years snail population sampling was carried out. The results showed rapid colonization by the competitor snail, whose densities reached 178 and 325 ind./m2 in November 1983 and a maximum of 9941 and 13,388 ind./m2 in October 1984. During that time, B. glabrata populations declined: 153 and 41 ind./m2 in November 1983, 4 and 0 ind./m2 in October 1984, and 0 ind./m2 in the two groups of water-cress beds in October 1985. A similar phenomenon was observed for B. straminea. Since October 1985 neither planorbid species has been found by exhaustive sampling of the habitats.(ABSTRACT TRUNCATED AT 250 WORDS)

[Activities of a Schistosoma mansoni focus of transmission in Martinique (French Antilles)]. / Le fonctionnement d'un site de transmission à Schistosoma mansoni en Martinique (Antilles Françaises).

A focus of intestinal schistosomiasis was discovered in november 1981 in Martinique in the Saint-Pierre area. An analysis of its structure and of the mecanisms of the transmission of the parasite was carried out between 1981 and 1983. This focus presents the following particularities: a transmission site very small constituted by water cress beds; a small human population infected with a prevalence of 13% (positive stools) to 41,3% (positive serologies); a weak fecal contamination of the water; a non functioning sewage stabilization tank is responsible for this contamination; a rich population of the snail host Biomphalaria glabrata (40,5 to 256,3 Bg/m2) with a low prevalence of infestation (0,13 to 0,59%); low cercarial densities in the water cress bed waters; a very low contamination of the Roxelane river water in to which the water from the water cress beds flows. The epidemiological importance of this contamination has proved very low but not altogether absent. This focus appears as a particular case in Martinique because all the surveys which have been conducted in the island to date has not uncovered a similar example.

[Freshwater snails and vectors of schistosomiasis mansoni in Martinique (French West Indies)]. / Faune malacologique dulaquicole et vecteurs de la Schistosomose intestinale en Martinique (Antilles Françaises)

An inventory of the freshwater Molluscs in Martinique was worked out during 1972 to 1978. Each of the 19 species is shown with its main characteristics. The distribution of Biomphalaria glabrata and Biompharia straminea was studied. The epidemiological importance of these two snails is discussed.