Una experiencia de acompañamiento con doula a adolescentes en trabajo de parto / Doula support during labor: experience in a sample of pregnant teenagers

Objetivo: Comparar la percepción del dolor-temor durante el trabajo de parto y parto, y el grado de dificultad-satisfacción con la experiencia de parto, en un grupo de adolescentes acompañadas por doula y otro con atención habitual. Método: El grupo estudio comprendió 80 adolescentes del "Programa Emprende Mamá" que controlaron sus embarazos en centros de salud de la comuna de La Florida y con parto en el hospital Dr. Sótero del Río, acompañadas por una mujer familiar o amiga, elegida por la joven, con capacitación previa de 2 horas. El grupo control estuvo formado por 80 adolescentes no participantes del programa, que controlaron sus embarazos en los mismos centros de salud, con parto en el mismo período. Resultados: El grupo estudio refirió menor percepción de dolor durante el trabajo de parto y parto, menor temor durante el parto y lo percibió como más fácil. No se encontraron diferencias significativas en el nivel de satisfacción respecto de la experiencia total. Sin embargo, las adolescentes con doula señalaron estar satisfechas por aspectos positivos de la vivencia, mientras que el grupo control centra su satisfacción en la ausencia de expectativas negativas temidas. Conclusión: El acompañamiento por doula en el parto de la embarazada adolescente, es una intervención de bajo costo que permite mejorar cualitativamente su vivencia de parto.

Objective: To compare the effects of continuous doula support and standard hospital care on pain and fear perception, during labor and delivery, as well as perception of difficulty and satisfaction with the birth experience, in a sample of pregnant teenagers. Method: The study group was conformed by eighty pregnant teenagers participants in "Emprende Mama Program" attended in the outpatient clinics of La Florida county for their prenatal care and delivery at a public hospital. They received emotional support during labor by a 2 hour trained female relative or friend, previously chosen by them. The control group was conformed by eighty non participants teenagers attended at the same outpatient clinics and delivery in the same period. Results: Teenagers with doula support reported less pain and fear during labor and delivery and perceived their birth experience as less difficult. No significant differences were reported in relation to satisfaction with birth experience. Although teenagers with doula support reported satisfaction due to positive aspects with birth experience, meanwhile the control group felt mostly satisfied due the absence of negative feared expectations. Conclusion: Labor support given by doula, is a low cost intervention which improves quality perception of birth experience in the adolescent pregnant.

Life-threatening complications of hepatitis B virus-related polyarteritis nodosa developing despite interferon-alpha2b therapy: successful treatment with a combination of interferon, lamivudine, plasma exchanges and steroids.

Polyarteritis nodosa (PAN) is a rare vasculitis associated with hepatitis B virus (HBV) infection in a significant proportion of cases. When used to treat HBV-related PAN, immunosuppressive agents may enhance viral replication and relaspes are frequent. In recent years the use of antiviral drugs has been proposed. We report the case of a patient with HBV-related PAN who, despite 6 weeks of interferon-alpha2b (IFN-alpha2b) monotherapy, developed life-threatening complications with bowel perforation. He was thereafter successfully treated with a combination of IFN-alpha2b, lamivudine, plasma exchanges and short-term steroids. In contrast to IFN-alpha2b, lamivudine is effective in rapidly suppressing viral replication. This may be valuable in the treatment of HBV-related PAN by contributing to a faster diminution of circulating immune complex levels. This case report highlights the importance of aggressive combined therapy in patients with HBV-related PAN.

Is high prevalence of Echinococcus multilocularis in wild and domestic animals associated with disease incidence in humans?

We investigated a focus of highly endemic Echinococcus multilocularis infection to assess persistence of high endemicity in rural rodents, explore potential for parasite transmission to domestic carnivores, and assess (serologically) putative exposure versus infection frequency in inhabitants of the region. From spring 1993 to spring 1998, the prevalence of E. multilocularis in rodents was 9% to 39% for Arvicola terrestris and 10% to 21% for Microtus arvalis. From June 1996 to October 1997, 6 (7%) of 86 feral dogs and 1 of 33 cats living close to the region tested positive for intestinal E. multilocularis infection. Testing included egg detection by coproscopy, antigen detection by enzyme-linked immunosorbent assay (ELISA), and specific parasite DNA amplification by polymerase chain reaction. Thus, the presence of infected domestic carnivores can increase E. multilocularis exposure risk in humans. A seroepidemiologic survey of 2,943 blood donors in the area used specific Em2-ELISA. Comparative statistical analyses of seroprevalence and clinical incidence showed an increase in Em2-seroprevalence from 1986 and 1996-97 but no increase in clinical incidence of alveolar hydatid disease.

The calcium-binding protein calretinin-22k is detectable in the serum and specific cells of cancer patients.

BACKGROUND: Calretinin-22k (CR-22k), an alternatively spliced form of calretinin (CR) belongs to the EF-hand family of calcium-binding proteins and is expressed in several colon adenocarcinoma cell lines (e.g. WiDr, HT-29). MATERIALS AND METHODS: Serum samples of cancer patients were screened with a sandwich ELISA technique using the CR-specific antiserum 7696. Highly positive samples were analyzed by Western blots and immunohistochemistry. RESULTS: CR-22k was detected in the serum of several patients and values were as high as 0.19 microgram/ml. Western blot analysis confirmed the identity of the bound protein as CR-22k. The highest concentrations were detected in patients with colon or breast cancer, but also in a patient with ischemic necrosis of the gut. CR immunoreactivity was localized to epithelial cells, nerve fibres, cells of the connective tissue and to mesothelial cells. CONCLUSIONS: Our results establish that CR-22k is detectable in the serum of cancer patients under specific pathological conditions.

Cladribine (2-CDA) given as subcutaneous bolus injections is active in pretreated Waldenström's macroglobulinaemia. Swiss Group for Clinical Cancer Research (SAKK).

Clinical trials with intravenous cladribine infusions in pretreated patients with Waldenström's macroglobulinaemia have shown a response rate of 40%. Our pharmacokinetic studies revealed that the bioavailability of subcutaneous cladribine is complete but that the concentration-time profile is very different from intravenous administration. We designed this phase II multi-institutional trial to study the activity and toxicity of cladribine given as s.c. bolus injections in patients with symptomatic Waldenström's macroglobulinaemia. Between May 1993 and October 1995, 25 patients were accrued: male/female 18/7, median age 65 years (range 44-85). All except one patient had been pretreated with more than one regimen (median 2, range 0-10). 18 patients had progressed under previous therapy and six were in relapse. All patients received cladribine for a total dose of 0.5 mg/kg per cycle as s.c. bolus injections divided over 5 d at > or = 4 week intervals, for a maximum of six cycles. All 25 patients were evaluable for toxicity and response. A total of 67 cycles were administered (median 3 cycles, range 1-6). Overall response rate including disease stabilization which had been progressive under previous therapy was 68%. 10 patients (40%, 95% CI 21-61%) achieved a partial remission. Seven responders had been progressive under previous therapy. Maximum responses were reached no later than the third cycle. Median time to treatment failure and remission duration were 4.4 (range 0.5-33) and 8 months (5-29), respectively. Four patients (16%) suffered from infections W.H.O. grade > or = 2 (pneumonia grade 2, Staphylococcus septicaemia grade 3, viral encephalitis and pneumonia, both grade 4 with complete resolution). No other severe adverse events were observed. Cladribine given as s.c. 5 d bolus injections was found to be active in pretreated Waldenström's macroglobulinaemia and resulted in durable remissions.

[Clinical presentation of primary cytomegalovirus infection in a non-immunodepressed adult]. / Présentation clinique de l'infection primaire a cytomégalovirus chez l'adulte non immunodéprimé.

In the immunocompromised patients and during foetal life an acute infection due to the cytomegalovirus (CMV) causes great morbidity. In adults without predisposing factors the acute infection with CMV is rarely symptomatic, but can also provoke fever, fatigue, headache and anorexia for weeks. The peripheral blood smear shows big atypical lymphocytes within a relative lymphocytosis. The suspicion of the CMV infection is confirmed by the serological evidence of IgM anti-CMV antibodies. There is no etiological treatment, the evolution is spontaneously favorable most of the time. Establishing the diagnosis is reassuring for the patient and for the physician and avoids unnecessary analyses and treatments. We describe a series of 11 adults without predisposing factors who contracted an acute cytomegalovirus infection.

[Successful treatment of a case of cutaneous Langerhans cell granulomatosis with 2-chlorodeoxyadenosine and thalidomide]. / Erfolgreiche Behandlung eines Falls von kutaner Langerhanszell-Granulomatose mit 2-Chlorodesoxyadenosin und Thalidomid.

We describe the case of a 65-year-old female patient with cutaneous Langerhans' cell granulomatosis without any signs of disease in other organs. She also had systemic lupus erythematosus that had been diagnosed several years before. The coexistence of these two diseases has not been described before as far as we know. The purine analogue 2-chlorodeoxyadenosine (Cladribin), which has been used successfully in the treatment of hairy cell leukaemia, induced complete remission in our patient after 1 week of treatment. After 2 months, however, the patient had a relapse; this was successfully treated with thalidomide. A new understanding of Langerhans' cells granulomatosis as a reactive but not cancerous disease has emerged as a result of recent investigations showing that tumour necrosis factor-alpha (TNF-alpha) plays an important part in the induction of Langerhans' cells from their immature precursors. Because thalidomide has been shown to inhibit TNF-alpha production, down-modulation of this cytokine seems to be a useful treatment strategy in Langerhans' cell granulomatosis. Some asspects of the diagnosis and therapy of this disease are briefly reviewed.

High incidence of infections after 2-chlorodeoxyadenosine (2-CDA) therapy in patients with malignant lymphomas and chronic and acute leukaemias.

BACKGROUND: 2-chlorodeoxyadenosine (2-CDA) is a new purine analogue which has been shown to be highly active in lymphoproliferative disorders. In this clinical trial we assessed 2-CDA toxicity and response rate in patients with various haematological malignancies who were heavily pre-treated and mostly refractory to standard treatment regimens. PATIENTS AND METHODS: Twenty-two refractory patients, 51 relapsing after standard chemotherapy and seven non-pre-treated patients were treated in a non-randomized prospective phase II multicentric study. Their median age was 54 years (range 18-84) and 56 of them were male. Thirty-one had non-Hodgkin's lymphoma (NHL), 11 chronic lymphocytic leukaemia (CLL), 1 prolymphocytic leukaemia (PLL), 13 hairy-cell leukaemia (HCL), 2 mycosis fungoides (MF), 3 multiple myeloma, 7 acute myeloblastic leukaemia (AML), 2 acute lymphoblastic leukaemia (ALL), 6 chronic myeloid leukaemia (CML) in blast crisis, 2 Hodgkin's disease, 1 Waldenström's macroglobulinemia and 1 Langerhans histiocytosis. 2-CDA 0.1 mg/kg/day was given as a continuous intravenous infusion for 7 days and recycled every 4 weeks. RESULTS: One hundred thirty-two courses of 2-CDA were administered to 80 patients, 76 of whom were evaluable for response. A) Toxicity: Myelosuppression: Neutropenia to over 50% of initial value occurred in 46% of patients, thrombocytopenia in 8%, and lymphopenia < 0.5 x 10(9)/l was seen in 41%. Infections occurred in 34/80 patients (43%). The risk of severe infections (WHO grades 3-4) correlated with increasing number of years after first diagnosis (p = 0.01) and low lymphocyte counts on days 1 and/or 14 (p = 0.04); 21 infections were opportunistic. B) Response: 70% patients with lymphoproliferative disorders of low malignancy attained complete or partial response (low-grade NHL 12/16, CLL + PLL 9/12, HCL 13/13, MF 2/2, myeloma 0/3); in patients with AML, ALL, CML in myeloid (n = 4) or lymphoid (n = 2) blast crisis and high-grade lymphoma responses were seen in only 11%. Response was inversely related to the number of pretreatments (p = 0.045). In responding NHL patients the mean lymphocyte count on day 14 of cycle 1 was significantly lower (median 0.6 x 10(9)/l) than that of non-responders (1.2 x 10(9)/l, p = 0.04). CONCLUSION: 2-CDA had a high activity even in heavily pretreated and refractory patients with low-grade lymphoproliferative disorders. In contrast to previously published studies, infections, mainly opportunistic, were a serious side effect in our study. In patients with severe lymphopenia at therapy initiation, the value of prophylactic anti-infective treatment should be studied.

[Primary Hodgkin disease of the lung]. / Maladie de Hodgkin primaire du poumon.

We describe a patient with a rare primary pulmonary manifestation of Hodgkin's disease who presented with multiple bilateral nodular lesions on the chest x-ray without significant hilar involvement.

[Autoimmune hemolytic anemia with medullary erythroplasia and black serum with methemalbuminemia]. / Anémie hémolytique auto-immune avec érythroaplasie médullaire et sérum noir sur methémalbuminémie.

A patient with idiopathic autoimmune hemolytic anemia is described. On day 5 of therapy with corticosteroids, immunoglobulin and several plasmaphereses, a high level of methemalbumin was found while RBC lysis had ceased and bilirubin and haptoglobin had normalized. The hemoglobin and the reticulocyte count were still very low and a bone marrow aspirate showed erythroaplasia. Since the LDH was consistently elevated during the entire period of erythroaplasia, ongoing intramedullary hemolysis due to antibodies (IgG) was assumed. The patient received cyclophosphamide. After 15 days all symptoms, signs of hemolysis and aplasia resolved. The patient has not had any other hemolytic crisis without treatment (follow-up 18 months). The presence of methemalbumin is observed in intravascular hemolysis and also in association with hemorrhagic pancreatitis. Its diagnostic and prognostic value is discussed.

Familial primary gastric lymphoma.

Familial lymphoma is uncommon and is usually associated with various forms of hereditary immunodeficiencies. Primary gastric lymphomas that occurred in three adults from the same family, who had no overt immunodeficiency or cancer of non-lymphomatous origin, are reported. Two sisters presented with a low grade lymphoma of the mucosa associated lymphoid tissue type. Their father presented with a high grade form of later onset. All lymphomas have been phenotypically characterised as being of B cell origin. Epstein-Bar virus DNA was detected by polymerase chain reaction in the biopsy specimen of the high grade lymphoma but bcl-2/JH protooncogene rearrangement, t (14:18), was not identified in either the low or high grade lymphoma specimens tested.

[HTLV-I/II in Switzerland: apropos of 4 case reports]. / HTLV-I/II en Suisse: à propos de quatre observations.

HTLV-I/II (human T-cell lymphotropic virus type I and II) infection is endemic in South Japan, Subsaharan Africa, the Caribbean and in regions of South America and of the United States. The infection almost always remains asymptomatic but is also associated with two distinct diseases: tropical spastic paraparesis (TSP), and adult T-cell leukemia (ATL). Although very rare in Europe, HTLV-I/II infection may occur in patients originating from endemic areas. We report the cases of four patients seropositive for HTLV-I/II, all of them living in Switzerland. Three of them originate from Zaire; the fourth is a Swiss female married to a Taiwanese. One patient has TSP; one has pyramidal signs along with systemic vasculitis-associated neuropathy; the third is HIV-position with stage III B infection, without symptoms of TSP or ATL; the last is entirely asymptomatic.

Interaction of heterozygous beta (0)-thalassemia and triplicated alpha globin loci in a Swiss-Spanish family.

We report a Swiss-Spanish family three members of which have the clinical picture of thalassemia intermedia. Restriction endonuclease mapping of the alpha-globin cluster and digestion with Mae I of the in vitro amplified 5' segment of the beta-globin gene shows a combination of triplicated alpha globin locus, anti-3.7 kb type, with heterozygous codon 39 C----T beta (0) thalassemic mutation. These, as well as 16 similar cases reported in the literature, permit the following conclusion: a single extra alpha-globin gene gives rise to a clinically significant degree of dyserythropoietic anemia only when it interacts with a severe beta(+) or beta(0) thalassemic mutation.

[Hypothyroidism and acanthocytes: diagnostic significance of blood smear]. / Hypothyroïdie et acanthocytes: importance diagnostique du frottis sanguin.

We report on 3 cases of hypothyroidism in which the diagnoses were suspected after having observed acanthocytes on the blood film. The diagnostic value of this erythrocyte change has been neglected, although the results of studies have shown a test specificity of 87-99%, other diseases related to acanthocytes being very rare. After an analysis of the studies and case reports dealing with acanthocytes we conclude that hypothyroidism must be excluded in all cases where acanthocytes are observed on the blood film.

[Acute myeloid leukemia with poor prognosis: treatment with oral 4-demethoxydaunorubicin (idarubicin) and low-dose cytarabine via subcutaneous route]. / Leucémies myéloïdes aiguës de mauvais pronostic: traitement par 4-démethoxydaunorubicine (idarubicine) per os et cytarabine à doses réduites par voie sous-cutanée.

26 patients with poor risk acute myelogenous leukemia (elderly, in relapse or resistant) were treated with a combination of oral idarubicin (30 mg/m2/d for 3 days) and low dose subcutaneous cytarabine (10 mg/m2 twice a day for 10 days). Of 26 patients, 14 achieved complete remission, 2 partial remission, and 5 died in aplasia (3 without evidence of response, 2 inevaluable); 5 further patients were non-responders. All responses but two occurred among patients treated for AML at presentation or in relapse. Side effects consisted mainly of severe hematologic and moderate gastrointestinal toxicities. The main interest of this regimen is adaptability to outpatient conditions and rapid cytoreduction in patients with hyperleukocytic presentation.

Histiocytic necrotizing lymphadenitis or Kikuchi's disease. Anatomo-clinical study of 4 cases.

Histiocytic necrotizing lymphadentis (HNL) is an uncommon clinical and histologic entity, essentially diagnosed in Japan since 1972. The clinical picture is usually characterized by cervical lymphadenopathy and fever, females being more often affected. Leukopenia and elevated erythrocyte sedimentation rate are frequent. The etiology is still unknown, but a viral origin is most likely. The clinical course is always favorable without treatment, except in one case. The histological picture, with necrotic foci surrounded by histiocytes, immunoblasts, small T lymphocytes and plasmacytoid monocytes (so-called plasmacytoid T cells), is characteristic. Nevertheless, HNL may be mistaken for malignant lymphoma both clinically and histologically. We report 4 cases of HNL. One of these presented severe leukothrombopenia; the serum of this patient significantly suppressed the maturation of granulocytic precursor cells in the bone marrow.

[Light chain myeloma or the pitfalls of myeloma diagnosis]. / Le myélome à chaînes légères ou les pièges du diagnostic du myélome.

The diagnosis of multiple myeloma is often suggested by disturbances found in routine laboratory tests such as sedimentation rate, electrophoresis of serum proteins and search for proteinuria. In light chain myeloma these tests are nonspecific and therefore misleading. We present 8 cases of light chain myeloma and discuss the diagnosis of multiple myeloma with its associated pitfalls.