Interest of an auto-adjustable nighttime compression sleeve (MOBIDERM® Autofit) in maintenance phase of upper limb lymphedema: the MARILYN pilot RCT.

PURPOSE: Breast cancer-related lymphedema (BCRL) is a debilitating condition. The recommended treatment is based on decongestive lymphedema therapy (DLT) with two separate phases: a short-term intensive phase to reduce lymphedema volume and a long-term maintenance phase to stabilize it. Optimizing compression therapy and compliance during maintenance phase are key factors for long-term control of lymphedema. The primary objective of this pilot prospective open-label randomized study was to assess the benefit of a new auto-adjustable nighttime arm sleeve (MOBIDERM® Autofit) on lymphedema volume during the maintenance phase after the intensive phase. METHODS: Forty women with BRCL were consecutively enrolled and randomized (D0) for 1 month in 1:1 ratio either in night-use group: with MOBIDERM® Autofit (on top of a daytime compression hosiery), or in no night-use group: without MOBIDERM® Autofit (daytime hosiery alone). From Day 31 to Day 90, all patients were fitted with MOBIDERM® Autofit. Primary endpoint was lymphedema volume variation between Day 0 and Day 30. Secondary endpoints were compliance, quality of life (LYMQOL arm questionnaire), functional symptoms (heaviness, limb use limitation, pain), sleep quality, and safety. RESULTS: In ITT population, between Day 0 and Day 30, mean lymphedema volume increase was higher in no night-use group with 92.9 mL (i.e., 3.2%) than in night-use group with 46.7 mL (i.e., 1.80%), p = 0.757. Between Day 30 and Day 90, all patients fitted with MOBIDERM® Autofit, lymphedema volume remained stable in both groups. The device improved functional symptoms and function domain of the LYMQOL arm questionnaire. MOBIDERM® Autofit was worn overnight almost 85% of the nights. It was well accepted by the patients and no adverse reaction leading to permanent device discontinuation occurred. CONCLUSIONS: Our results suggest that MOBIDERM® Autofit offers clinical benefits during maintenance phase of lymphedema treatment and enhances patient's self-management.

Epidemiology of the vascular assessment and correlation of the WIfI Classification in lower limb amputee patients at Martinique university hospital in 2018.

BACKGROUND: The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients. MATERIAL AND METHODS: We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique. RESULTS: Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients. CONCLUSION: A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.

A study of the action of clonidine on secretion from the adrenal medulla in dogs.

The effects of clonidine on adrenal catecholamine (adrenaline and noradrenaline) secretion were investigated in chloralose-anaesthetized dogs. Intravenous administration of clonidine (10 and 20 micrograms kg-1) induced a decrease in both adrenal catecholamine secretion rates and cardiovascular parameters (blood pressure and heart rate). In contrast, a dose of 5 micrograms kg-1 was ineffective. Intracisternal clonidine (in a lower dose of 3 micrograms kg-1) also decreased adrenaline and noradrenaline release from the adrenal gland. Clonidine failed to modify adrenal catecholamine release evoked by electrical stimulation of the splanchnic nerve. These results demonstrate that clonidine decreases adrenaline release from the adrenal gland through a central and not a peripheral mechanism in dogs. This action might contribute to its antihypertensive effects.

A program for automatic acquisition and processing of electroretinograms obtained in vivo in albino rats.

A program sequence has been developed on a microcomputer that affords automatic acquisition and processing of electroretinogram (ERG) obtained in vivo in dark-adapted albino rats. A 50-Hz digital filter and an averaging summation remove the background noise.

Effect of apomorphine on adrenal medullary catecholamine levels.

The effects of the dopamine receptor agonist, apomorphine, on the total catecholamine content of the adrenal medulla were studied in normotensive rats. Apomorphine (3, 15, 30 mg/kg SC) induced a dose-dependent decrease in catecholamine content of the adrenal gland. The action of apomorphine was suppressed by previous treatment with the non specific dopamine receptor antagonist, haloperidol (9 mg/kg IP), or the D2 antagonist domperidone (2 mg/kg IP), but not by the D1 antagonist SCH 23390 (1 mg/kg IP). The apomorphine-induced decrease in adrenal catecholamine concentration was suppressed by denervation of the adrenal medulla, i.e. unilateral section of splanchnic fibers performed 5 days before. These results show that, under our experimental conditions, the effect of apomorphine is due to the activation of D2 dopamine receptors probably located on splanchnic nerve endings and suggest the existence of a peripheral D2 dopaminergic system which modulates adrenal medullary catecholamine content.

Effects of calcium entry blockers on blood pressure and heart rate in neurogenic hypertensive dogs.

The hypotensive and negative chronotropic effects of 5 calcium entry blockers (verapamil 200 micrograms/kg IV; diltiazem 300 micrograms/kg IV; nifedipine 5 micrograms/kg IV; nicardipine 50 micrograms/kg IV; and bepridil 5 mg/kg IV) were compared in control normotensive and acute neurogenic hypertensive anaesthetized dogs. Acute neurogenic hypertension was induced by sino-aortic denervation (SAD). In control normotensive dogs, all drugs (except bepridil) induced a slight and transient decrease in blood pressure. Nifedipine and nicardipine increased heart rate whereas the three other drugs remained ineffective. SAD caused a 2-2.5-fold increase in the hypotensive properties of the 5 drugs in dogs. Moreover, the duration of this induced hypotension was longer than in control normotensive animals. In SAD dogs, all calcium entry blockers significantly decreased heart rate. This study indicates that the direct cardiac inhibitory action of calcium channel blockers is modulated by baroreceptor activity in intact animals. The mechanism of the selective action of calcium entry blockers in hypertensive SAD in contrast to normotensive dogs is discussed.

Effect of clonidine on adrenal medulla catecholamine levels in rats.

The effects of clonidine on adrenal medulla catecholamines levels were studied in normotensive rats. Intraperitoneal injections (50,100 micrograms/kg) of clonidine caused a dose-dependent decrease in adrenaline content of the gland. This effect was suppressed by denervation of the adrenal medulla, i.e. unilateral section of splanchnic fibers performed 5 days before. These results demonstrate that clonidine decreases the catecholamine content of the adrenal medulla only through a central action. They suggest that the adrenal medulla is involved in the hypotensive effect of clonidine.

An experimental evaluation of an AIDS educational intervention for WIC mothers.

The purpose of this study is to determine which of two educational approaches have the greater effect on the AIDS/human immunodeficiency virus (HIV) knowledge and attitudes of women participating in the Women, Infants, and Children (WIC) Program. A modified version of the Centers for Disease Control's (CDC) 1989 Health Risk Survey was administered to 217 women, who were then randomly assigned to either a control group receiving the usual written material, a nurse-educated group, or a videotape-educated group. The questionnaires were repeated immediately after and 2 months after the intervention. Chi square, Kruskall-Wallis ANOVA, and a repeated measures ANOVA were used for data analysis. Ninety-five percent of the subjects were black and the mean age was 25.8 years (+/- 5.9). The control group had significantly lower (p < or = 0.003) AIDS knowledge scores at both posttests, with the lowest knowledge level at 2 months. The videotape group had a greater (p < or = 0.048) intent to reduce risky behaviors at the initial posttest. Tolerance towards AIDS patients was significantly (p < or = 0.025) greater in the videotape and nurse groups. Both videotape and nurse education programs increased knowledge and influenced attitudes and behavioral intent. The more efficient videotape program had similar effects as the nurse program, and may be more generalizable to other populations.

An evaluation of a school-based AIDS/HIV education program for young adolescents.

This study evaluated the efficacy of a school-based AIDS/human immunodeficiency virus (HIV) education program on 6th and 7th grade students. Using a quasi-experimental pretest-posttest control group design, a control group and an education group (intervention I) received both pretest and posttest questionnaires and a second education group (intervention II) was posttested only. Students were evaluated using a modified version of the Centers for Disease Control's Health Risk Survey. Students who received AIDS education were less likely (p < or = 0.0001) than the control group to report that they had changed their behavior to avoid getting AIDS, but thought they had a greater (p < or = 0.0002) chance of acquiring AIDS as an adult. In the intervention I group, males who had never received prior AIDS instruction were more worried about acquiring AIDS as an adult (p < or = 0.013). In the intervention II group, the education had a significant impact on the level of knowledge about AIDS/HIV infection (p < or = 0.0003) and the degree of tolerance toward students with AIDS (p < or = 0.0008), but the effect was not greater than the learning that occurred in the other 2 groups from testing alone. Students who were pretested were also less worried that they had been exposed to AIDS (p < or = 0.0001), more worried that they would die if they acquired AIDS (p < or = 0.05), and less likely to think AIDS patients should be isolated (p < or = 0.0005). Although this AIDS education program appeared to be moderately successful in this group of younger adolescents, significant learning also occurred fro testing alone.

An evaluation of a school-based AIDS/HIV education program for high school students.

The effect of a 1-hr school-based AIDS/HIV education program on the knowledge and attitudes of high school students was evaluated with a modified version of the Centers for Disease Control Health Risk Survey. One urban and one suburban school each were randomly assigned to an educational intervention (n = 535) or a control group (n = 659). All students received a posttest 2 weeks after the intervention. Knowledge was based on responses to 12 true-false questions (pretest alpha = .76, posttest alpha = 0.81). Principal components analysis was used to develop three attitude scales and risk-taking behavior was assessed by self-report. Data were analyzed with Kruskall-Wallis analysis of variance (ANOVA) and multivariate ANOVA. The groups did not differ in knowledge level at pretest. At posttest the education group had significantly (p < or = 0.006) higher knowledge even after controlling for the effects of previous AIDS education (p < or = 0.019), gender (p < or = 0.007), and Hispanic ethnicity (p < or = 0.048). After the education program, students were less worried about exposure to the AIDS virus, but were more worried (p < or = 0.048) about AIDS acquisition during their adult life. Although single school-based AIDS/HIV education programs may increase knowledge, more extensive education may be needed to change the behavior and attitudes of older high school students.

Attitudinal and behavioral correlates of condom use in urban adolescent males.

To determine correlates of condom use in adolescent males, we administered a sexual behavior questionnaire to 105 urban males attending a general adolescent clinic. The mean age was 16.5 +/- 1.6 years, and all reported heterosexual activity during the prior 3 months. Condom use was significantly (p less than 0.05) associated with perceived hassle of use (Spearman's rho = -0.40), perception of girlfriend's attitude toward condoms (rho = -0.36), self-confidence in correct use (rho = 0.26), younger age (rho = 0.25), reported degree of exposure to sexually transmitted disease (STD) education (rho = 0.23), perceived condom safety (rho = 0.23), and perceived risk of STD if not wearing a condom (rho = 0.21). Using stepwise multiple regression, four variables explained a significant amount of variation in condom use: perceived hassle of use, perceived girlfriend's attitude toward condom use, age, and self-confidence in correct use (adjusted R2 = 0.28, p less than 0.001). Intention to use free condoms was significantly (p less than 0.05) associated with past use (rho = 0.63), girlfriend's attitude toward use (rho = -0.46), self-confidence in correct use (rho = 0.36), perceived hassle (rho = -0.31), and degree of exposure to STD education (rho = 0.25). Three variables in a regression model explained a significant amount of variation in intent to use free condoms: self-reported past use, girlfriend's attitude, and self-confidence in correct use (adjusted R2 = 0.51, p less than 0.001).

[PS2 as a prognostic factor in 1065 cases of human breast cancer. A multicenter study]. / Rôle pronostique de la protéine pS2 dans 1065 cas de cancer du sein. Etude multicentrique.

pS2 protein assay was performed with Elsa-pS2 kit (CIS-Biointernational) on a group of 1,065 patients with operable breast cancer who underwent breast surgery in the years 1982 through 1990. The median follow-up was 57 months. This group included exclusively infiltrating ductal carcinoma with primary surgery. Age mean was 58 yr; T0-T1, 33.6%; T2-T4, 66.4%; Differentiation grade I, 29%; node negative, 53%; estrogen receptor (ER) positive, 62.4%; progesterone receptor (PR) positive, 55.2%; mean tumor size, 2.4 cm; local recurrence, 5.2%; metastasis, 17.5%. pS2 values varied from 0.1 to 707 ng/mg of cytosol protein (median, 5.6; mean 24.5; 95th percentile 112 ng/mg p). There was no significant relationship between the mean level of pS2 and age, tumor size, nodal status, whereas pS2 was related to histological grade (P < 10(-3)), ER (P < 10(-5)), and PR (P < 10(-5)). By using 2 ng/mg p as pS2 cutoff, 77/391 (19.7%) of ER+PR+ tumors were pS2-, and 122/345 (35.4%) of ER-PR-tumors were pS2+; with this cutoff, a strong relationship existed between pS2 and overall survival, but not between pS2 and relapse-free survival. With Cox multivariate analysis, pS2 protein was classified after lymph node status, histological size, ER, differentiation grade, age, clinical stage, PR. In patients with axillary lymph node involvement (N+), pS2 status could discriminate between good and bad prognosis, specially for patients with small tumors (< 2 cm) and with less than seven invaded nodes. This study showed that pS2 protein was a poor prognostic factor in comparison with classical factors.

[Prognostic value of beta-2-microglobulin in Hodgkin disease in young adults]. / Valeur pronostique de la bêta-2-microglobuline dans la maladie de Hodgkin de l'adulte jeune.

From 1977 to 1989, we measured serum beta-2-microglobulin (beta 2-MG) levels from 64 unselected and untreated patients, between 18 to 50-year-old, affected by Hodgkin's disease. Serum beta 2-MG level was measured by radioimmunoassay (Phadebas beta 2 microtest). Then, all patients received a chemotherapy such as MOPP or alternating MOPP/ABVD followed or not by radiotherapy. Elevated serum beta 2-MG level (> 2.4 mg/l) is associated with advanced stage disease (stage III-IV), presence of systemic symptoms and bulky tumor. Nevertheless, a multivariate analysis shows that the serum beta 2-MG level is the most significant prognostic indicator for disease free survival. The prognostic value of serum beta 2-MG is demonstrated for myeloma and non Hodgkin's lymphoma. A few authors have evaluated the prognostic impact of serum beta 2-MG in Hodgkin's disease. This study requires confirmation by multicentric and prospective trial.

[Diagnostic value of SCC-TA4 determination in 4 localizations of epidermoid cancers. An experience of the FNCLCC subgroup of radio-analysis]. / Intéret diagnostique du dosage du SCC-TA4 dans quatre localisations de cancers épidermoïdes. Expérience du sous-groupe de radio-analyse de la FNCLCC.

A multicenter and retrospective study of the diagnosis value of SCC-TA4 in squamous cell carcinomas of 4 localisations was made with the 2 thresholds of 2 and 2.5 ng/ml. However, 3.1% of controls have a SCC value above 2.5 ng/ml. Sixteen benign gynecologic pathologies had no positive level. The benign digestive (N = 73), bronchial (N = 345) pathologies and no squamous cell carcinomas (N = 93, N = 220 respectively), had SCC-TA4 mean levels significantly lower than corresponding squamous cell carcinomas (N = 153, N = 128 respectively). Sensitivity of the test varied from 40% in the squamous cell carcinomas of the lung, to 72% in the squamous cell carcinomas of the uterine cervix. Specificity was always very high and varied from 91% in the SCC of lung, to 100% in the SCC of uterine cervix. For the SCC of uterine cervix, oesophagus and head and neck, the mean values and incidence of positive levels increased significantly with increasing tumor size and advancing disease stage. For the SCC of uterine cervix, mean SCC-TA4 levels and percentages of positive levels above 2 ng/ml were significantly higher for the patients with recurrence (22.5 +/- 4.6 ng/ml; 76%) or with metastasis appearance (23.6 +/- 5.4 ng/ml; 77%) than for the patients in remission (less than 1.5 ng/ml; 0%). In the SCC of oesophagus, we report levels before treatment that are significantly higher for the patients with metastasis at the first attempt (4.2 +/- 5.1 ng/ml; 59%), and an elevated SCC level at the diagnosis evoked a SCC of lung already disseminated (8.8 +/- 12.1 ng/ml; 50%) that will fail to respond to treatment (4.0 +/- 4.2 ng/ml; 48%).

Familial growth retardation with isolated thyroid-stimulating hormone deficiency.

Three brothers with isolated thyroid-stimulating hormone (TSH) deficiency were observed at ages 17, 15, and 10 years. They suffered from severely retarded growth, with a marked retardation in bone maturation. Their serum T4, T3, and TSH levels were low. Serum thyrotropin-releasing hormone (TRH) concentration was normal. No increases in TSH levels were elicited during the TRH test. The other pituitary hormones, adrenocorticotropic hormone, growth hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin hormone, responded normally to stimulation. Thyroxin treatment triggered a growth acceleration. Genetic investigation revealed several instances of small stature on the father's side.

An automatic stimulus generation system for electroretinogram capture and processing.

An automated system is presented for on-line capture and processing of the analog signal obtained in response to light or X-ray stimulation of isolated rat retina maintained in survival by perfusion. The most important part of the system is a microcomputer Apple II (48 K Europlus) equipped with interface boards. Basic and assembler programs automatically deliver light or X-ray stimulation every 5 min. Data capture and data processing are carried out following each retinal response. Calculated parameters of the ERG, and 200 values obtained after sampling of an ERG are placed in a data file on a floppy disc. One hundred ERGs can be stored in this way.

[Value of the study of circulating adrenergic receptors in the diagnosis and surveillance after surgery of pheochromocytoma]. / Intérêt de l'étude des récepteurs adrénergiques circulants dans le diagnostic et la surveillance après chirurgie des phéochromocytomes.

The purpose of the study was to investigate leukocyte beta adrenoceptors and platelet alpha 2 adrenoceptors in pheochromocytoma. The study concerned nine hypertensive patients, five men and four women (aged 42 +/- 8 years) with a pheochromocytoma demonstrated by high levels of urinary catecholamines and radiological data. Catecholamine plasma levels, assayed by HPLC were wide-ranging: 10.7 to 172.8 nM for noradrenaline and 0.7 to 3.9 nM for adrenaline. In each case the number of leukocyte beta adrenoceptors sites (measured with 125 I-cyanopindolol) significantly decreased: Bmax was 20.6 +/- 2.8 versus 48.5 +/- 1.5 fmol/mg protein in controls (p less than 0.05). In contrast, the number of platelet alpha 2 adrenoceptors sites (measured with 3H-yohimbine) was not modified: 206 +/- 22.6 versus 186.0 +/- 12.1 fmole/mg protein in controls. There was no change in affinity constant (Kd), neither for beta nor alpha2 adrenoceptors. After tumor removal, there was a significant increase in beta adrenoceptor number. We conclude that down regulation occurs in vivo for beta adrenoceptors but not for alpha2 adrenoceptors and that the decrease in leukocyte beta adrenoceptor number is an interesting and suitable index in the management of pheochromocytoma.

[Natural history of arterial hypertension due to primary hyperreninism]. / Histoire naturelle d'une hypertension artérielle par hyperréninisme primaire.

This case report deals with an eight-year duration severe high renin hypertension and its consequences. In 1975, a 13 years old girl was found to have blood pressure (BP) levels of 240/150 mmHg with bilateral papilloedema. Hypokalemic alkalosis, a 45 mm Sokolow index (SI) and very high peripheral renin activity (PRA) were also noticed. Renal vein renin sampling (RVRS) suggested secretion from the left kidney but intravenous pyelography and renal arteriography were normal. BP levels were first controlled by triple treatment but rose one year later, despite adjunction of beta-blockers. High PRA was again found, but without hormonal gradient on a second RVRS. From 1977 to 1982, BP never fell to normal levels despite quadruple treatment. In 1982, a stage II optic fundus, a 58 mm SI and 2 g/day proteinuria are noticed, so that a new complete etiologic work up is undertaken in 1983: PRA is still high, with a dramatic acute BP fall after captopril and no gradient on a third RVRS, but intravenous pyelography, tomodensitometry and selective arteriography disclose a 4 cm diameter poorly vascularized tumour on the surface of the lower pole of the right kidney. BP levels are controlled for three months by captopril + chlorothiazide. The tumour is removed in january 1984. RVRS by direct peroperative punction indicates (a posteriori) hormonal secretion from the right kidney lower pole. Histologic examination and immunofluorescence with antirenin serum corroborate the juxtaglomerular origin of the tumour. Eighteen months later, BP is permanently normal, SI is 30 mm, and there is no proteinuria.(ABSTRACT TRUNCATED AT 250 WORDS)

High school students' knowledge of HIV/AIDS and perceived risk of currently having AIDS.

Factors associated with AIDS knowledge and perceived risk of currently having HIV infection among adolescents were examined. A modified version of the Centers for Disease Control's Health Risk Survey was administered to 11th and 12th grade students (N = 2,483) in homerooms from nine schools in one southeastern community. Knowledge was based on cumulative responses to 12 questions. Many adolescents incorrectly answered seven questions. Based on multivariate analysis of variance, lower AIDS knowledge was associated with no prior school-based AIDS education (p less than or equal to 0.0001), previous IV drug use (p less than or equal to 0.0001), male gender (p less than or equal to 0.0001), and being Black or "other" ethnic group (p less than or equal to 0.0001). Based on interaction effects, Hispanics not receiving AIDS education in school (p less than or equal to 0.0001) and Black and "other" ethnic group IV drug users (p less than or equal to 0.0011) had a lower AIDS knowledge. When controlling for AIDS knowledge level (p less than or equal to 0.0001), higher perceived risk of current infection with HIV was associated with previous IV drug use (p less than or equal to 0.0001) and male gender (p less than or equal to 0.0001). However, previous IV drug users who never received AIDS education (p less than or equal to 0.0001) or were from Black or "other" ethnic group (p less than or equal to 0.008) had higher perceived risks of presently having HIV infection.

[Effects of a morphine-clomipramine combination on a test of experimental analgesia]. / Effets de l'association morphine-clomipramine sur un test d'analgésie expérimentale.

Morphine (2.5 mg/kg sc) i.e. at a non-antinociceptive dose, augmented clomipramine-induced antinociceptive effect but failed to alter the values of clomipramine (10, 20, 40 mg/kg orally) levels in rats. These results suggest that the potentiation of clomipramine-induced analgesia by morphine does not result from a peripheral pharmacokinetic mechanism but probably involves a central interaction between clomipramine and opiates pathways.