Intervention study to improve smoking cessation during hospitalization.

OBJECTIVES: In France, hospitals have been smoke free since February 2007. A period of hospitalization may be a good time to enhance a smoker's motivation to quit. This study aimed to assess whether training medical staff in smoking cessation management might improve the rate of smoking cessation during hospitalization. STUDY DESIGN: Non-randomized intervention study. METHODS: Staff of the participating care units either received (intervention group) or did not receive (control group) training in smoking cessation management. The dependent variable was the proportion of inpatients that continued to smoke before (Period 1) and after (Period 2) the training session. RESULTS: In total, 358 patients were included. In Period 1, 55.6% and 50% of the smokers from the intervention and control groups stopped smoking, respectively; the corresponding rates in Period 2 were 64.3% and 48.1%. In Period 2, 36.4% and 31.8% of the smokers from the intervention and control groups claimed that they had received motivational counselling. In the intervention group, the request rate for nicotine replacement therapy (NRT) was higher (41.7%) compared with the control group (11.1%). In both groups, patients asked for NRT more often (P < 0.001) when they had received motivational counselling. CONCLUSIONS: This study was not able to demonstrate that training medical staff in smoking cessation management has a significant impact on smoking cessation in hospitalized smokers. The delivery of medium-intensity support to all smokers appears to be out of reach of physician/nurse teams. New strategies are needed, including a team specifically dedicated to the problems of addiction.

Efficacy and safety of highly purified, doubly virus-inactivated VWF/FVIII concentrates in inherited von Willebrand's disease: results of an Italian cohort study on 120 patients characterized by bleeding severity score.

The efficacy of highly purified VWF/FVIII concentrates with standardized ristocetin cofactor content (VWF:RCo) has been already proven in patients with von Willebrand's disease (VWD). Aim of this retrospective study is to confirm efficacy and safety of two highly purified, doubly virus-inactivated VWF/FVIII concentrates in a large cohort of patients with VWD who were characterized at enrolment by bleeding severity score. Study drugs Alphanate or Fanhdi were given to 120 cases (51 males, 69 females, median age 50 years, range 6-83 years). Patients had VWD3 (10), VWD2A (19), VWD2B (25), VWD2M (10) and DDAVP-unresponsive VWD1 (56) and a median bleeding severity score of 8 (range 0-27). A total of 114 bleeding episodes in 55 cases and 131 surgical procedures in 85 cases could be analysed. Excellent-good clinical responses were seen in 97% of bleeding episodes and in 99% of surgical procedures. To prevent recurrent gastrointestinal (GI) bleeding, cerebral (CNS) haemorrhage, haemarthroses, urogenital or multisite bleeding in more severe patients, secondary prophylaxis was also carried out in 15 cases with VWD3 (3), VWD2A (3), VWD2B (2), VWD1 (7). A median dose of 42 IU VWF:RCo kg(-1) given every other day or twice a week over a median period of 334 days (range 24-799) prevented bleeding completely in 13 cases and reduced its incidence in the remaining two. These results confirm the efficacy and safety of the study concentrates, not only in the management of bleeding and surgery but also in secondary prophylaxis of severe VWD.

The antihypertensive effect of captopril. Evidence for an influence of kinins.

The acute effect of the orally-active converting enzyme inhibitor, captopril, was compared to that of saralasin in 13 patients with various forms of hypertension on ad libitum sodium intake. A significant difference between the effects of the two drugs on mean arterial pressure (MAP) was found (-11 +/- 3 mm Hg with saralasin, -24 +/- 4.5 mm Hg after captopril). This difference was not correlated with control plasma renin activity (PRA). To determine the influence of the endogenous kallikrein-kinin system in the antihypertensive action of captopril, the effect of aprotinin (Apro), an inhibitor of kinin generation, on the MAP level achieved by captopril was assessed in five normal subjects and 15 patients with hypertension on ad libitum sodium intake. In normal subjects, captopril did not alter MAP, nor did Apro have any effect. In six patients with essential hypertension and normal PRA, MAP decreased by 5.5 +/- 2 mm Hg following captopril, and Apro did not modify this level. In nine patients with renovascular hypertension (RVH), MAP fell by 22 +/ 3 mm Hg after captopril administration, and Apro infusion induced a rise in MAP of 13 +/- 1.7 mm Hg. A positive correlation between log control PRA and the effect of aprotinin was obtained ( r = 0.63, p less than 0.005). Apro had no effect in two patients with RVH who experiences a large drop in MAP during salasin. These results suggest that endogenous kinins as well as other substances, the generation of which is inhibited by aprotinin, may participate to the antihypertensive effect of captopril in patients with angiotensin-dependent hypertension. The lack of an aprotinin effect on the MAP level achieved during saralasin infusion suggests that the influence of the kallikrein-kinin system is related to the effect of captopril rather than the fall in arterial pressure resulting from angiotensin blockade.

Diaphragm kinetics during pneumatic belt respiratory assistance: a sonographic study in Duchenne muscular dystrophy.

The principal aim of this study was to demonstrate the usefulness of M-mode sonography as a noninvasive technique to evaluate diaphragm excursion. The secondary aim was to assess the efficacy of pneumatic abdomino-diaphragmatic belt ventilation in patients with Duchenne muscular dystrophy. Using M-mode sonography, we measured the amplitude of diaphragm excursion in seven patients with Duchenne muscular dystrophy in various positions (0 degrees, 45 degrees, 75 degrees ) with and without pneumatic abdomino-diaphragmatic belt respiratory assistance. The belt significantly increased mean amplitude of diaphragm excursion by 62% at 45 degrees and by 55% at 75 degrees, and increased mean tidal volume by 43.5% at 45 degrees and by 49% at 75 degrees. Two patients were unable to tolerate the horizontal position (0 degrees ) During quiet breathing without the belt, amplitude of diaphragm excursion and tidal volume were positively correlated at 45 degrees (r=0.81; P=0.027) and 75 degrees (r=0.75; P=0.05). There was a significant intra-individual correlation between these two parameters during belt use but no inter-individual correlation. Without the belt, thoracic posture had no significant effect on amplitude of diaphragm excursion, either in quiet or deep breathing. After overnight respiratory assistance, arterial oxygen pressure and arterial oxygen saturation increased significantly, and arterial carbon dioxide pressure decreased from 52+/-6.4 to 46.4+/-4 mmHg. The pneumatic abdomino-diaphragmatic belt significantly improved gas exchanges and ventilation by increasing diaphragm excursion, as was clearly shown by noninvasive M-mode sonography. Indeed, M-mode sonography may be helpful in pneumatic abdomino-diaphragmatic belt pressure adjustment.

Diagnosis of pneumothorax by ultrasound immediately after ultrasonically guided aspiration biopsy.

We report two cases of pneumothorax detected by echographic examination immediately after ultrasonically guided aspiration biopsy and confirmed by chest x-ray film. The pneumothorax was characterized by the disappearance of the lung tumor. In the real-time image, the respiratory excursions of the visceral pleura also disappeared.

Ultrasonically guided aspiration biopsy in osteolytic bone lesions of the chest wall.

Sixteen consecutive patients with one or more osteolytic bone lesions of the chest wall radiologically confirmed underwent ultrasonically guided aspiration biopsy. Nine patients (56.2 percent) had bronchogenic carcinoma with a direct extension. Other diagnostic techniques had failed to diagnose disease in these patients. The lesion showed heterogeneous echogenicity (n = 16) caused by the hyperechoic signals of bone fragments. The interruption of the cortex bone was detected in all cases and extraosseous tumor portion in 14 of 16 patients (87.5 percent). No respiratory motions of the lesion could be demonstrated (n = 16). Definitive histologic diagnosis was made in 14 of the 16 patients (87.5 percent). In malignancy, diagnosis was established in 13 of 14 patients (92.8 percent). Of two confirmed benign lesions, one diagnosis of tuberculosis was obtained. No complication occurred. Sonography and consequently ultrasonically guided aspiration biopsy are a useful, accurate, safe, and low-cost technique for osteolytic lesions in thoracic diseases.

Ultrasonographic approach to diagnosing hydropneumothorax.

Ultrasound results for 11 patients with HPN confirmed by CXR were compared with those for 100 healthy subjects. The observation of the hyperechogenic line of the pleuropulmonary surface (normal subjects) showed back-and-forth respiratory movements in every case which we call the "gliding sign." Ultrasonographic signs were shown in all patients with HPN. Visualizing the gassy effusion above the pleural fluid, the disappearance of the "gliding sign" (n = 11) indicates PN. The image of the HPN allows in addition a "curtain sign" which depicts the movement of air/fluid level (n = 11), the pulmonary collapse being calculated across the liquid window whose echostructure is analyzed. A "polymicrobullous" image (n = 2) caused by air microbubbles within the fluid effusion, is reported. We conclude that echography appears to be a new approach to diagnosing HPN, which is particularly useful during or after ultrasonically guided procedures including pleural drainage, and should be recognized by sonographers.

Pirarubicin phase II study in untreated metastatic small-cell lung carcinoma. A cooperative study of the Groupe Français de Pneumo-Cancérologie (GFPC).

Pirarubicin (THP) (Roger Bellon Laboratory, France) is a new anthracycline under clinical development. In order to assess the efficacy and toxicity of the drug in small-cell lung carcinoma (SCLC), we have undertaken this trial in front-line therapy in patients with metastatic disease, PS less than 3 and at least one evaluable lesion. Responses were assessed after two cycles of THP (60 mg/m2 i.v. bolus every 3-4 weeks) and a further cross over to VP16 + CDDP (three cycles) was systematic whatever the response to THP. This crossover was performed after only one cycle in case of obvious progression. From June 1988 to April 1990, 32 patients were enrolled: 6 were ineligible (4 non-SCLC, 2 M0), 26 patients were fully evaluable for THP and 18 patients for VP16-CDDP. The characteristics of the patients were as follows: mean age 57.4 years (38-71); T4: 54%; T3: 27%; T2: 19%; N3: 62%; N2: 35%; No: 4%. The efficacy was as follows 1 complete response and 2 partial responses (confirmed by endoscopy); 12 patients received only one cycle because of obvious progression; the overall response rate is 12% (95% confidence interval 0-24%). The patient who had complete response after pirarubicin remained in CR after VP16-CDDP, whereas the 2 patients who had partial response achieved CR for one and PR for the other; among the 15 who did not respond 1 CR and 7 PR were observed. The only significant toxicity of THP was granulopenia without infection. THP seems to be an effective anthracycline in SCLC, and the study is continuing. A response could be reached in 50% of the nonresponders with standard therapy and 10 of 24 patients (42%) finally responded. Therefore, this schedule for testing new drugs in metastatic SCLC appears ethically acceptable.

Childhood leukemia in south-west Sardinia (Italy).

AIM AND BACKGROUND: Public concern on an increased incidence of childhood leukemia in SW Sardinia prompted the authors to an epidemiological investigation. METHODS: Incident childhood neoplasms observed in the Cagliari province (Sardinia--Italy) in 1974-1989 were registered. Expected cases of the most frequent childhood cancers were calculated for each town, based on the sex-and age-specific incidence rates in the province. RESULTS: An excess risk of childhood acute lymphoblastic leukemia (ALL) was observed in Carbonia, a town located in the SW part of the province. The risk was highest in 1983-85, when 7 cases occurred versus 0.8 expected (RR = 8.7; 95% C.I. = 4.6, 16.3). No spatial clustering of ALL cases was observed within the town. CONCLUSIONS: A significantly higher than expected incidence of childhood ALL was observed in the town of Carbonia in 1983-85. In alternative to chance, possible exposure to environmental pollutants from a near industrial settlement is discussed as the cause of the observed excess, but it is far to be proven. Other hypotheses, including a viral infection in a population with increased susceptibility, as suggested for new urban settlements, cannot be discarded.

[Evaluation of the acute effect of a converting enzyme inhibitor, captopril, in normal and hypertensive subjects]. / Estimation de l'effet aigu d'un inhibiteur de l'enzyme de conversion, le Captopril, chez le sujet normal et l'hypertendu.

The response to acute oral administration of 50 mg of Captopril was assessed in 17 normal volunteers and 47 patients with hypertension; 17 had renovascular (RVH) abnormalities and 30 patients had essential hypertension (EH). All patients were maintained on ad libitum sodium intake. The effect of Captopril on mean arterial pressure (MAP) was rapid a maximal within 60 minutes. The converting enzyme inhibitor induced a similar decrease in MAP in normal subjects (-5.1 +/- I mm Hg) and patients with EH (-7.2 +/- I mm Hg). Control plasma renin activity (PRA) was similar in both groups; however, the increase in PRA following Captopril was more marked in normals (8.1 +/- 1.7 ng/ml/h) than in EH (1.7 +/- 0.7 ng/ml/h). In patients with RVH a marked fall in MAP occurred (-25.4 +/- 4 mm Hg). A fall in MAP higher than 20 mm Hg was observed in 65% of patients with RVH and none of the EH group. A negative correlation between log PRA and the change in MAP induced by Captopril was obtained (r = 0.65). Assessment of the response to acute administration of Captopril may be useful for screening patients with RVH.

[Electromyographic analysis of the motility of the right and transverse colon in 9 colostomized patients]. / Analyse électromyographique de la motricité du côlon droit et transverse chez 9 patients colostomisés.

The aim of this work was to study the electric pattern of proximal colonic motility in patients with permanent colostomy but without past history of an irritable bowel syndrome. Nine patients (55 to 70 years-old) were investigated using a colonoscope with 5 annular electrodes. An electromyogram was recorded during 4 h. In 5 patients, the results observed before and after a standard test meal were compared. The two usual types of electric activity (i. e. Long Spike Bursts (LSB) and Short Spike Bursts (SSB)) were recorded in the right and transverse colon. The duration of LSB and SSB activities were 8.3 +/- 5.5 and 3.7 +/- 3.5 p. 100 respectively (m +/- SD). In 6 patients, the right and transverse colons were recorded simultaneously; in these patients there was a significant difference in LSB activity between the ascending colon and the transverse colon (10.6 +/- 3.7 and 5.6 +/- 4.3 p. 100 respectively; p less than 0.01). After a meal, the right colonic LSB activity increased (greater than 30 p. 100 of the basal level) in 4 out of 5 patients whereas the transverse colonic LSB activity increased only in one patient. The most striking finding of this study was that colonic hypomotility was of a propulsive and tonic nature. These results could explain the nearly continuous flow of faeces commonly observed in patients with colostomy.

Analysis of risk factors in a cluster of childhood acute lymphoblastic leukemia.

A case-control investigation of childhood acute lymphoblastic leukemia was conducted in the town of Carbonia (Sardinia, Italy). Parents of 9 cases diagnosed between 1980 and 1989 and 36 controls were interviewed at their respective residences. None of the risk factors analyzed was associated significantly with childhood acute lymphoblastic leukemia. The following were associated with an increased risk for childhood acute lymphoblastic leukemia: parents born outside of Carbonia, family history of cancer, alcohol consumption by fathers that exceeded 60 g/d, exposure of fathers to solvents at their workplaces, maternal smoking, use of antinausea medications during pregnancy, and presence of a well in the backyard. Chance and recall bias likely played a role in generating positive associations. The increases in childhood leukemia risk associated with the presence of a well and with use of antinausea medications during pregnancy are consistent with previous reports and require further investigation.

[Right diaphragmatic kinetics measured by TM-mode ultrasonography with concomitant spirometry in normal subjects and asthmatic patients. Preliminary results]. / Cinétique diaphragmatique droite mesurée par ultrasonographie en mode TM avec spirométrie concomitante chez le sujet normal et asthmatique. Résultats préliminaires.

The purpose of this study was to assess the diaphragmatic excursion using the TM-mode ultrasonography with concomitant pneumotachography in eight normal and five asthmatic subjects before and after salbutamol. We report the results in normal and asthmatic patients of this procedure. Particular findings were demonstrated in asthma. Different significant correlations were found between sonographic and respiratory measurements. In view of the safety of this direct and real-time diaphragmatic investigation, we conclude that this new method could offer an effective and reliable procedure in the evaluation of patients with diaphragmatic dysfunction. However, our study was limited by the small number of patients included and definite conclusions should await further investigations.

[Towards another diagnostic approach of peripheral pulmonary masses. Ultrasound-guided puncture]. / Vers une autre approche du diagnostic des masses pulmonaires périphériques. La ponction échoguidée.

In a series of 50 patients with lung lesions touching the thoracic wall, percutaneous ultrasonically guided needle aspiration yielded a pathological diagnosis in 44 cases (sensitivity: 88%). The histological diagnosis of malignant lesion could be confirmed in 41 of these 44 patients. In this group of patients with neoplasia the diagnosis obtained by extemporaneous cytology was compared with that obtained by lung biopsy: the diagnostic sensitivity of cytology proved to be higher than that of biopsy (86.36% and 65.90% respectively). Using the two methods concomitantly increased sensitivity up to 93.18%. A pathological diagnosis could be obtained in 3 out of the 6 patients in this series who had benign lesions.

[Echography of pneumothorax]. / Echographie du pneumothorax.

Ultrasound of 28 radiologically confirmed cases of pneumothorax were compared to 100 controls. Specific ultrasonographic signs were shown in all cases and could be categorised into four groups: isolated pneumothorax (n = 16), hydro-pneumothorax (n = 9), subcutaneous emphysema (n = 1) and post aspiration pneumothorax (n = 2). The isolated pneumothorax was characterised by the disappearance of the lung deflection signal. The effusion of the hydropneumothorax allows in addition a curtain sign which depicts the movement of the air/fluid level, the detachment of the lung being calculated across the liquid window whose echo-structure is analysed. Pneumothoraces appearing during an echo guided thoracic puncture are confirmed by the disappearance of the pathological image. Thus echography appears to be a new method in the diagnosis of pneumothoraces and is complimentary to standard radiology. It should be confirmed as particularly useful during the process of thoracic puncture or juxta-diaphragmatic puncture when following the process of a pneumothorax, for emergency situations and/or those in which no radiological equipment is available.

[A phase II trial of pirarubicin in untreated disseminated small cell lung cancer. A cooperative study of the French Pneumo-Cancerology Group]. / Essai de phase II de la pirarubicine dans les cancers pulmonaires à petites cellules disséminés jamais traités. Etude Coopérative du Groupe Français de Pneumo-Cancérologie (GFPC).

The usual form of chemotherapy of metastatic small cell lung cancer gives a 50% objective response with a mean survival of 7-8 months. We have tested a new antimitotic drug using pirarubicin alone in 26 patients. After the second treatment we noticed a response level of 12% with moderate toxicity. Then, we undertook classical chemotherapy using cisplatin-V16. After 3 doses the response level was 50% with a median survival of 32 weeks. In our study the use of a single drug pirarubicin in metastatic small cell cancer did not appear to worsen the chance of survival in patients if polychemotherapy was carried out immediately in cases which failed on the single drug. Our monotherapy did not appear to induce resistance to affective polychemotherapy. This method applied carefully to patients with metastatic disease with a strict follow up may be utilised in the assessment of the efficacy of the newer antimitotic drugs.

[Incidence, mortality and survival in childhood tumors in meridional Sardinia. The Cagliari province, 1981-1988]. / Incidenza, mortalità e sopravvivenza per tumori infantili nella Sardegna meridionale. La provincia di Cagliari per gli anni 1982-1988.

Childhood cancer incidence, mortality and relative survival rates have been estimated in the province of Cagliari for the years 1982-86. Cases were collected from pediatric and non pediatric units operating either in the province or elsewhere. Deaths were identified through the registry offices of municipal administrations. A total of 151 cases were identified, corresponding to an incidence rate of 115.0 per million. Survival rate at three years of diagnosis was 63.3%.

[Disseminated intravascular coagulation in children. Therapeutic problems]. / La CID in età pediatrica. Problemi terapeutici.

The AA, after discussion on physiopathological and clinical aspects of DIC in childhood, focused their attention mostly on the utilization of AT III concentrates.

[Towards another diagnostic approach of peripheral pulmonary masses in pneumology: ultrasonically guided needle puncture]. / Vers une autre approche pneumologique du diagnostic des masses pulmonaires périphériques: la ponction échoguidée.

In a series of 50 patients with lung lesions touching the thoracic wall, percutaneous ultrasonically guided needle aspiration yielded a pathological diagnosis in 44 cases (sensitivity: 88%). The histological diagnosis of malignant lesion could be confirmed in 41 of these 44 patients. In this group of patients with neoplasia the diagnosis obtained by extemporaneous cytotology was compared with that obtained by lung biopsy: the diagnostic sensitivity of cytology proved to be higher than that of biopsy (86.36% and 65.90% respectively). Using the two methods concomitantly increased sensitivity up to 93.18%. A pathological diagnosis could be obtained in 3 out of the 6 patients in this series who had benign lesions. No bleeding was observed, and there was only one complication: a partial pneumothorax not requiring drainage which was detected by ultrasonography and confirmed by radiography. Thus, ultrasonically guided needle aspiration of lesions adjacent to the thoracic wall appears to be an efficient and reliable diagnostic method. Lack of irradiation, real-time guidance, low cost, high sensitivity and easily available equipment are as many reasons to prefer this method to other interventional radiology methods in patients with peripheral lung masses detectable by ultrasounds.