RESUMO
Medulloblastoma is a cerebellar grade IV tumour according to the WHO classification, mainly seen in children under the age of 15. This cancer can nevertheless occur in adults. We report the case of a 22-year-old patient with a medulloblastoma disseminated in the spine. The patient had a type 1 Arnold-Chiari malformation causing hydrocephalus treated by ventriculoperitoneal shunt. The current condition began with perineal and lower limb hypoesthesia, ataxic gait, erectile dysfunction and urinary incontinence. Subsequently, a predominant paraparesis of the right lower limb appeared. The patient was treated according to the PNET HR+5 protocol combining two courses of conventional chemotherapy followed by two courses of high-dose chemotherapy with autograft recovery. Given the excellent response, a proton therapy was then delivered to the whole cerebrospinal axis with boosts to the primary tumour sites. The case of this young adult patient shows on the one hand an atypical presentation, and on the other hand underlines, in the absence of a specific therapeutic strategy established for adults, the importance of collaboration between the adult and pediatric oncology departments, with management integrating innovations such as proton therapy and molecular typing.
Le médulloblastome est une tumeur cérébelleuse de grade IV selon l'Organisation Mondiale de la Santé, principalement observée chez les enfants de moins de 15 ans. Ce cancer peut néanmoins survenir chez l'adulte. Nous rapportons le cas d'un patient de 22 ans présentant un médulloblastome disséminé au niveau du rachis. Le patient est porteur d'une malformation d'Arnold-Chiari de type 1 provoquant une hydrocéphalie traitée par dérivation ventriculo-péritonéale. L'affection actuelle a débuté par une hypoesthésie du périnée et des membres inférieurs, une démarche ataxique, un trouble érectile et des troubles vésico-sphinctériens. Par la suite est apparue une paraparésie prédominant au membre inférieur droit. Le patient a été traité selon le protocole pédiatrique PNET HR+5 combinant deux cures de chimiothérapie conventionnelle suivies de deux cures de chimiothérapie à haute dose avec rattrapage par autogreffe. Vu l'excellente réponse, une protonthérapie a été administrée sur l'axe cérébrospinal avec surdosages sur les sites primaires de la tumeur. Le cas de ce jeune adulte illustre, d'une part, une présentation atypique et d'autre part, souligne, en l'absence de stratégie thérapeutique spécifique établie pour l'adulte, l'importance de la collaboration entre les services d'Oncologie adulte et pédiatrique, la prise en charge intégrant les innovations telles que la protonthérapie et le typage moléculaire.
Assuntos
Neoplasias Cerebelares , Meduloblastoma , Adulto , Neoplasias Cerebelares/tratamento farmacológico , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/cirurgia , Criança , Humanos , Masculino , Meduloblastoma/tratamento farmacológico , Meduloblastoma/terapia , Adulto JovemRESUMO
Cancers are rare pathologies in children. Improvement in survival rates has been obtained thanks to new therapeutic strategies based on the identification of risk factors. Targeted therapies in paediatric oncology are new treatments providing hope that cure is achievable without long-term sequelae.
Les cancers pédiatriques sont des pathologies rares. L'amélioration du taux de survie a été obtenue par de nouvelles stratégies de traitement basées sur l'identification de facteurs de risque. Les thérapies ciblées en oncologie pédiatrique, nouvelle arme thérapeutique, sont porteuses d'espoir de guérison, sans séquelles à long terme.
Assuntos
Oncologia , Neoplasias , Criança , Humanos , Neoplasias/tratamento farmacológico , Taxa de SobrevidaRESUMO
During the past 50 years, the mortality due to childhood cancers decreased dramatically thanks to improvements in supportive care and the use of multimodal approaches. In this context, the long-term follow up after childhood cancer has become a main concern for pediatric oncologists. The SALTO programme was developed in 2012 at the CHR Citadelle in Liège in order to organize a multidisciplinary long-term follow-up for the patients previously treated in our department for a childhood cancer. The aim of the present study was to review, for the most frequent childhood cancers, the long-term sequellae and the second cancers developed by the patients participating to the SALTO programme in order to define the follow-up needed. Our data confirm the importance of a multidisciplinary long-term follow-up, based on the treatments received and following international guidelines.
Au cours des cinquante dernières années, la mortalité liée aux cancers pédiatriques a fortement diminué grâce à une amélioration des soins de support et à l'utilisation d'approches multimodales. Dans ce contexte, le devenir à long terme des patients guéris d'un cancer pédiatrique est devenu une des préoccupations majeures pour les oncologues pédiatres. Dans cette optique, la consultation SALTO («Suivi À Long Terme en Oncologie¼) a été mise en place en 2012 au CHR de la Citadelle pour assurer le suivi multidisciplinaire des adultes ayant été traités dans notre secteur d'hémato-oncologie pédiatrique. L'objectif de cette étude a été de revoir, pour les cancers pédiatriques les plus fréquents, les séquelles et les tumeurs secondaires présentées par les patients suivis en consultation SALTO afin de préciser les modalités du suivi au long cours après cancer pédiatrique. Nos résultats confirment l'importance d'un suivi multidisciplinaire à long terme adapté aux traitements reçus, sur base de recommandations internationales.
Assuntos
Segunda Neoplasia Primária , Neoplasias , Criança , Seguimentos , Humanos , Neoplasias/terapia , Encaminhamento e Consulta , SobreviventesRESUMO
The article describes a clinical case of catatonic syndrome. We describe the manifestations of the syndrome, its diagnostic criteria and associated scales. The modalities of the challenge test, constituting a diagnostic test, and first line treatment are detailed. Clinical and paraclinical investigations are proposed to determine the etiology. The benzodiazepine withdrawal as an etiology of catatonic syndrome is detailed.
L'article expose un cas clinique de syndrome catatonique. Nous y décrivons les manifestations du syndrome, ses critères diagnostiques et échelles associées. Les modalités du «challenge test¼, constituant une épreuve diagnostique, et le traitement de première ligne sont détaillés. Des investigations cliniques et paracliniques sont proposées afin d'en déterminer l'étiologie. Le sevrage en benzodiazépines comme étiologie du syndrome catatonique est discuté.
Assuntos
Catatonia , Síndrome de Abstinência a Substâncias , Benzodiazepinas/efeitos adversos , Catatonia/induzido quimicamente , Catatonia/diagnóstico , Catatonia/tratamento farmacológico , Humanos , Síndrome de Abstinência a Substâncias/diagnóstico , Síndrome de Abstinência a Substâncias/etiologiaRESUMO
The goal of the article was to provide some clinical recommendations for a secure use of lithium. We described the mechanism of action of lithium, that acts as a mood stabilizer but also has anti-suicidal and neuroprotective effects. We also described the toxics effects of lithium and the toxicological tools that help to prevent and to treat those effects. We concluded that lithium remains a first choice for the treatment of bipolar disorders.
L'article fournit des recommandations cliniques pour utiliser le lithium de façon efficace et sûre. Nous décrivons les mécanismes d'action du lithium, stabilisateur de l'humeur aux propriétés antisuicidaires et neuroprotectrices. Nous détaillons les effets toxiques du lithium et les outils de toxicologie clinique qui permettent de les prévenir et de les diagnostiquer. Le lithium reste le traitement de référence des troubles bipolaires.
Assuntos
Transtorno Bipolar , Lítio/efeitos adversos , Psicotrópicos , Transtorno Bipolar/tratamento farmacológico , Humanos , Psicotrópicos/efeitos adversos , Medição de RiscoRESUMO
Congenital coronary artery fistulas are infrequent but sometimes hemodynamically important anomalies depending on their magnitude and the cardiac chamber or vascular site involved. Fistula from left circumflex artery to coronary sinus are potentially curable causes of ischemic heart disease.
Les fistules congénitales des artères coronaires sont des anomalies peu fréquentes, mais parfois importantes sur le plan hémodynamique, en fonction de leur taille et de la chambre cardiaque ou du site vasculaire impliqué. Les fistules entre l'artère circonflexe et le sinus coronaire sont des causes potentiellement curables des cardiopathies ischémiques.
Assuntos
Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Fístula Vascular , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Seio Coronário , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Humanos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgiaRESUMO
Cancer is the second leading cause of death among children aged 5 to 14, after accidents. We conducted a study on the epidemiology of childhood cancer in the university pediatric oncology department of the CHU-CHR in Liège, Belgium. We studied a cohort of 662 patients between the ages of 0 and 17 whose malignancy diagnosis was made between 1985 and 2016. The analyzes were performed retrospectively using medical files. The number of new cases, the proportion of different cancers, sex ratio, age at diagnosis and survival at 5 and 10 years were the epidemiological factors studied.We have been able to show an increase in the number of new diagnoses per year. More than 40 % of childhood cancers occur before the age of five. The most common neoplasias are leukemias, tumors of the central nervous system and lymphomas. This distribution is influenced by age. All malignant tumours combined, we observed a slightly larger proportion of affected boys than girls. Overall survival at 5 years reaches 80.2 %. However, it varies according to the type of tumour from 59.3 % for malignant soft tissue tumors up to 100 % for hepatoblastomas.
Le cancer est la deuxième cause de décès chez les enfants de 5 à 14 ans, après les accidents. Nous avons réalisé une étude sur l'épidémiologie des cancers de l'enfant au sein du service universitaire d'oncologie pédiatrique du CHU-CHR de Liège. Nous avons étudié une cohorte de 662 patients, âgés de 0 à 17 ans, dont le diagnostic de tumeur maligne a été posé entre 1985 et 2016. Le nombre de nouveaux cas, la proportion des différents cancers, le sex ratio, l'âge au diagnostic et la survie à 5 et 10 ans ont été les facteurs épidémiologiques étudiés. Nous avons pu démontrer une augmentation du nombre de nouveaux diagnostics par an. Plus de 40 % des cancers de l'enfant surviennent avant l'âge de 5 ans. Les néoplasies les plus fréquentes sont les leucémies, les tumeurs du système nerveux central et les lymphomes. Cette répartition est néanmoins influencée par l'âge. Toutes tumeurs malignes confondues, nous avons observé une proportion légèrement plus grande de garçons atteints que de filles. La survie globale à 5 ans s'élève à 80,2 %. Elle varie cependant selon le type de tumeur de 59,3 % pour les tumeurs malignes des tissus mous jusqu'à 100 % pour les hépatoblastomes.
Assuntos
Neoplasias , Adolescente , Bélgica/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Neoplasias/epidemiologia , Estudos RetrospectivosRESUMO
Somatic mutations are postzygotic mutations which may lead to mosaicism, the presence of cells with genetic differences in an organism. Their role in cancer is well established, but detailed investigation in health and other diseases has only been recently possible. This has been empowered by the improvements of sequencing techniques, including single-cell sequencing, which can still be error-prone but is rapidly improving. Mosaicism appears relatively common in the human body, including the normal brain, probably arising in early development, but also potentially during ageing. In this review, we first discuss theoretical considerations and current evidence relevant to somatic mutations in the brain. We present a framework to explain how they may be integrated with current views on neurodegeneration, focusing mainly on sporadic late-onset neurodegenerative diseases (Parkinson's disease, Alzheimer's disease and amyotrophic lateral sclerosis). We review the relevant studies so far, with the first evidence emerging in Alzheimer's in particular. We also discuss the role of mosaicism in inherited neurodegenerative disorders, particularly somatic instability of tandem repeats. We summarize existing views and data to present a model whereby the time of origin and spatial distribution of relevant somatic mutations, combined with any additional risk factors, may partly determine the development and onset age of sporadic neurodegenerative diseases.
Assuntos
Doença de Alzheimer/genética , Esclerose Lateral Amiotrófica/genética , Encéfalo/patologia , Mutação , Doenças Neurodegenerativas/genética , Doença de Parkinson/genética , Doença de Alzheimer/patologia , Esclerose Lateral Amiotrófica/patologia , Humanos , Mosaicismo , Doenças Neurodegenerativas/patologia , Doença de Parkinson/patologiaRESUMO
The Acquired ImmunoDeficiency Syndrome (AIDS) is a chronic infectious disease. By its complexity and the importance of psychiatric syndromes observed among HIV patients, the common contribution of somatic and psychiatric health specialists is often mandatory. Conversely, more or less 20 % of psychiatric patients are infected by the AIDS' virus. Moreover, these troubles would be their second reason of hospitalization. These psychiatric symptoms, so caused by HIV, may occur before its serological discovery. Thereby, it will be interesting for the psychiatrist to acquire enough knowledge about this disease to establish preventing actions and strategies of psychoeducation.
Le Syndrome de l'ImmunoDéficience Acquise (SIDA) est une pathologie infectieuse chronique. Par sa complexité et l'importance des syndromes psychiatriques observés chez les patients séropositifs, l'intervention conjointe des professionnels de la santé psychique et somatique peut s'avérer souvent nécessaire. Jusqu'à 20 % des patients psychiatriques seraient également infectés par le virus du SIDA. De plus, ces troubles seraient leur 2ème cause d'hospitalisation. Cette symptomatologie psychiatrique, alors induite par le VIH, pourrait même en précéder la découverte sérologique. Ainsi, il serait intéressant pour le psychiatre d'acquérir suffisamment de connaissances sur cette affection afin d'établir des actions de prévention et des stratégies de psychoéducation.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Transtornos Cognitivos/etiologia , Transtorno Depressivo/etiologia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade , Transtornos Cognitivos/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Interações Medicamentosas , Humanos , Psicotrópicos/uso terapêuticoRESUMO
Conversion disorder is a psychiatric disorder often encountered in neurology services. This condition without organic lesions was and still is sometimes referred as an imaginary illness or feigning. However, the absence of organic lesions does not exclude the possibility of cerebral dysfunction. The etiologic mechanisms underlying this disorder remain uncertain even today.The advent of cognitive and functional imaging opens up a field of exploration for psychiatry in understanding the neurobiological mechanisms underlying mental disorders and especially the conversion disorder. This article reports several neuroimaging studies of conversion disorder and attempts to generate hypotheses about neurobiological mechanisms.
Le trouble de conversion est une pathologie psychiatrique fréquemment rencontrée dans les services de neurologie. Cette pathologie «sans substrat¼ a été et est encore parfois qualifiée de maladie imaginaire ou de simulation. Cependant, l'absence de substrat «organique¼ n'exclut pas la possibilité d'un dysfonctionnement cérébral. Les mécanismes étiopathogéniques qui sous-tendent ce trouble sont longtemps restés incertains, encore aujourd'hui. L'avènement des sciences cognitives et de l'imagerie fonctionnelle ouvre un champ d'exploration pour la psychiatrie dans la compréhension des mécanismes neurobiologiques qui sous-tendent les troubles mentaux et, en particulier, le trouble de conversion. Cet article reprend plusieurs études de neuroimagerie sur le trouble de conversion et tente d'en dégager des hypothèses sur ses mécanismes neurobiologiques.
Assuntos
Transtorno Conversivo/diagnóstico , Neuroimagem Funcional , Transtorno Conversivo/psicologia , Transtornos Dissociativos/psicologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Schizophrenia is a complex pathology. Its prevalence reaches almost 1 %. Its semiology can be diversified. Sensorial perception can be altered included pain perception. Most of the studies conclude that psychotic patients have a hypoalgesia. It's important to consider this fact to avoid missing potentially grave somatic disease.
La schizophrénie est une pathologie complexe dont la prévalence avoisine 1 %. Sa sémiologie peut prendre de multiples formes. La discrimination sensorielle peut être altérée, y compris la perception douloureuse. La grande majorité des études réalisées à ce jour démontrent une hypoalgésie chez les patients atteints de schizophrénie. Il est important de tenir compte de ces données dans la prise en charge des patients exprimant des idées délirantes ou des hallucinations afin d'éviter de passer à côté d'affections non psychiatriques potentiellement graves.
Assuntos
Percepção da Dor/fisiologia , Esquizofrenia/fisiopatologia , Transtornos de Sensação/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Studies in pediatric oncology describe a relative good quality of life in child cancer survivor. However, few studies were interested in the parents of a child cancer survivor. 61 parents are recruited in the Belgian hospitals. Three groups of parents are constituted : the parents whose child is in 4 years of survivorship (group 1), in 5 years of survivorship (group 2) and in 6 years of survivorship (group 3). Clinical scales and a Stroop emotion task are administered. Parents (of the 3 groups) present a low tolerance of uncertainty, have excessive worries about the evolution of the health of their child, and suffer from anxious symptoms. The Stroop emotion tasks reveals a cognitive bias of the attention in favour of threatening stimuli. The study highlights the importance to detect parents who are intolerant of uncertainty at the cancer diagnosis stage and their continuous psychological follow-up once the treatments are ended.
Les études en oncologie pédiatrique décrivent une relativement bonne qualité de vie chez les enfants survivants de cancer. À ce jour, peu d'études se sont intéressées aux parents d'un enfant survivant de cancer. Soixante-et-un parents sont recrutés dans les hôpitaux belges. Trois groupes de parents sont constitués : les parents dont l'enfant est à 4 ans de rémission (groupe 1), à 5 ans de rémission (groupe 2) et à 6 ans de rémission (groupe 3). Des échelles cliniques et une tâche de Stroop émotion sont administrées. Les parents (des 3 groupes) présentent une faible tolérance à l'incertitude, ont des inquiétudes excessives quant à l'évolution de la santé de leur enfant et souffrent de symptômes anxieux. Le Stroop émotion révèle un biais cognitif de l'attention en faveur des stimuli de nature menaçante. L'étude met en exergue l'importance de détecter les parents intolérants à l'incertitude lors du diagnostic d'annonce du cancer et leur suivi psychologique continu une fois les traitements terminés.
Assuntos
Viés , Sobreviventes de Câncer , Pais/psicologia , Incerteza , Adolescente , Adulto , Ansiedade/psicologia , Bélgica , Criança , Humanos , Acontecimentos que Mudam a Vida , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
Anorexia nervosa is a complex pathology that regularly leads clinicians to a therapeutic impasse. The origin of this disorder is multifactorial. It occurs most often in adolescence and affects mainly women. Paradoxically, hunger is present but dissociated from adequate food function. Somatic and psychological impact can be particularly heavy. The treatment is difficult and requires a multidisciplinary care. An eclectic and integrative approach, moving away from rigid therapeutic methods and integrating the plurality of techniques, seems to be particularly recommended to increase the chances of therapeutic success. This article summarizes the various theoretical models of anorexia nervosa and its modalities of treatment.
L'anorexie mentale est une pathologie complexe qui entraîne régulièrement les cliniciens dans une impasse thérapeutique. L'origine de ce trouble est plurifactorielle. Il survient le plus souvent à l'adolescence et touche principalement les jeunes femmes. Paradoxalement, la sensation de faim est présente, mais elle n'est plus au service d'une fonction nutritive adéquate. Les répercussions somatiques et psychiques peuvent être particulièrement lourdes. Le traitement de l'anorexie mentale reste difficile et nécessite une prise en charge pluridisciplinaire. Une approche éclectique et intégrative, s'écartant de méthodes thérapeutiques rigides et intégrant la pluralité des techniques, semble être particulièrement recommandée pour accroître les chances de succès thérapeutique. Cet article résume les différents modèles théoriques de l'anorexie mentale et ses modalités de prise en charge.
RESUMO
Idiopathic Chronic Eosinophilic Pneumonia (ICEP) or Carrington's disease is a rare disease, exclusively pulmonary, and of an unknown origin. Connective tissues of the lungs are infiltrated by eosinophilic cell elements. This illness is progressive, consisting of dyspnea, cough and thoracic pain. In addition, the general condition is impaired. The average delay between onset of symptoms and discovery of chest radiographic opacities is often longer than 3-4 months. Symptoms and chest X-ray quickly improve under corticosteroid treatment. In the future, new research could lead to alternative treatments. We report the case of a woman with ICEP. We shall discuss the diagnostic approach, envisage the potential complications and describe the treatment of the disease.
Assuntos
Eosinofilia Pulmonar/diagnóstico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Capacidade de Difusão Pulmonar , Eosinofilia Pulmonar/tratamento farmacológico , Radiografia TorácicaRESUMO
Recent advances in the neurobiology of depression have underlined the importance of markers of inflammation, neurotrophins, and hypothalamo-pituitary adrenal (HPA) axis dysfunction in the development of this pathology. These disorders could have some impact on other systems such as the glucose metabolism regulation with an increased risk of insulin resistance and type 2 diabetes. Type 2 diabetes is also frequently associated with a pro-inflammatory state that could favour the development of a depressive episode. Inflammatory phenomena and HPA axis dysfunction could be biological links between depression and type 2 diabetes and account not only for the frequent association between those two disorders, but also for the treatment-resistance to classical antidepressants.
Assuntos
Depressão/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Comportamento/fisiologia , Comorbidade , Depressão/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Humanos , Sistema Hipotálamo-Hipofisário/fisiopatologia , Inflamação/complicações , Inflamação/epidemiologia , Sistema Hipófise-Suprarrenal/fisiopatologiaRESUMO
INTRODUCTION: The cancer of the cervix annually occurs in 150 women in Brittany in the absence of organized screening. MATERIAL AND METHODS: Retrospective study concerning 191 patients treated for an invasive cancer of the uterine cervix between 2000 and 2005 analyzing their cytological past. The average age of the patients was 52 years (22-87 years). The socioeconomic level of the patients was recorded. The distribution of under histological types was: squamous, 73% (54 years average age) and adenocarcinoma, 22% (average age 47 years). All the stages were represented: stage I 46%, II 32%, III 9% and stage IV 13%. RESULTS: Cancer was symptomatic in 89% of the cases and 72% of the patients had not profited from cytological screening according to French recommendations (50% no follow-up, 22% follow-up between three and 10 years), while 28% of the patients had a smear in the three years. The socioeconomic level of the patients strongly influenced the participation in screening. The proportion of patients having an invasive adenocarcinom was 31% in the patients with a smear going back to less than three years (versus 22% in our total population) and this histological subtype was mainly represented in patients less than 35 years old (35%). Lastly, 2,6% of the patients were lost after realization of a pathological smear. CONCLUSION: The extension of screening and its organization remain a priority in our area. The average sensitivity of the smear is illustrated by the on-representation of the adenocarcinoma, in particular among young women.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/estatística & dados numéricos , Adenocarcinoma/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Adenoescamoso/diagnóstico , Carcinoma Adenoescamoso/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Feminino , França , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia , Adulto JovemRESUMO
BACKGROUND AND STUDY AIMS: Mass screening for colorectal cancer in France was initiated in pilot regions on the basis of the fecal occult blood test (FOBT) followed by colonoscopy in positive cases. We report the colonoscopy results in one of the first areas to be screened (Ille et Vilaine). PATIENTS AND METHODS: Of the total regional population of 908,449, 187,342 of the 213,635 potential screening candidates who were aged 50 - 74 years were invited for FOBT. Of the 51.3% compliant individuals, 2.6% were positive, and of these 90.7% agreed to undergo colonoscopy (n = 2246). The colonoscopy procedure details, findings, and complications were recorded. Subjects were classified according to the most advanced lesion. Positive predictive values of FOBT were calculated according to sex and age. RESULTS: Colonoscopy was complete in 96.3% of cases. Only 23 adverse events were encountered (1.02%). Colorectal cancer was diagnosed in 237 cases (10.6%, 78.4% of which were clinical stages I - II). The rates of overall adenomas and advanced adenomas were 33.1 % and 21.6 %, respectively. The risk of cancer and advanced adenoma increased significantly in men and in older people. CONCLUSION: The results of mass screening with FOBT followed by colonoscopy in this population-based study are very encouraging in terms of compliance, early findings, and complications. Extension of this program to the whole of France is justified.
Assuntos
Colonoscopia , Neoplasias Colorretais/diagnóstico , Serviços de Saúde Comunitária , Programas de Rastreamento/organização & administração , Sangue Oculto , Cooperação do Paciente , Idoso , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Avaliação de Programas e Projetos de SaúdeRESUMO
Rectal prolapse is rare in children and usually benign. However, there are various diseases that can be associated with it, such as cystic fibrosis or other causes of increased abdominal pressure. Here, we review the various underlying conditions that pediatricians or pediatric gastroenterologists should consider in the case of rectal prolapse. We report on three cases of children with a rectal prolapse and intra-abdominal tumors. Current recommendations and practice do not include a systematic check via abdominal imaging in cases of rectal prolapse. However, in some situations, imaging is indicated to detect a possible expansive process. Thus, in the presence of recurrent prolapse or of associated urinary or neurological signs, imaging is justified so as to allow for an early diagnosis and treatment of these neoplasms. Given its lack of radiation exposure and good sensitivity in children, ultrasound imaging is the first choice.
Assuntos
Neoplasias Abdominais/complicações , Prolapso Retal/etiologia , Neoplasias da Bexiga Urinária/complicações , Neoplasias Abdominais/diagnóstico por imagem , Neoplasias Abdominais/patologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Neuroblastoma/complicações , Neuroblastoma/diagnóstico por imagem , Neuroblastoma/patologia , Rabdomiossarcoma/diagnóstico por imagem , Rabdomiossarcoma/patologia , Rabdomiossarcoma Embrionário/complicações , Rabdomiossarcoma Embrionário/diagnóstico por imagem , Rabdomiossarcoma Embrionário/patologia , Ultrassonografia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/patologiaRESUMO
In this retrospective study, we analyse epidemiology, clinical symptoms and therapeutic results in a group of 23 children with neuroblastoma. Half of them were less than 2 years of age; in 19 of 23, the primitive tumour was abdominal; 35% of them were initially metastatic. The overall survival was 83% at 5 years and the event free survival, 75% at 5 years. Pronostic factors are age, extension of the disease at diagnosis, biologic parameters and genetic study of the neuroblast cells (amplification of N-myc oncogen). Our study shows the deleterious effect of bone lesions.
Assuntos
Neuroblastoma/diagnóstico , Neuroblastoma/terapia , Neoplasias Abdominais/diagnóstico , Neoplasias Abdominais/genética , Neoplasias Abdominais/terapia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Neuroblastoma/genética , Estudos Retrospectivos , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/genética , Neoplasias Torácicas/terapiaRESUMO
Failure of the anterior neuropore can lead to three main types of anomalies: nasal dermal sinus, encephalocele and nasal glioma or heterotopia. In this report, we describe a case of intracranial and extracranial glial heterotopia that probably resulted from a common failure of anterior neuropore development. We describe the prenatal radiological assessment based on ultrasound and MRI results, and consider their limitation for early fetal diagnosis. We also discuss the embryogenesis and the possible pathogenic mechanisms involved.