[E-cigarette use among cannabis users and multi-users of psychoactive products: A cohort study]. / L'usage d'e-cigarette chez les usagers de cannabis et les polyconsommateurs : étude de cohorte.

INTRODUCTION: There is no evidence in the literature relating to the evolution of e-cigarette use among cannabis users and multi-users (of alcohol, tobacco or cannabis). OBJECTIVE: To describe the evolution over 12 months of e-cigarette use in cannabis users and multi-users. METHODS: A prospective observational cohort study in general practice, between 2015 and 2016. RESULTS: A total of 4.8% of monitored cannabis users remained or became current users of e-cigarettes by the end of the monitoring period versus 4.5% among non-users of cannabis, with no statistically significant difference. A total of 5.1% of monitored multi-users remained or became current users of e-cigarettes by the end of the monitoring period versus 2.4% among the non-multi-users, with no statistically significant difference. Cannabis users and multi-users reported more e-cigarette experimentation through curiosity and following someone's suggestion, compared to non-cannabis users or non multi-users. No statistically significant association was found between cannabis or multi-drug use and staying or becoming a current e-cigarette user over 12 months. CONCLUSION: Cannabis users and multi-users would tend to experiment with e-cigarettes more than other patients but this use would not be sustained.

Peripharyngeal space tumors: Can magnetic resonance and multidetector-row computed tomography help predict location, malignancy and tumor type?

PURPOSE: The goal of this study was to assess the performances of magnetic resonance imaging (MRI) and multidetector-row computed tomography (MDCT) in determining tumor location, suggesting the specific diagnosis of tumors involving the peripharyngeal space and identifying findings suggestive for malignancy using histopathological findings as standard of reference. MATERIAL AND METHODS: The MDCT and MRI examinations of 99 patients with a total of 102 tumors located in the retropharyngeal, carotid and parapharyngeal spaces were retrospectively reviewed. MDCT and MRI examinations were independently analyzed for tumor location and specific histological type of tumor. Finally, benign or malignant criteria were evaluated. Agreement between imaging features and final histopathological diagnosis that served as the standard of reference was assessed with the Kappa statistic. RESULTS: Regarding tumor location almost perfect agreement was obtained between imaging findings and histopathological findings (kappa=0.86 and 0.92 for MDCT and MRI, respectively). Agreement between the results of imaging and histopathological findings regarding malignancy was substantial for MDCT (Kappa=0.73), MRI (Kappa=0.65). A definite histopathological diagnosis was suggested on the basis of imaging findings for 84 tumors and in agreement with the final histopathological diagnosis in 77/84 tumors (92%). CONCLUSION: MDCT and MRI provide accurate information to localize and characterize peripharyngeal tumors. These two examinations provide complementary data to identify imaging criteria that suggest malignancy.

Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Extension assessment and principles of resection in cutaneous head and neck tumors.

Cutaneous head and neck tumors mainly comprise malignant melanoma, squamous cell carcinoma, trichoblastic carcinoma, Merkel cell carcinoma, adnexal carcinoma, dermatofibrosarcoma protuberans, sclerodermiform basalioma and angiosarcoma. Adapted management requires an experienced team with good knowledge of the various parameters relating to health status, histology, location and extension: risk factors for aggression, extension assessment, resection margin requirements, indications for specific procedures, such as lateral temporal bone resection, orbital exenteration, resection of the calvarium and meningeal envelopes, neck dissection and muscle resection.

Gastrocnaemius-propeller extended miocutanous flap: a new chimaeric flap for soft tissue reconstruction of the knee.

PURPOSE: Soft tissue defects involving the anterior aspect of the knee are a frequent finding in a number of pathological conditions. The aim of this article is to describe a new pedicled flap consisting of a conventional medial gastrocnaemius muscle flap associated with a propeller flap based on a perforator of the medial sural artery. MATERIAL AND METHODS: Five males ranging in age between 26 and 72 years underwent a reconstruction of the soft tissue of the knee by means of the described procedure. Three patients sustained complex tissue loss subsequent to high-energy trauma; two losses were due to septic complications after elective knee surgery. RESULTS: Four flaps survived allowing adequate proximal tibial metaphysis and patella coverage. One patient underwent early above-the-knee amputation due to life-threatening septicaemia. DISCUSSION: The described chimaera flap consists of a medial gastrocnaemius flap with a skin paddle that is elevated on a perforator of the medial sural artery and then rotated according to the propeller flaps' principles. It provides effective coverage of large soft tissue defects of the knee. In the authors' experience, the propeller flap portion proved to be particularly useful to cover the patella, while the muscle flap was used to cover the proximal metaphysis of the tibia and fill the dead space if present.

Leptomeningeal carcinomatosis from ethmoid sinus adenocarcinoma.

INTRODUCTION: Adenocarcinoma of the ethmoid is an aggressive tumor, with potential extension to surrounding structures. Leptomeningeal extension is a rarely reported entity. CASE REPORT: A carpenter, aged 55, developed multifocal cranial nerve-related symptoms 1 week after resection of adenocarcinoma of the ethmoid, evolving towards deteriorated general health status and death 10 weeks later. Brain MRI showed diffuse contrast enhancement of the cranial nerves, and repeated cerebrospinal fluid (CSF) examination found increased protein concentration associated with decreased glucose concentration, without malignant cells. The diagnosis of carcinomatous meningitis was based on the association of clinical, CSF and brain MRI data. DISCUSSION/CONCLUSION: Leptomeningeal dissemination of adenocarcinoma of the ethmoid is rare; diagnosis is guided by clinical signs. MRI reveals neurological spread, but the presence of malignant cells in the CSF is sufficient for diagnosis. Due to poor prognosis, the only currently available treatments are palliative.

Synchronous bilateral acinic cell carcinoma of the parotid: when a tumor reveals another one.

INTRODUCTION: Acinic cell carcinoma is a rare form (2-4%) of parotid tumor. It is, however, the most frequent form of bilateral parotid tumor and the second most frequent form in children. CASE REPORT: A 22-year-old man had several years' history of left parotid tumor, discovered to be acinic cell carcinoma. MRI found a synchronous contralateral tumor of the same histologic nature. DISCUSSION/CONCLUSION: This case highlights the need for rigorous examination of the contralateral parotid in case of parotid tumor and especially of acinic cell carcinoma.

[Prevention of cardiovascular diseases by an antihypertensive program in the elderly, a cohort study]. / Prevención de eventos cardiovasculares en hipertensos mayores de 65 años bajo el cuidado de un programa de control. Estudio de cohorte.

INTRODUCTION: We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients. AIM: To compare the risk of cardiovascular events and of dying in hypertensive patients under Program care. METHOD: We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements = 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test. RESULTS: Fourty eight point three percent of patients were hypertensive and differed from normotensive patients as to age (79 (5) years vs. 77 (5) p < 0.001), proportion of diabetic patients (16.1% vs. 7.6% p < 0.001). Mean follow-up time was 28 months. Mortality RR was 1.04 (95% CI 0.69-1.58). As to incidence of cardiovascular events it was 1.86 in normotensive vs. 3.02 (RR 1.62 95% CI 1.09-2.42). When adjusted by age, sex, smoking, dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98). CONCLUSIONS: Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up.

Vigilancia epidemiológica de las infecciones intrahospitalarias: estudios sistematizados de prevalencia (1993-1994) / Epidemiological surveillance in intrahospital infections: systemic studies of prevalence (1993-1994)

A partir de la sistematización de los estudios de prevalencia en 1993, continuamos con la presentación de los datos obtenidos en 1994, en conjunto con los del peíodo anterior. Esto permite tener una visualización gráfica de los resultados obtenidos pudiéndose analizar así sus tendencias. Si bien la metodología básica de los estudios no se ha modificado, a partir de diciembre de 1993 se incorporó al análisis, un sistema subjetivo que permite estratificar el nivel de gravedad de los pacientes y relacionarlo con el riesgo de infección intrahospitalaria. Este modelo fue validado a partir de los estudios de diciembre de 1993, abril y agosto de 1994, evaluándose además su reproducibilidad. El análisis comparativo de los estudios de prevalencia, muestra la persistencia de una proporción elevada de pacientes con acceso vascular (>50 por ciento) y catéter urinario (>20 por ciento), lo que determina un riesgo incrementado de desarrollar infecciones asociadas a estos factores. La tasa de prevalencia de infecciones intrahospitalarias se mantuvo por encima del 10 por ciento...