[Post-transfusion hepatitis C. From screening to compensation]. / Hépatites C post-transfusionnelles. Du dépistage à l'indemnisation.

In France, during the last decades preceding the 1990s, 100,000 to 400,000 blood recipients may have been infected by hepatitis C. Since 1990, thanks to advances in transfusion safety, the risk of hepatitis C contamination has become extremely low. Given the natural history of the disease, it can be a long time unnoticed. Thus, even today, a significant part of infected individuals do not know their serological status. Through several periods and several campaigns, we present the various means used for the detection of post-transfusion hepatitis C at the Caen University Hospital. These methods have been introduced as a result of legislation or through arrangements made by the institution. They were made possible through the action of haemovigilance system, monitoring adverse reactions related to blood products and of blood products traceability which helps to realise special researches in case of suspected transfused blood products. In addition to posttransfusion hepatitis C detection, we are discussing available victim ways to be indemnified for the injury suffered by contamination by hepatitis C.

Clinical evaluation of a screen pneumotachograph as an in-line filter.

The American Thoracic Society/European Respiratory Society Task Force underlined that the use of in-line filters during respiratory function tests "is an area of controversy". The aim of the present study was to measure the contamination occurring during forced expiration downstream from a screen pneumotachograph (SP) with and without an in-line filter (Pall PF30S). A total of 40 healthy subjects performed eight consecutive maximal expiratory manoeuvres into four sterile apparatuses (A1: no filter, no SP; A2: filter-only; A3: SP-only; A4: filter and SP) in random order. A blood agar plate was fixed downstream from the apparatus. Colony-forming units (CFUs) were counted after 24 h incubation at 37 degrees C. Of the 40 plates obtained with each apparatus, 13 were sterile with A1 (range 0-679 CFUs), 25 with A2 (0-49 CFUs), 30 with A3 (0-35 CFUs) and 39 with A4 (one CFU in the only positive plate). A1 versus A2 and also A3 versus A4 gave different values for the CFU number, but A2 and A3 showed similar contamination levels. The authors conclude that: 1) the in-line filter does not perform better than a screen pneumotachograph; 2) it does not eliminate the need to decontaminate the pneumotachograph; and 3) equipment placed downstream from an in-line filter and a screen pneumotachograph is almost protected from contamination.

Influence of rural environment on diagnosis, treatment, and prognosis of colorectal cancer.

STUDY OBJECTIVE: Several studies have shown that residential location (urban or rural) influences the incidence of colorectal cancer. The aim was to investigate the influence of rural environment on colorectal cancer history and survival in a well defined population. DESIGN: Patients with colorectal cancer diagnosed in the department of Calvados (France) were classified by place of residence (urban/rural) and information on clinical symptoms, tumour extension, treatment, and survival was collected. SETTING: The study was population based, in the department of Calvados in France. PATIENTS: During 1978-1984, 1445 colorectal cancers were collected by the Digestive Tract Cancer Registry of Calvados, 1047 with an urban place of residence (544 males and 503 females) and 284 with a rural place of residence (134 males and 150 females). MEASUREMENTS AND MAIN RESULTS: In both sexes, rural patients with colorectal cancers were treated less frequently in a specialised health care centre (40.0%) than patients from an urban population (53.4%). The difference was mainly but not entirely explained by distance from the specialised health care centre. In females in the rural population, cancers were diagnosed more frequently at the stage of severe clinical symptoms (22.1%) and metastases (18.8%) than they were in the urban population (15.5% and 12.3%). In addition among females a rural environment appeared to confer a worse prognosis (relative risk = 1.3). CONCLUSIONS: Our findings suggest an inequality between rural and urban populations, especially for women. The loneliness of rural women leads to a delay in diagnosis and worse survival. In health education campaigns on colorectal cancer, efforts must be made to provide medical information to rural women in order to reduce the delay in diagnosis and improve survival.

[Importance of the definition of urban zones in the study of cancer risk factors]. / Importance de la définition des zones urbaines dans l'étude des facteurs de risque de cancers.

1446 cases of colorectal cancer have been collected in the Registry of digestive tract tumours in the "Department" of Calvados with the aim of studying the effect of residential location on cancer incidence. The risk-ratio was different in males and in females and between different types of urban areas. Using the urban category of "Zone de Peuplement Industriel ou Urbain" (ZPIU) increased the observed risk-ratio (1.6 for males, 1.2 for females), and enabled definition of homogeneous populations. This improved classification, thus allowed a more discriminating analysis of the effect of residential location on risk of cancer in both sexes.

[Assessment of the inflammatory evolution of the sequelae of salpingitis]. / Appréciation de l'évolutivité inflammatoire des séquelles de salpingites.

Fifty-four patients who had consulted because of their sterility had a laparoscopy carried out with bacteriological, cytological and biochemical studies of the peritoneal fluid as well as a histological assessment of the peritoneal adhesions. The purpose of this prospective study was to show the usefulness of laparoscopy in pre-operative assessment of tubal sterility and to look for objective criteria of the progress of inflammation. To do the study, two groups of women in different clinical stages (29 patients with no pelvic infection and 25 patients who had salpingitis) were divided into three sub-groups: 25 free of disease, 4 subsiding salpingitis patients and 25 with tubo-peritoneal sequellae. Different samples taken with the laparoscope made it possible to decide whether the inflammatory process was carrying on or not in these 25 cases. Using swabs for bacteriological examinations we had to employ transport medium and this showed bacteria in 7 cases. We found a significant correlation between the serum and peritoneal levels of anti chlamydia antibodies and the levels of AC antibodies when there was a tubal lesion. There was little value in carrying out cytology on the peritoneal fluid except when the histology showed that this was necessary. The level of serum and peritoneal orosomucoid was found to be different in the two groups of patients. This study shows that it is necessary to assess several different parameters to exclude pelvic inflammatory disease before resorting to reparative tubal surgery.

[Contraception without risk of breast disease: epidemiologic and physiopathologic arguments]. / Elements pour une contraception sans risque mammaire: arguments epidemiologiques et physio-pathologiques.

PIP: Benign breast lesions are of interest primarily because of their potential carcinogenic role. Some studies have found a significantly reduced risk of benign mastopathy, fibrocystic disease or fibroadenomas in oral contraceptive (OC) users, but an indirect protective effect against breast cancer has not been proven. A few short term studies have found increased risk of breast cancer in OC users and among women using OCs before their 1st pregnancies. The maximum follow-up of the studies was only 12 years, too short a time to judge the role of OCs an an inductor of malignant transformation. In 1 study of breast cancer patients who had or had not used OCs, the users were more likely to have mothers with histories of breast cancer. Compared to nonusers, the OC users had identical or better clinical status, tumor classifications, and cellular differentiation, a lower proportion of axillary ganglion involvement, lower rates of recurrence, and a higher 10-year survival rate. A 30-month prospective study found a moderate decline in frequency of breast cancer among OC users, but no formal conclusions were possible because of the brief follow-up. All the studies cited concerned high or standard dose OCs, not the lower dose formulations in use at present. It therefore appears that OCs reduce the frequency of benign breast disease, a major risk factor for cancer, but it cannot definitely be stated that OCs protect against cancer. Histologists have responded to this apparent paradox by refining their classifications of benign breast tumors according to the degree of epithelial alteration. Ocs appear to play a strongly protective role against the less serious grade 1 or 2 tumors but to aggravate the more serious tumors of grade 3 or above. A balanced ratio of estrogen and progestin components of combined OCs has been found necessary for the wellbeing of breast tissue. OCs, by suppressing secretion of follicle stimulating hormone and luteinizing hormone, replace the woman's hormonal balance with their own. Standard dose combined pills offer the advantage of completely blocking the pituitary, but sequential pills should be avoided because they do not contain enough progestin to block the secretion of pituitary gonadotropins and are thus the source of imbalances. Low dose combined pills are associated with hyperestrogenism because of the persistence of endogenous estradiol secretion in users. High dose progestin-only pills appear indicated for women over 40 because of the relative hyperestrogenism common at that stage of reproductive life. Hormonal methods do not appear contraindicated for women under 35 with no personal or familial risk factors and normal clinical examinations. Young nulliparas should be followed with particular care. Women with premenstrual breast tension should choose progestin-dominant pills and avoid low-dose pills. Women with apparently benign breast tumors should not use combined OCs until the tumors are removed and analyzed. Even a minimal degree of atypical hyperplasia contraindicates any hormonal contraception.^ieng

[Medullary compression due to vertebral angioma in pregnancy. A case treated by embolization]. / Compression médullaire par angiome vertébral au cours de la grossesse. Un cas traité par embolisation.

A previously healthy 24 year old woman presented a progressive paraplegia during the third trimester of her second pregnancy. Partial improvement occurred after caesarian. The neuroradiological study revealed spinal cord compression by an extensive corporeo-pedicular angioma of the T2 vertebrae. Almost total recovery occurred after selective embolization. The occurrence of neurological complications of vertebral angiomas during pregnancy is rarely reported in the literature. Mechanisms of the spinal cord compression and their relations with the pregnancy are discussed and difficulties for diagnosis and treatment are emphasized. When technically possible, the embolization appears to be the most adapted treatment, especially for these extensive types of vertebral angioma.

[Does genital tuberculosis still exist? Current review]. / La tuberculose génitale existe-t-elle encore? Revue récente.

The diagnosis of female pelvic tuberculosis is seldom thought of although it is still an entity. The reason why it is so seldom considered is partly because it has greatly diminished in incidence and also because the population who suffer from it and who are becoming much older move about. Another reason is that the symptomatology has changed, and now most often shows in pure haemorrhagic forms. The authors therefore go over the system of diagnosis and show that treatment is reverting to surgery.