Development and evaluation of automated synovial fluid total cell count on an Iris iQ® 200 for identifying patients at risk of septic arthritis.

Septic arthritis is a diagnostic emergency. The white blood cell (WBC) count, in synovial fluid (SF), can guide the diagnosis. From November 2021 to November 2022, we included 350 SF. The WBC count was performed with the Iris iQ® 200 compared with the manual method. Automated and manual counts displayed good correlation. However, a Bland Altman plot demonstrates a higher percentage difference at higher WBC counts. The use of Iris iQ® 200 for SF analysis enables a rapid and accurate assessment for WBC count. Its implementation would advantageously replace the long and tedious optical analysis in daily routine.

[Gynécomastia. Management of diagnosis and therapy. Apropos of 148 cases]. / Gynécomastie : actualisation des données diagnostiques et thérapeutiques. À propos de 148 patients.

Gynecomastia is the most frequently breast lesion in males. 148 patients (mean age 24,7 years) operated in our department were reviewed with a mean follow-up of five years. Gynecomastia occurred most frequently during puberty (77,7 %), was bilateral (86,5%) and idiopathic (89,9%). The size of the enlargement was evaluated according to Simon's-classification based on breast-volume and skin-redundancy. 17 (11,5%) stage 1, 77 (52%) stage 2A, 32 (21,6%) stage 2B, 22 (14,9%) stage 3. Clinical examination and mammography determined the consistency of gynecomastia: adipose or firm. 4 different surgical managements were used: 17 (11,5%) subcutaneous mastectomies, 4 (2,7%) liposuctions, 110 (74,3%) liposuctions associated with subcutaneous mastectomy, 17 (11,5%) total mastectomy. All techniques gave good morphologic results. Nonetheless, the authors recommend the combination «liposuction and subcutaneous mastectomy¼, as this technique presents many advantages: small intraoperative blood loss, good skin redraping, short hospital stay, complete histologic examination of the material removed.

Changes in body composition during and after adjuvant or neo-adjuvant chemotherapy in women with breast cancer stage I-IIIB compared with changes over a similar timeframe in women without cancer.

PURPOSE: Body weight and body composition may change during and after adjuvant or neo-adjuvant chemotherapy for breast cancer. However, most studies did not include a comparison group of women without cancer, thus could not assess whether observed changes differed from age-related fluctuations in body weight and body composition over time. We assessed changes in body composition during and after chemotherapy in breast cancer patients compared with age-matched women not diagnosed with cancer. METHODS: We recruited 181 patients with stage I-IIIb breast cancer and 180 women without cancer. In patients, we assessed body composition using a dual-energy X-ray scan before start of chemotherapy (T1), shortly after chemotherapy (T2), and 6 months after chemotherapy (T3); for the comparison group, the corresponding time points were recruitment (T1) and 6 (T2) and 12 (T3) months. RESULTS: Fifteen percent of patients and 8% of the comparison group gained at least 5% in body weight between T1 and T3. Among the comparison group, no statistically significant changes in body weight, or body composition were observed over time. Body weight of patients significantly increased from baseline (72.1 kg ± 0.4 kg) to T2 (73.3 kg ± 0.4 kg), but decreased to 73.0 kg ± 0.4 kg after chemotherapy (T3). Lean mass of patients significantly increased from 43.1 kg ± 0.5 kg at baseline to 44.0 kg ± 0.5 kg at T2, but returned to 43.1 kg ± 0.5 kg at T3. There were no differential changes in fat mass over time between patients and the comparison group. CONCLUSIONS: Changes in body weight and body composition during and after chemotherapy for early stage breast cancer were modest, and did not differ substantially from changes in body weight and body composition among women without cancer.

[Long-term functional evaluation of complex traumatic heel defects reconstructed by flap in children]. / Évaluation fonctionnelle à long terme des reconstructions complexes du talon par lambeau chez l'enfant.

INTRODUCTION: Complex heel injuries in children are rare and their management requires coverage combining resistance and thinness, to allow walking and footwear. The objective of this study was to create a decision-making algorithm for heel defect in children. MATERIALS: Children received for heel defect, reconstructed with flap in our plastic surgery unit of Bordeaux with a follow-up greater than 10 years were investigated. Three children operated between 1999 and 2003 were included. A free contralateral reinnervated medial plantar flap, a free latissimus dorsi flap and a lateral supramalleolar flap were performed. Patients were reviewed in consultation to assess quality of reconstruction and functional outcomes. Three scores were used, the Foot Function Index (FFI), the AOFAS Ankle and Hindfoot Scale and the Maryland Foot Score. RESULTS: No growth disorder has been found. Scores greater than 80 for the Maryland Foot Score and AOFAS Ankle and Hindfoot Scale and less than 10 for the FFI were very satisfactory in cases 1 and 3. We found pain and greater functional impairment in the second case. CONCLUSIONS: "Like-with-like" reconstruction remains the gold standard, whether in loco-regional or free flap. The fasciocutaneous flaps allow custom reliable coverage with little donor site morbidity. Loco-regional flaps remain easily accessible but donor site sequelae are not negligible.

EORTC workshop on clinical trial methodology in older individuals with a diagnosis of solid tumors.

BACKGROUND: Due to the aging of the population, the number of older patients diagnosed with a malignant disease is increasing. A multidisciplinary approach to the senior adult cancer patient is mandatory, to assure optimal diagnosis and therapeutic management. DESIGN: European Organisation for Research and Treatment of Cancer (EORTC) has currently defined senior adult oncology as one of its priorities and has established an active Elderly Task Force (ETF). Under the auspices of the EORTC, the ETF organized a workshop on clinical trial methodology in older cancer patients and in this article, we present the conclusions of this workshop. RESULTS: Besides the 'classical' efficacy end points, quality of life, functional status and independence of the patient should be assessed in clinical trials in older patients. The participants of the workshop agreed on the use of a minimum dataset for the assessment of global health and functional status in older cancer patients. The panel also recommended that optimization of collaboration with pharmaceutical industry requires reporting of age-related data (subgroup analyses of clinical trials, age-related pooled analyses and obligatory post-marketing studies in vulnerable and frail older patients). CONCLUSION: The identification of proper clinical outcomes and the validation of geriatric screening tools are needed for conducting sound and comparable clinical trials.

Improving access to primary care: the impact of a quality-improvement strategy.

PROBLEM: Many patients are not satisfied with the accessibility and availability of general practice, and they would like to see improvement. DESIGN: Quality-improvement study with pre-intervention and post-intervention data collection in 36 general practices. SETTING: General practices located in the south of The Netherlands. KEY MEASURES FOR IMPROVEMENT: Patient satisfaction, experiences and awareness; practice information; and experiences of a mystery patient. STRATEGY FOR CHANGE: The practices received feedback about their accessibility and availability compared with data from practices of colleagues. The practices developed practice-based improvement plans using these feedback results. EFFECTS OF CHANGE: Eighty per cent of the improvement plans were completed or almost completed in 5 months. After the intervention, the accessibility by phone within 2 min increased significantly (10% improvement). The practices that designed an improvement plan showed a larger increase (25% improvement) than practices that did not. Patient awareness of an information leaflet and a separate telephone number for emergency calls also significantly increased (29% improvement and 12% improvement) in practices that designed improvement plans. LESSONS LEARNED: Feedback and practice-based improvement plans were a stimulus to work on and to improve accessibility and availability. All practices started improvement plans, but the overall effect of the changes was modest. This may be due to acceptable accessibility and availability before the intervention was introduced and to the time period of 5 months, which seemed to be too short to complete all practice-based improvement plans. The mystery patient was more satisfied with the accessibility than the real patients. This may be related to our concept of accessibility. We learned that adding a mystery patient for data collection can contribute to more objective measurements of practice accessibility than patient questionnaires alone.

The role of fungal polysaccharidases in the hydrolysis of cell wall materials from sunflower and palm-kernel meals.

Main fractions from multi-component polysaccharidase preparations (Driselase, Gamanase and an experimental preparation of fungal origin), previously used for the enzymic treatment of cell wall materials from sunflower and palm-kernel meals, were sub-fractionated by different chromatographic techniques to evaluate the contribution of each of their constituent activities in cell wall degradation. Based on activity measurements, 5- to 10-fold purification was achieved for the major enzymes but residual side-activities were still detectable in most sub-fractions. Solubilization of non-starch polysaccharides from the cell wall materials by the resulting pectolytic, xylanolytic, cellulolytic and mannanolytic sub-fractions and by highly purified glucanases, arabinanases and xylanases was, when acting individually, very low (1% to 5%). With few exceptions, the solubilizing effect of the main fractions could only be slightly enhanced by supplementation with pectolytic, cellulolytic or mannanolytic sub-fractions or by highly purified enzymes. The extent of solubilization remained mostly lower than the sum of both individually obtained values. In the degradation of palm-kernel cell wall material, however, synergistic action of mannanases and glucanases was observed. The hydrolysis of pectic compounds in sunflower cell wall material was most effective when polygalacturonases, arabinanases and rhamnogalacturonan-degrading activities were applied together. The resistance of 4-O-methyl-glucuronoxylan, the major hemicellulosic polymer in the cell wall material from sunflower meal, to enzymic hydrolysis was not only caused by its location in the cell wall or interlinkage to other polymers but also by its primary structure. Neither purified endo-xylanase nor the crude parent preparation were able to achieve complete hydrolysis of this polysaccharide after extraction.

The problem of entry to the medical course in Belgium.

Belgium already has a very high ratio of doctors to population. The output of new graduates is higher than can be justified by employment prospects. Applicants to university must be admitted if they have passed the school 'maturity examination'. The standard of this is set by the individual school, and the pass rate is unrelated to university requirements. Consequently the rate of entry to medical studies is very high and there is a very high failure rate (nearly half). The climate of opinion is against radical reform of this system. The author believes that under present circumstances a strongly selective examination at the end of the first university year is the least unsatisfactory solution.