Characteristics of adolescents with chronic poorly controlled type 1 diabetes - A qualitative study.

AIMS: During adolescence, a minority of adolescents with type 1 diabetes have persistent and serious poor metabolic control. The main cause of poorly controlled diabetes during adolescence seems to be poor adherence to therapy. The reasons are intertwined between social, family, psychological, and other factors. The aim of our qualitative study was to describe the characteristics of adolescents with chronic poorly controlled diabetes and those of their families. METHODS: We conducted 10 semi-structured interviews with adolescents aged 12-18 years and whose annual average hemoglobin A1c was greater than or equal to 9.5%. Six semi-structured interviews were conducted with parents (either with both or one parent). Interviews were then analyzed according to the comprehensive microanalysis method. RESULTS: We selected three recurrent themes: family life and diabetes, diabetes care and issues, and negative representations of the disease. Family situations were often complex, with limited involvement by fathers and many conflicts regarding medical care. Adolescents were disinvested from day-to-day care although they were aware of the possible long-term complications. Adolescents and their families had a very negative outlook of and experience with diabetes. CONCLUSION: The study highlighted family issues and difficult disease-related experiences among adolescents with persistent and poorly controlled diabetes. As a part of a comprehensive medical approach, it seems necessary to take into consideration the daily care of patients with diabetes within their unique family dynamic.

[Parathyroid cysts: reprot of 2 cases and review of the literature]. / Kystes parathyroïdiens: Deux cas rapportés et revue de la littérature.

Although parathyroid cysts are rarely described in the literature, they should be considered in the differential diagnosis of cysts occurring in the anterior compartment of the neck. We report two cases. The presence of elevated parahormone in the clear fluid aspirate is the diagnostic criterion. Parathyroid cysts may be functional, probably resulting from cystic formation of a parathyroid adenoma, or non function with their own epithelial lining, probably arising from remnants of the pharyngeal pouch or Kursteiner's canal. Search for both hypercalcemia and hypophosphoremia are needed. Fine needle aspiration provides the diagnosis and is also the treatment of choice for non-functional parathyroid cysts. Aspiration of functional cysts can reduce the hormone level to normal prior to surgical removal.

[Glandular tumors of the external auditory canal]. / Tumeurs glandulaires du conduit auditif externe.

Glandular tumors of the external auditory canal are rare; their etiopathogenesis is uncertain. The term ceruminoma, often used for these tumors, is imprecise. The 1978 who classification is reviewed. The authors describe their experience with 5 cases which illustrate the salient diagnostic therapeutic, and prognostic characteristics of these tumors.

[Melanoma of the nasal fossae and sinuses, apropos of a series of 7 cases]. / Mélanomes des fosses nasales et des sinus, à propos d'une série de 7 cas.

The authors present their experience of the malignant, mucosal melanomas involving the nasal cavity and paranasal sinuses through a retrospective study of 7 cases, observed in Rouen from 1977 to 1988. The results are compared to a review of world literature. The mucosal melanoma of the nose and sinus is a rare entity, representing approximatively 40 per cent of all sinonasal neoplasias. The signs and symptoms of sinonasal melanomas are non-specific. Therefore, the diagnosis is often delayed. The histological diagnosis is difficult given the substantial polymorphism of these tumors and the experience of achromatous forms. Electron microscope study and immuno-histo-chemical techniques using various monoclonal antibodies make it possible to eliminate the other major, differential diagnoses. Surgery is the primary method of treatment, sometimes combined with adjunctive postoperative radiotherapy. More recently, combined treatment with interferon and cimetidine appears to be interesting. The prognosis is very poor, if compared to skin melanomas, with a five year survival rate of 5 to 30 per cent. Local recurrence at the primary site and distant metastases are the most common caused of treatment failure.