Health-related quality of life in patients with melanoma expressed as utilities and disability weights.

BACKGROUND: Few studies about health-related quality of life (HRQoL) in patients with melanoma have expressed their results in terms of utilities or disability weights (DWs). Utilities are required for calculating quality-adjusted life years and therefore for cost-effectiveness analyses. DWs are useful to assess the burden of diseases through disability-adjusted life years. OBJECTIVES: To provide utilities and DWs regarding patients with melanoma. METHODS: The patients were classified into eight groups using four stages based on the 2009 American Joint Committee on Cancer stages, with each stage subdivided into treatment and remission phases. The EuroQoL Five Dimensions Five Levels (EQ-5D-5L) questionnaire was completed by the patients with melanoma to provide a mean utility for each group. In addition to this, the EuroQoL visual analogue scale (VAS) and a validated quality-of-life questionnaire dedicated to patients with melanoma [Functional Assessment of Cancer Therapy Melanoma (FACT-M)] were completed by the same patients in order to compare their results with the obtained utilities. DWs were obtained by calculating, for each patient, the difference between his/her utility and the corresponding sex- and age-specific population norm. RESULTS: A total of 395 questionnaire sets were completed. Utilities and DWs showed significant differences between follow-up groups. Treatment groups had similar utilities and DWs but these results were obtained during different treatment durations and therefore have different weights. The VAS and the FACT-M were found to be less sensitive. Nevertheless, the FACT-M identified some problems not found by the EQ-5D-5L questionnaire. CONCLUSIONS: The EQ-5D-5L questionnaire seems adequate to provide utilities and DWs in patients with melanoma. Lower HRQoL in female patients with melanoma is probably linked to lower HRQoL in the general population.

Availability of digital dermoscopy in daily practice dramatically reduces the number of excised melanocytic lesions: results from an observational study.

BACKGROUND: Digital dermoscopy has been shown to permit an earlier detection of melanoma. However, few studies have investigated its added value in reducing unnecessary excisions in everyday clinical practice. OBJECTIVES: To compare, in daily practice, the efficiency of three dermoscopy methods: dermoscopy alone with little training, dermoscopy alone with adequate training and dermoscopy with adequate training and access to digital dermoscopy, and to confirm the safety of this latter approach. METHODS: Thirty-six dermatologists working without digital dermoscopy were divided into two groups according to their training in dermoscopy. The third group constituted of two dermatologists working in a pigmented lesion clinic with access to the digital dermoscopy technique and eight additional dermatologists working in the same dermatology department. These 46 dermatologists included all presumed melanocytic lesions excised over a period of 1 year. The primary endpoint was the melanoma/nonmelanoma ratio (M/NM-R); secondary endpoints were the ratio of 'problem' naevi to common naevi (PN/CN-R), specificity and sensitivity for the diagnosis of melanoma, in situ/invasive melanoma ratio, and the mean Breslow thickness. RESULTS: In total, 1865 excised lesions, including 231 melanomas, were included. In the digital dermoscopy availability group (DD-G) the M/NM-R was significantly better (1/2.43), as was the PN/CN-R (1/1.48) (P < 0.001 in both cases). The specificity was significantly higher in the DD-G and significantly higher for trained examiners as compared with examiners with little training. More that one-third of all melanomas discovered by digital dermoscopy were in situ, and the mean Breslow thickness was 0.32 mm for the invasive ones. CONCLUSIONS: The reduction of unnecessary excisions when using digital dermoscopy compared with dermoscopy alone in our study suggests that access to digital dermoscopy offers a better management of pigmented lesions in daily practice. The high number of early lesions diagnosed by this technique confirms that its use is safe.

[Wernicke encephalopathy after subtotal gastrectomy for morbid obesity]. / Encéphalopathie de Gayet-Wernicke après gastrectomie partielle pour obésité morbide.

Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.

Incarcerated obturator hernia: early diagnostic using helical computed tomography.

Obturator hernia is a rare event with poor clinical signs. Delayed diagnosis is a cause of increased mortality due to ruptured gangrenous bowel. We report a case of incarcerated obturator hernia which highlights the usefulness of computed tomography (CT) scanning in diagnosing this condition.

[Multivisceral tuberculosis with aortic complication in an immunocompetent patient]. / Tuberculose multiviscérale avec complication aortique chez un sujet immunocompétent.

The medical and imaging data of a 59 year old male is reported. The patient presented with cough, fever, night sweats and weight loss, for which a final diagnosis of multivisceral tuberculosis (with peritoneal involvement and mycotic aneurysm) was made, by means of CT, MRI and laparoscopic findings. This disease is uncommon in developed countries with subjects lacking the usual risk factors. Because delayed treatment may be lethal, especially with such serious vascular complication, the authors review the value and limitations of CT and MRI along with the suggestive features.

[Pilocytic astrocytoma of the conus medullaris]. / Astrocytome pilocytique du cône médullaire.

We report the case of a rare glial tumor of the conus medullaris classified as pilocytic astrocytoma in a young adult. This tumor is most commonly found in the brain. The imaging findings will be correlated with the findings at histology. The literature will also be reviewed.

[Osteoarticular involvement in parasitic diseases: bone echinococcosis]. / Atteintes ostéo-articulaires d'origine parasitaire: l'échinococcose osseuse.

Hydatid disease is the most common human disease caused by helminths, but primary skeletal involvement is uncommon. Diagnosis is usually obtained late after considerable extension, half of which concerns the spine. The dissemination mode leads to local malignancy with severe prognosis. Medical imaging is essential. Plain x-ray findings are polymorphous and nonspecific, but computed tomography and magnetic resonance imaging are particularly useful for exhaustive pretherapeutic assessment of extension and for patient follow-up.

[Osteoarticular involvement in parasitic diseases: bone mycetoma]. / Atteintes ostéo-articulaires d'origine parasitaire: les mycétomes osseux.

Mycetoma remains a common pathology in tropical areas. Diagnosis, based on mycology and pathology is still frequently late and treatment often leaves severe functional disorders. Medical imaging is indispensable to evaluate disease spread to bone tissue. Plain radiograms usually show cortical erosion, defects with sclerosing margins, and bone thickening. CT is the most sensitive technique to detect bony involvement. CT and MR imaging, when available, are the most accurate techniques for determining disease extension in both bones and soft tissues.

[Osteoarticular involvement in parasitic diseases: bone treponematosis]. / Atteintes ostéo-articulaires d'origine parasitaire: les tréponématoses osseuses.

Bone and joint localizations of treponematosis vary greatly although there are many common features. Osteal and periosteal lesions are common. We report radiographic descriptions of bone and joint treponematosis, which must not go unrecognized due to the increasing incidence of these diseases.

[An MRI study of primary testicular tumors]. / Etude IRM de 14 cas de tumeurs testiculaires primitives.

Magnetic resonance imaging (MRI) is a high performance tool for morphological assessment and tissue characterization in the presurgical work-up of scrotal tumors. A wait-and-see attitude is now possible for benign lesions identified as epidermoid cysts. Pathology examination remains more pertinent for an exhaustive assessment of local extension, but MRI can provide a convincing, if not definitive, distinction between seminomatous and non-seminomatous germ cell tumors.

[Ureteral hematoma complicating anticoagulant treatment]. / Hématomes urétéraux compliquant un traitement anticoagulant.

Submucosal hemorrhage of the ureters, are a very uncommon quoted cause of hematuria when overdosing anticoagulants. We report two cases, CT shows some very typical aspects but can also highlight, as reported formerly, another associated complication: parietal hematoma of the small bowel.

Pharmacokinetics of doxycycline after parenteral administration in the Houbara bustard (Chlamydotis undulata).

Fourteen adult Houbara bustards (Chlamydotis undulata) infected with Chlamydia psittaci were administered doxycycline at 100 mg/kg body weight in seven intramuscular or subcutaneous injections at intervals of 7, 7, 7, 6, 6, and 5 days. Blood levels of doxycycline were measured after the first and seventh injections at the following intervals: 0, 12, 24, 36, 48, 72, 96, 120, 144, 168, and 180 hours. During these two periods, most of the birds showed plasma doxycycline levels in excess of 1 micrograms/ml, demonstrating effective doxycycline levels for 45 days. A multifactorial analysis of variance revealed no significant differences between males and females, between the two routes of administration, or among all four factors.

Assessment of anti-phenolic glycolipid-I IgM levels using an ELISA for detection of M. leprae infection in populations of the South Pacific Islands.

Anti-phenolic glycolipid-I (PGL-I) IgM levels were determined in 96% of the general population of the Southern Marquesas and Maupiti, remote islands of French Polynesia, where the average annual detection rates of leprosy during the past 30 years have been 57.1 and 4.4 per 100,000, respectively. The seropositivity in these two areas was 4.3% and 4.2%, respectively. No significant difference (p greater than 0.05) was found between either these two figures or between the percentages of persons with high (greater than or equal to 0.500 OD) anti-PGL-I IgM levels (9.2% and 5.3%). In the two islands, the age distributions of anti-PGL-I IgM were very similar; the percentage of positive responders was higher in females than in males and higher in adolescents than in adults. These results suggest that the usefulness of the determination of anti-PGL-I IgM levels by ELISA, using the synthetic trisaccharide as antigen, for detecting Mycobacterium leprae infection in leprosy control programs is extremely doubtful.

Drug immunotoxicological approaches with some selected medical products: cyclophosphamide, methylprednisolone, betamethasone, cefoxitine, minor tranquillizers.

Alterations of the normal immune response were estimated in C57B1/6 mice pretreated with cyclophosphamide, methylprednisolone sodium succinate, betamethasone sodium phosphate or cefoxitine as positive controls and three minor tranquillizers: dipotassium chlorazepate, diazepam and meprobamate. The specific immune response against sheep red blood cells (SRBC) was evaluated by numeration of the direct plaque-forming cells (PFC; humoral immunity) and by measurement of the footpad swelling (delayed-type hypersensitivity, DTH). In our experiments, the results with the positive controls were in the same order as those described by others, and at the dose levels used, these three minor tranquillizers did not really alter the specific humoral and cellular immune response against SRBC in the C57B1/6 mice.

[Veterinary anesthesiology, a pharmacological model (author's transl)]. / L'anesthésiologie vétérinaire. Modèle pharmacologique.

Different mechanisms are involved in drug interactions, especially between anesthetics and drug administrated before and during anesthesia: liver disease, bioavailability related to the route of administration, displacement of the protein-bound of the part, etc. Two peculiarities of veterinary anesthesiology were found useful to evaluate such drug interactions: changes in the frequency of the cyclic contraction of the reticulum (sheep) and decrease in the central body temperature (cat). These criteria were used in addition to electroencephalographic recordings to appreciate the inhibition of microsomal penthiobarbital metabolism by chloramphenicol, the effect of phenylbutazone on plasma-protein displacement and the non-bioavailability of chloramphenicol by the subcutaneous route.