[Dioxin emissions and soft-tissue sarcoma: results of a population-based case-control study]. / Emission de dioxines et sarcomes des tissus mous: étude cas-témoins en population.

BACKGROUND: In 1998, the French Ministry of Environment revealed that of 71 French municipal solid waste incinerators processing more than 6 metric tons of material per hour, dioxin emission from 15 of them was above the 10 ng international toxic equivalency factor/m3 (including Besançon, emitting 16.3 ng international toxic equivalency factor/m3) which is substantially higher than the 0.1 international toxic equivalency factor/m3 prescribed by a European directive of 1994. In 2000, a macrospatial epidemiological study undertaken in the administrative district of Doubs, identified two significant clusters of soft-tissue sarcoma and non Hodgkin lymphoma in the vicinity of the municipal solid waste incinerator of Besançon. This microspatial study (at the Besançon city scale), was designed to test the association between the exposure to dioxins emitted by the municipal solid waste incinerator of Besançon and the risk of soft-tissue sarcoma. METHODS: Ground-level concentrations of dioxin were modeled with a dispersion model (Air Pollution Control 3 software). Four increasing zones of exposure were defined. For each case of soft tissue sarcoma, ten controls were randomly selected from the 1990 census database and matched for gender and age. A geographic information system allowed the attribution of a dioxin concentration category to cases and controls, according to their place of residence. RESULTS: Thirty-seven cases of soft tissue sarcoma were identified by the Doubs cancer registry between 1980 and 1995, corresponding to a standardized incidence (French population) of 2.44 per 100,000 inhabitants. Compared with the least exposed zone, the risk of developing a soft tissue sarcoma was not significantly increased for people living in the more exposed zones. CONCLUSION: Before definitely concluding that there is no relationship between the exposure to dioxin released by a solid waste incinerator and soft tissue sarcoma, a nationwide investigation based on other registries should be conducted.

[Predictive factors of virological response to primary antiretroviral treatment]. / Facteurs prédictifs de la réponse virologique à un premier traitement antirétroviral.

OBJECTIVES: During 1999, first-line antiretroviral combinations for the treatment of HIV infections have diversified. The aim of our study was two-fold: define the factors associated with initial success and define the factors associated with virological rebound in patients in whom a primary antiretroviral therapy (ARV) had been initiated between 1999 and 2000. METHOD: We conducted a retrospective multicenter study regrouping 6 HIV clinics in the North-East of France. Data were Issued from the patients medical files. Primary success was defined as plasma HIV RNA viral load (VL<200 copies/ml within 6 Months of therapy and two consecutive VL<200 copies/ml. Virological rebound was defined as two consecutive VL>1000 copies/ml after primary success. Predictors of success were determined using multivariate logistic regression and SAS 8.2 software. RESULTS: Analysis concerned 123 patients, with 19% stage C when ARV was initiated. Their median CD4 and PVL values at baseline were 233/mm3 and 73,000 copies/ml respectively. The median duration of follow-up was of 20.7 Months [(mean (STD): 20.6 (6.7)]. Initial treatments were distributed as follows: 2 NRTI + 1NNRTI, n=66 (54%); 2 NRTI+1PI, n=44 (36%); 3 NRTI, n=13 (10%). Primary success was obtained in 100 (81,3%) patients. Among these, 6 (6%) developed secondary virologic failure. The absence of change in initial ARV treatment within first 4 Months, and good compliance to treatment were statistically associated with primary success in univariate (p values respectively: 0.004 and 0.04) and in multivariate analysis (p respectively: 0.009 and 0.03). The proportion of failure was higher in the patients with lower baseline CD4 levels lesser than 200/mm3 (p=0.09). CONCLUSION: In this cohort of patients, tolerance and compliance to the first regimen were associated to primary success. These results emphasize the role of compliance in primary success and reinforces need to work on compliance in such patients.

Anal human papillomavirus DNA screening by Hybrid Capture II in human immunodeficiency virus-positive patients with or without anal intercourse.

High risk human papillomaviruses (HPVs) have emerged as risk factors for anal carcinoma, of which incidence is higher in HIV-positive patients than in the general population. The aim of our study was to investigate the prevalence and risk factors for anal HPV infections in HIV-positive patients with or without history of anal intercourse. Fifty HIV 1-infected patients (36 men and 14 women) were tested at entry and followed-up every 3 months for one year for the presence of anal HPV DNA by the Hybrid Capture II trade mark assay. A series of 50 HIV-negative subjects matched for age and sex served as controls. At enrollment, anal HPV DNA was present in 29/50 HIV-positive patients (58 %) and in 3/50 control subjects (6 %). High risk (HR) HPV genotypes were detected in 20/50 HIV-positive patients (40 %) with no difference in homosexual men and other HIV-positive patients. Risk factors for HPV infection were CD4 + cell counts less than 500/microL (RR: 2.13 [95 % CI: 1.0-4.7]) and history of anogenital warts (RR: 2.36 [95 % CI: 1.2-4.6]). The HPV load was higher in patients with CD4+ < or = 500/microL than in patients with CD4 + > 500/microL (p < 0.04). During the follow-up, anal HR HPV DNA was repeatedly identified at high levels in 5 HIV-positive patients. There is some convincing evidence that HIV-positive patients with low CD4+ cells, whatever the routes of HIV transmission, have a high rate of anal HPV infection and might be at increased risk of developing anal neoplastic lesions. Identifying HR HPV infection might be warranted in immunosuppressed patients.

Is quality of life affected by season and weather conditions in ankylosing spondylitis?

OBJECTIVE: To examine the links between the quality of life (QOL) and season and weather conditions in ankylosing spondylitis (AS) patients. METHODS: A cohort of 146 AS patients (67% males), with a mean age of 47.3 years and a mean disease duration of 12.8 years, answered a self-administered questionnaire, the AS-AIMS2 validated for AS, 4 times over a period of one year in a postal survey. Clinical measures were assessed in a subsample of the cohort. Meterological data including daily temperature, hygrometry, wind speed and atmospheric pressure were collected over the same period. RESULTS: In this cohort, 106 patients completed the follow-up. A higher lumbar spine flexibility (Schober index) was associated with a higher climatic temperature and lower wind speed. Physical QOL improved in the summer, as did Social Interaction in the summer and fall, while Role QOL decreased in winter. A lower perceived QOL was significantly associated with a higher temperature and wind speed over the past 4 weeks, and with a higher hygrometry and atmospheric pressure over the past 2 days prior to completion of the questionnaire. CONCLUSION: This study provides some support to the popular belief and frequent patient complaints of a link between health status and perceived quality of life, as assessed by a specific questionnaire, with season and weather conditions.

[Relevance and validity of a new French composite index to measure poverty on a geographical level]. / Pertinence et validité d'un nouvel indice composite français mesurant la pauvreté au niveau géographique.

BACKGROUND: A number of disease conditions are influenced by deprivation. Geographical measurement of deprivation can provide an independent contribution to individual measures by accounting for the social context. Such a geographical approach, based on deprivation indices, is classical in Great Britain but scarcely used in France. The objective of this work was to build and validate an index readily usable in French municipalities and cantons. METHODS: Socioeconomic data (unemployment, occupations, housing specifications, income, etc.) were derived from the 1990 census of municipalities and cantons in the Doubs departement. A new index was built by principal components analysis on the municipality data. The validity of the new index was checked and tested for correlations with British deprivation indices. RESULTS: Principal components analysis on municipality data identified four components (explaining 76% of the variance). Only the first component (CP1 explaining 42% of the variance) was retained. Content validity (wide choice of potential deprivation items, correlation between items and CP1: 0.52 to 0.96) and construct validity (CP1 socially relevant; Cronbach's alpha=0.91; correlation between CP1 and three out of four British indices ranging from 0.73 to 0.88) were sufficient. Analysis on canton data supported that on municipality data. CONCLUSION: The validation of the new index being satisfactory, the user will have to make a choice. The new index, CP1, is closer to the local background and was derived from data from a French departement. It is therefore better adapted to more descriptive approaches such as health care planning. To examine the relationship between deprivation and health with a more etiological approach, the British indices (anteriority, international comparisons) would be more appropriate, but CP1, once validated in various health problem situations, should be most useful for French studies.

[Solid cell nests and thyroid pathologies. Retrospective study of 1,390 thyroids]. / <> et pathologies thyroïdiennes. Etude retrospective de 1,390 thyroïdes.

Solid Cell Nests (SCN) of the thyroid gland were considered as embryonic remnants or as squamous metaplasia of follicular epithelium. In a retrospective study of 1 390 thyroids, SCN were found in 9.7 % of thyroids (16 % men and 8 % women, chi(2) : p <0, 01). The number of SCN rises with increasing number of sections examined. No statistical differences were found with age or thyroid disorders and presence of SCN, excluding the metaplastic theory. SCN contained in 38 % of cases, neuroendocrine cells (calcitonin and/or calcitonin gene related peptide, chromogranin A) and thyroglobulin cells was observed in 78.3 % of SCN. The different cell types of SCN fitted with the ultimobranchial remnant theory. Thus, some rare carcinomas (like mixed medullary and vesicular carcinoma or mucoepidermoid carcinoma) might originate from SCN.

Associations of family environment and individual factors with tobacco, alcohol, and illicit drug use in adolescents.

Despite abundant literature the respective roles of psychosomatic status, personality, health perception, family environment, and sport activity in tobacco, alcohol and illicit drug use have not been well known. To assess their roles, an epidemiological cross-sectional study was conducted in 3294 middle and high school adolescents, 2396 (73%) of whom agreed to participate. The standardized questionnaire was filled out by the teenagers under the supervision of the teachers. Strong associations were found between tobacco, alcohol, and illicit drug use. The prevalence of alcohol use and illicit drug use were respectively 7 and 10 times higher in smokers than in non-smokers. On the whole, the potential risk factors for tobacco, alcohol, and illicit drug use were age, psychosomatic status and psychotropic drug consumption, boring family atmosphere, not living with both father and mother, and health perception. Mother being a housewife was a protective factor. No marked role was noted for the head of family's socio-occupational category. Personality would be indicators of self-control ability. Indeed, some self-reported personalities (serious, attentive, calm, organized) had protection roles whereas some others (easily irritable, aggressive, worried, clumsy, careless, solitary, etc.) were risk factors (risk-taking or deviant behaviors). Some sports activities were found to be negatively related, but some others related positively with drug use, possibly due to repetitive meetings between the adolescents at risk. Preventive measures may be targeted at these risk factors.

Deprived areas and attendance to screening of cervix uteri cancer in a French region.

OBJECTIVES: To examine the relationship between deprivation and attendance to cervical cancer screening. METHODS: Three deprivation indices (Carstairs, UnderPrivileged Area, Department of Environment) were calculated for women aged 25-65 attending a 1993-95 cervical cancer screening program (Doubs "département", France), with 594 municipalities as statistical units. Weighted multivariate linear regressions were performed, with attendance rate as the dependent variable, and the three deprivation indices in turn as independent variables along with women's mean age, average net income, density of (para)medical amenities, density of population and proportion of women. RESULTS: Per municipality women were numbered 1-29,822 (mean 210). In multivariate models, the three deprivation indices were negatively linked to attendance rate, and so were mean age of women and density of population. Average net income, proportion of women, and density of (para)medical amenities (nurses, laboratories, ambulances, physicians, dentists) were positively associated with attendance rate. CONCLUSIONS: In early stages, cervical cancer screening programs should account for populations living in deprived areas, through focused health promotion efforts and easier access to screening facilities.

Seizures and epilepsy following strokes: recurrence factors.

BACKGROUND AND PURPOSE: Though there have been many reports on poststroke seizures, there is still much we do not know about them. Using a large cohort of stroke patients we analyzed the characteristics of the seizure(s) and the rate and factors involved in seizure recurrence. METHODS: Out of the 3,205 patients admitted for a first-ever stroke to our department between 1984 and 1994, we retrospectively studied the data of all patients with a first-ever seizure and analyzed their evolution. Two types of seizure(s) were defined: 'early-onset' seizures (occurring within the 14 days following the stroke) and 'late-onset' ones (after the 14th day). RESULTS: 159 patients were included in the study, i.e. 4.96%. There were 116 ischemic strokes and 43 primary hematomas. Cortical involvement was found in 87% of the patients. Early-onset seizures occurred in 57 patients and late-onset ones in 102 patients, 76% of which were observed within 2 years. Follow-up was performed in 135 patients with a mean follow-up period of 47 months; 68 of them presented a seizure recurrence. A 2nd seizure occurred more often in the patients with late-onset seizures (p < 0.01); recurrence was either single (24 patients) or multiple (44 patients). Univariate analysis demonstrated 3 factors for multiple recurrences: hemorrhagic component, low Rankin scale after the initial seizure and occipital involvement. Multivariate analysis determined 2 factors: occipital involvement and late onset of the 1st seizure as a predictive model of multiple recurrences. CONCLUSIONS: This study confirms that poststroke seizures are frequent and must be divided into 2 types: early-onset (

Quality of life in ankylosing spondylitis: validation of the ankylosing spondylitis Arthritis Impact Measurement Scales 2, a modified Arthritis Impact Measurement Scales Questionnaire.

OBJECTIVE: To develop a questionnaire measuring quality of life in ankylosing spondylitis (AS). METHODS: A focus group technique contributed to the generation of an AS-specific questionnaire using the Arthritis Impact Measurement Scales 2 (AIMS2) (12 dimensions), supplemented with items from the Health Assessment Questionnaire for the Spondylar-thropathies, as well as original new items. Patients from a self-help group provided data to assess the validity (n = 146) and reproducibility (n = 43) of the AS-AIMS2. RESULTS: The focus group generated a thirteenth dimension including 6 items labeled "spine mobility." Principal component analyses on AS-AIMS2 showed satisfactory dimensionality (74.1% of variance explained), high internal consistency (Cronbach's alpha = 0.78-0.91), significant convergent validity of the new dimension with spine pain and mobility, and good reproducibility in the 13 dimensions and 5 components (intraclass correlation coefficient = 0.7-0.9). The scores in each component of the AS-AIMS2 showed a marked deterioration of quality of life in these young patients. CONCLUSIONS: The disease-specific AS-AIMS2 questionnaire should help improve care management in AS.

Eye patching in unilateral spatial neglect: efficacy of two methods.

OBJECTIVES: To determine whether patches obscuring half the visual field affect eye movement in subjects with unilateral spatial neglect and whether there is consequent improvement in the subject's everyday life, and to interpret the potential changes observed with the aid of a theoretical model. DESIGN: Prospective and randomized study. SETTING: Rehabilitation medicine department in an urban general hospital. PATIENTS: Twenty-two subjects with left unilateral neglect. INTERVENTION: Two eye-patching procedures-right half-field patches (n = 7) and right mononuclar patch (n = 7)-and control group (n = 8). MAIN OUTCOME MEASURES: Functional tests (FIM) and analytical tests (measurement of right eye movements by photo-oculography) at admission and after 3 months. RESULTS: Results of the paired comparison tests showed (1) significant differences between the control group and the group with the half-eye patches for total FIM score (p = .01) and the displacements of the right eye in the left field (p = .02), and (2) no significant differences between the control group and the group with the right monocular patch. CONCLUSION: Patching the right half-field helped subjects initially regain voluntary control over the deficit. The actual interpretation is based on physiologic and psychophysiologic models.

Vascular smooth muscle differentiation of murine stroma: a sequential model.

Previous studies by our group showed that stromal cells from human long-term marrow cultures were mesenchymal cells following a vascular smooth muscle pathway. The present study using 58 immortalized stromal lines from different hematopoietic sites was conducted to verify whether this hypothesis also held true for murine stroma. Principal components analysis performed using cytoskeletal and extracellular matrix proteins allowed the segregation of five factors explaining more than 70% of the variance. Factor I, including osteopontin and vimentin, and factor II, laminins and fibronectins, were representative of the mesenchyme. The remaining three factors were representative of vascular smooth muscle: factor III, including alphaSM actin, SM alpha actinin, SM22alpha, EDa+ fibronectin, and thrombospondin-1; factor IV, metavinculin and h-caldesmon; and factor V, smooth muscle myosin SM1 and desmin. All lines expressed factors I and II; 53 lines expressed factor III, 35 lines expressed factor IV; and 11 lines expressed factor V. A second principal components analysis including membrane antigens indicated the cosegregration of vascular cell adhesion molecule-1 with osteopontin and that of Ly6A/E with vimentin, whereas CD34 and Thy-1 appeared to be independent factors. The heterogeneity of vascular smooth muscle markers expression suggests that harmonious maintenance of hematopoiesis depends on the cooperation between different stromal cell clones.

[Ischemic stroke in young patients and/or livedo: is it important to look for anti-beta 2-glycoprotein I antibodies?]. / Accident vasculaire cérébral du sujet jeune et/ou livedo: y a-t-il un intérêt à rechercher les anticorps anti-beta 2-glycoprotéine I?

PURPOSE: This study was aimed at determining the prevalence of anti-beta 2glycoprotéine I antibodies (anti-beta 2-GPI antibodies) in young adult patients presenting with either livedo reticularis or ischemic stroke. METHODS: Forty patients referred between February 1996 and February 1997 underwent clinical examination and laboratory tests with search for anticardiolipin antibodies (ACL antibodies), lupus anticoagulant (LA) and anti-beta 2GPI antibodies. RESULTS: Twenty-one patients presented with ischemic stroke (one with ACL antibodies), 13 had livedo (six with ACL antibodies, two with LA) and six patients presented with Sneddon's syndrome (two with ACL antibodies, two with LA). Only one was positive for anti-beta 2-GPI antibodies. CONCLUSION: beta 2-GPI is a cofactor that increases anticardiolipin antibody adhesion to cardiolipin. Our results suggest that the prevalence of anti-beta 2GPI antibodies is not high in young patients with either livedo reticularis or ischemic stroke. However, due to the small number of patients included in the study, definite conclusions may not be drawn out. Anti-beta 2-GPI antibodies assay is not justified in routine evaluation of patients with either livedo reticularis or ischemic stroke.

Brain cancer mortality among French farmers: the vineyard pesticide hypothesis.

In this study, the authors assessed the contribution of vineyard pesticides to brain cancer mortality among agricultural workers. A pesticide exposure index (PEI) in vineyards was calculated for 89 French geographical units (départements). The authors estimated standardized mortality ratios among male farmers and farm laborers aged 35-74 y for the years 1984-1986. Poisson regression models, which were fitted to the ecological data, included random effects. Mortality from brain cancer among farmers was significantly higher than mortality for the overall population (standardized mortality ratio = 1.25, p < .001). Univariate analysis revealed a significant link with pesticide exposure in vineyards (relative risk = 1.10; 95% confidence interval = 1.03, 1.18), as did multivariate analysis (relative risk = 1.11; 95% confidence interval = 1.03, 1.19). These results corraborate the evidence that pesticides in vineyards contribute to mortality from brain cancer among farmers.

Garlic, onion and cereal fibre as protective factors for breast cancer: a French case-control study.

The role of diet on breast cancer risk was investigated in a case-control study of 345 patients diagnosed with primary breast carcinoma between 1986 and 1989 in the north-east of France (Lorraine). For each case, one control was matched for age (+/-3 years) and socio-economic status. The dietary history questionnaire consisted of a self-administered food frequency questionnaire, a 6-day food diary and an energy expenditure record. It also elicited personal characteristics and medical history. While taking into account total caloric intake and established risk factors, breast cancer risk was shown to decrease as consumption of fibre (p value for trend = 0.03), and garlic and onions (p value for trend <10(-6)) increased. This study also supports the epidemiologic evidence that saturated fat intake and breast cancer risk are associated in post-menopausal women (p value for trend = 0.03). Conversely, it suggests that unsaturated fat intake could lower the risk in the same subgroup (p value for trend = 0.03). Our findings on protective factors of breast cancer could induce effective preventive measures and warrant further experimental investigations to isolate specific subfractions.

Clinical and scintigraphic comparison of silicone and polyvinylpyrrolidone coated silicone perforated plugs.

BACKGROUND/AIM: Isolated stenosis of the lacrimal punctum is a frequent cause of epiphora. Treatment relies on surgical opening or dilatation with bi- or monocanalicular prosthesis. Recently, silicone perforated punctum plugs (PPP) were proposed. The drawback with these silicone PPP was that secretions accumulate in the central orifice blocking the spontaneous flow of tears. A modification of the surface of the PPP using polyvinylpyrrolidone (PVP) was thus proposed. The aim was to compare silicone PPP with new PVP surface treated PPP. METHODS: A prospective study was conducted of 20 patients with dilatable stenosis of the lacrimal puncta who developed epiphora. Epiphora, tolerance, implantation of the PPP, and lacrimal drainage were evaluated using scintigraphy of the lacrimal ducts. RESULTS: The raw data and statistical analysis showed evidence of a superior performance of PVP surface treated PPP. CONCLUSION: Long term evaluation of the advantages or risks of PVP plugs and comparison with microsurgical punctoplasty are warranted.

Alcoholic calories, red wine consumption and breast cancer among premenopausal women.

The role of alcohol consumption (alcoholic calories, alcoholic beverages) on breast cancer risk was investigated in a case-control study of 154 premenopausal female patients diagnosed with primary breast carcinoma. For each case, one control was matched for age (+/- 3 years) and socio-economic status. The survey was carried out in Northeastern France (Lorraine) between 1986 and 1989. While taking into account total caloric intakes and various breast cancer factors, breast cancer risk was shown to increase as consumption of alcohol increased (p value for trend = 0.007). A significant relative risk (RR = 2.69; 95% CI: 1.40-5.17) was shown above 60 kcal per day (approximately 9 g of alcohol per day). Breast cancer risk appeared to be restricted to red wine consumption among these premenopausal women, for monthly consumption (p value for trend = 0.003) as well as for duration of consumption (p value for trend = 0.01). A relative risk of 3.96 (95% CI: 1.59-9.84) was found for a monthly consumption higher than 4 liters per month. This reinforces the notion of a particular sensitivity of young women to breast cancer in relation to alcohol consumption.

Bladder cancer among French farmers: does exposure to pesticides in vineyards play a part?

OBJECTIVE: To appraise the potential contribution of pesticides sprayed on vineyards to the genesis of bladder cancer among agricultural workers. METHODS: A pesticide exposure index (PEI), based on labour time and the proportion of agricultural land used as vineyards, was constructed for 89 French geographical units (départements). The standardised mortality ratios (SMRs) for bladder cancer, as well as tobacco consumption and economic status of male farmers and farm labourers aged 35-74 in the same areas were estimated for the period 1984-6. Models were fitted to the geographical data with Poisson regressions and extra-Poisson models with geographically structured and unstructured random effects. RESULTS: Mortality from bladder cancer among farmers was lower (but not significantly so) than within the overall population (SMR 0.96, 95% confidence interval (95% CI) 0.85-1.08), but there was a significant link with exposure to pesticides in vineyards by univariate analysis (relative risk (RR) 1.17, 95% CI 1.10-1.24) and by multivariate analysis (RR 1.14, 95% CI 1.07-1.22). CONCLUSION: These results add some evidence to the view that pesticides in vineyards cause mortality from bladder cancer among farmers, and could explain the French south-north gradient in bladder cancer, as vineyards are mainly located in Southern France.