Dramatic Increase in Incidence of Ulcerative Colitis and Crohn's Disease (1988-2011): A Population-Based Study of French Adolescents.

OBJECTIVES: Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period. METHODS: Pediatric-onset IBD (<17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification. RESULTS: 1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn's disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8-Q3=16.0)) and UC (14.0 years (11.0-16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1-6). Mean incidence was 4.4/105 for IBD overall (3.2 for CD, 1.1 for UC and 0.1 for IBDU). From 1988-1990 to 2009-2011, a dramatic increase in incidences of both CD and UC were observed in adolescents (10-16 years): for CD from 4.2 to 9.5/105 (+126%; P<0.001) and for UC, from 1.6 to 4.1/105 (+156%; P<0.001). No modification in age or location at diagnosis was observed in either CD or UC. CONCLUSIONS: In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.

A practical approach for scaling up the alternative strategy for the elimination of lymphatic filariasis in Loa loa endemic countries - developing an action plan.

BACKGROUND: Lymphatic filariasis (LF) is a vector-borne parasitic disease that is being targeted for elimination through mass drug administration (MDA). The co-distribution of Loa loa in Central Africa poses a significant barrier to the expansion of the MDA due to risk of severe adverse events (SAEs) associated with the drug ivermectin that is routinely used. National LF programmes are yet to significantly scale up in co-endemic areas and need a practical approach to make preliminary decisions based on the mapping status and potential treatment strategies. METHODS: We reviewed relevant data available to WHO and in the literature for LF-L. loa endemic countries to develop a simple method to support the scale-up of MDA to eliminate LF. RESULTS: A basic model for national LF programmes to work from at the administrative or implementation unit (IU) level has been developed for LF - L. loa co-endemic countries. The model includes five practical steps, which comprise the development of a national filarial database and a simple classification system to help determine the mapping status and most appropriate treatment strategy. Steps are colour-coded and linked to a general decision tree, which is also presented. CONCLUSIONS: This IU-level model is simple to follow and will help LF elimination programmes develop an action plan and scale up the implementation of alternative treatment strategies in L. loa co-endemic areas. The model could be further developed to incorporate the additional complexity of IUs where an intervention is required to eliminate onchocerciasis, particularly in hypo-endemic areas where ivermectin has not been used.

Predictable waves of sequential forest degradation and biodiversity loss spreading from an African city.

Tropical forest degradation emits carbon at a rate of approximately 0.5 Pgxy(-1), reduces biodiversity, and facilitates forest clearance. Understanding degradation drivers and patterns is therefore crucial to managing forests to mitigate climate change and reduce biodiversity loss. Putative patterns of degradation affecting forest stocks, carbon, and biodiversity have variously been described previously, but these have not been quantitatively assessed together or tested systematically. Economic theory predicts a systematic allocation of land to its highest use value in response to distance from centers of demand. We tested this theory to see if forest exploitation would expand through time and space as concentric waves, with each wave targeting lower value products. We used forest data along a transect from 10 to 220 km from Dar es Salaam (DES), Tanzania, collected at two points in time (1991 and 2005). Our predictions were confirmed: high-value logging expanded 9 kmxy(-1), and an inner wave of lower value charcoal production 2 kmxy(-1). This resource utilization is shown to reduce the public goods of carbon storage and species richness, which significantly increased with each kilometer from DES [carbon, 0.2 Mgxha(-1); 0.1 species per sample area (0.4 ha)]. Our study suggests that tropical forest degradation can be modeled and predicted, with its attendant loss of some public goods. In sub-Saharan Africa, an area experiencing the highest rate of urban migration worldwide, coupled with a high dependence on forest-based resources, predicting the spatiotemporal patterns of degradation can inform policies designed to extract resources without unsustainably reducing carbon storage and biodiversity.

[Pleurodesis technics]. / Les méthodes de pleurodèse.

In patients with recurrent malignant or benign pleural effusion practitioners use specific treatments, but they are then faced with the problem of pleural fluid recurrence. Several techniques of pleurodesis have been used, including drainage, surgery, intrapleural injections and poudrage. From an analysis of the results obtained and from our own experience, we have come to the conclusion that poudrage under thoracoscopy is the best type of pleurodesis.

[High-dose cisplatin in primary non resecable non small cell lung cancer. Results of a multicenter prospective study of 57 cases]. / Cisplatine à hautes doses dans les cancers bronchiques non à petites cellules primitifs inopérables. Résultats d'une étude prospective multicentrique sur 57 cas.

In a prospective multicentre phase II study conducted on 57 patients suffering from carcinologically inoperable non small-cell lung carcinoma, three courses of CDDP 200 mg/m2 were administered at random in 2 dosage regimens: either 100 mg/m2 on Day 1 and Day 8 (arm A), or 40 mg/m2 per day during 5 consecutive days (arm B), every 28 days, with supportive hydration. All 27 patients were assessable for toxicity: there were 10 cases of major intolerance (grade 4 n = 3, grade 3 n = 7) and 34 cases of minor intolerance (grades 1 and 2). Only 27 of the patients who received the 3 planned courses (19 in arm A, 8 in arm B) were assessable for effectiveness which was poor: 10.5% objective response in arm A and 0 response in arm B. Thus, high-dose CDDP administered alone was poorly tolerated and insufficiently effective; intermittent infusions during 5 days did not improve tolerance and were totally ineffective.

[Value of talc administration using thoracoscopy in the symptomatic treatment of recurrent pleurisy. Apropos of 302 cases]. / Intérêt du talcage par thoracoscopie dans le traitement symptomatique des pleurésies récidivantes. A propos de 302 cas.

From the data of a retrospective study the authors assess the value of pleural symphysis by talc in the symptomatic treatment of recurrent pleural effusion. 300 patients, 254 of whom were suffering from pleural effusion secondary to cancer and 48 of whom had non-cancerous pleural effusion, were subjected to a thoracoscopy under local anaesthetic allowing the instillation of 5-10 mls of talc powder followed by aspiration drainage for 4-8 days. Out of 270 evaluable cases, an immediate positive result (defined as the absence of any recurrence of the pleural effusion at the drainage site) was obtained in 251 cases or 93% +/- 3% (being 92.1% +/- 3.5% of the cases of pleural cancer and 97.7 +/- 4.5% in cases of non-cancerous pleural effusion). At the end of 6 months there was no recurrence of the effusion in 80.6% of cases. There were 19 early failures (7% +/- 3%) and 25 late failures of whom 9 benefitted from a further attempt at a pleural symphysis (either a pleurectomy, or injection of talc in suspension, or new talc therapy by thoracoscopy). On the whole the complications were minor: pain, fever and rarely more serious: empyema in 6 cases and cancerous nodules down the drainage line in 10 cases. There had been 15 deaths (5.3% +/- 2.6%) during the period of drainage in some very weak and fragile patients. Pleural talcage leads to an improvement in dyspnoea in 82% +/- 7.4% of cases and the general condition was improved in 54% +/- 9.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transthoracic puncture and excavated pulmonary lesion. Diagnostic contribution and value of the extemporaneous cytologic test]. / Ponction transthoracique et lésion pulmonaire excavée. Apport diagnostique et intérêt de l'examen cytologique extemporané.

Twenty-six cases of excavated pulmonary masses are reported. In 18 cases malignancy was proven by transparietal needle aspiration. A false-negative result was due to the needle being introduced too centrally and bringing pus, whereas the tumour was an epidermoid carcinoma. The seven non-malignant lesions consisted of abscess in 4 cases, tuberculosis in 1 case and pulmonary embolism in 2 cases. The sensitivity and specificity of the technique were similar to those observed in large series of transparietal needle aspiration of solid masses. Using thin needles and extemporaneous cytology reduced the number of complications: haemothorax 6 percent, haemoptysis 0.4 percent. The authors conclude that in excavated pulmonary masses transparietal needle aspiration provides a diagnosis of malignancy when the radiological and clinical courses and bronchial fibroscopy are inconclusive. Transparietal needle aspiration avoids the need for other investigations, such as exploratory thoracotomy, thereby reducing the cost of diagnosis.

[Purulent pleurisy due to Legionella bozemanii]. / Pleurésie purulente due à Legionnella bozemanii.

Since the advent of antibiotics, the bacteriological profile of empyema has changed. It is necessary to recall the recently discovered organisms. Although rarely mentioned in the literature, the Legionnellas may be causative in an empyema. We report a case of empyema to Legionnella bozemanii proven seriologically.

[Thoracoscopic study of 6 cases of catamenial pneumothorax]. / Etude thoracoscopique de 6 cas de pneumothorax cataménial.

Six new cases seen personally, and 72 cases of catamenial pneumothorax found in the literature have had thoracoscopic talcage. We shall discuss several peculiarities of this syndrome: its relative rarity, symptoms linked to periods, the specific and unique endopleural aspects, confirming certain pathogenetic theories, the first among which is pleural endometriosis. Therapeutic methods are also discussed, stressing the sharing of the association between pleural symphysis surgically and above all by thoracoscopy with antigonadotrophic hormone therapy an association which alone gives good results in 95% of cases.

[Bullous dystrophy and bronchopulmonary cancer in young patients]. / Dystrophie bulleuse et cancers broncho-pulmonaires chez des sujets jeunes.

It is classically admitted that young subjects with bullous dystrophy may develop lung cancer, but this rarely occurs. We report the case of 2 patients under 40 years of age who were found to have bronchial carcinoma. In such cases the clinical signs are not different from those of ordinary bronchial cancer, but the lesions are very often located in the upper lobes, adenocarcinoma is rare in contrast with the usual cancers on scars, the histological diagnosis is difficult and the prognosis usually poor owing to frequent extension to the chest wall. The problem of cancer on bullous dystrophy is essentially that of management of the dystrophy in young subjects: systematic surgery or wait-and-see attitude?