[Update on manual bronchial clearance techniques (adults and adolescents)]. / Mise au point sur les techniques manuelles de désencombrement bronchique (adultes et adolescents).

In adults and teenagers, airway clearance physiotherapy techniques (ACPT) are various and numerous. However, they for still awaiting scientific validation. Among ACPTs, Slow Expiration with the Glottis Opened in the Lateral Posture (ELTGOL), Autogenic Drainage (DA), and Active Cycling Breathing Technique (ACBT) present a Grade B level of evidence with weak recommendations. Even though these maneuvers are widely applied, precise description of chest physiotherapy (CP) is largely absent from the scientific literature; it is difficult to standardize its implementation and reproduce the results; scientific validation and faithful execution of the techniques are consequently problematic. In this paper, the authors aim to depict each of the three CP techniques as precisely as possible; with this in mind, graphic modeling of the different respiratory exercises is presented in such a way that they can be easily learned, applied and reproduced by physiotherapists.

The joint actions of adolescents in peer conversations about career.

Ten career conversations between adolescent peers were video-taped to examine the joint actions of adolescents that emerge in actual conversations about career. Based on an action-theoretical approach, joint action refers to the intentional behavior of a group of people attempting to realize a common goal or engage in a common process. The actual conversations and the adolescents' recall of their thoughts and feelings during the conversations were used to identify the joint actions that occurred in the conversations and the meaning that the conversations had for the adolescents. Goals of the actions included educational planning, career selection, and personal future. The functions the adolescents undertook in the conversations to reach these goals were identified as exploring, formulating, validating, and challenging. Based on these results, it was proposed that self-refinement was the project that energized and guided the joint actions and lent meaning to the conversations.

Cytomorphometric parameters in exfoliated cells as biomarkers in head and neck cancer chemoprevention.

Quantitative DNA analysis has often been proposed as a potential tool capable of detecting preneoplastic tissue and as such to function as an intermediate endpoint in cancer chemoprevention trials. The first aim of this study was to test whether cytomorphometric parameters could be used to detect field cancerization characteristics in cytological preparations of oral mucosa. Cytomorphometric parameters in exfoliated cells of apparently normal oral mucosa of head and neck cancer patients were compared with those of healthy controls. The second aim was to assess the value of these parameters subsequently as intermediate endpoint biomarkers in the mucosa of 70 patients receiving N-acetylcysteine and/or retinyl-palmitate as chemopreventive drugs. No differences were detected between 'high risk' and healthy mucosa, nor were differences observed before and after treatment.

Tomographic digital subtraction angiography: initial clinical studies using tomosynthesis. Work in progress.

We have developed a method for acquiring multiple tomographic subtraction images using a rapid, repetitive, circular tomographic motion. The method combines the principles of digital subtraction angiography (DSA) and electronic tomosynthesis. Fifteen patients were examined with the technique using single intravenous bolus injections of contrast material. The image sequence obtained during each injection was first processed with a nontomographic mask subtraction, and the result was then compared with the tomographic DSA scans synthesized from the same sequence. The effective section thickness was approximately 0.5 cm, with each section being 0.5-1.0 cm apart. Twelve of the intravenous DSA scans provided the necessary diagnostic or clinically useful information. Two of the three nondiagnostic scans were caused by avoidable technical reasons. In eight cases, the tomographic DSA scans were superior in quality to the nontomographic scans, exhibited significantly less artifact from patient motion and overlying bowel gas, and were effective in separating overlapping vessels. Tomosynthesis permits multiple electronic imaging of the area of interest without reinjection of contrast material and appears to be more informative than nontomographic intravenous DSA imaging.