Theory-based approaches to understanding public emergency preparedness: implications for effective health and risk communication.

Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness. Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents' possession of emergency items and their stages of emergency preparedness. Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of preparedness, including both a person's cognitive stage of preparedness and checklists of emergency items on hand. We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication.

Action, not talk: a simulation of risk communication during the first hours of a pandemic.

This article describes the design, implementation, and evaluation of a simulation of risk communication in the first hours of a pandemic. The simulation design was based on Crisis and Emergency Risk Communication principles espoused by the Centers for Disease Control and Prevention, as well as the collective experience of the authors. Over 4 hours, 17 local health district risk communicators in Georgia responded to a scenario in which every community in the state had teenagers infected with avian flu after returning from an international conference. The evaluation revealed that local risk communicators had much greater difficulty following risk communication principles under the time pressures of a realistic and stressful event than they did in a tabletop exercise. Strengths and weaknesses of the performance of the local risk communicators are identified in addition to lessons learned about the design and implementation of a risk communication simulation.

Public support for government actions during a flu pandemic: lessons learned from a statewide survey.

To better inform public health officials during a flu pandemic, this study analyzes a representative statewide telephone survey among 1,602 adults to examine knowledge and perceptions about a flu pandemic, trust in government, and support for government actions in a flu pandemic. The findings show citizens do not understand what avian/bird flu is and how it evolves into a pandemic. They also seem to have divergent perceptions regarding the susceptibility and severity of a flu pandemic. More than half of the respondents trust the government to handle a flu pandemic and show strong support for many proposed government actions in a pandemic, except for offering non-fully approved drugs. The findings suggest public health and risk communicators should reinforce support for controversial actions through trust building and personalization of risks rather than mere education or publicity. Public education and engagement should also begin pre-pandemic and continue throughout all phases of the event.

Ascites revealing peritoneal and hepatic extramedullary hematopoiesis with peliosis in agnogenic myeloid metaplasia: case report and review of the literature.

A 61-year-old man presented with ascites in the course of agnogenic myeloid metaplasia (AMM). Ascitic fluid was exudative and contained mature and immature leukocytes, erythroid cells, and megakaryocytes as observed on a bone marrow smear. Peritoneal biopsy showed myeloid metaplasia, and liver biopsy revealed intrasinusoidal myeloid metaplasia and peliosis. Ascites cleared after abdominal radiotherapy but treatment resulted in transient aplasia. Subsequently, portal hypertension was demonstrated by hepatic transjugular catheterization. Complications of splenomegaly led to splenectomy and splenorenal shunt followed by fatal acute hepatitis and septic shock. A review of the literature and an analysis of mechanisms of ascites occurring in AMM, especially peritoneal implants of myeloid tissue and occurrence of peliosis in myeloproliferative disorders, are presented.

Tuberculosis of the sacroiliac joint: clinical features, outcome, and evaluation of closed needle biopsy in 11 consecutive cases.

Sacroiliac joint (SIJ) involvement has been reported in up to 9.7 percent of patients with skeletal tuberculosis. Lack of awareness of this now uncommon form of infection often leads to diagnostic delay and increased morbidity. Eleven consecutive cases of SIJ tuberculosis are reported; clinical and radiologic features, diagnosis, treatment, and outcome are discussed. Buttock pain was the presenting complaint in all patients. However, radicular pain in the lower back (seven patients) or lower limb (10 patients) was common and in one patient precipitated an unnecessary surgical intervention. SIJ tuberculosis is frequently an isolated phenomenon. Therefore, direct sampling of the SIJ is necessary to establish the diagnosis. The recently described technique of closed needle biopsy of the SIJ was employed in all 11 patients and established the diagnosis in nine of the 11.

Pathological features and mucin histochemistry of primary gastric stump carcinoma associated with gastritis cystica polyposa. A study of six cases.

Six unusual cases of primary gastric stump carcinoma associated with gastritis cystica polyposa and arising in old gastrojejunostomy stomas are presented. The clinical data, the gross and microscopic pathological features, and the histochemical mucin profile of these two lesions are described in detail. A review is undertaken of the most relevant and previously published reports concerning, separately, either primary gastric stump carcinoma or gastritis cystica polyposa. The findings available in these reports are compared with those observed in our six cases. Some aspects of gastritis cystica polyposa are not unlike those seen in the solitary ulcer syndrome of the rectum and Ménétrier's disease. The histological type and mucin profile of primary gastric stump carcinoma parallel those recorded in gastric cancer arising in the unoperated stomach. However, the role of intestinal metaplasia and its histochemical typing appear somewhat different in primary gastric stump carcinoma.

Lymphoid stromal reaction in gastrointestinal lymphomas: immunohistochemical study of 14 cases.

The lymphoid stromal reaction, particularly the T lymphoid reaction, was studied immunohistochemically on cryostat sections in 14 cases of primary gastrointestinal B lymphomas, and compared with the type and distribution of lymphoid cells in three cases of gastric lymphoid hyperplasia. A pronounced T lymphoid reaction, mainly of the T helper phenotype, occurred in both lesions. Most of these T cells bore HLA-DR antigens, but only a few of them had the receptor for interleukin 2. The T lymphoid reaction was observed inside the lymphomas in seven of a total of 14 cases, and around the lymphomas in four of the six cases clinically classified as stage I. Perivascular mucosal and submucosal nodules, entirely composed of T cells, seemed characteristic of gastric lymphoid hyperplasias. A T lymphoid reaction in lymphoid hyperplasias suggests an amplification of the cell mediated immune response; in lymphomas it could represent a host reaction against the lymphomatous infiltrate, therefore favouring a better prognosis.

Bacterial adhesion in human upper gastrointestinal tract.

Small bowel biopsy specimens were taken from 21 patients undergoing gastrointestinal endoscopy to detect a possible adhesion of bacteria to the mucous layer of the upper gastrointestinal tract. In 30 control biopsy specimens taken from 10 patients free from gastrointestinal pathology, no associated bacteria were found, whereas in 23 biopsy specimens taken from eight gastrectomized patients an associated bacterial flora including E. coli or Pseudomonas was grown. Bacterial adhesion was confirmed by means of transmission electron microscopy of the eight patients yielding positive cultures. Bacterial adhesion induced local alterations of the brush border membrane. These results suggest that adherent bacteria may be present in hypochlorhydric patients. Pathophysiologic consequences require further studies.

Osteoclastoma-like giant cell tumor of the renal pelvis associated with papillary transitional cell carcinoma.

This report documents an uncommon case of osteoclastoma-like giant cell tumor of the renal pelvis associated with papillary transitional cell carcinoma, which resulted in the patient's death. A low-grade transitional papillary carcinoma associated with a prominent osteoclastoma-like giant cell tumor was found in the pelvicalyceal system of the right kidney in a 69-year-old man. The spindle component of the tumor stained for epithelial membrane antigen, indicating an epithelial origin. Positive staining with antibody against p53 protein was observed in both tumoral components. Our results suggest that this osteoclastoma-like giant cell tumor was truly neoplastic and that the two components could have arisen from an initial monoclonal neoplastic proliferation.

Primary Epstein-Barr virus-related non-Hodgkin's lymphoma of the pleural cavity following long-standing tuberculous empyema.

Primary non-Hodgkin's lymphomas of the pleural cavity have been described mostly in Japan. We report a case of high-grade non-Hodgkin's lymphoma (immunoblastic type) of the pleural cavity occurring in a nonimmunocompromised patient 55 years after an artificial pneumothorax was performed for the treatment of pulmonary tuberculosis. Immunohistochemical study revealed a B phenotype (CD20), and an in situ hybridization detected small nuclear RNAs encoded by Epstein-Barr virus in most lymphomatous cells. A link between primary pleural lymphoma and the local long-standing chronic inflammation, inducing a clonal transformation of Epstein-Barr virus-infected immortalized B lymphocytes, is suspected.

[Are industrial toxic substances a risk factor in gallbladder cancer?]. / Les toxiques industriels sont-ils un facteur de risque du cancer de la vésicule biliare?

Increased prevalence of gallbladder cancer has been related to specific occupations and suggests a possible professional exposure to carcinogens. The authors report the case of a 64-year-old woman who had a squamous cell carcinoma of the gallbladder with hepatic metastases, and professional exposure to trichloroethylene in a degreasing metal laboratory. Although trichlorothylene could not be assumed to be a true carcinogen for gallbladder cancer, this case underscores that epidemiologic studies taking into account professional exposure, in addition to the usual risk factors of gallbladder cancer, are requested, in order to detect a new patient group at risk for gallbladder cancer.

[Tropical sprue. Apropos of a case observed in the Paris region]. / La sprue tropicale. A propos d'un cas observé en région parisienne.

A case of tropical sprue in a 73-year old parisian male returning from endemic areas is reported. Clinical manifestations were megaloblastic anemia, malabsorption and protein-losing enteropathy. Biopsy of the jejunal mucosa showed partial villous atrophy with thickening of the basement membrane region; fat droplets were observed inside and close to the epithelial cells on electron microscopy study. Fat intestinal absorption after a test meal was delayed. Clinical, biological and histological improvement was obtained with tetracycline and folic acid therapy. The particular clinical and anatomical features of this case, as well as the difficulties for establishing the diagnosis of tropical sprue in non-endemic areas are analyzed.

[Recklinghausen's disease with digestive localizations associated with gastric acid hypersecretion suggesting Zollinger-Ellison syndrome]. / Maladie de Recklinghausen à localisations digestives associée à une hypersécrétion gastrique acide evoquant un syndrome de Zollinger-Ellison.

We report the case of a 49 year old male patient who had Recklinghausen's disease associated with hyperchlorhydria. The principal features of Recklinghausen's disease were cutaneous localizations and countless digestive tumors, found mainly on the small bowel. The ultrastructural aspect of these tumors was neurinoma or schwannoma. Basal acid gastric hypersecretion and a positive secretin test were highly suggestive of a Zollinger-Ellison syndrome. Gastrinoma was not found at laparotomy even though a gastrin gradient had been demonstrated by pancreatic venous sampling. In a patient with Recklinghausen's disease, neuroendocrine tumors (APUDomas) should be looked for systematically.

[Acute diarrhea in adults in a Parisian district. Clinical, bacteriologic endoscopic and histologic aspects. Study of 52 cases]. / La diarrhée aiguë de l'adulte en région parisienne. Aspects cliniques, bactériologiques, endoscopiques et histologiques. Etude de 52 cas.

From 1985 through 1988, 52 patients aged 16 to 85 years and referred for acute diarrhea underwent routine clinical, microbiological, endoscopic and histopathological examinations. Enteropathogens were isolated in 50 percent of patients, mostly from stool samples rather than from biopsy samples, though results were sometimes dissociated. Significantly lower digestive endoscopic abnormalities were seen in 60 percent of patients. Upper gastrointestinal endoscopy was not contributive. Rectal and colonic biopsies showed histological abnormalities in nearly all cases half of which were polymorphonuclear infiltrates and crypt abscesses. Glandular distortion was not found. An analysis of clinical, endoscopic and histological data showed that major abnormalities were mostly, but not constantly, related to infections due to enteroinvasive bacteria. As in other studies, a high rate of negative stool cultures was observed. Based on these results, we suggest to perform either further and more sophisticated microbiological investigations, or to conduct a routine search for viral infections whose incidence, among adult patients with acute diarrhea, is actually unknown.

[Hypergastrin and hyperprolactin syndrome caused by mucinous cystadenoma of the ovary]. / Syndrome d'hypergastrinie et d'hyperprolactinie dû à un cystadénome mucineux de l'ovaire.

We report a case of a clinically and biologically typical hypergastrinemia syndrome due to ovarian mucinous cystadenoma. When examined under histoimmunofluorescence, this "border-line" tumor was shown to contain a polymorphous endocrine cell proliferation, composed primarily of G cells and, to some degree, of D cells. Electron microscopic study further evidenced a small amount of prolactin containing cells, which coincided with elevated prolactin-levels in blood. Ovariectomy combined with vagotomy and pyloroplasty resulted in a prompt disappearance of both clinical and biological abnormalities. Ovarian mucinous cystadenomas have been known for a long time to contain endocrine cells, but only five cases, including the present one, have been described with fully developed endocrine expression. We suggest that this particular condition could be more frequent than generally admitted, and could justify systematic screening for mucinous cystadenoma in the case of peptide hormone dysfunction.

[Colonic lymphoma simulating cryptogenetic colitis associated with common variable hypogammaglobulinemia]. / Lymphome colique simulant une colite cryptogénétique et associé à une hypogammaglobulinémie commune variable.

We report the case of a 72 year-old woman with late-onset common variable immunoglobulin deficiency who was hospitalized for diarrhoea and fever. Colonoscopy showed aphtoïd and deep ulcerations in the rectum, the sigmoid and transverse colon, suggestive of Crohn's disease. Histologic and immunohistochemical study revealed a low grade B cell mucosa-associated lymphoid tissue (MALT) lymphoma. This is an unusual presentation for colonic lymphoma, and the second case of colonic lymphoma associated with late-onset common variable immunoglobulin deficiency.

[Toxic megacolon with colonic perforation complicating Campylobacter jejuni ileo-colitis]. / Colectasie avec perforation colique compliquant une iléo-colite à Campylobacter jejuni.

Campylobacter jejuni is an enteropathogen with invasive ability which may be responsible for acute colitis. We report the case of a 38-year-old woman who was hospitalized for severe acute colitis. Stool specimen examination revealed Campylobacter jejuni. A laparotomy was performed due to clinical deterioration and toxic megacolon. Colic perforations were observed. The examination of the colectomy specimen revealed ulcerative pancolitis. This is the first published case of Campylobacter jejuni infection complicated by toxic megacolon and perforation.

[Bronchogenic cyst of the right hemidiaphragm mimicking a hydatic cyst of the liver].

Ectopic subdiaphragmatic development of a bronchogenic cyst is rare. We report the case of a 28-year-old woman with a symptomatic bronchogenic cyst of the right hemidiaphragm simulating a hydatic cyst of the liver on ultrasonography and CT scan. Diagnosis of a diaphragmatic lesion was made during laparotomy, and complete resection was successful. Final diagnosis was done on pathology.

[Osteoarticular tuberculosis. Diagnostic contribution of local sampling]. / Tuberculose ostéoarticulaire. Apport diagnostique du prélèvement local.

Bone and joint tuberculosis have recently gained a renewal of interest, especially with the spread of HIV infection which may increase its frequency. Bone and joint locations of tuberculosis are pauci-bacillary often requiring local sampling in order to confirm the diagnosis and to initiate early therapy. From 1983 to 1992 we have studied 19 patients with bone and joint tuberculosis. Seventeen local sampling were performed: 12 biopsies and five abscess punctures. Pathological examination of samples disclosed diagnosis of tuberculosis in eight cases out of 12. Among the remaining four patients, direct smear was positive once, and cultures grew Mycobacterium tuberculosis in two, yielding the diagnosis in 11 out of the 12 patients. Bacteriological and pathological examinations were non contributive in only one patient. Microbiological examination of pus disclosed two positive direct smear and three positive cultures. Treatment lasted 9 to 18 months. The outcome was favourable in all patients.

[Ultrasound-guided biopsy in focal lesions of the liver. Report on an automated biopsy system]. / Biopsie échoguidée des lésions focales du foie. Apport d'un système de prélèvement biopsique automatisé.

Two techniques for focal liver lesion biopsy were retrospectively evaluated to compare relative safety and efficacy. After sonographic localization of the focal liver lesion and biopsy with a hand-held 18-gauge cutting needle, a pathologically adequate specimen was obtained in 49 of 55 cases (89%) requiring 1 to 4 passes (mean, 2.1 per patient). A major complication occurred in one case and minor complication were noted in three cases. Forty one biopsies were performed by using a single use automatic core biopsy system with a 18-gauge cutting needle and real time sonographic guidance. With this automatized technique, specimens adequate for diagnosis were obtained in 40 of 41 cases (97.5%), requiring only 1 pass in all cases. Neither major nor minor complication was noted with this technique. We conclude that using sonographic guidance, the automatic core biopsy system with a 18-gauge cutting needle yields a slightly better rate of adequate specimens with a lower frequency of complications.