Lifestyle counseling in patients with carotid arteriosclerosis from Luxemburg should focus more on the reduction of sugar, sodium and saturated fat consumption.

BACKGROUND: Healthy diet and physical activity improve risk factors for cerebrovascular disease. It is unclear whether patients with carotid artery disease from Luxemburg meet common guideline criteria and whether systematic counseling has a sustained effect. METHODS: We assessed anthropometric data, eating habits and physical activity habits in 53 patients with carotid atherosclerosis at baseline, after 4 and 20 weeks, and advised them five times for 30 min to follow a modified Mediterranean diet and to perform moderate physical exercise at least during 30 min/day. RESULTS: The patients had a mildly increased BMI (mean 27.6, recommended below 25), they already ate enough vegetables and fruits (mean 485 g daily, recommended at least 400 g), they ate too much sugar (mean 74 g daily) and sodium (mean 2710 mg daily, recommended less than 1500), they consumed 13% of calories from saturated fatty acids (recommended less than 10%), and they already moved sufficiently (62 min daily of moderate and intense physical activity, recommended at least 30 min of moderate physical activity). Lifestyle counseling had a sustained effect on weight, reduction of global caloric intake, carbohydrate and cholesterol intake and on an increase in consumption of poly-unsaturated fatty acids, vegetables and fibres. There was no sustained effect on the consumption of sugar, sodium, and saturated fat. CONCLUSIONS: The reduction of sugar, sodium and saturated fat consumption should be stressed more in counselling of this patient group.

Home telemonitoring (forced expiratory volume in 1 s) in children with severe asthma does not reduce exacerbations.

Some children with severe asthma develop frequent exacerbations despite intensive treatment. We sought to assess the outcome (severe exacerbations and healthcare use, lung function, quality of life and maintenance treatment) of a strategy based on daily home spirometry with teletransmission to an expert medical centre and whether it differs from that of a conventional strategy. 50 children with severe uncontrolled asthma were enrolled in a 12-month prospective study and were randomised into two groups: 1) treatment managed with daily home spirometry and medical feedback (HM) and 2) conventional treatment (CT). The children's mean age was 10.9 yrs (95% confidence interval 10.2-11.6). 44 children completed the study (21 in the HM group and 23 in the CT group). The median number of severe exacerbations per patient was 2.0 (interquartile range 1.0-4.0) in the HM group and 3.0 (1.0-4.0) in the CT group (p=0.38 with adjustment for age). There were no significant differences between the two groups for unscheduled visits (HM 5.0 (3.0-7.0), CT 3.0 (2.0-7.0); p=0.30), lung function (pre-ß(2)-agonist forced expiratory volume in 1 s (FEV(1)) p=0.13), Paediatric Asthma Quality of Life Questionnaire scores (p=0.61) and median daily dose of inhaled corticosteroids (p=0.86). A treatment strategy based on daily FEV(1) monitoring with medical feedback did not reduce severe asthma exacerbations.

Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents.

OBJECTIVE: To describe the standardization process and reliability of anthropometric and bioelectrical impedance analysis (BIA) measurements. We examined both intra- and interobserver errors for skinfolds, circumferences and BIA. METHODS: For the intraobserver error assessment, first of all, 202 adolescents in the pilot study (110 boys, 92 girls, aged 13.64+/-0.78 years) were assessed. For the second intraobserver and interobserver assessments, 10 adolescents were studied (5 boys and 5 girls). RESULTS: The pilot study's intraobserver technical errors of measurement (TEMs) were between 0.12 and 2.9 mm for skinfold thicknesses, and between 0.13 and 1.75 cm for circumferences. Intraobserver reliability for skinfold thicknesses was greater than 69.44% and beyond 78.43% for circumferences. The final workshop's intraobserver TEMs for skinfold thicknesses and circumferences were smaller than 1; for BIA resistance TEMs were smaller than 0.1 Omega and for reactance they were smaller than 0.2 Omega. Intraobserver reliability values were greater than 95, 97, 99 and 97% for skinfold thicknesses, circumferences, BIA resistance and reactance, respectively. Interobserver TEMs for skinfold thicknesses and circumferences ranged from 1 to 2 mm; for BIA they were 1.16 and 1.26 Omega for resistance and reactance, respectively. Interobserver reliability for skinfold thicknesses and circumferences were greater than 90%, and for BIA resistance and reactance they were greater than 90%. CONCLUSIONS: After the results of the pilot study, it was necessary to optimize the quality of the anthropometric measurements before the final survey. Significant improvements were observed in the intraobserver reliabilities for all measurements, with interobserver reliabilities being higher than 90% for most of the measurements.The Healthy Lifestyle in Europe by Nutrition in Adolescence Study aims to describe total body fat percentage and anthropometric indices of body fat distribution in European adolescents.

Socioeconomic questionnaire and clinical assessment in the HELENA Cross-Sectional Study: methodology.

RATIONALE: Environmental factors such as dietary habits, breastfeeding, socioeconomic conditions and educational factors are strong influences on nutritional and puberty status, physical activity, food choices and their interactions. Several diseases of adulthood seem to be linked to, or to originate from, lifestyle in childhood and adolescence. OBJECTIVE: The aims of this study are to describe birth parameters and socioeconomic factors and to assess clinical status in adolescents aged 13-16 years from 10 European countries participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Cross-Sectional Study (CSS). METHODOLOGY: A self-report questionnaire on the socioeconomic status, a parental questionnaire concerning neonatal period and also a case report form (CRF), in which clinical items during clinical examination (such as medical history, treatments, anthropometry, Tanner staging, blood pressure, heart rate) were assessed. To develop these documents, first a list of items was established, a search of existing documents was performed and the advice of local and international experts was taken. All documents (questionnaires and an operations manual) were discussed in plenary HELENA meetings; a final version of these documents was fixed, and the process of translation and back translation was performed. RESULTS: The questionnaires and CRF were tested for validation in all 10 participant cities; 208 adolescents were enrolled during the pilot study. All items that caused problems or questions in one or more participating centers or were completed by < 85% of the adolescents were reviewed before the beginning of the HELENA-CSS. CONCLUSION: These final questionnaires and CRF will contribute to better understanding of the inequalities in nutrition, behavior and health in the European adolescent population. The experience and process should be useful for other multicenter studies.

Does nephroblastomatosis influence the natural history and relapse rate in Wilms' tumour? A single centre experience over 11 years.

The presence of multifocal or diffuse nephrogenic rests (NRs) in one or both kidneys is termed nephroblastomatosis (Nbm). Nbm may be a predisposing factor for Wilms' tumour (WT). The aim of this retrospective study was to evaluate the impact of Nbm on the outcome of WT in children. We assessed the outcome of 81 children with Wilms tumours and practical implications of Nbm in the treatment and follow-up. All the pathology slides have been reviewed in 1997. 63 had WT without Nbm (group A) and 18 had WT associated with Nbm (group B). There was no statistical difference between the two groups according to the age at diagnosis and histology. Clinical abnormalities were more frequent in group B (33 versus 8%). There was no statistical difference between the percentage of stage IV in both groups, but bilaterality (stage V) was present only in the group B. Relapse was observed in 20/81 patients (25%): 11 (17%) in group A and 9 (50%) in group B. Mean delay of relapse was longer (25 months) in group B than in group A (10 months). For the whole population, with a median follow-up of 9 years, the event-free survival (EFS) and the overall survival (OS) probabilities were respectively 74%+/-10 and 83%+/-9 at 120 months. The difference in EFS between groups A (82+/-9%) and B (38%+/-29) was significant (P=0.004). The discovery of Nbm in the non-tumoral part of the kidney with WT can be an adverse factor and in particular favours the subsequent development of a new Wilms tumour. It justifies separate follow-up guidelines.

A new abortion technique: intravaginal and intramuscular prostaglandin.

The 15-methyl analog of prostaglandin F2 alpha (15-ME-PGF2 alpha), administered in a 3-mg dose via a single vaginal suppository and supplemented at 24 hours by intramuscular injection(s) of 250 micrograms, successfully induced abortion in 80 of 81 patients in the midtrimester of pregnancy. The mean abortion time was 19.6 hours. Two thirds of the patients aborted after treatment with the suppository alone in a mean time of 14.6 hours; the remaining 27 patients required intramuscular injections of 15-ME-PGF2 alpha to effect expulsion of the products of conception. Twenty-six of these 27 patients subsequently aborted in a mean total abortion time of 29.6 hours. Fifty-eight patients aborted within 24 hours of the initial prostaglandin administration, and 78 aborted by 36 hours. Parity and length of gestation did not significantly affect abortion time in this series, although the mean abortion time for parous patients and patients with gestations earlier than 17 weeks tended to be somewhat shorter than that of nulliparous patients and those with more advanced gestations. The placenta was spontaneously expelled in the majority of patients. Abortion was incomplete in 3 patients and required curettage. Uterine activity, as measured via an intraamniotic catheter in 6 patients, developed very gradually with the suppository, peaking at 3 hours after insertion, and was characterized by regular contractions with low intrauterine baseline tonus. The gastrointestinal side effects that occurred in 59% of patients who received the suppository were also most frequently observed at 3 hours after administration. In contrast the gastrointestinal disturbances elicited by intramuscular injections of the analog immediately followed the administration.

[Physiopathology of inflammatory events in asthma]. / Physiopathologie de la réaction inflammatoire dans l' asthme.

Inflammatory events in asthma include an initiation step dependent on dendritic cells, an effector step which involves the release of a large number of mediators by inflammatory cells, mastocytes, polymorphonuclear neutrophils and eosinophils, alveolar macrophages and monocytes, and lymphocytes; and a repair phase leading to airway remodeling. In addition to classic mediators such as histamine and leucotrienes, it is currently accepted that cytokines and chimokines play an essential role in local cellular trafficking. The bronchial endothelium and epithelium are simultaneously activated. Bronchial inflammation is constant in patients with allergic asthma and persists even in the absence of symptoms. Links between the intensity of the inflammatory response and the occurrence of airway remodeling suggest that therapeutic interventions should take place as early as possible, particularly in children.

[Difficult asthma in children]. / L'asthme difficile de l'enfant.

Difficult asthma in children is defined as the persistence of exacerbations or frequent symptoms requiring rescue bronchodilator, or persistent airway obstruction in spite of treatment with inhaled steroid >/= 800 microg/d beclomethasone or equivalent and beta-2 long acting agonist. Management of difficult asthma in children first requires to identify conditions that may mimic asthma, asthma with bad compliance to treatment, and difficult asthma in relation with avoidable factors that worsen symptoms. The pathological bases of genuine difficult asthma remain unknown. Different patterns have been described according to the cells that are involved (eosinophil, neutrophil), the degree of airway remodeling, or the distal localization of the lesions. Difficult asthma requires specialized management including airway inflammation evaluation. Studies on bronchoalveolar lavage and bronchial mucosa biopsies will perhaps help to better understand the pathophysiology and to improve the management.

[Cancer of the vulva]. / Cancerul de vulva.

UNLABELLED: Our study includes 50 patients operated on between on between 1970 - 1995 for vulvar carcinoma. The age of patients varied from 36 to 85 years old with a media of 59.4. The localisation of the lesions were: 42 (84%) on the major labia; 7 on the minor labia; 1 on the clitoris and 1 on the Bartholin's gland. Histopathologically there were 46 (92%) squamous carcinoma, 2 adenocarcinoma and 2 fibrosarcoma. The staging after FIGO classification: stage 1--7 patients (14%); II--22 (44%); III--20 (40%); IV--I (2%). Palpable lymphadenopathy in the inguino-femoral regions has been present to 24 (48%) patients, but with positive nodes (N+) only 16 (32%). Preoperative radiant therapy was applied to 21 patients (42%). All the patients were operated on: 1. total vulvectomy (vv) 15 cases (30%); 2. total vv + various lymphadenectomies 23 (46%); 3. partial vv 8 (16%); 4, different interventions 4 (8%). Iterative intervention for recurrencies: 9 cases (1 of them operated on by us 4 years anterior). Postoperative morbidity was present to 27 patients (52%): the main complication was the local infection of the wound +/- wound break-down; 5 of those patients presented also persistent lymphorrhagia. We don't noticed postoperative lymphedema of the inferior limb (limbs). Without postoperative lethality. Postoperative all the patients were submitted to a complimentary oncological treatment. The longest survival after the combined treatment was available specially for "N-"patients (but not exclusive). We verified 29 (58%) patients from the total of 50 (the rest being lost of evidence or having a short postoperative interval of time). The index of survival was: 1 year: 29 (100%); 3 years: 23 (79%); 5 years 16% (56%); and between 6 and 25 years 9 (31%). CONCLUSIONS: a) early diagnosis + therapy = good results; b) complex therapy is mandatory; c) optimal operation total vv + inguinal-femoral lymphadenectomy; d) the optimal prognosis is available for "N-" cases.

[Rectal hemangioma--a pseudoneoplastic form. A case report and review of the literature]. / Hemangiomul rectal--forma pseudoneoplazica. Prezentarea unui caz si revista literaturii.

A patient, 23 years old, is presented. He was admitted on in our clinic for a lower, very bleeding rectal tumor, the macroscopically characters evoking quite sure a malignant neoplasm. Three successive histopathologically examinations remained inconclusive and only the fourth suggested the diagnosis of benign glandular polyp. That conclusion strongly contrasted with all the data obtained by the macroscopically examinations. Nevertheless the therapeutically option was in favor of a sphincter-saving surgery, the practiced operation being a pull-through rectosigmoid resection (Babcock). Recovery of the patient which is in a good condition at present (two years after surgery). The histopathological examination of the operative specimen stipulated like diagnosis: rectal haemangioma with component parts of lymphangioma. Carrying on, the paper presented a review of the literature data referring to the very limited experience of others authors, regarding clinical aspects, diagnostics and therapeutically problems of the rectal haemangioma. In similar cases presenting voluminous rectal (or colonic) possibly benign tumors, haemangioma like, macroscopically diagnostic being difficult or unsure, but also without a certitude for a malignant tumor, it is recommended a sphincter-saving operation, adapted to the general status of the patient. In cases with malignant characters at the final histopathological examination, on the operative specimen, the transformation of the initial intervention in a amputation type surgery may be a possible alternative.

[Mechanical digestive system suturing devices]. / Suturile digestive mecanice.

Between 1994 (December)-1996 (May) 150 patients have been operated on using one or many stapling devices. The staplers disposable to us were the "Linear Cutter" or GIA (Gastrointestinal Anastomosis), "Linear Stapler" (TA) and "Intraluminal Circular Stapler" or EEA (end-to-end anastomosis) types, produced by ETHICON (Johnson and Johnson Ltd. Company). The principles operations performed were various digestive resections, intervisceralis anastomosis and interventions of reconstructions (in oesophagus surgery, ileal pouch etc.). The advantages of staplers applications are: a) the reduction of the time of operation, of the anesthesia, of the blood loss; b) a soft manipulation of the tissues; c) a smaller inflammatory reaction and the prevention of intraoperative septic contamination and d) a better and faster take back of the functionality of the anastomosis. There were only 4 intraoperative haemorrhages easy controllable. Postoperative complications: a) 3 haemorrhages medically treated; b) immediate leakage 1 patient after colorectoanastomosis, treated by Hartman colostomy; precocious, 7 patients and after 4-6 month, 2 patients. Corrective iterative interventions were necessary only in 5 patients. The operative mortality-1 patient, the cause of death being a bronhopneumonia after a radical oesophagectomy with oesophagoplasty (oesophageal cancer). There was not postoperative mortality depending of stapling application. We don't observed late postoperative complications like stenosis of various anastomosis, quoted in the literature, because the time of following of our 150 patients is too short (maximum 18 months). The conclusions are that the stapling devices are a real surgical progress with the conditions of a correct indication and adequate tactics and operative technique. The economical effort is justified and entirely compensated by the major benefits obtained for the patients.

Dynamic study of postural tremor in high pressure conditions.

Tremor holds a central place in the high pressure nervous syndrome generated by hyperbarism, a fact that prompted us to carry out this study. We found that tremor appears after diving to a depth of 150 m (16ATA) and progressively intensifies with the increase of pressure. We discuss the pathogenic mechanism in which, besides the involvement of several central mechanisms, one can also incriminate some peripheral ones (probably the change of interstitial pressure at the nerve and/or muscle level).

Adenylate kinase isoenzyme patterns in normal and neoplastic human lung, and in various adult as compared to fetal rat tissues.

The isozyme pattern and total activity of adenylate kinase were studied in normal adult and fetal human and rat tissues using starch gel electrophoresis. Three adenylate kinase isoenzymes were identified in human tissues. Although normal adult lung exhibited higher adenylate kinase activity than did its fetal or neoplastic variant, isozyme patterns in the three types of tissues were indistinguishable from each other and from that in fetal human liver. The pattern of these three isozymes in rat lung (as in spleen) also did not change between fetal and adult life. However, adult kidney and heart of this species did appear to contain isozymes not present in fetal life. Brain (both adult and fetal) was striking different from all the other tissues in that it contained only one adenylate kinase isozyme. The total adenylate kinase activity per gram of adult rat liver, kidney and lung was significantly higher than in the cognate fetal organs, whereas that in brain or spleen did not change with age. The activity in adult heart (similar to the fetal one) was higher than in any other tissue examined.

Cervical priming prior to dilatation and evacuation: a comparison of methods.

Vaginal administration of prostaglandin analogues resulted in cervical changes that facilitated dilatation and evacuation in 80 patients in the late first trimester and the second trimester of pregnancy. When 0.5 mg and 1.0 mg of 15(S)-15-methyl-prostaglandin F2 alpha (15-ME-PGF2 alpha) was compared to 30 and 60 mg of 9-deoxo-16,16-dimethyl-9 methylene prostaglandin E2 (PGE2 analogue), the PGE2 analogue appeared to have more cervical ripening effect than did the 15-ME-PGF2 alpha. Overall, the 30 mg PGE2 vaginal suppository seemed to offer the most optimal combination of effectiveness, sufficient cervical dilatation, and minimal side effects. With the prostaglandins, maximal cervical effect was observed at 4 to 5 hours; this rapid effectiveness allows administration of the prostaglandin to accommodate a 1-day stay for surgical evacuation. The preoperative cervical priming results with the prostaglandins were compared to those obtained with the use of laminaria tents. Although the number of patients who needed further dilatation at the time of operation was less with the laminaria, the incidence of complications and the time for adequate dilatation were higher in that group.

[Idiopathic thrombocytopenic purpura in infants and small children (1 to 3 years old)]. / Purpura trombocitopenica idiopatica la sugar si la copilul mic (1-3 ani).

In infant and young children (1-3 yrs), I.T.P. (idiopathic thrombocytopenic purpura) is an acute, self-limited disease in 6 months since the diagnosis. The treatment with intravenous immunoglobulins or corticosteroids will be administered in severe forms of disease(predicted by the severity of hemorrhage and thrombocytes less than 10 G./l). A retrospective study of 29 cases with I.T.P. in infants and young children shows that 22 out of 29 were acute I.T.P., 7 out of 29 were recurrent I.T.P., in which 3 cases were chronic I.T.P. Post-hemorrhage associated anemia was present in 10 out of 29 cases, in which 3 cases was severe. Prolonged bleeding time appears only in severe I.T.P. Values of thrombocytes less than 10 G/l were met in 6 cases of acute I.T.P. and in 3 cases with recurrent I.T.P., there was no predictable correlation between the very low value in the time of diagnosis and the following clinical course of the disease. Neonatal I.T.P. (history of maternal I.T.P) had a favourable clinical course after i.v. immunoglobulins treatment (1 case) and a trend to chronicity (1 case) probably due to platelet antiphospholipid antibodies. Postvaccinal I.T.P. is a rare and benign complication. Only 5 of 29 cases had spontaneous remission. The clinical course was towards complete remission in 22 out of 29 cases with i.v. immunoglobulins and/or corticosteroid therapy. In conclusion, view the natural history of disease and the unvariables responses to treatment, spontaneous bleeding cannot be predicted only by platelet count in I.T.P.-Infant-low age (1-3 yrs).

High-dose methotrexate and HELP [Holoxan (ifosfamide), eldesine (vindesine), platinum]--doxorubicin in non-metastatic osteosarcoma of the extremity: a French multicentre pilot study. Fédération Nationale des Centres de Lutte contre le Cancer and Société Française d'Oncologie Pédiatrique.

UNLABELLED: This study evaluates histological response, long-term outcome, and toxicity in an intensive chemotherapy program given before surgery. PATIENTS AND METHODS: Sixty-two patients (39 males, 23 females: median age 14) with biopsy, chest computerised-tomography, technetium bone-scan and magnetic resonance imaging, were enrolled. Primary localisations were femur (44%) and tibia (26%). Induction chemotherapy involved seven courses of high-dose methotrexate and two courses of HELP (ifosfamide, eldesine (vindesine), cisplatin (platinum)-doxorubicin. After surgery, patients received six courses of high-dose methotrexate and two courses of HELP-doxorubicin. RESULTS: Pre- and postoperative toxicities were similar. Fifty-nine patients underwent surgery; histological response was good in thirty-eight patients (64%) and poor in twenty-one (36%). Median follow-up is 57 months (range 30-80), with 77% overall survival and 59% progression-free survival. In a multivariate analysis, age under 10 years is the only prognostic factor that significantly correlates with outcome. CONCLUSIONS: This regimen appears to increase histological necrosis, but associates with severe toxicity. Results for patients with less necrosis at surgery are encouraging. Future trials should determine the minimum effective doses to reduce toxicity. New drugs should be added.