Psycho-oncologie et culture du mourir à domicile : l’appel à la pluridisciplinarité des médecins généralistes (MG)

In France, general practitioners (GPs) express difficulties in exercise of home palliative care. Those difficulties are described in various studies but none assesses the multidisciplinary collaboration’s impact. In the present study (2005–2008), 291 GPs included in a palliative care network responded to a questionnaire. Results showed the benefits of this partnership organization. Detailed analysis of 36 collaboration cases clarified the reasons for these difficulties and the network influence.     

Dipyridamole-echocardiography test as a clue for assessing the organic 'ceiling' of individual coronary reserve

Twenty-four patients with a history of effort angina, a positiveexercise stress test (EST) and coronary artery disease wereenrolled in the study; 12 patientshada positive dipyridamole-echocardiographytest (DET) and 12 had a negative DET. Each patient performeda total of 4 ESTs in the absence of therapy on two successivedays; for each test the rate-pressure product (RPP), an establishedindex of my ocardial oxygen demand, was measured at the onsetof ischaemia (ST depression >0–15mV) or at the peakof maximal exercise (if a repeated EST was negative). Taking into account the lowest of the 4 RPP values ( x 1/100)in each patient, there was no significant difference betweenDET-negatives and DET-positives (185.2±49.3 vs 157.4±32.4).Conversely, when considering the highest of the 4 RPP valuesin each patient, there was a significant difference betweenDET-negatives and DET-positives (280.3 ± 63.9 vs 183.3± 37.0; p < 0.01). Thus, DET may provide a clinically useful tool for assessingin the individual the organic ’ceiling‘ of coronaryreserve, by eliminating the variability in coronary tone, whichmay affect EST reproducibility and the correct evaluation ofthe impairment of organic coronary reserve.     

Influence of oestrous cycle and pregnancy on the reactivity of the rat mesenteric vascular bed

In isolated, perfused mesenteric vascular beds from female rats, it was assessed whether the constrictor response to cirazoline, an alpha(1)-adrenergic agonist, or acetylcholine (ACh)-induced relaxation was altered by oestrous cycle or pregnancy and the ability of nitric oxide (NO), prostanoids and endothelium-derived hyperpolarizing factor (EDHF) to modulate these responses. Mesenteries, removed from female rats on each oestrous cycle day and gestation day 16, were perfused with physiological salt solution. Tone was induced with cirazoline (1 micromol/l), and concentration-response curves to ACh generated. Responsiveness to ACh was tested in the presence of N(omega)-nitro-L-arginine (L-NA), ibuprofen (IBU) and tetrabutylammonium (TBA), to inhibit nitric oxide synthase (NOS), cyclo-oxygenase and K(+) channels respectively. Cirazoline-induced tone was smaller in pro-oestrous and pregnant groups, but the increase in tone to L-NA was larger in pregnant compared with oestrous and dioestrous groups. Control responses to ACh were not different, but L-NA attenuated the response in virgin groups only. IBU did not affect the ACh response, but TBA attenuated it in all groups. When TBA was introduced first, ACh-induced dilatation was significantly reduced and not altered by L-NA addition. These results suggest that in the mesenteric vascular bed from cycling and pregnant rats, EDHF is the major mediator of ACh-induced dilatation and NOS may be up-regulated in pregnant and pro-oestrous rats.     

Open-door decompressive cervical laminotomy. Technic and initial experiences

The cervical laminectomy is usually applied in the treatment of cervical myelopathy caused by cervical canal stenosis and multiple spondylosis. Nevertheless, late complications are often reported, especially scar formation, the so-called laminectomy membrane, between the dura and overlying paraspinal muscles, which, compressing the cord, reduces until to abolish the favourable effects of the previous laminectomy; moreover, malalignment of the cervical spine with secondary kyphosis may follow an expansive laminectomy. In order to avoid these complications, in 1977 Hirabayashi introduced a new surgical technique, the "expansive open-door laminoplasty", which permits the enlargement of the spinal canal over multiple segments by completely incising the laminae laterally on one side and partially on the opposite: elevation with tilting of the laminae upward in the incised side, allows enlargement of the canal. The Authors describe in detail the operative procedure and report their experience in 10 patients.     

Medication-Related Osteonecrosis of the Jaw (MRONJ): Are Antiresorptive Drugs the Main Culprits or Only Accomplices? The Triggering Role of Vitamin D Deficiency

Osteonecrosis of the jaw (ONJ) is a severe clinical condition characterized mostly but not exclusively by an area of exposed bone in the mandible and/or maxilla that typically does not heal over a period of 6–8 weeks. The diagnosis is first of all clinical, but an imaging feedback such as Magnetic Resonance is essential to confirm clinical suspicions. In the last few decades, medication-related osteonecrosis of the jaw (MRONJ) has been widely discussed. From the first case reported in 2003, many case series and reviews have appeared in the scientific literature. Almost all papers concerning this topic conclude that bisphosphonates (BPs) can induce this severe clinical condition, particularly in cancer patients. Nevertheless, the exact mechanism by which amino-BPs would be responsible for ONJ is still debatable. Recent findings suggest a possible alternative explanation for BPs role in this pattern. In the present work we discuss how a condition of osteomalacia and low vitamin D levels might be determinant factors.     

Le cancer indépendant du psychisme: un manque d’interprétation créatrice?

Résumé: La recherche des liens entre les facteurs psychosociologiques et le cancer, tant en ce qui concerne l’étiologie de cette maladie que sa prise en charge et son évolution, n’a pas pour l’instant permis d’obtenir de résultats franchement significatifs, et ce malgré l’importance des efforts fournis. Cet article passe en revue les principales conclusions, mais, contrairement aux avis sceptiques qui prévalent dans la littérature médicale, il vise à dégager les pistes qui restent à explorer et qui demeurent prometteuses. Parmi elles, des recherches épidémiologiques chez l’enfant sont nécessaires, relativement aux événements de vie propres à cette tranche d’âge et en utilisant une approche systémique. Outre la survie, le confort et la qualité de vie et certaines caractéristiques comme l’anxiété, la dépression et le coping, de nouveaux objectifs devraient être envisagés pour évaluer l’impact des psychothérapies sur le cancer, entre autres en étudiant les variations des marqueurs principaux de l’immunité, des rythmes circadiens biologiques, du sommeil ou du cycle activité/repos. Les thérapies de groupe semblent avoir un effet principalement en raison des informations (médicales ou autres) dont elles permettent la communication, mais leur efficacité reste discutée. De nouveaux types d’intervention psychosociale devraient donc être introduits dans les essais, en raison de leurs effets rapides, dont certains prouvés sur l’immunité: par exemple l’hypnose. La psychologie clinique semble aussi bien adaptée à ce type d’étude. Les enfants, sous réserve d’une éthique satisfaisante, paraissent une cible privilégiée pour les recherches à venir, mais les essais doivent continuer à inclure des patients de tous âges et, ce, quels que soient le stade et le type de leur maladie. Enfin, sur le plan purement statistique, les analyses multivariées ont tendance à évincer les facteurs psychologiques quand leur pathogénéicité provient de conduites à risque (tabagisme, alcoolisme…) qu’ils favorisent. Les conclusions attribuant la responsabilité des cancers à ces seuls derniers facteurs (tabac, alcool) sont alors erronées. Au minimum, il faut réaffecter au facteur psychologique le poids de son influence sur l’exposition au carcinogène.     

Correction to: Intramuscular clodronate in erosive osteoarthritis of the hand is effective on pain and reduces serum COMP: a randomized pilot trial–The ER.O.D.E. study (ERosive Osteoarthritis and Disodium-clodronate Evaluation)

Clinical Rheumatology - One of the author names on this article was incorrectly tagged during the article mark-up; Luca Dalle Carbonare’s name has now been correctly tagged, with first name...     

Age determination of adult individuals by three-dimensional modelling of canines

Accurate age determination is fundamental in both forensic medicine and anthropology. Many methods that relate dental characteristics to adult age have been proposed, but there is still no simple and reliable method that does not damage the study material. The aim of this work was to propose a relevant and practical technique for determining age in adults that could be used in both living and deceased individuals. The sample was composed of 210 CT scans from individuals aged from 15 to 85 years old, with four healthy canines present in the mouth. The 840 canines were modelled using Mimics® 10.01 software. The pulp volume/total volume ratio ×100 was determined for each tooth. Seven mathematical models, corresponding to all possible real situations, were determined by the weighted least squares method and ranked in order of relative performance. The adequacy of the seven models to the data was very high with the regressions proposed (0.915?<?R ² _adjusted?<?0.964). Ranked in order of performance, the maxillary model was the most powerful of the seven models for age determination, followed by the 4 canines model, the 13 model and the 23 model.