Importance clinique du caryotype en hématologie. [Clinical importance of karyotype in hematology.]

Cytogenic analysis of leukemic cells has proven to be a mandatory part of the diagnosis of malignant hemopathies. Recurring clonal cytogenetic abnormalities may be divided into those exclusively associated with myeloid disorders, those uniquely observed in lymphoid diseases, and those detected in both myeloid and lymphoid hemopathies. Several of the common defects are characteristic of specific FAB types or subtypes and are associated with specific clinico pathologic syndromes and clinical complications. Cytogenetic abnormalities have served to define relatively homogeneous subsets of malignant hemopathies which are not evident from morphological and other available markers. Cytogenetic findings have been demonstrated to be powerful indicators in predicting clinical course and outcome in patients and in guiding their management. Given the significant progress made in the treatment of malignant hemopathies, it is very important to identify parameters which may be used to predict whether patients will respond favorably to standard therapies or if they are unlikely to do so and require alternative strategies, such as bone marrow transplantation. Cytogenetic studies have also provided important insights into the understanding of malignant transformation processes. In a number of recurring chromosome translocations characteristic of leukemias and lymphomas the genes that are located at the breakpoints have been identified. Molecular analysis has revealed that alteration in expression of these genes or in the properties of the encoded proteins resulting from the rearrangements plays an integral part in malignant transformation. Studies of clonality have suggested that several chromosome abnormalities may arise in pluripotent hemopoietic stem cells, whereas others may originate in cells of more restricted lineage. The author focuses first on the implications of the karyotype in the diagnosis and the prognosis of myeloproliferative syndromes, acute leukemias and myelodysplastic syndromes, then on the interest of describing new clinical-cytogenetic associations. Finally, some of the recent results obtained in a cytogenetic study of myelodysplastic syndromes are discussed.

Soutien informatique dans la gestion de la douleur aiguë aux urgences: acceptation par les soignants et impact sur les connaissances des Recommandations de Pratiques Cliniques (RPC)

Dans une étude précédente, nous avons démontré qu'un soutieninformatique rappelant les Recommandations de Pratiques Cliniques(RPC) améliore la gestion de la douleur aiguë aux urgences à moyenterme (JEUR 2009;22:A88). Par contre, son acceptation par lessoignants et son impact sur leurs connaissances des RPC sontinconnus. But de l'étude: mesurer l'impact du logiciel en termesd'acceptation et connaissance des RPC par l'équipe soignante.Méthode: analyse de 2 questionnaires remplis par les médecins etinfirmiers: le 1er administré en pré-, post-déploiement et 6 mois plustard (phases P1, P2 et P3) qui a évalué: a) l'appréciation subjective desconnaissances des RPC par échelle de Lickert à 5 niveaux; b) lesconnaissances objectives des RPC à l'aide de 7 questions théoriques(score max. 7 points); le 2ème administré en P2 et P3, l'utilité perçue dulogiciel (échelle à 4 niveaux). Analyses statistiques par test de chi2outest exact de Fisher; p bilatéral <0.05 significatif. Résultats: la proportiondes soignants estimant avoir une bonne connaissance des RPC apassé de 48% (45/94) en P1, à 73% (83/114) puis 84% (104/124) en P2et P3, respectivement (p <0.0001). Score des connaissances: cftableau. Entre P2 et P3, l'appréciation globale de l'utilité du logiciel s'estaméliorée: la proportion des avis favorables a passé de 59% (47/79) à82% (96/117) (p = 0.001). Conclusion: ce logiciel a été bien accepté et apermis une amélioration significative des connaissances des RPC parles soignants.

Dépendances [Addiction]

This year review emphasizes three aspects coming from addiction psychiatry: 1. Psychosis and cannabis: a motivational approach. 2. Connection between addiction services and psychiatric wards. 3. Use of antiepileptic agents in addiction medicine.

Qualitative and Hierarchical Analysis of Protective Factors against Illicit Use of Doping Substances in Athletes Calling a National Anti-Doping Phone-Help Service

Evidence of a sport-specific hierarchy of protective factors against doping would thus be a powerful aid in adapting information and prevention campaigns to target the characteristics of specific athlete groups, and especially those athletes most vulnerable for doping control. The contents of phone calls to a free and anonymous national anti-doping service called 'ecoute dopage' were analysed (192 bodybuilders, 124 cyclists and 44 footballers). The results showed that the protective factors that emerged from analysis could be categorised into two groups. The first comprised 'Health concerns', 'Respect for the law' and 'Doping controls from the environment' and the second comprised 'Doubts about the effectiveness of illicit products, 'Thinking skills' and 'Doubts about doctors'. The ranking of the factors for the cyclists differed from that of the other athletes. The ordering of factors was 1) respect for the law, 2) doping controls from the environment, 3) health concerns 4) doubts about doctors, and 5) doubts about the effectiveness illicit products. The results are analysed in terms of the ranking in each athlete group and the consequences on the athletes' experience and relationship to doping. Specific prevention campaigns are proposed to limit doping behaviour in general and for each sport.