Body mass index, cigarette smoking, and alcohol consumption and cancers of the oral cavity, pharynx, and larynx: modeling odds ratios in pooled case-control data.

Odds ratios for head and neck cancer increase with greater cigarette and alcohol use and lower body mass index (BMI; weight (kg)/height(2) (m(2))). Using data from the International Head and Neck Cancer Epidemiology Consortium, the authors conducted a formal analysis of BMI as a modifier of smoking- and alcohol-related effects. Analysis of never and current smokers included 6,333 cases, while analysis of never drinkers and consumers of < or =10 drinks/day included 8,452 cases. There were 8,000 or more controls, depending on the analysis. Odds ratios for all sites increased with lower BMI, greater smoking, and greater drinking. In polytomous regression, odds ratios for BMI (P = 0.65), smoking (P = 0.52), and drinking (P = 0.73) were homogeneous for oral cavity and pharyngeal cancers. Odds ratios for BMI and drinking were greater for oral cavity/pharyngeal cancer (P < 0.01), while smoking odds ratios were greater for laryngeal cancer (P < 0.01). Lower BMI enhanced smoking- and drinking-related odds ratios for oral cavity/pharyngeal cancer (P < 0.01), while BMI did not modify smoking and drinking odds ratios for laryngeal cancer. The increased odds ratios for all sites with low BMI may suggest related carcinogenic mechanisms; however, BMI modification of smoking and drinking odds ratios for cancer of the oral cavity/pharynx but not larynx cancer suggests additional factors specific to oral cavity/pharynx cancer.

Vincristine and intestinal pseudo-obstruction in children: report of 5 cases, literature review, and suggested management.

Summary: Intestinal pseudo-obstruction is a rare complication resulting from a variety of disorders. Symptoms include abdominal pain, nausea, vomiting, diarrhea, constipation, and malnutrition. Vincristine-related pseudo-obstruction has been reported in the literature, but its description in children and recommendations for management are lacking. A review of the literature revealed 21 reported pediatric cases of vincristine-related pseudo-obstruction. Most have, however, been attributed to a drug interaction with itraconazole, accidental vincristine overdose, or liver failure. Potential genetic causes are rarely addressed. We present here 5 cases of pseudo-obstruction related to vincristine without any identifiable predisposing factors, and a suggested algorithm for management

Physicochemical aspects and efficiency of albuterol nebulization: comparison of three aerosol types in an in vitro pediatric model.

BACKGROUND: Advances in nebulizer design have produced both ultrasonic nebulizers and devices based on a vibrating mesh (vibrating mesh nebulizers), which are expected to enhance the efficiency of aerosol drug therapy. The aim of this study was to compare 4 different nebulizers, of 3 different types, in an in vitro model using albuterol delivery and physical characteristics as benchmarks. METHODS: The following nebulizers were tested: Sidestream Disposable jet nebulizer, Multisonic Infra Control ultrasonic nebulizer, and the Aerogen Pro and Aerogen Solo vibrating mesh nebulizers. Aerosol duration, temperature, and drug solution osmolality were measured during nebulization. Albuterol delivery was measured by a high-performance liquid chromatography system with fluorometric detection. The droplet size distribution was analyzed with a laser granulometer. RESULTS: The ultrasonic nebulizer was the fastest device based on the duration of nebulization; the jet nebulizer was the slowest. Solution temperature decreased during nebulization when the jet nebulizer and vibrating mesh nebulizers were used, but it increased with the ultrasonic nebulizer. Osmolality was stable during nebulization with the vibrating mesh nebulizers, but increased with the jet nebulizer and ultrasonic nebulizer, indicating solvent evaporation. Albuterol delivery was 1.6 and 2.3 times higher with the ultrasonic nebulizer and vibrating mesh nebulizers devices, respectively, than with the jet nebulizer. Particle size was significantly higher with the ultrasonic nebulizer. CONCLUSIONS: The in vitro model was effective for comparing nebulizer types, demonstrating important differences between nebulizer types. The new devices, both the ultrasonic nebulizers and vibrating mesh nebulizers, delivered more aerosolized drug than traditional jet nebulizers.

Renal failure after high-dose methotrexate in a child homozygous for MTHFR C677T polymorphism

We report the case of an 11-year-old female treated for mediastinal T-cell lymphoma who presented renal failure following the second cycle of high-dose methotrexate (HDMTX). Because of life threatening plasma methotrexate (MTX) levels, carboxypeptidase G2 (CPDG2) was administered resulting in a dramatic decrease within 1 hr. The patient recovered from renal failure and no other side effects were observed. Homozygosity for the methylentetrahydrofolate reductase (MTHFR) C677T polymorphism diagnosed by molecular genetic analysis was the only explanation for this toxicity.

Outpatient prescriptions practice and writing quality in a paediatric university hospital.

BACKGROUND: The writing of prescriptions is an important aspect of medical practice. This activity presents some specific problems given a danger of misinterpretation and dispensing errors in community pharmacies. The objective of this study was to determine the evolution of the prescription practice and writing quality in the outpatient clinics of our paediatric university hospital.¦METHODS: Copies of prescriptions written by physicians were collected from community pharmacies in the region of our hospital for a two-month period in 2005 and 2010. They were analysed according to standard criteria, including both formal and pharmaceutical aspects.¦RESULTS: A total of 597 handwritten prescriptions were reviewed in 2005 and 633 in 2010. They contained 1,456 drug prescriptions in 2005 and 1,348 in 2010. Fifteen drugs accounted for 80% of all prescriptions and the most common drugs were paracetamol and ibuprofen. A higher proportion of drugs were prescribed as International Nonproprietary Names (INN) or generics in 2010 (24.7%) compared with 2005 (20.9%). Of the drug prescriptions examined, 55.5% were incomplete in 2005 and 69.2% in 2010. Moreover in 2005, 3.2% were legible only with difficulty, 22.9% were ambiguous, and 3.0% contained an error. These proportions rose respectively to 5.2%, 27.8%, and 6.8% in 2010.¦CONCLUSION: This study showed that fifteen different drugs represented the majority of prescriptions, and a quarter of them were prescribed as INN or generics in 2010; and that handwritten prescriptions contained numerous omissions and preventable errors. In our hospital computerised prescribing coupled with advanced decision support is eagerly awaited.

Spurious hyperphosphatemia in a patient with alteplase-locked central venous catheter.

Alteplase has been shown to be effective in preventing central venous access clotting in patients on hemodialysis. Because of a high phosphorus content in its excipient, it can inadvertently contaminate blood samples, leading the physician in care of the patient to erroneously increase dialysis time or change diet in order to control the pseudo-hyperphosphatemia.

A highly sensitive LC-tandem MS assay for the measurement in plasma and in urine of salbutamol administered by nebulization during mechanical ventilation in healthy volunteers.

The new-generation nebulizers are commonly used for the administration of salbutamol in mechanically ventilated patients. The different modes of administration and new devices have not been compared. We developed a liquid chromatography-tandem mass spectrometry method for the determination of concentrations as low as 0.05 ng/mL of salbutamol, corresponding to the desired plasma concentration after inhalation. Salbutamol quantification was performed by reverse-phase HPLC. Analyte quantification was performed by electrospray ionization-triple quadrupole mass spectrometry using selected reaction monitoring detection ESI in the positive mode. The method was validated over concentrations ranging from 0.05 to 100 ng/mL in plasma and from 0.18 to 135 ng/mL in urine. The method is precise, with mean inter-day coefficient of variation (CV%) within 3.1-8.3% in plasma and 1.3-3.9% in urine, as well as accurate. The proposed method was found to reach the required sensitivity for the evaluation of different nebulizers as well as nebulization modes. The present assay was applied to examine whether salbutamol urine levels, normalized with the creatinine levels, correlated with the plasma concentrations. A suitable, convenient and noninvasive method of monitoring patients receiving salbutamol by mechanical ventilation could be implemented. Copyright © 2011 John Wiley & Sons, Ltd.

Unlicensed and off-label drug use in a Swiss paediatric university hospital.

BACKGROUND: Many medicines used in newborns, infants, children and adolescents are not licensed ("unlicensed") or are prescribed outside the terms of the marketing authorization ("off-label"). Several studies have shown that this is a common practice in various healthcare settings in the USA, Europe and Australia, but data are scarce in Switzerland. OBJECTIVES: The aim of our prospective study was to determine the proportion of unlicensed or off-label prescriptions in paediatric patients. METHODS: This pilot study was conducted prospectively over a six month period in the department of paediatrics of a university hospital. RESULTS: Sixty patients aged from three days to 14 years were included in the study. A total of 483 prescriptions were written for the patients. More than half of all prescriptions (247; 51%) followed the terms of the marketing authorization. 114 (24%) were unlicensed and 122 (25%) off-label. All patients received at least one unlicensed or offlabel medicine. CONCLUSION: The use of unlicensed or off-label medicines to treat children was found to be common. Co-operation between the pharmaceutical industry, national regulatory authorities, clinical researchers, healthcare professionals and parents is required in order to ensure that children do not remain "therapeutic orphans".

Pediatric drug-related problems: a multicenter study in four French-speaking countries.

BACKGROUND: Pediatric intensive care patients represent a population at high risk for drug-related problems. There are few studies that compare the activity of clinical pharmacists between countries. OBJECTIVE: To describe the drug-related problems identified and interventions by four pharmacists in a pediatric cardiac and intensive care unit. SETTING: Four pediatric centers in France, Quebec, Switzerland and Belgium. METHOD: This was a six-month multicenter, descriptive and prospective study conducted from August 1, 2009 to January 31, 2010. Drug-related problems and clinical interventions were compiled from four pediatric centers in France, Quebec, Switzerland and Belgium. Data on patients, drugs, intervention, documentation, approval and estimated impact were compiled. MAIN OUTCOME MEASURE: Number and type of drug-related problems encountered in a large pediatric inpatient population. RESULTS: A total of 996 interventions were recorded: 238 (24 %) in France, 278 (28 %) in Quebec, 351 (35 %) in Switzerland and 129 (13 %) in Belgium. These interventions targeted 270 patients (median 21 months old, 53 % male): 88 (33 %) in France, 56 (21 %) in Quebec, 57 (21 %) in Switzerland and 69 (26 %) in Belgium. The main drug-related problems were inappropriate administration technique (29 %), untreated indication (25 %) and supra-therapeutic dose (11 %). The pharmacists' interventions were mostly optimizing the mode of administration (22 %), dose adjustment (20 %) and therapeutic monitoring (16 %). The two major drug classes that led to interventions were anti-infectives for systemic use (23 %) and digestive system and metabolism drugs (22 %). Interventions mainly involved residents and all clinical staff (21 %). Among the 878 (88 %) proposed interventions requiring physician approval, 860 (98 %) were accepted. CONCLUSION: This descriptive study illustrates drug-related problems and the ability of clinical pharmacists to identify and resolve them in pediatric intensive care units in four French-speaking countries.

Demonstration of the effectiveness of zinc in diarrhoea of children living in Switzerland.

We designed a double-blinded randomized clinical trial of zinc (10 or 20 mg of zinc sulphate for 2-5 month-old or 6-59 month-old children, respectively, during 10 days) vs. placebo in otherwise healthy children aged 2 months to 5 years who presented with acute diarrhoea (i.e. ≥3 stools/day for less than 72 h). Eighty-seven patients (median age 14 months; range 3.1-58.3) were analysed in an intention-to-treat approach. Forty-two patients took zinc and 45 placebo. There was no difference in the duration nor in the frequency of diarrhoea, but only 5% of the zinc group still had diarrhoea at 120 h of treatment compared to 20% in the placebo group (P = 0.05). Thirty-one patients (13 zinc and 18 placebo) were available for per-protocol analyses. The median (IQR) duration of diarrhoea in zinc-treated patients was 47.5 h (18.3-72) and differed significantly from the placebo group (median 76.3; IQR 52.8-137) (P = 0.03). The frequency of diarrhoea was also lower in the zinc group (P = 0.02). CONCLUSION: zinc treatment decreases the frequency and severity of diarrhoea in children aged 2 months to 5 years living in Switzerland. However, the intention-to-treat analysis reveals compliance issues that question the proper duration of treatment and the choice of optimal pharmaceutical formulation.

Lois des Lombards.

Acquis le 28 janvier 1843 de Benjamin Duprat, libraire, suite à la vente Saibante pour le prix de 900 francs; cf. B.n.F., département des Manuscrits, registre des acquisitions 1833-1848, n° 3163; — note "Questo codice è assai diffusamente descritto ed illustrato in una epistola di Lucio Doglioni al P. Paolo Canciani, la quale trovasi nel tomo secondo pag. 461 dell' opera: Canciani Barbarorum leges antiquae. Apparteneva al convento di Sa. Eufemia di Verona, indi passo nella Bibltioteca del Mse Gianfilippi" (f. de garde); — Pierre Pithou; cf. B.n.F., département des Manuscrits, nouv. acq. fr. 5527, f. 109

ALBUM AMICORUM de Jean Durand (1583-1592). In-8 de 2 f. lim. et 380 p., mar. r., comp. de mos. de mar. v., riche dorure à petits fers, tr. dor. et ciselée. (Rel. du XVIe siècle.)

Durand (Jean). Album amicorum (1583-1592)

Breviarium Strigoniense.

Cf. notice du ms. par Leroquais, Bréviaires, III, 182-185 n° 591 et pl. XCIX; P. Radó, Libri liturgici manuscripti bibliothecarum Hungariae et limitropharum regionum, Budapest, 1973. Un bréviaire d'Esztergom a été imprimé en 1524 à Venise. F. 2-8v Calendrier à l'usage d'Esztergom, avec un grand nombre de saints d'origines diverses (2-7v); cf. Leroquais, op. cit., 182. À noter les saints non mentionnés dans les Acta sanctorum, ou du moins pas pour la date correspondante; ne sont pas relevés les saints hongrois considérés comme classiques par Radó, op. cit., passim : 4 févr., «Victoris m.»; 8 févr., «Juliani m.»; 13 févr., «Adalberti m.», signalé une fois dans Radó, op. cit., 96 d'après ms. Budapest, B. N. Hung., c. l. m. ae. 395; 15févr., «Faustiani m.»; 21 févr., «Septuaginta mm.», non signalé sous cette forme pour cette date dans Radó, op. cit.; 15 mars, «Hilarii conf. et pont.», non signalé sous cette forme pour cette date dans Radó, op. cit.; 17 mars, «Bernardi conf.»; 26mars, «Eustachii abb.», signalé une fois dans Radó, op. cit., 96 d'après ms. Budapest, B.N. Hung., c. l. m. ae. 395; 28 mars, «Gastuli m.», non signalé dans Radó, op. cit.; 3 juill., «Bonifacii ep.», non signalé dans Radó, op. cit.; 5 juill., «Dominici m.»; 4 août, «Gaudentii ep. et conf.», signalé une fois dans Radó, op. cit., 329 d'après ms. Budapest, B. N. Hung., c. l. m. ae. 408; 8 août, «Adventus sanguinis D. N. J. C.»; 31 août, «Pauli ep. et m.», non signalé dans Radó, op. cit.; 12 oct., «Quatuor milium mm.», non signalé dans Radó, op. cit., à rapprocher de quatuor mille octingenti septuaginta mm., cf. Radó, op. cit., 167 d'après ms. Esztergom, B. metropolitana Strigoniensis I. 20; 14 oct., «Cerbonii conf.»; 27 oct., «Vedasti m.»; 15 nov., «Martini conf.», non signalé pour cette date dans Radó, op. cit; 20 nov., «Aniani ep. [Aurelianensis] et conf.». Pour plusieurs saints du calendrier on ne trouve pas d'office dans le sanctoral, et vice versa. — «Sequitur tabula impositionis historiarum...» (8-8v). F. 11-76 Psautier férial (11-72). — Office des défunts à l'usage d'Esztergom (72v-76); cf. K. Ottosen, The responsories and versicles of the latin office of the dead, Aarhus 1993, 127 (description des ff.74v-75v = «BN8879B») et 180 (description des ff.72v-74v = «BN8879A»). F. 77-528v Temporal : «Incipit breviarium secundum chorum alme ecclesie Strigoniensis. Dominica prima in adventu Domini...» (77-282v). Sanctoral : «Incipit secunda pars breviarii scilicet de festivitatibus. De s. Silvestro...» (286-486). À noter : office de l'Immaculée Conception composé par Léonard Nogarolo (480v). Commun des saints : «Incipit commune de sanctis et primo in vigilia unius apostoli...» (486v-513v). — «Sequitur de b. Virgine sabbatis diebus per estatem. Ad vesperas...» (513v-516v). «In quotidianis horis b. Virginis...» (516v-525). — «Sequuntur preces in quadragesima...» (525-526v). — «Sequuntur suffragia sabbatis diebus per estatem...» (526v-528), dont suffrages des ss. [Stephani regis Hungariae; Emerici ducis] (527), [Ladislai regis Hungariae; Adalberti ep. Pragensis et m.] (527v). — «Absolutio excommunicati...» (528-528v). 106 hymnes mentionnées dans la table des incipit, dont une non répertoriée dans Chevalier, Repert. hymn. ni dans les A. H., pour les confesseurs : «Christe lucis splendor vere fabrice mundi semper nobis parcens miserere confessorum precibus//...» (506v); cf. P. Radó, Répertoire hymnologique des mss. liturgiques dans les bibliothèques publiques de Hongrie, Budapest 1945, n° 111, relevée une fois dans le ms. Budapest, Bibl. nat. Hung. c. l. m. ae. 132, ms. décrit par Radó, Libri liturgici..., op. cit., 395-400.

Breviarium Strigoniense.

Cf. notice du ms. par Leroquais, Bréviaires, III, 182-185 n° 591 et pl. XCIX; P. Radó, Libri liturgici manuscripti bibliothecarum Hungariae et limitropharum regionum, Budapest, 1973. Un bréviaire d'Esztergom a été imprimé en 1524 à Venise. F. 2-8v Calendrier à l'usage d'Esztergom, avec un grand nombre de saints d'origines diverses (2-7v); cf. Leroquais, op. cit., 182. À noter les saints non mentionnés dans les Acta sanctorum, ou du moins pas pour la date correspondante; ne sont pas relevés les saints hongrois considérés comme classiques par Radó, op. cit., passim : 4 févr., «Victoris m.»; 8 févr., «Juliani m.»; 13 févr., «Adalberti m.», signalé une fois dans Radó, op. cit., 96 d'après ms. Budapest, B. N. Hung., c. l. m. ae. 395; 15févr., «Faustiani m.»; 21 févr., «Septuaginta mm.», non signalé sous cette forme pour cette date dans Radó, op. cit.; 15 mars, «Hilarii conf. et pont.», non signalé sous cette forme pour cette date dans Radó, op. cit.; 17 mars, «Bernardi conf.»; 26mars, «Eustachii abb.», signalé une fois dans Radó, op. cit., 96 d'après ms. Budapest, B.N. Hung., c. l. m. ae. 395; 28 mars, «Gastuli m.», non signalé dans Radó, op. cit.; 3 juill., «Bonifacii ep.», non signalé dans Radó, op. cit.; 5 juill., «Dominici m.»; 4 août, «Gaudentii ep. et conf.», signalé une fois dans Radó, op. cit., 329 d'après ms. Budapest, B. N. Hung., c. l. m. ae. 408; 8 août, «Adventus sanguinis D. N. J. C.»; 31 août, «Pauli ep. et m.», non signalé dans Radó, op. cit.; 12 oct., «Quatuor milium mm.», non signalé dans Radó, op. cit., à rapprocher de quatuor mille octingenti septuaginta mm., cf. Radó, op. cit., 167 d'après ms. Esztergom, B. metropolitana Strigoniensis I. 20; 14 oct., «Cerbonii conf.»; 27 oct., «Vedasti m.»; 15 nov., «Martini conf.», non signalé pour cette date dans Radó, op. cit; 20 nov., «Aniani ep. [Aurelianensis] et conf.». Pour plusieurs saints du calendrier on ne trouve pas d'office dans le sanctoral, et vice versa. — «Sequitur tabula impositionis historiarum...» (8-8v). F. 11-76 Psautier férial (11-72). — Office des défunts à l'usage d'Esztergom (72v-76); cf. K. Ottosen, The responsories and versicles of the latin office of the dead, Aarhus 1993, 127 (description des ff.74v-75v = «BN8879B») et 180 (description des ff.72v-74v = «BN8879A»). F. 77-528v Temporal : «Incipit breviarium secundum chorum alme ecclesie Strigoniensis. Dominica prima in adventu Domini...» (77-282v). Sanctoral : «Incipit secunda pars breviarii scilicet de festivitatibus. De s. Silvestro...» (286-486). À noter : office de l'Immaculée Conception composé par Léonard Nogarolo (480v). Commun des saints : «Incipit commune de sanctis et primo in vigilia unius apostoli...» (486v-513v). — «Sequitur de b. Virgine sabbatis diebus per estatem. Ad vesperas...» (513v-516v). «In quotidianis horis b. Virginis...» (516v-525). — «Sequuntur preces in quadragesima...» (525-526v). — «Sequuntur suffragia sabbatis diebus per estatem...» (526v-528), dont suffrages des ss. [Stephani regis Hungariae; Emerici ducis] (527), [Ladislai regis Hungariae; Adalberti ep. Pragensis et m.] (527v). — «Absolutio excommunicati...» (528-528v). 106 hymnes mentionnées dans la table des incipit, dont une non répertoriée dans Chevalier, Repert. hymn. ni dans les A. H., pour les confesseurs : «Christe lucis splendor vere fabrice mundi semper nobis parcens miserere confessorum precibus//...» (506v); cf. P. Radó, Répertoire hymnologique des mss. liturgiques dans les bibliothèques publiques de Hongrie, Budapest 1945, n° 111, relevée une fois dans le ms. Budapest, Bibl. nat. Hung. c. l. m. ae. 132, ms. décrit par Radó, Libri liturgici..., op. cit., 395-400.