Rôle de la chirurgie laparoscopique dans le traitement de la maladie de reflux gastro-oesophagien [Laparoscopic treatment of gastroesophageal reflux disease]

Un certain nombre de malades ne sont toujours pas soulagés de manière satisfaisante par le traitement médical de la maladie de de reflux gastro-oesophagien (MR). Ce travail rapport notre expérience de 55 malades ayant bénéficié d'un montage anti-reflux réalisé par laparoscopie entre février 1992 et février 1997. La durée opératoire moyenne a été de 181 minutes, et tend à diminuer. La médiane de s&jour postopératoire a été de 4 jours. Quatre-vingt-neuf pour-cent des malades ont eu un suivi complet de 2 à 62 mois. Nonante-deux pour-cent d'entre eux étaient satisfaits ou très satisfaits du résultat. L'enthousiasme lié au traitement laparoscopique de la MR est justifié. Les résultats dépendent de la maîtrise technique du chirurgien, de sa connaissance de la MR, et de ses capacités à adapter le type de montage anti-reflux en fonction de l'évaluation préopératoire. L'intervention donne alors un résultat prévisible, ce qui incite à la proposer aux malades mal contrôlés médicalement, ou qui préfèrent éviter les contraintes d'un traitement de maintien à long terme.

Communication skills in diagnostic pathology.

Communication is an essential element of good medical practice also in pathology. In contrast to technical or diagnostic skills, communication skills are not easy to define, teach, or assess. Rules almost do not exist. In this paper, which has a rather personal character and cannot be taken as a set of guidelines, important aspects of communication in pathology are explored. This includes what should be communicated to the pathologist on the pathology request form, communication between pathologists during internal (interpathologist) consultation, communication around frozen section diagnoses, modalities of communication of a final diagnosis, with whom and how critical and unexpected findings should be communicated, (in-)adequate routes of communication for pathology diagnoses, who will (or might) receive pathology reports, and what should be communicated and how in case of an error or a technical problem. An earlier more formal description of what the responsibilities are of a pathologist as communicator and as collaborator in a medical team is added in separate tables. The intention of the paper is to stimulate reflection and discussion rather than to formulate strict rules.

Pubic growth study: applicability in sexual and age diagnostic.

The growth of five variables of the ischiopubic area was analyzed from bone material from birth to old age. The main purpose was to evaluate its significance and capacity for age and sex determination during and after growth. The material used consisted of 327 specimens from four documented Western European collections. Growth curves were calculated by polynomial regression for two classical variables of the ischiopubic area (pubis length and ischiopubic index) and three new variables of the pubic acetabular area (horizontal and vertical diameter of the pubic acetabular area and the pubic acetabular index). None of the curves showed lineal growth, with the exception of the ischiopubic index and the masculine vertical diameter of the pubis acetabular area. Pubis length has the most complicated growth, expressed by a five-degree polynomial. All the variables are useful for adult sex determination, except the pubic acetabular index. The ischopubic index, vertical diameter of the pubic acetabular area and the pubic acetabular index seem to be good variables for sub-adult sex determination. For age estimation the best variables, in both archaeological and forensic remains, are the absolute measurements (pubic length, vertical and horizontal diameter of the pubis). However, pubis length is the best variable for age estimation because it can be applied until 25 years of age.

Performance of diagnostic centers in the classification of opportunistic screening mammograms from the Brazilian public health system (SUS)

Objective To evaluate the performance of diagnostic centers in the classification of mammography reports from an opportunistic screening undertaken by the Brazilian public health system (SUS) in the municipality of Goiânia, GO, Brazil in 2010. Materials and Methods The present ecological study analyzed data reported to the Sistema de Informação do Controle do Câncer de Mama (SISMAMA) (Breast Cancer Management Information System) by diagnostic centers involved in the mammographic screening developed by the SUS. Based on the frequency of mammograms per BI-RADS® category and on the limits established for the present study, the authors have calculated the rate of conformity for each diagnostic center. Diagnostic centers with equal rates of conformity were considered as having equal performance. Results Fifteen diagnostic centers performed mammographic studies for SUS and reported 31,198 screening mammograms. The performance of the diagnostic centers concerning BI-RADS classification has demonstrated that none of them was in conformity for all categories, one center presented conformity in five categories, two centers, in four categories, three centers, in three categories, two centers, in two categories, four centers, in one category, and three centers with no conformity. Conclusion The results of the present study demonstrate unevenness in the diagnostic centers performance in the classification of mammograms reported to SISMAMA from the opportunistic screening undertaken by SUS.

Pancytopénie avec anémie hémolytique et schizocytes: une approche pragmatique [Pancytopenia, Hemolytic Anemia and Schizocytes: a Pragmatic Approach].

ous discutons le cas d'une femme de 58 ans qui présente une asthénie progressive et une dyspnée ainsi que des paresthésies des membres. On découvre une pancytopénie avec des neutrophiles hypersegmentés, une anémie macrocytaire hyporégénérative et des éléments d'hémolyse (forte augmentation des LDH). Cette constellation doit faire suspecter une carence en vitamine B12 qui est confirmée chez notre patiente par un dosage de la cobalamine indétectable. Le bilan étiologique montre des anticorps anti-cellules pariétales gastriques positifs à 1/640, diagnostiques d'une maladie de Biermer. A 58 year old woman presents with a progressive fatigue and dyspnea associated with paresthesia. Laboratory tests show pancytopenia with hypersegmented neutrophiles, macrocytic hyporegenerative anemia and arguments for hemolysis, in particular highly increased LDH. This constellation strongly suggests vitamin B12 deficiency, which was confirmed with an undetectable cobalamine concentration in the blood of our patient. The etiologic work up shows the presence of anti-parietal cells antibodies at a titer of 1/640, diagnostic of Biermer anemia.

Les effets de la maladie de Parkinson sur l'écriture manuscrite

Cet article présente les caractéristiques de l'écriture d'une personne atteinte de la maladie de Parkinson, ainsi que l'influence des traitements de la maladie sur ces caractéristiques. L'expert est ainsi amené à mieux connaître cette source de variation de l'écriture, et vise à l'aider à évaluer les résultats de ses observations lorsqu'il fait face à un cas impliquant des écritures de parkinsoniens. Puisque les écritures imitées peuvent présenter des caractéristiques similaires à celles des écritures pathologiques, il est important de connaître les signes qui permettent de les distinguer. L'écriture des parkinsoniens peut notamment présenter une diminution de la taille des lettres, connue sous le nom de "micrographie", des tremblements ainsi que des formes indistinctes des lettres, et un alignement ondulatoire des mots. Les parkinsoniens écrivent moins vite et avec une accélération et une fluidité réduites. Ils ont tendance à augmenter la durée de l'exécution de leurs traits. Le traitement au moyen de médicaments ou par Deep Brain Stimulation (DBS) peut permettre aux parkinsoniens d'améliorer leur performance et d'atteindre une restauration partielle de l'exécution des mouvements séquentiels.

Suggestion of a national diagnostic reference level for 18F-FDG/PET scans in adult cancer patients in Brazil

Objective To suggest a national value for the diagnostic reference level (DRL) in terms of activity in MBq.kg–1, for nuclear medicine procedures with fluorodeoxyglucose (18F-FDG) in whole body positron emission tomography (PET) scans of adult patients. Materials and Methods A survey on values of 18F-FDG activity administered in Brazilian clinics was undertaken by means of a questionnaire including questions about number and manufacturer of the installed equipment, model and detector type. The suggested DRL value was based on the calculation of the third quartile of the activity values distribution reported by the clinics. Results Among the surveyed Brazilian clinics, 58% responded completely or partially the questionnaire; and the results demonstrated variation of up to 100% in the reported radiopharmaceutical activity. The suggested DRL for 18F-FDG/PET activity was 5.54 MBq.kg–1 (0.149 mCi.kg–1). Conclusion The present study has demonstrated the lack of standardization in administered radiopharmaceutical activities for PET procedures in Brazil, corroborating the necessity of an official DRL value to be adopted in the country. The suggested DLR value demonstrates that there is room for optimization of the procedures and 18F-FDG/PET activities administered in Brazilian clinics to reduce the doses delivered to patients. It is important to highlight that this value should be continually revised and optimized at least every five years.

The knowledge about diagnostic imaging methods among primary care and medical emergency physicians

Objective To evaluate the knowledge about diagnostic imaging methods among primary care and medical emergency physicians. Materials and Methods Study developed with 119 primary care and medical emergency physicians in Montes Claros, MG, Brazil, by means of a structured questionnaire about general knowledge and indications of imaging methods in common clinical settings. A rate of correct responses corresponding to ≥ 80% was considered as satisfactory. The Poisson regression (PR) model was utilized in the data analysis. Results Among the 81 individuals who responded the questionnaire, 65% (n = 53) demonstrated to have satisfactory general knowledge and 44% (n = 36) gave correct responses regarding indications of imaging methods. Respectively, 65% (n = 53) and 51% (n = 41) of the respondents consider that radiography and computed tomography do not use ionizing radiation. The prevalence of a satisfactory general knowledge about imaging methods was associated with medical residency in the respondents' work field (PR = 4.55; IC 95%: 1.18-16.67; p-value: 0.03), while the prevalence of correct responses regarding indication of imaging methods was associated with the professional practice in primary health care (PR = 1.79; IC 95%: 1.16-2.70; p-value: 0.01). Conclusion Major deficiencies were observed as regards the knowledge about imaging methods among physicians, with better results obtained by those involved in primary health care and by residents.

Approches diagnostiques des bactéries intracellulaires et des germes fastidieux [Diagnostic approach of intracellular bacteria and fastidious microorganisms].

Obligate or facultative intracellular bacteria are fastidious organisms that do not or poorly grow on conventional culture media. Some of them may be the cause of frequent and potentially severe infections, such as tuberculosis (Myco- bacterium tuberculosis), community-acquired respiratory infections (Legionella spp., Mycoplasma pneumoniae, Chlamydia pneumoniae) or blood culture-negative endocarditis (Coxiella burnetii, Bartonella spp., Tropheryma whipplei). The objective of this paper is to provide a comprehensive summary of the available and recommended diagnostic tests for the detection of these fastidious organisms in clinical practice.