Arthrite rhumatoide traitée par noréthynodrel associée à mestranol: Aspects cliniques et tests de laboratoire

A cause de l''effet favorable de la grossesse sur l''activité de l''arthrite rhumatoïde, on s''est demandé si une pseudo-grossesse, produite par un progestatif de synthèse n''entraînerait pas une rémission du moins partielle de cette maladie.Noréthynodrel associée à mestranol (Enovid), 30 mg./jour, a été administrée à 44 femmes pendant quatre à 24 mois. A cause d''effets secondaires indésirables, 11 patientes furent soustraites de l''investigation. Les résultats s''appuient sur 33 cas. Une rémission apparente complète s''est manifestée chez sept patientes aux stades précoces de la maladie; chez 15, une amélioration objective des signes inflammatoires a été observée; chez quatre, une amélioration subjective seule a été notée; chez sept, il n''y a eu aucune amélioration. Dix-sept femmes sur 36 ont présenté une altération d''un ou plusieurs tests hépatiques. Trois présentèrent un ictère cholestatique. Les 17-OH plasmatiques se sont élevés à trois ou quatre fois la normale.De cette étude il ressort que noréthynodrel associée à mestranol peut produire une atténuation des signes inflammatoires de l''arthrite rhumatoïde. L''effet est palliatif, mitigé et non curatif et ne résulte pas nécessairement de l''état de pseudo-grossesse en soi.     

Older Russian emigrés and medical care.

Although emigration from the former Soviet Union is dramatically increasing nationwide, little information has been reported on the medical problems of these emigrés. For older emigrés in particular, the medical realities of aging, in combination with cultural expectations, make the United States'' medical system an arena where the stresses of emigration are expressed and help is sought. We describe the influences of culture and aging on older emigrés'' health and interaction with the American medical system. A qualitative, exploratory study was done of problems and issues in health care use by older Russian emigrés at the ambulatory medical clinic of Mount Zion Medical Center, San Francisco. Cultural expectations and beliefs about health, adaptive health behaviors learned in the former Soviet Union, the stresses of emigration, and the medical realities of aging can result in serious problems in the care and treatment of older Russian emigrés. Recommended solutions include educating emigrés and health care professionals, integrating mental health services into the primary care setting, and expanding supportive services in the community such as adult day health care.     

Sézary's syndrome and generalized plane xanthoma.

The first case of Sézary''s syndrome associated with generalized plane xanthoma is reported, thereby extending the association of lymphoreticular proliferative disorders with plane xanthomatosis. The association of Sézary''s syndrome with plane xanthomatosis may be an in vivo example of defective cell regulation involving the major cellular components of the immune response.     

Research of a holiday kind: One giant leap for mankind? A cost-utility analysis of abolishing the law of gravity

Background

Canada''s Neo Rhino Party, a joke political party created in 2006 as a successor to the Parti Rhinocéros, is planning a new regulation to repeal the law of gravity, which could have an important impact on diseases attributable to gravity on earth.

Methods

We sought to estimate the number of quality-adjusted life-years that would be saved if the proposed regulation is passed and determine the cost-effectiveness of adapting Boris Volfson''s antigravity machine¹ for use on earth. We performed an economic analysis using a hidden Markov model.

Results

Our results suggest that a microgravity environment would save over 2 million quality-adjusted life-years. The cost for every quality-adjusted life-year saved is estimated to be $328.

Interpretation

Microgravity is the solution to the health care crisis in Canada. In addition, using technological, statistical and medical jargon gives us the opportunity to defy the laws of physics, mathematics and medicine.Canada''s Neo Rhino Party is a joke federal political party that was created in Montréal, Quebec, in 2006 as the successor to the Parti Rhinocéros. Commonly called the Rhinoceros Party in English, this party was a registered political party in Canada from the 1960s to the 1990s. It was founded in 1963 by Jacques Ferron, a Canadian physician and author. The party''s basic credo was “a promise to keep none of our promises.” Its election platforms comprised impossible schemes that were designed to amuse and entertain the voting public. Some Rhinoceros Party promises included reducing the speed of light because it''s much too fast, paving Manitoba to create the world''s largest parking lot, providing higher education by building taller schools and repealing the law of gravity. When this last promise was made in the 1980s, it was unthinkable, that is, until Boris Volfson of Huntington, Indiana, received US Patent 6 960 975 for his design of an antigravity machine.¹ The Neo Rhino Party is currently planning a new regulation to repeal the law of gravity that could have an important impact on diseases and other health outcomes attributable to gravity on earth.     

Le lymphosarcome folliculaire: La maladie de Brill-Symmers

From a survey of the literature on follicular lymphoma it appears that the lesion of Brill-Symmers disease may be considered to be a form of neoplasm. The authors have reviewed a series of 18 cases seen at the Hôtel-Dieu of Québec between 1950 and 1960 and have adopted Rappaport''s classification published in 1956, but leaving out the “Hodgkin” Type 5 which they propose to examine more fully in another paper.There appears to be a degree of positive correlation between the histologic type and the course of the disease, the well differentiated cell Type 1 being associated with a protracted course. This neoplasm should not be mistaken for benign follicular hyperplasia.     

CMA's CEO re-elected chair of World Medical Association's ethics committee

The CMA secretary general, Dr. Léo-Paul Landry, has been re-elected chair of the World Medical Association''s (WMA) Medical Ethics Committee. During an April meeting, the committee approved documents dealing with reductions in the number of embryos and the care of patients with mental illness. The author says a steady increase in WMA membership is a sign of physicians'' belief in the importance of the association''s representational function.     

A revision of the shore-fly genus Hydrochasma Hendel (Diptera,Ephydridae)

A revision of the shore-fly genus Hydrochasma Hendel. The species of the genus Hydrochasma Hendel are revised, including 27 new species (type locality in parenthesis): H. andeum (Ecuador. Guayas: Boliche (02°07.7''S, 79°35.5''W)), H. annae (United States. Utah. Grand: Swasey Beach (15.3 km N Green River; 39°07''N, 110°06.6''W; Green River; 1255 m)), H. capsum (Ecuador. Orellana: RíoTiputini (0°38.2''S, 76°8.9''W)), H. castilloi (Ecuador. Loja: Catamayo (03°59''S, 79°21''W)), H. crenulum (Peru. Cuzco: Paucartambo, Atalaya (Río Alto Madre de Dios; 12°53.3''S, 71°21.6''W; 600 m)), H. denticum (Ecuador. Orellana: Río Tiputini (0°38.2''S, 76°8.9''W)), H. digitatum (Peru. Madre de Dios: Diamante (Río Alto Madre de Dios; 12°19.9''S, 70°57.5''W; 400 m)), H. distinctum (Costa Rica. Limón: Parque Nacional Barbilla, Sector Casas Negras, (10°0.8''N, 83°28.1''W; 300 m)), H. dolabrutum (Dominican Republic. Barahona: Barahona (18°12''N, 71°5.3''W)), H. edmistoni (Dominican Republic. Azua: near Pueblo Viejo (18°24.8''N, 70°44.7''W)), H. falcatum (Peru. Madre de Dios: Río Manu, Erika (near Salvación; 12°50.7''S, 71°23.3''W; 550 m)), H. glochium (Dominican Republic. Peravia: San José Ocoa (10 km NE; 18°35''N, 70°25.6''W)), H. kaieteur (Guyana. Kaieteur Falls (05°10.5''N, 59°26.9''W)), H. lineatum (Trinidad and Tobago. Trinidad. St. George: Filette (1 km SE; 10°47''N, 61°21''W)), H. miguelito (Honduras. Cortés: San Pedro Sula (8 km S; 15°25.7''N, 88°01.4''W)), H. octogonum (Ecuador. Manabí: Pichincha (01°02.7''S, 79°49.2''W)), H. parallelum (Trinidad and Tobago. Trinidad. St. Andrew: Lower Manzanilla (16 km S; 10°22''N, 61°01''W)), H. peniculum (Dominican Republic. Pedernales: Pedernales (18°01.8''N, 71°44.7''W)), H. rictum (Honduras. Cortés: San Pedro Sula (8 km S; 15°25.7''N, 88°01.4''W)), H. robustum (Brazil. São Paulo. Ubatuba, Praia Puruba (23°21''S, 44°55.6''W; beach)), H. sagittarium (Trinidad and Tobago. Tobago: St. John: Parlatuvier (creek; 11°17.9''N, 60°35''W)), H. simplicum (Costa Rica. Limón: Parque Nacional Barbilla, Sector Casas Negras, (10°01.2''N, 83°26.2''W; 300 m)), H. sinuatum (Belize. Stann Creek: Mullins Creek (17 km N Dangriga; 17°06.2''N, 88°17.8''W)), H. spinosum (Costa Rica. Limón: Westfalia (4 km S; 09°54.5''N, 82°59''W; beach)), H. urnulum (Dominican Republic. Puerto Plata: Río Camu (14 km E Puerto Plata; 19°41.9''N, 70°37.5''W)), H. viridum (Guyana. Karanambo, Rupununi River (ox bow; 03°45.1''N, 59°18.6''W)), H. williamsae (Belize. Stann Creek: Mullins River (17 km N Dangriga; 17°06.2''N, 88°17.8''W)). All known species are described with an emphasis on structures of the male terminalia, which are fully illustrated. Detailed locality data and distribution maps for all species are provided. A lectotype is designated for Discocerina incisum Coquillett and Hydrochasma zernyi Hendel. For perspective and to facilitate genus-group and species-group recognition, the tribe Discocerinini is diagnosed and a key to included genera in the New World is provided.     

Stereotaxic Device for Optical Imaging of Mice Hind Feet

Imaging of in vivo model systems, especially mouse models, has revolutionized our understanding of normal and pathological developments. However, mice present several challenges for imaging. They are living and therefore breathing organisms with a fast heart rate (>500 beat/min), which necessitates the need for restraints and positioning controls that do not compromise their normal physiology. We present here a device that immobilizes the rear legs of a mouse while retaining the ability to position both the hind feet and legs for reproducible imaging deep below the skin''s surface. The device is highly adjustable to accommodate mice, 5 weeks of age and older. The function of this device is demonstrated by imaging the vasculature ∼250 μm beneath the skin in the hind leg. Whereas the overall dimensions are for a motorized stage (Märzhäuser Wetzlar GmbH, Wetzlar, Germany), minor modifications would allow it to be customized for use with most commercially available stages that accept an insert.     

Heated Relations: Temperature-Mediated Shifts in Consumption across Trophic Levels

A rise in temperature will intensify the feeding links involving ectotherms in food webs. However, it is unclear how the effects will quantitatively differ between the plant-herbivore and herbivore-carnivore interface. To test how warming could differentially affect rates of herbivory and carnivory, we studied trophic interaction strength in a food chain comprised of green algae, herbivorous rotifers and carnivorous rotifers at 10, 15, 20 and 25°C. We found significant warming-induced changes in feeding by both herbivorous and carnivorous rotifers, but these responses occurred at different parts of the entire temperature gradient. The strongest response of the per capita herbivore''s ingestion rate occurred due to an increase in temperature from 15 to 20°C (1.9 fold: from 834 to 1611 algal cells per h⁻¹) and of the per capita carnivore''s ingestion rate from 20 to 25°C (1.6 fold: from 1.5 to 2.5 prey h⁻¹). Handling time, an important component of a consumer''s functional response, significantly decreased from 15 to 20°C in herbivorous rotifers. In contrast, it decreased from 20 to 25°C in carnivorous rotifers. Attack rates significantly and strongly increased from 10 to 25°C in the herbivorous animals, but not at all in the carnivores. Our results exemplify how the relative forces of top-down control exerted by herbivores and carnivores may strongly shift under global warming. But warming, and its magnitude, are not the only issue: If our results would prove to be representative, shifts in ectotherm interactions will quantitatively differ when a 5°C increase starts out from a low, intermediate or high initial temperature. This would imply that warming could have different effects on the relative forces of carnivory and herbivory in habitats differing in average temperature, as would exist at different altitudes and latitudes.     

Hope for Haiti?

Haiti, one of the world''s five poorest nations, gets international attention because of the number of refugees who leave by boat in search of a better future. The 80,000 inhabitants of Ile de la Gonave are neglected, even in Haiti--there is no government medical post, and facilities in the health posts run by missions are minimal. Typhoid and cholera epidemics threaten the island. Médecins Sans Frontières plans to send staff and supplies and train local health workers.     

Fat Embolism in Patients with Fractured Hips

Fat embolism was assessed at necropsy and correlated with clinical findings in the patients who died among 854 with fractured hips admitted to hospital between 1967 and August 1971. Sixteen cases of clinical importance were found, eight of which were judged to have been fatal or to have seriously contributed to death. Frequencies were as follows: 2·4 to 3·3% among 424 patients with subcapital fractures; 0·7 to 0·8% in the 405 with trochanteric fractures; 4·1 to 7% among subjects treated without operation, representing 30% of those who died within seven days; and 0·9 to 1·1% among patients treated by pinning, nailing, or nail-plating. The higher frequency in the conservatively treated group is probably related to selection of poor-risk subjects. Fat embolism was found in 6·8 to 8·0% of those with subcapital fractures treated by primary Thompson''s arthroplasty which utilizes acrylic cement, and in none of those given Moore''s prostheses for which cement is not used. Study of a larger group after Moore''s prosthesis is required to establish its lack of special risk. Fat embolism accounted for all the deaths within seven days of Thompson''s arthroplasty and for most within 14 days; it was clearly related to surgery in some cases.A possible explanation of the hazard of Thompson''s arthroplasty is that fat globule entry is enhanced by a rise of intramedullary pressure due to proximal occlusion of the reamed marrow cavity. A controlled trial of the effect of venting the marrow cavity on the frequency of fat embolism is warranted. It is possible that the acrylic monomer may also contribute to venous entry of medullary fat. The higher-age group of those with subcapital fractures and associated chronic cardiac and pulmonary disease might make them more susceptible to fat embolization than those in whom arthroplasty is also carried out for chronic hip disease.     

Potential Cost-Effectiveness of a New Infant Tuberculosis Vaccine in South Africa - Implications for Clinical Trials: A Decision Analysis

Novel tuberculosis vaccines are in varying stages of pre-clinical and clinical development. This study seeks to estimate the potential cost-effectiveness of a BCG booster vaccine, while accounting for costs of large-scale clinical trials, using the MVA85A vaccine as a case study for estimating potential costs. We conducted a decision analysis from the societal perspective, using a 10-year time frame and a 3% discount rate. We predicted active tuberculosis cases and tuberculosis-related costs for a hypothetical cohort of 960,763 South African newborns (total born in 2009). We compared neonatal vaccination with bacille Calmette-Guérin alone to vaccination with bacille Calmette-Guérin plus a booster vaccine at 4 months. We considered booster efficacy estimates ranging from 40% to 70%, relative to bacille Calmette-Guérin alone. We accounted for the costs of Phase III clinical trials. The booster vaccine was assumed to prevent progression to active tuberculosis after childhood infection, with protection decreasing linearly over 10 years. Trial costs were prorated to South Africa''s global share of bacille Calmette-Guérin vaccination. Vaccination with bacille Calmette-Guérin alone resulted in estimated tuberculosis-related costs of $89.91 million 2012 USD, and 13,610 tuberculosis cases in the birth cohort, over the 10 years. Addition of the booster resulted in estimated cost savings of $7.69–$16.68 million USD, and 2,800–4,160 cases averted, for assumed efficacy values ranging from 40%–70%. A booster tuberculosis vaccine in infancy may result in net societal cost savings as well as fewer active tuberculosis cases, even if efficacy is relatively modest and large scale Phase III studies are required.     

Immune complexes in Beh?et's syndrome and recurrent oral ulceration.

Seventeen patients with Behçet''s syndrome, 11 with recurrent oral ulceration, and eight controls were studied in an investigation of the part possibly played by immune complexes in the transition from focal oral ulceration to the multifocal syndrome. Changes in the distribution of C3 within the first peak of Sephadex G200 fractionated plasma were found in nine of the 17 patients with Behçet''s syndrome (55%), three of the 11 patients with recurrent oral ulcers, and none of eight controls. These findings provide indirect evidence that immune complexes are found in the plasma of these patients. Immune complexes were more common in patients with the neuro-ocular type of Behçet''s syndrome than in those with the mucocutaneous type, and in those with herpetiform ulcers than in those with major or minor aphthous ulcers. Immune complexes were also associated with active disease. These findings support the hypothesis that the formation of immune complexes is an important step in the pathogenesis of Behçet''s syndrome.     

Malignant Lymphomas of Waldeyer's Ring: Natural History and Survival after Radiotherapy

The natural history of 292 consecutive cases of reticulum cell sarcoma and lymphosarcoma of Waldeyer''s ring and the survival rate after radiotherapy are reported. In our institute since 1928 from 30 to 35% of pharyngeal neoplasms have been lymphomas, and of these 55% have been reticulum cell sarcomas, 21% lymphosarcomas, and 1% Hodgkin''s disease. This high incidence may probably be ascribed to the fact that in all malignant lymphomas, irrespective of the clinical presentation, a systematic biopsy of the whole Waldeyer''s ring was carried out. Pharyngeal lymphomas were confined to Waldeyer''s ring in 19·6% of cases, with initial spread to contiguous cervical nodes in 43·8%, to distant nodes in 24·2%, and to extranodal tissues in 12·4%. Lymphography showed abnormal retroperitoneal lymph nodes in 38·3% of cases. There was gastrointestinal involvement either initially or later in 17·6% of cases. High-energy radiation therapy to both sides of the neck was the treatment of choice for local and regional disease. It achieved a five-year survival rate of 41·9% in the group of 97 patients treated during the past decade. The incidence of relapse (recurrence and new manifestations) was highest in the first year after treatment.     

Evaluation of haemodynamics by cardiac catheterisation: historical perspective and present practice

In 1956, three men were awarded the Nobel Prize in Physiology or Medicine, in particular ''for their discoveries concerning heart catheterisation and pathological changes in the circulatory system''. Their names in alphabetical order: André F. Cournand, Werner Forssmann and Dickinson W. Richards. Forssmann''s experiment dated from 1929, while Cournand and Richards started their work in 1941. The order in which they presented their Nobel lectures on 11 December 1956 was Forssmann, Richards, Cournand.     

Recent Advances in the Treatment of Deafness

By the utilization of reconstructive procedures (tympanoplasty), middle ear and mastoid infections can be eliminated with the acquisition of a clean, dry ear in about nine out of 10 cases, and hearing can be improved in about half of the patients so treated. Incapacitating attacks of Ménière''s disease can be successfully treated in selected cases by labyrinthectomy, ultrasound destruction of the vestibular system, or streptomycin treatment. With the advent of the transistor, improved power packs and miniaturization, hearing aids have become more acceptable to patients with sensorineural hearing losses. The most successful procedure for the management of otosclerosis is the stapedectomy operation.     

Autistic autobiography

Autism narratives are not just stories or histories, describing a given reality. They are creating the language in which to describe the experience of autism, and hence helping to forge the concepts in which to think autism. This paper focuses on a series of autobiographies that began with Grandin''s Emergence. These are often said to show us autism from the ‘inside’. The paper proposes that instead they are developing ways to describe experience for which there is little pre-existing language. Wittgenstein has many well-known aphorisms about how we understand other people directly, without inference. They condense what he had found in Wolfgang Köhler''s Gestalt Psychology. These phenomena of direct understanding what other people are doing are, Köhler wrote, ‘the common property and practice of mankind''. They are not the common property and practice of people with autism. Ordinary language is rich in age-old ways to describe what others are thinking, feeling and so forth. Köhler''s phenomena are the bedrock on which such language rests. There is no such discourse for autism, because Köhler''s phenomena are absent. But a new discourse is being made up right now, i.e. ways of talking for which the autobiographies serve as working prototypes.