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PubMed1997

Comparative diagnostic accuracy of magnetic resonance imaging and immunoscintigraphy for detection of bone marrow involvement in patients with malignant lymphoma.

PURPOSE: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) and immunoscintigraphy (IS) for detection of bone marrow infiltration in malignant lymphoma. PATIENTS AND METHODS: In 32 patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL), MRI of the axial skeleton and whole-body IS using technetium-99m (99mTc)-labeled monoclonal antibodies were reviewed and compared with iliac crest biopsies. Criterion for marrow infiltration was a positive biopsy or concordant positive results of MRI and IS. RESULTS: In 16 patients (50%), MRI, IS, and iliac crest biopsies were negative for marrow infiltration. Iliac crest biopsy showed infiltration in only four patients (13%). Infiltration was missed in two of 32 patients with IS and in one patient with MRI. In one additional patient, MRI was false-positive because of pelvic hematopoietic hyperplasia. A subset of nine patients (28%) with negative biopsies had bone marrow involvement according to MRI and IS with identical location and pattern of infiltration. In eight of these nine patients, diagnostic imaging indicated marrow involvement only in noncrest marrow. Subsequent biopsy confirmed infiltration in five patients. The clinical course suggested true-positive imaging results in the remaining four patients. Two patients (6%) remained equivocal. Overall concordance of MRI and IS for marrow infiltration was 88% (28 of 32 patients). CONCLUSION: Diagnostic imaging is essential for optimal staging in malignant lymphoma, as blind biopsies appear to have low sensitivity for bone marrow infiltration because of frequent involvement in noncrest marrow. both imaging modalities show a high rate of detection of bone marrow infiltration.

Adolescent↗
PubMed2005

Troponin as a marker of myocardiac damage in drug-induced cardiotoxicity.

Cardiac troponins T and I (cTnT and cTnI) are becoming the serum biomarkers of choice for monitoring potential drug-induced myocardial injury in both clinical and preclinical studies. The utility of cardiac troponins has been mainly demonstrated following the administration of antineoplastic drugs and beta-sympathomimetics, although the routine use of these markers in the monitoring in patients who received anthracyclines therapy is far from settled. Unlike the previous markers, which suffered from numerous shortages, the main advantages of cardiac troponins are their high specificity and sensitivity, wide diagnostic window and the possibility to use commercially available assays in clinical settings as well as in a broad range of laboratory animals. Nevertheless, in spite of vigorous research in this area, a number of questions are still unanswered and these are discussed in this review. The main problems seem to be the lack of standardisation of variety of troponin immunoassays, the assessment of suitable cutoff for drug-induced cardiotoxicity and determination of critical diagnostic window related to the optimal timing of sample collection, which may be drug-dependent.

Drug Evaluation, Preclinical↗
PubMed2003

Role of ADME characteristics in drug discovery and their in silico evaluation: in silico screening of chemicals for their metabolic stability.

Drug discovery is a long, arduous process broadly grouped into disease target identification, target validation, high-throughput identification of "hits" and "leads", lead optimization, and pre-clinical and clinical evaluation. Each area is a vast discipline in itself. However, all but the first two stages involve, to varying degrees, the characterization of absorption, distribution, metabolism, excretion, (ADME), and toxicity (T) of the molecules being pursued as potential drug candidates. Clinical failures of about 50% of the Investigational New Drug (IND) filings are attributed to their inadequate ADMET attributes. It is, therefore, no surprise that, in the current climate of social and regulatory pressure on healthcare costs, the pharmaceutical industry is searching for any means to minimize this attrition. Building mathematical models, called in silico screens, to reliably predict ADMET attributes solely from molecular structure is at the heart of this effort in reducing costs as well as development cycle times. This article reviews the emerging field of in silico evaluation of ADME characteristics. For different approaches that have been employed in this area, a critique of the scope and limitations of their descriptors, statistical methods, and reliability are presented. For instance, are geometry-based descriptors absolutely essential or is lower-level structure quantification equally good? What advantages, if any, do we have for methods like artificial neural networks over the least squares optimization methods with rigorous statistical diagnostics? Is any in silico screen worth application, let alone interpretation, if it is not adequately validated? Once deemed acceptable, what good is an in silico screen if it cannot be made available at the workbench of drug discovery teams distributed across the globe throughout multi-national pharmaceutical companies? These are not mere discussion points, rather this article embarks on the stepwise mechanics of developing a successful in silico screen. The process is exemplified by our efforts in developing one such screen for predicting metabolic stability of chemicals in a human S9 liver homogenate assay. A real-life use of this in silico screen in a variety of discovery projects at GlaxoSmithKline is presented, highlighting successes and limitations of such applications. Finally, we project some capabilities of in silico ADME tools for greater impact and contribution to successful, efficient drug discovery.

Computer-Aided Design↗
PubMed1995

Mental health care practices and educational needs of general practitioners.

OBJECTIVES: To describe current mental health care practices of general practitioners and to identify their educational priorities and training preferences. METHOD: Self-administered questionnaire to a stratified random sample of New South Wales general practitioners. SUBJECTS: 721 full-time general practitioners, of whom 534 (74%) responded. RESULTS: Mental health problems recognised by general practitioners at least once per week were psychosomatic (93%), emotional (89%), addiction (79%), social/economic (71%) and family (69%). At least two-thirds recognised sexual problems, sexual abuse and major psychiatric problems less frequently than once per week. Sixty-four per cent of general practitioners reported that patients felt uncomfortable about being referred to psychiatrists; 53% that referral service waiting lists were too long; 51% that there were insufficient local mental health services; and 25% that communication difficulties between referring general practitioners and mental health specialists obstructed optimal care. Educational priorities were diagnostic and counselling skills, with particular emphasis on crisis, family, individual and marital counselling and strategies to prevent general practitioner burn-out. CONCLUSIONS: General practitioners are interested in improving their mental health counselling and diagnostic skills but barriers remain. Both structural and educational initiatives are essential to enhance the quality of mental health care in general practice.

Adolescent↗
PubMed2006

Effect of Doppler angle in diagnosis of internal carotid artery stenosis.

OBJECTIVE: The purpose of this study was to compare velocity measurements obtained with 2 fixed insonation angles and to investigate whether there is a difference in their ability in determining internal carotid artery (ICA) stenosis. METHODS: Eighty-seven patients with ICA stenosis were examined with color duplex ultrasonography. Velocity measurements were made at 60 degrees and 45 degrees insonation angles, and they were compared with Bland-Altman and receiver operating characteristic curve analysis. RESULTS: Peak systolic velocity (PSV) and end-diastolic velocity measurements obtained at the 60 degrees insonation angle were higher compared with those obtained at the 45 degrees insonation angle (24.2% and 24.7%, respectively). The ICA-to-common carotid artery PSV ratio, conversely, was slightly higher (3.9%). Although the threshold values for the same velocity parameters obtained at 2 different insonation angles were different, the accuracy ratios (sensitivity and specificity) were not. With application of the Society of Radiologists in Ultrasound consensus criteria to the data obtained at either of the 2 insonation angles, the accuracy ratios of PSV and end-diastolic velocity were found to be statistically different. In the ICA-to-common carotid artery PSV ratio, however, there were no statistically significant differences in the accuracy ratios. CONCLUSIONS: Doppler velocity measurements made at different fixed insonation angles show considerable differences. In determining ICA stenosis, although optimal thresholds are different, the diagnostic performance is not different. In determining ICA stenosis with color duplex ultrasonography, angle-specific thresholds must be determined, and examinations must be made at a fixed angle.

Adult↗
PubMedDate not supplied

Receiver-operating characteristic (ROC) curve analysis of cathepsin D and pS2 in breast disease; results from a prospective study.

The cytosol values of estrogen-regulated proteins cathepsin D and pS2 were evaluated in 166 patients with breast diseases by a receiver-operating characteristic (ROC) curve analysis. Our aim was to compare their diagnostic accuracy and to define optimal cut-off levels for the cytosol values of these proteins in breast cancer (n = 133). The preoperative mean cytosol cathepsin D values in the breast cancer group were higher than in patients with benign breast disease (p < 0.001). The correlation coefficient (Pearson's r) between Cathepsin D and pS2 measurements was 0.286 (p < 0.001) in breast cancer patients. The ROC analysis indicated that the cathepsin D test was more sensitive than the pS2 test at all specificity levels, and the cathepsin D test reached considerably high sensitivity (86%) at the specificity level of 80%. According to present study, it would seem optimal to use the cut-off level of 33.0 pmol/mg for cathepsin D analysis and the level of 31.0 ng/mg for pS2 in breast cancer. In conclusion, the results of ROC curve analysis suggest that the cathepsin D test has advantage over pS2 because of its higher sensitivity in breast cancer.

Adolescent↗
PubMed2000

Chest pain in the emergency room. Importance of a systematic approach.

OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74% of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12%) had AMI without ST segment elevation and 202 (31%) had unstable angina (UA). In route 2 (high probability of ACS) 17% of patients had AMI and 43% had UA, whereas in route 3 (low probability) 2% had AMI and 7 % had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI ( 49%), with a positive predictive value considered only satisfactory (79%). CONCLUSION: A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.

Journal Article↗
PubMed2000

Chest pain in the emergency room. Importance of a systematic approach

OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74% of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12%) had AMI without ST segment elevation and 202 (31%) had unstable angina (UA). In route 2 (high probability of ACS) 17% of patients had AMI and 43% had UA, whereas in route 3 (low probability) 2% had AMI and 7% had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI (49%), with a positive predictive value considered only satisfactory (79%). CONCLUSION: A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.

Journal Article↗
PubMed2000

Chest pain in the emergency room. Importance of a systematic approach.

OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a preestablished process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74% of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12%) had AMI without ST segment elevation and 202 (31%) had unstable angina (UA). In route 2 (high probability of ACS) 17% of patients had AMI and 43% had UA, whereas in route 3 (low probability) 2% had AMI and 7% had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI (49%), with a positive predictive value considered only satisfactory (79%). CONCLUSION: A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.

Aged↗
PubMed1999

Soft tissue sarcoma.

Soft tissue sarcomas comprise approximately 1% of all adult malignancies. These mesenchymal neoplasms require carefully planned diagnostic and therapeutic strategies to optimize postextirpative functional preservation. Soft tissue sarcomas most frequently occur in the lower extremity and typically require a multidisciplinary team approach with surgical resection, radiation therapy, and possibly chemotherapy for limb salvage.

Adult↗
PubMed2001

[Antiphospholipid antibodies in digestive diseases].

DIAGNOSIS AND PROGNOSIS: Antiphospholipids comprise a very heterogeneous group of auto-antibodies including anticardiolipids demonstrated by immunological methods and lupus anticoagulants detected by coagulation tests. Antiphospholipids are encountered in various conditions other than dysimmune disease and are frequently involved in thrombotic manifestations. We discuss here the implications of these antibodies in digestive tract diseases and present an analysis of their diagnostic and prognostic value for optimal therapeutic and monitoring approaches. CLINICAL MANIFESTATIONS: The risk of thrombosis is high in patients with cryptogenetic inflammatory bowel disease. The prevalence of antiphospholipid antibodies (AcAPL) is abnormally high in these patients, but their contribution to the development of thrombosis remains controversial. Patients with liver disease generally exhibit coagulation disorders, with paradoxical thrombotic manifestations. AcAPL are strongly implicated in the development of thrombosis, particularly in patients with alcoholic liver disease, hepatitis C, regenerative nodular hyperplasia, and cirrhosis, independently of the presence of an associated hepatocellular carcinoma. Antiphospholipid syndrome is considered to be the second leading cause of non-tumor-related Budd-Chiari syndrome, after myeproliferative syndromes. Likewise for portal or mesenteric vein thrombosis where antiphospholipid antibodies would be involved in the causal mechanism. UNDERLYING MECHANISMS: Due to the diversity of these antibodies, it is unlikely that a unique mechanism could explain all the different thrombotic manifestations associated with their presence.

Adult↗
PubMed2002

Lymph node staging in extracranial head and neck cancer with FDG PET--appropriate uptake period and size-dependence of the results.

AIM: Identification of a rationale for the appropriate uptake period for static clinical extracranial head and neck PET imaging and evaluation of the diagnostic accuracy of such an optimized FDG PET approach for lymph node staging in the head and neck region. METHODS: In a subset of 5 patients, kinetic tumour studies were performed in order to identify the cellular activity plateau phase of FDG accumulation for head and neck cancer. Seventy-eight consecutive patients (11 women, 67 men; mean age +/- SD: 55 +/- 11 years; range, 36-78 years), presenting with histologically proven squamous cell carcinoma and sonographically detected lymph nodes in 86 neck sides, underwent clinically indicated FDG PET imaging. PET results were compared to those derived from histological examinations and follow-up imaging results after 6 months in order to calculate sensitivity and specificity for lymph node staging. RESULTS: FDG kinetics in head and neck cancer indicate that the cellular activity plateau of FDG accumulation is reached after an uptake period of 90 min. Using this protocol metastatic involvement of neck sides with lymph nodes less than 1 cm in diameter was correctly identified with a sensitivity of 71.4% and a specificity of 92.3%. Sensitivity increased with the lymph node diameter (1.1-1.5 cm 83.3%, 1.6-2.0 cm 100%, > 2 cm 88.9%). CONCLUSION: The appropriate uptake period for static clinical extracranial head and neck PET imaging that allows measurements in the activity plateau phase is about 90 min. FDG PET may add some significant information regarding metastatic spread into regional lymph nodes.

Adult↗
PubMed2002

[Severe falciparum malaria treated with exchange transfusion].

BACKGROUND: Acute severe malaria can be seen at any Norwegian hospital. The prognosis of this serious disease depends on rapid and effective treatment. MATERIAL AND METHODS: Two case reports of patients treated with exchange transfusions are presented. RESULTS: Two young Norwegian women travelled without adequate prophylaxis against malaria in South-East Asia and Central and Southern Africa respectively. A few days after leaving the endemic areas they got high fever, joint and muscular pain, and headache. In one of the patients the symptoms were interpreted as flu symptoms; one week later the patient was admitted to hospital suffering from severe malaria. The other patient was admitted to hospital on the day she returned to Norway, six days after getting febrile. Thin blood films showed Plasmodium falciparum, with 30% and 40-50% parasitaemia respectively. Both patients were icteric with thrombocytopenia and increased creatinine. The first patient had severe renal failure and signs of cerebral affection. She was treated with haemodialysis and exchange transfusions. The other patient was treated with exchange transfusions because of her high parasitaemia. Both patients made a complete recovery and were discharged after three and two weeks. INTERPRETATION: Severe falciparum malaria is a condition with high case-fatality if diagnostics and treatment is not optimal. In especially severe cases, exchange transfusion may be lifesaving.

Adult↗
PubMedDate not supplied

Ultrafast MR imaging of the foetus: a study of 25 non-central nervous system anomalies.

PURPOSE: The aim of this paper is to suggest Magnetic Resonance (MR) Imaging as a useful tool in prenatal diagnosis. Although ultrasonography (US) is the imaging technique of choice for prenatal screening, in cases of complex malformations US findings may be sub-optimal and give rise to diagnostic difficulties requiring further investigation. Our study is focused on non-central nervous system (CNS) abnormalities of the foetus imaged using the ultrafast sequence EXPRESS. MATERIALS AND METHODS: 38 women whose foetuses were between 21-34 gestational age were studied. Indications for the examinations included the evaluation of non-CNS abnormalities in 25 cases. Foetal MR imaging was performed on a 1.5 T system (Edge, Marconi Medical System Italia SpA, Vimercate, MI) with the half-Fourier, single-shot, fast spin-echo EXPRESS sequence. Mild maternal and foetal sedation was obtained by oral administration of benzodiazepine (1 mg). RESULTS: In the 25 foetuses investigated for non-CNS pathologies the abnormalities were localised in the chest (9), abdomen (15) and extremities (1). The MR imaging diagnoses were: in the chest - congenital diaphragmatic hernia (CDH) (5), congenital cystic adenomatoid malformation (CCAM) (1), hydrothorax (1), cystic lymphangioma (1), Jeune syndrome (1); in the abdomen - 10 cases of urinary tract diseases - polycystic kidney (4), crossed renal ectopia (2), unilateral renal agenesis (1), solitary pelvic kidney (1), bilateral stenosis of ureteropelvic junction (1), duplex collecting system in association with controlateral hydroureteronephrosis (1)#151;5 cases of non-urinary tract pathologies#151;cystic lymphangioma of the liver (1), abdominal cystic lymphangioma (1), gastroschisis (1), gastric duplication (1), cavernous haemangioma of the liver (1); in the extremities - longitudinal hemimelia (1). CONCLUSIONS: In our experience MR is to be considered a useful though adjunct study to prenatal US particularly in the evaluation of lung parenchyma, congenital diaphragmatic viscera herniation, thoracic masses, pleural effusion, abdominal cystic masses, and urinary tract malformations. The ultrafast EXPRESS sequence enables a complete study to be performed in a very short time; as a consequence the examination is well tolerated by the patient. Currently there is no legislation which regulates the use of magnetic fields in MR, only a series of recommendations based on studies on animal embryos and foetuses, on pregnant women exposed to magnetic fields and follow-up studies of children exposed to MR during gestation. Therefore the decision to proceed with foetal MR should be made on a case-by-case basis in close consultation with the referring obstetrician. Considering the results, in our opinion the potential of MR in the evaluation of a wide variety of non-CNS foetal diseases will increase in the near future.

Adult↗
PubMed2002

[Estimation of head-up tilt test in diagnosis of syncope of unknown origin. Can we come up with better results?].

UNLABELLED: Optimal conditions in assessment of diagnostic head-up tilt test (TT) value required classification, which identified reactions with syncope and discreet disturbance of consciousness. The aim of the study was to assess of usefulness TT in diagnosis of syncope of unknown origin investigated by classification, which take into consideration vasovagal and nonvasovagal types of neurocardiogenic reactions. We studied 218 pts (115M, 103F), mean age 39.7 +/- 16.1 and 35.2 +/- 17.7 years (adequately for male and female), with 2 or more syncope on unknown origin in last 6 months. Control group was 84 healthy volunteers (43M, 41F), mean age 37.41 +/- 2.6 years, range 18 to 73 years, with no syncope in anamnesis. All patients and controls underwent a TT in Westminster protocol. In case of negative TT, we performed next 20 min TT with 0.25 mg NTG sublinqualis (TT with NTG). Type of vasovagal syncope was defined according to American Experts Classification described in official guidelines of American College of Cardiology (ACC). In the case of vasovagal syncope, detailed specification of syncope was performed according to VASIS classification (the vasovagal Syncope International Study). Passive TT was positive in 51 (23%) pts. In control group passive TT was positive in 6 (7%) pts. TT with NTG generates syncope in additional 99 (45%) pts resulting in number of diagnosed group to 150 (68%) pts. In control group TT with NTG was positive in additional 21 (25%) pts. False positive TT with NTG was diagnosed in 19 (9%) pts in study group and 11 (13%) in control group. Subpopulation of study group with vasovagal syncope was larger than subpopulation with other, nonvasovagal type of reaction (108 vs. 23; p < 0.0001). Taking into consideration this dual types of reaction (vaso- and nonvasovagal) allowed to reveal that there were no statistical significance between sex, age, type of syncope provocation and defined types of vasovagal reactions. ACC classification in comparison to VASIS criteria, was more sensitive (60% vs. 49%), have better diagnostic value to positive (89% vs. 84%) and negative (44% vs. 39%) result of TT and accuracy of diagnosis (66% vs. 47%) with slightly worse specificity of TT (81% vs. 83%). CONCLUSIONS: 1. TT results assessment according to ACC classification is more sensitive and almost the same specificity method in diagnosing patients with syncope of unknown origin than VASIS classification. 2. Improvement in diagnostic values of TT concerns passive TT and NTG TT. 3. Nonvasovagal types of reaction of cardiovascular system to orthostatic stress defined in ACC classification are, as the symptomatically syncope, significant clinical indicator of vegetative system instability.

Adult↗
PubMed2004

[Stress echocardiography].

BACKGROUND: In stress echocardiography, ischaemia is detected as wall motion abnormalities. The test can be done both with exercise (which is the more sensitive) and pharmacological stress (which is more specific). MATERIAL AND METHODS: The paper gives an overview of the method, of diagnostic and prognostic value as well as indications and contraindications, based on present literature. RESULTS AND INTERPRETATION: The sensitivity is 80-90%, specificity 75-100%, dependent on the extent and degree of disease. A negative test predicts a low cardiac event rate of about 1% per year and a low preoperative cardiac risk. The diagnostic accuracy is dependent on optimal equipment quality and on the experience of the examiner. Without specific training, sensitivity is about the same as with exercise ECG. The complication rate is low, dependent on the type of stress. Stress echocardiography is useful in patients unable to exercise, in preoperative risk assessment and in suspected false-negative exercise ECG. In addition it is a supplement to coronary angiography for evaluation of the significance of intermediate stenoses, to identify culprit lesion and for viability detection. Finally, it is useful in aortic stenosis with reduced left ventricular function for evaluation of stenosis and contractile reserve.

Contraindications↗
PubMedDate not supplied

[Malaria diagnosis and treatment in a rural Health Centre in Mayotte (Comoro archipelago, 2002)].

With a marked increase in both morbidity and mortality, as well as a high level of resistance to chloroquine (CQ), malaria is once again a major public health problem in Mayotte, a French overseas territory in the Comoro archipelago. The object of this study is to assess the contribution in the field of two new antimalarial fight steps taken in 2001-2002: The use of the rapid diagnostic test (RDT) for malaria OptiMAL in the rural health centres and the drop of the CQ alone for the simultaneous administration of CQ and sulfadoxine-pyrimethamine (SP) as the first-line treatment for uncomplicated malaria. All 581 suspected malaria attacks, diagnosed by RDT during the year 2002 in a rural health centre of the island, were registered. The good positive predictive value of the RDT used (97.2%) calculated during the study has permitted an important reduction of the rate of wrongly administer antimalarial treatment. Before RDT was used, through lack of emergency microscopic diagnosis, the antimalarial treatment was presumptive in the isolated health centres and that rate was superior to 90%. It is now below 3%. Before the introduction of the new protocol, in the middle of the year 2002, the rate of therapeutic failures with CQ used alone was 40.2% (33/82). With the simultaneous administration of CQ and SP as a first-line treatment, this rate fell down to 1.8% (6/337). For the time being, this new treatment policy is acceptable in Mayotte. But the experience of the countries who have adopted this therapeutic policy shows that the effectiveness of the association CQ-SP is likely to be temporary. It is necessary to set up a "durable long-term" therapy strategy in Mayotte as soon as possible by adopting as first-line treatment for uncomplicated malaria a combination therapy according to the recommendations of the World Health Organization. It could be the artemether-lumefantrine combination which has already been the subject of an efficacy survey in the island.

Adolescent↗
PubMed2006

[Clinico-morpho-ultrasonographical characteristics of large uterine leiomyoma in females during late reproductive and premenopausal period].

The transvaginal and abdominal ultrasound examination is an effective method of defining the internal multinodular structure of large uterine leiomyoma. Ultrasonic Dopplerography allows us to evaluate uterine internal pattern and the blood flow in the patients with large uterine leiomyoma. The incidence of leiomyoma was the same in late reproductive and premenopausal uteri, although the average number of leiomyoma and the average size of the largest leiomyoma were higher in the premenopausal women. The correlation of the morphological and preoperational results of the ultrasound examination of 21 female with large uteral leiomyoma has been carried out. It has been found that the echographic picture of the nodules is defined by the combinations of the various components possessing the properties of hypoechogeneity (necrosis and the edema of the fibrous structures). Different variants of leiomyoma clinical course in the patients are of interest. The conformity of the echographic picture of large leiomyoma and their morphological structure were revealed at the examination of all the types have made up 94%. The data obtained allowed us to optimize the complex of the diagnostic investigations necessary for revealing proliferative process.

Female↗