[How are palliative care needs estimated in short-stay establishments? Apropos of an experience in Côte d'Or]. / Comment estimer les besoins en soins palliatifs dans les établissements de court séjour? A propos d'une expérience en Côte d'Or.

The evaluation of needs and means concerning the care of patients in palliative treatment is among the problems seen as priority by the High Committee for Public Health. We have thus tried to characterise, in a specific health sector, the patients receiving palliative care in short-stay establishments in order to evaluate their care needs. We carried out an exhaustive descriptive survey among all public and private short-stay establishments in the Côte d'Or region. Of the 2116 patients in the hospital on the day of the survey, roughly 30% were considered as eligible for palliative care (patients suffering from serious, chronic and progressive illnesses). The average age of these patients is 63.9 years (standard deviation 19.7). They mainly suffer from tumours (50%), circulatory pathologies (15%), mental illness (7%), or neurological illnesses (6%). Among the patients that may need palliative care, 38% say they feel pain despite treatment with pain-killers among 25.3% of them. The personnel providing care is insufficiently trained in palliative care or in pain, as only a maximum of 18% of nurses and 5% of doctors in short-stay establishments have been trained in these areas.

[What alternatives to rectal temperature recording with a mercury thermometer?]. / Quelles alternatives à la prise rectale de la température avec un thermomètre à mercure?

Fever is a major symptom to characterize individual health status. Measurement of temperature is systematically made in everyday medical practice. In France, this measurement is generally assumed with a rectal glass mercury thermometer. In order to protect people and the environment, the "Conseil Supérieur d'Hygiène Publique de France" has approved recommendations to withdrawn medical use of mercury, specifically for thermometer. Rectal measurement is also debated since infectious risks are described. Thus, substitution of rectal glass mercury thermometer is on the agenda. New sites and techniques for measurement of temperature have been studied through a literature review, interview of experts and companies, and clinical research protocols. Cutaneous and axillary measurements are inaccurate and unsatisfactory. Two methods seems to be worth: oral measurement and tympanic measurement. Oral measurement is widespread in the world. This technique has some limits. Tympanic measurement is a new method in progress without these limits. Whatever the choice of the technique is, the substitution of rectal glass mercury thermometer requires training and awareness of staff and patients.

Bone marrow necrosis and human parvovirus associated infection preceding an Ph1+ acute lymphoblastic leukemia.

A case of bone marrow necrosis associated with a serologically documented recent Parvovirus B 19 infection which preceded the development of PH1+ acute lymphoblastic leukemia is reported. No conclusions can be drawn on the basis of a single case but the question of the role of human Parvovirus B19 in the pathogenesis of bone marrow necrosis is discussed. It is suggested that the virus may act as a co-factor for the induction of bone marrow necrosis, in some cases.

[Emergency management of abnormalities of preoperative blood coagulation tests]. / Conduite à tenir en urgence devant une anomalie du bilan d'hémostase préopératoire.

Usual coagulation tests--Platelet count, Prothrombin Time (PT), Activated Partial Thromboplastine Time (APTT)--detect most of coagulation abnormalities in preoperative situation. Emergency surgery remains possible without bleeding in most cases. Patient history of haemostatic responses is absolutely necessary to know in addition to coagulation tests. Platelets transfusion may often be avoid in thrombocytopenic patients with platelet count higher than 50,000 mm3. The PT and/or APTT perturbations need further laboratory investigations to estimate the bleeding risk which is not constant. The correction of an antithrombotic treatment is usually easy except for drugs which inhibit platelet aggregation.

Haematopoietic malignancies in Côte d'Or (France): a population based study.

A registry of haematopoietic malignancies was established on January 1, 1980 in order to accurately determine the incidence and epidemiological features of these diseases in the department of Côte d'Or (population 478,000). Over five years (1980-1984), 704 new cases were recorded. The crude incidence rates were 32.7 per 100,000 for males and 24.9 per 100,000 for females. The corresponding age standardized rates were 26.4 and 16.7. The sex ratio was 1.6:1. In males, chronic lymphocytic leukaemias were the most common haematopoietic malignancies, followed by non Hodgkin's lymphomas, acute leukaemias and multiple myelomas. In females, multiple myelomas and acute leukaemias preceded non Hodgkin's lymphomas and chronic lymphocytic leukaemias. For men and women, the risk of haematopoietic malignancies was higher in urban areas than in rural areas. Compared to population based registries in other countries, incidence rates are among the highest reported and are particularly high for chronic lymphocytic leukaemia.

In vitro culture of spleen hairy cells.

In vitro culture of hairy cells were successful in 5 patients with hairy cell leukemia: splenic cells were cultured in methyl cellulose plus PHA-leucocyte conditioned stimulation medium for 7 days. Plating efficiency was 0.5% with colony cells having morphological and cytochemical characteristics of hairy cells. A linear correlation between the number of cells plated and the number of colonies produced was found for cell concentrations varying from 5.10(4) to 5.10(5).

[Antifactor VIII antibody in Rosai-Dorfman disease]. / Anticorps antifacteur VIII au cours d'une maladie de Rosai-Dorfman.

The case of a 72 year-old man with a sinus histiocytosis is reported. The clinical course was characterised by an hemorrhagic disorder linked to a factor VIII inhibitor. The characteristics of the antibody titer, affinity and saturability have been studied. In an attempt to stop the bleeding treatment included human and porcine factor VIII concentrates, plasmapheresis and immunosuppressive drugs. Repeated plasma exchanges did not modify the inhibitor titer for more than 24 h.

[Establishing a registry of malignant hemopathies in Côte-d'Or. Preliminary results]. / Mise en place d'un registre des hémopathies malignes en Côte-d'Or. Premiers résultats.

A registry of malignant haematological diseases was established on January 1st 1980 in order to assess the incidence and epidemiologic features of these diseases in the department of Côte-d'Or (population 470 000). Information was collected from various sources (public or private laboratories, public or private hospitals and death certificates). During the course of two years (1980 and 1981) 194 news cases were recorded. This registry collects acute leukaemia, lymphoid and myeloid proliferative diseases, lymphomas in leukaemic phase and myelodysplastic syndromes. The crude incidence rates were 25.0/100,000 in men and 16.1/100,000 in women. Sex ratio : 1.5. Compared to other French population based registries the incidence is higher in Côte-d'Or, showing the value of specialised registries. The rates are similar to those reported in Geneva and Connecticut.

Analysis of human genital warts (condylomata acuminata) and other genital tumors for human papillomavirus type 6 DNA.

32P-labelled cloned HPV 6 DNA was used as probe to analyze human genital tumors for DNA sequences homologous to HPV 6 DNA. Ninety three percent of all condylomata acuminata (41 out of 44) were found to harbor HPV 6 DNA. Of the remaining three, one contained HPV 1 DNA. No papillomavirus DNA was identified in the two other tumors. All three invasively growing giant condylomata acuminata (Buschke-Löwenstein tumors) investigated also contained HPV 6 DNA. Two out of six atypical condylomata of the cervix hybridized with HPV 6 DNA under stringent conditions, one only under conditions of low stringency. All DNA preparations from malignant tumors studies (54 cervical carcinomas, 10 penile carcinomas, two vulvar carcinomas) failed to anneal with HPV 6 DNA, even under conditions of low stringency. Although all HPV 6-positive condylomata acuminata analyzed in this study revealed HPV 6 DNA of regular molecular weight (5.1 x 10(6)), two of the Buschke-Löwenstein tumors, as well as one of the two positive atypical condylomata of the cervix, contained HPV 6 DNA with a remarkable size classes occurred in a supercoiled form without evidence for integration into host cell DNA.