Endosonographic features of unicentric Castleman Disease.

BACKGROUND: Castleman disease (CD) is a rare lymphoproliferative disorder most frequently occurring in the mediastinum. Peripancreatic forms are less frequent. Few cases of endoscopic ultrasonography-fine-needle aspiration (EUS-FNA) findings of this lesion have been reported, where no real-time tissue elastography (RTTE) has been described in the literature to our knowledge. METHODS: We describe the endosonographic, elastographic, cytologic and immunocytochemistry findings in two cases of unicentric CD of the hyaline vascular variant. RESULTS: Two females, aged 41 and 34 year were referred to our hospital for further EUS evaluation of a peripancreatic mass found incidentally on computed tomography. EUS examination revealed around, well-demarcated, uniformly hypoechoic mass measuring 52 and 23 mm respectively, with smaller adjacent hypoechoic lymph nodes. Doppler examination revealed intense peripheral vascularity, together with prominent penetrating feeding vessels entering a distinct hilum. RTTE revealed a relatively homogenous soft elastographic pattern. EUS-FNA provided smears with clusters of lymphocytes in a hemorrhagic background. Cell block preparation showed immature lymphocytes surrounding lymphocyte-poor centers with vascular proliferation. Immunohistochemical staining of the cell block sections showed CD45-leukocyte common antigen, CD20, CD23, CD79a, Bcl-2 and CD5 positivity in small lymphocytes. Cytology was suggestive of non-Hodgkin's lymphoma. Surgical excision was performed in both cases and histopathology was consistent with CD of the hyaline vascular type. CONCLUSION: The echo features of a solitary hypoechoic homogenous well-demarcated mass with prominent vasculature and increased elasticity should raise the possibility of unicentric CD. EUS-FNA usually cannot make a definitive distinction from certain kinds of lymphoma.

French adolescent attitudes towards informal care for physical and emotional or relational problems.

UNLABELLED: The objective of this study was to determine adolescents' attitudes concerning the use of self-care and traditional medicines. A self-administered anonymous questionnaire with open-ended questions was completed by 543 adolescents aged 15-19 y. The results showed that the most frequent self-care activity for general health problems, in more than three-quarters of them, was self-medication; 14% of them resorted to minor home treatment such as taking care of wounds, bandaging or massages. Instructions for use were mentioned by 69% of adolescents as a way of choosing self-prescribed drugs. Natural medicines were used by 32% of the girls and 23% of the boys, mainly herbal teas or plant-based medicines, followed by homoeopathy. Self-care for emotional and relational problems mainly involved thinking about the problem and questioning themselves about their own behaviour or about the way they are. They also mentioned activities such as sports, going out, listening to music, watching television, and trying to think about something else by keeping themselves occupied. Natural medicines were used by 19% of the girls and 13% of the boys. Plant-based medicines or herbal teas were used most often, followed by drugs or alcohol, with homoeopathy in third place. CONCLUSION: Self-care and alternative medicines were used by adolescents in this study for physical as well as for emotional or relational problems. Their use did not reflect dissatisfaction with physicians and hospital treatment or an objection to formal services, but rather was a choice of these approaches for their own specific characteristics. They were also viewed as being less harmful than conventional treatment.

[Attitudes regarding the delivery of formal and informal care: comparison of French and Chilean adolescents]. / Attitudes à l'égard des soins formels et informels: comparaison d'adolescents français et chiliens.

The representations that youth have of health professionals and young people's demands in terms of the operation and administration of services create an original and complex problematic. Clearly, this originality implies the important differences from one culture to another. For this very reason, it seemed that a comparative study relating the representations and attitudes confronted when care is sought by young people from countries with different cultural contexts would assist in comprehending why adolescents have such particular ways of using--or not using--formal and self-administered health services. An original open-ended response questionnaire was jointly designed and validated by a French and Chilean team. A mutually agreed upon sample of 957 school children, adolescents aged from 14 to 19, participated in the study in France and in Chili. The following correlations were found. In the event of a sleeping problem (or other general worry that is physically manifested), the mother is the privileged confidant, and in the specific case of a relationship or emotional problem, it is usually one of the adolescents' friends. The general practitioner is the favoured professional person in the event of a purely physical problem. When confronted with an emotional problem, one-third of adolescents say that they would not consider going to a consultation. The expectations of the French toward health professionals are more often within the "emotional" arena than those of the Chileans which generally concern the "medical/technical" field. The practice of self-administered care is qualitatively similar but the French prefer taking medication whereas the Chileans prefer the "little home remedies". The use of natural medicine is more widespread among young Chileans, but the types of medicine used are similar, namely herbal teas and other plant-based remedies and homeopathy. These results have a variety of implications, especially in terms of the need for training health professionals in the consideration of emotional and relationship problems. It is desirable that the official health care sector considers the care delivered outside of it as being complementary resources, which respond to the adolescents' need for autonomy, and then integrate those contributions into its own area of financial responsibility.

[Use of formal and informal health services by adolescents: cross-cultural study technics]. / Utilisation des services de santé formels et informels par les adolescents: méthode d'une étude transculturelle.

A cross-cultural study, in Chile and in France, has been held in order to compare care utilisation strategies used by teenagers and youths in two different contexts: self-administered cares, family cares, official or non-official professional cares. It has been decided to use a questionnaire with open-answers for collecting data on views and practices. Tool building and validation process, realised with both French and Chilean teams, has enabled to work with an original questionnaire, with good reproducibility of answers and very good acceptability. This tool can be used in other cultural contexts.

Mesothelial cyst complicated by torsion: preoperative imaging evaluation.

The diagnosis mesothelial cyst is infrequently made pre-operatively, because of the relative rarity of this lesion as a cause of distinct abdominal complaints and a lack of definitive diagnostic tests. A case of a mesothelial cyst complicated by ileal torsion evaluated preoperatively by various imaging modalities, including plain radiographs, ultrasound, computed tomography and enteroclysis studies is presented. It was shown that appearances on enteroclysis significant aided the differential diagnosis, by preoperatively defining the cause of clinical presentation and the extent and degree of the intestinal involvement.