[Long-term neuropsychological impact of type 1 diabetes in children]. / Impact neuropsychologique à long terme du diabète de type 1 chez l'enfant.

Type 1 diabetes, whose incidence is increasing in the youngest children, could have a long-term neuropsychological impact. Mood disorders are more frequent and some elements of cognitive performance, although within normal ranges, could decrease. In this review, we detail the contribution of animal models to current physiopathological knowledge. We summarize the main clinical studies regarding mood and cognitive performance in diabetic children. Finally, the advantages of imaging in this domain as related to brain development in children are discussed.

[Communicating the results in breast oncology: nonverbal and verbal exchange]. / L'annonce du diagnostic en sénologie: les techniques de communication.

The aim of this paper is to introduce the different modalities of communication to be used in the breast oncology context. Verbal and nonverbal communication are explained. Rewording, synthesis, listening, and silence with empathy during the consultation are processes that facilitate the patient's comprehension of the disease. These models of patient notification should be modulated within the doctor-patient relationship. Meaningful communication improves the comprehension of information, increases patient compliance and satisfaction, and in the short and long term, it allows an adapted psychological adjustment to breast cancer.

[Communicating the results of the BI-RADS categories to patients in senology]. / L'annonce du diagnostic en sénologie: en fonction de la classification BIRAD.

Clinical practice guidelines for psychological care and examples of announcing results are proposed for different categories of Breast Imaging Reporting and Data system (BI-RADS) of the American College of Radiology (ACR). Interpretation and recontextualization are explained for lesions category 2, management of paradox and doubt (probably benign and surveillance) for category 3, acceptance and emotions of patients for the category 4 or 5, psychological distress for the category 6. These models of exchange in doctor-patient relationship have to be modulated and adjusted to the women's profile and attitudes. A meaningful communication is necessary for the comprehension of information, for mammography adherence, for patient satisfactions and in the short and long term, it allows an adapted psychological adjustment for breast cancer.

[Psychological adjustment of stereotactic breast biopsy instrumentation procedures: about 73 cases]. / Le vécu psychologique de la procédure de prélèvements percutanés du sein. Etude quasi prospective à propos de 73 cas.

OBJECTIVE: The aim of the study was to investigate patients' perceptions after stereotactic breast biopsy instrumentation, after both procedure and results. PATIENTS AND METHOD: From 1 March 2002 to 31 March 2003, a questionnaire (Likert response type) on stress was given to 73 patients who had breast biopsies procedures, the first time at the end of the procedure (T1) and then after the histological diagnosis (T2). RESULTS: The questionnaire was validated through analysis of principal component with Varimax rotation. Three factors were identified: procedure, quality of life, information and perception after biopsy. Responses were analysed with Chi-square. Two groups of women were identified, the first group (G1) corresponding to patients with a benign diagnosis (N=32) and the second group (G2) to patients with malignant diagnosis (N=32). Only the "procedure" factor was different at T1 and T2 (P=0.022). Compression was found to be painful: 11% at T1 versus 21% at T2. Women were disturbed by local anesthesia: 26% at T1 versus 21% at T2. Biopsy was painful: 6% at T1 versus 13% at T2. Examination was too long: 24% at T1 versus 35% at T2. The procedure was discomfortable: 52% at T1 versus 54% at T2. Information satisfied patients in 90% cases. There was no statistically significant difference according to procedures and histological disease (P=0.357). DISCUSSION AND CONCLUSION: Information and medical empathy conditioned patients' perceptions. Patients tolerated the procedures well.

[Study on the management of patients following detection of a "probably benign" mammographic abnormality (ACR BI-RADS category 3): a review of 176 radiologists]. / Une étude exploratoire des pratiques et des comportements radiologiques devant la découverte d'une anomalie "probablement bénigne" sur la mammographie: à propos de 176 radiologues.

OBJECTIVES: To evaluate mid-term management of patients with category 3 findings (probably benign, ACR BI-RADS) at mammography three months after a CME course on breast cancer. METHODS: A questionnaire (33 items) was sent to 529 radiologists, three months after the CME course (May-December 2002). The answers were analysed using the chi-square test. RESULTS: A total of 176 radiologists completed the questionnaire; 63 were part of an organized screening mammography program; 162 used the BI-RADS classification. In the presence of a class 3 finding, 158 radiologists recommended short term follow-up, 28 recommended biopsy, 9 upgraded the level of abnormality, 116 consulted another radiologist, 42 consulted an expert mammographer, 36 submitted the case to a multidisciplinary committee and 12 asked for an overread. Management with short term interval follow-up was worrisome to 91 radiologists for fear of unfavorable outcome, and to 47 radiologists because of possible litigation. Twenty-six radiologists had difficulty explaining to patients the need for short term follow-up. The median score for perceived stress by the radiologists was 3 (0=low and 10=high). CONCLUSION: The practices of this sample of French radiologists are consistent with the recommendations presented during the CME course and by the ANAES. They may have some difficulty in communicating with patients the need for follow-up. The ethics of radiology are based on "primum non nocere".

[Psychological adjustment of short interval follow-up mammography: about 50 cases]. / Une étude exploratoire sur le vécu psychologique des femmes lors de la surveillance des anomalies mammographiques probablement bénignes: à propos de 50 cas.

The objective was to investigate women's perceptions and the perceived stress experience when undergoing surveillance mammography for benign lesions (ACR3, BI-RADS). A semi-prospective study was carried out on women with diagnosed "probably benign" breast abnormalities. It was a multicentric study from 1st March to 10th June 2002. The survey was performed at the first follow-up mammography and included questions about perceptions and perceived stress related to the follow-up experience. The response is analysed with chi-square test. Fifty women (35-75 years) answered the questionnaire. All women were satisfied with reception. The mammographies were painful (23 cases). Subsequent time seemed to be too long (seven cases) and they were anxious in 19 cases. Quality of life was spoiled (disturbed) (20 cases). Professional and social perturbations were not frequent (four cases). Speaking to a relative is frequent (39 cases), but patients were not satisfied with it (33 cases). Medical information was estimated (47 cases) but was not satisfactory (36 cases). The median of the stress scale is 4-5. There are two pickaxes, one at 2 (11 cases), the second at 5 (8 cases). "Low-stressed" women could have an avoidance coping. "High-stressed" women could use a helplessness- hopelessness coping strategy. Women reported a good and informative medical support and adequate comprehension of the short follow-up mammography. They were reassured by the medical care, but the evaluation of the stress level shows it to be high, probably due to the uncertainty of diagnosis.