[(Added) Value of a clinical pharmacist in the oncology department and optimalisation of the applicability of geriatric tools assessing potential inappropriate medication use in geriatric patients (Drug Burden Index and de Beers criteria)]. / Valeur (ajoutée) du pharmacien clinicien dans le service d'oncologie et optimalisation de l'applicabilité d'outils gériatriques évaluant l'utilisation potentiellement inadéquate de médicaments chez les patients gériatriques (Drug Burden Index et critères de Beers).

In a pilot project, the value of a clinical pharmacist in the oncology department is examined. There is special attention given to two clinical pharmaceutical criteria concerning use of potential inappropriate drugs in this population. First of all, the Drug Burden Index (DBI), a measurement of the individual exposure to anticholinergic and sedative drugs. Second of all, the Beers criteria, an explicit criterion of potential inappropriate use of drugs by the geriatric patient. Criteria are adapted for application in Belgian practice. It can be concluded that the clinical pharmacist can be used to support the multidisciplinary approach to cancer patients. The use of the two criteria mentioned above in the estimation of the clinical impact of drugs on functional outcome and cognition on the (oncolgeriatric patient and the correlation with hard endpoints, still need to be investigated.

Multi-detector row computed tomography angiography: an alternative imaging method for surgical strategy in lower extremity arterial occlusive disease.

In order to show the value of CT angiography in the pretherapeutic assessment of lower leg ischemia, we studied 93 CT angiographies in 85 patients. Two groups were defined according to the level of revascularization: 52 angioscanner were made prior to suprainguinal revascularization and 41 prior to infrainguinal reconstruction. Two decision attitudes were chosen by two different physicians, a radiologist and vascular surgeon, members of the same team. The attitudes where then compared in order to evaluate the value of CT angiography. The first attitude was a pragmatic strategy based on the images as interpreted by the first physician and on the intraoperative information including surgical treatment and, if necessary, angiography. This indicates that the results of this attitude cover the performed revascularizations. The second attitude determined a virtual strategy and was chosen by the second physician a posteriori, based solely on the medical file with the same CT angiography images. These two strategies were compared in order to assess the agreement on the level of the lesion and the choice of revascularization. In 84 CT angiographies (90.3%), the analysis of the lesions and the choice of lesions to be treated were identical. In 9.6% of scans the strategies were not comparable because the lesions were interpreted differently or the scans were difficult to read. The sensitivity of CT angiography in detecting lesions and guiding the therapeutic strategy was 96% and its positive predictive value was 93%. Follow-up was reported according to the life-table method to assess the overall outcome and the results in both groups. The overall survival rate at 12 months for 85 patients was 90%. Secondary patency rates at 12 months in the group of patients who underwent a suprainguinal and infrainguinal revascularization were 98% and 71% respectively. Overall limb salvage at 12 months was 94%. In this setting, CT angiography allowed us to select adequate treatment in the majority of cases. These results obtained after a strategy based on CT angiography images are comparable with the results as published in the literature after the strategy based on conventional angiography.

Cutaneous cryptococcosis in corticosteroid-treated patients without AIDS.

Two corticosteroid-treated patients with cutaneous cryptococcal infection are described. One patient had pustulous lesions on the back of his left hand and cellulitis of his left forearm, the other patient had ulcerous lesions of the right forearm and cellulitis of the right lower leg. In both cases diagnosis was suggested by histopathological examination of a biopsy and confirmed by culture. One patient may have had disseminated cryptococcal disease as suggested by a positive cryptococcal capsular antigen test, the other had no evidence of dissemination. Treatment consisted of oral fluconazole for six weeks. One patient died of an unrelated cause after four weeks treatment. Secondary antifungal prophylaxis was not given. Cutaneous cryptococcal infections are described in AIDS patients, but only seldom observed in other immunocompromised patients. Early recognition of the cutaneous lesions is important, as they can be the first sign of disseminated cryptococcosis. Untreated, the mortality of this disease is high. Therapy consists of amphotericin B with or without flucytosine. Fluconazole may be valuable alternative. The optimal treatment regimen and duration are not defined yet. Contrary to AIDS patients with cryptococcal infection, who need life-long secondary antifungal prophylaxis in order to prevent relapses, suppressive treatment is not indicated for immunocompromised non-AIDS patients.

Visual separability: a study on unschooled adults.

It has been suggested in previous studies that unschooled adults present serious difficulties at performing tasks which, like part verification, dimensional filtering, or orientation judgments, require them to pay attention to a specific aspect of the stimulus structure. In the present study we examined the performance of unschooled adults by using a task which does not explicitly require the subjects to attend selectively to a specific component of the stimuli. Separability either of parts or of dimensions as well as line-orientation registration were estimated by the occurrence of illusory conjunctions. Whatever the properties involved in the illusions, these occurred in unschooled adults, at about the same rate as in age-matched schooled controls. The two sets of contrasting findings suggest that a critical variable is whether or not the subjects' attentional control is required. The relevance of the present findings as regards the level of processing responsible for illusory conjunctions is discussed.

[Malaria in the Dunkerque hospital center from December 1979 to December 1990]. / Le paludisme au centre hospitalier de Dunkerque de décembre 1979 à décembre 1990.

Seventy-one cases of malaria were diagnosed in the hospital of Dunkerque from 1979 to 1990. Forty-five patients have been infected in the Comores islands. Among the 24 other imported cases, 17 (71%) have been contaminated in Western or Central Africa. One case of congenital malaria and one of malaria acquired by blood transfusion are also reported. Plasmodium falciparum was detected in 84.5% of the patients. The four human species were found among the Comorians. Two cases with abnormal forms of Plasmodium vivax were observed.

[Iron deficiency in hospitalized infants: study of the incidence of the nutritional factor]. / La carence martiale chez le nourrisson hospitalisé: étude de l'incidence du facteur nutritionnel.

We report an investigation on the iron status of 209 hospitalized 3-month--2-year-old infants over a 6-month period. Hematological parameters and infant feeding practice were determined: a total of 105 infants (50.2%) were found to be iron-depleted, with (24.8%) or without (25.4%) anemia. The mode of lactation appeared to be the main determining factor in iron deficiency, as shown by the fact that during the first months, breast feeding and consumption of an iron-fortified milk formula were 50% less frequent and of shorter duration in infants with iron deficiency than in normal infants. Incorrect diet was also more frequent in iron-deficient infants. It is concluded that iron deficiency in infants could be prevented by better informing mothers in order to encourage breast-feeding and develop the use of an iron-fortified milk formula until the infant reaches the age of one year.

[Atypical forms of Plasmodium vivax. Apropos of a case]. / Les formes atypiques de Plasmodium vivax. A propos d'une observation.

In one case of human malaria imported from Gabon, abnormal forms of Plasmodium vivax are described; severe multiple infections of the host erythrocytes are noticed (up to 6 amoeboid trophozoites in a single red blood cell). Attention is drawn to the numerous morphologically abnormal intra-erythrocytic stages of P. vivax: severe multiple infections of red cells, parasites "ressembling" P. ovale, mature schizonts of small size, with reduced number of merozoites... The geographical distribution of P. vivax in Central Africa is discussed, with reflections on the factors allowing the importation of few P. vivax cases from this area.

[Preferential action of chloroquine on Plasmodium within mature erythrocytes]. / Action préférentielle de la chloroquine sur les Plasmodium hébergés dans des hématies matures.

In vitro studies on the effects of chloroquine on Plasmodium berghei in relation to the age of the host cell made it possible to demonstrate the preferential effect of the drug on parasites growing in mature red blood cells. The ED-50 for parasites in mature red blood cells is lower (1,64 +/- 0,2 mg/kg/day) than in reticulocytes (2,45 +/- 0,2 mg/kg/day). The result of clumping test for chloroquino-sensitive P. berghei growing in young red blood cells, is almost similar as in a chloroquino-resistant strain of the same species. These results are compared with physiological observations on Plasmodium host parasite relationships and bioclinical discrepancies noticed between in vivo chloroquine sensitivity of P. falciparum wild strains versus in vitro testing.

Ultrasound by mouse pups from deaf and hearing strains.

Pups aged 1 to 10 days, of deaf and hearing mouse strains, were monitored with an ultrasound detector while submitted to standard conditions of cold, isolation, and retrieving. The number of detections varied with the age of the pups and with the type of treatment (as established previously) but not with the genotype of the pups. Thus, occurrence and changes with age in ultrasound emission do not seem to be greatly influenced by their effects upon adult behavior.