Epidemiology of cutaneous malignant melanoma in Reunion Island.

INTRODUCTION: The incidence of cutaneous malignant melanoma (CMM) is increasing worldwide. The aim of this study was to evaluate the epidemiology of CMM in Reunion Island, a French overseas department whose population is characterized by high ethnic diversity and high exposure to ultraviolet radiation. METHODS: This cross-sectional study examined all cases of in situ CMM and invasive CMM diagnosed between 1 January and 31 December 2015 in the Reunionese population. RESULTS: One hundred and three new cases of CMM were recorded in Reunion Island in 2015: 33 cases of in situ CMM and 70 cases of invasive CMM. The sex ratio of men to women was 1.3 and 80% of patients had a fair skin phototype (Fitzpatrick skin phototype≤III). Age-standardized incidence rates of invasive CMM for all skin phototypes combined were 6.7/100,000 person-years (PY) in women and 5.3/100,000 PY in men. Crude incidence rates of invasive CMM for fair skin phototypes were estimated to be over 21/100,000 PY in women and over 25/100,000 PY in men. CONCLUSIONS: In Reunion Island, the incidence of CMM in the population with fair skin phototype is very high. Primary and secondary prevention measures should be reinforced and tailored to the local context.

[Survival and epidemiological characteristics of women with lung cancer in Reunion]. / Survie et caractéristiques épidémiologiques des femmes atteintes de cancer pulmonaire à La Réunion.

Lung cancer is a common disease throughout the world, representing the main cause of death from cancer. Its incidence in the female population is increasing. In metropolitan France and Reunion Island, the main risk factor remains tobacco smoking. However, environmental, genetic and hormonal factors appear to play a role in bronchial oncogenesis and the survival of affected women is better than that of men. We studied retrospectively the survival and characteristics of a cohort in Reunion Island, diagnosed with lung cancer between January 2017 and December 2018. In total, 501 patients were included over the period including 166 women. The median overall survival was 23 months in women against 11 months in men (P<0.0005). Male sex has been identified as a poor prognostic factor for overall survival (HR=1.338; 95% CI=1.007-1.778) regardless of disease stage. Women smoked less often than men 85.4% of them had adenocarcinoma, with more EGFR mutations than men, and their environmental exposures were lower. The female population of Reunion Island in our study had better overall survival than the men. Smoking status, environmental exposures, histological and molecular characteristics varied by sex.

Epidemiological features of cancers of the oral cavity, oropharynx, hypopharynx and larynx cancer in Réunion Island.

INTRODUCTION: This study had two objectives: firstly, to identify and compare characteristics of cancer of the oral cavity, oropharynx, hypopharynx and larynx in Réunion Island, a tropical French overseas territory in the southern hemisphere; and secondly, to discuss how incidence of these cancers is presented in the international literature. MATERIAL AND METHOD: A retrospective study included 599 patients diagnosed with cancer of the oral cavity, oropharynx, hypopharynx or larynx between 2009 and 2013 in Réunion Island. Demographic characteristics and data on alcohol consumption, smoking habits and HPV infection were analyzed. Standardized incidences were calculated for the worldwide population for both genders. RESULTS: Sex ratio was 7.7 and mean age was 60 years. Cancer consisted of squamous cell carcinoma in 99.1% of patients. Three hundred and forty over 375 patients (81.25%) showed alcohol abuse; 309/359 (86.1%) were smokers; 31/184 (16%) had HPV infection. On the International Agency for Research on Cancer (IARC) anatomic classification, the incidence of "other pharynx" locations was 9.3/100,000 for men and 0.7/100,000 for women, and incidence of "larynx" locations was 6.4/100,000 for men and 0.4/100,000 for women. CONCLUSION: Réunion Island features some particularities in terms of incidence: women are less than half as likely as in Metropolitan France to develop any type of cancer, whereas incidence in males is among highest in France. The presentation of results in cancer registries could be improved in line with everyday practice in head and neck surgery.

[Evaluation of the smoking cessation at the patients of Saint-Denis (Reunion island), over the year 2014]. / Évaluation du sevrage tabagique chez les patients de Saint-Denis de la Réunion sur l'année 2014.

INTRODUCTION: The fight against smoking is a major challenge for public health in Reunion Island. This French overseas department knows considerable social inequalities and so there is a possibility of free access to nicotine substitution among disadvantaged patients. The objective was to describe the social characteristics, the level of addiction to smoking and the actual level of smoking cessation at 18 months of tobacco-smoking patients from Reunion who consulted in 2014. METHODS: It was an observational, retrospective, monocentric study carried out in the addictology service in the teaching hospital in Saint-Denis, Reunion Island. Inclusion of patients over the year 2014 who were mono-dependent on tobacco and who were consulting for the first time in order to give up smoking. RESULTS: 122 patients were included, 51 % of women, of an average age of 47.5 years. The rate of smoking cessation at a year and a half was 23 %. There was no significant difference concerning smoking cessation according to the patient's level of addiction, the educational level, the profession or the level of confidence when stopping. DISCUSSION: The proportion of patients who had given up at a year and a half in our study was comparable to the data found in international literature. The impact of free access to nicotine substitution on smoking cessation could not be estimated.

Incidence and survival of childhood cancer in the French islands of Reunion and Mayotte (2005-2011).

The aim of this study is to describe childhood cancer incidence and survival in the French islands of Reunion and Mayotte for the period 2005-2011. Data were taken from the population-based Cancer Registry of Reunion Island. All incident cases of malignant tumours and benign tumours of the Central Nervous System diagnosed between 2005 and 2011 in children under the age of 15 and living in Reunion or Mayotte were included. A total of 236 cases were registered (176 in Reunion, 60 in Mayotte). Age-standardised incidence rates (ASRs, world standard) for all cancers were 125.0 and 101.8 per million for Reunion and Mayotte, respectively. ASRs for the main cancer groups were lower than those described in mainland France for the same period. The 5-year overall survival rate for all patients was 78.5% (95%CI 71.9- 83.7), slightly lower than that reported in mainland France.

[The Jacquemier's maneuver: An overview of midwives knowledge and practices in a third level maternity hospital]. / La manœuvre de Jacquemier : évaluation des connaissances et des pratiques des sages-femmes d'une maternité de niveau 3.

OBJECTIVES: Shoulder dystocia is an uncommon but serious complication occurring in 0.2 to 3% of deliveries. We carried out a study in order to assess the midwives experience, knowledge and practices on shoulder dystocia, at the maternity hospital of Saint-Denis, Reunion Island. METHODS: The first part is a confidential questionnaire addressed to midwives working in the delivery unit. The second part is a retrospective desk review of shoulders dystocia which occurred from 2004 to 2014. RESULTS: (1) The population was made up of 28 midwives, having between 1 to 27 years of experience. Seventy-five percent of them had been faced with shoulder dystocia, and 62% had realized Jacquemier's maneuver. However, only 25% received this maneuver training. Less than a third of them answered correctly to at least 7 from the 8 theoretical questions about the Jacquemier's maneuver. (2) We studied 34 shoulders dystocia, occurring between 36+5 to 41+2 gestational weeks, mostly with no risk factors found. Mac Roberts' maneuver is used as first-line in 88% of situations. Jacquemier's maneuver is used in 52.9% of cases (5.9% as first-line, 47% as second-line). In 26.4% of situations, the midwife is not able to reduce the dystocia. She usually carries out a combination of maneuvers. The gynecologist is asked only for 23.5% of dystocia and he usually uses Jacquemier's maneuver (70% of situations). CONCLUSION: The Jacquemier's maneuver is rarely practiced (uncommon situation, lack of training). Simulation trainings should be put in place, because neonatal sequels can be avoided.

Penile length is comparable in boys with and without hypospadias.

INTRODUCTION: It has been suggested that penile length is negatively correlated to the degree of hypospadias; however, there are no studies in the literature actually comparing penile length in normal patients and patients with hypospadias. MATERIAL AND METHOD: Between January and May 2011, we measured penile length in two groups of children aged up to 5 years. The first group comprised all boys admitted for hypospadias (40 patients; 25 distal and 15 proximal hypospadias). The control group comprised 100 boys seen for other surgical procedures excluding those with endocrine disorders. We measured the length of the dorsal aspect of the penis in the flaccid state, without stretching. We then established, using our control group, a range of 'normal' values for penile length in our population and determined whether children with hypospadias were within this 'normal' range. RESULTS: Mean penile length in the control group was 4.07 ± 0.92 cm, mean penile length in the hypospadias group was 4.36 ± 0.9 cm (4.48 ± 0.89 cm for distal hypospadias and 4.21 ± 0.79 cm for proximal hypospadias). There was no difference in penile length between the hypospadias group and the control group regardless of degree of hypospadias. CONCLUSION: This study indicates that penile length in children with hypospadias whether proximal or distal is within the normal range.

[Influenza A(H1N1)2009 epidemic in Réunion Island: experience in the out-patient influenza clinic, July-September 2009]. / Épidémie de grippe A(H1N1)2009 à La Réunion: expérience de la consultation ambulatoire dédiée, juillet-septembre 2009.

From July 6 to September 29, 2009, 380 patients were seen as out-patients for flu-like illness, and 355 files (253 women and 102 men) were available for retrospective analysis. Mean age was 32 years. 158 patients, including 22 with A(H1N1)2009 influenza had underlying medical conditions: pregnancy (N = 87), asthma (N = 37), obesity (N = 17). Most frequent symptoms of A(H1N1)2009 influenza patients were fever (97% of the patients), cough (94%), rhinorrhea (59%), myalgia (56%), headache (36%). A nasopharyngeal swab for influenza virus detection by PCR was performed on 118 patients including 27 pregnant women. 44 patients, including 40 A(H1N1)2009 influenza cases were tested positive. 21 patients were referred to the emergency department for further tests or treatment and 31 patients were admitted as in-patients. 20 pregnant women were referred for further obstetrical monitoring; none presented with respiratory failure or foetal distress. None of the patients were admitted to the ICU or died.

[Cluster analysis in geographical epidemiology: the use of several statistical methods and comparison of their results]. / L'analyse de cluster en épidémiologie géographique: utilisation de plusieurs méthodes statistiques et comparaison de leurs résultats.

BACKGROUND: The increasing interest in environmental epidemiology has been followed by the development of many statistical tests for detecting disease clustering near a point source. The objectives of this study were to compare several tests to detect disease clustering, among which modelisation using Markov Chain Monte Carlo methods. METHODS: We compared six statistical methods for detecting disease clustering of bladder cancer around an industrial centre of Isère (France) for the period 1983-1997: Stone's test, score test, and two log-linear modelisations (with and without corrections for extra-Poisson variations) using two ways of parameters estimation (maximum likelihood and Markov Chain Monte Carlo methods). RESULTS: The results of the Stone test and the score test are not in favour of a higher risk of bladder cancer around the considered point source. The conclusions brought by the log linear modelisations are the same, but the results obtained using the Markov Chain Monte Carlo Method are very dependant of prior distributions determined for the different parameters. CONCLUSION: Markov Chain Monte Carlo methods, which allow taking into account complex geographical effects, seem well adapted to cluster analysis in geographical epidemiology. However, they remain difficult to implement.

Pathological prognostic factors in a series of 137 stage I TNM/UICC endometrial carcinomas.

PURPOSE: We report on the long-term results of combination surgery-radiotherapy in cT1 carcinoma of the endometrium according to prognostic factors. PATIENTS AND METHODS: From 1974 to 1993, 130 women suffering from cT1Nx-O Mo endometrial carcinoma, underwent surgical resection. The median age was 62 years. Thirteen received pre-operative irradiation, two pre-operative brachytherapy followed by post-operative external irradiation and 115 patients (88.35%) underwent post-operative irradiation therapy by brachytherapy or external beam irradiation. RESULTS: The median follow-up is 67 months. Overall and specific survival rates for patients with cT1pT1 tumours were 71.1 and 85% at 10 years. For overall survival, lymph node invasion was the most powerful prognostic factor in the multivariate analysis (P = 0.02). If lymph node invasion is not taken into account, the WHO histological grade exerts a significant prognostic impact (P = 0.001). CONCLUSION: For stage cT1 endometrial carcinoma, primary surgery allows radiotherapy to be adjusted according to the WHO histological grade, myometrial invasion and the pelvic lymph node status.

[Current studies of combined radiotherapy-hormone therapy in localized and locally advanced prostatic cancers]. / Données actuelles de l'association radiothérapie-hormonothérapie dans les cancers de la prostate localisés et localement évolués.

In locally advanced prostate cancer three clinical randomized trials have shown that external irradiation combined with LHRH analogue with or without antiandrogen improved survival: disease-free survival, local recurrence-free survival, metastasis-free survival (P < 0.001). EORTC trial 22863 alone has shown a significant improvement of overall survival (P = 0.001), with an LHRH analogue (goserilin acetate, zoladex) started the first day of irradiation and followed every 4 weeks for 3 years; for RTOG trial 85-31 the same LHRH analogue started during the last week of irradiation and given until relapse increases survival of patients with poor differentiated tumours with gleason score ranging from 8 to 10 (P = 0.03). In locally confined prostate carcinoma randomized trials are ongoing to assess the impact of conventional irradiation or three dimensional conformal radiotherapy with or without adjuvant hormonotherapy.

[Prostate cancer in Isère and Tarn (France) between 1985 and 1995: evolution of therapeutic indications]. / Le cancer de la prostate dans les départements de l'Isère et du Tarn entre 1985 et 1995: évolution des indications thérapeutiques.

The objective is to describe the evolution of therapeutic practices of prostate carcinoma in the departements of Tarn and Isère in France for the 1985-1995 period. This retrospective study is based on patient folders for whom a prostate carcinoma has been diagnosed between 1985 and 1995. A sample of 871 patients have been included after randomisation stratified on the year and the department of the diagnostic in the files of the cancer registries of Tarn and Isère. Therapeutic practices of the prostate cancer have significantly evolved between 1985 and 1989. The rate of radical prostatectomies increased from 1986 whereas the rate of radiotherapy remained stable. This evolution has been made to the detriment of non curative treatments with the decrease of the rate of hormonotherapies. This is due to the important development of diagnostic technics which led to an earlier diagnostic of these cancers; but, the evolution of therapeutic technics and particularly of the radical prostatectomy allowed the evolution of indications for the treatment of this cancer, with the increase of the rate of radical prostatectomies and the decrease of the rate of radiotherapies at the same stage of disease evolution. For 1990 to 1995, there was no major evolution. Some indications are discussed in this disease touching old man, with a slow evolution.

Evaluation of prescription-writing quality in a French university hospital.

OBJECTIVE: To evaluate the quality of prescription writing at a university hospital in France. DESIGN/PATIENTS: Each of the 42 medical, surgical, and intensive-care departments were invited to participate in the study. The initial medication orders were reviewed for 866 patients, resulting in 3,254 medications prescribed. One prescription per patient was reviewed for a total of 866 patients, presenting 3,254 medications. RESULTS: Of the 866 prescriptions reviewed, 95.5% were dated. Patient identification was complete in 35.3%. The prescriber was identified properly by both full name and signature in 7.5% of prescriptions. Medication information was complete in only 24% of cases. CONCLUSION: This study showed that prescriptions were not written correctly. Results of this study have been disseminated, and education has begun on proper prescription practice.

[Pulmonary scintigraphy in the diagnosis of pulmonary embolism]. / La scintigraphie pulmonaire dans le diagnostic d'embolie pulmonaire.

Venous thromboembolism (VTE) and pulmonary (PE) are difficult to diagnose. Pulmonary scintigraphy is a key investigation in the diagnosis of PE due to its innocuity and high sensitivity. A complete examination requires analysis of ventilation and perfusion (with at least four different views). The sensitivity of the method is excellent and a normal perfusion pulmonary scintigraphy excludes the diagnosis (10-15% of cases). On the other hand, the specificity is not nearly as good as only 10 to 15% of scintigraphies show changes which make the diagnosis of PE certain. In about 2 out of 3 cases, pulmonary scintigraphy alone is not decisional and only allows an estimation of the probability of PE this investigation must be integrated in the diagnostic strategy based on the "a priori" clinical probability, non invasive venous exploration and, in second intention, pulmonary angiography. The authors report the diagnostic strategy defined in Grenoble University hospital after multidisciplinary concertration. An evaluation in 103 patients with suspected PE showed a divergence from this diagnostic protocol in 38% of cases. However, when the protocol is respected, a therapeutic decision can be taken in 73% of cases based on clinical assessment scintigraphy and Doppler ultrasonography. Therefore, the diffusion and observance of these diagnostic strategies should be improved. In these conditions, pulmonary scintigraphy plays an essential role in the diagnosis of PE. The necessity of a control pulmonary scintigraphy and the value of systematic scintigraphy in the presence of proximal venous thrombosis are also discussed.