[Recommendations for writing patient information statements]. / Recommandations pour la rédaction de notices d'information pour les patients.

With Evidence-Based Medicine, shared decision making is attracting considerable interest as a means by which patient preferences can be incorporated into clinical decisions. Patients cannot express informed preferences unless they are given sufficient and appropriate information, including a detailed explanation concerning their condition, the different therapeutic options and the likely outcomes with and without treatment. A patient education leaflet is a potentially powerful tool for communicating information to patients, who will be able to participate in the process of decision making. The present article is a review of available guides for the writing of patient information materials. It also includes criteria for evaluating their quality.

[Selection of EBM resources on the internet]. / Sélection de ressources EBM sur l'Internet.

To integrate Evidence-Based Medicine (EBM) into practice, the physician has access to a number of resources on the Internet. They belong to two distinct groups: tools intended for EBM learning and EBM syntheses prepared by different international organizations. The present article presents the main EBM resources on the network and comments on them. These information are also available on the URL site: http:www.ebm.lib.ulg.ac.be/prostate/link_ebm .htm.

[How to practically solve diagnostic or therapeutic problems in an EMB process?]. / Comment résoudre en pratique un problème diagnostique ou thérapeutique en suivant une démarche EBM?

Evidence-Based Medicine (EBM) can be defined as the use of best current evidence from clinical research in making decisions about the care of individual patients. It consists of a process of turning clinical problems into questions and then locating the best available evidence to answer them, critically appraising the evidence for its validity and usefulness, and applying the findings to clinical practice. The present article presents the EBM principles and their application to diagnostic and therapeutic questions. Further detailed information on Evidence-Based Medicine is presented at the URL address: http:¿www.ebm.lib.ulg.ac.be/prostate/ebm.+ ++htm.

[Problem-based learning, description of a pedagogical method leading to evidence-based medicine]. / Le Problem-Based Learning, description d'une pédagogie conduisant à la médecine factuelle.

Problem-Based Learning is an educational method which uses health care scenarios to provide a context for learning and to elaborate knowledge through discussion. Additional expectations are to stimulate critical thinking and problem-solving skills, and to develop clinical reasoning taking into account the patient's psychosocial environment and preferences, the economic requirements as well as the best evidence from biomedical research. Appearing at the end of the 60's, it has been adopted by 10% of medical schools world-wide. PBL follows the same rules as Evidence-Based Medicine but is student-centered and provides the information-seeking skills necessary for self-directed life long learning. In this short article, we review the theoretical basis and process of PBL, emphasizing the teacher-student relationship and discussing the suggested advantages and disadvantages of this curriculum. Students in PBL programs make greater use of self-selected references and online searching. From this point of view, PBL strengthens the role of health libraries in medical education, and prepares the future physician for Evidence-Based Medicine.

[Atherosclerotic pathology of the aortic arch and cerebrovascular accidents]. / Pathologie athéroscléreuse de la crosse aortique et accidents vasculaires cérébraux.

Over the last 10 years, transoesophageal echocardiography has allowed the visualisation of the particularly frequent atheromatous involvement of the initial part of the aorta in patients suffering from cerebral as well as peripheral embolism. Recent studies have shown that atherosclerosis of the initial, precarotid, part of the aorta is both a marker of general as well as coronary atherosclerosis and an important, accident independent risk factor of recurrence of stroke. The therapy of these aortic lesions is still currently under debate and there are no published guidelines about this issue in the literature. We therefore have applied the Evidence-Based Medicine information gathering method described earlier in this journal in order to better define the best therapeutic approach of this type of pathology.

[Pancreatic adenocarcinoma: role of pathologic anatomy]. / Adénocarcinome pancréatique: rôle de l'anatomie pathologique.

Duct cell adenocarcinoma is by far the most frequent neoplasm of the pancreas, accounting for about 80% of malignant tumors. In this report, we describe the main diagnostic pitfalls of this cancer in routine or frozen sections, as well as the help of immunohistology to make the differential diagnosis. We also discuss the potential interest of tumor markers for evaluating the prognosis of these tumors and provide information about the creation of a Web site (URL: http://www.ebm.lib.ulg.ac.be/index.htm) created to help clinicians exploit the laboratory results.

[Prognostic evaluation of human solid tumors by immunohistology]. / Evaluation pronostique des tumeurs solides humaines par immunohistologie.

The aim of this project is to evaluate the interest of new tumor markers in the most frequent solid tumors (breast, colon, prostatic cancers, ...). For each of these tumors, potential prognostic markers have been selected according to the literature and an immunohistologic technique has been developed to analyse them. We will first discuss the role of pathology in oncology, then briefly describe the analyzed markers and finally give information about a Web site (URL: http:/(/)www.ebm. lib.ulg.ac.be/index.htm) created to help clinicians exploit the laboratory results.

Detection of human papillomaviruses in paraffin-embedded biopsies of cervical intraepithelial lesions: analysis by immunohistochemistry, in situ hybridization, and the polymerase chain reaction.

One hundred and forty biopsies with an initial diagnosis of cervical intraepithelial lesion (CIL) were tested for the presence of human papillomavirus (HPV) by immunohistochemistry and in situ hybridization using commercial biotinylated probes (Vira-Type in situ assay; Digene Diagnostics, Silver Spring, MD) or probes labeled with digoxigenin by the random primer technique. Immunohistochemistry was more inferior to the in situ hybridization method, with a detection rate of 14% (20/140) compared to 61% (86/140) for the in situ assay with the digoxigenin-labeled probes. Biotinylated probes proved to be slightly less sensitive than digoxigenin-labeled probes, with a detection rate of 53% (74/140). Although less sensitive in our series taken as a whole, immunohistochemistry was positive in a few cases of CILs negative by in situ hybridization, so that the association of these techniques gave the highest detection rate (66%; 92/140). The CILs that remained negative with these methods (34%; 48/140) were investigated by the polymerase chain reaction (PCR) using consensus primers to determine definitively the presence of HPV in these lesions and were reviewed histologically to assess the diagnosis of CILs. The PCR method increased the detection rate of HPV in our series to 76% (107/140). The diagnosis of CILs was confirmed for all the biopsy specimens positive by PCR (15/15; 100%) and for all the HPV negative tissues with histological features of a high-grade lesions (7/7; 100%).(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of c-erbB2, TGF-beta 1 and pS2 genes in primary human breast cancers.

The presence of c-erbB2, TGF-beta 1 and pS2 mRNAs was examined in primary breast tumours. The c-erbB2 mRNA was overexpressed in 34% of the tumours. There was a positive, statistically significant correlation between c-erbB2 gene overexpression and nodal status. TGF-beta 1 mRNA was detected in 84% of the tumours, regardless of their clinical status. When possible, the c-erbB2 and TGF-beta 1 proteins were identified immunohistochemically on frozen sections from the same tumours. For TGF-beta 1, the mRNA and immunohistochemical results were divergent in 6 cases, 5 of which did contain clearly detectable mRNA but did not stain with the antibody. The pS2 mRNA was detected in 22% of the tumours and in the BT474 cell line. There was a significant correlation between the presence of pS2 mRNA and of oestrogen receptors. No statistically significant correlation was observed between pS2 and TGF-beta 1 genes expression and the clinical parameters of the tumours.

Stimulatory effect of oestradiol-17 beta and tamoxifen on gross cystic disease fluid protein 15,000 production and mRNA levels in T47D human breast cancer cells.

Oestradiol-17 beta and tamoxifen regulate the synthesis of a gross cystic disease fluid protein (GCDFP-15) in T47D human breast cancer cells. Dose-response curves of GCDFP-15 mRNA contents and GCDFP-15 levels in culture media and cells versus hormone or antihormone concentration have been established. Production of GCDFP-15 was increased by oestradiol-17 beta, tamoxifen and 4-OH tamoxifen. The effect of tamoxifen and 4-OH tamoxifen was greater than the effect of oestradiol-17 beta. Moreover, oestradiol-17 beta and 4-OH tamoxifen acted synergystically in enhancing GCDFP-15 release. The strong oestrogenic effect of the antioestrogen tamoxifen in regulating GCDFP-15 may reflect an unusual interaction between the tamoxifen-oestrogen receptor complex and the DNA oestrogen-responsive elements. As oestrogen control of GCDFP-15 depends also on the cell line studied, investigation of GCDFP-15 could extend our knowledge of the possible mechanism of action of oestrogens or antioestrogens.

Cellular events in radiation-induced lymphomagenesis.

Fractionated whole-body irradiation induces thymic lymphomas in most of treated C57Bl/Ka mice. The cellular events occurring during the latency period consist of the emergence of preleukaemic cells and of marked alterations to the T-cell lineage and the microenvironment within the thymus. The proportions of the various thymocyte subsets are modified, suggesting a blockage in the normal differentiation process. Thymic epithelial cells are functionally modified, leading to decreased interactions with immature thymocytes. Interestingly, bone marrow grafting early after irradiation, which inhibits the development of lymphomas, induces the disappearance of preleukaemic cells from the thymus, whereas thymocyte subpopulations and thymic epithelium are restored. Interferon gamma and tumor necrosis factor alpha also prevent the onset of lymphomas. Studies on the effect of bone marrow transplantation and cytokine inoculation in split-dose irradiated mice should allow characterization of the factors that modulate the progression of preleukaemic cells towards the neoplastic state.

Cellular aspects of the pathogenesis of radiation--induced thymic lymphomas in C57 BL mice (review).

Radiation-induced thymic lymphomas in C57Bl/Ka mice are interesting models for studying the successive steps of carcinogenesis. Irradiation initiates "preleukemic" cells, which are promoted to become neoplastic. Studies in mice in which lymphoma development is inhibited by a bone marrow transplantation after irradiation suggest that radiation--induced alterations to the T cell lineage, and particularly to thymic microenvironment, are critical for the promotion of preleukemic cells. It is proposed that the lack of physiological differentiation signals within the thymus, as a result of irradiation, allows these cells to escape the normal controls of thymocyte production and pushes them towards neoplastic transformation. A disturbance in the production of cytokines may be involved, since exogenous cytokines, such as Interferon gamma or Tumor Necrosis Factor a, can inhibit radiation-induced lymphomagenesis, reproducing the effects of bone marrow transplantation. The model is thus suitable for studying the mechanisms of carcinogenesis and designing biological manipulation devoted to cancer prevention in individuals who have been exposed to oncogenic agents.

Radiation leukemia virus: a marker for the study of intrathymic T cell differentiation.

Radiation Leukemia Virus (RadLV) is a retrovirus, which displays a highly specific thymotropism; after inoculation into young C57 BL/Ka mice, active virus replication is observed only in thymocytes and thymic lymphomas develop in most treated mice. The specific interaction between RadLV and the thymus resides in the particular susceptibility to infection of the most immature cells involved in the intrathymic lymphoid differentiation pathway and of non lymphoid thymic stromal cells. Recent data obtained from 'in situ' hybridization studies for detection of viral transcripts yield more detailed informations on these intriguing interactions.