[Follow-up and evaluation of plans developed during pulmonary rehabilitation]. / Suivi et évaluation sur une année de projets élaborés en réhabilitation respiratoire.

BACKGROUND: Pulmonary rehabilitation inevitably contains two essential components: therapeutic education and exercise training. The principal aim of this study was to evaluate the evolution over a year of the realization of plans determined during a pulmonary rehabilitation program (PRP). METHODS: At the end of a PRP the patient made plans in accordance with his health condition. A telephone enquiry was undertaken at 3, 7 and 12 months to evaluate the progress of the plans, the motivation to perform them, dyspnoea and quality of life. RESULTS: The data of 65 patients were analyzed (87 inclusions). Fifty-seven percent of the plans continued for one year. Walking had an adherence rating of 71%. Loss of motivation appeared to be the main cause for stopping (20%). Quality of life remained stable (p=0.39) and an increase in dyspnoea, though statistically significant (p<0.01), was of no clinical relevance. CONCLUSION: The majority of plans were maintained but without clinical effect on the quality of life or the level of dyspnoea. Decreased motivation was the major limitation to realization or continuation of the plans. New studies will have to be implemented to analyze the factors which lead to this decrease.

[Reproducibility of strength and endurance measurements of the quadriceps in patients with COPD]. / Reproductibilité de la mesure de la force et de l'endurance du quadriceps dans la BPCO.

INTRODUCTION: Patients with COPD frequently have lower strength and endurance in their lower limbs compared to healthy subjects and evaluation of their quadriceps strength is recommended in practice. The handheld dynamometer has been validated and is easy to use for this measurement but its reproducibility has never been studied for endurance evaluation and only poorly for strength. The objective of this study was to estimate the inter and intra-operator reproducibility of maximal voluntary strength and endurance measurements of the quadriceps with a handheld dynamometer in patients with COPD. METHODS: The measurements of maximal voluntary strength and endurance were performed with a single handheld dynamometer using isometric contraction. Three measurement sessions were undertaken, separated by 24hours. The intra- and interoperator reproducibility were estimated by calculation of the intraclass correlation coefficient. RESULTS: Overall, 21 patients were included in the study. The intraclass correlation coefficient calculated for the maximal voluntary strength for intra and interoperator reliability ranged between 0.95 and 0.99. For endurance, the coefficient for intra-operator reliability was 0.81 and the two for interoperator reliability were 0.69 and 0.77. CONCLUSION: The handheld dynamometer allows an excellent inter and intra-operator reproducibility for the measurement of quadricipital maximal voluntary strength and a correct to excellent reproducibility for the measurement of quadricipital endurance. This tool may be used for the evaluation of quadriceps strength in clinical practice in COPD patients, particularly during rehabilitation.

An outbreak of cyclosporiasis in 1996 associated with consumption of fresh berries- Ontario.

BACKGROUND: A large foodborne outbreak of cyclosporiasis occurred in North America in 1996. An index cluster of cases associated with a catered event on May 11, 1996, in Ontario sparked the recognition of this outbreak in Canada. OBJECTIVES: To describe the Ontario experience with the North American outbreak of cyclosporiasis in 1996. PATIENTS AND METHODS: Public health units investigated the index and subsequent event-associated clusters. Investigations included retrospective cohort studies of clusters, traceback of suspect foods and a case-control study of sporadic cases. These activities, coordinated with those in the United States, were part of an international investigation. RESULTS: In Ontario, 232 cases of cyclosporiasis (20 laboratory-confirmed and 72 clinically defined cases associated with seven events plus 140 additional laboratory-confirmed sporadic cases) were identified between May 1 and July 30, 1996. For the index cluster, a strawberry flan with raspberries and blueberries was the only significant exposure (relative risk 2.16, P=0.02). Fresh berries were served at all seven events associated with clusters of cases. Raspberries were definitely served at three events, possibly served at three events, and not served at one event. Only imported berries were available in Ontario in May 1996, when initial clusters and sporadic cases were identified. The raspberries served at the two events with well documented traceback data came from Guatemala. Univariate analyses of the matched case-control study demonstrated that illness was associated with consumption of raspberries (matched odds ratio 21.0, 95% CI 3.48 to 448) and strawberries (matched odds ratio 28.5, 95% CI 4.02 to 478). Further evidence amassed by the international investigation compellingly implicated Guatemalan raspberries as the vehicle of the outbreak. CONCLUSION: Cyclosporiasis may be acquired domestically from the consumption of contaminated produce. The scope and vehicle of this international foodborne outbreak were recognized through a coordinated public health response.

[Chronic hyperventilation syndrome]. / Le syndrome d'hyperventilation chronique.

Hyperventilation syndrome is a frequent, but poorly understood clinical entity. The clinical expression is a rich combination of respiratory, cardiac and neurological signs which can simulate various organic diseases. Hypocapnia remains the primum movens for most authors although the relationship with psychiatric situations, in particular in anxious patients, is increasingly emphasized. The diagnosis is currently based on the elimination of diseases associated with hyperventilation, then on Nijmegen's questionnaire and is confirmed by the reproduction of the same clinical picture in a voluntary hyperventilation test. Respiratory function tests offer little information. Treatment is based on combining rehabilitation therapy focused on the diaphragm and on relaxation. Specialized care may be needed in psychiatric patients.

[Plastic bronchitis]. / La bronchite plastique.

We report a case of plastic bronchitis occurring in a 58 year-old man free from underlying pulmonary disease. Relief of symptoms was observed under steroid therapy (1 mg/kg), but relapse occurred as treatment being tapered. Such evolution is in accordance with recent published data.

[Rhabdomyosarcoma of the thoracic wall in an adult. Apropos of a case]. / Rhabdomyosarcome de la paroi thoracique chez un adulte. A propos d'un cas.

Rhabdomyosarcoma is a malignant tumour generally observed in children or adolescents; thoracic localization is rare. The authors report a case of embryonary rhabdomyosarcoma of the thoracic wall in a 36-year-old subject. Pathology examination of surgical specimens confirmed the diagnosis. Treatment included surgical exeresis together with pre- and post-operative chemotherapy combining doxorubicine (40 mg/m2/cycle), ifosfamide (6 g/m2/cycle) and dacarbazine (900 mg/m2/cycle). Local recurrence, requiring radiotherapy, was observed a few months later and led to the patient's death after a 9-month clinical course.