[Stroke due to spontaneous calcified cerebral embolus as presenting feature of calcified aortic stenosis]. / Infarctus cérébral par embolie calcaire spontanée révélant un rétrécissement aortique calcifié.

We report a case of calcified aortic stenosis revealed by an ischemic stroke. An 81-year-old man with hyperlipidemia, hypertension and renal function impairment presented with acute onset of right-sided hemiparesis and aphasia. Head CT scan revealed a rounded calcified high-density mass within the distal segment of the left anterior cerebral artery, consistent with a calcified cerebral embolus, and an infarct in the left paracentral lobule. Transesophageal echocardiography demonstrated a sclerotic aortic valve. The patient was discharged from hospital on aspirin and atorvastatin, and the outcome was favorable. Calcified embolus remains a rare event and it has been not yet reported in the territory of anterior cerebral artery. It may be observed in aortic and mitral valve diseases, calcified plaques of the internal carotid artery and aortic arch. Renal failure promotes their development and is the cause of cardiovascular diseases. To date, aortic valve calcification is not considered as a marker of stroke risk, except when associated with severe stenosis or left ventricular hypertrophy.

[Echocardiography in the catheterization unit]. / L'échocardiographie en salle de cathétérisme.

Non-coronary interventional cardiology has for about ten years been undergoing significant development, with the arrival of new percutaneous procedures in various domains. Some of them have already been well validated, notably percutaneous mitral comissurotomy, percutaneous closure of inter-atrial (IA) communications and patent foramen ovale, trans-septal catheterisation, and alcohol septal ablation of hypertrophic obstructive cardiomyopathy. Other interventional techniques are still in the validation phase, such as the techniques for percutaneous occlusion of the left atrium, percutaneous implantation of valvular prostheses, or the new approaches to percutaneous treatment of mitral valvulopathy. The rapid development of these techniques has benefited widely from the use of echocardiography in the catheter suite, providing a very precise clarification of the anatomy and continuous guidance during procedures. This echocardiographic guidance provides optimal results for the interventional procedure and reduces the incidence of complications.

[Treatment in primary Streptococcus pneumoniae peritonitis in adult: a case report and review of the literature]. / Prise en charge thérapeutique de la péritonite primitive à Streptococcus pneumoniae de l'adulte: étude d'un cas et revue de la littérature.

INTRODUCTION: Streptococcus pneumoniae primary peritonitis is rare. The diagnosis is uneasy and the treatment is not standardised. CASE REPORT: We report a single case of S. pneumoniae primary peritonitis needing surgical treatment. DISCUSSION: S. pneumoniae primary peritonitis can be medically treated. Surgery is needed in case of sepsis, associated digestive injuries or failure of medical treatment.

Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation.

CONTEXT: The Consolidated Standards for Reporting of Trials (CONSORT) statement was developed to help improve the quality of reports of randomized controlled trials (RCTs). To date, a paucity of data exists regarding whether it has achieved this goal. OBJECTIVE: To determine whether use of the CONSORT statement is associated with improvement in the quality of reports of RCTs. DESIGN AND SETTING: Comparative before-and-after evaluation in which reports of RCTs published in 1994 (pre-CONSORT) were compared with RCT reports from the same journals published in 1998 (post-CONSORT). We included 211 reports from BMJ, JAMA, and The Lancet (journals that adopted CONSORT) as well as The New England Journal of Medicine (a journal that did not adopt CONSORT and was used as a comparator). MAIN OUTCOME MEASURES: Number of CONSORT items included in a report, frequency of unclear reporting of allocation concealment, and overall trial quality score based on the Jadad scale, a 5-point quality assessment instrument. RESULTS: Compared with 1994, the number of CONSORT checklist items in reports of RCTs increased in all 4 journals in 1998, and this increase was statistically significant for the 3 adopter journals (pre-CONSORT, 23.4; mean change, 3.7; 95% confidence interval [CI], 2.1-5.3). The frequency of unclear reporting of allocation concealment decreased for each of the 4 journals, and this change was statistically significant for adopters (pre-CONSORT, 61%; mean change, -22%; 95% CI, -38% to -6%). Similarly, 3 of the 4 journals showed an improvement in the quality score for reports of RCTs, and this increase was statistically significant for adopter journals overall (pre-CONSORT, 2.7; mean change, 0.4; 95% CI, 0.1-0.8). CONCLUSION: Use of the CONSORT statement is associated with improvements in the quality of reports of RCTs.

A randomized clinical trial of care for women with preterm labour: home management versus hospital management.

BACKGROUND: Preterm labour occurs in about 10% of all pregnancies and is the most important cause of premature birth. Women with preterm labour are admitted to hospital to have the contractions stopped. Thereafter, many women remain in hospital until delivery. We conducted a randomized clinical trial to compare hospital care with home care of women who had been admitted to hospital for preterm labour. METHODS: After they had received treatment for an acute episode of premature labour, women at 2 regional perinatal centres associated with teaching hospitals were randomly assigned to home care or hospital care. Eligible women (n = 250) were aged 18 years or older, lived within 50 km of the hospital, had a gestational age between 20 and 35 weeks, had no prior preterm delivery and were experiencing their first episode of preterm labour and first admission to hospital for preterm labour. Analysis was by intention to treat. RESULTS: There were no significant differences between the 2 groups in mean gestational age at delivery (home: 37.52 weeks, hospital: 37.50 weeks) or in mean birth weight (home: 2974 g, hospital: 3020 g). There were no significant differences between the 2 groups with respect to the proportions of babies born before term or the mean duration of neonatal hospital stay, neonatal intensive care unit stay and intermediate care nursery stay. The mean duration of the first stay in hospital for the women in the home group (3.8 days) was significantly shorter than the mean duration for women in the hospital group (6.1 days). In addition, the mean duration of all maternal stays in hospital was significantly shorter for the women in the home group (3.7 days) than in the hospital group (5.0 days). INTERPRETATION: Home care management is an efficient and acceptable alternative to hospital care for women experiencing preterm labour.

A controlled clinical trial of home care management versus hospital care management for preterm labour.

Prenatal hospitalisation has not been shown to reduce perinatal morbidity and mortality, yet it is still the treatment of choice for women who experience preterm labour. Home care management may be an alternative means of delivering safe, efficacious and care for these women. The objectives of this controlled clinical trial were to examine differences in neonate's gestational age and birthweight, and antenatal stress, social support satisfaction, and family functioning among pregnant women receiving home care and those receiving hospital care management. Pregnant women experiencing preterm labour (N=250) were randomly assigned to home care management (the experimental group [EG]) or hospital care management (the control group [CG]). A Perinatal Information Form was used to collect data on sociodemographic and pregnancy variables. The High-Risk Pregnancy Stress Scale, Brown's Social Behaviors Inventory, and the Family Assessment Measure III Dyadic Relationships Scale were administered to the women at randomisation (T1) and at 1-week (T2) and 2-weeks (T3) after randomisation. Gestational age and birthweight were similar in the two groups of neonates. Women in the EG reported that antenatal stress was significantly lower at T3 than at T1 and T2, while for those in the CG, antenatal stress was significantly lower at T3 than at T1, and significantly lower at T2 than at T1. Women in the EG were more satisfied with support from the male partner at T3 than women in the CG. There was no significant difference between the two groups in family functioning at T1, T2 and T3. These findings indicate that home care management is a safe and efficacious mode of health care delivery for women experiencing preterm labour.

Expression of T lymphocyte p56(lck), a zinc-finger signal transduction protein, is elevated by dietary zinc deficiency and diet restriction in mice.

Compromised immune function is common to Zn deficiency, protein and energy malnutrition; however, the causative mechanisms at the molecular level have not been elucidated. The T lymphocyte signal transduction pathway contains several Zn-finger proteins, and it is possible that the in vivo functioning of these proteins could be affected by dietary deficiency of Zn and amino acids. Thus, the objective was to investigate the effects, on expression of the T lymphocyte signal transduction proteins p56(lck), phospholipase Cgamma1 (PLCgamma1) and protein kinase C (PKCalpha), of dietary Zn deficiency (ZnDF, < 1 mg Zn/kg diet) and protein-energy malnutrition syndromes [2% protein deficiency (LP), combined Zn and 2% protein deficiency (ZnDF+LP), and diet restriction (DR, body weight equal to ZnDF)] compared with control (C) mice. Indices of nutritional status and splenocyte counts were also determined. Based on serum albumin and liver lipid concentrations, the ZnDF+LP and LP groups had protein-type malnutrition, whereas the ZnDF and DR groups had energy-type malnutrition. For Western immunoblotting of the signal transduction proteins, mouse splenic T lymphocytes were isolated by immunocolumns. The expression of T lymphocyte p56(lck) was significantly elevated in the ZnDF+LP, ZnDF and DR groups compared to the C group. In contrast, the expression of PLCgamma1 and PKC was unaffected. There was a significant negative correlation between T lymphocyte p56(lck) expression and serum Zn (r= -0.65, P = 0.0007) or femur Zn (r = -0.73, P = 0.0001) concentrations. We propose that elevated T lymphocyte p56(lck) may contribute to altered thymoctye maturation, apoptosis and lymphopenia in Zn deficiency and protein-energy malnutrition syndromes.

[Randomized trial of two health care deliveries during premature labor]. / Essai randomisé de deux modes de prestation des soins lors de travail prématuré.

The main target of this clinical trial was to determine if, for a diagnosis of premature labour, a home prenatal follow-up compared to a classical hospitalization influenced the outcome of pregnancy in terms of gestation age and weight at birth. The participants were recruited in the population of pregnant women in hospital for a threat of premature delivery. The data collection was carried out with the help of four instruments, i.e. the perinatal and personal information Guide, the Scale of antenatal stress, the Inventory of support behaviour and the Scale of the dyadic relations. The analyses carried out do not reveal any statistically significant differences between the two groups for the main variables. But staying at home presents a safe and human alternative to traditional hospitalization and offers some advantages for the pregnant women, specially those faced with socio-economic difficulties.

[Psychosocial adjustment to asthma and juvenile diabetes mellitus in school-age children]. / L'ajustement psychosocial à l'asthme et au diabète juvénile chez des enfants d'âge scolaire.

The main purpose of this study was to compare psychological and social problems among chronically ill school-aged children to those observed in a group of healthy children of the same age. On the basis of the data collected, it was also possible to compare self-perception and social functioning problems between the 2 groups of children, as well as to identify the contributing factors explaining the observed differences in psychosocial adaptation between these 2 groups. Three measures were used to assess psychological and social problems. Mental health problems were measured by the Dominique (Valla, Bergeron, Bérubé, Gaudet, & Saint-Georges, 1994). Self-Perception and Social Functioning were assessed by the Self-Perception Profile (Harter, 1985) and the Rating Scale of Child's Actual Behavior (Harter, 1985). Information on characteristics of the child and his or her family was also collected. Sixty children aged 6 to 11 and diagnosed as having juvenile diabetes or asthma, 59 control children, and the children's parents participated in this study. A chi-square test and multivariate analysis of variance were used to compare the 2 groups of children. Results indicate that children with diabetes and asthma do not present more psychological and social problems than other children of the same age. Results also suggest that age is the only variable indicating a higher proportion of mental health problems among chronically ill children. Results are discussed and compared to those of previous studies from which the conceptual frame-work of this study was developed.

Social support received by mothers of chronically ill children.

The main purpose of this study was to describe the characteristics of the social networks and social support of mothers of chronically ill children and adolescents. The data collected also allowed for the identification of the predisposing factors to receiving low social support among the mothers. Receipt of social support was assessed according to six dimensions: source of support, type of support, perceived need for support, satisfaction with the quality and the quantity of support, as well as most valued source of support. Results indicate that mothers wanted more support than they received, particularly in the areas of emotional, appraisal, and informative support. Furthermore, spouses, professionals, and immediate family members were identified by mothers as important sources of support. Discriminant analysis showed that the probability of receiving low support increased if the chronically ill child was an adolescent, the father had a higher level of education, and the family income was middle-low. Results are discussed in terms of the implications for intervention.

The pattern of influence of perceived behavioral control upon exercising behavior: an application of Ajzen's theory of planned behavior.

The aim of the present studies was to verify the basic assumptions underlying the theory of planned behavior for the prediction of exercising intentions and behavior among adults of the general population (study 1) and a group of pregnant women (study 2). In both studies, baseline data were collected at home with trained interviewers and with the use of paper-and-pencil questionnaires. The self-report on behavior was obtained 6 months (study 1) and between 8 and 9 months (study 2) after baseline data collection. In study 1, perceived behavioral control influenced behavior only through intention. In study 2, none of the Ajzen model variables was associated to exercising behavior. Nonetheless, intention was influenced by attitude, habit, and perceived behavioral control. The results of the present studies suggest that perceived behavioral control contributes to the understanding of intentions to exercise but not to the prediction of exercising behavior.

Predictors of smoking behaviour: an application of Ajzen's theory of planned behaviour.

The aim of the present paper was to verify the basic assumptions underlying the theory of planned behaviour for the prediction of cigarette smoking intentions and behaviour among adults of the general population (study 1) and a group of pregnant women (study 2). Each study was developed based upon Ajzen's theory of planned behaviour. In both studies, baseline data was collected at home with trained interviewers and with the use of paper and pencil questionnaires. The self-report on behaviour was obtained 6 months (study 1) and between 8 and 9 months (study 2) after baseline data collection. In study 1, for smokers, perceived behavioural control, attitudes and subjective norm were explaining intention, whereas perceived behavioural control and habit were the most important predictors of behaviour. In study 2, smoker's intentions was mainly under the influence of perceived behavioural control and attitude, whereas behaviour was predicted by perceived behavioural control only. The present studies suggest that promotional programmes should help smokers to know and develop their will-power regarding non-smoking of cigarettes and should be informed of the effort required in order to modify smoking behaviour.

Self-reported smoking and exercising behaviours during the postnatal period: assessing congruence between spouses.

The aim of the study was to assess the congruence between women's self-reported behaviours during the postnatal period and the answers provided by their husbands. One hundred nineteen couples participated. Firstly, women reported their own smoking and exercising behaviours for four months following childbirth. Subsequently, husbands evaluated their spouses' behaviours over the same period of time. Smoking behaviour was assessed on 5-category scale ranging from non-smoker to daily smoker whereas physical activity was measured on a 6-category scale ranging from no physical activity to regular physical activity. The polychoric correlation coefficients and the weighted Kappa indexes indicated that the degree of congruence between respondent pairs were appropriate, but better for smoking than exercising. The results of the present study support the idea that the information obtained from spouses can be helpful in the assessment of the reliability of the answers provided by their live-in partner, particularly in surveys regarding smoking.