Smoking Experimentation in Adolescents. Is There a Risk for Health?

peer reviewedIt is clear that even low rate smoking is hazardous for health, the risk being independently increased by the daily number of cigarettes smoked and by the duration of smoking. The question raised is thus: will an adolescent experimenter be a non smoker, an experimenter for ever, a regular smoker, light or heavy? This short review shows that there are numerous factors from genetics, to familial environment not limited to tobacco issues, smoking situation at school as well as school performances of the student, and also individual psychological characteristics. The experimenter is a very good target for smoking cessation actions and should deserve particular attention from preventive medicine and, thus, from school medicine, before he becomes a regular smoker, who will be more resistant to smoking cessation programs

Tétanie, spasmophilie, syndrome d'hyperventilation : synthèse théorique et thérapeutique.

peer reviewedLe syndrome d’hyperventilation(SHV), caractérisé par des symptômes somatiques multiples induits par une hyperventilation inappropriée, constitue la description physiopathologique d’un trouble fréquent en médecine générale. Synonyme de spasmophilie, ou encore de tétanie normocalcique, il présente l’avantage de proposer des critères diagnostiques, même si ceux-ci sont encore vagues. Mais sa définition permet des mesures objectives : en effet, on peut facilement quantifier la chute de PCO2 lors d’un test de provocation d’hyperventilation, ou la PCO2 anormalement basse au repos. Le concept de syndrome d’hyperventilation propose également un traitement structuré (rééducation respiratoire, psychothérapie et pharmacologie) et efficace. Malgré tout, il subsiste certaines incertitudes scientifiques à son sujet. Il n’existe pas de consensus concernant les critères à prendre en compte lors d’un test de provocation d’hyperventilation pour diagnostiquer un syndrome d’hyperventilation ; la spécificité de ce test est faible et un placebo (hyperventilation isocapnique) peut induire autant de symptômes que lui. La rééducation respiratoire, si elle donne de bons résultats, n’agit pas pour autant nécessairement sur la PCO2. Certains y voient uniquement un mécanisme de relaxation et une explication rationnelle aux symptômes effrayants. Tout ceci pousse certains auteurs à rejeter le terme « syndrome d’hyperventilation », pour préférer celui «d’hyperventilation chronique de cause inconnue »

stop Smoking Help: A Need

peer reviewedToday the smoker carries a risk of mortality 70% higher compared to the nonsmoker. In Belgium active smoking is indisputably the most important cause of avoidable death. In 2004 it appears that 27% of the belgian population was smoking. This review describes the comorbidity associated with active tobacco consumption and defines the concepts of dependence and smoking cessation. It also identifies the three factors which determine the success of smoking cessation, i.e. the degree of nicotinic dependence, the presence of anxio-depressive disorders and the importance of the motivation to the stop

Cytokine production from sputum cells after allergenic challenge in IgE-mediated asthma

Background: Th2 cytokine production from airway cells is thought to govern the eosinophilic airways in ammation in allergic asthma. Induced sputum has become a widely used technique to assess airways in ammation. Methods: By applying the technique of induced sputum to collect airways cells, we have assessed the spontaneous production of a set of cytokines, including interleukin-4, 6, 10, interferon-gamma and tumour necrosis factor-alpha 6 h after a bronchial allergenic hallenge with Dermatophagoides pteronyssinus (Dpt) in 12 sensitized asthmatics and compared the results obtained after inhalation of saline as control. A group of eight healthy non-allergic subjects was enrolled to control for any non-specific effect of Dpt. Cytokines were measured by a dynamic immunoassay during a 24-h sputum cell culture. Results: Allergen challenge in sensitized asthmatics caused an acute and a late bronchospasm together with a rise in sputum eosinophil counts. Afterwards allergen sputum cells from allergic asthmatics displayed a rise in their production of IL-4 (P < 0.01), IL-6 (P < 0.05) and IL- 10 (P < 0.05) when compared to saline. By this time sputum generation of IL- 4 in atopic asthmatics was greater than in healthy subjects (P < 0.001). Furthermore, in allergic asthmatics there was a strong correlation between the rise in interleukin-4 production from sputum cells and the rise in sputum eosinophils (r = 0.87, P < 0.001). Conclusions: Sputum cell culture is a useful model to assess cytokine production in allergic asthmatics who show a marked up-regulation of Th2 cytokines following acute allergen exposure. The rise in sputum eosinophil count following allergen challenge strongly correlates with the rise in IL-4 generation from sputum cells

L'hyperventilation chronique existe-t-elle?

Longtemps, on a considéré que les sujets atteints d’attaques de panique étaient des hyperventilants chroniques qui plongeaient soudainement en hypocapnie. En fait, l’examen des résultats au test de provocation d’hyperventilation, de la rééducation respiratoire et de la mesure ambulatoire de PCO2 montre qu’il n’y a pas de recouvrement parfait entre les deux phénomènes. Le syndrome d’hyperventilation est sans doute une entité à part entière. Les modèles biologiques se basent sur les expériences utilisant le lactate ou le dioxyde de carbone pour aboutir, avec Klein (1993), à l’hypothèse d’une hypersensibilité au CO2. Les modèles psychologiques envisagent diverses options. Lum (1994) y voit la conséquence d’une mauvaise habitude respiratoire. Pour Clark (1986), l’hyperventilation joue un rôle dans les attaques de panique seulement si elle est interprétée de manière catastrophique. Ley (1993) considère la dyspnée comme l’élément initiateur d’un réflexe de peur innée. Enfin, Van den Bergh (1995) a réalisé des études prometteuses sur le conditionnement respiratoire. Si tous les sujets souffrant d’attaques de panique ne sont pas des hyperventilants chroniques, il faut admettre que les deux phénomènes coexistent souvent. Une approche intégrative des modèles biologiques et psychologiques pourrait éclaircir la nature de leur relation

Clinical case of the month. MacLeod syndrome

peer reviewedMacLeod syndrome is a rare cause of localized hypertransradiancy of the lung. This syndrome is defined by radiological features: localized hypertransradiancy due to oligemia and presence of air-trapping on expiratory chest radiography. Involvement of one entire lung is called "unilateral hyperlucent lung". Whereas the etiology is different, the physiopathology is probably identical to that of the panacinar emphysema of chronic obstructive pulmonary disease. The syndrome is believed to be related to acute bronchiolitis during infancy. Clinical manifestations and prognosis depend mainly on the presence of other lesions due to the same infectious agent like bronchiectasis. Pulmonary function tests, chest CT-scan, ventilation and perfusion scintigraphy and, if necessary, bronchoscopy help the differential diagnosis and detect associated bronchiectasis

Quantification of short and long asbestos fibers to assess asbestos exposure: a review of fiber size toxicity.

International audienceThe fibrogenicity and carcinogenicity of asbestos fibers are dependent on several fiber parameters including fiber dimensions. Based on the WHO (World Health Organization) definition, the current regulations focalise on long asbestos fibers (LAF) (Length: L ≥ 5 μm, Diameter: D  3). However air samples contain short asbestos fibers (SAF) (L < 5 μm). In a recent study we found that several air samples collected in buildings with asbestos containing materials (ACM) were composed only of SAF, sometimes in a concentration of ≥10 fibers.L-1. This exhaustive review focuses on available information from peer-review publications on the size-dependent pathogenetic effects of asbestos fibers reported in experimental in vivo and in vitro studies. In the literature, the findings that SAF are less pathogenic than LAF are based on experiments where a cut-off of 5 μm was generally made to differentiate short from long asbestos fibers. Nevertheless, the value of 5 μm as the limit for length is not based on scientific evidence, but is a limit for comparative analyses. From this review, it is clear that the pathogenicity of SAF cannot be completely ruled out, especially in high exposure situations. Therefore, the presence of SAF in air samples appears as an indicator of the degradation of ACM and inclusion of their systematic search should be considered in the regulation. Measurement of these fibers in air samples will then make it possible to identify pollution and anticipate health risk

Increased IL-6 and TGF-beta(1) concentrations in bronchoalveolar lavage fluid associated with thoracic radiotherapy

peer reviewedaudience: researcherPURPOSE: To assess, in lung cancer patients, the effects of thoracic radiotherapy (RT) on the concentrations of transforming growth factor-beta(1) (TGF-beta(1)) and interleukin-6 (IL-6) in the bronchoalveolar lavage (BAL) fluid. METHODS AND MATERIALS: Eleven patients with lung cancer requiring RT as part of their treatment were studied. BAL was performed bilaterally before, during, and 1, 3, and 6 months after RT. Before each BAL session, the patient's status was assessed clinically using pulmonary function tests and an adapted late effects on normal tissue-subjective, objective, management, analytic (LENT-SOMA) scale, including subjective and objective alterations. The National Cancer Institute Common Toxicity Criteria were used to grade pneumonitis. The TGF-beta(1) and IL-6 levels in the BAL fluid were determined using the Easia kit. RESULTS: The TGF-beta(1) and IL-6 concentrations in the BAL fluid recovered from the irradiated areas were significantly increased by thoracic RT. The increase in TGF-beta(1) levels tended to be greater in the group of patients who developed severe pneumonitis. In the BAL fluid from the nonirradiated areas, the TGF-beta(1) and IL-6 concentrations remained unchanged. CONCLUSION: The observed increase in TGF-beta(1) and IL-6 concentrations in the BAL fluid recovered from the irradiated lung areas demonstrated that these cytokines may contribute to the process leading to a radiation response in human lung tissue

Sidus Stem-Free Shoulder System for primary osteoarthritis: short-term results of a multicenter study

BACKGROUND: The aim of this prospective multicenter study was to evaluate clinical and radiologic results of a new metaphyseal anchored system. This system features a different anchor geometry that potentially leads to better bony integration and less loosening. METHODS: From November 2012 until December 2015, 148 patients (151 shoulders) were treated with the Sidus Stem-Free Shoulder System at 9 centers in Europe. The main indication was primary osteoarthritis (80.1%). This analysis only includes patients diagnosed with primary osteoarthritis (n = 121). A clinical evaluation was performed using the Constant-Murley score, Subjective Shoulder Value, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, and range of motion. Radiologic assessment was based on the occurrence of radiolucent lines and signs of implant migration, osteolysis, loosening, and heterotopic ossification. RESULTS: We evaluated 105 patients after a follow-up period of 2 years. There were 53 women and 52 men. The average age was 64 years. Total shoulder arthroplasty was performed in 73 cases and hemiarthroplasty in 32. The Constant-Murley score improved from 26 points preoperatively to 70 points at 2 years' follow-up (P < .001). The Subjective Shoulder Value increased from 34% to 84% (P < .001), and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form increased from 34 points to 86 points (P < .001). Radiologically, neither migration nor loosening was found. However, radiolucent lines of 2 mm or greater could be detected around the glenoid in 2 cases, but none of them have had clinical relevance yet. The overall complication rate was 6.7%, and the revision rate was 0%. CONCLUSION: Patients with the Sidus Stem-Free Shoulder System achieve good clinical and radiologic short-term results that are comparable with the results of other stem-free shoulder implants

European Neuroendocrine Tumor Society 2023 guidance paper for functioning pancreatic neuroendocrine tumour syndromes.

This ENETS guidance paper aims to provide practical advice to clinicians for the diagnosis, treatment and follow-up of functioning syndromes in pancreatic neuroendocrine tumours (NET). A NET-associated functioning syndrome is defined by the presence of a clinical syndrome combined with biochemical evidence of inappropriately elevated hormonal levels. Different hormonal syndromes can be encountered in pancreatic NET patients, including insulinoma, gastrinoma as well as the rare glucagonoma, VIPoma, ACTHoma, PTHrPoma, carcinoid syndrome, calcitoninoma, GHRHoma and somatostatinoma. The recommendations provided in this paper focus on the biochemical, genetic and imaging work-up as well as therapeutic management of the individual hormonal syndromes in well-differentiated, grade 1-3, functioning NET with the primary tumour originating in the pancreas, and for specific subtypes also in the duodenum