L'union medicale du Canada最新文献

Chemoprevention, or pharmacological intervention in healthy individuals at risk of developing cancer, is attracting attention as a potential tool in cancer prevention. Lung cancer, with its high incidence and poor prognosis, is a particularly interesting disease for these studies. The retinoids are a promising group of chemopreventive agents, since they are involved in growth control and are a necessary cofactor for proper activity of a protein receptor which we have shown to be a lung cancer suppressor. Nevertheless, the toxic side effects of retinoids at pharmacological dose present difficulties and current studies are aimed at determining the efficacy of various forms of retinoids and chemoprevention protocols in the target populations.

Before recommending systematic screening for Chlamydia trachomatis in young sexually-active women in its population, the Laval Community Health Department set out to document current practices in chlamydia testing. The objective of the study was to determine for whom these tests were prescribed, by whom and why. Data were obtained from a representative sample of 413 medical records. The greatest proportion of tests were prescribed for young women between the ages of 15-24 years. More than 85% of the tests were ordered by general practitioners, most of whom practiced in both hospital setting and private clinics. More than half of the tests were administered to obtain a diagnosis; approximately 42% were done for screening purposes. The study revealed a failure to document the sexual history of patients. It was estimated that between 30 and 40% of Chlamydia tests were not justified in being prescribed (according to the recommendations in the literature). It is possible that the criteria in the medical literature are too complex for use in everyday practice. The authors recommend the creation of specific tools adapted to physicians' needs, and the development of a screening program based on a systematic, step-by-step approach to determine whether or not a test is warranted.

A review of various historical events in oncology at l'Hôtel-Dieu de Montréal is presented as well as a description of the services offered and the structural organization of the oncology center. The surgical and medical oncology subspecialties are very active in clinical research. Their contribution to various protocols is noted and a highlight of their conclusions is given. The research unit in epidemiology has expertise in the nutritional evaluation of patients with cancer. They have also published two atlas on the mortality and incidence of cancer by regions in the Province of Québec. The hospital has also a molecular pathology laboratory which helps physicians in pursuing the diagnosis and to understand the biology of cancers.

The differential diagnosis of Cushing's disease remains difficult to establish. The selective transsphenoidal adenomectomy is the initial treatment of choice. In a group of 65 patients, 50 (77%) initially responded to surgery with correction of their hypercortisolism. Forty-three out of 51 (84%) patients with small pituitary tumors responded favourably to surgery, but recurrency occurred in 10% of the cases. Medical treatment with steroids inhibitors or antagonists is only an adjuvant treatment. In case of surgery failure or recurrency, bilateral adrenalectomy is usually performed. Conventional radiotherapy may be used after surgery in presence of macroadenomas or invasive adenomas. Correction of the hypercortisolism, after a second surgery, was achieved in 50% of the cases and was always associated with a panhypopituitarism.

Research has documented differences between hyperactive and normal children. However, to be valid, a diagnostic entity must differ in etiology, course, characteristics, or treatment response from other behavior problems as well as from normality. In order to demonstrate the validity of this syndrome, the research has followed three lines: the search for a biological marker, the study of symptoms and the evaluation of the suspected cognitives deficits. No final answers have been obtained yet but understanding of this clinical entity is still progressing.

Presently, Alzheimer's disease can only be diagnosed with the coexistence of clinical symptoms and the presence of neuropathological alterations. Thus, in the absence of pre mortem biological markers, cognitive deficits form the starting point and the basis of inclusion criteria on which the clinician relies in order to make a putative diagnose of dementia of the Alzheimer type (DTA). Cognitive deficits should thus be accurately described through neuropsychological testing since it is essential to identify the cognitive deterioration patterns of the patients--in terms of selective impairment of cognitive functions--as well as the evolution of these patterns. Regarding this issue, the classical teaching of the Geneva school has proposed a homogeneous deterioration of the aphasic-apraxicagnosic syndrome into four stages. However, recent work does not support this hypothesis. On the contrary, these studies tend to show the presence of heterogeneity in neuropsychological manifestations of the disease. The aim of the present paper is to provide a critical review of this topic through a brief survey of the classical work and research that have recently been conducted. An analysis of the possible candidates responsible for the existence of this heterogeneity of cognitive profiles is presented. Finally, theoretical implications and clinical repercussions are discussed.

Musculoskeletal problems are very frequent amongst musicians. The most frequent ones are tendinitis, professional cramps and dystonias, thoracic outlet syndrome, carpal tunnel syndrome, overuse syndrome and back pain. Preventive measures should included information to students about potential problems, body awareness, good physical condition, proper technique and early management of arising problems. In many cases, musicians consult only at an advance stage of their disease and a prolonged rest of the instrument is then mandatory but not easily accepted.