Introduction. -Since benzodiazepines (BZD) are largely prescribed during pregnancy, the Regional Pharmacovigilance Center (RPVC) of Tours regularly deals with questions about the risk of their administration to pregna...Introduction. -Since benzodiazepines (BZD) are largely prescribed during pregnancy, the Regional Pharmacovigilance Center (RPVC) of Tours regularly deals with questions about the risk of their administration to pregnantwomen and the monitoring of the newborns exposed in utero to these drugs. During the third trimester, we recommend a switch in the BZD maternal treatment to oxazepam, which has an intermediary half-life and no active metabolite, and a hospitalisation of the newborn in order to monitor his respiratory rate. The purpose of our study was to evaluate the neonatal consequences of BZD used at the end of pregnancy and to analysed if our recommendations were taken into account and if they were appropriate. Methods. -From 1989 to the end of 2002, we studied the files in which women had received a BZD during the 30 days prior to delivery. We analysed maternal treatments, the outcome of pregnancy and the development of the newborn, the therapeutically attitude recommended and whether or not it was respected. Results. -A total of 73 files were selected. Seventy neonates were born to 73 women. The newborns were hospitalised (73% ) and they developed adverse reactions possibly related to the use of BZD (51,5% ) : an impregnation syndrome (42% ) characterized by hypotonia and hypoventilation, and a with drawal syndrome (20% ) with tremulations as the main symptom. Conclusion. -Considering the most frequent neonatal manifestations, hospitalization and the respiratory monitoring recommended by the RPVC seemed adequate. However, the switch to oxazepam was seldom done and its advantages should be pointed out.展开更多
Background: There is still lack of consensus regarding the most effective follow- up for stage I and II melanoma patients although some consensus conferences have provided guidelines stating that clinical examination ...Background: There is still lack of consensus regarding the most effective follow- up for stage I and II melanoma patients although some consensus conferences have provided guidelines stating that clinical examination should be the standard. Ob- jectives: Our aim was to study the value of adding ultrasound lymph node examination (7.5 MHz) to the routine clinical examination recommended by French guidelines in melanoma follow-up. Methods: A cohort of melanoma patients was enrolled between 1 July 1995 and 1 July 2000 in a follow-up protocol including clinical examination performed four times a year for thick melanomas (Breslow index > 1.5 mm) and twice ayearforthinmelanomas(Breslowindex < 1.5mm)according to French guidelines, and ultrasound lymph node examination performed every 6 months for thick melanomas and every year for thin melanomas. Follow- up was continued up to 1 July 2003. When clinical or ultrasound examination indicated signs of node recurrence, surgical biopsy of the involved node was performed. When ultrasound examination was only suspicious, another ultrasound examination was performed within the following 3 months. The results of both clinical and ultrasound examinations were compared with histopathology examination when node biopsy was performed. Results: Ultrasound followup was performed for 373 patients(213 females and 160 males). Mean age at diagnosis of melanoma was 59 years (range 1490, SD 15). In total, 1909 ultrasound examinations combined with clinical examination were analysed. Node biopsy was performed in 65 patients and demonstrated melanoma metastases in 54. Sensitivity of clinical examination and ultrasound examination was 71.4% 95% confidence interval (CI) 55.484.3 and 92.9 (95% CI 80- 5- 98- 5), respectively, P=0.02. Specificity of clinical examination and ultrasound examination was 99.6% (95% CI 99.2- 99.8) and 97.8% (95% CI 97.0- 98.4), respectively. Despite this apparent superiority of ultrasound examination over palpation, only 7.2% of the patients really benefited from ultrasound examination(earlier lymph node metastasis detection or avoidance of unnecessary surgery), while 5.9% had some deleterious effect from ultrasound examination (unnecessary stress caused by repetition of ultrasound examination for benign lymph nodes, useless removal of benign lymph node). Conclusions: This study confirms the greater sensitivity of ultrasound examination to clinical examination in the diagnosis of node metastases from cutaneous melanoma. However, the place of ultrasound in routine follow-up is at least questionable as only a very small proportion of patients (1.3% ) really benefited from adding ultrasound examination to clinical examination.展开更多
文摘Introduction. -Since benzodiazepines (BZD) are largely prescribed during pregnancy, the Regional Pharmacovigilance Center (RPVC) of Tours regularly deals with questions about the risk of their administration to pregnantwomen and the monitoring of the newborns exposed in utero to these drugs. During the third trimester, we recommend a switch in the BZD maternal treatment to oxazepam, which has an intermediary half-life and no active metabolite, and a hospitalisation of the newborn in order to monitor his respiratory rate. The purpose of our study was to evaluate the neonatal consequences of BZD used at the end of pregnancy and to analysed if our recommendations were taken into account and if they were appropriate. Methods. -From 1989 to the end of 2002, we studied the files in which women had received a BZD during the 30 days prior to delivery. We analysed maternal treatments, the outcome of pregnancy and the development of the newborn, the therapeutically attitude recommended and whether or not it was respected. Results. -A total of 73 files were selected. Seventy neonates were born to 73 women. The newborns were hospitalised (73% ) and they developed adverse reactions possibly related to the use of BZD (51,5% ) : an impregnation syndrome (42% ) characterized by hypotonia and hypoventilation, and a with drawal syndrome (20% ) with tremulations as the main symptom. Conclusion. -Considering the most frequent neonatal manifestations, hospitalization and the respiratory monitoring recommended by the RPVC seemed adequate. However, the switch to oxazepam was seldom done and its advantages should be pointed out.
文摘Background: There is still lack of consensus regarding the most effective follow- up for stage I and II melanoma patients although some consensus conferences have provided guidelines stating that clinical examination should be the standard. Ob- jectives: Our aim was to study the value of adding ultrasound lymph node examination (7.5 MHz) to the routine clinical examination recommended by French guidelines in melanoma follow-up. Methods: A cohort of melanoma patients was enrolled between 1 July 1995 and 1 July 2000 in a follow-up protocol including clinical examination performed four times a year for thick melanomas (Breslow index > 1.5 mm) and twice ayearforthinmelanomas(Breslowindex < 1.5mm)according to French guidelines, and ultrasound lymph node examination performed every 6 months for thick melanomas and every year for thin melanomas. Follow- up was continued up to 1 July 2003. When clinical or ultrasound examination indicated signs of node recurrence, surgical biopsy of the involved node was performed. When ultrasound examination was only suspicious, another ultrasound examination was performed within the following 3 months. The results of both clinical and ultrasound examinations were compared with histopathology examination when node biopsy was performed. Results: Ultrasound followup was performed for 373 patients(213 females and 160 males). Mean age at diagnosis of melanoma was 59 years (range 1490, SD 15). In total, 1909 ultrasound examinations combined with clinical examination were analysed. Node biopsy was performed in 65 patients and demonstrated melanoma metastases in 54. Sensitivity of clinical examination and ultrasound examination was 71.4% 95% confidence interval (CI) 55.484.3 and 92.9 (95% CI 80- 5- 98- 5), respectively, P=0.02. Specificity of clinical examination and ultrasound examination was 99.6% (95% CI 99.2- 99.8) and 97.8% (95% CI 97.0- 98.4), respectively. Despite this apparent superiority of ultrasound examination over palpation, only 7.2% of the patients really benefited from ultrasound examination(earlier lymph node metastasis detection or avoidance of unnecessary surgery), while 5.9% had some deleterious effect from ultrasound examination (unnecessary stress caused by repetition of ultrasound examination for benign lymph nodes, useless removal of benign lymph node). Conclusions: This study confirms the greater sensitivity of ultrasound examination to clinical examination in the diagnosis of node metastases from cutaneous melanoma. However, the place of ultrasound in routine follow-up is at least questionable as only a very small proportion of patients (1.3% ) really benefited from adding ultrasound examination to clinical examination.
