Health Blog – Cancer information, Mesothelioma

Asbestos: the miracle material [editing]

The outstanding properties presented by asbestos (insulation, mechanical, chemical and heat resistance and flame) and its relative low cost, may explain its numerous industrial applications, as well as the fact that figure, or has figured for many years in the composition of many products and industrial finishes. In addition, there are numerous sites around the world and its cost of extraction is low.
Because of these characteristics, it has been used extensively as a building material in tiles, slabs, tiles, paper, cement, automobile industry in clutches, brakes, transmission components, or in various textile materials, packaging coatings . With the exception of chrysotile, all forms of asbestos are very resistant to acids and alkalis and all decompose at high temperatures (800-1000 ° C) and therefore have been used for fire protection of steel structures, costumes firefighters and for example, the “crocidolite”, was used in the manufacture of pressure pipes and plastics as reinforcing their mechanical strength.
The chrysotile , also known as ” white asbestos “asbestos fiber is the most widely used and represents 94% of world production. The cement industry is by far the largest user of chrysotile fibers and represents about 85% of total use4
The main carcinogenic asbestos [edit]

The effects of asbestos on health have been known for a long time, because in the first century, Pliny the Elder , in Rome , described the disease in the lungs of slaves who wove asbestos clothing.
The ancient alchemists believed that the extraordinary asbestos fibers, came from “the hair of mythical and toxic salamanders fire resistant “and called” salamander wool . ” The deadly substance that poisoned the salamander segregated fruit trees and the waters of rivers and wells. It is said that 2000 men and 4000 horses of Alexander the Great died in India after drinking poisoned by a stream salamander.
Charlemagne had a tablecloth asbestos fibers, with which acts of fire impressed with their guests and diners, who cleaned and bleached by simply inserting it into the fire.
During the second half of the thirteenth century explorer Marco Polo visited asbestos mines in China describing the process of mineral extraction and finally discarding the myths and eliminating the old “theory of the salamander.”
It was in 1906in London (England) when he described the first known case of “pulmonary fibrosis Asbestos” in a worker 33, carding area of a textile factory.
Since 1935the first known scientific work related to asbestos exposure and lung cancer and 1947describes the mesothelioma of pleura and peritoneum , and today it is recognized that asbestos is the best known of industrial chemicals linked to lung cancer
Today there is absolute certainty of two types of cancer caused by asbestos exposure: asbestosis, lung cancer and mesothelioma. 5not recognized a minimal amount of the agent under which a set is safe. Lung cancer in workers exposed becomes 10 times more frequent than in the general population

Nearly 7.9% of patients with Down syndrome have an abnormality of the hip (ED Shaw and RK Beals., 1992), which
dysplasia
dislocation
avascular necrosis, or
epiphysiolysis
The dislocation of the hip patient with Down syndrome is
rarely painful at first, but
may become over time.
Treatment is difficult, because the dislocation recurs but not exceptional.
The non-surgical brace contention is rarely effective, while the plaster pelvicrural may allow the hip to stabilize position of reduction.
The reduction by direct approach with a capsule capsuloraphie willingly obliged and the femoral and pelvic osteotomies may ensure the stability of the hip (Bennet GC, Rang M, Roye DP and Aprin H., 1982).
Epiphysiolysis The hip is also known association with Down syndrome.
Hypothyroidism may be a predisposing factor, and thyroid function would be readily studied in children with Down syndrome and epiphysiolysis.
The treatment is fixation (screws) in situ, with its risk of failure of equipment.
The indications for hip replacement are still rare here clearly demonstrated their interest.
The general aging of the population (life expectancy) should see some increase in subjects instructions here still “young” (dysplasia).
The risk of infection seems very reasonable, if not identical to the rest of the population, although extraordinary and terrible complications from surgery can make the bed (pneumonia, mechanical ventilation, fistula hip).

Pascal Duquenne , actor, winner ( a tie with Daniel Auteuil ) the best actor award at Cannes 1996for his performance in the movie The Eighth Day of Jaco Van Dormael.
Chris Burke , American actor known for having played for four seasons, the role of Corky in the TV series Corky, a boy like no other ( 1989).
Nathalie Nechtschein , French writer and poet, one of whose text is found on the album D’Elles of Celine Dion.
Stephane Ginnsz first actor with Down syndrome to achieve, in 1995the leading role in a movie called Duo , telling the story of a young boy with Down syndrome in love with a violinist whose dream is to one day accompany on piano. Winner of Martin Scorsese and Warner Bros. Pictures prices, official entry at the 23rd Academy Awards in the Student Film category, a finalist at the International Festival of Films for Children in Chicago (all in 1996), and was nominated for a TASH Award ( 1997).

People with the syndrome have a life somewhat more difficult than the average course they are victims of their physical and mental retardation, but more often anxious or hostile gaze of some concern that their anomaly is not yet contagious and the more familiar and less desperate for many families congenital.
The Down syndrome need to develop an emotional and sociable, like everyone else. It is necessary for families to take the advice of specialists who will help to stimulate and encourage intellectual progress and physical (muscular rehabilitation, adapted physical activity ) of the subject.
Among other rules of communication, it is recommended to speak with clear and concise sentences, answer questions appropriately and with a short delay.
It has long been hidden in places specializing in children with Down syndrome. Their existence was so terrible and very short, their average life expectancy does not exceed adolescence. Wherever possible it is advisable not to confine the children with Down syndrome attending a specialized center: many studies show that contact with school children and ordinary has a tremendous positive impact on the overall development and the IQ of patient with trisomy (IQ ranging from about 20 to 80, according to various parameters, including intellectual stimulation offered by the environment). With a consideration of their physiological deficiencies and treating them as thinking beings and loving they are, medicine is now put to them a nearly normal life expectancy and it is not uncommon for them to take a place in the workforce.
The WHO describes a Qi between 50 and 69 of delayed light: people experiencing difficulties at school, however, are able to integrate into society independently in adulthood. The people excited and properly processed reaching a greater number are considered as contrary to “normal” on an intellectual level.

Several studies conducted in the United States or the United Kingdom have shown that 90 to 93% of pregnancies that resulted in the diagnosis of Down syndrome were terminated 9. These figures may give rise to charges of eugenics 10. Some associations of Disability Advocates argue that such abortions send a very demeaning to those affected: “It is better not to exist than to have a disability”

The diagnosis can be done by highlighting the chromosome 21again by the karyotype . In the first quarter by a levy of trophoblast that is made from 11 weeks to 14 weeks. In addition, the risk of iatrogenic abortion increases significantly. Before it is 1% as for amniocentesis. After it takes a puncture amniotic fluid cells to examine the fetus. When the due date is near, we must perform a puncture of fetal blood by puncturing the umbilical cord because the realization of the karyotype requires only a few days while it takes several weeks by amniocentesis.

The signs of Down syndrome during first quarter
Ultrasound [edit]
This technical assessment of trisomy 21 (and other aneuploidies ) owes much to Professor K. Nicolaides of the Fetal Medicine Foundation in London.
The marker used is ultrasound nuchal translucency . The measurement technique must meet strict criteria.
There is another sonographic marker but as more delicate: the nasal bone.

Mega bladder in a 11-week embryo carrying a trisomy 21

Bladder in a normal embryo of 12 weeks

Biology [edit]
The substances used are the HCG free and PAPP-A ( pregnancy-associated plasma protein A )
The signs of the second quarter [change]
Ultrasound [edit]
No evidence ultrasound is symptomatic of trisomy 21. However, it can sometimes highlight a number of minor or major abnormalities occur more frequently in this chromosomal disorder.
Minor anomalies :
hypoplasia or absence of bones of the nose,
short femur, below the 5 th percentile for age,
thick neck above 6 mm at 20 weeks
large gap between first and second toe,
brevity of the second phalanx of the fifth finger (brachymésophalangie)
protruding tongue …
Major anomalies :
heart defects ( atrioventricular canal and in particular) (in 40% of cases)
of stenosis gastrointestinal (in 10 to 18% of cases) (image “double bubble” of duodenal stenosis).
Biochemistry [edit]
The evaluation is between 14 +0 weeks of gestation and 17 6 weeks gestation. The markers used are the alpha-fetoprotein and hCG free. Some laboratories add the estriol plasma but adding the third marker increases the sensitivity and is in fact little used. The technical evaluation of three serum markers is called the triple test . Some laboratories weight the result according to the weight of the patient and / or the number of cigarettes smoked per day.

Having signed relevant: this table based on article published in the British Medical Journal summarizes the available signs in screening for Down syndrome. The markers in italics are currently being evaluated8.
Different markers for the detection of trisomy 21
Markers Risk factor
Maternal
Maternal age Increases with age (age is used in the algorithm of calculating integrated)
Serum markers
Total HCG Increases in Second Quarter
Beta HCG free Increases in first quarter
Alpha fetoprotein Decreases in the second quarter
Free Estriol Decreases in the second quarter
PAPP-A Decreases in the first quarter
Inhibin Increases in Second Quarter
ADAM12 Decreases in the first quarter
Sonographic markers
Nuchal Increase
Nasal bone Absence
Doppler of ductus venosus Abnormal increase in the pulsatility index
Regurgitation at the tricuspid valve Presence

In practice, the calculation of risk of trisomy 21 [edit]
The risk calculation is based on the risk a priori , which is a function of gestational age and maternal age. Indeed, the risk of trisomy 21 decreases during pregnancy because approximately 30% of fetuses with trisomy 21 die in utero.
Evolution of total number of pregnancies with a trisomy 21 birth, according to maternal age and gestational
Maternal age Gestational age in weeks
12 16 20 40
20 1068 1200 1295 1527
25 946 1062 1147 1352
30 626 703 759 895
31 543 610 658 776
32 461 518 559 659
33 383 430 464 547
34 312 350 378 446
35 249 280 302 356
36 196 220 238 280
37 152 171 185 218
38 117 131 142 167
39 89 100 108 128
40 68 76 82 97
41 51 57 62 73
42 38 43 46 55
Before the test, a woman has a risk of having an affected fetus with trisomy 21: is the risk pre-test. After the test, a woman has a risk of having an affected fetus with trisomy 21: the risk posttest. The likelihood ratio or likehood ratio multiplier is the number that skips risk pre-test risk post-test.
If a sign is present in 50% of fetuses with Down syndrome and 5% non-affected fetuses, the likelihood ratio is 10, that is to say that the risk is multiplied by 10. The likelihood ratio is also true in the other direction. If a sign is present in 20% of fetuses with Down syndrome and 40% among non-affected fetuses, the likelihood ratio is 0.5 which is to say that the risk is divided by 2.
It should also be on the signs used are not linked it to say that one does depends on the other. Signs must be statistically independent.
The integrated risk is carried by some obstetricians to say the risk given by the measurement of nuchal translucency and the risk provided by the dosages of HCG and alpha-feto-protein (blood test proposed in France to all pregnant women) is the integration of all likelihood ratios. It requires the use of software that eliminates the risk of breast in a two calculations.
The risk from which makes a karyotype depends on the countries it is 1 / 300 in England and 1 / 250 in France.

Trisomy 21 is the most common cause of mental retardation , accounting for 25% of mental retardation among children of school age 7. These are among the chromosomal abnormalities seen during pregnancy, those whose incidence is higher: around 1 / 770 births or 1.3 per 1000 births. Currently, with the use of modern screening the proportion has been postponed to 1 / 2000 births. In France there are 65 000 to 70 000 individuals with trisomy 21.
The principle of evaluation is therefore to assess the risk of trisomy 21 in order to decide whether the risk of puncture is tolerable. The purpose of the assessment of risk is when the risk is high, to allow for parents to decide whether to pursue a amniocentesis to diagnose it. The threshold is an arbitrary choice, it is difficult to compare the risk of killing a healthy fetus with that permit the birth of a child with Down syndrome.
The purpose of screening is based on one or more clinical parameters or para-clinical, to separate into two women pregnant subpopulations:
A population whose risk is considered low and why we’ll refrain from conducting any invasive sampling, explaining, however, that zero risk does not exist and it must not ignore the fact that a minimal risk persists .
An estimated population at high risk for an invasive procedure which will be proposed to the couple after information regarding the risk of the diagnostic method used.
The risk assessment relies on statistical methods and following probabilities:
Have relevant evidence, that is to say about the sensitivity , specificity, positive predictive value and negative and finally the prevalence of the sign.
To calculate the individual probability of having a patient has a given disease after passing a test and assuming a baseline risk determined in the population belongs to the patient: using Bayes theorem.