Stilbestrol by Sharpe and Dohme, Box of 25 Ampoules 1 cc. size

Diethylstilbestrol or DES was sold under many different names

Stilbestrol
Watch @DES_Journal diaporama and DES drugs album on Flickr.

Diethylstilbestrol or DES was sold under many different names including Benzestrol®, Distilbène®, Stilbestrol®, Stilbetin®, Stilboestrol-Borne®, Stilbosol® to name just a few… Several pharmaceutical companies manufactured and marketed this drug under more than 200 different brand names.

Watch this DES drugs album on Flickr.

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Dr Now smartphone app connects you with qualified UK GPs through remote video consultation

Dr Now: the smartphone app that puts you in touch with a GP – for a fee

doctor-video image
New health apps exploit gaps in overstretched NHS by offering subscribers virtual consultation with a GP.

A UK tech firm is offering video consultations with doctors via mobile phone. The revolutionary Dr Now(®) platform connects patients with qualified GPs through remote video consultation to “give them the medical diagnosis they need, when they need it“.

The Dr Now website, which boasts it is the world’s first website to diagnose and deliver medicine, even has a corporate page that lets businesses calculate potential cost savings, based on the number of staff and average salary. It is in discussions with several big pharmaceutical companies.

Sources and more information

  • Dr Now: the smartphone app that puts you in touch with a GP – for a fee, theguardian, 2 August 2015.
  • Find the app on iTunes and GooglePlay.

Les perturbateurs endocriniens et la puberté précoce

Environnement et précocité pubertaire chez la fille

Intervention du Pr Charles Sultan, endocrinologue au CHU de Montpellier sur les perturbateurs endocriniens et la puberté précoce, lors de la table-ronde “Perturbateurs endocriniens : effets et mécanismes d’action de la conception à la maturité” organisée par WECF le 10 avril 2012 à l’Assemblée nationale.

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Less is more, choosing healthcare wisely

In medicine, more is not always better…

List of factors that contribute to Inappropriate Health Care infographic
Patients and healthcare providers can work together to pursue care that improves health outcomes, all the while minimizing harm and unnecessary interventions. If we avoid testing and treating when is not needed, we can focus on doing more of the things that really matter.

I’m constantly working on this list of factors that contribute to Inappropriate Health Care – and the things that can save us from it. I usually expand on each of these in my talks with examples and references.

If you have any suggestions for changes or additions, or would like to use this graphic in any way, please let me know via email .
Dr. Jessica Otte

Sources and more information

Very late recurrence of DES-related clear cell carcinoma of the cervix

Long term surveillance of DES exposed women is a must

image of clear-cell-carcinoma-of-the-cervix
This 2015 case demonstrates the need and the importance for continued and frequent follow-up examination in individuals prenatally exposed to diethylstilbestrol.

2015 Study Abstract

Clear cell adenocarcinoma of the cervix is a rare tumor of the lower genital tract. It has been described in young women with a history of intra uterine exposure to diethylstilbestrol. This tumor is characterized by a greater tendency for late recurrences. In this article, we report the case of one exposed-patient who developed recurrence as liver metastases, 24 years after the initial treatment. This case demonstrates the need and the importance for continued follow-up in individuals prenatally exposed to diethylstilbestrol.

2015 Study Conclusions

To summarize, this case represents the longest reported disease-free interval till recurrence and the first description of metastatic liver disease of DES related clear cell adenocarcinoma of the cervix. It reemphasizes the necessity of long term surveillance of DES exposed women and confirms previous reports recommending the importance of frequent follow-up examination not only of the pelvis but also of all distant potential sites of metastasis. It also shows that treatment with paclitaxel, carboplatin and bevacizumab can be an effective and safe therapeutic option for treating recurrence of this rare tumor.

Sources and more information
  • Very late recurrence of Diethylstilbestrol – related clear cell carcinoma of the cervix: case report,Ablavi Adani-Ifè, Emma Goldschmidt, Pasquale Innominato, Ayhan Ulusakarya, Hassan Errihani, Philippe Bertheau and Jean François Morère, Gynecologic Oncology Research and Practice 2015, $article.volume.volumeNumber:3 doi:10.1186/s40661-015-0010-5, gynoncrp.com/content/2/1/3, 17 July 2015.
  • Gynecologic Oncology Research and Practice PDF case report.
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Is Fracking Clean and Safe enough?

What the frack are we doing to our planet?

Cartoonist Mike Keefe has his doubts about the safety of fracking.
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Clear cell carcinoma of the cervix: a multi-institutional review in the post-DES era

Patients with low risk early stage CCCC may be managed with radical surgery alone

Cervix Normal Squamocolumnar Junction
This 2008 study results suggest that patients with low risk early stage CCCC may be managed with radical surgery alone, without the need for adjuvant chemotherapy or radiation.
Cervix: Normal Squamocolumnar Junction image by Ed Uthman.

2008 Study Abstract

Objective
To conduct an outcome analysis of patients with cervical clear cell carcinoma (CCCC) in the post-DES era.

Methods
A retrospective review was conducted at 3 major gynecologic cancer centers of all primary CCCC between 1982 and 2004.

Results
CCCC was confirmed in 34 patients. Median age was 53 years. DES exposure was confirmed in 2 (6%) patients. A history of smoking was elicited in 22%, and of abnormal Pap smear 18% patients. Primary surgical resection was performed in all stage I or IIA patients (n=26); they displayed superior 3-year overall survival (OS) compared to advanced stage (n=8) patients (91% vs. 22%, p<0.001). Pelvic lymph node involvement was noted in 25%; all patients with positive para-aortic nodes (20% of patients sampled) had positive pelvic nodes. All node positive patients were treated with adjuvant radiation, but nevertheless displayed reduced progression free (31% vs 92%, p<0.001) and overall survival (80% vs. 100%, p=0.02). Adjuvant radiotherapy did not appear to impact OS in patients with negative lymph nodes.

Discussion
This series provides insight into the management of early stage CCCC in the post-DES era. Although these patients may be at slightly higher risk of nodal spread, clear cell histology by itself does not appear to portend a worse prognosis than squamous cell carcinoma of the cervix in the absence of traditional risk factors. Our data suggest that patients with low risk early stage CCCC may be managed with radical surgery alone, without the need for adjuvant chemotherapy or radiation.

Sources and more information
  • Clear cell carcinoma of the cervix: A multi-institutional review in the post-DES era, M. Bijoy Thomas, Jason D. Wright, Aliza L. Leiser, Dennis S. Chi, David G. Mutch, Karl C. Podratz, and Sean C. Dowdya,, Gynecol Oncol. 10.1016/j.ygyno.2008.02.007, NCBI PMC3667392, 2008 Apr 3.
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Could we use a simple and easy routine eye test to screen every baby for autism?

Why use eye-tracking to predict autism?

While we can reliably diagnose autism spectrum disorder (ASD) at 24 months, most children are diagnosed much later. This is largely due to:

  • a lack of resources,
  • poor adherence to screening guidelines
  • and the fact that primary care physicians are often uncomfortable talking about autism risk to parents.

But what if we could use a simple and easy, routine eye test to screen every baby for autism?

baby-looking-up image
For children with autism, early intervention is critical. Therapies and education – especially in the first two years of life – can facilitate a child’s social development, reduce familial stress and ultimately improve quality of life.
Looking Up image by Jason Pratt.
  • Why use eye-tracking to predict autism?
  • What does ‘risk’ of autism mean?
  • How do you treat a child “pre-diagnosed” with autism?
  • Not a diagnosis, but a pre-preexisting condition

Read Are we ready for a test that could ‘pre-diagnose’ autism in babies?,
by Karen Rommelfanger, Jennifer Sarrett, The Conversation, July 31 2015.