Spyware Netherlands

Spyware Netherlands--Spyware Netherlands

Spyware is de naam voor computerprogramma's (of delen daarvan) die informatie vergaren over een computergebruiker en deze doorsturen naar een externe partij. Het doel van spyware is meestal om geld te verdienen. De term komt van het Engelse woord spy, dat spion betekent, en het achtervoegsel ware, dat aangeeft dat het om software gaat.


De opkomst van spyware is mede het gevolg van het illegaal kopiëren van software. De programmamakers zoeken, nu ze minder inkomsten uit verkopen halen, naar andere manieren om geld te verdienen. Het toevoegen van spyware aan een programma is een manier. Zo zijn er bijvoorbeeld twee versies van het peer-to-peerprogramma Kazaa: de ene kost geld, de andere bevat spyware. Naast deze commerciële vorm van spyware bestaat er ook een vorm met meer criminele doeleinden.


Meestal weten gebruikers niet van de spywarefunctie van een programma. Er zijn echter varianten waarbij gebruikers wel over de spywarefunctionaliteiten ingelicht worden. Vaak vindt dit dan op een listige wijze in de algemene voorwaarden plaats. Detectieprogramma's kunnen gebruikt worden om de spyware na installatie te ontdekken en eventueel te verwijderen. Deze werking is anders dan bij virusscanners. Deze voorkomen namelijk installatie van ongewenste programma's. Men moet wel opletten voor slechte, valse en malafide spyware-detectieprogramma's. Een aantal van deze programma's werkt slecht, of probeert de gebruiker aan te zetten tot het kopen van een betaalde variant, door middel van het geven van valse positieven, of door zelf spyware of adware te installeren.


In de laatste jaren is spyware een van de grootste gevaren geworden voor computers waarop Microsoft Windows gebruikt wordt. Dit geldt speciaal voor gebruikers van Internet Explorer, vanwege de nauwe integratie van deze webbrowser met het Windows-besturingssysteem.


Malwarevarianten


Spyware mag niet verward worden met andere soorten malware, ook al zijn er vaak wel bepaalde overlappingen. Het specifieke aan spyware is dat het gaat om spioneren: het aftappen van gegevens. Meestal wordt de informatie gebruikt voor reclamedoeleinden.


Adware laat reclameboodschappen aan de gebruiker zien. Deze kunnen door middel van spyware op de gebruiker afgestemd zijn, maar dat is niet altijd het geval. Adware bevat dus soms spywarefunctionaliteit maar niet altijd.


Ook phishing is anders dan spyware. Door misleidende informatie proberen de phishers de gebruikers te laten denken dat ze met een echt bedrijf te maken hebben (bijvoorbeeld een bank) in plaats van een neppagina. Vervolgens vragen de phishers of de gebruikers gegevens aan hen verstrekken. Deze werkwijze is dus anders dan bij spyware.


Een Trojaans paard is software die zonder medeweten van de gebruiker op zijn computer geïnstalleerd wordt en op die computer handelingen kan gaan verrichten. De handelingen die verricht worden, worden door het programma zelf aangestuurd. Deze handelingen kunnen onder andere bestaan uit het aanrichten van schade. Deze malwarevariant doet dus meer dan het enkel vergaren van gegevens.


Een keylogger registreert toetsaanslagen op een computer en kan de vergaarde gegevens doorsturen naar een andere computer. Dit is vaak een vorm van spyware.


Een autodialer is een programma dat automatisch het inbelnummer op een computer verandert. Vaak wordt dit veranderd in een nummer waarvoor een hoog bedrag per minuut betaald moet worden. Dit is geen spyware omdat het geen gegevens verzamelt.
[bewerken] Spyware en virussen


Spywareprogramma's lijken in zekere zin op computervirussen. Beide worden geïnstalleerd zonder dat de gebruiker er iets van weet en beide hebben nadelige gevolgen voor de gebruiker. Ook veroorzaken beide vaak instabiliteit van het besturingssysteem. Maar er zijn toch wat verschillen.


Een virus kopieert zichzelf: het zal proberen andere computers te infecteren. Spyware kopieert zichzelf in het algemeen niet. Virussen verspreiden zichzelf (met hulp van computergebruikers die onvoorzichtig met hun computer omgaan) op een zo onopvallend mogelijke manier om maar niet ontdekt te worden. Spyware wordt verspreid door programma's juist duidelijk aan te prijzen, zodat ze door onwetende gebruikers worden uitgevoerd.


Spyware installeert zichzelf op zo'n manier dat het steeds mee opstart als de computer gestart wordt, waarbij het processortijd en geheugen gebruikt en het systeem instabiel kan maken.


Spywareprogramma's kunnen bijvoorbeeld bijhouden welke websites er worden bezocht, welke e-mails worden verstuurd, welke programma's geïnstalleerd zijn, enzovoort. Het kan in virussen zitten, maar meestal zit het bijgeleverd bij bepaalde programma's (zoals Bonzi Buddy, CometCursor en Kazaa). Ook bepaalde cookies kunnen als spyware worden beschouwd: iemands surfgedrag over diverse websites kan worden getraceerd als de reclamebanners op die diverse websites vanuit één centrale server worden verzorgd.
[bewerken] Bekende programma's die spyware mee installeren


Kazaa
Kazaa lite (minder dan Kazaa weliswaar, maar draait men Spybot Search & Destroy na het installeren van Kazaa Lite, dan vindt deze enige spyware en na verwijdering hiervan door Spybot S&D werkt Kazaa Lite niet meer)
DivX (behalve voor de betaalde versies en de 'standaard'-versie zonder de encoder)
eXeem™ (volgens sommige gebruikers gaat eXeem vergezeld van spyware, niet bevestigd)
Morpheus
Grokster
Messenger Plus! (optionele sponsor, in de laatste versie is er geen sponsor meer aanwezig)
BSPlayer (de gratis variant)


[bewerken] Spyware en de wet
[bewerken] Nederland
[bewerken] Strafbaarheid


Het gebruik van spyware is onder bepaalde omstandigheden strafbaar. Zo is het bij wet verboden om zonder toestemming een computerprogramma op iemands harde schijf te installeren. De juridische term hiervoor is computervredebreuk en staat vermeld in artikel 138ab Wetboek van Strafrecht en artikel 144a Wetboek van Strafrecht BES. Een lacune in de wet is dat deze spyware toelaatbaar acht wanneer de algemene voorwaarden melding maken van de spyware — zelfs als dit op een zeer onduidelijke wijze gebeurt. Daarnaast maakt spyware computers instabiel door slecht programmeerwerk. Dit valt onder het strafrechtelijk delict vernieling van geautomatiseerde bestanden door schuld.


Tevens verzamelt spyware persoonsgegevens zonder toestemming, hetgeen in strijd is met de privacywetgeving: 'de Wet bescherming persoonsgegevens'. Ook kan spyware in strijd zijn met artikel 4.1 van 'Het besluit universele dienstverlening en eindgebruikersbelangen'. Deze bepaling luidt als volgt:


1. Een ieder die door middel van elektronische communicatienetwerken toegang wenst te verkrijgen tot gegevens die zijn opgeslagen in de randapparatuur van een abonnee of gebruiker van openbare elektronische communicatiediensten dan wel gegevens wenst op te slaan in de randapparatuur van de abonnee of gebruiker van openbare elektronische communicatiediensten, dient voorafgaand aan de desbetreffende handeling de abonnee of gebruiker:


a. op een duidelijke en nauwkeurige wijze te informeren omtrent de doeleinden waarvoor men toegang wenst te verkrijgen tot de desbetreffende gegevens dan wel waarvoor men gegevens wenst op te slaan en


b. op voldoende kenbare wijze gelegenheid te bieden de desbetreffende handeling te weigeren.
[bewerken] Handhaving


Een gebruiker kan zelf het bedrijf in rechte aanspreken tegen diens handelwijze. Ook is het College Bescherming Persoonsgegevens bevoegd een boete per overtreding op te leggen wanneer de privacywetgeving is overtreden. Daarnaast is de OPTA bevoegd om op te treden en boetes op te leggen. Tot slot is ook het OM belast met de opsporing.


Een struikelblok in de handhaving van de gestelde regels, is dat men meestal niet kan nagaan waar de spyware vandaan komt. In de gevallen waarin dit wel lukt, blijkt meestal het bedrijf buiten Europa gevestigd te zijn, en zullen instanties als het CBP, het OM en de OPTA machteloos staan.


In Europa is enkel één Duitse rechtszaak aangaande spyware bekend (Hertz versus Claria). In de VS zijn meerdere rechtszaken gevoerd met uiteenlopende uitspraken.


De eerste Nederlandse (en Europese) maatregel tegen spyware: OPTA heeft boetes opgelegd van in totaal 1 miljoen euro. Het gaat over de besmetting van 22 miljoen computers. De spyware heet DollarRevenue. Het betreft een overtreding van art. 4.1 van het bovenvermelde besluit. De boetes zijn opgelegd volgens art. 15.4 en art. 15.10 van de Telecommunicatiewet. Een deel van deze boetes moet betaald worden door de directeurs zelf.[1] Door een bezwaarprocedure moeten de boetes pas betaald worden nadat een rechter hierover uitspraak gedaan zal hebben. De verdachten beweren dat het bewijs illegaal werd verzameld. OPTA heeft de namen van de bedrijven en hun directeurs niet bekendgemaakt omdat het niet duidelijk is of OPTA dergelijke informatie openbaar mag maken.[

spyware

spyware--spyware--spyware

Spyware is a type of malware (malicious software) installed on computers that collects information about users without their knowledge. The presence of spyware is typically hidden from the user and can be difficult to detect. Typically, spyware is secretly installed on the user's personal computer. However, some spyware such as keyloggers may be installed by the owner of a shared, corporate, or public computer on purpose in order to secretly monitor other users.


While the term spyware suggests software that monitors a user's computing, the functions of spyware can extend beyond simple monitoring. Spyware programs can collect various types of personal information, such as Internet surfing habits, a history of visited sites, and user logins and passwords. Spyware can also interfere with user control of a computer in other ways, such as installing additional software or redirecting web Web browsers. Some spyware can change computer settings, resulting in slow Internet connection speeds, un-authorized changes in home pages, loss of Internet connection, or functionality of other software. Sometimes, spyware is included along with genuine software, and may come from an official software vendor. In an attempt to increase the understanding of spyware, a more formal classification of its included software types is provided by the term privacy-invasive software.


In response to the emergence of spyware, a small industry has sprung up dealing in anti-spyware software. Running anti-spyware software has become a widely recognized element of computer security practices for computers, especially those running Microsoft Windows. A number of jurisdictions have passed anti-spyware laws, which usually target any software that is surreptitiously installed to control a user's computer.


History and development


The first recorded use of the term spyware occurred on 16 October 1995 in a Usenet post that poked fun at Microsoft's business model.[1] Spyware at first denoted software meant for espionage purposes. However, in early 2000 the founder of Zone Labs, Gregor Freund, used the term in a press release for the ZoneAlarm Personal Firewall.[2] Since then, "spyware" has taken on its present sense.[2]


According to a 2005 study by AOL and the National Cyber-Security Alliance, 61 percent of surveyed users' computers were infected with form of spyware. 92 percent of surveyed users with spyware reported that they did not know of its presence, and 91 percent reported that they had not given permission for the installation of the spyware.[3] As of 2006, spyware has become one of the preeminent security threats to computer systems running Microsoft Windows operating systems. Computers on which Internet Explorer (IE) is the primary browser are particularly vulnerable to such attacks, not only because IE is the most widely-used,[4] but because its tight integration with Windows allows spyware access to crucial parts of the operating system.[4][5]


Before Internet Explorer 6 SP2 was released as part of Windows XP Service Pack 2, the browser would automatically display an installation window for any ActiveX component that a website wanted to install. The combination of user ignorance about these changes, and the assumption by Internet Explorer that all ActiveX components are benign, helped to spread spyware significantly. Many spyware components would also make use of exploits in Javascript, Internet Explorer and Windows to install without user knowledge or permission.


The Windows Registry contains multiple sections where modification of key values allows software to be executed automatically when the operating system boots. Spyware can exploit this design to circumvent attempts at removal. The spyware typically will link itself from each location in the registry that allows execution. Once running, the spyware will periodically check if any of these links are removed. If so, they will be automatically restored. This ensures that the spyware will execute when the operating system is booted, even if some (or most) of the registry links are removed. (The detection and removal is very difficult)even with up-to-date softwares.
[edit] Comparison
[edit] Spyware, adware and tracking


The term adware frequently refers to any software which displays advertisements, whether or not the user has consented. Programs such as the Eudora mail client display advertisements as an alternative to shareware registration fees. These may be classified as "adware", in the sense of advertising-supported software, but not as spyware. Adware in this form does not operate surreptitiously or mislead the user, and provides the user with a specific service.


Most adware is spyware in a different sense than "advertising-supported software": it displays advertisements related to what it finds from spying on users. Gator Software from Claria Corporation (formerly GATOR) and Exact Advertising's BargainBuddy are examples. Visited Web sites frequently install Gator on client machines in a surreptitious manner, and it directs revenue to the installing site and to Claria by displaying advertisements to the user. The user is shown many pop-up advertisements.


Other spyware behavior, such as reporting on websites the user visits, occurs in the background. The data is used for "targeted" advertisement impressions. The prevalence of spyware has cast suspicion on other programs that track Web browsing, even for statistical or research purposes. Some observers describe the Alexa Toolbar, an Internet Explorer plug-in published by Amazon.com, as spyware, and some anti-spyware programs such as Ad-Aware report it as such. Many of these adware-distributing companies are backed by millions of dollars of adware-generating revenues. Adware and spyware are similar to viruses in that they can be considered malicious in nature. People are profiting from misleading adware, sometimes known as scareware, such as Antivirus 2009.


Similarly, software bundled with free, advertising-supported programs acts as spyware (and, if removed, disables the 'parent' program), yet people are willing to download it. This presents a dilemma for proprietors of anti-spyware products whose removal tools may inadvertently disable wanted programs. For example, WhenUSave is ignored by popular anti-spyware program Ad-Aware (but removed as spyware by most scanners) because it is part of the popular (but recently decommissioned) eDonkey client.[6] To address this dilemma, the Anti-Spyware Coalition was formed in 2005 to establish and document best practices regarding acceptable software behavior.[2] Its website however does not appear to have been updated since late 2008.
[edit] Spyware, viruses and worms


Unlike viruses and worms, spyware does not usually self-replicate. Like many recent viruses, however, spyware—by design—exploits infected computers for commercial gain. Typical tactics include delivery of unsolicited pop-up advertisements, theft of personal information (including financial information such as credit card numbers), monitoring of Web-browsing activity for marketing purposes, and routing of HTTP requests to advertising sites.


However, spyware can be dropped as a payload by a worm.
[edit] Routes of infection
Malicious websites attempt to install spyware on readers' computers.


Spyware does not directly spread in the manner of a computer virus or worm: generally, an infected system does not attempt to transmit the infection to other computers. Instead, spyware gets on a system through deception of the user or through exploitation of software vulnerabilities.


Most spyware is installed without users' knowledge. Since they tend not to install software if they know that it will disrupt their working environment and compromise their privacy, spyware deceives users, either by piggybacking on a piece of desirable software such as Kazaa, or by tricking them into installing it (the Trojan horse method). Some "rogue" spyware programs masquerade as security software.


The distributor of spyware usually presents the program as a useful utility—for instance as a "Web accelerator" or as a helpful software agent. Users download and install the software without immediately suspecting that it could cause harm. For example, Bonzi Buddy, a program bundled with spyware[7] and targeted at children, claims that:


He will explore the Internet with you as your very own friend and sidekick! He can talk, walk, joke, browse, search, e-mail, and download like no other friend you've ever had! He even has the ability to compare prices on the products you love and help you save money! Best of all, he's FREE![8]


Spyware can also come bundled with other software. The user downloads a program and installs it, and the installer additionally installs the spyware. Although the desirable software itself may do no harm, the bundled spyware does. In some cases, spyware authors have paid shareware authors to bundle spyware with their software. In other cases, spyware authors have repackaged desirable freeware with installers that slipstream spyware.


Some spyware authors infect a system through security holes in the Web browser or in other software. When the user navigates to a Web page controlled by the spyware author, the page contains code which attacks the browser and forces the download and installation of spyware. The spyware author would also have some extensive knowledge of commercially-available anti-virus and firewall software. This has become known as a "drive-by download", which leaves the user a hapless bystander to the attack. Common browser exploits target security vulnerabilities in Internet Explorer and in the Sun Microsystems Java runtime.


The installation of spyware frequently involves Internet Explorer. Its popularity and history of security issues have made it the most frequent target. Its deep integration with the Windows environment and scriptability make it an obvious point of attack into Windows. Internet Explorer also serves as a point of attachment for spyware in the form of Browser Helper Objects, which modify the browser's behavior to add toolbars or to redirect traffic.


In a few cases, a worm or virus has delivered a spyware payload. Some attackers used the Spybot worm to install spyware that put pornographic pop-ups on the infected system's screen.[9] By directing traffic to ads set up to channel funds to the spyware authors, they profit personally.
[edit] Effects and behaviors


A spyware program is rarely alone on a computer: an affected machine usually has multiple infections. Users frequently notice unwanted behavior and degradation of system performance. A spyware infestation can create significant unwanted CPU activity, disk usage, and network traffic. Stability issues, such as applications freezing, failure to boot, and system-wide crashes, are also common. Spyware, which interferes with networking software, commonly causes difficulty connecting to the Internet.


In some infections, the spyware is not even evident. Users assume in those situations that the performance issues relate to faulty hardware, Windows installation problems, or another infection. Some owners of badly infected systems resort to contacting technical support experts, or even buying a new computer because the existing system "has become too slow". Badly infected systems may require a clean reinstallation of all their software in order to return to full functionality.


Only rarely does a single piece of software render a computer unusable. Rather, a computer is likely to have multiple infections. The cumulative effect, and the interactions between spyware components, causes the symptoms commonly reported by users: a computer, which slows to a crawl, overwhelmed by the many parasitic processes running on it. Moreover, some types of spyware disable software firewalls and anti-virus software, and/or reduce browser security settings, thus opening the system to further opportunistic infections, much like an immune deficiency disease. Some spyware disables or even removes competing spyware programs, on the grounds that more spyware-related annoyances make it even more likely that users will take action to remove the programs. One spyware maker, Avenue Media, even sued a competitor, Direct Revenue, over this; the two later settled with an agreement not to disable each others' products.[10]


Some other types of spyware use rootkit like techniques to prevent detection, and thus removal. Targetsoft, for instance, modifies the "Winsock" Windows Sockets files. The deletion of the spyware-infected file "inetadpt.dll" will interrupt normal networking usage.


A typical Windows user has administrative privileges, mostly for convenience. Because of this, any program the user runs (intentionally or not) has unrestricted access to the system. As with other operating systems, Windows users too are able to follow the principle of least privilege and use non-administrator least user access accounts, or to reduce the privileges of specific vulnerable Internet-facing processes such as Internet Explorer (through the use of tools such as DropMyRights). However, as this is not a default configuration, few users do this.


In Windows Vista, by default, a computer administrator runs everything under limited user privileges. When a program requires administrative privileges, Vista will prompt the user with an allow/deny pop-up (see User Account Control). This improves on the design used by previous versions of Windows.
[edit] Advertisements


Many spyware programs display advertisements. Some programs simply display pop-up ads on a regular basis; for instance, one every several minutes, or one when the user opens a new browser window. Others display ads in response to the user visiting specific sites. Spyware operators present this feature as desirable to advertisers, who may buy ad placement in pop-ups displayed when the user visits a particular site. It is also one of the purposes for which spyware programs gather information on user behavior.


Many users complain about irritating or offensive advertisements as well. As with many banner ads, spyware advertisements often use animation or flickering banners, which can be visually distracting and annoying to users. Pop-up ads for pornography often display indiscriminately. Links to these sites may be added to the browser window, history or search function. When children are the users, this could possibly violate anti-pornography laws in some jurisdictions.


A number of spyware programs break the boundaries of illegality; variations of “Zlob.Trojan” and “Trojan-Downloader.Win32.INService” have been known to show undesirable child pornography, key gens, cracks and illegal software pop-up ads, which violate child pornography and copyright laws.[11][12][13][14]


A further issue in the case of some spyware programs concerns the replacement of banner ads on viewed web sites. Spyware that acts as a web proxy or a Browser Helper Object can replace references to a site's own advertisements (which fund the site) with advertisements that instead fund the spyware operator. This cuts into the margins of advertising-funded Web sites.
[edit] "Stealware" and affiliate fraud


A few spyware vendors, notably 180 Solutions, have written what the New York Times has dubbed "stealware", and what spyware researcher Ben Edelman terms affiliate fraud, a form of click fraud. Stealware diverts the payment of affiliate marketing revenues from the legitimate affiliate to the spyware vendor.


Spyware which attacks affiliate networks places the spyware operator's affiliate tag on the user's activity — replacing any other tag, if there is one. The spyware operator is the only party that gains from this. The user has their choices thwarted, a legitimate affiliate loses revenue, networks' reputations are injured, and vendors are harmed by having to pay out affiliate revenues to an "affiliate" who is not party to a contract.[15]


Affiliate fraud is a violation of the terms of service of most affiliate marketing networks. As a result, spyware operators such as 180 Solutions have been terminated from affiliate networks including LinkShare and ShareSale.[citation needed]
[edit] Identity theft and fraud


In one case, spyware has been closely associated with identity theft.[16] In August 2005, researchers from security software firm Sunbelt Software suspected the creators of the common CoolWebSearch spyware had used it to transmit "chat sessions, user names, passwords, bank information, etc.";[17] however it turned out that "it actually (was) its own sophisticated criminal little trojan that's independent of CWS."[18] This case is currently under investigation by the FBI.


The Federal Trade Commission estimates that 27.3 million Americans have been victims of identity theft, and that financial losses from identity theft totaled nearly $48 billion for businesses and financial institutions and at least $5 billion in out-of-pocket expenses for individuals.[19]


Spyware-makers may commit wire fraud with dialer program spyware. These can reset a modem to dial up a premium-rate telephone number instead of the usual ISP. Connecting to these suspicious numbers involves long-distance or overseas charges which invariably result in high call costs. Dialers are ineffective on computers that do not have a modem, or are not connected to a telephone line, and are now very rare due to the decline in use of dial-up internet access.
[edit] Digital rights management


Some copy-protection technologies have borrowed from spyware. In 2005, Sony BMG Music Entertainment was found to be using rootkits in its XCP digital rights management technology[20] Like spyware, not only was it difficult to detect and uninstall, it was so poorly written that most efforts to remove it could have rendered computers unable to function. Texas Attorney General Greg Abbott filed suit,[21] and three separate class-action suits were filed.[22] Sony BMG later provided a workaround on its website to help users remove it.[23]


Beginning on 25 April 2006, Microsoft's Windows Genuine Advantage Notifications application[24] was installed on most Windows PCs as a "critical security update". While the main purpose of this deliberately uninstallable application is to ensure the copy of Windows on the machine was lawfully purchased and installed, it also installs software that has been accused of "phoning home" on a daily basis, like spyware.[25][26] It can be removed with the RemoveWGA tool.
[edit] Personal relationships


Spyware has been used to surreptitiously monitor electronic activities of partners in intimate relationships, generally to uncover evidence of infidelity. At least one software package, Loverspy, was specifically marketed for this purpose. Depending on local laws regarding communal/marital property, observing a partner's online activity without their consent may be illegal; the author of Loverspy and several users of the product were indicted in California in 2005 on charges of wiretapping and various computer crimes.[27]
[edit] Browser cookies


Anti-spyware programs often report Web advertisers' HTTP cookies, the small text files that track browsing activity, as spyware. While they are not always inherently malicious, many users object to third parties using space on their personal computers for their business purposes, and many anti-spyware programs offer to remove them.[28]
[edit] Examples


These common spyware programs illustrate the diversity of behaviors found in these attacks. Note that as with computer viruses, researchers give names to spyware programs which may not be used by their creators. Programs may be grouped into "families" based not on shared program code, but on common behaviors, or by "following the money" of apparent financial or business connections. For instance, a number of the spyware programs distributed by Claria are collectively known as "Gator". Likewise, programs that are frequently installed together may be described as parts of the same spyware package, even if they function separately.


CoolWebSearch, a group of programs, takes advantage of Internet Explorer vulnerabilities. The package directs traffic to advertisements on Web sites including coolwebsearch.com. It displays pop-up ads, rewrites search engine results, and alters the infected computer's hosts file to direct DNS lookups to these sites.[29]


Internet Optimizer, also known as DyFuCa, redirects Internet Explorer error pages to advertising. When users follow a broken link or enter an erroneous URL, they see a page of advertisements. However, because password-protected Web sites (HTTP Basic authentication) use the same mechanism as HTTP errors, Internet Optimizer makes it impossible for the user to access password-protected sites.[30]


HuntBar, aka WinTools or Adware.Websearch, was installed by an ActiveX drive-by download at affiliate Web sites, or by advertisements displayed by other spyware programs—an example of how spyware can install more spyware. These programs add toolbars to IE, track aggregate browsing behavior, redirect affiliate references, and display advertisements.[31][32]


Movieland, also known as Moviepass.tv and Popcorn.net, is a movie download service that has been the subject of thousands of complaints to the Federal Trade Commission (FTC), the Washington State Attorney General's Office, the Better Business Bureau, and other agencies. Consumers complained they were held hostage by a cycle of oversized pop-up windows demanding payment of at least $29.95, claiming that they had signed up for a three-day free trial but had not cancelled before the trial period was over, and were thus obligated to pay.[33][34] The FTC filed a complaint, since settled, against Movieland and eleven other defendants charging them with having "engaged in a nationwide scheme to use deception and coercion to extract payments from consumers."[35]


WeatherStudio has a plugin that displays a window-panel near the bottom of a browser window. The official website notes that it is easy to remove (uninstall) WeatherStudio from a computer, using its own uninstall-program, such as under C:\Program Files\WeatherStudio.[36] Once WeatherStudio is removed, a browser returns to the prior display appearance, without the need to modify the browser settings.


Zango (formerly 180 Solutions) transmits detailed information to advertisers about the Web sites which users visit. It also alters HTTP requests for affiliate advertisements linked from a Web site, so that the advertisements make unearned profit for the 180 Solutions company. It opens pop-up ads that cover over the Web sites of competing companies (as seen in their [Zango End User License Agreement]).[15]


Zlob trojan, or just Zlob, downloads itself to a computer via an ActiveX codec and reports information back to Control Server[citation needed]. Some information can be the search-history, the Websites visited, and even keystrokes.[citation needed] More recently, Zlob has been known to hijack routers set to defaults.[37]


[edit] Legal issues
[edit] Criminal law


Unauthorized access to a computer is illegal under computer crime laws, such as the U.S. Computer Fraud and Abuse Act, the U.K.'s Computer Misuse Act, and similar laws in other countries. Since owners of computers infected with spyware generally claim that they never authorized the installation, a prima facie reading would suggest that the promulgation of spyware would count as a criminal act. Law enforcement has often pursued the authors of other malware, particularly viruses. However, few spyware developers have been prosecuted, and many operate openly as strictly legitimate businesses, though some have faced lawsuits.[38][39]


Spyware producers argue that, contrary to the users' claims, users do in fact give consent to installations. Spyware that comes bundled with shareware applications may be described in the legalese text of an end-user license agreement (EULA). Many users habitually ignore these purported contracts, but spyware companies such as Claria say these demonstrate that users have consented.


Despite the ubiquity of EULAs and of "clickwrap" agreements, under which a single click can be taken as consent to the entire text, relatively little caselaw has resulted from their use. It has been established in most common law jurisdictions that a clickwrap agreement can be a binding contract in certain circumstances.[40] This does not, however, mean that every such agreement is a contract, or that every term in one is enforceable.


Some jurisdictions, including the U.S. states of Iowa[41] and Washington,[42] have passed laws criminalizing some forms of spyware. Such laws make it illegal for anyone other than the owner or operator of a computer to install software that alters Web-browser settings, monitors keystrokes, or disables computer-security software.


In the United States, lawmakers introduced a bill in 2005 entitled the Internet Spyware Prevention Act, which would imprison creators of spyware.[43]
[edit] Administrative sanctions
[edit] US FTC actions


The US Federal Trade Commission has sued Internet marketing organizations under the "unfairness doctrine" [44] to make them stop infecting consumers’ PCs with spyware. In one case, that against Seismic Entertainment Productions, the FTC accused the defendants of developing a program that seized control of PCs nationwide, infected them with spyware and other malicious software, bombarded them with a barrage of pop-up advertising for Seismic’s clients, exposed the PCs to security risks, and caused them to malfunction, slow down, and, at times, crash. Seismic then offered to sell the victims an “antispyware” program to fix the computers, and stop the popups and other problems that Seismic had caused. On November 21, 2006, a settlement was entered in federal court under which a $1.75 million judgment was imposed in one case and $1.86 million in another, but the defendants were insolvent[45]


In a second case, brought against CyberSpy Software LLC, the FTC charged that CyberSpy marketed and sold "RemoteSpy" keylogger spyware to clients who would then secretly monitor unsuspecting consumers’ computers. According to the FTC, Cyberspy touted RemoteSpy as a “100% undetectable” way to “Spy on Anyone. From Anywhere.” The FTC has obtained a temporary order prohibiting the defendants from selling the software and disconnecting from the Internet any of their servers that collect, store, or provide access to information that this software has gathered. The case is still in its preliminary stages. A complaint filed by the Electronic Privacy Information Center (EPIC) brought the RemoteSpy software to the FTC’s attention.[46]
[edit] Netherlands OPTA


An administrative fine, the first of its kind in Europe, has been issued by the Independent Authority of Posts and Telecommunications (OPTA) from the Netherlands. It applied fines in total value of Euro 1,000,000 for infecting 22 million computers. The spyware concerned is called DollarRevenue. The law articles that have been violated are art. 4.1 of the Decision on universal service providers and on the interests of end users; the fines have been issued based on art. 15.4 taken together with art. 15.10 of the Dutch telecommunications law. A part of these fines has to be paid personally by the directors of these companies, i.e. not from the accounts of their companies, but from their personal fortunes.[47] Since an appeal has been lodged, the fines will have to be paid only after a Dutch law court makes a decision in this case. The culprits maintain that the evidence for violating the two law articles has been obtained illegally. The names of the directors and the names of the companies have not been revealed, since it is not clear that OPTA is allowed to make such information public.[48]
[edit] Civil law


Former New York State Attorney General and former Governor of New York Eliot Spitzer has pursued spyware companies for fraudulent installation of software.[49] In a suit brought in 2005 by Spitzer, the California firm Intermix Media, Inc. ended up settling, by agreeing to pay US$7.5 million and to stop distributing spyware.[50]


The hijacking of Web advertisements has also led to litigation. In June 2002, a number of large Web publishers sued Claria for replacing advertisements, but settled out of court.


Courts have not yet had to decide whether advertisers can be held liable for spyware that displays their ads. In many cases, the companies whose advertisements appear in spyware pop-ups do not directly do business with the spyware firm. Rather, they have contracted with an advertising agency, which in turn contracts with an online subcontractor who gets paid by the number of "impressions" or appearances of the advertisement. Some major firms such as Dell Computer and Mercedes-Benz have sacked advertising agencies that have run their ads in spyware.[51]
[edit] Libel suits by spyware developers


Litigation has gone both ways. Since "spyware" has become a common pejorative, some makers have filed libel and defamation actions when their products have been so described. In 2003, Gator (now known as Claria) filed suit against the website PC Pitstop for describing its program as "spyware".[52] PC Pitstop settled, agreeing not to use the word "spyware", but continues to describe harm caused by the Gator/Claria software.[53] As a result, other anti-spyware and anti-virus companies have also used other terms such as "potentially unwanted programs" or greyware to denote these products.
[edit] WebcamGate
Main article: Robbins v. Lower Merion School District


In the 2010 WebcamGate case, plaintiffs charged two suburban Philadelphia high schools secretly spied on students by surreptitiously and remotely activating webcams embedded in school-issued laptops the students were using at home, and therefore infringed on their privacy rights. The school loaded each student's computer with LANrev's remote activation tracking software. This included the now-discontinued "TheftTrack". While TheftTrack was not enabled by default on the software, the program allowed the school district to elect to activate it, and to choose which of the TheftTrack surveillance options the school wanted to enable.[54]


TheftTrack allowed school district employees to secretly remotely activate a tiny webcam embedded in the student's laptop, above the laptop's screen. That allowed school officials to secretly take photos through the webcam, of whatever was in front of it and in its line of sight, and send the photos to the school's server. The LANrev software disabled the webcams for all other uses (e.g., students were unable to use Photo Booth or video chat), so most students mistakenly believed their webcams did not work at all. In addition to webcam surveillance, TheftTrack allowed school officials to take screenshots, and send them to the school's server. In addition, LANrev allowed school officials to take snapshots of instant messages, web browsing, music playlists, and written compositions. The schools admitted to secretly snapping over 66,000 webshots and screenshots, including webcam shots of students in their bedrooms.[54][55]
[edit] Remedies and prevention


As the spyware threat has worsened, a number of techniques have emerged to counteract it. These include programs designed to remove or to block spyware, as well as various user practices which reduce the chance of getting spyware on a system.


Nonetheless, spyware remains a costly problem. When a large number of pieces of spyware have infected a Windows computer, the only remedy may involve backing up user data, and fully reinstalling the operating system. For instance, some versions of Vundo cannot be completely removed by Symantec, Microsoft, PC Tools, and others because it infects rootkit, Internet Explorer, and Windows' lsass.exe (Local Security Authority Subsystem Service) with a randomly-filenamed dll (dynamic link library).
[edit] Anti-spyware programs
See also: Category:Spyware removal


Many programmers and some commercial firms have released products dedicated to remove or block spyware. Steve Gibson's OptOut pioneered a growing category. Programs such as PC Tools' Spyware Doctor, Lavasoft's Ad-Aware SE (free scans for non-commercial users, must pay for other features) and Patrick Kolla's Spybot - Search & Destroy (all features free for non-commercial use) rapidly gained popularity as effective tools to remove, and in some cases intercept, spyware programs. On December 16, 2004, Microsoft acquired the GIANT AntiSpyware software,[56] rebranding it as Windows AntiSpyware beta and releasing it as a free download for Genuine Windows XP and Windows 2003 users. In 2006, Microsoft renamed the beta software to Windows Defender (free), and it was released as a free download in October 2006 and is included as standard with Windows Vista as well as Windows 7.


Major anti-virus firms such as Symantec, PC Tools, McAfee and Sophos have come later to the table, adding anti-spyware features to their existing anti-virus products. Early on, anti-virus firms expressed reluctance to add anti-spyware functions, citing lawsuits brought by spyware authors against the authors of web sites and programs which described their products as "spyware". However, recent versions of these major firms' home and business anti-virus products do include anti-spyware functions, albeit treated differently from viruses. Symantec Anti-Virus, for instance, categorizes spyware programs as "extended threats" and now offers real-time protection from them (as it does for viruses).


In June 2006, the anti-virus company Grisoft, creator of AVG Anti-Virus, acquired anti-spyware firm Ewido Networks, re-labeling their Ewido anti-spyware program as AVG Anti-Spyware Professional Edition. AVG also used this product to add an integrated anti-spyware solution to some versions of the AVG Anti-Virus family of products, and a freeware AVG Anti-Spyware Free Edition available for private and non-commercial use. This shows a trend by anti virus companies to launch a dedicated solution to spyware and malware. Zone Labs, creator of Zone Alarm firewall have also released an anti-spyware program.


Anti-spyware programs can combat spyware in two ways:


They can provide real time protection against the installation of spyware software on the computer. This type of spyware protection works the same way as that of anti-virus protection in that the anti-spyware software scans all incoming network data for spyware software and blocks any threats it comes across.
Anti-spyware software programs can be used solely for detection and removal of spyware software that has already been installed onto the computer. This type of spyware protection is normally much easier to use and more popular. With this spyware protection software the user can schedule weekly, daily, or monthly scans of the computer to detect and remove any spyware software that have been installed on the computer. This type of anti-spyware software scans the contents of the windows registry, operating system files, and installed programs on the computer and will provide a list of any threats found, allowing the user to choose what to delete and what to keep.


Such programs inspect the contents of the Windows registry, the operating system files, and installed programs, and remove files and entries which match a list of known spyware components. Real-time protection from spyware works identically to real-time anti-virus protection: the software scans disk files at download time, and blocks the activity of components known to represent spyware. In some cases, it may also intercept attempts to install start-up items or to modify browser settings. Because many spyware and adware are installed as a result of browser exploits or user error, using security software (some of which are antispyware, though many are not) to sandbox browsers can also be effective to help restrict any damage done.


Earlier versions of anti-spyware programs focused chiefly on detection and removal. Javacool Software's SpywareBlaster, one of the first to offer real-time protection, blocked the installation of ActiveX-based and other spyware programs.


Like most anti-virus software, many anti-spyware/adware tools require a frequently-updated database of threats. As new spyware programs are released, anti-spyware developers discover and evaluate them, making "signatures" or "definitions" which allow the software to detect and remove the spyware. As a result, anti-spyware software is of limited usefulness without a regular source of updates. Some vendors provide a subscription-based update service, while others provide updates free. Updates may be installed automatically on a schedule or before doing a scan, or may be done manually.


Not all programs rely on updated definitions. Some programs rely partly (for instance many antispyware programs such as Windows Defender, Spybot's TeaTimer and Spysweeper) or fully (programs falling under the class of HIPS such as BillP's WinPatrol) on historical observation. They watch certain configuration parameters (such as certain portions of the Windows registry or browser configuration) and report any change to the user, without judgment or recommendation. While they do not rely on updated definitions, which may allow them to spot newer spyware, they can offer no guidance. The user is left to determine "what did I just do, and is this configuration change appropriate?"


Windows Defender's SpyNet attempts to alleviate this through offering a community to share information, which helps guide both users, who can look at decisions made by others, and analysts, who can spot fast-spreading spyware. A popular generic spyware removal tool used by those with a certain degree of expertise is HijackThis, which scans certain areas of the Windows OS where spyware often resides and presents a list with items to delete manually. As most of the items are legitimate windows files/registry entries it is advised for those who are less knowledgeable on this subject to post a HijackThis log on the numerous antispyware sites and let the experts decide what to delete.


If a spyware program is not blocked and manages to get itself installed, it may resist attempts to terminate or uninstall it. Some programs work in pairs: when an anti-spyware scanner (or the user) terminates one running process, the other one respawns the killed program. Likewise, some spyware will detect attempts to remove registry keys and immediately add them again. Usually, booting the infected computer in safe mode allows an anti-spyware program a better chance of removing persistent spyware. Killing the process tree may also work.


A new breed of spyware (Look2Me spyware by NicTechNetworks is a good example) hides inside system-critical processes and start up even in safe mode, see rootkit. With no process to terminate they are harder to detect and remove. Sometimes they do not even leave any on-disk signatures. Rootkit technology is also seeing increasing use,[57] as is the use of NTFS alternate data streams. Newer spyware programs also have specific countermeasures against well known anti-malware products and may prevent them from running or being installed, or even uninstall them. An example of one that uses all three methods is Gromozon, a new breed of malware. It uses alternate data streams to hide. A rootkit hides it even from alternate data streams scanners and actively stops popular rootkit scanners from running.
[edit] Security practices


To detect spyware, computer users have found several practices useful in addition to installing anti-spyware programs.


Many system operators install a web browser other than IE, such as Opera, Google Chrome or Mozilla Firefox. Though no browser is completely safe, Internet Explorer is at a greater risk for spyware infection due to its large user base as well as vulnerabilities such as ActiveX.[citation needed]


Some ISPs—particularly colleges and universities—have taken a different approach to blocking spyware: they use their network firewalls and web proxies to block access to Web sites known to install spyware. On March 31, 2005, Cornell University's Information Technology department released a report detailing the behavior of one particular piece of proxy-based spyware, Marketscore, and the steps the university took to intercept it.[58] Many other educational institutions have taken similar steps. Spyware programs which redirect network traffic cause greater technical-support problems than programs which merely display ads or monitor users' behavior, and so may more readily attract institutional attention.[citation needed]


Some users install a large hosts file which prevents the user's computer from connecting to known spyware-related web addresses. However, by connecting to the numeric IP address, rather than the domain name, spyware may bypass this sort of protection.


Spyware may get installed via certain shareware programs offered for download. Downloading programs only from reputable sources can provide some protection from this source of attack. Recently, CNet revamped its download directory: it has stated that it will only keep files that pass inspection by Ad-Aware and Spyware Doctor.[citation needed]


The first step to removing spyware is to put a computer on "lockdown". This can be done in various ways, such as using anti-virus software or simply disconnecting the computer from the internet. Disconnecting the internet prevents controllers of the spyware from being able to remotely control or access the computer. The second step to removing the spyware is to locate it and remove it, manually or through use of credible anti-spyware software. During and after lockdown, potentially threatening websites should be avoided

Couche pour adulte

Couche pour adulte

Une couche pour adulte est un accessoire semblable aux couches pour bébé, à cette différence près qu'elle est disponible dans des tailles beaucoup plus grandes et qu'elle possède quatre ou six attaches au lieu de deux.




Où acheter des couches pour adulte ?[modifier]


L'augmentation du marché de l'incontinence fait qu'il est aujourd'hui possible de trouver des couches pour adulte à peu près partout.1


Dans les pharmacies : les marques des couches proposées sont peu nombreuses, généralement de bonne qualité, mais souvent très chères.


Dans les supermarchés : les marques des couches proposées sont peu nombreuses, généralement de qualité moyenne ou mauvaise, souvent très bon marché.


Dans les magasins spécialisés (matériel médical) : les marques des couches proposées sont plus nombreuses, généralement de très bonne qualité, et bon marché. Ces boutiques sont généralement l'endroit idéal pour acheter des couches pour leurs conseils, leur discrétion et la remise pour les grosses commandes. Elles permettent assez souvent de livrer à domicile.


Sur Internet : les marques de couches proposées sont les plus nombreuses, généralement de très bonne qualité, les prix sont variables en fonction des boutiques. Ces boutiques connaissent un essor important du fait de la discrétion des commandes en ligne et de la livraison qui s'effectue directement à domicile.




Les différents types de couches pour adulte[modifier]


Les fabricants proposent différents types de couches pour adulte afin de répondre à des besoins spécifiques en fonction que la personne est autonome ou dépendante, alitée ou mobile, que l'incontinence est faible ou forte, et urinaire ou mixte.23


Les changes-complets, également appelés couches-culottes, forment une vraie culotte que l'on referme sur les cotés avec des fixations autocollantes ou à scratch. Ce sont des couches adaptées à une incontinence forte ou mixte.


Les couches anatomiques forment une couche en forme de 8 à glisser dans une culotte de maintien ou une culotte imperméable en plastique. Ce sont des couches adaptées à une incontinence modérée essentiellement urinaire.


Les pants sont des couches à enfiler comme des sous-vêtements. Ce sont des couches adaptées à une incontinence faible ou modérée urinaire.


Les couches droites, également appelées inserts, sont une couche rectangulaire à glisser dans une culotte imperméable en plastique. Ce sont des couches adaptées à une incontinence faible urinaire. Il existe également des inserts traversables qui sont utilisés en supplément à l'intérieur des changes-complets pour renforcer leur absorption et diminuer la fréquence des changes.


Tous ces modèles existent également en couches lavables pour adulte.4


Les couches pour adulte jetables sont généralement pourvues d'un indicateur d'humidité sur toute la longueur qui change de couleur au contact de l'humidité et permet de savoir quand la couche a besoin d'être changée, généralement une ligne jaune qui vire au bleu foncé.


La majorité des couches pour adulte bénéficient des dernières avancées technologiques issues des couches pour enfant, notamment les revêtements doux en non-tissé pour plus de discrétion, une épaisseur moindre avec une absorption renforcée, des barrières anti-fuites et des composants anti-odeurs5.


Chaque fabricant propose une marque de couche qui a ses propres spécificités, qui est déclinée en plusieurs modèles (du moins absorbant au plus absorbant) et en plusieurs tailles (généralement Small, Medium, Large).




Les fabricants de couches pour adulte[modifier]


Il existe nombreuses sociétés fabriquant différentes marques de couches pour adulte dans le monde entier. Les marques de couches pour adulte produites par ces sociétés sont volontairement différenciées des marques de couches pour enfant.


Les principaux fabricants de couches pour adulte en Europe sont les sociétés SCA Hygiene avec la marque Tena, la société Abena et la marque Abri, la société Procter & Gamble et la marque Attends, la société Hartmann et les marques Molicare et Confiance6.

Adult Diaper

Adult Diaper----Adult Diaper---Adult Diaper

Adult Diapers -- Managing Incontinence Issues for the Medically Compromised

Family members, friends and caregivers of individuals who have serious medical or functional problems may be very familiar with managing incontinence issues. Due to aging, illness or accident, coping with incontinence or physical problems calls for resolution and sanitary care products. Many people are not incontinent, but due to other factors cannot utilize the bathroom or bedside commode. Use of a bed pan or catheter may not be indicated or manageable. Most people will opt for adult diapers or briefs as the best way to keep a person dry with the least amount of movement or physical distress. Whether this is the first choice or the last choice, there are facts about the use of these products that are worth noting.
WHO USES ADULT DIAPERS?
Some people who are otherwise completely independent, must rely on an adult diaper to stay dry. Incontinence can affect virtually anyone who has bladder or bowel problems. Weak muscles may be unable to control urine or feces adequately. Sometimes, this can become a major problem. Other causes for urinary incontinence, such as lack of sensation below the waist, as seen in neurological impairments, cause lack of control as well. Prostate cancer treatments may cause incontinence. While age may be a factor, younger individuals also may rely on extra absorbent undergarments.
COST

Many of those who need to buy incontinence supplies will ask if insurance can cover the cost. Unfortunately, not usually. Medicare and Medicaid, as well as most private insurance companies state that this product is not a “medical” supply, nor is it needed for medical therapy, such as bandages or walkers would be. While there are specialized organizations that will assist with the cost of incontinence supplies, most do not. The exception, under Medicare and Medicaid is Hospice. Hospice is always glad to discuss equipment or supportive needs with anyone who has questions about therapies or supplies in the home. They have the ability and the funds to secure needed incontinence supplies for patients in their care. Some community organizations will also assist with or provide incontinence supplies for low income individuals.

MANAGING SELF-CARE

The manufacturers for incontinence briefs make every effort to make wearing and changing them easy for the wearer or caregiver. Therefore, designs are made for alternative fasteners at the sides, or pull-up styles which are elasticized. For recovering patients, it is important that they perform as much self-care as possible for independence, modesty and dignity. Most individuals who are otherwise independent, manage their own needs well, and become completely comfortable performing all changes themselves.

DESIGNS

For those who need nothing short of an adult brief for urinary issues, it is important that moisture stays within the confines of the garment itself, and does not leak or smell. Products are designed to control both urine and feces, and in that way are designed with snug fit around the legs and waist. The legs may use elastic elements to prevent leakage, and the waist band may, also. Proper fit can otherwise be attained by fasteners that are adjustable for comfort and movement. Anatomical differences between men and women may necessitate different designs for maximum absorption. For males, extra padding or shape may be in the front, while for females, it may be at the bottom or back. Designs and materials also focus on keeping the wetness away from the wearer as much as possible.

CONCERNS ABOUT USE

One of the most important issues concerning the use of adult briefs is the need for frequent changes. Urine and feces contain acids and chemicals that are irritating to the skin if kept in prolonged contact. In the elderly, especially, this can lead to skin redness, rashes or skin breakdown. This may result in skin ulcers, discoloration, infection or deep sores that may take a long time to heal. Bed bound individuals or those who spend long hours sitting in wet briefs are especially at risk. Therefore, it is important to change them frequently to avoid medical complications and to minimize unsanitary situations.

USER RESISTANCE

Deciding to wear an adult diaper or brief can often be difficult for an individual who wants to maintain their independence. It is important to support the wearer in this decision, and to let them know what the benefits of wearing them will be. Benefits that may be identified to a new wearer might be increased independence, less risk of falls or other injury, convenience, caregiver relief, and modesty. Educating a new briefs or diaper wearer about the widespread use of them in other situations than incapacity, is important. A few minutes spent in research online will reveal many instances where diapers or briefs were worn out of need or convenience by people who were completely capable of using the bathroom. Astronauts, workers who could not take bathroom breaks, or those who did not have suitable facilities or place to relieve themselves are only a short list of users of adult briefs. Some people wear them simply because they feel it is more sanitary and convenient. Use of the words “brief,” “pull-ups” or “undergarment” may be more psychologically acceptable to an adult who will wear them.

MANUFACTURERS
Due to consumer needs for size and design options, it may be difficult to locate a suitable brief design in local grocery stores, drugstores or through medical equipment suppliers. Sizes may be very limited, or other factors may indicate specific requirements. Incontinence supply stores may also order special designs as needed. Online incontinence products sites offer a lot of variety, also. Manufacturers use different materials in their products, to provide alternatives for those who may be allergic to the materials or tape in specific brands.

Lésion blanche de la muqueuse buccale

Lésion blanche de la muqueuse buccale



Lésion blanche de la muqueuse buccale
White plaque of oral mucosa
S. Trojjet a, I. Zaraaa,∗, I. Chellyb, H. Zribi a,
M. Moknia, M. Zitounab, A. Ben Osmana
a Service de dermatologie, hôpital La Rabta, Jabbari, Baab Saadoun, 1007 Tunis, Tunisie
b Service d’anatomie pathologique, hôpital La Rabta, Tunis, Tunisie
Rec¸u le 15 juillet 2008 ; accepté le 12 septembre 2008
Disponible sur Internet le 16 avril 2009
Observation du cas
Une femme âgée de 68 ans était suivie en stomatologie
depuis plus de 35 ans pour lésions gingivales chroniques. Plusieurs
extractions dentaires avaient été alors pratiquées.
L’anamnèse retrouvait la notion de lésions gingivales blanchâtres
lentement extensives, occasionnant une gêne à
l’alimentation, pour lesquelles elle avait rec¸u des traitements
symptomatiques sans aucune amélioration. La
patiente ne présentait pas d’antécédents pathologiques
notables, en particulier il n’y avait pas de notion de tabagisme.
L’examen de la cavité buccale relevait des lésions
blanchâtres verruqueuses, confluant en plaques à bords irréguliers,
atteignant de fac¸on diffuse la région antérieure de
la gencive inférieure et la face interne de la lèvre inférieure
jusqu’aux prémolaires (Fig. 1). Il n’y avait pas d’infiltration.
La langue et le palais étaient indemnes de toute lésion. Le
reste de l’examen cutanéo-muqueux était normal, en particulier
il n’y avait pas d’adénopathies cervicales.

Fracture pathologique de la mandibule Pathological mandibular fracture

Fracture pathologique de la mandibule
Pathological mandibular fracture



Un patient aˆge´ de 19 ans est admis dans le de´partement
de chirurgie maxillofaciale suite a` une agression
sur la voie publique. Il pre´sente une tume´faction
douloureuse de la re´gion mandibulaire gauche en
regard de la premie`re molaire.
L’examen clinique objective une tume´faction douloureuse
accompagne´e d’un he´matome de la re´gion mandibulaire
au niveau du vestibule buccal adjacent aux dents 36 et 37.
La radiographie panoramique re´ve`le la pre´sence d’une
double fracture de la branche horizontale gauche, dans
une zone osseuse d’aspect lytique et irre´gulie`re de la re´gion
pe´riapicale des dents 36 et 37 (fig. 1).
Vu l’aspect de´labre´ des dents 36 et 37, le diagnostic de
kyste pe´riapical avec fragilisation de la mandibule est
e´voque´.
Le bilan sanguin re´alise´ a` l’admission est normal.
Le patient est hospitalise´ et, sous anesthe´sie ge´ne´rale, les
dents 36 et 37 sont extraites, la le´sion mandibulaire curete´e
et le produit de curetage envoye´ pour une analyse anatomopathologique.
Les fractures sont alors re´duites et oste´osynthe
´se´es par une plaque (fig. 2).
Les suites ope´ratoires sont normales et le patient quitte le
service au deuxie`me jour postope´ratoire.
Quelle le´sion l’examen anatomopathologique a-t-il re´ve´le´ ?
Figure 1.

Facteurs de risque des cancers de la cavité buccale, du pharynx (cavum exclu) et du larynx

Facteurs de risque des cancers de la cavité
buccale, du pharynx (cavum exclu)
et du larynx



Facteurs de risque des cancers de la cavité
buccale, du pharynx (cavum exclu)
et du larynx
Christian Adrien Righini1,2,3, Alexandre Karkas1, Nils Morel1, Edouard Soriano1,3,
Emile Reyt1,3
1. Clinique ORL, Pôle tête et cou et chirurgie réparatrice, CHU de Grenoble, F-38043 Grenoble, France
2. Unité Inserm UJF/U823, Centre de recherche Albert Bonniot, F-38042 Grenoble, France
3. Unité Joseph Fourier, Grenoble I, F-38000 Grenoble, France
Correspondance :
Christian Adrien Righini, Clinique ORL, Pôle tête et cou, CHU de Grenoble F-38000
Grenoble, France.
Tél. : +33 4 76 76 56 93
Fax : +33 4 76 76 51 20
CRighini@chu-grenoble.fr
Disponible sur internet le :
27 mai 2008
Reçu le 11 mai 2007
Accepté le 12 mars 2008
Presse Med. 2008; 37: 1229–1240 en ligne sur / on line on
2008 Elsevier Masson SAS.
Tous droits réservés.
www.masson.fr/revues/pm
www.sciencedirect.com
1229 Revue systématique
Summary
Risk factors for cancers of the oral cavity, pharynx (cavity
excluded) and larynx
Objective > To review the risk factors for squamous cell carcinoma
of the oral cavity, pharynx, and larynx.
Methods > Review of the literature using the Medline digital
database (1980–2007). Previously published studies or studies not
found in the database were included if relevant. Four types of
studies were selected: (1) epidemiological, (2) toxicologic, (3)
clinical, and (4) fundamental research. Publications concerning
cancer of the nasopharynx were excluded. This work is based upon
the ANAES guide for analysis of the literature and rating of
guidelines, published in January 2000.
Results > The principal risk factors are tobacco and alcohol. Other
risk factors, particularly infectious (viral) or environmental (nutritional
and occupational), are also involved. From this analysis we
conclude that: (1) most clinical and fundamental publications
concern smoking and alcohol use; (2) studies of other risk factors are
relatively old, especially those concerning nutritional and occupational
factors; (3) most publications have a low level of scientific
Résumé
Objectif > Faire le point sur les facteurs de risque des carcinomes
épidermoïdes de la cavité buccale, du pharynx et du larynx.
Méthodes > Revue de la littérature à partir de la base de données
informatisée Medline (1980–2007). Des études antérieures citées
dans les articles retenus, ou ne faisant pas partie de la base de
données, ont été incluses en fonction de leur pertinence. Quatre type
d’études ont été sélectionnés : (1) études épidémiologiques ; (2)
études toxicologiques ; (3) études cliniques ; (4) recherche fondamentale.
Ont été exclues de ce travail toutes les publications relatives
au cancer du rhinopharynx. Notre travail s’est appuyé sur le guide
d’analyse de la littérature et gradation des recommandations, publiée
par l’Anaes en janvier 2000.
Résultats > Les facteurs de risques principaux sont le tabac et l’alcool.
D’autres facteurs en particulier infectieux (virus) ou environnementaux
(nutritionnels et professionnels) sont également impliqués. Il
ressort de notre analyse que : (1) l’essentiel des publications cliniques
et fondamentales portent sur le tabac et l’alcool ; (2) pour les autres
facteurs de risques identifiés, les publications sont relativement
anciennes en particulier en ce qui concerne les facteurs nutritionnels
et professionnels ; (3) la plupart des publications ont un faible niveau
tome 37