Les dermites des mains (DM) chez les soignants sont fréquentes, dominées par les dermites d’irritations et les eczémas de contact. L’objectif de notre étude était d’évaluer leurs répercussions. Nous avons élaboré conjointement (dermatologue, médecin du travail du personnel hospitalier et médecin hygiéniste) un questionnaire pour les soignants du CHU. Les questions portaient sur la présence ou non de lésions des mains lors des 12 derniers mois, le type de symptômes présentés, la modification ou non des habitudes de travail (lavage des mains, utilisation des solutions hydro-alcoolique [SHA], gants) et la prise en charge. Deux mille questionnaires ont été distribués sur 2 semaines au personnel présent au CHU pendant cette période puis retournés par courrier interne. Les réponses étaient anonymes, déclaratives. Au total, 1159 questionnaires ont été retournés (58 %). Sept cent quatre-vingt-sept professionnels (67,9 %) déclaraient avoir présenté des lésions cutanées : sécheresse 93,4 %, rougeur 56,7 %, fissures et/ou crevasses 55,3 %, démangeaisons 45,2 %, douleurs 20,8 % et suintement 3,4 %. Parmi eux, 63,7 % déclaraient avoir modifié leurs habitudes de travail. Au total, 66,8 % déclaraient utiliser moins souvent la SHA, 15,5 % avoir arrêté de l’utiliser, 44,1 % se lavaient les mains plus souvent, 15,6 % moins souvent et 19,4 % avaient changé de type de gants. Quatre-vingt-treize pour cent des personnes avec symptômes avaient utilisé une crème : hydratante (97,1 %) ou dermocorticoïde (10,3 %), 16,9 % avaient consulté un médecin (médecin du travail 8,8 %, médecin traitant 8,1 %, dermatologue 6,2 %, allergologue 1,7 %) et 0,8 % ont eu un arrêt de travail. Malgré les limites de cette enquête (les répondeurs ne concernent que 15,7 % de tout le personnel hospitalier et possible sur-représentation du personnel concerné par la DM), notre échantillon est représentatif de la population soignante exerçant au CHU en terme d’âge, de sexe et de répartition professionnelle. Il s’agit de la première étude qui s’intéresse aux répercussions des DM en particulier sur l’hygiène. Les hygiénistes recommandent l’usage exclusif des SHA pour limiter les risques d’infections nosocomiales or notre enquête montre que 52 % des soignants ayant une DM ont arrêté ou diminué l’utilisation des SHA. Or si les SHA provoquent des sensations de brûlures sur peau abîmée, elles sont moins irritantes que les lavages de mains itératifs notamment grâce à la présence d’un émollient dans leur composition, et sont peu allergisantes. On constate également que la prise en charge des DM chez les soignants est très insuffisante. Les DM sont fréquentes chez les soignants, leur prise en charge est inadaptée et leurs conséquences en terme d’hygiène majeures. Il est urgent d’améliorer la prévention des DM dans les établissements de soins, et de prendre en charge rapidement les soignants affectés afin de respecter les protocoles d’hygiène et limiter la transmission d’agents pathogènes.

Le syndrome d’intolérance aux odeurs chimiques (SIOC) est la dénomination française usuelle d’une affection nommée Multiple Chemical Sensitivity en Anglais et qui s’intègre dans le cadre de l’« Idiopathic Environmental Intolerance » (IEI) ; ce syndrome regroupe l’intolérance aux odeurs et l’intolérance aux champs électromagnétiques, plus communément appelée « électrosensibilité ». L’affection touche des patients âgés en moyenne de 45 ans, ayant un bon niveau d’éducation, qui se plaignent d’un grand nombre de symptômes, touchant plusieurs organes, en particulier les voies respiratoires, le système nerveux et l’appareil digestif, alors que l’examen clinique et le bilan biologique sont toujours normaux. Ils sont convaincus d’être allergiques ou intoxiqués. Le nombre et la variété des symptômes qui n’entrent dans aucun cadre nosologique connu et qui sont souvent apparus après un évènement tel que l’emménagement dans des locaux neufs (ou rénovés) ou l’exposition à des produits odorants tels que peintures, solvants, colles doit attirer l’attention du praticien, d’autant que l’entourage familial ou professionnel exposé au même environnement est indemne. Il faut alors poser la question clé : supportez-vous les odeurs de la vie courants telles que détergents ménagers, eau de javel, sprays, parfums et cosmétiques, carburant, gaz d’échappement, vernis, insecticide… ? Une réponse négative permet de poser cliniquement le diagnostic qui sera confirmé facilement par l’auto-questionnaire QEESI, simple, rapide et fiable. (http://drclaudiamiller.com/Other/QEESI-French.pdf) L’affection, décrite dans les années 50 aux USA par Randolph, a été redécouverte en France au début des années 90 dans les consultations de pathologie professionnelle (32 en France) devant des patients adressés pour suspicion d’intoxication mais qui ne remplissaient ni les critères cliniques ni les conditions d’exposition adéquats. Nous rapportons une série de 201 patients vus entre 2001 et 2015 à la consultation de pathologie professionnelle et environnementale du CHU Nantes.

BACKGROUND:Occupational allergic contact dermatitis (OACD) is one of the most common occupational skin diseases in developed countries, but data about its temporal trends in incidence remain sparse.OBJECTIVES:The aim of this study is to describe OACD trends in terms of industrial activities and main causal agents in France over the period 2001-2010.MATERIALS AND METHODS:Data were collected from the French National Network of Occupational Disease Vigilance and Prevention (RNV3P, Réseau National de Vigilance et de Prévention des Pathologies Professionnelles). All OACD considered probably or certainly associated with an occupational exposure were included in the study. Trends were examined (i) on annual crude numbers of OACD and (ii) on reported odds ratios of OACD calculated using logistic regression models.RESULTS:Overall, 3738 cases of OACD were reported and the mean age of OACD cases was 35 years, 52% being women. The most frequent occupations were hairdressers, health care workers, cleaning staff and masons. The total number of OACD cases remained stable over the study period, but increases in OACD related to isothiazolinones (P = 0·002), epoxy resins (P = 0·012) and fragrances (P = 0·005) were observed. Conversely, decreases were noted for cement compounds (P = 0·002) and plant products (P = 0·031). These trends highlight specific sectors and exposures at risk of OACD.CONCLUSIONS:Trends in OACD depend on the nature of exposure. Observed decreases were consistent with prevention measures taken during the study period, and the increases observed serve to highlight those areas where preventative efforts need to be made to reduce skin allergies in the workplace.

In many working environments, employees face important biomechanical constraints, heavy physical demands and/or shift work. However, epidemiological surveillance has rarely addressed the issue of co-exposure to neurotoxic chemicals and biomechanical risk factors for musculoskeletal disorders that may affect peripheral nerves. Data from the regional sample of the SUMER 2003 survey were used to study these professional co-exposure phenomena in the Pays de la Loire region. After raking ratio adjustment of the regional survey data (i.e. 916,361 employees after extrapolation), descriptive analyses were carried out separately for men and women and showed that 43% of men and 27% of women were exposed to repetitive tasks and/or vibrating tools and/or cold environment, and 30% of men and 5% of women were exposed to at least one neurotoxic chemical. In men, co-exposure to neurotoxic chemicals and biomechanical constraints was common, especially in the construction and metal processing sectors. This study shows that co-exposure to biomechanical and chemical factors which may cause peripheral neuropathies focuses on the same occupational categories. (C) 2014 Elsevier Masson SAS. All rights reserved.

Le syndrome d’intolérance aux odeurs chimiques (SIOC, MCS) est un ensemble de symptômes subjectifs variés, touchant plusieurs organes chez le même individu (brûlures buccales et pharyngées, dyspnée, asthénie, céphalées, difficulté de concentration…), qui se reproduisent à chaque exposition, surviennent pour des concentrations très faibles des substances incriminées, et qui n’entrent dans le cadre d’aucune affection organique connue. C’est l’une des facettes de l’intolérance environnementale idiopathique (IEI), l’autre étant l’intolérance aux champs électromagnétiques. Le point commun des produits responsables est leur odeur caractérisée : peintures, solvants, insecticides, détergents, eau de Javel, sprays, parfums, cosmétiques, plastique neuf… Tous les examens complémentaires sont normaux. Un auto-questionnaire standardisé (Quick Environmental Exposure and Sensitivity Inventory [QEESI©]) permet de confirmer le diagnostic et de quantifier la gravité du syndrome. Aucun traitement n’a fait la preuve de son efficacité ; une psychothérapie peut dans certains cas améliorer la qualité de vie. Il est important pour le praticien consulté (souvent un allergologue ou un pneumologue) de savoir poser le diagnostic et d’évaluer le retentissement social et professionnel qui peut devenir majeur du fait de l’impossibilité d’utiliser des substances odorantes et de séjourner ou de travailler auprès de personnes parfumées ou dans des locaux neufs.

Objective. - Evaluate a self-screening questionnaire for bladder cancer of occupational origin and analyse an influence of exposure to a carcinogen bladder tumor on prognosis.Patients and methods. - Five hundred and thirty-one patients followed, between 2005 and 2010, for bladder cancer in two university centers have received a self-screening questionnaire derived from questionnaire KVP 08. Patients who responded positively to at least one of the items were considered to have a self-screening questionnaire "positive". Patients were finally invited to take an appointment for consultation in occupational pathology.Results. - The response rate to self-screening questionnaire was 39.9% (212/531). It was "positive" in 82 cases (38.7%). Among the 82 patients with a self-screening questionnaire "positive", 46 patients consulted in occupational pathology (56%). Occupational exposure to a bladder carcinogen was documented in 91.3% of cases. Among the 22 patients who consulted in occupational pathology with a self-screening questionnaire "negative", an occupational exposure to a bladder carcinogen was documented in 13.6% of cases. The sensibility of the self-screening questionnaire was 91.3%, the specificity 86.4% and the accuracy 89.7%. The relative risk to have an occupational exposure if the self-screening questionnaire was "positive" was 6.69. The analysis of groups "positive" versus "negative" does not reveal any statistically significant difference in terms of tumor aggressiveness and disease-free survival.Conclusion. - The self-screening questionnaire was considered relevant with good reliability for detection of occupational exposure to a bladder carcinogen. (C) 2013 Elsevier Masson SAS. All rights reserved.

Multiple chemical sensitivity (MCS) is a chronic condition, which belongs to the group of medically unexplained syndromes. Patients (men as well as women) complain of many subjective symptoms such as nose and mouth irritation, sore throat, dyspnea, tiredness, dizziness, headache and concentration difficulties. Patient typically report at least four or five symptoms occurring when they are exposed to particular substances, at a very low concentration that usually does not cause symptoms or harm in normal individuals. The common feature of products that appear to be responsible (either occupational or domestic) is that they have a strong smell and include: solvent, paint, glue, tar, oil, pesticides, perfume, cosmetics and spray products. MCS is nowadays considered to be one aspect of idiopathic environmental intolerance (IEI) whose other main aspect is hypersensitivity to electromagnetic fields. If the diagnosis is suspected clinically it can be confirmed using the Quick Environmental Exposure and Sensitivity Inventory (QEESI(©)) self-questionnaire. MCS is often misdiagnosed as asthma or an allergic conditions which means that patients are frequently referred to respiratory and allergy specialists. Misdiagnosis can lead to many futile medical investigations. Psychotherapy can improve quality of life in some cases. Preventive measures are often ineffective and do not stop the condition worsening: hypersensitivity can spread to common environmental odors so that a few people become severely disabled and limited in their workplace as well as in private life. In France, 435 cases were registered in the university hospital occupational disease departments network (RNV3P) during the period 2007-2010. It is therefore important that every clinician be able to recognize the condition and ensure that their patients could get compensation when unable to go on working.

El blushing es una disautonomía que afecta al área craneofacial y se manifiesta en forma de rubor facial que puede conllevar trastornos psíquicos. La eficacia del tratamiento farmacológico y de la terapia cognitivo conductal es anecdótica y no hay estudios rigurosos que demuestren su validez.Evaluar la efectividad de la simpaticotomía videotoracoscópica, así como las variables de personalidad y ansiedad fóbica en una serie de pacientes cuyo motivo de consulta fue el enrojecimiento facial incontrolable (blushing).Se realizó un estudio observacional retrospectivo durante un periodo de 7 años (2001-2008) en los pacientes afectos de blushing a los que se les efectuó simpaticotomía torácica bilateral videotoracoscópica. Todos los pacientes fueron visitados por un dermatólogo, un psicólogo y un cirujano torácico e informados de los efectos secundarios y expectativas de la intervención.Doscientos cuatro pacientes, con una distribución por sexos similar y una edad media de 34 años (rango: 15-67) fueron incluidos en el estudio. Solamente un 10% tuvo un resultado no esperado de la invervención, debido a la poca eficacia o a un excesivo sudor reflejo posquirúrgico que fue considerado grave en un 2% de los casos. No hubo mortalidad y solo un caso de síndrome de Horner transitorio. Se realizó una toracotomía videoasistida por sínfisis pleural y 5 pacientes desarrollaron un neumotórax, de los cuales uno requirió drenaje pleural.La simpaticotomía videotoracoscópica es un tratamiento seguro, eficaz y permanente del blushing incapacitante. La ansiedad medida prequirúrgicamente es reactiva al blushing y no al revés.Involuntary craniofacial erythema, or blushing, due to autonomic dysfunction can be a cause of psychological distress. Although anecdotal reports have suggested that pharmacologic treatments or cognitive behavioral therapy can be used to treat the condition, no rigorous analyses of their efficacy have been reported.To assess the efficacy of video-assisted thoracoscopic sympathectomy and to study phobic anxiety and other personality traits in a series of patients with involuntary facial blushing.We carried out a retrospective observational study of patients treated with bilateral video-assisted thoracoscopic sympathectomy for blushing over a 7-year period (2001-2008). All the patients were treated by a dermatologist, a psychologist, and a thoracic surgeon and were informed of the predicted outcomes.A total of 204 patients with a mean age of 34 years (range, 15-67 years) were included; the numbers of males and females were similar. Only 10% had unpredicted outcomes; in such cases, either the procedure was insufficiently effective or postoperative reflex sweating developed (and was considered serious in 2%). There were no deaths and only 1 case of transient Horner syndrome. Video-assisted thoracotomy was required for pleural symphysis in 1 patient; 5 patients developed pneumothorax, but only 1 of them required pleural drainage.Video-assisted sympathectomy is a safe, effective and definitive treatment for disabling blushing. Anxiety that is detected before surgery is a reaction to blushing rather than a cause of it.

L'hypertension artérielle est une maladie fréquente, la plus fréquente des maladies chroniques. L'urgence hypertensive est beaucoup plus rare et ne concerne que 1 à 2 % des hypertendus.La véritable urgence hypertensive est caractérisée par l'atteinte d'au moins un organe cible requérant une prise en charge sans délai et un traitement intraveineux.L'élévation tensionnelle isolée ne doit pas être considérée comme une urgence hypertensive s'il n'existe pas d'atteinte d'organe cible, même si les chiffres de pression artérielle sont très élevés. Ces situations de « fausse urgence hypertensive » relèvent le plus souvent d'un traitement sans délai, mais par voie orale.Les signes de souffrance viscérale de la véritable urgence hypertensive sont le plus souvent une altération de l'état général, des céphalées intenses, une baisse d'acuité visuelle, un déficit neurologique d'origine ischémique ou hémorragique, une confusion, une dyspnée avec orthopnée sur insuffisance cardiaque, un angor, une douleur thoracique sur possible dissection aortique, une protéinurie, une insuffisance rénale aiguë ou encore une éclampsie.La vraie urgence hypertensive regroupe plusieurs entités comprenant : l'HTA sévère, l'HTA maligne et l'HTA accélérée.Si l'HTA maligne n'est pas traitée, son pronostic est sombre avec un décès pour 50 % des sujets dans l'année.Hypertension is a common disease, the most common chronic disease. Hypertensive emergency is much less frequent and only affects 1 to 2% of all hypertensive patients.The true hypertensive emergency is characterized by the serious damage of one hypertensive target organ and requires an urgent intravenous treatment.Isolated blood pressure elevation should not be regarded as a hypertensive emergency if there is no target organ damage, even if the blood pressure is very high. These situations of "false hypertensive emergency", or hypertensive urgencies, often requires an immediate treatment, but oral.Signs of visceral pain of true hypertensive emergency often are a poor general condition, severe headache, decreased visual acuity, neurological deficit of ischemic or hemorrhagic cause, confusion, dyspnea with orthopnoea revealing heart failure, angina, chest pain revealing an aortic dissection, proteinuria, acute renal failure or eclampsia.True hypertensive emergencies include several entities, namely: severe hypertension, malignant hypertension and accelerated hypertension.If malignant hypertension is not treated, the prognosis is poor with 50% death risk in the following year.

ObjectiveThe aim of this study was an evaluation of the occupational risk perceveid by the employees in a health care establishment in accordance with French legislation.MethodAn anonymous questionnaire based on JCQ, physical and environmental stressors was addressed to the employees. Employees were categorised by socioprofessional category (SPC), health care department or group, age, sex, professional statute.Results1868 subjects were included in the study; major job strain was found in non specialized nurses, nurse aides and the health care executives. The main risk factors emerging are musculoskeletal symptoms in geriatric, orthopedics and traumatology departments, violence verbal and physical aggressiveness in psychiatric and emergency departments.Sleeping pills use seems related to a high psychological demand at work. It seems also related to a weaker social support. Analgesics consumption is related to perceived stress and musculoskeletal disorders.

The late blowing defect still represents a problem for hard cheeses. Thus, the behaviour of the cheese spoiling bacterium C. tyrobutyricum was studied throughout the cheesemaking and ripening of Grana Padano using an innovative approach. Cells and spores, independently sealed within dialysis tubes, were kept in the vat during the entire cheesemaking and then into cheese until 6-month ripening. At each sampling step, morphological changes of cells and spores were monitored by electron microscopy and supported with plate counts. Vegetative cells died during curd cooking and then were no longer cultivable. However, 2 × 102 spores appeared at the end of this stage, likely triggered by the exponential growth phase, and were present until 6-month ripening. In cheese, C. tyrobutyricum UC7086 proved to convert free arginine to citrulline and then to ornithine, and to produce γ-aminobutyric acid by glutamate transamination rather than by decarboxylation. Compartmentalization of vegetative cells and spores into dialysis tubes was effective in studying their respective behaviour in a real cheesemaking. This approach allowed to demonstrate that the number of vegetative cells in milk in addition to that of spores should be considered for the eradication of the late blowing defect.

Les pertes de substance ostéo-articulaire du coude posent fréquemment des problèmes de reconstruction chirurgicale. Les prothèses totales manchonnées par allogreffe massive constituent une alternative aux prothèses de reprise et aux allogreffes ostéo-articulaires isolées, dont les inconvénients sont nombreux. Leur utilisation, relativement récente en chirurgie de révision prothétique et en chirurgie tumorale, reste exceptionnelle en post-traumatique (5 cas décrits).Nous rapportons un cas de coude ballant post-traumatique pris en charge avec cette technique. A 75 mois de recul, le résultat clinique était excellent avec un index de performance de la Mayo Clinic de 100 points sur 100. La fusion allogreffe-os natif était complète et il n’existait aucune complication, notamment aucun descellement.Cette technique mixte, particulièrement adaptée aux défects ostéo-articulaires majeurs, permet de pallier aux inconvénients spécifiques de chaque technique employée isolément : l’allogreffe permet la reconstitution du stock osseux tandis que l’élément prothétique assure l’absence de retentissement clinique de la lyse épiphysaire de la greffe.Loss of bone stock in the elbow joint raises serious problems for reconstruction surgery. Total allograft-prosthesis composite arthroplasty is an attractive alternative to revision prosthesis and isolated osteoarticular allografts known to have many drawbacks. Use of this method is rather recent for revision procedures and tumor surgery and posttraumatic cases are rare (five reported cases). We report a case of posttraumatic floating elbow treated with this technique.At 75 months follow-up, the clinical result was excellent with the Mayo Clinic performance score at 100/100. Allograft-native bone fusion was complete and there were no complications, particularly no loosening.This composite technique is particularly well adapted for patients with major bone and joint loss. It can avoid the specific problems associated with each of the techniques used alone. The allograft reconstructs bone stock while the prosthetic component avoids the clinical expression of graft epiphyseal lysis.

Catatonia is a neuropsychiatric disorder that can occur in the setting of many illnesses, but the frequency of catatonia diagnosis among hospitalized patients is poorly characterized. This study reports the occurrence of catatonia diagnosis among acute care hospital discharges in the United States and the cooccurring diagnoses of these patients.The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients older than 18 discharged with a diagnosis of catatonia in 2019.13,630 encounters among the 30,080,038 adult hospitalizations in the NIS during the study year included a diagnosis of catatonia. Total hospital charges for these admissions were $1.15 billion, with 215,165 cumulative hospital days. In this sample, approximately 60% of admissions had a primary psychiatric discharge diagnosis, while 40% had a primary neurologic or medical discharge diagnosis. Procedures were performed in 36.7% of hospitalizations involving catatonia, of which electroconvulsive therapy was most common.Catatonia is a rare but costly discharge diagnosis among patients in acute care hospitals. It occurs across the age spectrum and is associated with a range of medical and psychiatric comorbidities. Further research is needed to better characterize the occurrence of catatonia and its optimal treatment.