Comment construire un questionnaire de psychologie ? Souvent peu détaillée dans les études, l'étape de construction d'un questionnaire est pourtant un aspect méthodologique essentiel du travail de mesure des phénomènes psychologiques. Au-delà des précautions prises ultérieurement lors de sa validation, un questionnaire ne peut mesurer que ce pourquoi il a été créé, d'où l'importance cruciale de cette étape. À l'aide de l'exemple de la SChool REfusal EvaluatioN (SCREEN), un questionnaire visant à mesurer le refus scolaire anxieux, cet article présente pas à pas et discute les différentes phases de sa création : (a) rédaction des items ; (b) évaluation et pré-sélection des items ; et (c) structuration du questionnaire dans sa forme pilote (avant validation). Outre ces aspects techniques, pour chaque phase sont présentées les différentes contraintes à envisager, de manière à construire un questionnaire pertinent sur le terrain selon l'objet d'étude choisi.What should we pay attention to when designing a psychological scale? Often sketchily outlined in studies, the design phase is an essential aspect of any study measuring phenomena in psychology. Using the example of the School Refusal EvaluatioN (SCREEN), a scale designed to assess school refusal, this article details the design phase step by step and discuss the different stages of its creation: (a) writing of items; (b) assessment and pre-selection of items and (c) structuring the questionnaire in its pilot form before validation. Besides these technical aspects, this article discusses how the constraints inherent to each stage are to be addressed so that a scale relevant to the field and topic of study can be correctly developed.

Hypothenar hammer syndrome (HHS) is an uncommon form of secondary Raynaud phenomenon, occurring mainly in subjects who use the hypothenar part of the hand as a hammer; the hook of the hamate strikes the superficial palmar branch of the ulnar artery in the Guyon space, leading to occlusion and/or aneurysm of the ulnar artery. In patients with HHS, such injuries of the palmar ulnar artery may lead to severe vascular insufficiency in the hand with occlusion of digital artery. To date, only a few series have analyzed the long-term outcome of patients with HHS. This prompted us to conduct the current retrospective study to 1) evaluate the prevalence of HHS in patients with Raynaud phenomenon and 2) assess the short-term and long-term outcome in patients with HHS. From 1990 to 2006, 4148 consecutive patients were referred to the Department of Internal Medicine at the University of Rouen medical center for evaluation of Raynaud phenomenon using nailfold capillaroscopy. HHS was diagnosed in 47 of these 4148 patients (1.13% of cases). Forty-three patients (91.5%) had occupational exposure to repetitive palmar trauma. The more common occupations were factory worker (21.3%), mason (12.8%), carpenter (10.6%), and metal worker (10.6%); the mean duration of occupational exposure to repetitive palmar trauma at HHS diagnosis was 21 years. One patient (2.1%) had recreational exposure (aikido training) to repetitive trauma of the palmar ulnar artery, and 3 other patients (6.4%) developed HHS related to a single direct injury to the hypothenar area. Clinical manifestations were more often unilateral (87.2%) involving the dominant hand (93%). HHS complications included digital ischemic symptoms (ischemia: n = 21, necrosis: n = 20) and irritation of the sensory branch of the ulnar nerve (n = 11). In HHS patients, angiography demonstrated occlusion of the ulnar artery in the area of the Guyon space (59.6%), aneurysm of the ulnar artery in the area of the Guyon space (40.4%), and embolic multiple occlusions of the digital arteries (57.4%). All patients were advised to change their occupational exposure. They were given vasodilators, including calcium channel blocker (n = 37) and buflomedil (n = 12); 36 patients (76.6%) also received oral platelet aggregation inhibitors. Twenty-one patients with digital ischemia/necrosis were further given hemodilution therapy to reduce the hematocrit level to 35%. In 3 patients with HHS-related digital necrosis who exhibited partial improvement with vasodilators, prostacyclin analog therapy (a 5-day regimen of intravenous prostacyclin analog) was instituted, resulting in complete healing of digital ulcer in these 3 patients. Other conservative treatment options included controlling risk factors (smoking cessation, low-lipid diet, therapy for arterial hypertension) and careful local wound care of fingers in the 20 patients with digital necrosis. Only 2 patients, exhibiting digital necrosis and multiple digital artery occlusions, with nonthrombotic ulnar artery aneurysm underwent reconstructive surgery, that is, resection of the aneurysm with end-to-end anastomosis of the ulnar artery. The median length of follow-up in patients with HHS was 15.9 months. Thirteen patients (27.7%) exhibited clinical recurrences of HHS; the median time of HHS recurrence onset was 11 months. Outcome of HHS relapse was favorable with conservative measures in all cases. Awareness of HHS is required to increase suspicion of the disorder so that further exposure to risk factors like repetitive hypothenar trauma can be avoided for these patients; this is of great importance for their overall prognosis. We found favorable outcomes in most patients after conservative measures were initiated; therefore we suggest that surgery may be undertaken in the subgroup of patients who exhibit partial improvement while receiving conservative therapy. Finally, because we observed recurrence of HHS in 27.7% of patients, we note that HHS patients require close follow-up, including both regular and systematic physical vascular examination. Abbreviations: acL = anticardiolipin antibodies, ANA = antinuclear antibodies, CT = computed tomography, HHS = hypothenar hammer syndrome, LAC = lupus-like anticoagulant, MRA = magnetic resonance angiography, RF = rheumatoid factors.

Sir, Cold agglutinin disease (CAD) is an autoimmune haemolytic anaemia in which cold-reactive auto-antibodies bind to erythrocyte carbohydrate antigens, causing hemagglutination and complement-mediated haemolysis.1–4 It is associated with various conditions, including infections ( Mycoplasma pneumoniae , hepatitis C), autoimmune diseases (especially systemic lupus erythematosus) and lymphoproliferative disorders (mainly lymphoma.1–8 However, it has rarely been described in patients with malignant solid tumours. We report a case of interest, where a patient developed CAD-associated haemolytic anaemia related to mediastinal seminoma, with a favourable outcome after chemotherapy. A 61-year-old man presented in December 2001 with a 1-month history of asthenia. On admission, he was pale, but general physical examination was otherwise normal, and in …

La migration du cathéter après la dérivation ventriculopéritonéale (DVP) d’une hydrocéphalie est une complication très rare. Elle est due à une déconnection ou rupture de ce cathéter. Cette migration peut aller jusqu’à l’extériorisation de ce dernier par l’anus ou la bouche. Notre travail rapporte un cas d’extériorisation du cathéter de dérivation d’une hydrocéphalie par le canal péritonéovaginal diagnostiqué en peropératoire au cours d’une cure d’hydrocèle chez un enfant qui avait subi une DVP pour son hydrocéphalie, il y a plus de deux ans. Les enfants dérivés pour hydrocéphalie nécessitent une surveillance régulière clinique et par des radiographies de contrôle du trajet de la valve, une fois par an.The catheter migration after ventriculoperitoneal shunt (VPS) for hydrocephalus is a very rare complication. It is caused by a disconnection or rupture of the catheter. Then, this one can be exteriorized through the anus or the mouth. We report here the case of catheter exteriorization after VPS through the peritoneovaginal duct diagnosed during the hydrocele surgical cure, two years after VPS insertion. The children with VPS require a regular clinical surveillance and a radiographic control of the hydrocephalus valve track, once per year.

These data suggest that JAK2 V617F mutation may be a novel diagnostic marker of PV. Moreover, JAK2 V617F mutation finding may permit promising therapeutic approaches in patients with PV, particularly tyrosine kinase inhibitors; preliminary series have, in fact, underscored the potential efficacy of imatinib mesylate in PV.

A 63-year-old man, with unremarkable previous medical history, was admitted with a tender mass in the right breast that had been evolving for 3 months. Mammography showed an opaque mass within the right retromammary region; a thoracic CT scan showed a heterogeneous mass in the same area. MRI demonstrated: (i) a heterogeneous lesion involving the right pectoral muscle (10 cm in diameter) enhanced after intravenous gadolinium on T1-weighted images; and (ii) a heterogeneous high-signal intensity involving the pectoral muscle on T2-weighted images. Surgical exploration revealed a necrotic abscess within the pectoral muscle. Histological analysis of muscle biopsy specimens showed granulomatous nodules composed of epithelioid histiocytes, multinucleated giant cells, and caseous necrosis damage; Ziehl-Neelsen staining yielded acid-fast bacilli in muscle biopsy specimens, and polymerase chain reaction for Mycobacterium tuberculosis complex further proved positive. Cultures grew M. tuberculosis. Other investigations, including gastric aspiration and urine cultures, were negative for M. tuberculosis. Muscle involvement is a rare complication of tuberculosis, occurring in 0.01–1.8% of patients; it is more often limited to a single muscle (principally the quadriceps femoris). Internists should be aware that tuberculous myositis may mimic breast cancer, resulting in earlier diagnosis and therapy. MRI may be useful in the management of tuberculous myositis, in delineating the anatomical extent of muscle lesions, and guiding the surgeons in debridement. Photograph and text from Professor I. Marie

We report the original case of a patient with polymyositis (PM) who developed severe gastritis related to Helicobacter heilmanii. H. heilmanii eradication, using triple therapy with omeprazole, metronidazole and amoxicillin, resulted in the complete disappearance of digestive manifestations. As an association has been found between gastric adenocarcinoma/MALT lymphoma and both polymyositis/dermatomyositis (PM/DM) and H. heilmanii infection, respectively, we suspect that PM/DM patients who develop H. heilmanii infection may have a higher risk of gastric malignancy occurrence. Further studies are warranted to confirm whether Helicobacter species infections do, in fact, increase the risk of gastric adenocarcinoma/MALT lymphoma in patients with PM/DM.

Purpose. - Recent studies have suggested that the prevalence of Helicobacter pylori may be more frequent in patients with primary Raynaud's phenomenon (PRP) compared to healthy subjects. These data prompted us to conduct this prospective study, in order to assess the prevalence of H. pylori infection in a large series of patients with PRP.Methods. - Forty consecutive patients with a definite diagnosis of PRP were included in the study. The findings in the PRP patients were compared with those of 80 age- and sex-matched healthy subjects. H. pylori infection was diagnosed using serology and urease breath test.Results. - The prevalence of H. pylori infection was as high as 12.5% in PRP patients using both serology and urease breath test, whereas it was found to be 16.7% and 18%, respectively, in healthy controls.Conclusion. - As prevalence of H. pylori infection was similar in PRP patients compared to controls (P = 0.53 and 0.43, respectively), our data underscore that H. pylori infection may not play a role in the genesis of PRP-related vascular complication onset. Interestingly, PRP patients exhibited more commonly digestive symptoms consistent with H. pylori infection compared to controls (P < 0.05). (C) 2006 Elsevier Masson SAS. Tous droits reserves.

Introduction. - Proton pump inhibitors (PPIs) are an efficient therapy, being widely used by physicians. In 2004, cost of PPIs' therapy was as high as 748 millions of euros (for The Caisse primaire d'Assurance Maladie) in France. Although validated indications of PPIs are well known, numerous un-necessary prescriptions of PPIs are common. The aim of this prospective study was to evaluate PPIs' prescriptions of patients in a department of internal medicine.Patients and methods. - This is a 12-week assessment of medical charts of patients, receiving PPI therapy in patients in our Department of internal medicine. Data were collected by a standardized questionnaire, with regards to: PPIs' nature and regimen, PPIs' indications as well as duration of therapy.Results. - The medical charts of 729 consecutive patients, with a mean age of 67 years, were collected. Two hundred (and) twenty-four patients (30.7%) received PPI therapy; 157 of these patients were given PPI before admission in our department. Omeprazole was used in 71% of patients. Duration of PPI therapy was over one year in 45% of cases. Thirty-five per cent of family physicians' PPI prescription were validated and 23.8% of those of physicians working in the department of internal medicine. The main non-conform PPI's indications, by family physicians and internists were as follows: prevention of hemorrhagic risk of anti-platelet agent (21 vs 16.4%), anticoagulant (17.8 vs 16.4%), steroids (8.3 vs 13.4%) or non-steroid anti-inflammatory therapy without risk factor (1.9 vs 9%). Finally, in patients receiving PPI therapy before admission, this therapy was maintained in 76% of cases.Conclusion. - This prospective study confirms the frequent prescription of PPI therapy in a department of internal medicine (31% of patients). It also underscores the importance of PPIs' use by family physicians and physicians working in a department of internal medicine; this series further highlights the difficulties to interrupt this well tolerated therapy. To date, PPI therapy should be prescribed with a cautious reweighted costibenefit consideration. (c) 2006 Elsevier Masson SAS. Tous droits reserves.

PURPOSE:Recent studies have suggested that the prevalence of Helicobacter pylori may be more frequent in patients with primary Raynaud's phenomenon (PRP) compared to healthy subjects. These data prompted us to conduct this prospective study, in order to assess the prevalence of H. pylori infection in a large series of patients with PRP.METHODS:Forty consecutive patients with a definite diagnosis of PRP were included in the study. The findings in the PRP patients were compared with those of 80 age- and sex-matched healthy subjects. H. pylori infection was diagnosed using serology and urease breath test.RESULTS:The prevalence of H. pylori infection was as high as 12.5% in PRP patients using both serology and urease breath test, whereas it was found to be 16.7% and 18%, respectively, in healthy controls.CONCLUSION:As prevalence of H. pylori infection was similar in PRP patients compared to controls (P=0.53 and 0.43, respectively), our data underscore that H. pylori infection may not play a role in the genesis of PRP-related vascular complication onset. Interestingly, PRP patients exhibited more commonly digestive symptoms consistent with H. pylori infection compared to controls (P<0.05).