Background. - Dermatosurgery has been gaining in importance in recent years.Study aims. - The aim of our study was to describe this activity to increase its value and to inform the other specialists and the general public.Patients and methods. - We perfomed a national prospective study during one month in the hospital centers and university teaching hospitals in France and among the members of the Surgical Group of the Societe francaise de dermatologie. Data were collected with a preestablished questionnaire. They were captured on EpiData 3.1 and Excel software package and were analysed using the SPSS 15.0 software package.Results. - The participation of dermatology departments in hospital was 66.7%. For the members of the surgical group, it was 43.1 %. A total of 2308 dermatological surgical procedures was performed. The mean age was 55.5 years +/- 20.7. Three hundred and thirty-six (14.6%) procedures were performed with antiplatelet agents or anticoagulants. The excisions of skin cancers were carry out with no previous biopsy in 71.3% of cases. We described repairs in one time in the majority of cases (92.2%), and the most frequent type of procedure was direct closure (83.4%). Complete excision was obtained directly in 95.2% of cases and the clinicopathological correlation was also excellent (89.5%). Three percent of patients suffered complications during or following surgery and these complications were more frequent with the patients treated by antithrombotic medications.Conclusion. - This is, in our knowledge, the first prospective study on dermatosurgery activity practised by dermatologists in France. The important rate of participation exemplified the implications of dermatologists in the treatment of skin cancers with an optimal follow-up. (C) 2011 Elsevier Masson SAS. All rights reserved.

Plusieurs études ont montré l'influence de facteurs socio-démographiques sur la participation de la population au dépistage des cancers (1, 2). Le but de notre étude était d'analyser les facteurs territoriaux prédictifs de la participation au dépistage organisé du cancer colorectal. La population cible était constituée de 183 978 personnes résidant à Marseille pour la première campagne et de 175 596 personnes pour la deuxième. L'influence de l'âge, du sexe, du prix des appartements au mètre carré, du pourcentage d'étrangers par arrondissement sur le taux de participation aux deux campagnes a été analysée en multivariée par régression logistique multi-niveaux. L'âge et le sexe influencaient la participation avec un maximum chez les 65-69 ans et une moindre participation des hommes par rapport aux femmes OR = 0,85 [0,83 ; 0,86]. Les taux de participation pour les deux campagnes de dépistage étaient significativement différents d'un arrondissement à l'autre (min : 22,8 % ; max : 36,7 % ; OR = 1,97 [1,86 ; 2,08]). En multivariée, le pourcentage d'étrangers est un facteur prédictif significatif OR = 0,96 [0,95 ; 0,97]. Aux cotés de facteurs individuels, la localization du lieu de vie des personnes, caractérisée par des variables de type socio-économiques, semble être un facteur impactant le taux participation au dépistage organisé du cancer colorectal.

Background. The 2000 French Conseusus Conferenee for Acute Viral Brochiolitis management underlined clinical practice recommendations.Objective. To assess the impact of these guidelines on management of acute bronchiolitis, 3 and 8 years after publication.Methods. A standardized questionnaire was mailed to 762 general practitioners (GPs) in 2003 and 800 GPs in 2008. It described two clinical case scenarios (moderate acute viral bronchiolitis and severe acute bronchiolitis) and inquired about the physican's conduct in each case. The primary outcome was the percentage of responders who described patient management in accordance with current guidelines: correct diagnosis and treating the patient symptomatically in an outpatient setting in the first case and correct diagnosis in addition to requiring an inpatient setting for the second case. Secondary outcome was the percentage of responders who would have given unnecessary or potentially harmful treatments. Physician responses in 2003 and 2008 were compared using the Student t-test and the Chi(2) test. Multivariate analysis was conducted to assess the potential factors associated with good adherence to guidelines.Results. nearly 25% of the questionnaires were returned in 2003 and 2008. patient management was described in accordance with the guidelines in only 6% in 2003 and 20% in 2008 (p <= 0.001). Unnecessary treatments were prescribed in 77% in 2003 vs 60% in 2008 (p < 0.001) and potentially dangerous treatments in 38% in 2003 vs 22% in 2008 (p = 0.006). Using multivariate analysis, the GP's age was inversely correlated with adherence to clinical recommendations (adjusted odds ratio [adOR] = 0.93; 95% CI = 0.87-0.98: p = 0.01). Fifty-four percent of GP's reported knowing, These guidelines, only 57% of them declared that the latter has modified their practice.Discussion. GP's are still prescribing unnecessary or even potentially dangerous treatments for bronchiolitis. On the other hand, severe cases are correctly diagnosed and well managed in an inpatient setting.Conclusion. Three and 8 years after their publication, adherence to guidelines in insufficient. (C) Elsevier Masson SAS. All rights reserved.

Au cours des 20 dernières années, la littérature relative à la qualité de vie (QV), a connu une croissance exponentielle. En effet, les indicateurs usuels de résultats ne traduisent pas toujours des bénéfices de nouvelles stratégies, organisations de soins. Si l’appréciation de la QV des patients par la communauté médicale est une préoccupation ancienne, le souci de disposer d’instruments de mesure standardisés s’est matérialisé de façon plus récente.

Background: Despite dual antiplatelet therapy, the rate of major adverse cardiovascular events (MACE) after percutaneous coronary angioplasty remains high. Studies have shown interindividual variations in response to clopidogrel. Furthermore, there is an apparent link between clinical outcomes and clopidogrel resistance. Objectives: To investigate the value of platelet reactivity index (PRI), assessed by vasodilator-stimulated phosphoprotein (VASP) phosphorylation analysis, for predicting MACE after percutaneous coronary intervention (PCI) with stent implantation. Methods: A prospective monocentric study was performed on 144 patients undergoing PCI. PR was evaluated by VASP phosphorylation analysis 24 h after they received a 300-mg loading dose of clopidogrel. MACE were recorded during a 6-month follow-up. Patients were divided into quintiles according to PRI, as assessed by VASP analysis. The receiver operating characteristic (ROC) curve served to determine the optimal cut-off value of VASP analysis to detect MACE. Results: Of the 144 patients, 34% had stable angina pectoris, 40% silent ischemia, and 26% low-risk non-ST-segment elevation acute coronary syndrome. During the follow-up, 21 MACE were observed. Patients in quintile 1 of VASP analysis had a significantly lower risk of MACE as compared with those among the four higher quintiles (0 vs. 21, P < 0.01). ROC curve analysis of VASP showed an optimal cut-off value of 50% PR to exclude MACE. The negative predictive value of the test was 100%. Conclusions: VASP phosphorylation analysis can evaluate the individual response to clopidogrel loading dose prior to PCI and predict postprocedural MACE.

The aim of this study was to assess occupationally induced chromosomal damage in a large population of hospital workers exposed to low doses of ionizing radiation. We used the cytokinesis-block micronucleus (CBMN) assay in the peripheral lymphocytes of 132 exposed workers compared with 69 controls matched for gender, age and smoking habits. The CBMN assay was combined with fluorescence in situ hybridization with a human pan-centromeric DNA probe in 32 exposed subjects and 30 controls randomly chosen from the initial populations. Occupational dosimetry records were collected over the last 10-year period and revealed very low exposure levels. The average binucleated micronucleated cell rate (BMCR) was significantly higher in the exposed subjects than in the controls (14.9 per thousand+/-8.1 versus 11.8 per thousand+/-6.5; P=0.011). About one-third of the micronuclei were centromere-negative in the exposed and control groups. BMCR significantly positively correlated with donor age in the exposed population; this correlation was at the border of significance in the control group. In the two groups, BMCR was significantly greater in females than in males, and the significant correlation between age and BMCR was observed in the female population, but not in the male one. No effect of smoking habits emerged. Univariate analysis revealed a possible influence of familial cancer history and diagnostic medical radiation dose (estimated from examinations reported in the questionnaire) on BMCR. Multiple regression analysis, taking into account all the previous confounding factors, showed that only occupational exposure status, gender and age had a significant effect on BMCR. In conclusion, the present study shows that chromosomal damage leading to micronucleated lymphocytes is more frequent in hospital workers exposed to ionizing radiation than in controls, despite the very low levels of exposure.

Baclground. Quality of life is now regarded as of great significance in psychiatry as a measure of outcome, with the aim of providing data for establishing the cost-utility of treatment. This paper is the second of two reporting on the psychometric properties of the short version of the Lehman Scale (QoLI), and focuses on validity. Methods. Our sample comprised 128 subjects with schizophrenia recruited within two French psychiatric sectors. Scores on the QoLI were compared with other measures of quality of life, in particular, the EuroQol, and examined in relation to sociodemographic variables and the clinical attributes of the illness. We made specific hypotheses that quality of life would be positively correlated with integrated living arrangements, a better clinical state, and freedom from the side-effects of medication. Results. Correlations between the scores on individual sections of the QoLI and our other measures of quality of life were positive but not always statistically significant. This was partly a problem of the comparison measures. Quality of life was, as predicted, better in people living in their own homes, and in those living with spouses or other family members. It was also better in relation to indications of better clinical state. Although these findings offer some validation of the QoLI, some of the correlations were non-significant. Conclusions. The short version of the Lehman Scale is easy to administer and acceptable, and we have demonstrated appreciable validity, particularly construct validity. The scale is a useful addition to our ability to measure relevant outcomes in psychiatry.

OBJECTIVE:To assess the incidence and clinical characteristics of herpes simplex keratitis in France. DESIGN:National multicenter prospective study on herpetic keratitis. PARTICIPANTS:During a 3-month study period (September-December 2002), all cases of herpes simplex keratitis were prospectively reported by a randomly selected sample of 412 ophthalmologists representative of the 5471 French ophthalmologists in terms of gender, geographic distribution, and clinical practice. METHODS:The following set of assumptions were made to calculate the incidence of herpectic keratitis: (1) the participating (self-selected) ophthalmologists in the study could adequately represent French ophthalmologists, (2) estimates based on the 3-month study period could be used to calculate the annual incidence (i.e., no significant seasonal variations), and (3) all patients suffering from herpetic corneal lesions consult or are referred to an ophthalmologist. We calculated the incidence of herpetic keratitis by (1) estimating the average number of incident cases per ophthalmologist per year, (2) multiplying the average number of incident cases by the total number of French ophthalmologists (n = 5471), and (3) dividing the result by the French population. RESULTS:Four hundred twelve ophthalmologists reported 357 cases of herpes keratitis. We estimated that the overall incidence of herpetic keratitis during the study period was 31.5 per 100,000 person-years (95% confidence interval [CI], 25.5-37.5), and incidences were 13.2 per 100,000 person-years for new cases (95% CI, 10.4-15.9) and 18.3 per 100,000 person-years for recurrences (95% CI, 14.6-22.1). The most frequent types were dendritic keratitis (56.3%, n = 153), stromal keratitis (29.5%, n = 81), and geographic keratitis (9.8%, n = 27). Other ocular lesions were associated with keratitis in 35.0% (n = 125) of cases; the most frequent were conjunctivitis (18.8%, n = 67), uveitis (11.8%, n = 42), and/or lid involvement (8.6%, n = 31). CONCLUSIONS:This prospective epidemiological study provides an estimate of the incidence of herpes keratitis in France. Herpetic keratitis remains an epidemiologically important eye disease that justifies the need to pursue health care and research programs aimed at improving the outcome of ocular herpetic disease.

Chronic treatment with classical neuroleptics in humans can produce a serious side effect, known as tardive dyskinesia (TD). Here, we examined the effects of V. officinalis, a medicinal herb widely used as calming and sleep-promoting, in an animal model of orofacial dyskinesia (OD) induced by long-term treatment with haloperidol. Adult male rats were treated during 12 weeks with haloperidol decanoate (38 mg/kg, i.m., each 28 days) and with V. officinalis (in the drinking water). Vacuous chewing movements (VCMs), locomotor activity and plus maze performance were evaluated. Haloperidol treatment produced VCM in 40% of the treated rats and the concomitant treatment with V. officinalis did not alter either prevalence or intensity of VCMs. The treatment with V. officinalis increased the percentage of the time spent on open arm and the number of entries into open arm in the plus maze test. Furthermore, the treatment with haloperidol and/or V. officinalis decreased the locomotor activity in the open field test. We did not find any difference among the groups when oxidative stress parameters were evaluated. Haloperidol treatment significantly decreased [3H]-dopamine uptake in striatal slices and V. officinalis was not able to prevent this effect. Taken together, our data suggest a mechanism involving the reduction of dopamine transport in the maintenance of chronic VCMs in rats. Furthermore, chronic treatment with V. officinalis seems not produce any oxidative damage to central nervous system (CNS), but it also seems to be devoid of action to prevent VCM, at least in the dose used in this study.

The implication of environmental carcinogens in childhood cancer is still unknown. To assess a possible link between DNA damage and alterations of the tumor suppressor gene p53, blood samples of 21 children with malignancies were examined for the presence of micronuclei in lymphocytes using the cytokinesis blocked micronucleus assay (CBMA). The constitutional karyotypes were analyzed for chromosome abnormalities and the presence of anti-p53 antibodies in blood sera was evaluated by an enzyme-linked immuno sorbent assay (ELISA). A control group of 20 children was also included. The rates of micronucleated cells were 5.1 per thousand+/-3.9 and 2.4 per thousand+/-2.3 for the cancer and control groups, respectively. The difference between the groups were statistically significant (P<0.05 by the Mann-Withney rank sum test). Two children in the cancer group showed extensive chromosome breakage in lymphocytes. The sera of two other children from the cancer group and of one child from the control group contained anti-p53 antibodies. Chromosome breakage and anti-p53 antibodies from the five children were associated with increased micronucleated cell rates. The results of the present study suggest that genotoxic events can occur in the lymphocytes of children with a cancerous state.

Evaluating patient satisfaction: in France, patient satisfaction is a criteria for health care facility accreditation. In this context, the anesthesia community has studied tools available for assessing satisfaction with anesthesia. Limitations of available instruments: The construction of a satisfaction assessment instrument can be divided into three phases: design, sorting items, validation. Instruments available in the currently literature (1987-1997) focus mainly on pie, per- or postoperative management but little on overall patient satisfaction. As the concept of satisfaction concerns a variety of elements, many of the available instruments use a muitidimensional approach. The areas explored however vary greatly depending on the author or the study. In addition, patient experience is rarely taken into consideration when designing instruments. Four instruments: Among the available instruments we retained 4 questionnaires: Patient Satisfaction with General Anaesthesia, Peri-operative Anesthesia Experience Scale, Iowa satisfaction with Anesthesia Scale, and Amerstadam Preoperative Anxiety and Information Scale. These last 2 scales only assess patient information and anxiety. The Peri-operative Anesthesia Experience Scale alone is available in French (Echelle de Vecu perioperatoire de l'Anesthesie). Patient satisfaction is also approached with specialized instruments designed to assess specific items. The most widely used scales assess anxiety and pain. Based on these findings, it is clear that the fundamental concept of patient satisfaction must be revisited. We propose a few points for thought.

To assess the patient's experience of anaesthesia in the early postoperative period, with a self-completed questionnaire (Evan).Descriptive and evaluative study.The study included 742 adults undergoing an elective surgical or non surgical procedure under anaesthesia.An Evan questionnaire with 25 questions was completed 24 hours after anaesthesia by the patient. The questionnaire explored six areas, each one being marked out from 0 to 100, as the visual analogue scale. The marks were compared with consideration of age, gender, ASA physical class, type of anaesthesia, anaesthesia duration and type of surgery.The mean global mark was 76 +/- 9 (min-max: 34-99). Marks were lower in the youngest patients, in females, in ASA 1 patients, in longest surgical procedures, especially with regard to areas belonging to "apprehension", "pain-discomfort" and "physical needs". The lowest mark was given for the "information" provided during the pre-anaesthetic evaluation. Differences in marks occurred also between surgical specialities.The Evan questionnaire is a valuable tool for assessing the patient's opinion on the perioperative period. Further studies are required to extend its use to other fields, as ambulatory surgery.

OBJECTIVE:To develop and to validate a scale assessing perioperative patient's satisfaction with anaesthesia (Evan).STUDY DESIGN:Descriptive and evaluative study.PATIENTS:The study included 742 adults undergoing a surgical or a diagnostic procedure under general anaesthesia. Emergency, ambulatory and obstetrical cases were excluded.METHODS:A multidisciplinary working party produced 85 questions focusing on various pertinent areas describing satisfaction. After a validation, 25 out of them were selected for the questionnaire. The latter was completed within the 24 hours following anaesthesia by 742 inpatients.RESULTS:Item analysis showed a homogeneous distribution of the answers to each item. Main component analysis allowed to explain 53% of total variance. Six dimensions were isolated by the exploratory analysis: anxiety, embarrassment, fear, pain-discomfort, information and physical needs. Scoring method followed a simple additive model: for each dimension, the scale scored 0-100. The global score represented the sum of the six dimensions also scored 0-100. Acceptability of Evan questionnaire was satisfactory, with a spontaneous non response rate of less than 1% and a completion duration at 11 +/- 8 min.CONCLUSION:A self-completed questionnaire on patient's satisfaction with anaesthetic period was validated, allowing a global and multidimensional assessment of patient's satisfaction.

Purpose: To assess the patient's experience of anaesthesia in the early postoperative period, with a self-completed questionnaire (Evan).Study design: Descriptive and evaluative study.Patients: The study included 742 adults undergoing an elective surgical or non surgical procedure under anaesthesia.Methods: An Evan questionnaire with 25 questions was completed 24 hours after anaesthesia by the patient. The questionnaire explored six areas, each one being marked out from 0 to 100, as the visual analogue scale. The marks were compared with consideration of age, gender, ASA physical class, type of anaesthesia, anaesthesia duration and type of surgery.Results: The mean global mark was 76 +/- 9 (min-max: 34-99). Marks were lower in the youngest patients, in females, in ASA 1 patients, in longest surgical procedures, especially with regard to areas belonging to "apprehension", "pain-discomfort" and "physical needs". The lowest mark was given for the "information" provided during the pre-anaesthetic evaluation. Differences in marks occurred also between surgical specialities.Conclusion: The Evan questionnaire is a valuable tool for assessing the patient's opinion on the perioperative period. Further studies are required to extend its use to other fields, as ambulatory surgery. (C) 1999 Editions scientifiques et medicales Elsevier SAS.

OBJECTIVE:To assess the effects of midazolam on oxygen consumption (VO2) and the level of vigilance. To search for a possible "sedative effect" of the canopy of the Deltatrac (Datex) when a placebo is administered instead of midazolam.STUDY DESIGN:Prospective, comparative, randomized, double-blinded, cross-over study.PATIENTS:Eight healthy volunteers of ASA physical class 1, not under stress, fasting and at rest.METHODS:The volunteers were administered at T0 either midazolam (0.07 mg.kg-1, IM), or a placebo at a one week interval in an order at random. The VO2 was measured with a Deltatrac. Circulatory status was monitored with non invasive methods and the level of vigilance assessed using the Ramsay scale. Statistical analysis was obtained with Anova for repeated measurements with two within factors (drug and time).RESULTS:VO2 decreased similarly and significantly between T0 and T45 min (P < 0.05). The decrease continued only after midazolam until T60 min. However the variation of VO2 between the midazolam and placebo group was not significant. The haemodynamic variables remained unchanged. Midazolam had a stronger sedative effect at T120 min.

Objective: To assess the effects of midazolam on oxygen consumption ((V) over dotO(2)) and the level of vigilance. To search for a possible "sedative effect" of the canopy of the Deltatrac(TM) (Datex) when a placebo is administered instead of midazolam.Study design: Prospective, comparative, randomized, double-blinded, cross-over study.Patients: Eight healthy volunteers of ASA physical class 1, not under stress, fasting and at rest.Methods: The volunteers were administered at T0 either midazolam (0.07 mg.kg(-1), IM), or a placebo at a one week interval in an order at random. The (V) over dotO(2) was measured with a Deltatrac(TM). Circulatory status was monitored with non invasive methods and the level of vigilance assessed using the Ramsay scale. Statistical analysis was obtained with Anova for repeated measurements with two within factors (drug and time).Results: (V) over dotO(2), decreased similarly and significantly between T0 and T45 min (P < 0.05). The decrease continued only after midazolam until T60 min. However the variation of (V) over dotO(2), between the midazolam and placebo group was not significant. The haemodynamic variables remained unchanged. Midazolam had a stronger sedative effect at T120 min.Conclusion: As (V) over dotO(2) decreased as well after placebo than after midazolam it is concluded that the decrease occurring during the 45 first minutes is related to the presence of the canopy, especially from its acoustic isolation. Such a "canopy effect" should be considered when (V) over dotO(2) is assessed with such a device. (C) 1998 Elsevier, Paris.

The effects of fetal calf serum (FCS) or serum fractions on the development of bovine embryos was investigated. Bovine zygotes were produced in vitro and were cultured in a semi-defined culture medium (mSOF). In the first experiment, blastocysts produced in mSOF supplemented with 10% whole heat-treated FCS or desalted FCS appeared about 1 day earlier, their proportion was significantly (P < 0.05) higher (whole: 30%, desalted: 29%) and they had significantly (P < 0.05) more cells at day 8 (119 cells, 127 cells) than did blastocysts produced in mSOF without any supplement (16%, 98 cells) or mSOF supplemented with a glucose concentration equivalent to that of serum (15%, 88 cells). Our results indicate that high molecular mass components (> 5 kDa) of serum are responsible for the effects of FCS on the kinetics of development, on the percentage of blastocysts obtained and the total number of cells in blastocysts. A further analysis using time-lapse microcinematography showed that the acceleration of development induced by serum occurred between the 9-16-cell and morula stages. Finally, in an experiment designed to analyse by microcinematography the effect of the addition of FCS using semen from a different bull to inseminate the oocytes, a different batch of serum and adding mSOF at a different time (42 h after insemination), acceleration was similarly observed between these two stages. Our microcinematographic studies demonstrate that the addition of FCS at two developmental stages (three-four-cell and five-eight-cell) before the 8-16-cell stage accelerates development just after this critical blocking stage.