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Head and neck melanomas (HNMs) are frequent and have a poorer prognosis than melanomas at other sites. Photoprotection in these locations is difficult. In this population-based study of 279 HNMs diagnosed in a French region between 2004 and 2009, major differences were found between genders. A clearcut, sex-related distribution was found between a "peripheral" area (scalp, forehead, temples, ears, and neck) and a "central" one (other parts of the face), with 56.7% of HNMs being located in the peripheral area in men and 79.3% in the central area in women (P<0.0001). Moreover, HNMs located in the peripheral area occurred on the left side in 57.6% of men and on the right side in 73.1% of women (P=0.009). Peripheral HNMs differed from central HNMs by a higher proportion of invasive tumors, nodular or superficial spreading melanomas, and a lower proportion of lentigo maligna melanomas (LMMs). We hypothesized that this differential distribution between men and women could be explained mostly by a major role of long-term photoprotection by hair and sun exposure in a car. Important public health messages could result from these observations, such as the role of hairstyles in melanoma prevention and the importance of reducing sun exposure in a car, particularly in professional drivers.

Background: Training procedures for dermatology residents have never been evaluated in French university hospitals. The present study describes the methods used over the last 5 years., Methods: This was a retrospective survey using a questionnaire sent to French dermatology-residents completing their residency between 2005 and 2010. The data collated included information on theoretical aspects (courses, local, regional or national seminars, meetings) and on practical training (consultations, surgery, laser and cosmetic dermatology), research, post-residency assistantship and additional university diplomas, as well as overall opinions on dermatology training. Statistical analysis was descriptive and comparative according to the number of dermatology teachers (professors, senior lecturers) in the region in which training was given., Results: One hundred and twenty-two questionnaires were analyzed: 72 from regions with two or less than two university hospital dermatology teachers (group 1) and 50 with more than two such teachers (group 2). Fewer residents had completed a research year in group 1 (19% vs 40%; P=0.01), but the two groups were comparable concerning post-graduate training (DESC) (16%) or post-residency (87%) placement. There were no differences concerning local theoretical training or participation in seminars or meetings, apart from inter-regional seminars, which were more frequent in group 2 (24% vs 3%; P<0.001). There were no differences between the two groups in terms of personal consultations (91%), surgery (62%), laser treatment (13%) or cosmetic dermatology (3%). Satisfaction rates regarding theoretical and practical training were similar in both groups (69% vs 70% and 72% vs 78%, respectively)., Discussion: This is the first survey carried out with the aim of evaluating suitability of training for dermatology residents in France with regard to the "reference" dermatological practice recently submitted to the French health ministry. The present results, obtained from 47% of residents receiving training during this period, show only very few differences concerning dermatology residency training with respect to the number of university hospital dermatology teachers, apart from research training., Conclusion: Despite an overall good opinion on their residency, the dermatology residents involved underlined the need for greater focus on teaching of technical skills (surgery, laser, cosmetic dermatology)., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: Little data are available concerning the role of general practitioners (GPs) in the diagnosis of melanoma., Objectives: To evaluate the actual role of GPs in a population-based study covering five regions of France and 8·2 million inhabitants., Materials and Methods: A survey of cancer registries and pathology laboratories, and questionnaires to practitioners were used to identify incident melanomas in 2008, and evaluate characteristics of patients (age, sex, area of residence, social isolation), tumours (Breslow, ulceration, location, histological type), and GPs (training, conditions of practice), and their influence on patterns of diagnosis and Breslow thickness., Results: Among 898 melanomas, 376 (42%) were first diagnosed in a general practice setting (GP group). Breslow thickness was much higher in the GP group than in other melanomas (median: 0·95 vs. 0·61 mm, P < 0·0001). Multivariate analysis identified an older age, lower limb location, nodular subtype and Breslow thickness as factors associated with the GP group. Within this group, 52·5% of melanomas were detected by patients (median Breslow thickness: 1·30 mm) and 47·5% by GPs (median Breslow thickness: 0·80 mm, P = 0·0009), including 8% during a systematic full-body skin examination. Previous GP training on melanoma was associated with active detection by GPs. Male sex and social isolation of patients were associated with thicker melanomas, whereas active detection by GPs was associated with thinner CMs., Conclusions: GPs play a key role in melanoma diagnosis in France, but still frequently detect thick tumours. Increasing awareness and training of GPs and focusing attention on male and/or socially isolated patients should help to improve early detection of melanoma., (© 2012 The Authors. BJD © 2012 British Association of Dermatologists.)

Objective: To identify clinical and sociodemographic factors associated with very thick melanoma (VTM) (Breslow thickness, 3 mm) in France., Design: Retrospective, population-based, case-case study using a survey of cancer registries and questionnaires to practitioners., Setting: Five regions covering 19.2% of the French territory and 8.2 million inhabitants., Cases: Cases included all incident melanomas with a Breslow thickness of 3 mm or greater (ie, VTM), diagnosed between January 1 and December 31, 2008, in residents of the study area (Alsace, Bourgogne, Champagne-Ardenne, Franche-Comte', and Lorraine, France), and a randomly selected sample of melanomas thinner than 3 mm., Main Outcome Measures: Circumstances of diagnosis,clinical and pathological characteristics of melanomas,and sociodemographic characteristics of patients(age, sex, residence, home and family life conditions, educational level, and smoking habits)., Results: Among 898 melanomas, 149 (16.6%) were VTMs. Very thick melanomas were more often diagnosed in a general-practice setting than thinner melanomas.The rate of immediate clinical recognition by dermatologists was lower for VTMs than for thinner melanomas. In a multivariate logistic regression analysis,factors associated with VTM were the nodular and acrolentiginous types; the head and neck and lower limb locations; older age; male sex; and being single, separated,divorced, or widowed. When only factors related to patients were taken into account, older age, male sex,and living alone were independent risk factors for VTM.The most significant risk was observed for patients living alone., Conclusions: Intrinsic factors related to the tumor and socio demographic characteristics of patients contribute to the occurrence of VTM. These factors should be better targeted in future secondary prevention programs.

Objectives: To describe and compare the evolution of digital pressure on both hands during a dialysis session in patients without digital ischemia, and to identify the parameters influencing the digital pressure., Materials: Patients with an upper limb vascular access were prospectively included. Digital systolic pressure on the third finger of both hands measured by photoplethysmography and brachial systolic pressure were recorded before dialysis (H0) and every hour (from H1 to H4)., Results: Among 53 patients, 49 were included (exclusions: one surgery for ischemia, one hand tremor, two no consent). None of them had digital ischemia. Digital pressure homolateral to the vascular access was significantly lower compared with controlateral side before and during dialysis. Digital pressure significantly decreased on both sides during dialysis. Brachial pressure decreased significantly compared to H0. Only the brachial pressure decrease was correlated with the decrease of digital pressure. The digital pressure was less than 30 mmHg in six patients. No evidence of digital ischemia was reported after a 6-month follow-up., Conclusion: To our knowledge, this is the first study showing a significant decrease of digital pressure in both hands during hemodialysis in patients without digital ischemia. Further studies are necessary to investigate which parameters can affect digital pressure and to look for clinical consequence of this measurement., (Copyright © 2012. Published by Elsevier Masson SAS.)

Background: Medical therapeutic options for the treatment of emphysema remain limited. Lung volume reduction surgery is infrequently used because of its high morbi-mortality. Endobronchial lung volume reduction coil (LVRC(®), PneumRx, Mountain View, CA) treatment has been recently developed and has been shown to be feasible and associated with an acceptable safety profile, while resulting in improvements in dyspnea, exercise capacity and lung function. The objective of this study is to analyze the cost effectiveness of LVRC treatment in severe emphysema., Methods: This prospective, multicenter study, randomized with a 1:1 ratio (LVRC vs conventional treatment) will include 100 patients who will be followed up for 1year. The primary outcome measure is the 6-month improvement of the 6-minute walk test: the percentage of patients showing an improvement of at least 54m will be compared between groups. A cost-effectiveness study will estimate the cost of LVRC treatment, the global cost of this therapeutic option and will compare the cost between patients treated by LVRC and by medical treatment alone., Expected Results: This study should allow validating the clinical efficacy of LVRC in severe emphysema. The cost-effectiveness study will assess the medical-economic impact of the LVRC therapeutic option., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The objective of this study was to analyze the place for the balloon remodeling and stenting in the endovascular treatment of intracranial aneurysms as well as the impact of their use on the failure and complications rates. Analysis was conducted in a recent 3-year period (2008-2010) in a single center., Methods: A total of 287 aneurysms, harbored by 252 patients (age, 16-87 years; mean, 50.9 ± 13.4 years), were proposed for endovascular treatment. Patient and aneurysms characteristics, modalities of treatment (coiling, remodeling, or stenting), failure rate, and rate of adverse events related to the treatment were analyzed., Results: Treatment failed in 3/287 aneurysms (1.0%). The use of the remodeling technique and stenting increased over time (23.9% and 4.6% in 2008, 39.5% and 14.9% in 2009, and 43.9% and 20.7% in 2010, respectively). The remodeling technique was used in a similar percentage of cases independent of aneurysm characteristics (aneurysm status, location, and size, and neck size), except dome-to-neck ratio. Stenting was more frequently used in unruptured aneurysms, in internal carotid artery aneurysms, and in wide neck aneurysms. The rate of specific adverse events (thromboembolism and intraoperative rupture) was similar in coiling (2.8%), remodeling (6.9%), and stenting (1.1%). The rate of specific adverse events was similar in 2008, 2009, and 2010 (2.3%, 4.4%, and 6.1%, respectively)., Conclusion: In the endovascular management of intracranial aneurysms, the large use of the remodeling technique combined with stenting in selected cases enables a low rate of treatment failures without increasing the rate of complications.

Objectives: To assess whether health-related quality of life is an independent prognostic factor for mortality or nursing home placement in frail elderly patients., Design: A prospective, multicenter study with a 12-month follow-up., Setting: Nine French hospitals., Participants: A total of 1306 patients aged 75 and older hospitalized through an emergency department., Measurements: Data obtained from sociodemographic characteristics, Comprehensive Geriatric Assessment and the Duke Health Profile (DHP) were used into a Cox model to identify prognostic variables for 12-month mortality and institutionalization., Results: Crude mortality and nursing home placement rates were 34.1% (n = 445) and 16.1% (n = 210), respectively. Independent prognostic factors identified for mortality were: Comorbidity level (moderate: hazard ratio [HR] [95% confidence interval (CI)] = 1.40 [1.09-1.78]; severe: 2.70 [1.63-4.46]), dependence for activities of daily living (1.68 [1.06-2.67]), pressure sore risk (1.49 [1.16-1.90]), risk of malnutrition (2.09 [1.46-3.00]), delirium (2.25 [1.75-2.90]), and 10-point increase in the DHP perceived health score (0.96 [0.93-0.99]). Independent prognostic factors identified for nursing home placement were the following: living alone at home (1.82 [1.30-2.55]), having 2 children or more (0.71 [0.51-0.99]), dependence for activities of daily living (2.48 [1.39-4.44]), dementia (1.93 [1.39-2.69]), unplanned hospital readmission during follow-up (2.05 [1.45-2.91]), and 10-point increase in the DHP social health score (0.90 [0.83-0.99]). Balance troubles and risk of malnutrition were no more significant when adjusted for the DHP scores and other clinical variables., Conclusion: The perceived health and social health scores of the DHP were independent prognostic factors of survival and nursing home placement among hospitalized elderly patients, respectively. When associated with Comprehensive Geriatric Assessment, they could help screen frail patients to set up as early as possible targeted interventions to restore/maintain modifiable prognostic factors, such as nutritional status, functional ability, and social support., (Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)

Herpes simplex virus 1 (HSV-1) esophagitis diagnosis is routinely based on the endoscopic findings confirmed by histopathological examination of the esophagitis lesions. Virological diagnosis is not systematically performed and restricted to viral culture or to qualitative PCR assay from esophagitis biopsy specimens. The aim of this study was to assess the interest of quantitative real-time PCR assay in HSV-1 esophagitis diagnosis by comparing the results obtained to those of histological examination associated with immunohistochemical staining, which is considered the "gold standard." From 53 esophagitis biopsy specimens, the PCR assay detected HSV-1 in 18 of 19 histologically proven to have herpetic esophagitis and in 9 of 34 that had esophagitis related to other causes, demonstrating sensitivity, specificity, positive predictive value, and negative predictive value of 94.7%, 73%, 66.7%, and 96%, respectively. Interestingly, HSV-1 was not detected in 16 specimens without the histological aspect of esophagitis. The viral loads normalized per μg of total extracted DNA in each biopsy specimen detected positive by HSV PCR were then compared and appeared to be significantly higher in histopathologically positive herpetic esophagitis (median = 2.9 × 10(6) ± 1.1 × 10(8)) than in histopathologically negative herpetic esophagitis (median = 3.1 × 10(3) ± 6.2 × 10(3)) (P = 0.0009). Moreover, a receiver operating characteristics analysis revealed that a viral load threshold greater than 2.5 × 10(4) copies would allow an HSV-1 esophagitis diagnosis with a sensitivity and specificity of 83.3% and 100%, respectively. In conclusion, this work demonstrated that HSV quantitative PCR results for paraffin-embedded esophageal tissue was well correlated to histopathological findings for an HSV-1 esophagitis diagnosis and could be diagnostic through viral load assessment when histopathological results are missing or uncertain.

Objective: In multiple endocrine neoplasia type 1, the main risk factor for metastases is pancreatic tumour size. We and others recommend limiting surgery to non-functioning pancreatic tumors ≥20 mm or growing, based on their size measured with endoscopic ultrasonography. Because endoscopic ultrasonography is invasive, we compared endoscopic ultrasonography (EUS) to non-invasive magnetic resonance imaging (MRI) for the detection of pancreatic tumours ≥10 mm in multiple endocrine neoplasia type 1 patients., Methods: A prospective study was performed in nine participating centres; 90 patients with multiple endocrine neoplasia type 1 underwent EUS and MRI with gadolinium infusion. Gastroenterologists and radiologists were blinded to the results, magnetic resonance images were reviewed centrally., Results: EUS detected 86 tumours ≥10 mm, and 48 (53.3%) patients had at least one tumour ≥10 mm. MRI detected 67 tumours ≥10 mm, and 46 (51.1%) patients had at least one tumour ≥10 mm. EUS and MRI agreement was moderate for detection of tumours ≥10 mm (Kappa coefficient=0.49), and for selection of patients with tumours ≥10 mm (Kappa coefficient=0.55). EUS and MRI missed 11/24 and 4/24 lesions ≥20 mm, respectively. EUS failed to identify 9/57 (15.7%) patients with pancreatic tumours ≥10 mm, and MRI failed to identify 11/57 (19.3%) patients with pancreatic tumours ≥10 mm., Conclusions: EUS and MRI are complementary and should be performed at initial evaluation in multiple endocrine neoplasia type 1 patients. Whether follow-up should be based on either technique or both, requires further evaluation., (Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Although incidence and mortality data are numerous, population-based studies including clinical and pathological characteristics of melanoma are rare., Objectives: To describe the characteristics of melanoma in a rural French region during 2004-2008 and to identify differences according to age, gender and geographical areas., Methods: Pathology reports of cutaneous melanomas diagnosed in residents from the Champagne-Ardenne region during 2004-2008 were anonymously collected from pathology laboratories. Demographic, clinical and pathological data were extracted and analysed by experts, including dermatologists, pathologists and epidemiologists., Results: One hundred and seventy-seven in situ melanomas were diagnosed in 177 patients (female/male ratio : 1.72). Patients with head and neck in situ melanomas were older than patients with melanomas in other locations (72 vs. 54 years; P < 0.0001). Six hundred and sixty-one invasive melanomas were diagnosed (female/male ratio : 1.26), corresponding to an annual incidence rate of 6.3/100,000. Male patients had thicker and more frequently ulcerated tumours. The location widely varied between genders, involving the trunk in 47% of male patients and the lower limb in 48% of female patients. Older patients had thicker and more advanced melanomas, with a more frequent head and neck location. Nodular, acral lentiginous and unclassified melanomas were much thicker than superficial spreading and lentigo maligna melanomas (4.37 vs. 1.33 mm, P < 0.0001). Primary melanomas of advanced stages were more frequent in one of the four districts of the study area. Overall, the mean Breslow thickness (2.02 mm) was much higher than that previously observed in other regions of north-eastern France (1.59 mm)., Conclusions: Information and screening campaigns should particularly target rural areas, males, older people and focus on nodular, acrolentiginous and unclassified subtypes., (© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.)

Objective: The aim of this study was to identify the factors associated with differences between how Alzheimer's disease (AD) patients and their caregivers rate the patient's health-related quality of life (QoL)., Methods: Cross-sectional, multicentre study. Patients were 65 years or more, suffering from mild to moderate AD, native French speakers, with a main caregiver. Interrater agreement of the QoL-AD was assessed using the intraclass coefficient. A generalised linear model was used to identify factors related to the difference in health-related QoL scores between patients and their caregivers., Results: The 122 patients of the study were 82 ± 6 years old and mainly women (69%). Independent factors related to the difference between patients and caregivers were: Mini Mental State Exam score (β = 0.32; 95% CI = 0.05-0.59); instrumental activities of daily living score (β = -0.61; 95% CI = -1.14 to -0.07); total Neuropsychiatric Inventory score (β = 0.10; 95% CI = 0.05-0.59), and Zarit's burden score (β = 0.09; 95% CI = 0.01-0.17)., Conclusion: Practitioners must take into account the trend towards underestimation when health-related QoL is rated by caregivers or proxies., (Copyright © 2012 S. Karger AG, Basel.)

Background: Global cardiovascular (CV) risk associated with abdominal aortic aneurysms (AAAs) has been poorly documented. The aim of this study was to evaluate whether the presence of AAA in patients hospitalized for acute coronary syndrome with coronary stenosis (≥50%) was associated with an increased CV risk at 1-year follow-up., Methods: Between February 1, 2008 and March 30, 2009, 304 patients admitted for acute coronary syndrome with significant (≥50% stenosis) coronary lesions underwent echocardiography to check for presence of AAA. Twenty AAAs were diagnosed, of average (±standard deviation) diameter 33 ± 3.7 mm. Follow-up at 1 year was available for 288 patients (95%). Variables recorded at 1 year were death, cause of death, and occurrence of nonfatal CV events of cardiac or peripheral vascular origin., Results: During follow-up, 65 patients (22.6%) experienced an event (all-cause death or nonfatal CV event), including 21 deaths (7.3%) and 44 nonfatal CV events (15.3%). The presence of AAA significantly increased the risk of any CV event (fatal or nonfatal) at 1 year (hazard ratio: 2.96, 95% CI: 1.49-5.89, p = 0.002) but did not influence overall mortality or CV mortality., Conclusion: Our results show that in patients with coronary artery disease already at high CV risk, the presence of AAA was associated with worse CV prognosis at 1 year, and incurred an increased risk of occurrence of any CV event (fatal and nonfatal)., (Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the value of endothelin-1 (ET-1) expression in predicting extracapsular extension (ECE) in clinically localized prostate cancer (PCa)., Patients and Methods: ET-1 expression was determined by immunohistochemistry on archival needle biopsies (NBs) from 94 patients (49 pT2 and 45 pT3a) who underwent radical prostatectomy (RP) for clinical T1-T2 PCa. Each sample was analysed independently by two pathologists blinded to the clinical data., Results: In univariate analysis, high ET-1 expression in NBs, pre-operative prostate-specific antigen (PSA) level >10 ng/ml, percentage of positive biopsy cores and NB Gleason score ≥7 were significantly associated with ECE as determined on subsequent RP. No significant association was found between clinical stage and ECE. In multivariate analysis, there was a significant association with high ET-1 expression in NBs (p = 0.006), pre-operative PSA level >10 ng/ml (p = 0.049), and NB Gleason score ≥7 (p = 0.002). These three pre-operative factors combined provided the best model for predicting ECE with 93.3% sensitivity, 49% specificity, 62.5% positive predictive value, 88.9% negative predictive value. The combination yielded a higher concordance index (0.760 vs 0.720) and offered a higher log partial likelihood than the same model without ET1 (112.8 vs 105.7, p = 0.01)., Conclusions: ET-1 expression was strongly associated with ECE and, when combined with pre-operative PSA level and Gleason score, improved the predictive accuracy of pre-operative NBs. Its assessment in patients with localized PCa might be useful when making treatment decisions. Further studies with standardisation of immunohistochemical staining and multi-institutional validation are now needed to establish the appropriate use of ET-1 staining in PCa staging and to evaluate inter-observer reproducibility., (© 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.)

Objective: • To determine oncological outcomes after high-intensity focused ultrasonography (HIFU) treatment in patients with localized prostate cancer using a new, more accurate, definition ('Stuttgart' definition) of biochemical failure., Patients and Methods: • We performed a retrospective review of all patients in our centre who received first-line treatment with a second-generation Ablatherm™ device (EDAP-TMS, Lyon, France). • Oncological failure was given either by biochemical failure (prostate-specific antigen, PSA, nadir plus 1.2 g/mL) (Stuttgart definition) or the start of salvage therapy because of a persistently positive biopsy after the HIFU procedure. • The 5-year biochemical-free survival rate and 5-year disease-free survival rate were calculated., Results: • In total, 53 patients were included (mean age, 72.5 ± 4.5 years, range 60-79 years; 28 low risk and 25 intermediate risk). None had undergone previous hormonal therapy. Mean ±sd follow-up was 45.4 ± 15.5 months (range 16-71 years). Mean (range) pre-treatment PSA was 8.5 ± 4 (0.29-18) ng/mL. The median (range) PSA nadir value was 1 (0.01-14) ng/mL and occurred after a mean (range) of 5.09 (3-24) months. • Overall, 36 patients (67.9%) experienced oncological failure. • These included 33 cases (62.2%) of biochemical failure. A PSA nadir of ≤0.2, 0.21-1.0 and >1 ng/mL was reached in 20.8%, 30.2% and 49% of patients, respectively, and was associated with biochemical failure in 9.1%, 30.3% and 60.6%, respectively. • The 5-year biochemical-free survival rate and disease-free survival rate were 21.7% and 13.5%, respectively. In multivariate analysis, a PSA nadir of >1 ng/mL was significantly associated with a risk of biochemical and oncological failure (P= 0.002 and P < 0.001). • Oncological failure was not associated with any risk group. • No patient died from prostate cancer., Conclusions: • In our experience, Ablatherm™ treatment for clinically localized prostate cancer was associated with a high rate of biochemical failure as determined by the 'Stuttgart' definition, and did not achieve effective cancer control. • The PSA nadir value after HIFU treatment was a significant predictor of treatment failure., (© 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.)

Objective: To investigate the diagnostic value of commercially available BP230 and BP180-NC16a enzyme-linked immunosorbent assays (ELISAs) in routine practice in patients with bullous pemphigoid (BP)., Design: Single-center retrospective study., Setting: French academic dermatology department., Patients: The study population comprised 138 patients, who were admitted from January 1998 through December 2008., Interventions: Sera samples were analyzed by ELISA; clinical and immunopathological data were recorded from the patients' medical charts., Main Outcome Measures: BP230 and BP180-NC16a ELISA scores were evaluated with respect to clinical characteristics (number of blisters, mucosal involvement, localized or generalized disease, and outcome) and routine indirect immunofluorescence (IF)., Results: Of the 138 study patients, 81 (59%) had a positive BP230 ELISA result and 119 (86%) had a positive BP180 ELISA result. There was no relationship between a positive ELISA BP230 result and the disease extent at diagnosis or the presence of mucosal involvement. Serum anti-basement membrane zone autoantibodies (indirect IF) were more frequently detected when the BP230 ELISA result was positive (P < .001). The median anti-basement membrane autoantibody titer as detected by indirect IF was higher in patients with a positive BP230 result (P < .001). The BP180 ELISA result was associated with disease extent at diagnosis as estimated by both the percentage of patients with extensive BP (P = .01) and the mean number of blisters (P = .03) but was not associated with mucosal involvement., Conclusions: The currently available BP230 ELISA is a reliable although less-sensitive test than BP180 ELISA in BP, and its diagnostic added value compared with BP180 ELISA alone is approximately 5%. Our results support the predominant contribution of the BP230-specific autoantibodies to anti-basement membrane zone antibody titer as detected by indirect IF.

Background: There is no consensus regarding the therapeutic utility of sentinel lymph node biopsy (SLNB) versus that of nodal observation (NO) in melanoma., Objective: To prospectively evaluate a standardized counseling procedure and its effect on patient choices to undergo SLNB or NO., Methods: In four centers, patients with melanoma eligible for SLNB or NO received a complete counseling procedure that included verbal information from dermatologists and surgeons, a detailed information sheet, and a written consent form. Data collected included patient and tumor characteristics, counseling conditions, and specialties of informing doctors. Factors influencing patients' choices were studied using multivariate analysis., Results: Of 343 consecutive patients, 309 were offered SLNB and NO and received complete verbal and written information from a dermatologist alone (62%) or in association with a surgeon (38%). Approximately half took advice from trusted persons, and half asked for additional time before making a decision; 268 (86.7%) ultimately decided to undergo SLNB. Multivariate analysis showed that older patients, those with a head and neck melanoma, and those informed without a surgeon present were more likely to prefer NO., Conclusions: This counseling procedure was easily implemented in clinical practice. Patients favored SLNB but were able to understand uncertainties and express preferences., (© 2011 by the American Society for Dermatologic Surgery, Inc.)

Background: Little is known about the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary heart disease. The aims of this prospective study were to evaluate the prevalence of AAA and of large abdominal aorta in patients hospitalized for acute coronary syndrome and coronary stenosis of 50% or greater., Methods: AAA ultrasound screening was prospectively performed in 306 patients after they gave informed consent. AAA and large abdominal aorta were defined by maximum anteroposterior diameter of 30 mm or greater and of 20 to 29 mm, respectively. Patient characteristics were prospectively collected. Univariate and multivariate analyses were used to identify risk factors for AAA and large abdominal aorta. A p value <0.05 was considered statistically significant., Results: AAAs were diagnosed in 20 patients (6.6%). Mean diameter was 33 +/- 3.7 mm, and median diameter [min--max] was 31 mm [30 - 45 mm]. All except one AAA were between 30 and 40 mm. No AAAs were detected in patients younger than 50 years. Prevalence reached 7.7% in patients older than 50 years. Using stepwise logistic regression analysis, age (odds ratio [OR] 1.04. 95% confidence [CI] 1.00-1.09 per year of age, p = 0.06) and previous coronary events (OR 2.44, 95% CI 0.96-6.25, p = 0.06) showed a borderline significant association with AAA. Large infrarenal aortic diameter was observed in 32% of patients. Age (OR 1.03, 95% CI 1.02-1.05 per year of age, p < 0.0001), male gender (OR 16.7, 95% CI 6.25-50.0, p < 0.0001), and overweight (OR 2.0, 95% CI 1.2-3.4, p = 0.01) showed a significant independent association with large aorta., Conclusion: AAA and large infrarenal aorta prevalence seems high in patients with acute coronary syndrome and proven coronary stenosis of 50% or greater. Previous coronary events and older age might be associated with higher risk of AAA, and age, male gender, and obesity are significantly associated with large infrarenal aorta. If these results are confirmed in larger studies, further guidelines concerning AAA screening in this well-defined population should be considered., (Copyright (c) 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

The aim of the study was to determine predictive factors of epidemic extended spectrum beta-lactamase-producing Escherichia coli acquisition. All patients presenting any type of culture positive for ESBL-producing E. coli between November 2006 and October 2007 were included. An epidemic case was defined as a patient colonized with a clonal strain having epidemiological link with an another patient harbouring the same strain. Clinical and administrative data were recorded. Groups were compared by univariate and multivariate analysis using SAS software. Were included in this study 148 patients: 60 epidemic and 88 sporadic cases. Multivariate analysis showed several predictive factors of epidemic strain acquisition: female gender, high Charlson index, treatment by amoxicillin or ticarcillin-clavulanic acid, admission to emergency unit and hospitalisation in a high number of different care units. Identification of predictive factors of epidemic ESBL-producing E. coli strains acquisition may help to limit cross transmission of such strains., (Copyright (c) 2009 Elsevier Masson SAS. All rights reserved.)

Background: Gemella morbillorum is an anaerobic to aerotolerant Gram positive coccus. It is considered a member of the normal upper respiratory tract flora including the oropharynx and also the gastro-intestinal and female genital tract. However severe infections are reported like endocarditis, septic shock and septic arthritis, more often in immunocompromised hosts. It is an infrequently isolated organism and a rare cause of pulmonary or pleural infections., Case Report: We report a case of necrotizing pneumonia due to Gemella morbillorum in a 45-years-old Melanesian, smoker patient. The presentation was subacute with a four month history of loss of appetite, progressive weight loss and cough without fever. Initial presentation seems to be a malignant disease. The positive diagnosis has been established on the results of BAL fluid and the protected specimen brush samples. It was an immunocompetent patient presenting dental inflammation but not oral infection. Further management included intravenous administration of amoxicillin during two weeks. We recommended oral antibiotic treatment for another six weeks. After two months the patient was reevaluated. The CT scan showed no evidence of persistent infection. The HR CT scan will reveal multiple kystic bronchiectasies not seen on the first CT scan., Conclusion: Gm can be found endoscopic samples. Gemella morbillorum can be responsible of community-acquired pneumonia in immunocompetent host.

A novel and highly versatile doping method has been developed to allow active dopants, including materials incompatible with the polymer matrix, to be incorporated into microstructured polymer optical fibers through the use of nanoparticles. The incorporation of quantum dots and silica nanoparticles containing Rhodamine isothiocyanate is demonstrated.

Objective: The education of diabetic subjects has been the object of numerous studies which have demonstrated its importance as an integral part of treatment. Few studies have focused on the particular problem of education in the elderly., Patients and Methods: An inquiry was conducted in 60 elderly patients with diabetes in order to assess their knowledge of the disease, comparing those who had received specific education and those who had not, and to determine the characteristic features of patients who had received education. A specific questionnaire was designed for this study. The maximal score was 50., Results: Mean age of the 60 patients was 77 years (range 65-94). Lack of knowledge was most patent concerning acute metabolic decompensation with hypoglycemia an hyperglycemia and concerning foot care. Only one-third of the patients had received diabetic education. The average score in the educated group was 42 +/- 0.4 versus 23 +/- 7 in the non-educated group (p = 0.0001). The best results were obtained in educated and younger patients. The inquiry showed that education had been distributed preferentially to the youngest patients, to men, and to patients treated with insulin., Conclusions: Our findings demonstrate that elderly diabetics can benefit from an education program and prove a real insufficiency in current education of elderly diabetics. These results should also lead to further work on an educational tool specifically designed for elderly diabetics.

In the field of percutaneous access to soft tissues, our project was to improve classical pericardiocentesis by performing accurate guidance to a selected target, according to a model of the pericardial effusion acquired through three-dimensional (3D) data recording. Required hardware is an echocardiographic device and a needle, both linked to a 3D localizer, and a computer. After acquiring echographic data, a modeling procedure allows definition of the optimal puncture strategy, taking into consideration the mobility of the heart, by determining a stable region, whatever the period of the cardiac cycle. A passive guidance system is then used to reach the planned target accurately, generally a site in the middle of the stable region. After validation on a dynamic phantom and a feasibility study in dogs, an accuracy and reliability analysis protocol was realized on pigs with experimental pericardial effusion. Ten consecutive successful punctures using various trajectories were performed on eight pigs. Nonbloody liquid was collected from pericardial effusions in the stable region (5 to 9 mm wide) within 10 to 15 minutes from echographic acquisition to drainage. Accuracy of at least 2.5 mm was demonstrated. This study demonstrates the feasibility of computer-assisted pericardiocentesis. Beyond the simple improvement of the current technique, this method could be a new way to reach the heart or a new tool for percutaneous access and image-guided puncture of soft tissues. Further investigation will be necessary before routine human application.

Until now, computer assisted surgery has focused primarily on surgical procedures involving rigid anatomical structures. Because soft tissues can be highly mobile and deformable, they may require specific imaging devices, suitable modeling tools, and guiding systems. Percutaneous pericardial puncture is a good clinical target for computer assisted surgery; this procedure is often performed without direct visualization and is dangerous even though echographic control is used. Computer assistance can greatly improve this technique and will allow accurate puncture of preplanned targets. This paper describes a new approach for computer assisted pericardial punctures (CASPER) and describes a first feasibility analysis of CASPER demonstrated with anesthetized animals. The approach is based on the use of echographic data localized in space, from which an optimal strategy is defined. Because of the specificity of the pericardial effusion, a stable target can be selected despite the heart motions. A passive guiding system is used. We have demonstrated the feasibility of the approach.

Unlabelled: Genital Chlamydia Trachomatis (CT) infections are the most common cause of tubal infertility. Its prevalence is variable between the authors, but seems to be more frequent in the young population., Objective: Evaluate the CT genital infection rate in a population consulting either in a sexually transmitted disease center (STD) or in a family planning unit (FPU). --Judge the interest of a routine screening, and by which technic. --Estimate the information level of population about STD and their prevention., Methods: 270 men and 331 women were detected by uretral or endocervix sample with an immunofluorescence method (Syva Microtrack). CT serology were also realised., Results: 18.5% of man samples, 20% of woman samples in the STD center and 17.9% of woman samples in the FPU were positive for CT. There is a strong correlation between CT positivity and cervical discharge or cervicitis (RR = 4.64, p < 0.01). Serology was positive in 45.5%, 32.5% and 21.2% respectively for STD center's men, STD center's women and PFU's women. The correlation between samples and serology was 62%. Positive samples were more frequent in the 15-30 years old population and positive serology in the over 30 years old population (RR = 3.57, p < 0.01). There is a correlation between CT positive samples and nulliparity, multiple sexual partner and history of genital infection., Conclusion: The high prevalence of CT genital infection observed in our centers justify a routine screening especially in the young population.

We report an epidemic of acute pulmonary histoplasmosis which occurred in February 1994 among a group of 24 persons after they had once or twice visited a cave in New Caledonia. This study describes the physical and laboratory findings, which lead to the diagnosis of histoplasmosis. Each test was evaluated. All members of the group had a physical examination, early and late serological tests, pulmonary X-rays (including CT) and some had mycological examination of bronchoalveolar washes. Mycological investigations were made on samples collected from the cave. Histoplasmic skin testing was not possible. We defined a case as a person who visited the cave in January 1994, had evocative radiological features and at least four symptoms among the following: weakness, fever, headache, arthralgia, thoracic pains, dyspnea, cough and nausea. Of the 24 exposed persons, 7 cases were considered as severe, 8 cases as moderate, and 6 cases as mild, for a total of 21 cases and an attack rate of 87.5%. There was no progression towards disseminated histoplasmosis and no recorded death. The incubation period lasted from 5 to 17 days. The symptoms were divided into three groups. In the first group, the symptoms of fever, headache and arthralgia were common and nonspecific. In the second group, the symptoms of chest pain, cough, and dyspnea which often occurred later, were less common and more specific. In the third group, the symptoms of vomiting, diarrhea and dizziness were less common. The chest X-ray showed abnormalities in 100% of the cases, and in 11 of the 21 cases the characteristic finding was a miliary.(ABSTRACT TRUNCATED AT 250 WORDS)

The complex nature of "all in one" formulas for TPN, makes it difficult to ensure the stability of the lipid emulsions in these preparations. Despite the fact that studies on this issue are increasing, official guidelines on maximum acceptable particle size and the methods to control it are still lacking. The objective of this study was to assess the stability of a lipid emulsion in four standard mixtures also containing amino acids, glucose or F-G-X, electrolytes and vitamins or trace elements. Lipid stability was assessed visually through electronic counts and microphotographs. The pH of mixtures ranges between 5.3 and 5.9, not changing with time nor storage temperature. Visual observation showed a possible rupture of the emulsion in one mixture after storing 96 hours at room temperature, but not when stored at 4 degrees C. Mean diameter of fat particles did not change. The percentage of droplets having a diameters under 1.2 micron was higher than 90%, although particles greater than 6 micron appeared in all mixtures. Micrographic observation revealed the presence of aggregates with a diameter greater than 8 microns in one mixture. According to the results obtained, one of the mixtures may be considered physically unstable. The clinical viability of this mixture and of the other three stable mixtures, depends on the limits considered acceptable regarding particle size. Due to the slight composition differences of the mixtures studied, it is difficult to explain the difference in behavior observed. Therefore, it would be adviceable to study standard "all in one" mixtures of known stability, while waiting for more conclusive studies to be performed, especially in the case of critical mixtures.

Observers evaluated five odors and their 26 mixtures (two, three, four, and five components) by magnitude estimation. Estimates revealed that in mixtures there is moderate suppression of perceived intensity; a vector model proposed by Berglund (Annals of the New York Academy of Sciences, 1974, 237, 35-51) provides a good prediction of the intensity of binary mixtures, but overpredicts the intensity of three, four, and five component mixtures. Hedonic tones of mixtures were difficult to predict from hedonic tones of components. Qualities of mixtures were difficult to predict from quality of components. Intermediacy, of quality and hedonic values, was often observed.

Modification of Sepharose 6MB affinity beads by conjugation with CIBA blue dextran and albumination together with siliconization and modification of the bed supports of glass chromatography columns permitted the construction of affinity columns with low non-specific binding characteristics. When used with staphylococcal protein A as the affinity ligand to fractionate antibody-coated lymphocytes, non-specific adherence was reduced to 2--3% of the viable input cells and essentially the entire input cell number could be recovered in viable, functional form. The capacity of the columns permitted quantitative separation of T and B lymphocytes in 250 microliter amounts at cell densities up to 5 X 10(8)/ml on 1.2 ml columns. Once used, the columns may be regenerated and reused numerous times without alteration of their characteristics. The method thus appears useful for preparative separation without loss of large numbers of highly purified cells having normal in vitro reactivity.