Search

Background Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is used increasingly when performing a prophylactic mastectomy. Few prospective studies have reported on complication rates. This complementary trial to the French prospective multicentre MAPAM trial aimed to evaluate the nipple–areola complex (NAC) necrosis rate in prophylactic NSM with IBR. Methods Patient characteristics and surgical data were recorded. Morbidity after prophylactic NSM with a focus on NAC necrosis was analysed. Results Among 59 women undergoing prophylactic NSM, 19 (32 per cent) of the incisions were partly on the NAC. Reconstructions were performed with 46 definitive implants and 13 expanders. The crude rate of postoperative complications was 25 per cent (15 patients). Complete NAC necrosis was reported in two women (3 per cent) and partial or total necrosis in nine (15 per cent). No NAC resection was necessary. Median BMI was lower in women with total or partial NAC necrosis compared with the others (20.0 versus 21.3 kg/m2 respectively; P = 0.034). Conclusion Results of this prospective study confirm that prophylactic NSM with IBR is associated with a low risk of total NAC necrosis.

Intra-operative radiotherapy for breast cancer has been developed throughout the last two decades. It is already well-established regarding local control and toxicity for intra-operative radiotherapy using electrons as we now have the necessary background knowledge. However, very few data on later toxicity are available for intra-operative radiotherapy using low-energy photons. We report here the case of a 36-year-old woman who experienced rib fracture following intra-operative and external radiotherapy. This patient has been included in the Targit-boost trial. The intra-operative irradiation has been operated with an INTRABEAM device delivering low-energy photons of 50-kV.

Resume Objectif Le pessaire gynecologique, utilise pour le traitement du prolapsus urogenital, est un dispositif qui a su traverser les millenaires. Ce travail se propose de faire le point au travers d’une revue bibliographique actualisee afin de mettre en lumiere les modalites pratiques de l’utilisation du pessaire en termes, notamment, d’indication, de choix de la taille du dispositif, d’insertion, de retrait et de suivi. Methode Une revue de la litterature, a la lumiere des dernieres publications et recommandations des societes savantes francaise et internationales ainsi que notre propre experience ont ete analysees. Resultats Le pessaire contribue sans nul doute a la restauration de l’image corporelle de la femme. Il peut etre utilise de facon temporaire, dans l’attente d’une solution chirurgicale ou en alternative possiblement definitive a celle-ci (choix de la patiente, desir de grossesse, terrain recusant une intervention). Il peut aussi etre d’une aide precieuse a titre de test therapeutique (resultat fonctionnel attendu d’une cure chirurgicale, mise en evidence d’une incontinence urinaire masquee). Toutefois, en depit de son efficacite, de son cout modere ainsi que de sa relative innocuite, le pessaire demeure sous-utilise et les principes, quant a son utilisation, peu connus. Conclusion Une brochure destinee a l’attention des patientes ainsi qu’un film quant aux modalites pratiques d’utilisation du dispositif ont ete elabores pour ameliorer les connaissances tant des professionnels que des utilisatrices afin d’optimiser et securiser le parcours de soins.

Radiotherapy's main skin toxicities are now well-separated, acute (acute radiation dermatitis) or chronic complications (chronic radiation dermatitis, induced cutaneous carcinoma, aesthetic sequelae). Exceptionally, radiotherapy may induce, by isomorphic reaction or Koebner's phenomenon, some specific dermatosis. In this article, we report five new observations of these unusual complications of radiation therapy, occurring in very variable time after breast irradiation and remaining strictly localized in the irradiated field (cutaneous mastocytosis, Sweet syndrome, lichen planus, vitiligo). These cases emphasize the need to realize a systematic histological exam if any atypical skin lesion appears after radiotherapy, even long after.

Intra-operative radiotherapy for breast cancer has been developed throughout the last two decades. It is already well-established regarding local control and toxicity for intra-operative radiotherapy using electrons as we now have the necessary background knowledge. However, very few data on later toxicity are available for intra-operative radiotherapy using low-energy photons. We report here the case of a 36-year-old woman who experienced rib fracture following intra-operative and external radiotherapy. This patient has been included in the Targit-boost trial. The intra-operative irradiation has been operated with an INTRABEAM device delivering low-energy photons of 50-kV.

Breast reconstruction’s objective is to improve patients’ quality of life without affecting oncological prognosis. Recent advances in radiotherapy and multidisciplinary management enable more immediate breast reconstructions to be performed, thanks to new therapeutic sequences that are immediate–delayed reconstruction and reverse sequence. In this article, breast reconstruction choice, type (implants versus flap), and moment (immediate or delayed) are discussed with regard to oncological risk and characteristics of patients in current scientific, technical, and economical context.

The use of gynecological pessary to put back up prolapsed organs to their normal position appears to be as effective as surgical management to relieve symptoms related to uro-genital prolapse and restore body image. This millenary device can be used temporarily, awaiting a surgical solution or as a therapeutic test (mimicking the effect of a surgical procedure to predict its functional outcome or identifying a masked urinary incontinence). It can also represent an alternative to surgery (patient choice, women who wish to complete childbearing or who are unsuitable for surgery because of medical comorbidities) and thus can be used in first intention. Pessary can also be used to confirm or deny the responsibility of pelvic organ prolapse for atypical symptomatology as pelvic heaviness or pain. However, this use requires adjuvant treatment. In this paper, we highlight an original effective process not yet published to optimize the tolerance of pessary.L’utilisation du pessaire gynécologique afin de réintégrer les organes prolabés dans l’enceinte pelvienne est une alternative efficace dans le soulagement des symptômes liés au prolapsus uro-génital et la restauration tant de l’image corporelle que de l’estime de soi. Ce dispositif millénaire peut être utilisé temporairement, dans l’attente d’une intervention chirurgicale, à titre de test thérapeutique préopératoire (prédiction du résultat fonctionnel attendu, identification d’une possible incontinence urinaire masquée par le prolapsus, confirmation de la responsabilité du trouble de la statique pelvienne quant à une symptomatologie inhabituelle à type de pesanteur pelvienne ou de douleurs). Le pessaire peut aussi être considéré en alternative définitive à la chirurgie (choix de la patiente, désir de grossesse, terrain récusant une intervention). Cette alternative nécessite toutefois un traitement adjuvant. Nous mettons en lumière un procédé original, non encore publié, optimisant la tolérance dudit pessaire.

Objective Glucocorticoid excess is one of the most important causes of bone disorders. Bone marrow fat (BMF) has been identified as a new mediator of bone metabolism. Cushing syndrome (CS) is a main regulator of adipose tissue distribution but its impact on BMF is unknown. The objective of the study was to evaluate the effect of chronic hypercortisolism on BMF. Design This was a cross-sectional study. Seventeen active and 17 cured ACTH-dependent CS patients along with 17 controls (matched with the active group for age and sex) were included. Methods The BMF content of the femoral neck and L3 vertebrae were measured by 1H-MRS on a 3-Tesla wide-bore magnet. Bone mineral density (BMD) was evaluated in patients using dual-energy X-ray absorptiometry. Results Active CS patients had higher BMF content both in the femur (82.5 ± 2.6%) and vertebrae (70.1 ± 5.1%) compared to the controls (70.8 ± 3.6%, P = 0.013 and 49.0 ± 3.7% P = 0.005, respectively). In cured CS patients (average remission time of 43 months), BMF content was not different from controls at both sites (72.3 ± 2.9% (femur) and 46.7% ± 5.3% (L3)). BMF content was positively correlated with age, fasting plasma glucose, HbA1c, triglycerides and visceral adipose tissue in the whole cohort and negatively correlated with BMD values in the CS patients. Conclusions Accumulation of BMF is induced by hypercortisolism. In remission patients, BMF reached values of controls. Further studies are needed to determine whether this increase in marrow adiposity in CS is associated with bone loss.

Introduction La plupart des patients hemodialyses (HD) en France sont supplementes en cholecalciferol. L’evolution de la 25OH vitamine D (25OHD) apres sevrage en cholecalciferol est inconnue. Methodes L’etude VITADIAL « La correction du taux plasmatique de 25OH vitamine D des HD par la supplementation en cholecalciferol ameliore-t-elle la force musculaire ? » est une etude prospective, multicentrique, randomisee, ouverte. Dans cette etude, seuls les patients avec une 25OHD ≤ 20 ng/mL sont randomises. Les autres patients beneficient d’un sevrage en cholecalciferol durant 3 a 12 mois jusqu’a obtention d’un taux de 25OHD ≤ 20 ng/mL. Nous presentons ici les donnees d’evolution de la 25OHD des HD qui ont beneficie d’un sevrage pendant 6 mois ou qui ont ete randomises dans le groupe ne recevant pas de vitamine D. Resultats obtenus ou attendus La cohorte comportait 74 HD d’âge moyen 70,2 ± 12,9 ans, dont 64,8 % d’hommes, 50 % de diabetiques. Quatre-vingt onze pour cent des patients recevaient du cholecalciferol avant la mise en sevrage. La 25OH moyenne etait de 38,9 ± 15,4 ng/mL a l’inclusion, 36,6 ± 17,2 ng/mL a M3 et de 30,5 ± 12,2 ng/mL a M6. Les 6 patients avec 25OHD 30 ng/mL (groupe 3). L’evolution de la 25OHD durant les 6 mois de suivi selon les groupes est decrite sur la Fig. 1 . En analyse univariee, l’age, le sexe et l’anciennete en dialyse n’influencaient pas la vitesse de decroissance de la 25OHD sur 6 mois. Les patients diabetiques avaient une vitesse de decroissance plus lente que les non-diabetiques (−6,2 ± 8,3 versus −10,8 ± 10,2 ng/mL ; p = 0,04). La vitesse de decroissance etait correlee aux taux de 25OHD a l’inclusion (p Conclusion Les taux de 25OHD des HD baissent de facon lente apres sevrage en cholecalciferol, suggerant une decorrelation entre la 25OHD et les stocks de vitamine D. Ces donnees confirment un important stockage visceral de la vitamine D.

Emulsified fat injection showed its interest in aesthetic facial surgery. The adipose tissue harvested is mechanically emulsified and filtered. The suspension obtained is injected into the dermis through small diameter needles (27 to 30 gauges). The objective of our study was to evaluate the biological composition of emulsified fat and its clinical effectiveness in the treatment of peri-oral wrinkles in 4 patients aged 50 to 59 years.Each patient received an intradermal injection of emulsified fat in the peri-oral wrinkles prepared from abdominal fat under local anesthesia. The cell viability, stromal vascular fraction (FVS) composition in emulsified fat and the adipocyte differentiation capacity of mesenchymal stem cells (MSC) were studied. The clinical results were evaluated by standardized photographs, 3D microphotography, confocal microscopy, and self-evaluation of patient satisfaction over a period of 4 months.The biological study of the emulsified fat found a lysis of all the adipocytes. The mean number of FVS cells was 126,330±2758 cells by cc of emulsified fat with preserved cell viability (85.1±6.84 %) and a good proportion of regeneratives cells (18.77±6.2 %). The clinical study found a tendency to decrease the volume of wrinkles on standardized photography and 3D microphotography no significative. Patients were satisfied with treatment with an average score of 7±1.15/10 to 4 months.Intradermal injection of emulsified fat seems to be an interesting treatment of face wrinkles. Our study has shown its safety, but additional studies seems necessary to confirm its clinical efficacy.

The use of pessary to put back up prolapsed organs to their normal position dates back prior to several millennia. This work aims to discuss its place in our clinical practice through an updated bibliographic review and emphasizes a hands-on approach to pessary fitting and management in terms of indication, pessary type selection, device' size, insertion, removal, follow-up visits and care.A review of the literature, in the light of the latest publications and recommendations of French and international learned societies, as well as our own experience, were analyzed.This device appears to be as effective as surgical management to relieve symptoms related to urogenital prolapse and restore body image. It can be used temporarily, awaiting a surgical solution or as a therapeutic test (mimicking the effect of a surgical procedure to predict its functional outcome or identifying a masked urinary incontinence). It can also represent an alternative to surgery (patient choice, women who wish to complete childbearing or who are unsuitable for surgery because of medical comorbidities) and thus can be used in first intention. However, despite its moderate cost and its harmlessness, this device remains somewhat little known as regards the practical modalities of its use, which, moreover, appear not consensual.A guide intended for the attention of the patients as well as a film relating to the practical modalities of the device' use were elaborated to improve the knowledge of both professionals and users in order to optimize and secure the care pathway.

Introduction Les patients hemodialyses (HD) ont une diminution de la force musculaire (FM). En population generale, la supplementation en cholecalciferol augmente la FM et diminue l’incidence des chutes ; cet effet est principalement observe au-dela de 65 ans et avec les taux de 25OH vitamine D (25OHD) les plus bas. La FM des HD mesuree par handgrip est independamment correlee a la 25OHD [1] . L’objectif principal de cette etude est de montrer que la supplementation en cholecalciferol des HD avec une 25OHD Patients et methodes Etude prospective, multicentrique francaise, randomisee, ouverte, avec deux bras paralleles qui inclura 150 patients HD prevalents (effectif calcule). Les patients avec une 25OHD ≤ 20 ng/mL seront randomises. Les patients qui a l’inclusion auront des taux de 25OHD > 20 ng/mL beneficieront d’un wash-out de 3 a 6 mois durant lequel ils ne recevront pas de vitamine D. Si malgre 6 mois de wash-out les patients ont toujours une 25OHD > 20 ng/mL, ils seront exclus. Apres la randomisation, les patients seront suivis durant une periode de 6 mois durant laquelle ils recevront soit 100 000 UI de cholecalciferol 1 × /mois (bras traite) soit ne recevront rien (bras non traite). Le critere de jugement principal sera l’evolution de la FM mesure par handgrip entre la randomisation et la fin de l’etude (6 mois). Les objectifs secondaires sont de (1) analyser si la supplementation en cholecalciferol ameliore l’autonomie (echelle des activites de base de la vie quotidienne ADL-index de Katz) (2) analyser si la supplementation en cholecalciferol diminue la fragilite (auto-questionnaire FIND) (3) analyser si la supplementation en cholecalciferol ameliore leur qualite de vie (auto-questionnaire KDQOL-SF™). Resultats L’accord du Comite de protection des personnes a ete obtenu le 05/09/2017. Les premiers patients ont ete inclus en janvier 2018. Actuellement, 3 centres sont ouverts et 35 patients inclus dont 2 avec 25OHD Discussion Cette etude devrait permettre d’obtenir des reponses claires sur l’effet de la supplementation en cholecalciferol sur la FM. Conclusion L’etude VITADIAL : « La correction du taux plasmatique de 25OHD des patients HD par la supplementation en cholecalciferol ameliore-t-elle la force musculaire ? » est actuellement en cours de recrutement. Resultats attendus au cours de l’annee 2020.

Radiotherapy's main skin toxicities are now well-separated, acute (acute radiation dermatitis) or chronic complications (chronic radiation dermatitis, induced cutaneous carcinoma, aesthetic sequelae). Exceptionally, radiotherapy may induce, by isomorphic reaction or Koebner's phenomenon, some specific dermatosis. In this article, we report five new observations of these unusual complications of radiation therapy, occurring in very variable time after breast irradiation and remaining strictly localized in the irradiated field (cutaneous mastocytosis, Sweet syndrome, lichen planus, vitiligo). These cases emphasize the need to realize a systematic histological exam if any atypical skin lesion appears after radiotherapy, even long after.

No study on side effects had showed that conformal radiation therapy for prostate cancer is more harmful in patients older than 70 years to patients younger. The aim of this study was to evaluate acute and late toxicities of conformal radiotherapy, with high dose for localized prostate cancer in patients older than 70 years and compared to patients younger than 70 years. Between 1996 and 2009, 104 patients were treated with radiation therapy and hormonal therapy for localized cancer prostate. Median follow-up was 105 months (9-300). Acute (occurred at ≤ three months) and late side effects of 55 patients older than 70 years (median age: 75 [71-92]) were graded according to the CTCAE 3.0 criteria and compared to the younger population. Median dose to the prostate was 75.6 Gy (67-80) in both groups. There were no significant differences in acute and late side effects between age groups. For patients above 70 years, the incidence of grade II or higher acute and late side effects were respectively 27 and 22% for urologic symptoms and 13 and 16% for rectal symptoms. The frequency of grade III late symptoms was low and ranged between 0 and 6% for the evaluated symptoms, irrespective of age group. Older patients had a better biochemical recurrence-free survival than younger patients (86 versus 77% at four years, P=ns). High dose 3D conformal radiotherapy for localized prostate cancer was well tolerated in patients older than 70 years. Age is not a limiting factor for conformal radiation therapy and hormonotherapy for older patients.

The management of adenocarcinoma in situ of the cervix (ACIS) is difficult because it is often diagnosed in younger women who may wish to preserve their potential of fertility. Conservative treatment has been accepted as an appropriate strategy but interrogations persist as to carcinological safety. We report a complete review of the literature on this subject where conservative attitude appears possible but is associated with recurrence risk (5 to 10%) and invasive disease (2%). Conditions to perform conservative management are: cold knife cone biopsy, negative margins, cone resection of at least 25 mm, realization of endocervical curettage and total patient compliance. In all cases, regular cytological and histological monitoring must be performed. If maintaining reproductive capacity is not desired, hysterectomy is systematically proposed to patient.

Introduction Une cohorte des patients transplantes renaux a ete suivie dans 5 centres en France dans le but (i) d’ameliorer notre questionnaire de qualite de vie (QDV), le ReTransQol, et (ii) d’identifier les facteurs lies a la QdV. Patients et methodes Tous les patients volontaires de plus de 18 ans porteurs d’un greffon fonctionnel depuis au moins un an ont ete inclus. Ont ete recueillies, les donnees demographiques, sociales (comme le soutien social par le Questionnaire du Soutien Social Percu (QSSP) et l’utilisation d’Internet), medicales [Index de Comorbidites de Charlson (ICC) et de Karnofsky (IK)] ainsi que la qualite de vie (QDV) par le SF-36 et le ReTransQol. Des analyses multivariees ont ete utilisees pour identifier les facteurs lies a la QDV. Resultats Au total, 1425 patients âges en moyenne de 56 ans (± 13) ont ete inclus. Soixante et un pour cent etaient des hommes, 38 % avaient un niveau d’etude college et 68 % vivaient en couple. Trente-neuf pour cent exercaient une activite professionnelle et 35 % etaient en invalidite. Sur le plan clinique, 13 % avaient eu une greffe preemptive et 15 % un episode de rejet aigu, 31 % avaient une dysfonction chronique du greffon. Dix-huit pour cent etaient diabetiques, 82 % hypertendus et 15 % obeses. Le score de l’ICC etait de 4,1 ± 1,8 et 94 % avaient un bon etat de sante general selon l’IK. Pres de deux tiers des patients avaient besoin d’un soutien social selon le QSSP. L’âge avance, le genre feminin, le besoin de soutien social, l’isolement, l’invalidite et un taux eleve de creatinine diminuaient significativement les scores de QDV. En revanche, un bon revenu, un bon etat de sante (selon IK) et l’utilisation d’Internet augmentaient la QDV. Discussion Les resultats de cette etude ont permis d’identifier de nombreux facteurs significativement associes a la QDV chez les patients greffes renaux. Conclusion De nouvelles variables liees a la QdV ont ete mises en evidences dans cette etude, en particulier l’utilisation d’Internet et le soutien social percu. Ces resultats fournissent les bases pour de futures recherches pour mieux etudier l’impact des donnees sociales sur la QDV de ces patients.

To evaluate our elective single embryo transfer policy performed at 48/72h and define predictive factors of pregnancy after frozen/thawed embryo transfer.Analysis of 289 elective single embryo transfers (eSET) performed in a selected population in the ART center of Marseille University Hospital from January 2005 to December 2011, as well as the 325 following frozen/thawed embryo transfers performed in this population between May 2005 and December 2012.Cumulative pregnancy rate/oocyte retrieval was of 62.6%; 45% of the couples obtained the birth of at least one child. During this studied period, cumulative pregnancy and delivery rates in the whole population remained stable while multiple delivery rate/delivery clearly decreased. Elective single embryo after frozen/thawed transfer gave satisfying results (24.6% pregnancy/transfer) only in the lack of lysis or in case of mild lysis (1-25%) of the transferred embryo.The implementation of an eSET policy gives satisfying results, depending largely on embryo quality. By proposing eSET to a well-targeted population, chosen both on clinical and biological criteria, a clear reduction of cumulative multiple delivery rate/delivery was obtained in our center over this period, without any global decrease of cumulative pregnancy rate/attempt. Embryo quality is a major factor of success, especially in frozen/thawed cycles. The elective single embryo frozen/thawed transfer should be carried out only if embryo lysis after thawing does not exceed 25%.

Introduction Les recommandations sur la prise en charge de l’acne par isotretinoine orale preconisent l’evaluation des troubles depressifs. Cette identification est complexe chez l’adolescent (idees suicidaires plus frequentes chez les adolescents acneiques non traites, tres rares mais gravissimes cas de suicides et syndromes depressifs sous isotretinoine). L’objectif de cette etude etait d’evaluer l’acceptabilite de l’utilisation de l’Adolescent Depression Rating Scale (ADRS) comme outil d’aide au reperage des symptomes depressifs pour le dermatologue. Materiel et methodes Une etude nationale de soins courants a ete menee aupres de dermatologues tires au sort et de leurs patients acneiques severes âges de 13–20 ans, suivis 6 mois. Un algorithme integrant le score ADRS et ses variations entre deux visites etait fourni, associe si besoin a un guide d’entretien des troubles depressifs. Le patient remplissait en debut de chaque consultation l’ADRS. Le medecin remplissait a chaque visite un questionnaire d’acceptabilite sur l’algorithme puis realisait a la fin de l’etude un questionnaire d’acceptabilite globale. Resultats Cette etude nationale a porte sur les modalites de suivi de 283 adolescents par 83 dermatologues francais ayant eu a utiliser. Concernant les patients ( n = 225/293, soit 76,8 %), l’acceptabilite globale de l’echelle etait bonne (93,8 % aucune difficulte ou gene), quelle que soit la tranche d’âge consideree. Parmi les medecins ayant repondu au questionnaire de satisfaction globale ( n = 52, soit 62,7 % des participants), 80,8 % etaient satisfaits/tres satisfaits de l’echelle ADRS ; 75 % soulignaient son interet comme vecteur d’informations (question sur la capacite de l’echelle a mettre plus facilement l’accent sur les risques psychiatriques ou depressifs et de mieux informer) ; 79,9 % mentionnaient aucun impact/peu important sur la duree de la consultation. Enfin, 82,7 % notaient l’integration de l’echelle dans la pratique courante comme facile/tres facile. L’utilite du guide d’entretien etait rapportee par 48,1 % des dermatologues. L’algorithme decisionnel est facilement applique par 94,2 %. La poursuite de l’utilisation de l’echelle etait mentionnee par 65,4 % des medecins. Discussion Cette etude confirme la bonne acceptabilite de l’ADRS par les adolescents ainsi que sa bonne integration dans la pratique medicale sur le versant faisabilite et utilite. Bien que l’echantillon de medecins soit reduit, l’extrapolation des donnees est envisageable puisque les caracteristiques des medecins participants sont concordantes avec les donnees issues d’un observatoire des prescriptions d’isotretinoine. Conclusion Cette etude souligne l’apport de cette conduite pratique resume par un algorithme integrant l’ADRS dans le suivi des patients, favorisant ainsi le bon usage de l’isotretinoine.

No study on side effects had showed that conformal radiation therapy for prostate cancer is more harmful in patients older than 70 years to patients younger. The aim of this study was to evaluate acute and late toxicities of conformal radiotherapy, with high dose for localized prostate cancer in patients older than 70 years and compared to patients younger than 70 years. Between 1996 and 2009, 104 patients were treated with radiation therapy and hormonal therapy for localized cancer prostate. Median follow-up was 105 months (9-300). Acute (occurred at ≤ three months) and late side effects of 55 patients older than 70 years (median age: 75 [71-92]) were graded according to the CTCAE 3.0 criteria and compared to the younger population. Median dose to the prostate was 75.6 Gy (67-80) in both groups. There were no significant differences in acute and late side effects between age groups. For patients above 70 years, the incidence of grade II or higher acute and late side effects were respectively 27 and 22% for urologic symptoms and 13 and 16% for rectal symptoms. The frequency of grade III late symptoms was low and ranged between 0 and 6% for the evaluated symptoms, irrespective of age group. Older patients had a better biochemical recurrence-free survival than younger patients (86 versus 77% at four years, P=ns). High dose 3D conformal radiotherapy for localized prostate cancer was well tolerated in patients older than 70 years. Age is not a limiting factor for conformal radiation therapy and hormonotherapy for older patients.

The objective of this study is to evaluate the validity of a new self questionnaire: the "ESQ" (Emotional State Questionnaire).This novel instrument possesses a number of original attributes: first of all, it is designed to assess a general emotional profile, in opposition to other similar scales which can only be applied to the emotional reactions provoked by specific stimuli. Secondly, this scale is composed of several emotional dimensions. The ESQ has been constructed according to four components: recognition, expression, internal emotional experience and social context. The first three dimensions were selected because of their wide use through behavioral experiments. Indeed, contrary to most scales used in this field, which only assess the emotional experience, we wanted to propose an instrument also able to assess the subject's impression of his own capacities to encode and decode emotions. We hypothesized that these three dimensions could not be dissociated from a fourth dimension, the social context, which therefore also figures in this scale. The emotions explored were the five fundamental emotions indicated by Izard (fear, happiness, sadness, disgust and surprise) to which we added a neutral feeling that we considered as a basic emotion.To establish this instrument, a first conceptual phase was conducted by a group of experts. These experts all worked in the psychological field. They proposed the scale on the base of their clinical experience and after study of the literature. The scale was then validated in a population of 218 healthy volunteers, aged between 15 and 88 years. Subjects were not included if they presented depression (score above 16 in the Beck Depression Scale) or pathological anxiety (score above 5 in the Spieberger State Anxiety Inventory). The psychometric characteristics tested were: the item analysis, the item-dimension correlation, the factor analysis and the internal consistency reliability.The population studied was equally distributed according to gender (sex ratio: 0.97), the mean age was of 36.2 2 +/- 16.1 years. Acceptability was good with less than 5% of data missing. The analysis of items revealed no floor or ceiling effect and a low correlation between items. Item-dimension correlation ranged from 0.23 to 0.62, with most scores above 0.4. The items were always better correlated to their dimension than to other dimensions, except for one item. The 4 dimensions (recognition, expression, internal emotional experience and social context of emotions) explained 42% of the total variance. Finally, the scale showed good internal consistency with Cronbach coefficients, equal or above 0.84 for the total score, the recognition and the expression dimensions. This coefficient reached 0.77 for the feeling dimension but only 0.58 for the social context dimension.All together, results showed satisfactory characteristics in regard of the complexity of the notion measured. However, an important drawback is the lack of an external instrument to assess convergent validity. This instrument can be of great interest in the emotional characterization of healthy volunteers. More-over, if validated in psychiatric populations, this scale could be most useful in psychopathological assessment and also in comparison with behavioral evaluations of emotion.

The management of adenocarcinoma in situ of the cervix (ACIS) is difficult because it is often diagnosed in younger women who may wish to preserve their potential of fertility. Conservative treatment has been accepted as an appropriate strategy but interrogations persist as to carcinological safety. We report a complete review of the literature on this subject where conservative attitude appears possible but is associated with recurrence risk (5 to 10%) and invasive disease (2%). Conditions to perform conservative management are: cold knife cone biopsy, negative margins, cone resection of at least 25 mm, realization of endocervical curettage and total patient compliance. In all cases, regular cytological and histological monitoring must be performed. If maintaining reproductive capacity is not desired, hysterectomy is systematically proposed to patient.

Schizophrenic patients suffer from positive (delusions, hallucinations) and negative signs (social withdrawal) as well as emotional disturbance that included quantitative (blunted affect) and qualitative impairments (discordance of emotional level). Ketamine, a phencyclidine derivative, is a non competitive N-methyl-D-aspartate (NMDA) glutamate receptor antagonist. In healthy subjects its administration induces some positive symptoms (perceptual distortions.), negative symptoms (emotional deficit, apathy, social withdrawal) and cognitive changes (memory impairments and perseverations) that resemble some aspects of the symptoms of schizophrenia. A double blind cross over, placebo controlled was performed in 12 normal subjects with 2 sessions separated by one week of wash-out to determine ketamine-induced effects on behavioral and emotional responses. During each session, subjects received either ketamine or placebo (saline) infusion. A subanesthetic dose of ketamine (0,5 mg/kg) was administered by constant perfusion over 60 min. Behavioral and cognitive responses were assessed using positive and negative symptoms scales (BPRS, items from SAPS and SANS), vigilance and mood visual analog scale, subjective feelings using the Addiction Research Center Inventory (ARCI) and the Profile of Mood States (POMS). Using Philippot's method, emotions were elicited by films segments which induce a diversity of predictable emotions (fear, anger, sadness, joy, disgust and neutral state) and emotional responses were assessed by the Differential Emotions Scale (DES Izard). Low dose of ketamine induced significant effects on 7-items BPRS score (positive and negative items) and significant effects on positive and negative symptoms from SANS and SAPS. This was associated with emotional blunting of visually-induced responses that resemble aspects of schizophrenic emotional impairments. Ketamine impaired ARCI subscales (benzedrine subscale, pentobarbital-chlorpromazine subscale and LSD subscale). The recent findings of ketamine's pharmacology and imaging studies allow to draw several hypothesis related to neurotransmitter systems (glutamate, dopamine, serotonin interactions) and cerebral areas (particularly prefrontal cortex, anterior cingulate cortex, hippocampus) underlying some of these ketamine-induced effects.

To reply to the following questions: what is the status of the accreditation process and what are the general trends pointed out by the experts-visitors ?A study was conducted on the 182 accreditation reports regarding health centres, published by the Anaes from June 2000 to July 2002. A reading scale was developed and data was registered in the database. Statistical analysis first described the hospitals (legal status, location, size, number of sites, presence or lack of technical devices, emergency units, and consultations) and then matched them with the specific parameters of the accreditation process (date of involvement, date of audit, date of the accreditation deliberation, number of experts and visitors and number and type of decisions.The results underlined the most frequent decisions among the 10 referentials of the accreditation process. The patients' case reports and the management of quality and prevention predominated. Recent French laws and the decision of the Anaes to apply these themes in their strategic orientation can explain this.The large hospital size and multi-sites organisation appeared to be negative elements and justify the apprehension felt by the 'major hospitals'.

Sensitization and educational training programmes are important pre-requisites in order to ensure the understanding of the issues at stake in the accreditation process. According to the preparatory research involved for this work, there has been no study published nor is there any documentation available on such a topic, specifically on carrying out the sensitization process to successful completion. The aims of this study are to evaluate the effectiveness of the sensitization phase and to refine general recommendations to serve as a guide for health institutions and their communications policies. A transversal randomised study was conducted through the distribution of a questionnaire to 107 health professionals from 23 clinical services in the public hospital system in Marseille. The results demonstrate that the knowledge about accreditation seems to be well integrated, with only 7 of the professionals being unaware of the accreditation programme, and 58% of them associating the accreditation process with an administrative procedure. Grouping the staff's responses according to professional category has shown to have almost no influence on the results. The level of overall knowledge is greater in more highly trained personnel (p0.05), but there was a poor level of knowledge regarding the internal organisational structures that existed. 75% of the health professionals thought that communication about accreditation was insufficient. The study authenticated the positive benefits of communication and identified a certain number of stumbling blocks to avoid. Several recommendations are proposed.

The authors describe the design of a video codec CCITT H.261 on 2 PC/AT boards based on special purpose DSPs, RAMs and Xilinx LCAs. The CCITT H.261 recommendations describes the video coding and decoding methods for the moving picture component of audiovisual services at the rates of p*64 kbit/s, where p is in the range 1 to 30. The codec has been developed jointly with Centre National d'Etudes des Telecommunications and is now connected to ISDN for videophone and videoconferencing communications. In addition to describing the architecture and design, the authors discuss the development system used in the implementation. >

Clinical guidelines (CG) constitute a means to facilitate the decision-making process, defining what is and is not appropriate in fields concerned with public health matters or unregulated practices.A bibliographical review has been conducted on factors likely to influence physicians' compliance to CG. These factors involve physicians, the guidelines themselves and the actions taken to encourage their implementation.In physicians' attitudes, we find not only their propensity to ask for help, to admit mistakes and weakness, but also their wish for continuing medical education. Practicing in an establishment or group consulting offices enhances their awareness of CG. The use of CG and the consequences of their implementation, as well as legal or financial concerns, increase physicians' confidence in the benefits of CG for themselves and their patients.Clinical guidelines should be issued by multi-professional groups, among which there should be recognized experts and day-to-day specialists. Their access should be easy and their updating frequent. The adaptation to the individual conditions of local practices is essential.Once established, an intensive dissemination and active appropriation policy should be enacted. On the other hand, it is unlikely that passively diffused and non-updated CG will be adopted by newly qualified or long-established physicians installed in routine practice. Account must also be taken of the nature of certain CG, considered restrictive or coercive, and the targeted physician's attitudes and practicing habits - which is still unusual in France.

The purpose of this study was to evaluate the effects of age in French naval crew on risk-proneness. We tested 130 male navy personnel, age range 19-41 yr, with EVAR, a visual analog scale designed to rate risk-proneness and composed of 24 items distributed among 5 factors: "self control," "danger-seeking" "energy," "impulsiveness," and "invincibility." We observed a significant negative correlation between "energy" and age, whereas the other factors were not influenced by age. Risk-proneness change is limited and should not be a safety issue in the decision-making process if the age of navy crews is going to increase moderately.

This paper describes the factor structure and validity of a visual analogue scale designed to rate risk proneness: EVAR (EVAluation of Risk). Risk behaviors and sensation seeking are related, therefore we correlated EVAR (24 100 mm items) with Zuckerman Sensation Seeking Scale (SSS) (40 conventional items) in a population of 199 volunteers. Subjects had an age range of 18-68 years (mean age of 31), and 49 were females. Factor analysis using a principal component solution and an orthogonal rotation of the factor matrix were computed. Five factors were selected, accounting for 46 per cent of the total variation: F1 "self control", F2 "danger seeking", F3 "energy", F4 "impulsiveness", F5 "invincibility". F1, F2 and F3 from EVAR were correlated with SSS factors "general", "danger seeking", "experience seeking" and "boredom susceptibility". F4 was correlated with "general", "boredom susceptibility" and "disinhibition" whereas F5 was not correlated with any of SSS factors. This visual analogue scale is likely to reveal change in subjects, regarding risk proneness, when submitted to various stressors (sleep deprivation, fatigue...).

To describe the pharmacokinetic-pharmacodynamic modelling of the psychomotor and mnesic effects of a single 2 mg oral dose of lorazepam in healthy volunteers.This was a randomized double-blind, placebo-controlled two-way cross-over study. The effect of lorazepam was examined with the following tasks: choice reaction time, immediate and delayed cued recall of paired words and immediate and delayed free recall and recognition of pictures.The mean calculated EC50 values derived from the PK/PD modelling of the different tests ranged from 12.2 to 15.3 ng ml-1. On the basis of the statistical comparison of the EC50 values, the delayed recall trials seemed to be more impaired than the immediate recall trials; similar observations were made concerning the recognition vs recall tasks.The parameter values derived from PK/PD modelling, and especially the EC50 values, may provide sensitive indices that can be used, rather than the raw data derived from pharmacodynamic measurements, to compare CNS effects of benzodiazepines.

Healthy volunteers who participate in clinical trials usually present a specific personality profile characterized by high extroversion and low anxiety traits. Herein, we examined whether anxiety traits influence performance and vigilance, as well as reactivity for six emotions (fear, anger, disgust, sadness, happiness and a neutral state), the latter being induced by the presentation of six film excerpts. Sixty-four healthy volunteers were stratified into high and low anxiety groups on the basis of their score on the Cattell and Hamilton Anxiety Scales. They were assessed on the Digit Symbol Substitution Scale (DSST), Choice Reaction Time (CRT) and Visual Analogue Scales (VAS). Their emotional reactivity was evaluated before and after each film excerpt, on responses to the Differential Emotions Scale (Izard DES). Prior to emotional induction, high-anxious subjects presented a pattern of low positive emotions and high negative emotions. After each film excerpt, emotional reactivity was more pronounced for high-anxious subjects compared with low-anxious subjects. However, there were no significant interactions between anxiety level and the values of DSST, CRT or VAS. The present findings raise the question of the relevance of selecting healthy volunteers according to their personality traits. In future studies, anxiety level will be further investigated as a factor of response variability to drugs, by examining differences in response to psychotropic drugs as a function of this factor.

The prognostic value of the score of embryo transfer (SET) was assessed on 1079 embryo transfers in a homogene population of patients. The SET is obtained adding the embryo score (ES) of each transferred embryos. ES is based both on the conventional parameters of embryo morphology, and on the 4-cell stage which is the optimum division stage regarding implantation. The SET is strongly correlated with the pregnancy rate (p10-5), and is, with the mean score of transferred embryos (MSTE), the most sensitive and specific parameter of all studied parameters. However, embryo quality seems not to be correlated with miscarriages.

The development of refractive corneal surgery involves numerous attempts to isolate the effect of individual factors on surgical outcome. Computer simulation of refractive keratotomy allows the surgeon to alter variables of the technique and to isolate the effect of specific factors independent of other factors, something that cannot easily be done in any of the currently available experimental models.We used the finite element numerical method to construct a mathematical model of the eye. The model analyzed stress-strain relationships in the normal corneoscleral shell and after astigmatic surgery. The model made the following assumptions: an axisymmetric eye, an idealized aspheric anterior corneal surface, transversal isotropy of the cornea, nonlinear strain tensor for large displacements, and near incompressibility of the corneoscleral shell. The eye was assumed to be fixed at the level of the optic nerve. The model described the acute elastic response of the eye to corneal surgery.We analyzed the effect of paired transverse arcuate corneal incisions for the correction of astigmatism. We evaluated the following incision variables and their effect on change in curvature of the incised and unincised meridians: length (longer, more steepening of unincised meridian), distance from the center of the cornea (farther, less flattening of incised meridian), depth (deeper, more effect), and the initial amount of astigmatism (small effect).Our finite element computer model gives reasonably accurate information about the relative effects of different surgical variables, and demonstrates the feasibility of using nonlinear, anisotropic assumptions in the construction of such a computer model. Comparison of these computer-generated results to clinically achieved results may help refine the computer model.

Introduction Les troubles de la memoire episodique sont caracteristiques de la maladie d’Alzheimer (MA) et se retrouvent des le stade predementiel (MCI). Il est reconnu que la memoire semantique est egalement touchee dans la MA et le MCI : les patients MCI amnesiques (MCIa) peuvent souffrir d’une defaillance precoce de la connaissance des personnes celebres (Estevez et Gonzalez, 2004). Aussi, un test de denomination de personnes celebres apparait etre un indicateur sensible des troubles de memoire semantique. Notre etude a pour but de mettre en evidence le manque du nom propre chez les sujets MCIa et de savoir si ce manque du nom est du a une difficulte d’acces lexical. Materiel/Methode Un test informatise de Denomination de Personnes Celebres Francaises (DPCF) constitue de 20 photos a ete mis au point. Ce test permet de calculer un score total sur 80 et un score de denomination echouee sur 20. il a ete propose a 122 sujets repartis en 4 groupes : controles normaux (CN), sujets ayant une plainte mnesique isolee (MCI subjectif), sujets MCIa et sujets MA. Trois indices leur sont proposes pour recuperer le nom propre : l’indice contextuel (photo en contexte), l’indice du prenom et l’indice phonologique. Resultats Une courbe ROC a ete etablie entre le score de rappel total au RL/RI 16 et le score total du DPCF. Cette correlation montre une sensibilite a 0.8 et une specificite a 0.7 (pour un cut-off a 20). En comparant les resultats intergroupes, il en ressort qu’il existe une difference significative (p = 0,0049) au score moyen de denominations echouees entre les sujets MCIs et les sujets MCIa. Ainsi, avec le DPCF, le manque du nom propre chez les sujets MCIa et la plainte mnesique isolee exprimee par les sujets MCIs sont mis en evidence. Pour chaque groupe, l’indice du prenom est le plus efficace. Cependant, on ne peut pas affirmer que le manque du nom propre chez les sujets MCIa est reellement du a une difficulte d’acces lexical : il n’y a pas de difference significative entre les groupes. Conclusion Le DPCF, facile et ecologique, bien correle au RL/RI 16, a toute sa place dans les outils de depistage dans le cadre de la plainte mnesique, (MCIs) des troubles cognitifs objectifs (MCIa) predictifs d’une MA. Le suivi dans le cadre d’une constitution de cohorte d’un groupe de MCIa permettrait d’analyser s’il y a une perte semantique sous-jacente a l’anomie.