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A comparative, randomised, 12-week (two periods of six weeks) cross-over study including 150 patients (mean age: 63.4 years) suffering from stable but symptomatic (a minimum of three attacks per week) angina pectoris was performed in order to compare the effect on quality of life of two discontinuous nitrate treatments: transdermal 10 mg nitroglycerine patch (12 hours) and long-acting oral 40 mg isosorbide-5-mononitrate (once a day). The efficacy and safety were also compared. The two treatments equally and significantly improved patients' quality of life. The number of attacks and sublingual nitrate consumption significantly decreased under treatment. Attack severity was lower under nitroglycerine than isosorbide-5-mononitrate treatment. Finally, even though nitroglycerine more frequently induced headache than did isosorbide-5-mononitrate (13 cases versus 8), patients, and in particular those having received nitroglycerine treatment in the second period of the study, preferred the transdermal nitroglycerine treatment. In conclusion, results did not show any relevant difference in terms of efficacy or tolerability between the two treatments. Nevertheless, the facility of use and the feeling of protection were better under transdermal nitroglycerine patch than oral isosorbide-5-mononitrate treatment.

Objective: Our purpose was to demonstrate the clinical efficacy and effect of hormone replacement therapy in menopause on quality of life., Study Design: A randomized, open, 6-month comparison of hormone replacement therapy (estradiol transdermal system [Estraderm TTS] plus chlormadinone) and symptomatic treatment (verapipride) was performed. Analysis was by intention to treat., Results: In 499 postmenopausal women with moderate and severe symptoms enrolled by 101 physicians, hormone replacement therapy was superior to symptomatic treatment on all assessments of quality of life and clinical efficacy. The effects were independent of the incidence of hot flushes., Conclusion: The effect of hormone replacement therapy on the quality of life of postmenopausal women was significantly superior to symptomatic treatment.

A prospective study was designed to assess the quality of skin analgesia provided by the EMLA anaesthetic cream, an eutectic mixture of local anaesthetics (prilocaine and lidocaine). The children, aged 3 months to 15 years, and scheduled for genital and urinary surgery, were allocated to two groups, those aged less than or equal to 5 years (35 +/- 14 months, n = 17), and those aged greater than 5 years (97 +/- 26 months, n = 22). The cream (1.6 +/- 0.6 g) was applied by a nurse in the ward as a thick layer on the area of skin to be anaesthetised (on the dorsum of the hand and at the elbow), and covered by a closed adhesive dressing. This required 2.6 +/- 1.7 min, and was considered to be very easy (72%) or easy (28%). The venepuncture (22 or 20 gauge catheter) was carried out by one of the seven anaesthetists of the paediatric surgical units, 92 +/- 51 min after the cream had been applied. The children aged less than or equal to 5 years complained of pain of intensity 7.5 +/- 2.2 (CHEOPS scale, range 4 to 13) and, for those aged greater than 5 years, 24 +/- 21 on a visual analogic scale (range 0 to 100). Local adverse effects occurred in ten patients (skin paleness, erythema, or both). It was concluded that EMLA cream provides convenient analgesia for venepuncture in toddlers and children.

The advantage of EMLA cream for regional blocks (spinal or caudal blocks) was assessed in 46 children. The study included three groups: group 1, with 1 to 6 month-old children (n = 11); group 2, with children aged between 6 months and 5 years (n = 21), scheduled for emergency surgery and with full stomach; group 3, with 5 to 10 year-old children (n = 14), who were to have a regional block as an alternative to general anaesthesia. The cream was applied as a thick layer on the area of skin to be anaesthetised and covered by a closed adhesive dressing, approximately 2.2 h before performing the regional block. A dose of 1 to 2 g was used in children of more than 1 year, and 0.5 to 1 g for those of less than 1 year. All the blocks were carried out by the same anaesthetist. The technique was considered as being little (45/46) or not constraining (1/46). Patient cooperation in carrying out the regional block was judged to be good or very good in 34/46 children. Additional sedation was required in 7 children of groups 2 and 3. The block was as easy to carry out as usual in 37/46 children. In all three groups, most children complained of little or no pain. Local adverse effects occurred in 19/46 patients, consisting of erythema (14), skin paleness (4), or both (1). The investigator qualified the use of EMLA cream as satisfactory or very satisfactory in 36/46. It is concluded that EMLA cream provides convenient analgesia for regional blocks in toddlers and children.

In 1986 and 1987, 224 patients were operated on for microcalcification without palpable lesions of the breast. Classical orthogonal (perpendicular grid) localisation was performed in 123 patients: external cutaneous localisation of the nipple was performed in 78 patients and hook localisation in 25 patients. Primary excision without the need for re-excision was possible respectively in 88% and 94% with external and hook localisation and in 83% after orthogonal localisation. The mean volume of the operation specimen was lower after hook (38.3 cm3) than after cutaneous or orthogonal localisation (54.6 cm3). 43% of the patients had a malignant lesion and even when the cluster of microcalcifications was single 50% of the margins were positive. Pre-operative localisation of occult breast lesions has simplified the surgical technique of excision. Nevertheless the pre-operative diagnosis of malignancy should be improved on in order to perform a procedure both diagnostic and therapeutic in the same operation.

Unlabelled: Excisions with histological examination were performed in 227 cases of breast microcalcifications without palpable tumor. 99 benign lesions, 27 borderline lesions and 101 carcinomas, 58 of them in situ, were found. Different radiological parameters were studied in relation to histological results: According to the morphology of the calcifications, a classification of 5 types was made. Type 1: annular: 100 per cent were benign lesions. Type 2: regularly punctiform: 22 per cent were malignant lesions. Type 3: too fine for precizing the shape: 40 per cent were malignant lesions. Type 4: irregularly punctiform: 66 per cent were malignant lesions. Type 5: vermicular: 100 per cent of the lesions were malignant. The number of calcifications was higher in carcinomas and 56 per cent of the lesions with more than 30 calcifications were malignant. Close grouping: when there were more than 10 calcifications within a 5 mm diameter area, 57 per cent of malignant lesions were found. Several clusters: 70 per cent were correlated with malignant lesions. Uneven sizes: no signification., Location: the rare retroareolar location correlated with benign lesions in 64 per cent of the cases. Furthermore, the malignant lesions were rare (24%) in women under 40 years of age. For these young women, the authors suggest to directly excise the most suspicious microcalcifications as based on the factors of suspicion and to simply follow the other cases.