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Sickle cell disease is the leading genetic disease in Île-de-France. Stroke is one of its most severe complications. In SS sickle cell children, transcranial Doppler (TDC) is, through the study of average speeds of the skull base arteries, the gold standard for screening and diagnosis of vasculopathy. To our knowledge, in adults with sickle cell disease, no standards have been established for the speed of the arteries at the base of the skull. It therefore seemed useful to us to establish an approach to brain speeds recorded in adults with sickle cell disorders without neurovascular complications.This was an observational, prospective, monocentric study conducted between February 2017 and June 2017. The main objective of the study was to determine the mean and standard deviation of maximum systolic velocities (MSS) and mean maximum velocities for all arteries recorded during the transcranial Doppler echo. The secondary objectives were to compare the mean maximum systolic velocities in sickle cell adults with those of healthy adults, to compare the mean maximum systolic velocities in sickle cell adults with those of sickle cell children, and to determine whether parameters could influence the speeds recorded at TCD.Forty patients were included between February 1, 2017 and June 30, 2017, with an average age of 39.3 years. The mean maximum velocities recorded were: 78cm/s for the middle cerebral arteries; 59.6cm/s for the internal carotid arteries; 61cm/s for the anterior cerebral arteries; 44cm/s for the posterior cerebral arteries and 55cm/s for the basilar trunk.The highest circulatory velocities are found in the middle cerebral arteries. The speeds found in the internal carotid arteries and anterior cerebral arteries are faster than in the vertebrobasilar system. Speeds in sickle cell adults are slower than those described in sickle cell children SS but significantly faster than those found in healthy adults.To our knowledge, this study is the first to evaluate transcranial Doppler circulatory velocities in adult sickle cell patients. This work has limitations due to its small sample size, however, it provides a basis for further studies on transcranial Doppler in sickle cell adults.

The rates of pregnant women with functional symptoms of venous insufficiency who accepted or refused to wear therapeutic compression stockings were evaluated and compared in relation to their clinical evolution and their compliance levels.The observational study was conducted in pregnant women between 4 and 28 weeks of amenorrhea presenting a CEAP C0S to C3S venous disease. Therapeutic compression stockings (BSN medical, UltraSheer Maternity stockings, 15-20 mmHg) were offered to pregnant women satisfying the inclusion criteria during routine check visits, and both groups of patients (those who accepted as well as those who refused) were followed up until the end of the pregnancy. The clinical profiles of both groups and the evolution of the venous insufficiency were monitored and compared. The women were requested to indicate pain and further quality of life parameter by means of a specific questionnaire (CIVIQ).Ninety-eight women were included in the study and followed up; 30.6% (N.=30) of the women refused to wear compression stockings (Wr), 69.4% accepted 10.6% were not compliant to a daily wear (Wanc) and 58.8% wore them every day (Wac). Leg pain was more prominent in case of the Wac group (49.5 ± 21.3) than in case of the Wanc (42.1 ± 20.4) and Wr groups (36.6 ± 18). Their global quality also decreased (48.8 ± 15.7 vs. 43.6 ± 16.1 and 36.6 ± 15.6). Regular use of compression stockings led to decrease of pain (Wac -17 ± 10.1 vs. Wanc -10.3 ± 10.5 vs. Wr -4.2 ± 9.8 [P0.0001]) and enhanced total quality of life (Wac 13.5 ± 9.6 vs. Wanc 10.7 ± 11.3 vs. Wr -3.3 ± 9.4 [P0.0001). Similar results were observed on the CIVIQ subscale (pain, psychological, social, physical impact of legs' pain on women quality of life).In daily practice, more than two third of the pregnant women accepted to wear compression stockings. The use of compression stockings reduced the legs pain and increased the quality of life of pregnant women.

The largest-to-date randomized trial (Women's Health Initiative) comparing the effects of hormone replacement therapy (HRT) and a placebo concluded that the continuous use of an oral combination of conjugated equine estrogens (CEE) and medroxy-progesterone acetate (MPA) increases the risk of breast cancer. This conclusion may not apply to women taking other estrogen and progestin formulations, as suggested by discrepancies in the findings of in vitro studies, epidemiological surveys and, mostly, in vivo studies of human breast epithelial cell proliferation showing opposite effects of HRT combining CEE plus MPA or estradiol plus progesterone. To evaluate the risk of breast cancer associated with the use of the latter combination, commonly prescribed in France, a cohort including 3175 postmenopausal women was followed for a mean of 8.9 years (28 367 woman-years). In total, 1739 (55%) of these women were users of one type of estrogen replacement with systemic effect during at least 12 months, any time after the menopause, and were classified as HRT users. Among them, 83% were receiving exclusively or mostly a combination of a transdermal estradiol gel and a progestin other than MPA. Some 105 cases of breast cancer occurred during the follow-up period, corresponding to a mean of 37 new cases per 10 000 women/year. Using multivariate analysis adjusted for the calendar period of treatment, date of birth and age at menopause, we were unable to detect an increase in the relative risk (RR) of breast cancer (RR 0.98, 95% confidence interval (CI): 0.65-1.5) in the HRT users. The RR of breast cancer per year of use of HRT was 1.005 (95% CI 0.97-1.05). These results do not justify early interruption of such a type of HRT, which is beneficial for quality of life, prevention of bone loss and cardiovascular risk profile, without the activation of coagulation and inflammatory protein synthesis measured in users of oral estrogens.

The aim of this observational study in patients with chronic hepatitis C and treated with interferon alpha-2a was to assess 1) monitoring in everyday practice, 2) the acceptability of treatment and 3) the intensity of fatigue.Three hundred and fifty four patients were enrolled by physicians in both teaching and general hospitals, or private practice. Before treatment, clinical, epidemiological, and virological data were collected as well as a self-evaluation of fatigue using a visual analogic scale. Clinical follow-up was assessed every 3 months during treatment and 6 months after the end of treatment and included an evaluation of fatigue and the number of workdays missed due to sickness.Two hundred and nineteen men and 135 women, mean age 45 +/- 13, were included. The epidemiological, histological and virological features of this group were similar to those patients usually treated for chronic hepatitis C. Before treatment, the mean measurement of fatigue was 41 on a scale from 0 (perfect form) to 100 (exhausted). Fatigue was unrelated to age, source of infection, biological activity, or histological score. It worsened in patients who stopped interferon after 3 or 6 months, but was stable in patients who continued treatment for 12 months. Fatigue decreased after the end of treatment and was unrelated to treatment response. The need to stop work was strongly related to the intensity of fatigue and the number of workdays missed due to sickness represented nearly two months out of three in 25% of active patients during the first quarter and in 15% of patients thereafter. 61% of patients self-injected interferon (mainly previous drug users) whereas 30% of patients used nurse care throughout treatment.This study not only provides a realistic evaluation of fatigue in patients with chronic hepatitis C, before, during and after treatment, but also highlights its social and economic consequences. It shows the need for further cost-effectiveness studies on new therapeutic strategies using combined treatments.

Low back pain (LBP)-related disability involves patients with chronic outcome.To identify the factors predictive of chronic evolution of acute LBP and to develop a predictive clinical index.Prospective investigation of 2487 employed patients referred for their first consultation with acute LBP (less than eight days). Chronic evolution defined by persistence of symptoms, unchanged or worse, at seven weeks. A predictive index was developed according to a logistic regression model.One hundred fifty-five patients (6.2%) were considered to have unchanged or worsened LBP at the time of final evaluation, which was carried out on average 42 +/- 15 days after the initial visit, and were thus regarded as having a chronic outcome. When comparing patients with chronic outcome and the others, there were 25 elementary characteristics for which the degree of significance of the bilateral test was less than 0.01. They were introduced into a logistic regression model. Five parameters appeared to be related to chronic outcome: characteristics of current episode (isolated acute low back pain, acute exacerbation of chronic low back pain, sciatica), two daily living activity items, duration of certificate to remain off work and taking part in a sport. They were used to develop an easily applied index providing identification, as of the initial consultation, of the risk of chronic evolution.The early recognition of patients with LBP with high risk of chronic outcome can be achieved with an easily applied clinical index.

The prevalence of pressure ulcers in hospitals in France is given, and the anatomical location of these ulcers is explored. The importance of establishing accurate stages for these wounds is also emphasized. Four methods of cost-effectiveness analysis are proposed and described: analysis of one case; analysis of one ward; analysis of care time; and analysis of one tetraplegic young man.

The authors used a prospective study of 309 great saphenous veins to analyse, by Doppler and ultrasonography, the mechanism of sclerosis following sclerosing injections. These were administered at a maximum of 50mm from the sapheno-femoral junction using a protocol based upon five sessions. It was found possible to establish a close relationship between the quality of results and small calibre. Similarly, recurrence by early repermeation was generally secondary to a sclerosing reaction having caused thrombosis. Other changes were seen during or at the end of treatment, sometimes differing greatly from clinical findings. This type of sclerosing injection therapy provided more than 90% favourable responses to treatment after a follow-up period of 15.7 months. Analysis of other parameters may possibly enable even better definition of the treatment of this condition and its natural history.