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Ability to assess flares in osteoarthritis (OA) of the knee and hip (KHOA) is important in clinical care and research. Using mixed methods, we developed a self-reported instrument measuring flare and assessed its psychometric properties.We constructed questionnaire items from semi-structured interviews and a focus group (patients, clinicians) by using a dual-language (English-French) approach. A Delphi consensus method was used to select the most relevant items. Patients with OA from Australia, France and the United States completed the preliminary Flare-OA, HOOS, KOOS and Mini-OAKHQOL questionnaires online. We used a factor analysis and content approach to reduce items and determine structural validity. We tested the resulting questionnaire (score 0-100) for internal consistency, convergent and known-groups validity.Initially, 180 statements were generated and reduced to 33 items in five domains (response 0 = not at all, to 10 = absolutely) by Delphi consensus (50 patients, 116 professionals) and an expert meeting. After 398 patients (mean [SD] age 64 [8.5] years, 70.4% female, 86.7% knee OA) completed the questionnaire, it was reduced to 19 items by factor analysis and a content approach (RMSEA = 0.06; CFI = 0.96; TLI = 0.94). The Cronbach's alpha was0.9 for the five domains and the whole questionnaire. Correlation coefficients between Flare-OA and other instrument scores were as predicted, supporting construct validity. The difference in Flare-OA score between patients with and without flare (31.8) largely exceeded 2 SEM (10.2).Flare-OA is a valid and reliable patient-reported instrument for assessing the occurrence and severity of flare in patients with KHOA in clinical research.

Although three-dimensional conformal radiotherapy (3D-CRT) remains the gold standard as a curative treatment for NSCLC when surgery is not possible, intensity modulated radiotherapy (IMRT) is increasingly used routinely. The purpose of this study was to assess the clinical (immediate toxicities) and dosimetric impact of IMRT compared to 3D-CRT in the treatment of locally advanced (stages IIIA to IIIC) non-small cell lung cancer (NSCLC) treated with concomitant radiochemotherapy, while IMRT in lung cancer was implemented in the radiotherapy department of the Jean-Perrin Center.Between March 2015 and October 2019, 64 patients treated with concomitant radiochemotherapy were retrospectively included. Thirty-two received 3D-CRT and 32 IMRT. The radiotherapy prescription was 66Gy in 33 fractions of 2Gy.IMRT has improved coverage of target volumes (V95 increased by 14.81% in IMRT; P0.001) without increasing doses to OARs and reducing dysphagia (RR=0.67; P=0.027). Low doses to the lung were not significantly increased in IMRT (pulmonary V5 increased by 7.46% in IMRT).Intensity modulated radiotherapy, compared with the standard RC3D technique, improve the coverage of target volumes without increasing the dose to the OARs. It also improves the immediate tolerance of the treatment by reducing the number of dysphagia.

Purpose New multiple sclerosis (MS) disease-modifying therapies (DMTs), which exert beneficial effects through prevention of relapse, limitation of disability progression, and improvement of patients’ quality of life, have recently emerged. Nonetheless, these DMTs are not without associated complications (severe adverse events like. progressive multifocal leukoencephalopathy). Patient follow-up requires regular clinical evaluations and close monitoring with magnetic resonance imaging (MRI). Detection of new T2 lesions and potential brain atrophy measurements contribute to the evaluation of treatment effectiveness. Current MRI protocols for MS recommend the acquisition of an annual gadolinium (Gd) enhanced MRI, resulting in administration of high volume of contrast agents over time and Gd accumulation in the brain. Methods A consensus report was established by neuroradiologists and neurologists from the French Observatory of MS, which aimed at reducing the number of Gd injections required during MS patient follow-up. Recommendations The French Observatory of MS recommends the use of macrocyclic Gd enhancement at time of diagnosis, when a new DMT is introduced, at 6-month re-baseline, and when previous scans are unavailable for comparison. Gd administration can be performed as an option in case of relapse or suspicion of intercurrent disease such as progressive multifocal leukoencephalopathy. Other follow-up MRIs do not require contrast enhancement, provided current and previous MRI acquisitions follow the same standardized protocol including 3D FLAIR sequences.

It is proposed to delineate the anatomo-clinical target volumes of primary tumor (CTV-P) in ethmoid cancers treated with post-operative radiotherapy. This concept is based on the use of radioanatomy and the natural history of cancer. It is supported by the repositioning of the planning scanner with preoperative imaging for the replacement of the initial GTV and the creation of margins around it extended to the microscopic risk zones according to the anatomical concept. This article does not discuss the indications of external radiotherapy but specifies the volumes to be delineated if radiotherapy is considered.

Background Granular cell or Abrikossoff’s tumors are usually benign however rare malignant forms concern 1 to 3% of cases reported. Pelvic locations are exceptional. Case presentation We report a case of a 43-years-old patient who had a benign Abrikossoff’s tumor localized in the right femoral triangle diagnosed at the biopsy. The patient underwent a surgical tumorectomy and inguinal lymph nodes resection. Histologically, the tumor showed enough criteria to give diagnosis of malignancy: nuclear pleomorphism, tumor cell spindling, vesicular nuclei with large nucleoli. Moreover, five lymph nodes were metastatic. Immunohistochemistry findings confirmed the diagnosis of granular cell tumor which is positive for S100 protein and CD68 antibodies. The mitotic index was nevertheless low with a Ki67 labeling index of 1–2%. A large surgical revision with an inguinal curage following radiotherapy were decided on oncology committee. Adjuvant radiotherapy on the tumor bed and right inguinal area of ​​50 Gy in conventional fractionation was delivered with the aim of reducing local recurrence risk. There was no recurrence on longer follow-up (10 months post radiotherapy). Conclusions Adjuvant radiotherapy seems an appropriate therapeutic approach, even if controversial, given that some authors report effectiveness on local disease progression.

In our study, we aimed to assess the pathologic complete response after neo-additive chemotherapy that contains a taxan associated to trastuzumab for patients treated from breast cancer at the institute Jean-Godinot between 2012 and 2014, and to evaluate factors associated to this pathologic complete response.Retrospective study with clinical, anatomopathologic and radiologic parameters analysis before and after new adjuvant chemotherapy. The statistical analysis was done on logiciel XL-STAT, the Mann-Whitney-Wilcoxon for quantitative variables and Fisher exact tests for qualitative variables, the Spearman rang test.The rate of pathologic complete response is 38.8%. The prognostic factor associated to pathologic complete response is a Ki-6744%.The pathologic complete response rate corresponds to international lower rate; because of the lack of several data, we found out only one prognostic factor, Ki-6744%.

Background Depressive mood has been associated with all-cause mortality in both men and women. This study aimed at exploring gender differences in the association between depressive mood and specific causes of mortality as well as factors that may account for it, including education, marital status, social support, health behaviors, and chronic diseases. Methods A population-based survey including 6043 subjects (2892 men and 3151 women) was conducted in 1996 in the north-east of France with a questionnaire covering education, marital status, social support, health behaviors (smoking status, alcohol consumption, body mass index), and chronic diseases. Depressive mood was measured using the Duke Health Profile questionnaire. Cox regression models were used to examine its association with subsequent natural all-cause mortality, and cardiovascular and cancer mortality. Results During a follow-up of 12.5 years, 406 men and 303 women died from a natural cause. Adjusting for all covariates, depressive mood predicted natural mortality in both men [Hazard Ratio (HR) = 1.30; 95% confidence interval (CI): 1.00–1.69] and women (HR = 1.37; 95% CI: 1.06–1.77). However, this association was significant for cardiovascular mortality in men (HR = 1.63; 95% CI: 1.00–2.65) whereas it was significant for cancer mortality in women (HR = 1.71; 95% CI: 1.11–2.64). Limitations Baseline data were self-reported and the response rate was low. Discussion Preventive strategies aiming at reducing the increased mortality associated with depressive mood should take gender into account. Depressed men may warrant a better screening for cardiovascular risk factors and diseases, whereas depressed women may benefit from better cancer prevention measures.

This study aims to describe the prevalence and incidence rates of multiple sclerosis (MS) in Lorraine, France, and its secular trend from 1990 to 2002. Cases were sourced from the regional network of MS healthcare workers in the Lorraine region and include all cases with definite or probable MS according to Poser's criteria. We identified 2718 patients with MS on 31 December 2004. The prevalence rate was 120/100 000 (95% confidence interval [CI]: 119—121). Between 1990 and 2002, the average age- and sex-adjusted annual incidence rate was 5.5/100 000 (95% CI: 4.4—6.6). During this same period, there was a significant increase in overall incidence in women but not in men. The mean age at MS onset, disability score five years after onset, number of relapses during the first five years, and proportion of first attack with sequelae or polysymptomatic symptoms were not significantly different between each annual cohort during the study period. The prevalence and incidence rates of MS we found in our study were higher than in previous studies in France. The increase in incidence of MS between 1990 and 2002, mostly in women, was not related to better ascertainment of patients with mild disability. Multiple Sclerosis 2007; 13: 962—967. http://msj.sagepub.com

Purpose Fatigue is a frequent and common symptom of multiple sclerosis (MS) that can interfere with patients' everyday activities. There is no objective scale for assessing fatigue in French MS patients. The objective of this study was to adapt an English language scale for use with French patients. Methods The Fatigue Impact Scale was translated and culturally adapted into French by a committee of medical and linguistic specialists. The psychometric properties of this new instrument, called EMIF-SEP were assessed. Results EMIF-SEP is composed of 40 items. Four dimensions of this scale (cognitive, physical, social role and psychological) were identified by factor analysis. Each dimension had a high internal consistency (Cronbach's alpha >0.80). The test-retest reproducibility was very satisfactory; intra-class correlation coefficients were all above 0.70. Conclusion EMIF-SEP is the first scale for assessing MS-related fatigue which has been adapted to French-speaking patients. It is useful for clinical practice and MS-related research. Multiple Sclerosis 2007; 13: 1026—1032. http://msj.sagepub.com

Aims To review a series of 23 consecutive patients with squamous cell carcinomas arising from oropharynx who underwent infra hyoid musculo-cutaneous flap reconstruction including soft palate in alternative to free radial forearm flap or maxillofacial prosthesis. Post operative radiotherapy was performed for all patients. Results Every reconstruction healed quickly without major wound complications. The functional results evaluated by speech and swallowing capacities, were good for 17 patients, fair for 4 patients and bad for 2. Conclusions The infra hyoid musculo-cutaneous flap is a versatile, reliable and convenient flap suitable for repairing small and medium sized defects; it can be used in combination with other flaps, and in selected cases obviates the need for a microvascular free radial forearm flap or maxillofacial prosthesis.

Purpose: Spina bifida (SB) is the most common congenital cause of incontinence in childhood. This study attempts to determine the relationships between urinary/faecal incontinence, methods of management, and Health Related Quality of Life (HRQoL) in people with SB. Patients and method: A total of 460 patients (300 adults and 160 adolescents) from six centres in France have taken part in this cross-sectional study. Clinical outcome measures included walking ability, urinary/faecal continence, and medical management. HRQoL was assessed using the SF36 in adults and the VSP in adolescents and their parents. Univariate and multivariate analysis was used to determine the relationships between clinical parameters and HRQoL. Results: HRQoL were significantly lower than in the general population. Adult women had significantly lower scores than men, and adolescent females had significantly lower scores for psychological well being. We did not found strong relationship between incontinence and HRQoL in this population. Moreover patients surgically managed for urinary/fecal incontinence did not show significantly higher scores of HRQoL. Conclusion: Using generic HRQoL measures, urinary/faecal incontinence and their medical management may not play a determinant role in HRQoL of persons with SB. However many other factors affect HRQoL in these patients. A longitudinal study design is recommended to assess whether incontinence management is associated with improve HRQoL.

In France, as in other countries, breast cancer care has changed due to therapeutic advances and organized screening programs. Can the effect of new therapeutic procedures over time be measured by health care institutions considering these changes? The present study used data from a hospital-based cancer registry to analyze changes in 5-year disease-specific and event-free survival among women with primary breast cancer over three time periods (1990-1993, 1994-1997, and 1998-2001).All cases of primary invasive breast carcinomas, initially treated in a French Comprehensive Cancer Center between 1990 and 2001, were included. In situ breast carcinoma and male breast cancer were excluded. Cox proportional hazards models were used to analyze disease-specific and event-free survival (DSS and EFS) rates over the three time periods (1990-1993, 1994-1997, and 1998-2001).During the 1990-2001 period, 4,165 primary breast cancers were initially treated at the Comprehensive Cancer Center. Out of 1,012 deaths overall, 74.6% were due specifically to primary breast cancer (respectively 98% from cancer itself and 2% from treatment side effects); the cause was unknown for only 3.3% of deaths. Out of 3,810 complete remissions, 18.2% presented local, regional or metastatic relapse and 3.8% presented a second primary breast cancer. Comparison of DSS and EFS rates in a recent reporting period (1998-2001) with those in earlier time periods (1994-1997 and 1990-1993) indicated that substantial survival gains were achieved with respectively 88.4% (95% CI: 86.4-90.5), 83.2% (95% CI: 81.3-85.2), and 79.8% (95% CI: 77.4-82.2) (p0.01) for 5-year Disease-Specific Survival, and respectively 78.3% (95% CI: 75.7-81.0), 73.9% (95% CI: 71.6-76.3), and 70.1% (95% CI: 67.4-72.8) (p0.01) for 5-year Event-Free Survival. After adjustment for prognostic factors, period was identified as an independent predictor of survival.Survival improvement is likely to be due to changes in routine clinical practice such as an increased use of systemic adjuvant therapy over the study periods, dose modification of epirubicin in adjuvant chemotherapy for node-positive breast cancer since 1994, and organized screening programs since 1997. However the effect of possible early diagnosis and over-diagnosis biases due to screening cannot be assessed.

We describe urinary continence management and outcome in patients with spina bifida to identify the procedures that are most successful.In a multicenter retrospective cohort study medical charts were studied. At the same time in a cross-sectional survey sociodemographic characteristics, orthopedic features and urinary continence were described based on the frequency of leakage from the viewpoint of patients or close relatives using a Likert scale of 5 items, namely 1-leakage permanent to 5-leakage never.A total of 421 patients were included, of whom 191 (45%) had been medically treated with a normal voiding pattern according to the patient viewpoint in 21%, clean intermittent catheterization in 61% and no specific bladder emptying method in 18%. The mean leakage score +/- SD was 2.74 +/- 1.55. On the other hand, 230 patients (55%) were surgically treated. Except for 23 patients who underwent noncontinent urinary diversion 207 were considered for treatment and continence description. The mean leakage score was 3.45 +/- 1.60. An artificial urinary sphincter in male and females, and a sling or Kropp technique in females were satisfactory when bladder enlargement was not required. In cases of bladder augmentation without continent diversion an artificial urinary sphincter in males and a bladder neck sling or cinch, Kropp and Young-Dees procedures in females have provided the best results. In cases of bladder enlargement with continent urinary diversion bladder neck closure or a wrap have provided the best results whatever the patient sex.Many factors may influence the choice of a technique, such as patient sex, bladder characteristics or orthopedic conditions. However, since to our knowledge no randomized, controlled study has been yet performed, definitive conclusions on the best way to achieve urinary continence in patients with spina bifida cannot be established.

Background In 1986, Wang described the infra hyoid musculo-cutaneous flap. Here, we report technical adaptations and improvements to this flap. Methods From 1994 to 1996, we performed 61 infrahyoid flaps using the classical procedure. After 5 years of technical evolution, we studied a new series of 91 flaps from January 2000 to June 2002. We reviewed our experience with the infra hyoid flap and described the surgical procedure, its evolution and the impact on the fiability of the flap. Results In the two series, the main arterial pedicle was usually the superior thyroid artery. Venous drainage was more variable; consequently we always performed a modified neck dissection with preservation of the internal jugular vein. In the first series, the surgical results were good with only seven local complications essentially skin necrosis. The functional and aesthetic results seemed acceptable. In the second series, the results, after technical evolution with better venous drainage and cervical closure, were improved (only one necrosis) and the indications were extended. Conclusion With experience, the infra hyoid myocutaneous flaps is reliable and appears as a particularly useful flap for oral cavity, oral pharynx and pharyngeo-laryngeal reconstruction.

Apoptosis induced by photodynamic therapy (PDT) is considered to be an important factor defining the treatment outcome. Nevertheless, the relevance of apoptotic events in overall cell death should be established for every given photosensitizer. The present study addresses the contribution of Foscan-(meta-tetra(hydroxyphenyl)chlorine; mTHPC) photosensitized apoptosis in overall cell death in a model of cultured HT29 adenocarcinoma cells. Early events of cell death were assessed by the evaluation of mitochondrial response to mTHPC-mediated PDT, cytochrome c release and membrane depolarization. Apoptosis was measured through the activity of caspase-3 and the binding of the fluorescent conjugate Ca2+-dependent protein Annexin-V on membrane externalized phosphatidylserine at 2, 4, and 24 h post-PDT. Immediately after mTHPC-PDT, from 28 to 57% cells exhibited cytochrome c release concomitantly with mitochondrial membrane depolarization for light doses inducing more than 90% overall cell death. The maximum of caspase-3 activation (12-fold more than control) was reached 24 h after irradiation at fluence inducing 90% cell death (LD(90)). The corresponding measurement of apoptotic cells (12% of Annexin-V bound cells) confirmed the mild and delayed apoptotic response of HT29 cells to mTHPC-PDT.

Define the phases composing the learning curve of total hysterectomy (TH) and radical hysterectomy with pelvic lymphadenectomy (RHPL) robot-assisted performed by a single surgeon with no prior experience in laparoscopic surgery.We retrospectively analyzed 72 procedures (TH, n=34 and RHPL, n=38) conducted between 2002 and 2011. The surgeon console time (CT) was used to determine the learning curve of TH and RHPL using CUSUM analysis. Epidemiological data, perioperative and postoperative complications were compared from the different phases of the learning curve.CUSUM analysis of surgeon console time (CUSUMCT) identified two learning phases for the TH group (phase 1: initial learning, phase 2: surgical skill increase). For the RHPL group, three learning phases were identified (phase 1: initial learning, phase 2: extending surgical indications, phase 3: control of surgical skills). Perioperative and postoperative complication rates did not differ significantly between the learning phases. Surgeon CT decreased from the 9th case (P=0.01) for the TH group and from the 13th case (P=0.04) for the RHPL group.CUSUM analysis of the learning curve in robotic-assisted gynecologic oncology surgery identified two phases of learning curve for simple procedures such as total hysterectomy and three phases for more complex procedures as radical hysterectomy with pelvic lymphadenectomy.

To develop an Animated Activity Questionnaire (AAQ) based on video animations for assessing activity limitations in patients with hip/knee osteoarthritis (OA) that combines the advantages of self-reported questionnaires and performance-based tests without many of their limitations and to preliminarily assess its reliability and validity. We hypothesized that the AAQ would correlate highly with performance-based tests and moderately with self-reported questionnaires.Item selection was based on the pilot AAQ, prespecified conditions, the International Classification of Functioning, Disability, and Health core set for OA, existing measurement instruments, and focus groups of patients. Test-retest reliability was assessed in 30 of 110 patients. In 110 patients, correlations were calculated between the AAQ and the self-reported Hip Disability/Knee Injury and Osteoarthritis Outcome Score activities of daily living subscale (H/KOOS). In 45 of 110 patients, correlations with performance-based tests (stair climbing test, timed up and go test, and 30-second chair stand test) were calculated.In total, 17 basic daily activities were chosen for the AAQ. Video animations were made showing a person performing each activity with 3-5 different levels of difficulty. Patients were asked to select the level that best matched their own performance. Reliability was high (intraclass correlation coefficient 0.97 [95% confidence interval 0.93-0.98]); the AAQ correlated highly with performance-based tests (0.62), but higher with the H/KOOS (0.76) than expected.A computerized AAQ for assessing activity limitations was developed. Content validity was considered good. Preliminary validation results showed high reliability, but construct validity needs further study with a larger sample size. Continuing research will focus on construct validity and crosscultural validity.

Contexte et objectifs de l'etude: L'identification endoscopique des dysplasies et des carcinomes precoces de l'oesophage est difficile et effectuee au moyen de biopsies etagees systematiques. Cette etude evalue la capacite de la spectroscopie d'autofluorescence UV a detecter ces lesions precoces avec un interet particulier pour l'endobrachyoesophage (EBO). Patients et methodes: Les mesures ont porte sur 24 patients en utilisant une excitation lumineuse a 330 nm. La determination de la distribution spectrale caracteristique de chaque type histologique est faite en utilisant les trois rapports d'intensite de fluorescence. R 1 =I 390nm /I 450nm ; R 2 =I 550nm / I 450nm; R3 =I 390nm /I 550nm . Resultats: Les distributions spectrales relatives a la muqueuse malpighienne oesophagienne saine et a la muqueuse specialisee de l'EBO non dysplasique sont similaires. La presence d'une dysplasie de haut grade ou d'un carcinome intramuqueux se traduit par une modification de la distribution spectrale. L'analyse statistique montre que la modification spectrale associee a la transformation neoplasique est plus forte que les variations intra- et interpatients. Ces resultats ont permis la determination de criteres de discrimination fondes sur les rapports R 1 et R 3 . L'utilisation du rapport R 3 permet de differencier le tissue neoplasique de la muqueuse malpighienne et de la muqueuse de Barrett avec une sensibilite de 86% et une specificite de 95%. Conclusion: La spectroscopie d'autofluorescence UV, en orientant les biopsies, devrait accroitre l'efficacite diagnostique de l'endoscopie conventionnelle.

Background. Reports have suggested that hepatitis C virus (HCV)-infected kidney recipients may develop de novo glomerular lesions caused by the virus. We studied the relationships between pretransplantation anti-HCV antibodies and the occurrence of proteinuria and the link with short- and long-term patient and graft survival. Methods. A total of 322 consecutive renal recipients treated at a single center from 1989 to 1994 whose sera were routinely assayed for anti-HCV antibodies at the time of transplantation were analyzed. The risks of persistent proteinuria (>1 g/day), graft loss, or death were estimated by Kaplan-Meier analysis. The relationship between clinical variables and each outcome was examined by Cox multivariate regression analysis. Results. Before transplantation, 9.6% of the recipients were anti-HCV antibody positive. Persistent proteinuria developed in 13.6% recipients. The presence of anti-HCV antibodies was strongly associated with proteinuria (relative risk [RR]=5.36, 96% confidence interval [CI] =2.49-11.51). Proteinuria occurred more frequently in second grafts (RR=2.64, 95% CI=1.10-6.29). The number of HLA-A,B mismatches was an independent risk factor (RR=1.55, 95% CI=1.10-2.19). Recipient age (RR=0.80, 95% CI=0.63-1.02) and duration of dialysis (RR=0.86, 95% CI=0.77-0.96) were protective factors. Histology of biopsies from 26/44 recipients with proteinuria showed that de novo glomerular lesions were more frequent in HCV-positive patients, although the difference was not significant. One- and five-year graft survival rates were significantly worse in patients with proteinuria (90.7% and 41.1%) than in patients without it (95.6% and 91.8%) (P

Patients with systemic lupus erythematosus (SLE) and antiphospholipid antibodies (aPL) are at a greater risk for venous thromboembolism (VTE) than SLE patients without these antibodies. For patients without SLE there is a controversy about the risk associated with these antibodies and about their prognostic significance. We reviewed the degree of evidence and describe the odds ratio for VTE associated with aPL, namely the lupus anticoagulant (LA) and anticardiolipin antibodies (aCL), in patients without SLE. The study was a meta-analysis of seven observational studies of risk for antiphospholipid associated venous thromboembolism (VTE), excluding SLE patients. The strategies to identify published research included a computerized literature search and the review of citations in primarily relevant articles for the period 1983 to 1997. A summary of study characteristics and a critical appraisal of study quality were done. Summary odds ratios were obtained conducted using a random and a fixed effects-model. The overall odds ratio for aCL associated VTE obtained by fixed-effects model was 1.56 (95% CI, 1.10—2.24) and 1.64 (95% CI, 0.93—2.89) by random-effects model. The heterogeneity of these results appeared to be due in part to the detection limit of the aCL assay: the odds ratio was 3.21 (95% CI, 1.11—9.28) with both models when high titres only were considered. The overall odds ratio for LA associated VTE was 11.1 (95% CI, 3.81—32.3). In conclusion meta-analysis of the risk for antiphospholipid associated thrombosis demonstrated a higher risk in patients with the LA than in other patients. This risk was also higher than in patients with aCL even when high titres only were considered.

Chronic obstructive pulmonary disease (COPD) induces changes in daily activities and mood. Health-related quality of life (HRQL) measures are of particular relevance in the management of such patients, but predictors of HRQL have rarely been investigated. The aim of this study was to seek factors predicting HRQL in severe COPD patients under long term oxygen therapy (LTOT). The pulmonary function parameters at the start of LTOT were studied as potential predictors of future HRQL. HRQL was assessed after an average of 40 months follow-up by the Duke Health Profile (Duke) and by the St. George Respiratory Questionnaire (SGRQ). Sixty-one patients (47 males and 14 females) with a mean age of 66 years were included in the study. Stepwise multiple regression analyses conducted in each HRQL dimension identified few significantly predictive factors. By the Duke, higher Self-esteem scores were associated with higher Pao2 (p < 0.01) and with older age (p < 0.05); higher Social Health scores were associated with older age (p < 0.005), and higher Pain scores were associated with a higher FEV1/FVC ratio (p < 0.05). By the SGRQ, the Activity score correlated with FEV1/FVC (p < 0.05). The proportion of the variance in each score accounted for by covariates in the model did not exceed 10%. No other significant regression models could be identified using the other HRQL dimensions. Our findings demonstrated weak relations between lung function at the start of LTOT and some dimensions of HRQL measured by the Duke and the SGRQ at the end of follow-up.

Objective To evaluate the performance of a computer-controlled monitor of bladder pressure in the prevention of transurethral resection (TUR) syndrome. Patients and methods The in vitro pressure loss in catheters and endoscopes of different size was measured for irrigant flow rates of 0–500 mL/min to calibrate them before surgery. The calibrations were used in a computerized monitoring system designed to control bladder pressure during TUR of the prostate (TURP). The performance of the system was assessed in a randomized study of 53 patients with a prostate adenoma or carcinoma (Group A, 27 unmonitored patients; Group B, 26 monitored patients). The primary criterion for evaluating the absorption of irrigating fluid was the level of glycine in the blood. Results When patients with capsule perforation were included in the analysis, there was no statistically significant difference in mean glycine absorption between the groups, although glycine levels were highest in Group A, particularly in those cases with perforation (four in Group A; two in Group B). When the results for patients with capsule perforation were excluded from the analysis, there was a significant difference in the incidence of irrigant absorption between the groups. The extent of absorption was not related to the duration of operation (which was shorter in Group B) nor to the weight of resection chippings. Conclusion The continuous computerized monitoring of bladder pressure during TURP effectively reduced the absorption of irrigant fluid, making the procedure safer for the patient and easier for the surgeon.

Navigation surgery, initially applied in rhinology, neurosurgery and orthopaedic cases, has been developed over the last twenty years. Surgery based on computed tomography data has become increasingly important in the head and neck region. The technique for hardware fusion between RMI and computed tomography is also becoming more useful. We use such device since 2006 in head and neck carcinologic situation. Navigation allows control of the resection in order to avoid and protect the precise anatomical structures (vessels and nerves). It also guides biopsy and radiofrequency. Therefore, quality of life is much more increased and morbidity is decreased for these patients who undergo major and mutilating head and neck surgery. Here we report the results of 33 navigation procedures performed for 31 patients in our institution.

A development of a non-docking system is described which enables collimation of an electron beam for intraoperative radiation therapy. This system, adapted to a linear accelerator (SATURNE 43-CGR MeV), has been designed to minimize the mechanical, electrical and tumor visualization problems associated with a docking system. A number of dosimetric considerations and technical innovations have been used in the design of this system. Among them are the central axis of the beam alignment with the axis of the cone via a laser system and the clamping method of the intraoperative cone to the treatment couch by a rigid system. This collimation system can be adapted for different makes of linear accelerator. The dose distribution in this new design system shows a better homogeneity in the patient's target volume and small (thus accessable) leakage radiation dose to tissues outside the intraoperative cone. The design concept and dosimetric characteristics of this novel applicator system are presented in this paper.

Humanitarian Medicine's practical experiences show the potential violence of the medicine's power over bodies everywhere. The inequality between assistance and people receiving benefits is comparable to the asymmetrical relationship between doctor and patient. Efforts have to be done in order to comprehend other possibilities of life's organization. The understanding of double subjectivities in the therapeutic relationship is a requirement for success, in any situation--as usual. Furthermore, the adverse effects of assistance remind us the primary principle not to harm. These admissions of failure urge to develop assessment reasoning, including all factors of influence on health (resources, policy...), and an approach which aims people to become self-sufficient.

Surgical resection remains the standard treatment for patients with resectable retroperitoneal sarcomas. The aim of this study was to retrospectively analyse the outcomes of patients with primary retroperitoneal sarcoma.We analysed data of 50 patients with primary retroperitoneal sarcoma who underwent curative-intent resection from 1975 to 2008. External beam radiotherapy and chemotherapy were delivered postoperatively. Demographics, surgical, pathological variables and chemo/radiation therapy were analysed as prognosis factors.There were 22 males and 28 females (mean age 54 ± 13 years). Surgery required visceral resections in 30 patients. There were 16 leiomyosarcomas, 25 liposarcomas and eight other sub-types. Twenty-one patients had clear surgical margins. Twenty-eight patients received postoperative external beam radiotherapy (median 45 Gy) and 15 received chemotherapy. At the end of the follow-up (median 55 months), local recurrence occurred in 39% (n=14) among R0/R1 resection group (n=36). Postoperative external beam radiotherapy tends to increase the time of local recurrence from surgery (27 vs. 13 months, P=0.05). The overall survival rates were 81%, 55% and 46% at 1, 3 and 5 years, respectively. Although R0 resection (P=0.01), well tumour differentiation (P=0.004) and postoperative external beam radiotherapy (P=0.02) significantly influenced overall survival in univariate analysis, only R0 resection was an independent prognostic factor in a multivariate analysis.We confirm the pre-eminence of radical surgery with negative margins as major prognostic factor and the benefit of postoperative radiotherapy.

Osteoarthritis (OA) epidemiologic data are scarce in Europe. To estimate the prevalence of symptomatic knee and hip OA in a multiregional sample in France.A two-phase population-based survey was conducted in six regions in 2007-2009. On initial phone contact using random-digit dialing, subjects 40-75 years old were screened with a validated questionnaire. Subjects screened positive were invited for ascertainment: physical examination and hip and/or knee radiography (Kellgren-Lawrence grade≥2). Multiple imputation for data missing not-at-random was used to account for refusals.Of 63,232 homes contacted, 27,632 were eligible, 9621 subjects screened positive, 3707 participated fully in the ascertainment phase, and 1010 had symptomatic OA: 317 hip, 756 knee. Hip OA prevalence according to age class ranged from 0.9% to 3.9% for men and 0.7-5.1% for women. Knee OA ranged from 2.1% to 10.1% for men and 1.6-14.9% for women. Both differed by geographical region. The hip and knee standardized prevalence was 1.9% and 4.7% for men and 2.5% and 6.6% for women, respectively.This confirmed the feasibility of using a screening questionnaire for eliciting population-based estimates of OA. In France, it increases with age and is greater among women above the age of 50. The geographical disparity of hip and knee OA parallels the distribution of obesity. Study registration ID number 906297 at http://www.clinicaltrials.gov/.

To compare radiation dose and image quality for CT of the lumbar spine between helical CT and wide volume mode scanning with a 320-detector row CT.Monocenter prospective study on 20 consecutive patients divided into two groups. All 20 patients underwent lumbar spine CT on the 320-detector row scanner (Aquilion One, Toshiba). The CT examinations for group 1 were performed using the wide volume mode with 320 detector rows while the CT examinations for group 2 were performed using a 64-detector row helical CT mode. The acquisition length and delivered dose corresponding to the DLPe (extended dose length product) as well as qualitative and quantitative image quality were compared between both groups.The mean acquisition length was comparable between both groups. There was a significant dose reduction of about 35% for group 1 compared to group 2 (mean DLPe of 970 mGy.cm for group 1 compared to 1503 mGy.cm for group 2, p0.028) when using the wide volume mode acquisition at 320-detector row CT compared to the 64-detector row helical CT mode. No significant difference was noted for image quality between both groups.The acquisition of lumbar CT using the wide volume mode at 320-detector row CT allows significant dose reduction to patients compared to the 64-detector row helical CT mode while preserving image quality.

MAIN OF STUDY: Management and surgical reconstruction of head and neck cancers remain a challenge. From the first consultation to surgery and radiotherapy it is necessary to gain time to ensure optimum treatment and better survival rates.To establish a kind of quality approach to the management of patients with head and neck cancers. 54 patients who received microsurgical reconstruction after head and neck cancer were included in this study between 1997 and 2006.Multiple data were considered: body mass index (BMI), ASA stage, age, existence of a pre-or postoperative radiotherapy, the surgeon's experience and the number of drainage veins. The success rate is superior when more than one draining vein is sutured to the flap for patients with a BMI20. Radiotherapy does not seem to affect the survival of the flap.According to current literature, the survival rate of these patients is better when the overall time care is less than 100 days. That period is possible with a perfect organization of the medical and paramedical team. Therefore, we propose to include these patients in a circuit protocolisation care, which saves time, to better inform patients and improve survival rates.

International audience; Aims:Various types of musculoskeletal disorders (MSDs) have comorbid mental disorders, which may in turn have a negative influence on disease course and role impairment, but the contribution of social factors to this type of comorbidity is a much under-researched area. This study investigates whether there is a socially patterned association of MSDs with different dimensions of mental malaise. Methods: The sample included 3,368 economically active participants aged 18—64 years, randomly selected from the Lorraine region in north-eastern France. Information was provided through a post-mailed questionnaire on fatigue, sadness/depression (Duke questionnaire) and cognitive disability during the last eight days. Results: MSDs were significantly more prevalent in manual workers, clerks and other occupations than in upper and intermediate professionals, and similar occupational disparities were found for cognitive disability, fatigue and sadness/ depression. Stratifying the sample, we found the occupational disparities in cognitive disability to be much stronger among participants suffering from MSDs than among participants not suffering from MSDs, and the occupational disparities in fatigue and sadness/depression to be limited to the subsample of subjects suffering from MSDs. Conclusions: The findings demonstrate that the association of MSDs with mental malaise is much stronger in the lower occupational groups than in the higher groups. Given that psychological factors are implicated in disease prognosis and in the development of disabilities, awareness of the social dimension of the association and treatment of the comorbid mental disorders could open a promising avenue for reducing social inequalities in disability related to MSDs.

To determine the impact of a joint PACS implementation at a university medical center and cancer center on the radiology practice profile. Materials and methods. In 5 radiology sections, patients, selected based on identifiable acute or chronic diseases, underwent US, CT or MRI. Data were collected on datasheets from each provider with regards to clinical history, availability of prior examinations, description of patient management during the different phases of the examination, duration of examinations, and satisfaction. Data obtained prior to PACS implementation and 6-12 months and 30-36 months after implementation were compared.A total of 1098 datasheets were collected. Hard copy readings rapidly decreased. Comparison with prior examinations improved (+20.6% to 25.6%) as well as frequency of post-processing (+29%). The time required for image management was much more reduced for technologists (-75%) than for physicians (-23%). PACS implementation only temporarily improved the availability of radiology reports and the distribution of work between senior and junior radiologists. User satisfaction, initially high, progressively decreased due to saturation of the archival capabilities.PACS implementation in a large university center improves the efficiency of image acquisition but does not solve some of the inefficiencies of hospital organization.

Lung cancer is the leading cause of cancer mortality in the world. Its incidence is still rising, especially in women, and its prognosis is poor with a 5-year survival of 15%. Since 1970, several studies on lung cancer screening have been conducted using different investigations. Screening by chest X-ray and sputum cytology does not lead to improved survival in lung cancer. Screening by CT scan has the same outcome but the detection of lung cancer, especially in its early stages, is better than with chest X-ray and sputum cytology. Fluorescence endoscopy is a valuable examination for the detection of pre-invasive bronchial lesions. Genetic studies and identification of circulating tumour cells are being developed. All these examinations are very stressful for the patients. Only few trials have studied the consequences of lung cancer screening on the quality of life. In this review, we analyze the various screening strategies, their impact on quality of life and health and their adverse effects.

Fatigue is a frequent symptom of multiple sclerosis (MS). It has been reported to varying degrees at all stages of the disease by 50 to 90% of all MS patients. Fatigue is now recognised as a disabling symptom which negatively impacts daily living. This symptom was underrated until recently but has now been included in clinical practice. Most fatigue scales have been developed in the English language and are culturally specific to their country of origin. The Fatigue Severity Scale is a one-dimensional nine-item scale which briefly assesses the impact of fatigue on the daily lives of MS patients. It has been widely used in different studies, even though it appears to be less relevant than the multi-dimensional 40-item Fatigue Impact Scale which was developed in Canada by Fisk et al (1994). The Fatigue Impact Scale is useful because it assesses different aspects of MS-related fatigue, such as the effects of fatigue on cognitive and physical activities and can include daily living. The Multiple Sclerosis Council for Clinical Practice Guidelines recommends the use of a 21-item Modified Fatigue Impact Scale which is a shortened version of the 40-item Fatigue Impact Scale. Using word-for-word translations of these scales into French would fail because the results would not be interpretable. We first translated and culturally adapted the Fatigue Impact Scale to French-speaking patients. We then evaluated the psychometric properties of this French version (EMIF-SEP). We used the EMIF-SEP scale to study fatigue in French MS patients. We found a significant correlation between higher EMIF-SEP total scores and higher EDSS scores; likewise physical dimension of the EMIF-SEP were linked to disability. But no correlations were found between the cognitive aspects of fatigue and disability. Other studies have failed to show any correlation between fatigue and disability. We suggest that this may be due to differences in sample size, or to the type of instrument used to quantify fatigue. As seen above, some tools do not allow for multi-dimensional assessment of fatigue. The EMIF-SEP scale is useful in that it allows for qualitative and quantitative assessment of fatigue.

Hyperthermic intraperitoneal chemoperfusion (HIPEC) is an innovative treatment of the peritoneal carcinomatosis with potential iatrogenicity. This observational study was designed to improve our understanding of HIPEC's impact on the renal and respiratory functions, on temperature, blood cells counts, body fluids/electrolytes and acid-base balance.We retrospectively analyzed the perioperative care of 20 patients that underwent HIPEC with oxaliplatin (n=19) and mitomycin C (n=1). The abdominal cavity was filled with the peritoneal dialysis fluid with dextrose 5%: volume of 2L/m(2). Follow-up for the study was stopped on postoperative day 7.The main changes were appearing just after the HIPEC procedure: increased diuresis, lactic acidosis, hyponatremia and hyperglycaemia (despite aggressive intravenous insulin therapy). In our series, there was no renal failure or impact on blood cells counts until the 7(th) day, neither some changes on the arterial blood gases.Hyperglycemia might explain increased diuresis of lactic acidosis and the rapid installation of hyponatremia. Taken together, these results suggest that glycemic control must be improved in order to avoid the other metabolic disturbances.

Objective The currently published works regarding the multiple sclerosis (MS) natural history report data were collected most often on population of patients recruited in MS centers. The aim was to compare the natural history of a population of patients followed in a MS centre (MSC) with patients followed outside a MS centre (NMSC). Methods Cases were identified through the LORSEP cohort, a network of neurologists (private ambulatory practice, hospitals, and MS centers) in France. Results A total of 3602 patients had been analyzed: 1036 MSC patients and 2566 NMSC patients. No difference was observed regarding gender and initial symptoms. Conversely, MSC patients were younger at MS onset and were more likely to have a primary progressive initial form. Median times (years) to the EDSS scores of 3, 4, and 6 were 5.8 (5.0–6.8), 8.4 (7.9–9.0), 16.0 (14.8–18.1) in the MSC group, respectively, whereas corresponding times were 8.4 (7.9–9.0), 12.3 (11.4–13.4), 19.1 (18.0–20.2) in the NMSC group. These differences according to the type of MS supervision were statistically significant for EDSS3 ( P Conclusions The patients followed in a MS centre had earlier disability than patients managed otherwise. Analyses exclusively conducted in patients with MS supervised in specialized centers may falsely misestimate the times needed to reach major disability landmarks. Before using registries to study the natural history of MS, efforts should be performed to verify in how far data are exhaustive and to understand the local health care system.

International audience; BACKGROUND: To describe the rate and timing of DMARD start in patients with early inflammatory arthritis in France, and to determine the factors leading to this treatment start. METHODS: The ESPOIR cohort study collects data on patients presenting with early arthritis. Baseline characteristics were assessed, and Cox regression analysis was performed to estimate the likelihood of starting DMARD treatment over time, adjusting for patient-, disease- and physician characteristics. RESULTS: Of the 775 analysed patients, 598 (77.2%) received at least 1 DMARD during the follow-up period, after a median time of 4.0 months. In general, a higher tender joint count, involvement of the hands, involvement of more than 3 joint groups, presence of abnormal CRP-levels or CCP-antibodies significantly increased the likelihood of being treated (p

ISUIA is a prospective study that ran from 1991 to 1998 and included 4060 patients from 161 centers. Analysis of the methodology focused on: (1) sampling: inclusion was more intensive towards the end of the study period, which was likely to generate a selection bias; (2) a possible indication bias, as direct comparison between observation and treatment groups showed that patients receiving preventative treatment were more at risk of complications; (3) the statistical analyses, which never compared these groups directly, although that would have been the best approach for answering the research question. The size and site of aneurysm appear to be risk factors that were also never included in the multivariate analysis; (4) the outcome criteria, which were either not comparable (spontaneous rupture rate), not compared (disability rate) or presented in a non-comparable way (mortality rate by the Kaplan-Meier method versus raw estimates); (5) interpretation of the results, which should be made with caution as, with no statistical calculations provided, it is assumed that the risk of rupture is constant over time. In spite of the practical difficulties such a study would raise, only a randomized controlled comparison of strategies would offer a clear basis for improved clinical practices, given the fact that increasingly smaller aneurysms can now be identified.

To estimate the prevalence of functional disability in France and assess its association with the health-related quality of life (HRQoL).Each member in 8,000 households randomly selected in the Lorraine population were mailed a questionnaire asking about their sociodemographic characteristics; the presence of chronic locomotor or non-rheumatic diseases; functional disability on the Health Assessment Questionnaire (HAQ); and HRQoL on the Duke Health Profile. The prevalence of functional disability was described, and its relationship with HRQoL was assessed by logistic regression analysis.Among the 6,148 subjects who responded (mean age 46 years +/- 18.3, 48% men), the prevalence of moderate (HAQor= 1) and severe (HAQor= 2) functional disability, adjusted for age and sex, was 6.5% and 1.6% respectively. HRQoL was significantly low in all dimensions for subjects with severe functional disability. Functional disability of locomotor origin significantly affected the physical (OR = 10.6 [5.1-22.1]), mental (OR = 4.4 [2.5-7.8]), and social (OR = 2.4 [1.4-4.3]) dimensions, with a threshold effect according to the disability level and perceived health (OR= 10.6 [5.8-19.4]), with a cause-effect relationship.The prevalence of reported (i.e., not observed) functional disability in terms of its impact on HRQoL helps physicians to better understand its differential consequences, which should ease patient dependence, facilitate the analysis of health care needs and the development of prevention measures, and improve the HRQoL of patients and their families.

The adaptation of the European directive 2001/20/CE on clinical drug trials was the opportunity for a profound reform of the legislative framework on biomedical research in France. Within the main innovations, the distinction between the three broad research categories was retained: biomedical research, research on standard care, and non-interventional research. These changes have rendered the legislative arsenal of research more complex, and therefore these changes should be reviewed. This article presents how the 2007 French healthcare research regulations can be applied. Briefly, four questions should be asked before research is undertaken: (1) does the study require a specific procedure on a person (intervention or investigation)? (2) Does it use material from the human body that will be preserved or discarded? (3) Does it require processing personal patient data? (4) Does it include genetic data? Researchers are expecting a simplification of procedures with the new regulations. This objective has been partially met, but a certain number of questions remain unanswered, particularly in the field of epidemiology.

The expectations of patients with osteoarthritis are essential for health care provision and may be used to improve the patient-doctor relationship.A total of 96 osteoarthritis patients aged 42-89 years (mean=65; 81% female) were recruited among customers of 10 pharmacies in 10 towns in 10 regions (selected at random from the 22 French regions). Ten focus groups were organized looking at three categories of expectation: 1) Information about and understanding of osteoarthritis; its impact on lifestyle, and its treatment, consequences, and outlook; 2) Communication skills, attitudes of practitioners and communication between health professionals; 3) Support available from doctors, family circle and society.The patient-practitioner relationship begins with a dialogue, the quality of which, the participants could be improved by: developing greater trust: patients expect communication skills and expressions of sympathy that practitioners seem ill-prepared to provide. Strengthening involvement: general practitioners in particular should act as mediators and facilitators to improve recognition and understanding of osteoarthritis by employers and public decision-makers.The present study enabled patients to express their expectations. Meeting those expectations could markedly improve the therapeutic process, but the question arises of whether practitioners are ready to agree that there is a need to reconsider and modify the care they provide for their patients.

Population ageing and longer duration of the working career could increase the prevalence of impairments and disabilities whereas there have been few data to help prevention and care. This study aimed at describing the prevalence of various types of impairments and assessing their social inequalities in the Lorraine population (north-eastern France).The sample included 6.214 subjects aged 15 or more from 8.000 households randomly selected in the Lorraine population. A mailed questionnaire including socio-demographical characteristics, job, and various types of impairments was used. The data were analysed with the chi2 independence test, the adjusted odds ratio (OR) and the Mantel-Haenszel test.The prevalence of at least one impairment was 30% in both sexes. It varied from about 20% for subjects aged less than 40 years to about 60% for the subjects aged 70 years or more. It was higher in men than in women among the individuals aged more than 50 years (OR adjusted on age: 1.22, 95% CI: 1.04-1.44). The impairments were generally multiple for the subjects aged over 50. The prevalence of at least one impairment was higher for workmen (OR adjusted on age: 2.11, 95% CI: 1.68-2.66), farmers, craftsmen, traders and heads of firms (OR adjusted on age: 1.60, 95% CI: 1.17-2.18) and for employees (OR adjusted on age: 1.62, 95% CI: 1.29-2.03) in comparison with executives, intellectual professionals and teachers. For workmen a higher prevalence was observed for all types of impairments: intellectual and psychological functions, language, hearing, vision, visceral functions, and skeleton and posture. Farmers, craftsmen, traders, heads of firms and employees showed an excess for most types of impairments. Social inequalities were significant for various age groups during their period of occupational activity, but not after retirement. Unemployed people also had an excess of impairments.The prevalence of impairments strongly increased with advancing age. Marked inequalities were observed between various socio-occupational categories. Men were more affected than the women over 50 years of age. Impairments represent a health index which is useful for prevention to reduce their causes and consequences.

Patients with spinal dysraphism may have severe constipation and faecal incontinence. The impact of antegrade colonic enema (ACE) in the management of patients with spina bifida (SB) is analysed. In a multicentre cross-sectional study, constipation, faecal incontinence and faecal management were described. Cases surgically treated were identified. Data were collected from 423 patients, of whom 230 did not use any manoeuvre or laxatives to assist evacuation. Conventional treatment was used in 193 patients, including digital extraction in 39%, retrograde enema in 21% and oral laxatives in 52%. For intractable constipation and overflow of faecal incontinence, 47 patients were treated with ACE, of whom 41 used the method at a mean time of interview of 4.1 +/- 1.9 years after ACE operation; six abandoned ACE for conventional management. With ACE, faecal continence was significantly improved compared with conventional management, and neither retrograde rectal enema nor digital extraction were required. The conduit was fashioned to the right colon in 32 cases and to the left colon in nine cases. This study provides information on a multicentre experience in bowel management in SB patients. Whatever the technique used, ACE has improved faecal status compared with conventional therapy.

Summary Objective To develop and validate a new health related quality of life (HRQOL) questionnaire specific to obesity and its management. Methods This study was in two parts. The first (Study 1) consisted of the creation of a new tool derived from the American "Impact of Weight on Quality of Life Questionnaire" (IWQOL, 74 items) by adding to it a 17 items specific complementary module. This initial questionnaire (91 items) was reduced so as to obtain a questionnaire adapted to socio-cultural factors of obesity and dietary weight management in France. The objective of the second (Study 2) was to validate this final questionnaire by evaluating its psychometric properties: construction validity, internal reliability, concurrent validity in relation to a generic questionnaire, the SF-12, clinical validity by studying the effects of age, gender and body mass index (BMI), and reproducibility. Results The results of Study 1, obtained in 128 obese patients (mean age: 42.5 12.1, BMI: 34.5 2.8 kg/m 2 , women: 83.6%) enabled reduction of the 91 questionnaire items to 36, grouped into 5 dimensions: physical impact, psycho-social impact, sex life, comfort with food and diet experience. Two hundred and twelve patients (mean age: 43.3 12.2, BMI: 35.8 7.4 kg/m 2 , women: 77.7%) were included in Study 2, among whom 75 filled out the questionnaire twice at a one week interval. Analyses enabled verification of the construction validity and internal reliability (Cronbach alpha > 0.7) of the questionnaire as well as its concurrent validity in relation to summarized SF-12 scores and its clinical validity. The "physical impact" dimension was significantly influenced by BMI and age, the dimensions "sex life" and "diet experience" by the factors gender and BMI, while "psycho-social impact" was influenced by the 3 factors cited. Its reproducibility was also deemed satisfactory (intra-class correlation coefficient > 0.8). Conclusion This new questionnaire, called the "Echelle Qualite de Vie, Obesite et Dietetique (EQVOD)"/"Quality of Life, Obesity and Dietetics (QOLOD)" rating scale is sufficiently reliable and reproducible to be used in clinical practice. It is a simple tool adapted to socio-cultural factors of obesity in France, enabling taking into account of the effects of dietary management on the HRQOL of obese people.

Health related quality of life is becoming of greater importance in the medical field. Nevertheless, methodological problems persist, and particularly when it comes to processing missing data on quality of life questionnaires. In fact, this leads to three difficulties: (i) loss of power; (ii) bias; (iii) choice of the most adequate method for treating missing data. Prevention is the best recommendation in order to avoid unanswered questions. Unfortunately, this does not guarantee the absence of missing data. Therefore, the treatment of missing data depends on: i) identification of the missing data mechanism and ii) choice of the most appropriate method to correct the data. The main objective of this article is to illustrate the identification of non-response items as described in the SF-36 questionnaire items in the SU.VI.MAX study.A logistic regression on the characteristics of the subjects was used to distinguish between two missing data mechanisms: missing completely at random (MCAR) and missing at random (MAR). Two global Chi-2 tests on MCAR mechanism were proposed. The missing data not at random (MNAR) mechanism was also analysed considering the questionnaire features.The percentage of non-responses was small (1.7%), with a maximum equal to 3% for four questions of the General Health dimension (GH2 to GH5). Both global Chi-2 tests rejected the hypothesis that all SF-36 non-responses were MCAR. As to the 32 items with less than 2.3% of non-responses, the mechanisms were: MCAR for 29 items, MAR for 2 items, and probably MNAR for 1 item. The logistic regression indicates that the factors related to non-responses were gender (female), age (or =50 years), attention problem, and number of children (or =3). The hierarchical feature of item PF5 (climb one flight of stairs) in relation to PF4 (climb several flights of stairs) would be a generator MNAR non-responses. The "I don't know" response modality of bloc GH2 to GH5 would also be generator of non-responses of the MNAR type.The identification of missing data mechanisms through statistical analysis and through further reflection on the questionnaire's features is a necessary preliminary in the treatment of non-responses.

To determine the value of known computed tomographic (CT) criteria to differentiate non-complicated from complicated (strangulation, necrosis) small bowel obstruction.43 patients with a definitive diagnosis of small bowel obstruction based on clinical, sonographic, CT, surgical and pathological findings were included. All patients had small bowel obstruction caused by adhesions confirmed at surgery. The obstruction was non-complicated in 28 patients and complicated in 15 patients. The CT examinations from all patients were retrospectively reviewed by three experienced radiologists using a set of pre-defined criteria. Attention was focused on the following signs: reduced enhancement of the small bowel wall, mural thickening, congestion of small mesenteric veins, and ascites. Results were correlated with surgical and/or pathological data.For the diagnosis of complicated obstruction, reduced bowel wall enhancement had a sensitivity of 57% and a specificity of 100%, a bowel wall thickness greater than 3 mm had a sensitivity of 35% and a specificity of 100% and a bowel wall thickness less than 1 mm had a sensitivity of 35% and a specificity of 93%. Ascites and congestion of small mesenteric veins were not significant. The multivariate analysis showed that the association of bowel-wall thickening and reduced enhancement of the small bowel wall was significant (sensitivity of 71%, specificity 100%, and accuracy 90%).Among the CT criteria used to diagnose complications from small-bowel obstruction that were evaluated in this study, only three were significant with a high specificity but low sensitivity.

The cingulate gyrus (CG) is often involved during partial epileptic seizures. The purpose of the study was to analyse the CG morphology and to measure the CG volume in epileptic patients, in order to detect subtle MRI abnormalities such as atrophy, which could be indicative of its implication in the epileptogenic area. The population consisted of 20 epileptic patients (31.2 +/- 9.4 years) and 20 normal volunteers (31.8 +/- 7.7 years). The epileptic patients underwent intracerebral recordings, and were sub-divided into five patients presenting with seizures involving the CG (CG 1), seven patients in whom the CG was only secondarily involved (CG 2) and eight patients in whom the CG was not invoved at all (CG 3). All subjects were investigated by MRI (1.5 tesla Gyroscan Philips): axial T1w 3D Gradient Echo acquisitions, thickness 1.5 mm, reconstructions in all planes. At first, we described the sulcal limits of the CG, trying to define a "normalised CG". In a second step, we segmented the CG intrasulcal grey matter using the "Surgiscope Scopeplan" (Elekta). We compared (Mann and Whitney U test [alpha=0.05]), the CG volumes of CG 1 to CG 2 + 3, and the volume of CG 1 and of CG 1 + 2 + 3 to that of normal volunteers. There was no significant difference between CG 1 and CG 2 + 3 (P= 0.89), between CG 1 and normal volunteers (P= 0.75) or between CG1 + 2 + 3 and normal volunteers (P = 0.83). The volumetric analysis showed no atrophy of the CG in epileptic patients and did not distinguish the group in whom seizures involved the CG, from the other groups.

Developing countries exhibit the highest adolescent fertility rate in the world. Undesirable outcome frequency during adolescents' pregnancy and delivery is debated. The aim of this study is to determine the incidence of these events and the factors predicting their occurrence among pregnant Senegalese adolescents and their newborn. The study was conducted between August 1st, 1999 and July 31st, 2000 in a national sample of 435 women attending prenatal clinics after a 20-week gestation. The data were collected by interviews: sociodemographic characteristics, obstetrical antecedents, current pregnancy history before inclusion in the study; the clinical characteristics were determined at inclusion. Then pregnancy and delivery complication occurrences were observed for mothers and their newborn during follow-up. Logistic regression analyses were performed to determine the factors associated with each complication, controlling the effects of other sociodemographic and clinical factors. The most frequent pregnancy complications were pregnancy-induced hypertension and toxaemia (17.5%). Anemia occurred in 25% of the women. At delivery, at least one of dystocia, eclampsia, or placenta haemorrhage complications occurred in 46% of women. The caesarian rate was 20% and the mortality rate was 71%. When planned, caesarian interventions lowered mortality. Forty percent of the newborns presented a neonatal distress while 17.9% of them weighed less than 2,500 g. The pregnancy-induced hypertension and toxaemia incidence rates were higher when the weight at onset of pregnancy was unknown (OR = 3.7 [1.9-7.5] for hypertension and 3.1 [1.3-7.6] for toxaemia). When a woman with a narrow pelvis was less than 1.50 m tall, the delivery was more frequently assisted by forceps and extracting action in breech delivery. Dystocia, eclampsia, placenta haemorrhage and premature delivery were associated with high mortality. Overall, complications were not more frequent in the youngest (16 years and below), as suggested in previous studies. Those results suggest that undesirable events occur frequently during adolescents' pregnancy and delivery, and in their newborn, while attendance in prenatal clinics is adequate. The prognostic factors of these complications are identified. These complications can be avoided by improving ante- and perinatal care quality.