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International audience; Very high spatial resolution (VHR) images allow to feature man-made structures such as roads and thus enable their accurate analysis. Geometrical characteristics can be extracted using mathematical morphology. However, the prior choice of a reference shape (structuring element) introduces a shape-bias. This paper presents a new method for extracting roads in Very High Resolution remotely sensed images based on advanced directional morphological operators. The proposed approach introduces the use of Path Openings and Path Closings in order to extract structural pixel information. These morphological operators remain flexible enough to fit rectilinear and slightly curved structures since they do not depend on the choice of a structural element shape. As a consequence, they outperform standard approaches using rotating rectangular structuring elements. The method consists in building a granulometry chain using Path Openings and Path Closing to construct Morphological Profiles. For each pixel, the Morphological Profile constitutes the feature vector on which our road extraction is based.

Purpose: The internal snapping hip syndrome is caused by slippage of the iliopsoas tendon over the iliopectineal eminence or the femoral head. Open surgical techniques have been successfully used to treat this condition. More recently, endoscopic techniques have become available to address this problem. The purpose of this study was to investigate an endoscopic technique for release of the iliopsoas tendon and its short-term results. Type of Study: Consecutive case series. Methods: Six patients (7 hips) with an average age of 38.5 years had an endoscopic release of the iliopsoas tendon for internal snapping hip syndrome. Hip arthroscopy was performed in every patient. Special inferior portals were used for psoas bursoscopy. The iliopsoas tendon was identified and released at the level of the lesser trochanter in all cases. Results: Intra-articular concomitant injuries were identified and treated in 4 cases. No snapping symptoms were present in any patient after surgery nor at the last follow-up at, on average, 21 months. Significant loss of flexion strength was present after surgery but had improved by 8 weeks. Conclusions: In our hands, the endoscopic technique for iliopsoas tendon release was effective and reproducible and our results compare well with results of open procedures in the short term. Level of Evidence: Level IV.

Summary: Arthroscopically the hip joint can be divided into 2 compartments: the central compartment or iliofemoral joint and the peripheral compartment, which includes structures in the capsule and lateral to the labrum. The central compartment can only be accessed with hip distraction. Supine or lateral positioning of the patient on traction devices has been described in the literature as a means to obtain adequate joint distraction for hip arthroscopy. The peripheral compartment is better examined without traction. Most of the literature describes this procedure after central compartment arthroscopy, traction is released, and the peripheral compartment is accessed. This has been described using the supine position. This study describes the same technique using the lateral position. We describe findings in a series of 24 hip arthroscopies in which both compartments were accessed with the patient in the lateral position. The standard anterolateral, posterolateral, and anterior portals were used for arthroscopy of the central compartment. Inferior accessory portals were used to access the peripheral compartment. Central compartment pathology was found in every case. Peripheral compartment arthroscopy was done successfully in all cases. Only 5 patients presented pathology, which included hypertrophic synovial folds in two cases, and inferior osteophytes, loose bodies, and synovitis in one case, respectively. We found that the peripheral compartment can be accessed reproducibly and safely using the lateral position, although we do not access it routinely in cases with loose bodies and synovial disease or cases in which peripheral compartment pathology is demonstrated, are good indications for the procedure.

We reviewed a series of consecutive total hip replacements with cemented femoral components. Modern cementing techniques were followed in all cases, but two different medullary plugs were used—one was polyethylene and the other bioabsorbable gelatin. Cement mantle quality and plug migration were assessed by three different observers (X, Y, and Z); their findings did not agree. This was particularly evident when the cement mantles were assessed. There was a better cement mantle grading and less distal migration with polyethylene plugs, although there was no significant statistical difference between the two groups.

In 1991 a space charge calculation for bunched beam with a three-dimensional ellipsoid was proposed, replacing the usual SCHEFF routines. It removes the cylindrical symmetry required in SCHEFF and avoids the point to point interaction computation, whose number of simulation points is limited. This routine has now been improved with the introduction of two or three ellipsoids giving a good representation of the complex non-symmetrical form of the bunch (unlike the 3-d ellipsoidal assumption). The ellipsoidal density distributions are computed with a new method, avoiding the difficulty encountered near the centre (the axis in 2-d problems) by the previous method. It also provides a check of the ellipsoidal symmetry for each part of the distribution. Finally, the Fourier analysis reported in 1991 has been replaced by a very convenient Hermite expansion, which gives a simple but accurate representation of practical distributions. Comparisons with other space charge routines have been made, particularly with the ones applying other techniques such as SCHEFF. Introduced in the versatile beam dynamics code DYNAC, it should provide a good tool for the study of the various parameters responsible for the halo formation in high intensity linacs. Improvements of the method are under development by the authors. These improvements, which might lead to a new step in space charge computations, are however beyond the scope of this article.

Hip arthroscopy has become a standard surgical procedure. Specific portals and portal placement techniques are well described and routinely used. The anterior portal placement relies on the ability of the surgeon to introduce a needle into the joint from the landmark located at the crossing of a vertical line from the anterior superior iliac spine and a horizontal line from the greater trochanter. Directing the needle at 30 degrees medially and 45 degrees proximally is recommended, but some adjustment is always necessary to access the joint. Multiple punctures are often needed to place the needle in the correct path into the hip. This increases the risk of injury by puncture of the structures adjacent to the site of the anterior portal and increases surgical time. This study reports the use of a guide device we developed to assist anterior portal placement. The device consists of an intra-articular probe attached to an extra-articular aiming guide that introduces the needle into the hip joint. The needle enters at the previously described landmark and is directed towards the tip of the probe inside the joint. Early clinical results are presented.

In this paper, a new technique is presented to detect the river networks in simulated SWOT images. The proposed algorithm is based on a noise reduction step followed by a directional morphological filter. In this work, the speckle noise reduction has been achieved by using a Curvelet-based filter preserving the structures of interest. After the filtering task, a river contrast enhancement has been presented by using the Path-Opening filter. This morphological filtering has retained the curvilinear structures on the image independently of their orientation. Hence, the river detection has been possible by a simple thresholding on the Path-Opening result. The obtained results are evaluated using a visual inspection and a quantitative evaluation. The potential of the proposed algorithm has been evaluated by studying the robustness of the parameters.

International audience; Remote sensing is a widely-used utility in supporting multilateral environmental treaties such as the Water Framework Directive (WFD). Regarding the WFD most remote sensing applications aim on the assessment of the biochemical status of surface water, while the general detection of water networks is disregarded. Therefore, a methodology for the automatic extraction of river networks from multispectral satellite data is presented. Moreover, a new index called RE-NDWI is introduced, which highlights open water bodies in optical remotely sensed data, using the red edge and green band. The river detection method is tested on RapidEye data from three test sites in Germany and clearly outperforms a regular, supervised SVM-classification.

Background & Aims: Considering the disadvantages of liver biopsy, alternative noninvasive methods have been sought to assess the stage of liver fibrosis. The aim of this study is to determine the prevalence of different stages of chronic liver disease using noninvasive methods (transition elastography (Fibroscan®) and Forns and AST-to-platelet ratio index–APRI-indexes) in HCV/HIV-coinfected patients. Materials & Methods: An observational, cross-sectional, multicenter study conducted between September 2007 and May 2008. The study enrolled coinfected patients who had a transient elastography performed in the year of the study and/or biochemical markers (Forns/APRI indexes) to assess the stage of liver fibrosis. Results: A total of 109 patients were finally enrolled. Mean elastography velocity was 15.3 kPa, and mean APRI and Forns indexes were 1.4 and 6.1, respectively. According to transient elastography: 41% had mild, 24% moderate, and 35% severe fibrosis; 35% with significant fibrosis. According to the APRI index: 29% had mild, 45% moderate, and 26% severe fibrosis; 28% with significant fibrosis. According to the Forns index: 16% had mild, 54% moderate, and 30% severe fibrosis; 30% with significant fibrosis. The Kappa concordance index between the three methods was 0.42 for fibrosis stage and 0.52 for significant fibrosis detection (p

Remote sensing plays a major role in supporting decision-making and surveying compliance of several multilateral environmental treaties. In this paper, we present an approach for supporting monitoring compliance of river networks in context of the European Water Framework Directive. Only a few approaches have been developed for extracting river networks from satellite data and usually they require manual input, which seems not feasible for automatic and operational application. We propose a method for the automatic extraction of river structures in TerraSAR-X data. The method is based on mathematical morphology and supervised image classification, using automatically selected training samples. The method is applied on TerraSAR-X images from two different study sites. In addition, the results are compared to an alternative method, which requires manual user interaction. The detailed accuracy assessment shows that the proposed method achieves accurate results (Kappa ~ 0.7) and performs almost similar in terms of accuracy, when compared to the alternative approach. Moreover, the proposed method can be applied on various datasets (e.g., multitemporal, multisensoral and multipolarized) and does not require any additional user input. Thus, the highly flexible approach is interesting in terms of operational monitoring systems and large scale applications.

L. Seebauer developed a radiologic classification of arthropathy due to massive rotator cuff tear, based on the medial and/or proximal displacement of the humeral head as a result of disease progression. The purpose of this paper is to conduct an evaluation of the concordance of such classification.A group of 34 patients with massive rotator cuff lesion was created. Their X-rays were reviewed and classified by 5 independent observers. An inter- and intraobserver concordance analysis was carried out using the Kappa index, and the results were interpreted according to the Landis and Kock criteria.The intraobserver concordance determined for the 5 observers showed that the one with the greatest experience had an agreement close to 100%; the interobserver concordance found that only 2 of the 5 observers had moderate agreement and, finally, the interobserver concordance of the stages of classification 2A showed a substantial agreement, while a moderate agreement was found for IA and IB.An important variability was found in the intraobserver concordance, where the capacity to reproduce the same results depends on the observer's experience. The results of the interobserver concordance show that the criteria established by Seebauer are insufficient to be reproduced. Finally, in the concordance among the stages a moderate agreement was found in each of the stages.The results of this paper show that the Seebauer classification is experience-dependent, which hinders its routine use by orthopedists not sufficiently trained on shoulder surgery or by residents in training.

Background: Preventing anatomic failure after rotator cuff repair (RCR) remains a challenge. Augmentation with a surgical mesh may permanently reinforce the repair and decrease failure rates. The purpose of this study is to assess the postoperative outcomes of open RCR augmented with a novel reticulated polycarbonate polyurethane patch. Materials and methods: Ten patients with supraspinatus tendon tears underwent open RCR augmented with a polycarbonate polyurethane patch secured in a 6-point fixation construct placed over the repaired tendon. Patients were evaluated with preoperative and postoperative outcome measures, including the Simple Shoulder Test, visual analog pain scale, American Shoulder and Elbow Surgeons shoulder score, Cumulative Activities of Daily Living score, and University of California, Los Angeles shoulder scale, as well as range of motion. Postoperative magnetic resonance imaging was used to evaluate repair status. Results: Patients showed significant improvements in visual analog pain scale, Simple Shoulder Test, and American Shoulder and Elbow Surgeons shoulder scores at both 6 and 12 months postoperatively (P

This paper presents a new method for extracting roads in Very High Resolution remotely sensed images based on advanced directional morphological operators. The proposed approach introduces the use of Path Openings and Closings in order to extract structural pixel information. These morphological operators remain flexible enough to fit rectilinear and slightly curved structures since they do not depend on the choice of a structural element shape and hence outperform standard approaches using rotating rectangular structuring elements. The method consists in building a granulometry chain using Path Openings and Closing to perform Morphological Profiles. For each pixel, the Morphological Profile constitutes the feature vector on which our road extraction is based.

To show how open treatment of the elbow stiffness offers an improvement in the range of motion, pain control, and patient's satisfaction.We present a case series analysis of patients who suffer elbow stiffness and were treated with open surgery. We analyzed the range of motion (ROM), visual analogue scale (VAS) for pain and satisfaction, and the Mayo Score. Statistical analysis was performed using Student's t-test, Fisher's exact and Pearson correlation coefficient.33 patients were included mean, age was 30.3 +/- 13.4. Twenty patients were male and 13 female, 32 patients had an articular fracture of the elbow and 1 with ectopic ossification. In 90.9% the column procedure was the option and in 9.1% open reduction and internal fixation was made. Compared with preoperative ROM was 58.8 degrees +/- 28.6 degrees, postoperative 96.10 +/- 25.5 (p0.001). Pain versus registered 5.06 points in the Preoperative 1.7 points in the postoperative period (p = 0.001). 75% of the patients were satisfied. Preoperative Mayo score was 47.2 +/- 17.8 versus 89.2 +/- 13.4 in the postoperative (p0.0001).The open treatment of the stiff elbow offers the patient pain relief; increased motion and most patients report final results as satisfactory.

In the frame of seismic vulnerability assessment in urban areas, it is very important to estimate the nature of the roof of every building and, in particular, to make the difference between flat roofs and gable ones. In order to perform this tedious task automatically on a large scale, remote sensing data provide a useful solution. In this study, we use simultaneously very high resolution panchromatic data, and an accurate digital elevation model. The fusion of these two modalities enables the extraction of two mixed features. Based on these features the classification between the two considered classes becomes a simple linearly separable problem.

Analysis of the inter-observer variability of biomicroscopy used for the diagnosis of Diabetic Retinopathy.This was a descriptive study. Parallel observer-blind evaluations of the degree of retinopathy in type 2 diabetic patients, as defined on biomicroscopic photographs, were performed by two ophthalmologists. The sample size required for the Kappa index among ophthalmologists with a disagreement ratio of 15%, precision ratio of 5% and confidence level of 95% is n=196 (nbeing the number of eyes). The only variable measured was the degree of Diabetic Retinopathy, according to the modified Early Treatment Diabetic Research Study (ETDRS) classification.The average age of the 217 patients photographed was of 65.42 years (SE= 9.91). In 191 instances there was total agreement between the 2 ophthalmologists. In 24 instances the discrepancy was only of one degree of the classification of the ETDRS, and in 2 the discrepancy was of two degrees. In no case was it greater than this. (Quadratic weighed Kappa = 0.876, IC95%: 0.655-0.952 and linear weighed Kappa = 0.804, IC95%: 0.729-0.878).The Weighed Kappa index demonstrated avery goodagreement of the degree of diabetic retinopathy. The discrepancies were slight, were of no clinical importance, and would not have affected treatment decisions. The results indicate that this examination, performed by a single ophthalmologist, can be utilised as a reference standard in Diabetic Retinopathy diagnosis.

To describe the occurrence of erosive arthropathy in systemic lupus erythematosus (SLE) and its relationship to anti-CCP antibodies.Retrospective medical record review of a case series of five female patients with SLE and erosive arthropathies.The initial disease presentation in all patients was a polyarthritis. Anti-CCP antibodies were detected in 4 out of 5 (80%) patients, 2 of whom had a positive rheumatoid factor.Erosive arthritis was strongly associated with the presence of anti-CCP antibodies in these patients with SLE, who presented with polyarthritis. Anti-CCP in patients with SLE may be a marker of a more severe joint disease.

Purpose: The purpose of this study was to examine the arthroscopic findings in the hips of patients with long-term follow-up of Chiari osteotomies. Type of Study: Prospective consecutive series of patients. Methods: Seven consecutive patients (1 male, 6 female; average age, 23 years) having a Chiari osteotomy performed in 1 hip during childhood or adolescence for developmental dysplasia of the hip were studied. They presented mechanical hip symptoms and had adequate head coverage as a result of the osteotomy with preservation of joint space. Hip arthroscopy was performed in all cases. Results: A massive labral tear dislocated in the midportion of the joint was found in all cases with varying degrees of cartilage damage in the acetabulum or femoral head. The labral tear was resected, cartilage lesions were repaired, and microfracturing of the exposed subchondral bone was performed. Mechanical symptoms improved after surgery and all of the patients were able to go back to activities of daily living. Conclusions: In the Chiari osteotomy, medial displacement of the acetabulum leaves the labrum in the center of the load-bearing area of the resulting acetabulum. Over time this can produce a tear of the labrum, which may be the cause of the mechanical symptoms in our series. It has been documented that labral tears can lead to early degenerative hip disease and, combined with the cartilage lesions, may explain in part the long-term bad results of the Chiari osteotomy. Level of Evidence: Level IV.

Small incisions in total hip replacement should be easily extensile to provide further exposure when needed without compromising the safety of the surgical approach or the skin.

An 84-year-old man was hospitalized because of a febrile neutropenia (neutrophils 400/mm). His medical history included chronic lymphocytic leukemia (CLL) known since 2005. After 4 years of indolent clinical course (Binet stage A), lymphadenopathies associated with a high rate of lymphocytes (119 10/mm) appeared, leading to chemotherapy. Chlorambucil was not effective. Therefore, he was administered fludarabine that allowed remission but had to be stopped because of anemia. Six months later, the patient presented with relapsing fever without any clinical nor any chest radiographic abnormalities. Upon admission, he had fever (40 8C), splenomegaly, inguinal and axillary lymphadenopathies, jaundice, and dyspnea. The laboratory values were as follows: hemoglobin 8,3 g/dL, reticulocytes 17,000 10, platelets 28,000/mm, leukocytes 200/mm, lactate dehydrogenase 584 U/L (N: 230–460), hypertriglyceridemia 2,40 g/L, ferritin 39088 IU/L (N: 30–300), alkaline phosphatase (295 IU/L) and increase of aminotransferases (62 ALAT, 99 ASAT IU/L). A thoracoabdomino-pelvic computed tomography scan revealed left axillary, hilar, mediastinal, mesenteric and retroperitoneal lymph nodes with a thoracic alveolar process. Intravenous immunoglobulin with subcutaneous granulocyte colony-stimulating factor was initiated. In addition, the patient received a broad-spectrum empiric antibiotic therapy with intravenous piperacillin/tazobactam (4.0/0.5 g thrice daily), oral ciprofloxacin (500 mg twice daily) and anti-fungal medication with voriconazole (400 mg/day). A bone marrow biopsy led to the diagnosis of hemophacocytic syndrome (HPS) (Fig. 1). Infection screen included Epstein-Barr Elderly

Background Sinusoidal obstruction syndrome (SOS) is an important non-haematological toxicity in patients who have received chemotherapy for haematopoietic stem cell transplantation (HSCT). In March 2013, European Medicines Agency refused marketing authorisation for the orphan drug defibrotide to prevent and treat SOS. In July 2013, after re-examination, defibrotide had a new positive opinion for marketing authorisation but only for treatment. Purpose To investigate the effectiveness, safety and cost of defibrotide for SOS. Materials and methods Retrospective observational study (Period: January 2009–September 2013). We analysed patients with SOS treated with defibrotide. Response criteria were defined as total serum bilirubin Results Eleven patients (five adults (mean age: 55.7(SD = 4.3) years) and four children (3.1(SD = 1.3)) received defibrotide at a dose of 6.25 mg/kg every 6 h (two patients received 10 mg/kg/6 h). Median duration of treatment was 9 days (range: 5–25). Overall complete response was achieved in seven patients (63.6%), all four children and only three adults. 45.5% of patients had completely recovered from hepatomegaly at the end of defibrotide administration. Six of the eight patients with ascites and one patient with encephalopathy recovered their normal status. All patients reduced their weight gain after defibrotide treatment. 100 day post-HSCT survival was 72.7%. Three patients presented haemorrhagic episodes during defibrotide treatment (two gastrointestinal episodes and one nasal bleeding). Median cost per patient was 19,180 € (range 5,480–41,100 €). Conclusions According to our limited results, defibrotide is an effective option for SOS treatment in children, although cost per patient is high. Cost-effectiveness studies comparing treatment for SOS with and without defibrotide are needed. No conflict of interest.

Background A new method for the measurement of bone density of the phalanx using digitised conventional X-ray films of the hand has been developed in our centre. Objectives To test the reliability and internal validity (test-retest) of this method, especially regarding the digitalisation process and the software developed for segmentation and optical density analyses. Methods The non-dominant hand is radiographed together with an aluminium wedge used for calibration and correction of the variability associated with the XR technique and digitalisation process. A single exposure at 46 kV is performed and the resulting film is read with an AgfaScan T1200 device with predefined settings. Results To assess the reproducibility of our technique, XR hand films of 17 patients were scanned 5 times in different days. CV was found to be 0,913 (95% CI 0,650–1,825) for the middle phalanx; 0,632 (95% CI 0,470–1,265) for the proximal phalanx; and 1,194 (95% CI 0,918–2,387) for the central area of the third metacarpal. A test-retest experiment with 2 films in 50 patients gave an almost perfect internal correlation (Pearson’s R of 0,985; 0,995 and 0,986) for these same sites. We also validated our technique in a sample of 171 women referred by general practitioners with a clinical diagnosis of osteoporosis. Construct validation was performed against conventional lumbar spine and hip DXA (Lunar DPX). Also,78 of these women had a phalanx DXA measurement with a commercial device (AccuDXA). Correlations between BMD in several sites are described below: View this table: Abstract SAT0203 Table 1 Conclusion The reproducibility and internal correlation of measurements made with our newly developed technique is very high for the three areas of the hand studied. Correlation of BMD of the hand with BMD in the lumbar spine and hip is moderate and similar to that found among these places themselves.

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional. © 2018 American Academy of Allergy, Asthma & Immunology

The problem of electrostatics repulsion between charged particles in a bunch is a classical mixed Dirichlet-Neumann problem. In this paper, an analytical solution of this problem is described. The approach proposed here can be extended to other problems in mathematical physics.

Introduction Many risk factors for cocaine-induced psychosis (CIP)in cocaine-dependent patient (CDP) have been described although there not exactly known. Differences in the personality traits or disorders in CDP with or without CIP has been described. However, there are few studies studding the relationship between CIP and personality with a dimensional approach in order to clarify if there are any personal dimension related with CIP or/and personality disorders (PD) in CDP. Objetives This study the relationship between CIP and personality trails evaluates with ZKPQ, and attempted to identify any personality dimension as a risk factors for CIP. Aims & Methods We performed a cross-sectional, observational study in 260 (75.5% man, 36.5 y.o) CDP according DSM-IV-TR seeking treatment between May 2009 and April 2013. The SCID-I, SCID–II, ZKPQ and a structured interview about CIP were performed. Results CIP was reported for 66.4% of the patients. Patients with CIP had an earlier onset of cocaine dependence (p Conclusions The detection of high scores of neuroticism-anxiety and aggression-hostility trails should lead to evaluate the presence of CIP in CDP in order to alert them of the risk of develop CIP.

The computer code Zgoubi calculates trajectories of charged particles in magnetic and electric fields. At the origin specially adapted to the definition and adjustment of beam lines and magnetic spectrometers, it has so-evolved that it allows the study of systems including complex sequences of optical elements such as dipoles, quadrupoles, arbitrary multipoles and other magnetic or electric devices, and is able as well to handle periodic structures. Compared to other codes, it presents several peculiarities: (1) a numerical method for integrating the Lorentz equation, based on Taylor series, which optimizes computing time and provides high accuracy and strong symplecticity, (2) spin tracking, using the same numerical method as for the Lorentz equation, (3) calculation of the synchrotron radiation electric field and spectra in arbitrary magnetic fields, from the ray-tracing outcomes, (4) the possibility of using a mesh, which allows ray-tracing from simulated or measured (1-D, 2-D or 3-D) field maps, (5) Monte Carlo procedures: unlimited number of trajectories, in-flight decay, etc. (6) built-in fitting procedure, (7) multiturn tracking in circular accelerators including many features proper to machine parameter calculation and survey, and also the simulation of time-varying power supplies. The initial version of the Code, dedicated to the ray-tracing in magnetic fields, was developed by D. Garreta and J.C. Faivre at CEN-Saclay in the early 1970`s. It was perfected for the purpose of studying the four spectrometers (SPES I, II, III, IV) at the Laboratoire National Saturne (CEA-Saclay, France), and SPEG at Ganil (Caen, France). It is now in use in several national and foreign laboratories. This manual is intended only to describe the details of the most recent version of Zogoubi, which is far from being a {open_quotes}finished product{close_quotes}.

Background Nowadays, in our health area, most of the oral antineoplastic drugs prescribed to outpatients are dispensed in hospital pharmacy services. Patients receiving these kinds of drugs are susceptible to suffering adverse events (AE) due to medicines errors (MEs). Purpose To evaluate the quality of oral chemotherapy drug prescriptions (OCDPs) in oncohaematological outpatients. Materials and Methods Descriptive prospective study. OCDPs for adult patients received in a pharmaceutical outpatient care unit were analysed for two months. The information necessary for OCDPs was established based on legal rules and international recommendations. We established that omitted or confused information in patient identification (identification number), weight, height and/or corporal surface (in drugs dosed depending on these parameters), diagnosis, treatment duration, dose and frequency of administration, presented serious risk based on possible consequences. Results 291 prescriptions were analysed from 183 patients. 100% of prescriptions had almost one omission, 78.7% of which showed serious errors of omitted or confused information related to the following items: patient identification (0.7%), weight, height or corporal surface (56.7%), diagnosis (28.9%), treatment duration (14.1%), dose (5.8%) or frequency (12.1%). Information omitted or confused about patient and treatment information included: age or birth date (1.4%), allergies (omitted 56%, unknown 38.8%), morbidities (59.5%), cycle number (67%) and periodicity (46.7%). Drug information omitted or confused included: drug name (generic 35.7%, originator 61.5% or both 2.7%), dose units (10.7%), pharmaceutical form (83.1%) or route of administration (58.4%). Physician information omitted or confused included: name (7.6%), signature (1%) and collegiate number (1%). Conclusions Our results show a high rate of omitted and confused information in prescriptions in OCDP. Extreme attention during the validation process was required in order to prevent MEs and AEs. New tools, such as electronic prescription, pre-printed medical orders or educational programmes for prescribers, must be implemented in order to improve the quality of OCDP. No conflict of interest.

Background Efficacy of chronic hepatitis C genotype 1 treatment has been improved with protease inhibitors (PIs) telaprevir and boceprevir. However, triple therapy (PI, peginterferon alfa and ribavirin) has increased the number, type and severity of adverse events. Purpose To assess the safety of triple therapy in the first 12 weeks of treatment with telaprevir and boceprevir used for chronic hepatitis C treatment in clinical practise. Materials and Methods Between March and September 2012, all patients treated with telaprevir and boceprevir receiving medicines in the outpatient pharmaceutical care unit of a tertiary hospital were interviewed. Adverse events were collected in a predefined questionnaire. Anaemia, neutropenia and thrombocytopenia were also included as adverse effects if the patient had been treated for any of them. Interviews were conducted during the medicines dispensing (monthly). Results Fifty-one patients with triple therapy were interviewed; 34 of them were treated with telaprevir and 17 with boceprevir. All patients had at least one adverse event on any of the visits. Globally, the most frequent adverse events were tiredness (84.3%), digestive disorders (70.6%), dermatological disorders (64.7%) and influenza-like syndrome (62.7%). Patients being treated with telaprevir mainly suffered from tiredness (85.3%) and dermatological disorders (70.6%). However, tiredness (82.4%) and mood disorders (70.6%) were the most usual adverse events in patients being treated with boceprevir. The frequencies of other side effects are listed in Table 1. Conclusions Efficacy in the first 12 weeks of triple therapy results in a high frequency of adverse events. Information on possible side effects and how to prevent or treat them is important for patients. Since PIs have only recently come onto the market, it is also important to communicate and record any new adverse events not identified in clinical trials. No conflict of interest.

The case of an idiopathic polymyositis preceded by several episodes compatible with the diagnosis of bronchiolitis obliterans organizing pneumonia is herein reported. This kind of pulmonary affection in polymyositis can be simultaneous or later to the diagnosis of the systemic disease, but as the first manifestation is exceptional. In the case we report, paradoxically, when the diagnosis of polymyositis was made the patient had not clinical or radiographic bronchopulmonary affection. If the first clinical manifestation of an autoimmune disease like polymyositis can be an idiopathic bronchiolitis obliterans organizing pneumonia, we think that a prolonged follow up of these patients is necessary.

Background Pharmaceutical industry does not always provide suitable preparations for paediatric population. In these situations formulations should be developed for small scale compounding in hospital pharmacies, especially when cytotoxic drugs are involved. Purpose Some guidelines for non-sterile pharmaceutical compounding preparations (eg, USP797) recommends in absence of stability information, an expiry date of 14 days under refrigeration for liquid preparations. The aim of the study is to develop a methotrexate oral formulation that yields stable for at least 25 days, an adequate period for three weekly administrations of one chemotherapy cycle. Materials and methods Two formulations of 2.5 mg/ml were prepared by dissolving respectively tablets or injectable solution of methotrexate with Ora-Plus and Ora Sweet SF mixed in a 1:1 ratio. Preparations packed in amber coloured bottles were kept at 2-8° C. Samples were taken at 1, 7, 15, 25 days, and were analysed for appearance, pH, microbiological growth and methotrexate concentrations by Fluorescense Polarisation Immunoassay (FPIA) and ultraviolet-visible spectroscopy (UV-S) at 370 nm only with the solution (no supported for suspensions). Assays were specific for methotrexate (without cross-reactivity with metabolites) and calibrated with a known concentration. A stability study has been performed on these two formulations. Samples were diluted 1/100 with Xsystems Dilution Buffer. In FPIA was also performed the 1:100 dilution protocol of TDx/TDxFLx analyser. Results Both formulations show stability for at least 25 days, with remaining content of methotrexate of 98.76% in suspension and 97.06% (FPIA) or 96.20% (UV-S) in solution. Appearance assay (no odour or colour changes), pH (5.0) and microbiological growth (negative) in all samples were appropriate and similar for both formulations. Conclusions Methotrexate can be extemporaneously prepared in suspension or solution and stored at least 25 days under refrigeration without significant degradation. For paediatric patients who cannot swallow tablets, these formulations provide an accurate and suitable option for administering oral methotrexate.

Background Because of its high cost, incorporation of new antineoplastic drugs to hospitals need to be evaluated. Purpose Economic and clinical evaluation of the use of new parenteral anticancer drugs (PAD) authorised by the European Medicines Agency (EMA) between 2006 and 2011 in a Spanish tertiary hospital. Materials and methods It is a descriptive study about new PAD. Purchase costs, number of treated patients and the incorporation rate to the Hospital Drug Therapy Guide (HDTG) were analysed using management database and electronic prescription program data. Results The authors observed that three of the nine new PDA authorised by the EMA and marketed in Spain (bendamustine, clofarabine, ipilimumab, nelarabine, panitumumab, temsirolimus, trabectedine, azacitidine and vinflunine) were included on the HDTG as second line treatment. The rest of the new antineoplastic drugs were not incorporated to our HDTG but specific patient administration was accepted if there was a medical justification. 133 patients were treated with these medications between 2006 and 2011. Bendamustine Panitimumab and Clofarabine were used most frequently during the study period: Bendamustine was used in 24 patients, Clofarabine in 18 and Panitimumab in 40 patients. Leukaemia and lymphoma (28,7%) and colon and colorectal neoplasm (NCC) (33,3%) were the indication with the highest consumption of new antineoplastic drugs and with a higher cost. New PAD total cost purchased derived during the specified period of time was 1.658.792€, (0,37% of total drug expenses) with 3151 vials purchased. By the first half of 2011, new PAD supposed 0,93% of drug expenses, with an average consumption of 77,537€ per month. Conclusions Despite the low incorporation rate of new PAD to the HDGT, they have an economic impact in our hospital. Economic repercussion and the number of patients in treatment show the importance of the drugs selection process in order to rationalise antineoplastic drugs use.

Le protoxyde d’azote est un melange gazeux connu pour ses effets analgesiques, anxiolytiques et sedatifs et est utilise dans des indications medicales variees chez l’adulte et l’enfant avec ou sans anesthesie locale. Deux effets majeurs sont observes apres 2 a 3 minutes d’inhalation: – un effet anxiolytique, sedatif ; – un effet antalgique de surface avec diminution du seuil de perception du stimulus douloureux. Au sein de notre service de soins somatiques, a l’EPS de Ville-Evrard, le protoxyde d’azote est largement utilise et permet la realisation du geste technique sans le recours a une sedation complementaire chez des patients poly-medicamentes et souvent opposes aux soins en raison de leur pathologie psychiatrique, Nous presentons notre experience d’utilisation du produit avec ses specificites de prise en charge et d’utilisation aupres de nos patients.