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Background and Objective: Infusion containing lorazepam is used by geriatric department to limit anxiety disorders in the elderly. Currently, these infusions are prepared according to demand by the nursing staff, but the preparation in advance in a centralized service could improve quality of preparation and time management. The aim of this study was to investigate the long-term stability of this infusion in polypropylene syringes stored at 5 ± 3°C. Then, results obtained were compared with stability data of lorazepam in syringes stored at room temperature, glass bottles at 5 ± 3°C, and glass bottles at room temperature. Method: Eight syringes and 6 bottles of infusion were prepared by diluting 1 mL lorazepam 4 mg in 23 mL of NaCl 0.9% under aseptic conditions. Five syringes and 3 bottles were stored at 5 ± 3°C and 3 syringes and 3 bottles were stored at room temperature for 30 days. During the storage period, particle appearance or color change were periodically checked by visual and microscope inspection. Turbidity was assessed by measurements of optical density (OD) at 3 wavelengths (350 nm, 410 nm, 550 nm). The stability of pH was also evaluated. The lorazepam concentrations were measured at each time point by high-performance liquid chromatography with ultraviolet detector at 220 nm. Results: Solutions were physically unstable in syringes at 5 ± 3°C after 4 days: crystals and a drop of OD at 350 nm were observed. However, pH was stable. After 2 days, solutions were considered as chemically unstable because a loss of lorazepam concentration higher than 10% was noticed: the lower 1-sided confidence limit at 95% was below 90% of the initial concentration. To assess temperature and polypropylene influence, results were compared with those obtained for syringes at room temperature and bottles at 5 ± 3°C and room temperature. Precipitation, drop of OD at 350 nm, and chemical instability were observed in all conditions. Conclusion: Solutions of lorazepam were unstable after 2 days in syringes at 5 ± 3°C. Preparation in advance appears, therefore, not possible for the clinical use. Storage conditions (temperature and form) do not improve the stability.

Background The intensive care unit (ICU) use drug solutions with higher concentration to avoid fluid overload. Purpose To determine the physicochemical stability of a concentrated solution of amiodarone in a polypropylene syringe during 28 days at 5°C±3°C with protection from light. Material and methods Five syringes of 50 ml, containing 25 mg/ml of amiodarone in 0.9% NaCl were prepared and stored at 5°C±3°C with protection from light during 28 days. Immediately after preparation and periodically during the storage, amiodarone concentrations were measured by an ultra performance liquid chromatography (UPLC). Spectrophotometric absorbance at different wavelengths, pH measurement, and visual and microscopic observations were also performed. Results All solutions were physico-chemically stable during the whole period storage at 5°C±3°C: no colour change, turbidity, precipitation or opacity, no significant pH variations or optic densities were observed in the solutions. Any crystals were seen by microscopic analysis. Solutions are considered chemically stable as the lower limit of the 95% unilateral confidence interval on the mean remained above 90% in the initial concentration for at least 28 days. Conclusion Solutions of amiodarone 25 mg/ml in syringes of 0.9% NaCl are physically and chemically stable for at least 28 days when stored in syringes at 5°C±3°C with protection from light and may be prepared in advance by a Centralised IntraVenous Admixture Service (CIVA). Reference and/or Acknowledgements 1. Simar J, Delcave C, Godet M, Decoster C, Gillet P, Bihin B, Jamart J, Galanti LM, Hecq JD. Stabilite physique du chlorhydrate d’amiodarone dans des seringues de glucose 5% pour perfusion. Journal de Pharmacie de Belgique2016;98(1):24–25. No conflict of interest

Background In order to avoid fluid overload, the use of more concentrated drug solutions in intensive care units is common. Purpose Quantifying the physicochemical stability of concentrated solution of salbutamol in polypropylene syringe during 30 days at 5°C±3°C with protection from light. Material and methods Five syringes of 50 ml, containing 0.060 mg/ml of salbutamol in 0.9% NaCl were prepared and stored at 5°C±3°C with protection from light during 30 days. Immediately after preparation and periodically during the storage, salbutamol concentrations were measured by an ultra performance liquid chromatography (UPLC). Spectrophotometric absorbance at different wavelengths, pH measurement, and visual and microscopic observations were also performed. Results All solutions were physicochemically stable during the whole period storage at 5°C±3°C: no colour change, turbidity, precipitation or opacity, no significant pH variations or optic densities were observed in the solutions. Any crystals were seen by microscopic analysis. Solutions are considered chemically stable, as the lower limit of the 95% unilateral confidence interval on the mean remained above 90% of the initial concentration for at least 30 days. Conclusion Solutions of salbutamol 0.060 mg/ml in syringe of 0.9% NaCl are physically and chemically stable for at least 30 days when stored in syringes at 5°C±3°C with protection from light, and may be prepared in advance by a Centralised IntraVenous Admixture Service (CIVA). Reference and/or Acknowledgements 1. Closset M, Hecq JD, Soumoy L, Simar J, Gonzalez E, Charlet L, Declave C, Gillet P, Galanti L. Physical stability of highly concentrated injectable drugs solutions used in intensive care units. Ann Pharm Fr201713 Feb;S0003–4509(16):30055–4. doi: 10. 1016/j. pharma. 2016. 12. 004 No conflict of interest

Human hair is a non-homogeneous complex material made of keratin fibers oriented along the longitudinal axis which offer anisotropic mechanical properties. Nowadays, it is possible to measure the mechanical properties of hairs with the classical tests, but most often, these tests are destructive and make hard to measure the influence of some external factors or treatments on the behavior of a same hair fiber. In the current paper, vibrations induced by a non-contact impact have been utilized as a representative response of the mechanical behavior of hair. The characteristics of the vibratory response allow measuring the variation in the mechanical properties and the instantaneous effect of an external factor on the properties of a same sample. First, load relaxation tests have been performed on hair samples after moisturization and for different times of an air-drying process in order to characterize the change in the visco-elastic behavior of hair during the water desorption. Other hair samples have been tested with our non-contact impact and vibration technique in order to observe the change in the vibratory response during the water desorption. The vibratory response has then been correlated to the mechanical properties of the hair fiber.

Human hair is a biological material constantly exposed to different external factors,such as humidity, sunrays, temperature, chemical treatments, etc. All these treatments influence and modify its physical behaviour. Studying the biophysical properties of human hair is very important in both dermatology to provide useful markers for the diagnosis of hair disorders and in cosmetics to develop better hair-care products. Water is one of the external factors whose action on the mechanical behaviour of hair is the most visible. To understand the role of water in the biophysical behaviour of hair, it is essential to study its influence on alpha-keratin, which composes the major part of the structure of hair. The influence of water on the biomechanical behaviour of hair has been studied using relaxation tests. The generalised Maxwell model was used to analyse rheological results. The results indicate a modification of the rheological behaviour of hair before and after immersion in water and during ambient air-drying. Finally, a correlation between the rheological results and the chemical bond structure of hair is discussed.

Resume Objectif Internet est devenu le premier media par lequel les patients s’informent. Le type et la qualite de l’information medicale disponible en langue francaise demeurent mal connus notamment dans le domaine de l’oncologie ORL. L’objectif de cette etude etait de reproduire la strategie de recherche d’information des patients sur Internet et d’evaluer la qualite des sites visites. Methode Six mots cles « cancer du larynx », « cancer de l’amygdale », « cancer de la thyroide », « carcinome papillaire de la thyroide », « cancer de la langue » et « cancer de la parotide » ont ete soumis a deux moteurs de recherche. Les 50 premiers sites Internet correspondant a chaque mot cle ont ete evalues pour un total de 600 sites. Resultats Quatre-vingt quinze sites (16 %) presentaient une information exploitable par le patient et ont fait chacun l’objet d’une evaluation portant sur la qualite (outil DISCERN et lecture par deux chirurgiens ORL) et le caractere comprehensible du contenu. Selon ces criteres, 8 % des sites sont juges « Excellent », 24 % « Bon », 14 % « Assez bon », 15 % « Moyen », 27 % « Pauvre » et 12 % « Tres pauvre ». Quarante-neuf a 62 % des sites sont consideres comme comprehensibles par le grand public. L’etude statistique montre que l’ordre de classement d’un site dans les moteurs de recherche, son affiliation, sa cible ou son type de financement ne sont pas des gages de qualite. Seul un auteur identifie medecin, l’existence de reference bibliographique et une date recente de mise a jour sont en faveur d’un site de qualite. Conclusion Ce travail confirme que la quete d’information medicale sur Internet est fastidieuse et decevante. Rares sont les sites delivrant une information a la fois exhaustive et comprehensible. Les inexactitudes graves sont cependant peu frequentes. La creation, dans l’espace francophone, de sites Internet de qualite sur les cancers ORL repondrait a un besoin croissant des patients. De meme, l’existence d’un site portail en oncologie ORL orientant vers des sites comprehensibles et selectionnes offrirait, en plus du gain de temps et de securite, des gages de qualites aux patients.

Other injectable preparations than parenteral nutrition admixture and injectable cytotoxic drugs could be prepared by Centralised IntraVenous Admixture Service (CIVAS) if the Long-term stability of the drugs is known. However, this information is not always available.To develop a program of chemical drug stability analysis in collaboration between Hospital Pharmacy, Medical Laboratory and Scientific Support Unit to determine the long-term stability of largely used injectable anti-infectious and non-anti-infectious drugs.After a setup of the High Performance Liquid Chromatography (HPLCI method, 28 drugs were reconstituted in laminar air flow hood, 17 of them stored directly at 5 +/- 3 degrees C and 19 stored in the freezer at -20 degrees C, thawed by microwave following a standardised procedure and stored at 5 +/- 3 degrees C before use. Concentration stability was evaluated by regression analysis.For each drug, long-term stability has varied from 11 days to 180 days. The freeze-thaw treatment by microwave may enhance the stability (from 30 to 120 days) and allow batch-scale production of intravenous drugs, less expensive in term of manpower and sterile device than a drug reconstitution at the ward. The results were published by 55 posters in international congress and by 36 publications in national and international pharmaceutical journals.Our findings contribute to enhance the scale of drugs that may be take on by a CIVAS.

Because the proportion of elderly patients admitted to the intensive care unit (ICU) is increasing, the objective of this study was to test the hypothesis that very elderly patients with better preadmission functional status would have better medium-term survival and functional status after an ICU stay.In this observational study, 96 patients (68% surgical and 32% medical) aged ≥80 years and admitted to the ICU between May 2008 and June 2009 were recruited. Functional status was assessed using a modified Katz Scale and the Lawton Scale. Primary outcomes were: one-year mortality and its independent predictive factors, one-year functional status and perceived quality of life.Multivariate analysis showed that type of admission (surgical vs. medical), existence of cancer, Sequential Organ Failure Assessment (SOFA) Score at ICU admission and occurrence of septic complications during the ICU stay were independent predictive factors for one-year mortality, but preadmission functional status was not. At one year, despite functional decline in 50% of survivors, 68% perceived their health status to be equivalent to or better than before and 82.6% would agree to a further ICU stay.One-year mortality of very elderly patients after an ICU stay is not related to preadmission functional status but to the type of admission, existence of cancer, SOFA Score at ICU admission and occurrence of septic complications during the ICU stay. Despite functional decline in half of these patients, one year after admission 82.6% would agree to another ICU stay.

The aim of this study was to investigate the long-term stability of morphine hydrochloride in 0.9% NaCI infusion polyolefin bags and polypropylene syringes after storage at 5 degrees C + 3 degrees C and to evaluate the influence of initial freezing and microwave thawing on this stability. Ten polyolefin bags and five polypropylene syringes containing 100 mL of 1 mg/mL of morphine hydrochloride solution in 0.9% NaCI were prepared under aseptic conditions. Five polyolefin bags were frozen at -20 degrees C for 90 days before storage. Immediately after the preparation and after thawing, 2 mL of each bag were withdrawn for the initial concentration measurements. All polyolefin bags and polypropylene syringes were then refrigerated at 5 degrees C + 3 degrees C for 58 days during which the morphine concentrations were measured periodically by high-performance liquid chromatography using a reversed-phase column, naloxone as internal standard, a mobile phase consisting of 5% acetonitrile and 95% of KH2PO4 buffer (pH 3.50), and detection with diode array detector at 254 nm. Visual and microscopic observations and spectrophotometric and pH measurements were also performed. Solutions were considered stable if the concentration remained superior to 90% of the initial concentration. The degradation products peaks were not quantitatively significant and were resolved from the native drug. Polyolefin bag and polypropylene syringe solutions were stable when stored at 5 degrees C + 3 degrees C during these 58 days. No color change or precipitation in the solutions was observed. The physical stability was confirmed by visual, microscopic, and spectrophotometric inspection. There was no significant change in pH during storage. Freezing and microwave thawing didn't influence the infusion stability. Morphine hydrochloride infusions may be prepared in advance by centralized intravenous additive service, frozen in polyolefin bags, and microwave thawed before storage under refrigeration until 58 days either in polyolefin bags or polypropylene syringes. Such treatment could improve safety and management.

The aim of this study was to assess whether early intermittent I.V. administration of disodium pamidronate can effectively achieve primary prevention of glucocorticoid-induced osteoporosis (GIOP). A total of 27 in- or outpatients who required first-time, long-term corticosteroid therapy at a daily dose of at least 10 mg prednisolone were studied. Patients were randomly selected to receive either pamidronate and calcium or calcium alone. Patients allocated to pamidronate treatment (pamidronate group) received a first intravenous infusion of 90 mg pamidronate simultaneously with the initiation of their steroid treatment. Subsequently, they received 30 mg pamidronate, intravenously, every 3 months, for as long as steroid therapy was continued. As with the control patients (calcium group), they were put on a daily 800-mg elemental calcium supplement given as calcium carbonate. Lumbar spine and hip (total and subregions) bone mineral densities (BMDs) were measured at the start and every 3-months by dual-energy X-ray absorptiometry (Hologic(R) QDR-2000). Over 1 year, the pamidronate group showed a significant BMD increase in the lumbar spine (3.6%), and at all sites of the hip (2.2% at the femoral neck). In the calcium group, a significant BMD reduction was registered at the lumbar spine (-5.3%) and at the femoral neck (-5.3%). Differences between the groups were significant at all sites measured. Intermittent intravenous pamidronate effectively achieves primary prevention of GIOP, as assessed by BMD measurements over 1 year.

The advance preparation of intravenous solutions of teicoplanin, which is often used in antibiotic infusions for hospitalized patients, may be advantageous. The objective of this study was to investigate the stability of teicoplanin stored at 4 deg C in polyvinyl chloride bags to determine whether such solutions could be safely stored without deterioration. Five bags containing 0.4g teicoplanin per 100 mL of 5 % dextrose injection were studied for 1 month by means of high-performance liquid chromatography, visual inspection, and pH measurement. The color of teicoplanin diluted in dextrose became slightly yellow, and the pH values of the preparations decreased significantly during the period of the study without affecting the chromatographic parameters. The teicoplanin solution was stable for 6 days at 4 deg C as a result of the shortest shelf life of 90% residual potency of the five major glycopeptide components. Despite the color and pH variations, the teicoplanin infusion remained chemically stable when stored up to 6 days at 4 deg C in polyvinyl chloride bags. Thus the infusion could be prepared in advance by a centralized intravenous admixture service for use within the limits described.

Mechanically ventilated patients are prone to develop ventilator associated pneumonia due to microaspirations of subglottic secretions around the endotracheal tube cuff (usually constructed of polyvinyl material). A novel polyurethane cuff has been designed to minimize these leakages. The aim of the study was to compare the tracheal sealing capacities between the two tubes.Twenty-nine consecutive patients from whom tracheal intubation was necessary as part of their care were randomized to receive either a polyvinyl HI-LO Evac® or a polyurethane SEALGUARD Evac® endotracheal tube. Patients requiring emergency intubation, with unstable hemodynamics or history of tracheal/laryngeal disease were excluded. For the entire study, cuff pressure was set at 30 cmH2O, and ventilator parameters were adjusted for a plateau pressure ≤30 cmH2O; Patients were fasting, placed in a strict 45° position during 12 hours and sedated if needed. After injection of 74 MBq 99mTc-DTPA diluted in 5 mL 0.9% NaCl just above the cuff, tracheal radioactivity was assessed sequentially (hourly from T0 to T6, then T8 and T12 hours) using a scintillation camera.Sixteen polyurethane and 13 polyvinyl tubes were compared. Leakages were observed in 11/29 patients (38%) (5/16 polyurethane and 6/13 polyvinyl tubes [P=NS]). Leakages occurred more often in female (7/8) than in male patients (4/21) (P0.001). Microaspirations were decreased with larger tubes (size 9 vs. ≤8.5: 24% vs. 75%; P=0.01), whatever the cuff membrane.These preliminary results suggest that both tubes are poorly effective in preventing microaspirations.

La gastrite lymphocytaire est d’un point de vue histologique, caracterisee a l’examen histologique par un infiltrat lymphocytaire dense de l’epithelium foveolaire et de surface. En endoscopie, la gastrite lymphocytaire se presente frequemment sous forme d’une gastrite varioliforme a plis muqueux epaissis, porteurs de petits nodules et d’erosions superficielles. Notre etude porte sur 5 macrobiopsies a l’anse diathermique et deux pieces de gastrectomie de patients presentant a l’endoscopie une gastrite varioliforme et une gastrite lymphocytaire a l’examen histologique. Les comptages lymphocytaires confirment les donnees precedentes fournies par les biopsies per endoscopiques. L’etude morphometrique montre que l’epaississement des plis muqueux est consecutif a un oedeme de la sous-muqueuse. La gastrite lymphocytaire associee a la gastrite varioliforme constitue une entite anatomique a integrer dans le groupe des gastropathies a plis geants.

Introduction et but de l’etude Apres conception et mise a disposition dans notre service d’un logiciel permettant une representation graphique de l’adequation de la prescription de nutrition artificielle, nous avons souhaite evaluer l’impact de cet outil sur nos habitudes de prescription. Materiel et methodes Le logiciel informatique (« NutriREAD-2.12.8 », programme en Visual Basic- Excel®) fut mis a disposition (reseau) sur chaque ordinateur de chevet des patients, avec acces aise et facultatif lors de la redaction du traitement quotidien par les medecins du service (30 lits ; six medecins seniors ; sept medecins juniors). Apres encodage des donnees anthropometriques, du status renal (+ support eventuel) et metabolique, du type et debit des solutions d’alimentation artificielle (enterale [E]/parenterale [P]) et des autres apports caloriques (propofol, perfusions glucosees,…) le programme permet une visualisation immediate de la conformite de la prescription (apports/besoins caloriques et proteiques, rapport caloricoazote, rapport glucidolipidique) aux recommandations recentes (SFNEP, Sfar, SRLF 2014). Pour evaluer l’impact de l’outil, nous avons analyse les prescriptions journalieres de nutrition artificielle exclusive des patients ayant sejourne plus de 10 jours dans le service au cours des 6 mois precedant (« groupe avant » ; n = 44) et suivant (« groupe apres » ; n = 34) la mise a disposition du programme. Les 3 premiers jours d’alimentation artificielle (implementation progressive), ainsi que les jours correspondant a des modifications de prescription dues aux complications digestives ou aux procedures (intubation et chirurgie) ont ete systematiquement exclus. L’analyse statistique (test de Mann-Whitney) a porte sur les caracteristiques generales des deux groupes, la quantite prescrite de calories, proteines, et rapport caloricoazote, ainsi que sur le pourcentage de journees ou le patient a beneficie d’une prescription adequate (calories, proteines, rapport caloricoazote) avant et apres l’implementation du logiciel. Resultats et analyse statistique Les deux groupes etaient comparables en termes d’âge, de poids, d’indice de masse corporelle, de duree de sejour, de type d’alimentation artificielle (E/P), de besoins en agents vasoactifs, de complications digestives, d’insuffisance renale et de recours a la ventilation mecanique ou a l’hemofiltration. Le recours a la dialyse etait plus frequent dans le groupe avant. Le Tableau 1 presente les modifications de prescriptions aux deux temps de l’etude. Conclusion La simple mise a disposition d’un outil informatique a permis d’ameliorer la qualite de la prescription d’alimentation artificielle au sein de notre service de reanimation. Singulierement, le programme a permis de detecter et corriger des prescriptions proteiques trop frequemment inferieures aux recommandations, qui s’accompagnaient de rapports caloricoazotes excessifs.

Altemeier's procedure (perineal rectosigmoidectomy) is the operation of choice for rectal prolapse in the elderly. The aims of this prospective observational study were to evaluate its long-term actuarial recurrence risk and the influence of the length of rectosigmoid resection and associated levatorplasty on recurrence rate and continence.The perioperative and long-term data for all patients undergoing Altemeier's procedure since 1992 were analysed with regard to mortality, morbidity, continence, anorectal function and recurrence rate.Sixty patients [median age 77 years (35-98)] underwent rectosigmoid resection [median length of bowel 14 (6-60) cm] with associated levatorplasty in 21 (35%). Overall mortality and morbidity were 1.6 and 11.6%, respectively. Manometry showed increased anal sphincter basal pressure and maximal squeeze pressure. We observed a decrease in postoperative rectal compliance (P=0.002). Age, gender, prolapse duration before surgery, levatorplasty and length of resection had no statistically significant relationship with recurrence. Continence improved in 62% and was stable over a median follow-up of 48 (1-186) months. Continence was positively related to a short length of bowel resection, but not to decreased rectal compliance. Actuarial recurrence was 14% at 4 years.The long-term recurrence rate after the Altemeier procedure was low and not linked to resection length or to levatorplasty. Improvement in continence was stable over time.

Hemoblot, a new immunological faecal occult blood test, produced by Gamma, Angleur, Belgium, was characterized and compared with another immunological test (HemeSelect, SmithKline Diagnostics, USA) and with a guaiac test (Hemoccult II, SmithKline Diagnostics). The analytical sensitivity of Hemoblot is 0.15 mg haemoglobin/g faeces and the test is specific for human haemoglobin. In addition, 135 symptomatic patients who had to undergo a colonoscopy were tested using the three tests. Two criteria were considered for the analysis: (1) the blood criterion: any pathology likely to cause colorectal or other bleeding; and (2) the precancerous-cancerous criterion: the pathology being either a colorectal polyp > 0.5 cm or a colorectal cancer. Considering both criteria, the sensitivity of Hemoblot was significantly higher than the sensitivity of Hemoccult: 38% and 23%, respectively, for the blood criterion; and 54% and 29% for the precancerous-cancerous criterion. Sensitivity and specificity did not differ statistically between Hemoblot and HemeSelect but Hemoblot was faster and simpler to perform. It could be widely used in mass screening.

Neuromuscular blocking agents have always shown wide inter-individual variability when it comes to their duration of action. This prevents clinicians from anticipating the evolution of the neuromuscular block for any given patient. With this study, we aimed to assess the nature of the relationships existing between different time course parameters used to describe paralysis onset and offset.Sixty American Society of Anesthesiologists (ASA) score III-IV anaesthetised patients were randomised to receive a single equipotent dose (2ED95) of either rocuronium, mivacurium or atracurium. We used acceleromyography to monitor neuromuscular transmission. We described the relationships between the time-interval measurements of: onset, the first response (T1) reappearance, T1 25% of control, train-of-four ratio 0.25 and 0.75. Pearson correlation coefficients were calculated.We found no significant relationships between onset and any of the four parameters used to describe the offset. On the other hand, we showed strong and highly significant linear relationships between all the parameters describing the offset for each of the muscle relaxants studied (correlation coefficients ranging from 0.850 to 0.992).We evidenced strong linear correlations between the four offset time course parameters of spontaneous recovery after a single neuromuscular blocking agents (NMBAs) bolus. Such relationships open up new clinical perspectives concerning quantitative neuromuscular transmission monitoring: the scope of individual valuable anticipation of the patient's recovery.

The profile of recurrent ischemic strokes has not been much investigated. The aim of this study was to evaluate how the therapeutic strategies recommended for secondary prevention after an ischemic stroke are implemented in the real world of clinical practice. All patients admitted for a recurrent ischemic stroke or TIA were prospectively registered. The etiology was determined according to the TOAST classification. The risk factors and cardiovascular treatment at the time of the recurrence were recorded. A total of 168 patients were evaluated. Most of the patients (61%) recurred after 1 year. The recurrent stroke was not associated with a particular etiological subtype. The most frequent risk factor was hypertension (79%), followed by hypercholesterolemia (43%), smoking (25%), and diabetes (22%). Most of the patients had more than 1 risk factor (84%). Hypertension was not satisfactorily controlled in 38% of patients, hypercholesterolemia in 42%, and diabetes in 59%. A significant minority of patients (15%) were not taking any antithrombotic agent despite a history of stroke or TIA. Only 34% of the cases with a known atrial fibrillation were on anticoagulant therapy and the International Normalized Ratio was2.0 in 71% of them. In conclusion, stroke prevention needs to be improved by better implementation of therapeutic strategies in clinical practice. The patients should also be better informed about target values as well as the importance of physical activity and smoking cessation.

To compare post aural soft tissues tolerance of the old and new titanium RetroX (Auric GmbH, Rheine, Germany) tube, and to compare the hearing improvements between the old (DSP-pro) and the new (Concertino) hearing aid units of the RetroX.Retrospective case review of 46 patients with high-frequency sensorineural hearing loss, fitted with DSP-pro or Concertino, and who received 51 implantations (with the old or new generation titanium tube) in a tertiary referral center at a university hospital. The RetroX consists of an electronic unit situated in the postaural sulcus connected to a titanium tube implanted under the auricle between the sulcus and the external auditory meatus. Implanting requires minor surgery (10 minutes under local anaesthesia). Three months after their implantation, patients were asked to fill out a questionnaire to evaluate acoustic feedback annoyance and to undergo 3 audiometric tests: pure-tone audiometry in silence, speech audiometry in silence, and speech audiometry in noise.The new tube is more reliable (12 explantations from patients who received 26 older tubes compared with 1 explantation in 25 who received new tubes) even if the size must be adjusted more often (2/26 for the old model and 5/25 for the new one). Concertino allows a higher amplification before feedback appears, which improves hearing gain.The new RetroX is better tolerated than the older one, and improves hearing ability.

The present study is the outcome of 5 former studies aiming at adapting the V.H.I. to singers. We propose in this last version a V.H.I. valid for all types of singers, dysodic or not.The reliability, validity and internal coherence were evaluated on a population of 192 classical singers and 27 non singers.The comparison of the mean scores at the test and the retest shows that the results at the retest are significantly inferior in both the functional scale (p= 0.013) and the global score (p= 0.006). The test/re-test stability is good (ICC: Functional scale (F): 0.869, Emotional scale (E): 0.846, Physical scale (P): 0.85, Global score (G): 0.878/ Spearman's rho F: 0.855, E: 0.834, P: 0.858, G: 0.886). The internal coherence of each sub scale is good (Cronbach's alpha:0.80). The correlation between the 3 subscales is quite high (FvsE: 0,613 /EvsP: 0,737/ FvsP: 0,693) which means that each scale measures a specific dimension but that they are still homogeneous. The test/re-test difference between the singers and the controls are not significant but the control group has a greater variability in their answers (Levene test: F: p0.001; P: p= 0.009; G: p= 0.02). Three variables increase the results: being a solist (F: p= 0.046; E: p= 0.002; P: p= 0.056; G: p= 0.006), being an amateur (F: p0.001; E: p= 0.019; P: p0.001; G: p= 0.001), having a vocal complaint (F, E, P et G: p0.001).This version of the V.H.I. is reliable, valid and adapted to the population of classical singers.

This study aimed to assess long-term function after total perineal reconstruction (TPR) with dynamic graciloplasty (DG) and systematic Malone appendicostomy (MA) adjunction after abdominoperineal excision (APR) for rectal cancer.From 1999 to 2004, TPR using DG and MA was performed in 10 patients [seven women; median age 40 (range 28-55) years] after APR for rectal cancer (cT2 in one patient, cT3 in six patients and cT4 in three patients). We prospectively recorded early and late morbidity, mortality, oncological outcome, functional results (using the modified Working Party on Anal Sphincter Replacement 'WPASR' scoring system) and quality of life (QoL; using the European Organisation for Research and Treatment of Cancer 'EORTC' QLQ-C30 and QLQ-CR38 questionnaires).There was no procedure-related mortality. One patient required intra-abdominal re-operation. Nine patients required local and multiple revisions [there was one coloperineal anastomosis (CPA) stenosis, five CPA mucosal prolapse, three stenosis related to graciloplasty, two MA stenosis and one MA reflux]. After a median follow up of 78 months, there was no local recurrence and six patients were alive and disease-free. Regarding the functional results, the median modified WPASR score, of 8, after a follow up of 78 months, was good. The overall QoL scores remained stable over time.In carefully selected patients who want to avoid definitive abdominal colostomy after APR for rectal cancer, reconstruction involving MA and DG after APR for low rectal cancer is followed by good long-term function and QoL.

ObjectivesThe treatment of brain tumors in childhood is frequently complicated by growth retardation with a high proportion of irradiation (Irr)-induced GH deficiency (GHD) resulting in reduced adult final height (AFH) even after GH therapy (GHT). In order to optimize future GHT protocols, more information on the factors influencing the growth response to GH in these children is needed.This retrospective study evaluated AFH and influencing auxological and treatment factors of a standardized daily biosynthetic GHT in childhood survivors of brain tumors with documented GHD after brain Irr.Design and methodsFrom the Belgian GH Registry, 57 children survivors of a brain tumor outside the hypothalamo-pituitary area with available AFH were stratified into two groups depending on cranial (C-Irr; n=25) or craniospinal (CS-Irr; n=32) Irr.ResultsIn the C-Irr patients, results showed an AFH of −0.8 (−2.5, 1.4) SDS (median (range)) and in the CS-Irr patients, results showed a significantly (PConclusionsGHT failed to restore adult height to MPH in nearly half of Irr-induced GHD patients for brain tumor, especially those receiving CS-Irr, irradiated at a younger age or shorter at start GHT.

Internet has become the first place where patients go when seeking information on their disease. The type and the quality of the medical information available on French-language websites is poorly known, especially in the field of head and neck surgery. The purpose of this study was to evaluate the quality of these sites.We entered six keywords-"cancer du larynx", "cancer de l'amygdale", "cancer de la thyroïde", "carcinome papillaire de la thyroïde", "cancer de la langue", and "cancer de la parotide"-in two different search engines and, for each keyword, the first 50 websites were reviewed using the tool called DISCERN. With two head and neck surgeons, we rated their contents in terms of quality and comprehension.On 600 websites only 95 (16%) contained information that proved to be somewhat useful to patients. According to our scoring system, 8% of websites were found to be excellent, 24% good, 14% fairly good, 15% mediocre, 27% poor, and 12% very poor. Just over 60% of the websites were found to be clear. The study also showed that the order in which these websites were ranked in the search engine, their affiliation, the target population, or who financed them had little impact on quality. The websites were more likely to be high quality if they were managed by doctors and had bibliographical references as well as a date indicating a recent website update.This study again shows that the search for medical information on the Internet is time-consuming and often disappointing: very few websites provide information that is both clear and exhaustive. However, we also found that very few websites contained information that was seriously inaccurate. Given the growing popularity of the Internet, a high-quality French-language website specializing in head an neck surgery would be highly beneficial to patients, as would an ENT portal that would take them to selected websites, saving time and providing a guarantee of quality.

Effect of dialysis membrane and patient's age on signs of dialysis-related amyloidosis. This 12 center study was designed to assess factors affecting the development and progression of β2-microglobulin amyloidosis in long-term dialysis. A total of 221 patients who were on hemodialysis for more than five years, and who were treated the entire time only with AN69, a biocompatible, highly permeable membrane, or cuprophane, a less permeable, poorly biocompatible membrane (Cell) were evaluated for time on dialysis, development of carpal tunnel syndrome, and cystic bone lesions X-ray documentation was taken in a minimum of four of the six following joints: both hips, wrists and shoulders. The data demonstrate that patients treated solely by AN69 membranes display signs of bone amyloidosis less frequently than do those treated by Cell membranes. Age at onset of dialysis was found to have a striking correlation with the development of carpal tunnel syndrome and bone amyloidosis, while no significant influence was found for hyperparathyroidism, sex or year of first dialysis.

The development of pediatric liver transplantation is considerably hampered by the dire shortage of small donor organs. This is a very sad situation because in most experienced centers, liver replacement can offer a long-term hope of survival of more than 70% in a growing variety of pediatric liver disorders. The reported experience with 54 reduced-size grafts on a total of 141 transplants performed in 117 children between 1984 and 1988 demonstrates that the technique of reduced-size liver transplantation not only allows long-term survival but, in fact, offers the same survival hope with the same quality of liver function, regardless of the child's age and clinical condition. The prominent feature of our experience with the reduced liver concerns its deliberate use for elective cases. Seventy-seven per cent of the 30 children who electively received a reduced liver were alive 1 year after transplantation, as were 85% of the 62 children who received a full-size graft. There is no difference in the long-term survival rate of patients who received elective grafts, which is in the range of 75% with both techniques.

We conducted a reliability comparison study to determine the intrarater and inter-rater reliability and the limits of agreement of the volume estimated by circumferential measurements using the frustum sign method and the disk model method, by water displacement volumetry, and by infrared optoelectronic volumetry in the assessment of upper limb lymphedema. Thirty women with lymphedema following axillary lymph node dissection surgery for breast cancer surgery were enrolled. In each patient, the volumes of the upper limbs were estimated by three physical therapists using circumference measurements, water displacement and optoelectronic volumetry. One of the physical therapists performed each measure twice. Intraclass correlation coefficients (ICCs), relative differences, and limits of agreement were determined. Intrarater and interrater reliability ICCs ranged from 0.94 to 1. Intrarater relative differences were 1.9% for the disk model method, 3.2% for the frustum sign model method, 2.9% for water displacement volumetry, and 1.5% for optoelectronic volumetry. Intrarater reliability was always better than interrater, except for the optoelectronic method. Intrarater and interrater limits of agreement were calculated for each technique. The disk model method and optoelectronic volumetry had better reliability than the frustum sign method and water displacement volumetry, which is usually considered to be the gold standard. In terms of low-cost, simplicity, and reliability, we recommend the disk model method as the method of choice in clinical practice. Since intrarater reliability was always better than interrater reliability (except for optoelectronic volumetry), patients should therefore, ideally, always be evaluated by the same therapist. Additionally, the limits of agreement must be taken into account when determining the response of a patient to treatment.

The Pascal dynamic contour tonometer (DCT) was designed to measure IOP independently of corneal properties. This study aimed at 1) assessing the intra- and interindividual variability of DCT IOP measurements, the differences between DCT and applanation tonometry IOP measurements (APL), and their correlations with central corneal thickness (CCT); 2) analyzing the variability of the ocular pulse amplitude (OPA) and its correlations with age, blood pressure (BP), cardiac beat pulse (CP), diagnosis of glaucoma, IOP, and severity of glaucomatous visual field (VF) defects.Twenty-five normal subjects (25 eyes), 14 patients with ocular hypertension (27 eyes), and 54 glaucomatous patients (104 eyes) were included in this prospective study. In the first 12 normal subjects, three consecutive IOP measurements were taken by three different observers using DCT, directly followed by three measurements with APL by the same observer. In the following 13 subjects, the reverse sequence was followed. In the other group, the IOP measurements (three DCT and three APLs) were taken by the same observer. Only DCT measurements with quality levels 1-3 were considered for analysis.In the normal group, DCT IOP measurement variability varied between 4.4%-7.3% (intraobserver variation coefficient) and 8% (interobserver variation coefficient). DCT IOP measurement was not influenced by the sequence of measurements or the observer. DCT overestimated IOP by a mean of 2.2 mmHg compared with APL (p0.001). The 95% limits of agreement for each subject tested with both tonometers ranged from -0.5 mmHg to +6.3 mmHg. IOP APL and DCT measurements were strongly correlated. Both DCT and APL were not correlated with CCT. OPA ranged from 1.2 mmHg to 6.6 mmHg (mean, 3.1+/-1.2 mmHg) and was comparable between the three observers. Intraobserver OPA variability ranged from 7.6% to 9.5%. The interobserver OPA variability coefficient was 8.8%. OPA was only correlated with systolic BP (p0.05). In glaucomatous patients, the correlation between DCT and APL IOP measurements was highly significant (r=0.860, p0.001). DCT overestimated IOP by a mean 2 mmHg compared with APL (p0.001). IOP differences between both tonometers were not influenced by the sequence of measurements. Unlike APL, DCT was not or only slightly influenced by CCT (p=0.07 for DCT; p=0.001 for APL). The mean difference between IOP DCT and APL was larger in thin corneas (520 microm): 2.8+/-3.1 mmHg versus 0.8+/-2.3 mmHg in thick corneas (580 microm) (p=0.001). OPA was not correlated with age. It was positively correlated with IOP (p0.001), systolic BP (p=0.047), and MD (mean deviation) (p=0.018). It was negatively correlated with diastolic BP (p=0.003), cardiac frequency (p0.001), severity of glaucomatous VF defects (p=0.002), and PSD (pattern standard deviation) (p=0.008). It was significantly higher in the OHT subgroup and significantly lower in the NTG subgroup (p0.05). In both groups, the IOP difference between DCT and APL was not correlated with age (p0.05).IOP measurements with the Pascal(R) DCT and APL correlated well and were reproducible. DCT IOP measurement variability was slightly higher than APL with relatively wide 95% limits of agreement. Considering the entire study population, DCT overestimated IOP by a mean 2.0 mmHg compared with APL. DCT was independent of CCT, especially in thin corneas. The DCT does not appear to be clinically advantageous over the Goldmann tonometer in the IOP measurement in thick corneas. Therefore an IOP follow-up by APL tonometry and pachymetry appeared to be mandatory for the interpretation of the true IOP. Interindividual OPA variations were high, as was measurement variability. OPA was correlated with BP, cardiac frequency, IOP, diagnosis of glaucoma, and severity of glaucomatous VF defects. These must be considered in the clinical interpretation of this parameter.

Internet has become the first place where patients go to when seeking information about their disease. Little is known about the type and the quality of the medical information available on French-speaking websites, especially in the field of neuro-oncology. The purpose of this study was to evaluate the quality of these sites.We entered six key words "glioblastome", "méningiome", "métastase cérébrale", "neurinome de l'acoustique", "adénome à prolactine" and "lymphome primitif cérébral" into 2 different search engines and, for each key word, the first fifty websites were reviewed using the tool "DISCERN", and with the help of two neuro-oncologists, we rated their content in terms of quality and comprehension.On 612 websites only 110 (18%) contained information that proved to be somewhat useful to patients. The average score for quality was 32, which is considered to bepoor. According to our scoring system, 1.8% of websites were found to be "excellent", 11.8% "good", 24.5% "fairly good", 15.4% "average", 32.7% "poor" and 13.6% "very poor". Just over 50% of the websites were found to be clear. The study also showed that the order in which these websites were ranked in the search engine, their affiliation, their target or who financed them had little impact on quality. The websites were more likely to be of high quality if they were managed by doctors and had bibliographical references as well as a date indicating a recent website's update.This study shows that the search for medical information on the Internet is time consuming and often disappointing: very few websites provide information that is both clear and exhaustive. However, we also found that very few websites contained information that was seriously inaccurate. Given the growing popularity of the Internet, patients could certainly benefit from a high quality French speaking website that would specialize in cerebral tumors, as well as from a neuro-oncological portal that would take them to selected websites as it would save time and would be a guarantee for quality.

The Icare dynamic tonometer (impact or Rebound tonometry) is a new tonometer based on making a moving object collide with an eye and on monitoring the motion parameters of this object following contact. The purpose of this study was to assess intra- and interobserver variability of IOP measurements with the Icare and their correlations with Goldmann applanation tonometry (GAT) and central corneal thickness (CCT).A prospective study including three groups of patients: group 1 (50 normal subjects), group 2 (50 patients with OHT or POAG and GAT IOP22 mmHg), and group 3 (38 glaucomatous patients with GAT IOPor =22 mmHg). In group 1, three consecutive IOP measurements were taken by three distinct observers with Icare followed by three GAT measurements by the same clinician. In group 2, the same procedure was followed from patients 1 to 25 and the reverse sequence from patients 25 to 50 after a 10-min break. In group 3, only one clinician took three GAT measurements followed by three Icare measurements after a 10-min break to exclude a tonographic effect in eyes with statistically normal-range IOPs.: In group 1, intraobserver variability was about 6% for each observer (NS). There was no learning curve effect. The interobserver variation coefficient was 6.4%. Icare overestimated IOP compared to GAT (mean difference, 1.5-2.2 mmHg) (p0.001). Icare IOP was 23.4 mmHg for observer 1 when GAT was 22 mmHg (95% individual CI, 18-28.9 mmHg). In group 2, intraobserver variation coefficients of the IOP ranged from 5% to 5.4% (NS). Icare overestimated IOP by mean 0.84 mmHg compared with GAT. In group 3, mean IOP was not different between Icare and GAT. Icare IOP of 20.7 mmHg corresponded to a value of 22 mmHg using GAT. In this group, correlations between CCT and IOP measurements were higher for Icare than for GAT (p=0.062).Icare measures IOP in an unanesthetized sitting patient in a very brief time. Patient's minimal cooperation is needed. As long as the device is correctly positioned, the learning curve is short. Icare gives reproducible IOP measurements. Intra- and interobserver variability of IOP measurements are close to those of GAT. Icare overestimates IOP measurements an average 1.5 mmHg compared with GAT. Whatever the IOP level, Icare IOP measurements are well correlated with GAT. To a greater extent than for GAT, the reliability of IOP measurements is influenced by CCT. This tonometer can be used as a screening device for ocular hypertension as long as CCT measurements can be taken.

The voice handicap index by Jacobson et al doesn't render the difficulties experienced by singers. The aim of this study is to adapt the V.H.I. to the singing voice and evaluate it's reliability and coherence. In order to obtain this first scale, we went through three stages. MATERIAL ET METHOD: The first consisted in the modification of the existing items and the creation of new ones. The second was to measure the stability by a test - retest and the coherence of the adapted and the new items. This was done on groups of dysodic singers and professional voice users. The third stage consisted in evaluating the reliability and the coherence of 31 items on a homogeneous population of 132 classical singers with and without vocal impairment. The subjects were divided in three groups. The first group was composed of 95 normophonic singers, the second included 37 dysphonic singers and the third group was the control group, composed of 20 non singers without vocal complaints.The statistical results show a good stability of the test - retest (ICC=0.949; Rho: 0.912; Bland et Altman [-010.19, +13.23]). The internal coherence of each sub scale (Cronbach's alpha) is good (0.70). The correlations between the three sub scales are moderate between the functional and the emotional sub scale: 0.58; between the emotional and the physical: 0.64; and between the functional and the physical: 0.78). Each sub scale is measuring a specific dimension; still they are homogeneous between one another. Four variables have a significative influence on the results: the pathology (p0.001), being a professional singer (p0.001), the repetition (p=0.003), being a chorister (p=0.002).The VH.I adapted to the singers, appears to be reliable, valid and adapted to the population of dysodic classical singers.

Acceleromyography is commonly used to monitor perioperative neuromuscular blockade and to prevent residual neuromuscular blockade at the time of tracheal extubation. However, there are problems associated with this method, such as obtaining stable values, particularly beneath the surgical fields. We compared TOF ratios obtained on both hands simultaneously using on one side mechanomyography and on the other acceleromyography, installed in four different ways: the hand simply lying on a board, fingers fixed with tape, use of the hand adaptor or the TOF-tube. Further to maintaining free thumb movement, the TOF-tube improves feasibility of acceleromyography by reducing the measurement variability while retaining accuracy.

The RetroX is a new semi-implantable hearing aid which does not occlude the external ear canal. It consists of an electronic unit that plugs into a titanium tube which is implanted under the pinna so as to connect the retroauricular sulcus with the inside lumen of the external ear canal. Implantation requires minor surgery which can be performed under local anesthesia. Moreover, a pre-implant simulator exists and allows patients to try the device before deciding on definite implantation. The RetroX auditory implant is indicated in case of high-frequency sensorineural hearing loss with a steep slope (ski-slope audiogram). We implanted 25 adults suffering from such a hearing loss, and we report their hearing measured after 2.5 to 15 months of use. Four patients developed a persistent granulomatous reaction which disappeared after explantation. Two patients complained of acoustic feedback and needed supplementary fitting. Twenty three of our 25 subjects are satisfied or even extremely satisfied with the hearing improvement provided by the RetroX; they wear the implant daily, from morning until evening. Audiometrically, we observed a statistically significant improvement of the pure-tone thresholds at 1, 2, 4 and 8 kHz. In quiet, the speech reception thresholds decreased by 10 dB SPL and in noise, speech intelligibility increased by 15% for signal-to-noise ratios between -5 dB and +5 dB. Up till now, our patients were implanted monaurally because of financial considerations and our initial inexperience with this new implant. The overall results, however, are promising and nowadays, we advise bilateral implantation for patients who tolerate the first implant. By doing so, we hope to improve hearing in noise and spatial sound perception.

Examination of tobacco butts and its possible use in tobacco control.Macroscopic examination of cigarette butts collected outside or in dedicated smoking rooms of a smoke-free hospital.Of 925 butts, 3.8% were cigarillos, 11.1% cigarettes without filter, 57.7% ventilated filter cigarettes, 22.5% filter cigarettes without macroscopic ventilation and 4.9% undetermined. Thirty-six different cigarette brands were identified. A wide distribution of butt lengths (mean 32.1 mm, variation coefficient 28%), peripheral ovalisation of the filter in 83.9%, and extended browning of the mouth end of the filter in 48.6% were observed. Vent holes were macroscopically detectable in 70.5% and a sharp decrease in browning in 53.4% of the filter cigarettes. Most (94.7%) ventilation holes were located ator =10 mm from the mouth end.In a smoke-free hospital, the use of tobacco products (mainly ventilated filter cigarettes) remains sizeable. Given the wide distribution of butt lengths, the number of cigarettes per day is a poor marker of toxin intake. Vent-hole localisation and signs of vent-blocking confirm the inadequacy of machine-measured smoke yields and the presence of compensatory smoking. More intensive individual cessation advice with pharmacological support is necessary. Examination of a smoker's own cigarette butts can be used as a tool for individual cessation advice.

In secondary prevention, reduction of the risk of recurrent ischemic stroke might be expected with statins if a correlation can be established between hyperlipidemia and ischemic stroke or some specific ischemic stroke/TIA subtypes. However, such correlation remains controversial, and more particularly with the etiologic stroke/TIA subtypes. Few studies have evaluated the plasma lipid profile in different ischemic stroke subtypes, and notably in lacunar infarctions and cardioembolic strokes. The objectives of this case-control study was to determine (1) which cholesterol fractions is associated with large vessel disease (LVD), small vessel disease (SVD), and cardioembolic disease (CED); (2) whether hypertriglyceridemia is related more to any particular stroke subtype; and (3) whether the lipid profile is different between LVD and SVD which are both responsible for atherothrombotic cerebral ischemia. From a cohort of 485 patients, were selected 240 consecutive cases with ischemic stroke (n = 182) or transient ischemic attack (n = 58) due to a single etiology. The levels of total cholesterol (total-C), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), and triglycerides (TG) were measured in 61 patients with LVD, in 65 with SVD, and in 114 with CED, and compared with age- and sex-matched control subjects. Additional analysis was performed to compare the lipid profile between LVD and SVD after adjustment for other risk factors. Compared to controls, the total-C level was significantly higher in patients with SVD (p = 0.005) and LVD (p = 0.018). A significant increase in the LDL-C level (p0.004) and a significant decrease in the HDL-C level (p = 0.001) were only observed in the LVD patients. The three stroke subtypes showed higher TG levels than the controls (CED, p = 0.037; SVD, p0.001; LVD, p = 0.014). The plasma lipid profile was similar in the SVD and LVD subtypes except for HDL-C, which was significantly lower in LVD than in SVD (p = 0.047). Logistic regression adjusted for confounders showed that decreased HDL-C (p = 0.020), and smoking (p = 0.019) were significant discriminative factors for LVD vs. SVD. In conclusion, this controlled study shows that hypertriglyceridemia is commonly found in patients with ischemic cerebrovascular disease whatever the etiologic subtype, whereas hypercholesterolemia is related more to SVD and LVD. In addition to hypertension and diabetes, hypercholesterolemia may also be involved in the etiology of SVD and differs from LVD by a lower decrease in HDL-C.

We reviewed the degree to which extension from transitional cell carcinoma into the prostate affects survival. We also compared whether prostatic stromal invasion occurring via direct extension through the bladder wall differs from stromal invasion arising intraurethrally.A total of 76 men who underwent radical cystectomy for transitional cell carcinoma also had prostate involvement. Patients were separated into group 1-18 with primary bladder tumor extending transmurally through the bladder wall to invade the prostate and group 2-58 with prostate involvement arising from within the prostatic urethra. In the latter group the degree of prostate invasion was classified as urethral mucosal involvement, ductal/acinar involvement and stromal invasion.The 5-year overall survival and recurrence-free rate were 22% and 28% in group 1 versus 43% and 45% in group 2, respectively. In group 2 survival rates were similar in those with prostatic urethral and ductal tumors (without stromal invasion). Five-year overall survival rates without and with stromal invasion were 49% and 25%, respectively (p = 0.024). Prostate involvement decreased survival, which varied according to primary bladder stages (Pis, P1, P2a/b and P3a/b, p = 0.004) or superficial (Pis, Pa and P1) and muscle invasive (P2a/b and P3/b, p = 0.045), disease in 2 groups. Those with positive lymph nodes experienced poorer outcomes in each group. The 5-year overall survival rate in the 19 men with positive lymph nodes was 13% and it was 44% with negative lymph nodes (p = 0.034). The major prognostic factors were age, degree of prostate invasion and lymph node involvement.The invasion pathways of prostate invasion in patients with transitional cell bladder carcinoma have a statistically significant prognostic role in survival. Transitional cell carcinoma of the bladder extending into the prostate through the bladder wall and bladder carcinoma that did not directly infiltrate the prostate through the bladder wall are 2 distinct clinicopathological entities that should not be included in the same staging grade.

Our study encompasses 61 patients (49 men--80.3%; 12 women--19.7%) treated from September 1998 through August 2001. Mean follow-up covers 25 months (range: 7-43 months). Our CO2-LAUP technique involves vaporizing the palatine mucosa along a rectangular surface from the palatal dimple to the base of the uvula; trimming the palatine arches under the velum; and resecting the uvula. For 22 patients, we employed intravelar diode laser coagulation in the expectation of reducing the postoperative pain whilst achieving the same therapeutic effectiveness. There is no pain difference between the CO2-LAUP technique versus that combining intravelar diode laser coagulation with CO2 laser uvula resection and trimming of the palatine arches. Mean maximal pain reaches 6.93 +/- 3.55 with CO2 laser and 6.95 +/- 3.64 with CO2 laser plus diode laser. Similarly, both techniques involve the same mean algesic period of 22 days with the day of maximal pain at 1 week after surgery. Associating base of tongue vaporization significantly increases the algesic period (p = 0.042). No long-term complications were observed in relation to intravelar coagulation or LAUP, whether combined or not with base of tongue vaporization. In terms of patients satisfaction, no significant difference exists between the various surgical techniques of the velum alone. The satisfaction rate reaches 5.26 +/- 3.92 with CO2 laser and 5.82 +/- 2.67 with the CO2 laser plus diode laser. Satisfaction is statistically identical when base of tongue vaporization is included in the procedure.

Neuromuscular blockade monitoring at the adductor pollicis has become easier using acceleromyography. In order to guarantee a reliable analysis of its acceleration, the thumb movement has to be free and protected from external influences. To this end, we describe here-in two hand fixation- and protection-devices for use with acceleromyography. After a bolus of 0.3 mg/kg rocuronium, we compared acceleromyography data obtained simultaneously on both hands with, on one side, the cumbersome TOF-Guard/TOF-Watch arm board, and the smaller and handier TOF-tube on the other. Results showed little differences between the two devices. Yet, a short and clinically irrelevant delay was observed for TOF-tube data during recovery. This was probably caused by a difference in thumb position and repositioning technique. In conclusion, the more convenient TOF-tube can be used as well as the TOF-Guard/TOF-Watch arm board in daily clinical practice.

We studied the time of arrival of 235 consecutive patients admitted to the emergency department of a University Hospital located in a rural area after the first symptoms of ischemic stroke or TIA. Among the following factors, we determined those that might be involved in delayed admission: place of symptom onset, time and place of onset of the first symptoms, contact with a general practitioner before admission time, mode of transportation, clinical score, impairment of consciousness, presence of seizures, heart complaints or headache, age and past medical history of cerebrovascular, cardiovascular and hypertension diseases. Half of the patients arrived within 4 h 10 of symptom discovery and 55 p. cent arrived within 6 hours. The percentage of patients arriving within 3 h (p = 0.001) and 6 h (p = 0.001) was higher for those who had a stroke during the day (8 a.m.-8 p.m.) than during the evening and night. The other characteristics associated with a shorter delay included a low neurological score on the Mathew's Stroke Scale (p0.001 at 3 h and p = 0.001 at 6 h) and younger age (p = 0.015 at 3 h). Presence of headache delayed admission (p = 0.010). Forty-five percent of patients arrive at the hospital 6 hours after the discovery of symptoms, too late to receive optimal stroke therapy. Widespread public education on stroke is necessary to reduce the delay of admission, particularly for old patients and in case of mild to moderate deficits.

To determine the range of plasma homocysteine values in a cohort of type 1 diabetic subjects and to analyse the relationship between homocysteine levels and chronic degenerative complications.71 type 1 diabetic inpatients admitted for poor glycaemic control and/or treatment of complications, especially macroangiopathic, were included in this study. Chronic diabetic complications, smoking prevalence, as well as current use of drugs were recorded, alongside fasting plasma homocysteine.Age and diabetes duration were 51 (34-63) and 23 (13-32) years respectively (median [percentile 25-75]). HbA(1)c was 9.3% (8.2-10.5). Homocysteine was 9.2 (7.1-13.6) micromol/l, and 17% of patients had elevated homocysteinaemia on the basis of a laboratory cutoff value of 15 micromol/l. Folic acid and vitamin B(12) levels were within the normal range. Univariate statistical analysis showed a significant positive association between homocysteine and age (P0.001), diabetes duration (P0.001), systolic blood pressure (P0.001), plasma creatinine (P0.001), cholesterol/HDL-C (P=0.021) as well as with retinopathy (P=0.016) and all complications (P0.001), and a negative correlation with folic acid (P=0.004) and creatinine clearance (P0.001). Using a multiple regression analysis taking into account major variables, we confirmed an independent association of homocysteine with age (P=0.003), creatinine (P0.001) and folic acid (P=0.014), but not with vascular complications.Increased homocysteine is present in 17% of a limited group of poorly controlled type 1 diabetic patients, and is associated with age, creatinine and folic acid levels. In this type 1 population, there was no independent correlation of homocysteine with vascular complications, in particular macroangiopathy.