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Introduction Resistance to clarithromycin and fluoroquinolones is increasing in many countries. We aimed to assess the efficacy of a tailored PCR-guided triple therapy versus an empirical triple therapy in the treatment of H. pylori infection. Patients and methods French multicenter prospective open-label randomized study to assess H. pylori and resistance to clarithromycin and levofloxacin with GenoType HelicoDR® test. Patients of the control group were treated with empirical therapy of proton pump inhibitor (PPI), amoxicillin, and clarithromycin for 7 days. Patients of the experimental group with clarithromycin-susceptible strains, clarithromycin-resistant/levofloxacin-susceptible strains, and with clarithromycin-resistant/levofloxacin-resistant strains received tailored therapy of PPI, amoxicillin, and clarithromycin for 7 days, PPI, amoxicillin, and levofloxacin for 10 days, and PPI, amoxicillin, and metronidazole for 14 days, respectively. H. pylori eradication was assessed by 13C urea breath test at least 28 days after the end of treatment. Results We included 526 patients: 260 (49.4%) were randomly assigned to empirical triple therapy and 266 (50.6%) to tailored therapy. Clarithromycin and levofloxacin resistances were 23.3% and 12.8%, respectively. Follow-up urea breath test was available for 415 (78.9%) patients. Tailored therapy was superior to empirical therapy in terms of eradication (85.5% vs. 73.1%, RR = 1.85, 95%CI [1.25–2.78], p = 0.003). Findings were consistent in the susceptibility analysis using multiple imputation (RR = 1.61, 95%CI [1.14–2.27], P = 0.003) and per-protocol analysis (RR = 1.89, 95%CI [0.25–2.78], p = 0.003). Conclusion In a country with a high level of clarithromycin resistance, tailored PCR-guided therapy was superior to empirical triple therapy for H. pylori eradication ( https://www.ClinicalTrials.gov : NCT01168063 ).

Background Heart Failure (HF) is a major public health problem resulting in high rates of hospitalization and mortality. Frequency of HF increase due to the aging of population and improvement of treatments. Therefore, we hypothetized that elderly is a factor that might limit access to appropriate HF Care. Purpose and methods Our aim was to analyzed the optimization therapy and participation in rehabilitation and education programs depending according to classes of age (80) in a large French HF population (out and in-patients, de novo/chronique/acute; consultation/hospitalization/rehabilitation; all LVEF classes and any type of cardiologist practice). Data were analized according to age groups Results A total of 2729 HF patients from 79 French departments were included of whom 36% were out patients, 53% were in-patients and 11% were in rehabilitation center. 16% were de novo Chronic HF and 31% were in Acute HF. Elderly patients were more frequently included in acute HF. Main data according on classes of age are presented in the table. Ischemic etiology and valvular diseases increased with age (p Beta-blockers, angiotensin converting enzyme inhibitors, and anti-aldosterone, were less prescribed after 60 years old (p Main data according on classes of age Characteristics All (n=2729) 80 (n=573) p SBP 120±21 107±15 117±21 117±21 118±21 122±20 126±22 Origin of patients according on classes Conclusion Elderly patients receive less Chronic HF treatment, and are less included in patient education and rehabilitation program despite having more comorbidities and cardiovascular risk factors. Thus, to improve outcome, the health care system needs to be adapt to the patients'age. Acknowledgement/Funding SFC, CNCF, CNCH, FFC, Alliance du coeur, GERS, SNSMCV

Inicialmente, la epidemiologia se limitaba al estudio de la distribucion de las enfermedades en las poblaciones (epidemiologia descriptiva) y al estudio de las influencias que determinan esta distribucion (epidemiologia analitica). En la actualidad, la epidemiologia abarca tambien la evaluacion de las estrategias diagnosticas y terapeuticas, asi como de los factores pronosticos. La epidemiologia permite proporcionar los elementos de la decision medica y de salud publica. En los estudios descriptivos se emplean los indices de mortalidad, incidencia y prevalencia. Las informaciones se recogen a partir de registros sistematicos o mediante estudios especificos. El objetivo de la epidemiologia analitica es demostrar la existencia de una asociacion causal entre una exposicion y una enfermedad. La fuerza de dicha asociacion se estima mediante el riesgo relativo (RR) o la «odds ratio» (OR). Las otras medidas del riesgo son el riesgo atribuible y la fraccion etiologica. Para interpretar un estudio explicativo es necesario verificar que el estudio no presenta sesgos significativos y buscar argumentos a favor de la causalidad. En la evaluacion de las estrategias diagnosticas y de deteccion sistematica se aplican las nociones de sensibilidad, especificidad y, sobre todo, las razones de verosimilitud, que permiten determinar la probabilidad de que un paciente presente la enfermedad en funcion de sus caracteristicas y del resultado de la prueba. La evaluacion de los factores pronosticos permite construir puntuaciones y estimar la probabilidad de la evolucion clinica en funcion de caracteristicas del paciente.

Epidemiology, which was initially confined to the distribution of diseases in populations (descriptive epidemiology) and the factors responsible for such distribution (analytical epidemiology), also involves the evaluation of diagnostic and therapeutic strategies, as well as prognostic factors. Epidemiology provides elements that form the basis for medical and public health decisions. Information is collected from systematic records, which include large databases, or through specific surveys. Descriptive studies utilise mortality rates, as well as incidence and prevalence figures. The aim of aetiological epidemiology is to demonstrate a causal relationship between exposure and disease. It is necessary to check that studies do not present any major bias and to seek evidence in favour of causality. The strength of a causal relationship is calculated using relative risk or odds ratio. Other measurements of risk include attributable risk and aetiological fraction. Screening and diagnostic strategies are evaluated using the concepts of sensitivity, specificity, and above all, levels of likelihood that help determine the probability of a given patient becoming ill as a result of his or her personal characteristics and of test results. Evaluation of prognostic factors enables scores to be constructed allowing the probability of a given clinical outcome to be calculated as a function of patient characteristics.

Resume Introduction La drepanocytose est la maladie genetique la plus frequente, souvent associee a des complications ophtalmologiques retiniennes potentiellement cecitantes. Nous presentons la prevalence de la retinopathie drepanocytaire dans une population de patients suivis dans un centre de reference. Patients et methodes Il s’agit d’une etude retrospective longitudinale portant sur une periode de 13 ans, incluant des patients le plus souvent adultes souffrant de drepanocytose SS, SC ou ayant un trait drepanocytaire AS. Les patients inclus dans cette analyse ont tous beneficie d’un examen ophtalmologique a la lampe a fente et d’un fond d’œil complet. Resultats Sept-cent trente patients (âge moyen 32,5 ± dix ans), dont 492 patients SS (67,4 %), 229 patients SC (31,4 %) et neuf patients AS (1,2 %) ont ete inclus dans l’etude. 54,6 % des patients SC et 18,1 % des patients SS avaient une retinopathie drepanocytaire de grade 3 a 5. La prevalence des formes graves etait moins importante parmi les femmes drepanocytaires SS que parmi les hommes (15,5 % versus 21,7 % ; p Conclusion La prevalence elevee de la retinopathie drepanocytaire proliferante et les complications potentiellement severes qu’elle peut engendrer justifient le depistage et la prise en charge par une equipe multidisciplinaire dans un centre de reference.

Resume Introduction La determination de sous-groupes homogenes de degenerescence maculaire liee a l’âge (DMLA) est necessaire pour les etudes cliniques ou genetiques, l’elaboration d’une classification simple, reproductible et la plus discriminante possible est ainsi indispensable. La deuxieme partie de notre etude (SPA-2) porte sur le phenotypage de la DMLA atrophique et se base sur les photographies couleur du fond d’œil, les cliches monochromatiques, l’autofluorescence, l’angiographie a la fluoresceine, l’angiographie a l’indocyanine et l’OCT Spectral-Domain. Patients et methodes Dix items portant sur l’atrophie ont ete selectionnes a partir de la litterature et la pratique clinique. Vingt yeux de 20 patients atteints de DMLA atrophique ont ete inclus. Pour chaque patient, la grille a ete remplie par cinq observateurs independants et un expert. Le coefficient Kappa a ete calcule pour chaque item. Resultats L’accord le plus pertinent entre observateurs est retrouve pour l’item « presence d’atrophie » (Kappa = 1). La plus mauvaise concordance concerne l’item « taille de l’atrophie » (Kappa = −0,0286 ± 0,0769 a 0,1813 ± 0,0835). Conclusion La classification de la DMLA atrophique est complexe et actuellement peu consensuelle, d’ou la necessite d’une grille discriminante et reproductible. Dans ce sens, l’evaluation de notre grille portant sur la DMLA atrophique montre un accord satisfaisant entre observateurs pour la plupart des items, quelques modifications ont ete proposees afin de la rendre encore plus discriminante et reproductible.

Resume L'epidemiologie etait initialement cantonnee a l'etude de la distribution des pathologies dans les populations (epidemiologie descriptive) et a l'etude des influences qui determinent cette distribution (epidemiologie analytique). Aujourd'hui l'epidemiologie s'interesse egalement a l'evaluation des strategies diagnostiques ou therapeutiques, et des facteurs pronostiques. L'epidemiologie permet de fournir les elements de la decision medicale et en sante publique. Les etudes descriptives utilisent les taux de mortalite, d'incidence et la prevalence. Les informations sont recueillies a partir d'enregistrements systematiques ou par des enquetes specifiques. L'objectif de l'epidemiologie analytique est de montrer une association causale entre une exposition et une maladie. La force de l'association est estimee par le risque relatif ou l'odds ratio. Les autres mesures du risque sont le risque attribuable et la fraction etiologique. Pour interpreter une enquete explicative, il est necessaire de verifier que l'etude ne presente pas de biais majeur et de rechercher des arguments en faveur de la causalite. L'evaluation des strategies diagnostiques et de depistage utilise les notions de sensibilite, specificite et surtout les rapports de vraisemblance qui permettent de determiner la probabilite qu'un patient a d'etre malade en fonction de ses caracteristiques et du resultat du test. L'evaluation de facteurs pronostiques permet de construire des scores et d'estimer la probabilite de l'evolution clinique en fonction de caracteristiques du patient.

Understanding patients' expectations with regard to medical care is critical as it guarantees an efficient therapeutic process. Our aim was to determine outpatients' expectations concerning clinical encounters in a dermatology clinic and to study how these matched the opinions of dermatologists regarding them.Consecutive outpatients consulting in five dermatology centres in the Paris suburbs between February 2013 and March 2013 were prospectively included. For this pilot cross-sectional study, we used two standardized forms to collect data from patients and dermatologists. Patients' answers were compared to those of their dermatologist, and the degree of matching was calculated to assess the ability of dermatologists to accurately identify their patients' expectations.Two hundred and sixty-five patients were included, with a median age of 41 years (interquartile range: 25; 62), of whom 166 were women (65.4%). Patient's principal expectations concerned diagnosis (51.7%) and medication (40.8%), with 32.1% of patients requiring reassurance. The rates of matching between patients' and dermatologists' answers ranged from 33.3% to 65.7% according to the type of expectations. The highest rate concerned expectation with regard to medications, being only 52.6% and 58.8%, respectively for expectations regarding diagnosis and the need for reassurance.This study highlights the need for improved identification of outpatient expectations in dermatology consultations.

Malignant peripheral nerve sheath tumours (MPNSTs) are the main cause of death in neurofibromatosis 1 adult patients.To determine the clinical type of neurofibromas associated to MPNSTs.Case-control study. Cases were neurofibromatosis 1 adults with MPNSTs and controls were patients without MPNSTs individually matched by age and sex (1 : 3). Both were recruited from our database. The following variables were studied: clinical presence of cutaneous, subcutaneous or plexiform neurofibromas and of internal neurofibromas. Internal neurofibromas were confirmed by clinical imaging. Multivariate odds ratios (aORs) were estimated with their 95% confidence interval (CI).From January 1995 to December 2007, 52 patients (cases) were identified with a MPNSTs, 155 controls could be recruited. In the multivariate analysis, MPNSTs were significantly associated with the presence of internal NFs (aOR: 7.5; 95% CI: 3.2-17.4), a trend for an association was observed for the presence of subcutaneous neurofibromas (aOR: 2.11; 95% CI: 0.89-5).This study confirms the association between the MPNSTs and the internal neurofibromas. The later are indeed associated with a high risk of malignant transformation.

Day hospital is a unit allowing the provision of several services together in a single day such as complex or specific therapy, or investigations requiring the services of different technical departments. This paper describes the structure and activity of dermatological day hospitals within French university hospitals (CHU).A transverse prospective study was performed over a 2-week period in 2009 based on a first questionnaire which assessed the organisation and structure of the day hospitals (one questionnaire per day hospital unit), while the second assessed the activity of the day hospitals (one questionnaire for each patient attending day hospitals) throughout the period covered by the survey.Twenty-eight of the 44 dermatology French university hospital day centres responded to the survey (participation rate: 63 %). Six had access to shared day hospital facilities while the 22 others had dedicated dermatology facilities. The day hospital unit was part of a national reference centre in 13 of 24 cases. The median number of beds per day-hospital structure was six for a median of eight patients admitted per day and 1500 sessions recorded each year. On average, the teams comprised two full-time doctors, two nurses, 1.25 hospital workers and one secretary. The mean number of administrative documents generated per unit each week was 57. There were 793 admissions to day hospitals throughout the survey period, for examinations in 61 % of cases and for treatment in 37 % of cases. Fifteen percent of patients were seen without prior arrangement for a variety of intercurrent events. The mean amount of doctor's time devoted to each patient was 25 min. Among the main diseases seen at dermatology day hospitals, we noted cancer (44 % of admissions, 322 cases), psoriasis (7 % of admissions, 54 cases) and chronic wounds (5 % of admissions, 43 cases).Dermatology day hospitals serve to provide treatment for complex or costly diseases requiring a variety of specialised laboratory examinations in a single unit all at one time. A considerable workload is generated, particularly in medical and administrative terms. These are well-adapted structures with their own staff, a selection of technical means and upstream scheduling allowing multidisciplinary patient management. Day hospitals meet a real need in dermatology.

Sickle-cell disease is the most common genetic disease in the world, frequently complicated by potentially blinding retinal complications. The prevalence of sickle-cell retinopathy in patients followed in a referral center is presented in this study.The prevalence of proliferative sickle-cell retinopathy by Goldberg classification was determined via a retrospective study of primarily adult SS and SC sickle-cell disease patients and AS sickle trait patients followed in a single referral center for a mean period of 13 years. All patients underwent slit lamp examination and complete fundus examination.Seven hundred and thirty patients (mean age 32.5±10 years), consisting of 492 SS patients (67.4%), 229 SC patients (31.4%) and nine AS patients (1.2%), were included in the study. 54.6% of SC patients and 18.1% of SS patients had grade 3 to 5 proliferative sickle-cell retinopathy. The prevalence of severe forms of sickle-cell retinopathy was higher among SS men than among SS women (21.7% versus 15.5% ; P0.05).The high prevalence of sickle-cell retinopathy and the potentially severe complications associated with this disease justify screening and therapeutic management by a multidisciplinary team in the setting of a referral center.

Background Nosocomial infections are extremely common in the elderly and may be related to ageing of the immune system. The Immune Risk Phenotype (IRP), which predicts shorter survival in elderly patients, has not been evaluated as a possible risk factor for nosocomial infection. Our aim was to assess the prevalence of nosocomial infections in elderly in-patients and to investigate potential relationships between nosocomial infections and the immunophenotype, including IRP parameters. Results We included 252 consecutive in-patients aged 70 years or over (mean age, 85 ± 6.2 years), between 2006 and 2008. Among them, 97 experienced nosocomial infections, yielding a prevalence rate of 38.5% (95% confidence interval, 32.5-44.5). The main infection sites were the respiratory tract (21%) and urinary tract (17.1%) When we compared immunological parameters including cell counts determined by flow cytometry in the groups with and without nosocomial infections, we found that the group with nosocomial infections had significantly lower values for the CD4/CD8 ratio and naive CD8 and CD4 T-cell counts and higher counts of memory CD8 T-cells with a significant increase in CD28-negative CD8-T cells. Neither cytomegalovirus status (positive in 193/246 patients) nor presence of the IRP was associated with nosocomial infections. However, nosocomial pneumonia was significantly more common among IRP-positive patients than IRP-negative patients (17/60 versus 28/180; p = 0.036). Conclusion Immunological parameters that are easy to determine in everyday practice and known to be associated with immune system ageing and shorter survival in the elderly are also associated with an elevated risk of nosocomial pneumonia in the relatively short term.

Purpose. - The determination of homogeneous subgroups of age-related macular degeneration (AMD) is necessary for clinical and genetic studies; therefore, the development of a simple, reproducible, and discriminating classification is essential. In this second part of our study (SPA-2), we evaluated a selected list of items for atrophic AMD based on color photographs of fundus, red-free frames, autofluorescence, fluorescein angiography, indocyanine angiography, and Spectral-Domain OCT. Methods. - Ten items for atrophy were chosen from the literature and clinical experience. Twenty eyes of 20 patients with atrophic AMD were included. For each patient, the grid was completed by five independent, experienced readers from our reading center and by an expert. The Kappa coefficient was calculated for each item. Results. - The greatest agreement between observers was found for the item "presence of atrophy" (Kappa = 1). The worst concordance was recorded for the item "size of atrophy" (Kappa = -0.0286 +/- 0.0769 to 0.1813 +/- 0.0835). Conclusion. - The classification of atrophic AMD is complex and currently not very consensual, hence the need for a discriminant and reproducible classification grid. The evaluation of our grid for atrophic AMD shows satisfactory agreement between observers for the majority of the items. Some modifications are proposed to make it more discriminant and reproducible. (C) 2010 Elsevier Masson SAS. All rights reserved.

Background . Assessment methods for atopic dermatitis (AD) are not standardized, and therapeutic studies are difficult to interpret. Aims . To obtain a consensus on

Relapsing polychondritis (RP) is a rare and severe disease which may lead to destruction of elastic cartilages. Until now, no reliable biomarker of disease activity in RP has been available. This study was designed to measure serum levels of cartilage biomarkers during both active and inactive phases of the disease.Serum levels of cartilage oligomeric matrix protein (COMP), chondroitin sulfate 846 epitope (CS846) of proteoglycan aggrecan and collagen type II collagenase cleavage neoepitope (C2C) were measured retrospectively in 21 subjects with RP. The Wilcoxon matched-pairs signed-rank test was used for statistical comparisons of biomarker levels in active and inactive phases of RP.Only the serum level of COMP was significantly increased during disease flares. Steroids did not alter the serum cartilage-related biomarker levels. However, during the active phase, C2C levels were significantly higher in steroid treated patients compared with non-steroid treated patients.This study suggests that serum COMP level may be useful for monitoring disease activity of RP. Further prospective studies are required to confirm this result.

Summary Background Discrepancies between cutaneous specimen sizes reported by the dermatosurgeon and the pathologist are important to evaluate because of their legal implications for malignant tumours and the downcoding of surgical acts. Objectives The objective of this study was to determine the magnitude of changes in size and the factors influencing the retraction of routine skin excision specimens. Methods Three measurements of 82 skin excision specimens—consisting of length and width of the planned surgical excision (in vivo), length, width and depth of the specimens following excision (ex vivo) and of the specimens after formalin fixation (in vitro)—were performed and compared using a nonparametric paired test. Factors (age, sex, type and location of the lesions and initial measures) that could influence the amount of shrinkage were analysed using multiple linear regression models. Results The mean in vivo to in vitro shrinkage was 16% for length and 18% for width (P

International audience; BACKGROUND AND AIMS: Colorectal cancer (CRC) harbours different types of DNA alterations, including microsatellite instability (MSI). Cancers with high levels of MSI (MSI-H) are considered to have a good prognosis, probably related to lymphocyte infiltration within tumours. The aim of the present study was to characterise the intratumoural expression of markers associated with the antitumour immune response in mismatch repair (MMR)-proficient (MSS) colon cancers. METHODS: Ninety human colon cancers (T) and autologous normal colon mucosa (NT) were quantified for the expression of 15 markers of the immune response with quantitiative reverse transcription-PCR (qRT-PCR). mRNA expression levels were correlated with MMR status. Immunohistochemistry (IHC) was performed using both interleukin 17 (IL17) and CD3 antibodies. RESULTS: Expression of cytotoxic markers (FasL, granzyme B and perforin), inflammatory cytokines (IL1beta, IL6, IL8, IL17 and transforming growth factor beta (TGFbeta)) and a marker of regulatory T cells (forkhead box P3 (Foxp3)) was significantly higher in tumours than in autologous normal tissues. Adjusting for MMR status, higher tumoural expression of both granzyme B and perforin was associated with the MSI-H phenotype, and the perforin T/NT ratio was higher in MSI-H tissues than in MSS tissues. Higher tumoural expression of Foxp3, IL17, IL1beta, IL6 and TGFbeta was associated with the MSS phenotype, and the IL17 T/NT ratio was higher in MSS tissues than in MSI-H tissues as assessed by both qRT-PCR and IHC. CONCLUSIONS: Immune gene expression profiling in CRC displayed different patterns according to MMR status. Higher Foxp3, IL6, TGFbeta and IL17 expression is a particular determinant in MMR-proficient CRC. These may be potential biomarkers for a new prognostic "test set" in sporadic CRCs.

Requests for emergency appointments are fairly common in private dermatologic practice in France. To our knowledge the frequency and reasons for such requests have not yet been evaluated. The primary objective of our study was to provide a quantitative and qualitative evaluation of such requests and to assess the underlying reasons. The secondary aim was to investigate for an association between emergency requests where response was justified within 48 hours and the symptoms reported by patients in order to establish a predictive score for the validity of requests.The study took place during one week in April 2004. Forty French dermatologists took part on a voluntary basis. They deliberately reduced their ongoing schedule to accommodate patients seeking an urgent appointment. We collected data regarding the normal professional activity of each dermatologist, reasons for appointments, symptoms, diagnosis and evaluation of the degree of emergency by the attending dermatologist. Univariate and multivariate analyses were performed and a score was attributed based on the results for the variables used in the logistic regression model.The mean number of patients seen at emergency appointments during the study week doubled in comparison with a normal period. During the week, 613 patients phoned and all questionnaires were completed for 538 (88%) patients. The most common reasons for requesting an appointment were: rash, eczema, pruritus, tumour modification, localized lesion and allergy. The most frequent diagnoses were: eczema, bacterial and viral infection, atopic dermatitis, mycosis and naevus. The dermatologists considered that the consultations were justified within 48 hours for one third of patients. In the multivariate analysis, factors significantly associated with a justified request were of a general medical rather than a dermatological nature: enlarged cysts, blisters, insomnia, impaired activity, onset or aggravation within the previous 7 days, inability to work. The score showed good specificity but poor sensitivity and discriminative value.These results suggest that requests for emergency appointments are more frequent than previously suspected (14% of all requests). Physicians considered that emergency appointments within 48 hours were justified for one third of patients. The reasons for consultation and the resulting diagnoses were similar to those seen in emergency hospital consultations. The criteria on which the need for emergency consultation was based were not for the most part dermatologic. The scoring system we established was not sensitive enough to allow reliable pre-selection of patients requiring emergency consultation by telephone.

Provisional stenting is associated with longer physician time but the use of fewer stents. This randomized controlled trial in tertiary care in French hospitals compared strategies of systematic and provisional stenting. We estimated the costs and financial incentives associated with each strategy, based on individual data on 12-month resource use drawn from a 251-patient database. Resources were evaluated using French costs; data on costs in the United States were drawn from the literature and interviews with hospital administrators in one center. In France 1-year costs were 8,267+/-528 dollars for provisional stenting and 7,973+/-553 dollars for systematic stenting, compared to 18,715 dollars and 18,632 dollars in the United States. Given the uncertainty of longterm results, the choice between stenting strategies might be guided by financial incentives. In the United States financial incentives favor systematic stenting, while in France public hospitals and physicians are neutral.

There is little data available on current practice related to prescription of labile blood products (LBP) by French physicians. The aim of this study was to assess whether prescriptions were conform to Anaes (French Medicine's agency) guidelines, with regard not only to indications but also quality of the products, so as to define the improvements that could be made.Thirty-four clinical case reports, classified by specialties were sent to prescribing physicians working in the regional health centers, from 17 different blood banks, from October 1997 to February 1998. The prescribers were requested to answer only the questions that were specific to their particular field of experience. Each case description included multiple choice questions on the indication for transfusion of concentrated of red blood cells (RBC) and/or platelets (CP) and/or plasma, and the possible requirements for specification or modification of the guidelines applicable to these products. The primary end point of analysis was the adequation of the answers to the Anaes recommendations.Answers were obtained regarding 5092 clinical cases from 818 physicians. The participation rate was of 30%. The specialties were as follows: 34% anesthesiologists, 14% oncologists-haematologists, 13% internal medicine specialists, 11% emergency physicians, 10% paediatricians, 8% obstetricians, 7% geriatricians, and 3% transplantation surgeons. Eighty-two percent of the answers came from physicians working in the public health services. The adequation with the indication for transfusion was of 90.3% for RBC, 92.3% for platelets and 93.8% for plasma. The percentages of correct answers regarding the indications for specification or modification of the LBP were as follows: 90.3% were correct for irradiation (of either RBC or platelets); 68.8% and 53.2% respectively for leukocyte depletion from RBC and platelets; 64% for phenotyped RBC; 68.2% for compatibilized RBC; and 57.3% for apheresis platelet concentrates. There was no difference in results depending on the type of center, private or public, and the quality of LBP prescribed. The answers obtained from the anaesthesiologists' clinical cases were less accurate with regard to RBC but more accurate with regard to PC compared with other specialists.This study shows the correct management of the indications for transfusion by the prescribing physicians who participated in the study, but the lack of knowledge with regard to the indications for specifications and/or transformations of LBP. The respect of the indications for transfusion is the corner stone of safe transfusion and this phase should be optimized with improved dissemination of information on transfusion and training for the physicians and programs that would improve the quality.

The number and level of the publications reflect the scientific activity of physicians. The assessment of this activity is required for nomination and for the internal promotion of University Professors--Hospital Practitioners (UP-HP). We present the results of such an assessment.The list of the individual publications of 62 UP-HP was established from research on the Medline on the PubMed website. We eliminated the journals without an Impact Factor and the articles of continued medical training. A score was obtained for each of the authors on each of their publications. This was calculated by multiplying the rank coefficient of the author by the coefficient of the type of publication (letter, clinical case or article) and by the coefficient of the journal (ranging from 1 to 4). The global score of a UP-HP was the sum of the scores per publication. The mean score of each UP-HP was assessed by dividing their global score by the number of their publications.One thousand thirty-one scientific publications in 3 years was divided into 502 articles, 316 clinical cases and 213 letters. The yearly number of publications per UP-HP was a mean of 5.5 (+/- 4.2) ranging from 0 to 17.3. The publications were mainly written in English (p=10(-2)). There were more articles than clinical case reports and letters (p=10(-1)). The yearly number of publications was greatest among those aged 46-55. No difference was noted in gender, function (head of a department or not) or the size of the town. The UP-HP working in a team including other UPs had written a greater number of publications (p=10(-2)). The global scores did not significantly differ between the 3 age ranges considered; conversely, the mean score decreased significantly with age (p=0.04). The UP-HP working in teams including several UPs had significantly higher global score (p=0.03).These results show the heterogeneity of the "publishing" activity. The method used in this study for the scientific assessment could be subject to improvement; its principle is indisputable, but its methods of use remain to be specified. The best "publication structure" of young UP-HP may be related to age, demonstrating a decline in scientific activity during the working life, or a cohort-effect--i.e., the progressive improvement in recruitment conditions and scientific activity over the past 20 years. The better performance of the UP-HP working in a team including several UP-HP must be interpreted with care; however, it may help to define a geographical policy of Dermatology.

Background: The nosologic field of aphthosis is not well defined. While criteria for Behçet’s disease (BD) are lacking in severe unipolar or bipolar aphthosis, these disorders however lead to an important impairment of quality of life. The aim of this study was to assess the relationship between severe aphthosis and BD. Methods: Records of all patients hospitalized for aphthosis or BD during a 20-year period were reviewed. Results: According to clinical data, cases (n = 104) were classified as unipolar aphthosis (group I, n = 53), bipolar aphthosis (group II, n = 30) or BD (group III, n = 21). The characteristics of aphthae (number, localization, recurrences, presence of scars) were similar in all groups. Specific cutaneous manifestations (erythema nodosum, pseudofolliculitis, papulonodules) were present in 15, 17 and 95% of patients of groups I, II and III. Cutaneous puncture hypersensitivity was present in 14 out of 18 patients of group III and no patient of the two other groups. At least one extramucous specific manifestation (cutaneous, ophthalmologic, neurologic, articular, vascular) was present in 43% of patients of group I and II, and 100% in group III. Conclusion: These data support the hypothesis of a continuous spectrum linking severe aphthosis to BD.

To assess clinicians' agreement on how they interpret lung scan reports with regard to the diagnosis of pulmonary embolism.In this prospective study, nuclear medicine physicians provided two types of reports for each lung scan: a routine descriptive report and a short form with a standardized conclusion on the likelihood of pulmonary embolism: "high probability," "no conclusion," and "diagnosis excluded." Three independent blinded senior clinicians reviewed all routine reports and chose one of the following conclusions: "high probability," "no conclusion," or "diagnosis excluded."An acute care teaching hospital near Paris.Eighty-two lung scans were studied.Inter-clinician agreement and agreement between clinicians' conclusions and the nuclear medicine physicians' standardized reports were analyzed using the kappa index.The distribution of the clinicians' conclusions from routine reports strongly differed (p0.001). Agreement among the three clinicians was observed in 40.2% of the routine reports, and the inter-clinician agreement was poor to moderate (kappa range, 0.28 to 0.52). A complete agreement among the three clinicians and the nuclear medicine physicians' standardized conclusions was observed for 32.9% of the reports. The agreement between each clinician and the standardized conclusions was also poor to moderate (kappa range, 0.32 to 0.55).Reading the same routine reports, clinicians reached different conclusions. Furthermore these differed greatly from the nuclear medicine physicians' standardized conclusions. These results support the notion that physicians should be given standardized reports.

Objectifs.— Evaluer la valeur pronostique du score CCP et de l’expression de PTEN pour la prediction de la recidive biologique (RB) dans une cohorte de patients traites par prostatectomie radicale. Methodes.— Six cent patients traites par prostatectomie radicale entre 2000 et 2006 ont ete inclus dans l’etude. Les patients avec un traitement neoadjuvant, un suivi de moins de 6mois, ou un PSA nadir > 0,1 ng/mL etaient exclus de l’etude. La recidive biologique etait definie par l’existence d’au moins deux valeurs consecutives de PSA > 0,2 ng/mL ou l’introduction d’un traitement adjuvant. Le score CCP mesure le taux d’expression de 31 genes du cycle cellulaire et a ete determine comme precedemment decrit. Le taux d’expression de PTEN, a ete etablie par immuno-histochimie en utilisant le seuil de 10% pour definir la positivite. Toutes les analyses d’expression ont ete realisees a l’aveugle sans connaitre le suivi des patients. Resultats.— A ce jour, l’analyse portant sur le score CCP de 452 patients a ete realisee. Les analyses moleculaires n’ont pu etre validees pour 43 echantillons (10 %) qui ont ete exclus. L’analyse univariee en regression logistique des donnees montre que le score CCP est significativement associe a la recidive biologique, avec un odds ratio (OR) pour une augmentation d’un point du score CCP de 1,71 ([95 %CI : 1,23, 2,36] p-value = 0,0006). L’analyse d’expression de PTEN a ete realisee pour 418 patients dont 51 (12 %) ne montraient pas d’expression de PTEN. Cette perte d’expression de PTEN etaient significativement associee a la recidive biologique avec un OR de 1,92 ([95 %CI : 1,05, 3,49], p-value = 0,018). Conclusion.— Dans cette analyse, le score CCP et le taux d’expression de PTEN etaient significativement associee a la recidive biologique apres prostatectomie radicale. L’analyse multivariee sera completee sur 600 patients.

To assess the relationship between immune system and nevi, we studied two models of immunodeficiency caused by different mechanisms, i.e., virus and drug. Our rationale was that if an excess of nevi was found in these two epidemiologic models, it could be concluded that the excess was due to immunodeficiency itself rather than its cause. One hundred ten renal transplant recipients (RTR) were compared with age-, sex-, and phenotype-matched controls. Eighty four HIV-positive patients (HIV+) were compared with similarly matched controls. Nevi5 mm (N5) oror = 5 mm (Nor = 5) were counted in three sites representative of regularly, intermittently, and never sun-exposed sites. The number of N5 was higher in RTR (p0.001) and in HIV+ (p0.001) than in respective controls. Nor = 5 were significantly higher only in RTR. These differences tended to be the same for all sites and persisted after adjustment for possible confounding factors. The incidence of atypical nevus was higher in RTR than in controls. Immunodeficiency seems to promote the occurrence of nevi. This supports the concept of immune surveillance of nevi and raises the question of whether sun-induced immune suppression plays a role in the development of nevi. As nevi are risk markers for melanoma, a higher incidence of melanoma could be expected in immunocompromised patients.

Recent studies have suggested that pemphigus foliaceus is quite frequent in young Tunisian women. In order to confirm this hypothesis, we compared the incidence of pemphigus in general in Tunisia with that in the Ile-de-France region.All new cases of pemphigus diagnosed during a 6-year period were reviewed in our dermatology and pathology laboratories. These cases were classed as pemphigus foliaceus or pemphigus vulgaris on the basis of histology reports.In France, the incidence was 1-7 new cases per million per year (95 p. 100 confidence interval 1.4-2.1). Pemphigus vulgaris was diagnosed in 73 p. 100 of the cases with an incidence increasing with age. Sex ratio (F/M) was 1.2. The incidence observed in Tunisia was significantly higher than that observed in France with 6.7 new cases per million per year (95 p. 100 confidence interval 5.8-7.7). Pemphigus foliaceus was more frequent (61 p. 100), the sex ratio (F/M) was 4.1. Incidence was higher in young women, with 20 new cases of pemphigus foliaceus per million per year among women from 25 to 34 years of age. These levels were higher in rural desert areas. No familial cases were observed and only one case occurred in a child.These findings confirm the specific epidemiology of pemphigus in Tunisia, which appears to be similar and also different from that in Brazilian pemphigus. As in Brazil, there was a predominance of pemphigus foliaceus in young adults living in rural areas in poor socioeconomic conditions. However in Tunisia the disease predominates significantly in women and there are no familial and rare juvenile cases.