[Immunizations: a matter for all physicians].
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Autoimmune Diseases↗
Biomedical subjects
T Hanslik
Publications and source records attributed to T Hanslik.
[Is there an evidence-based management of idiopathic retroperitoneal fibrosis?].
BACKGROUND: Nowadays it is quite easy to diagnose idiopathic retroperitoneal fibrosis (IRF), particularly with the help of medical imaging. However there is no guideline about the treatment. PURPOSE: Looking for data about an evidence-based management. METHODS: Screening of the database Medline. Titles and abstracts of articles published between 01/01/1985 and 31/12/2004 have been read to identify clinical trials and series about more than ten patients. RESULTS: No record of any therapeutic trials has been found. Eight series in total, which included 177 patients, were identified. Two of the patients have been treated by an ureteral desobstruction only (endoscopy or nephrostomy), 45 by surgery (ureterolysis), 65 by corticotherapy and 64 both by surgery and steroids. For 38 patients, immunosuppressive drugs were combined with corticotherapy (azathioprine, cyclophosphamide or D-penicillamine). According to the authors, doses and duration of corticotherapy varied. Median follow-up lasted 56 months. The outcome is satisfactory in 73% for surgery alone, 86% for medical treatment alone and 73% for both. The association between steroids therapy and immunosuppressive drugs is efficient in 97% of the cases. No clear data about side effects was mentioned. DISCUSSION: Treatment of the IRF is still empirical, based on surgery and corticotherapy. There is no guideline about the treatment strategy. Although tamoxifen has been proposed, efficacy evidence is lacking. Prospective multicenter studies will help us to progress in the management of the IRF.
Adrenal Cortex Hormones↗
[Acute schistosomiasis in French travellers].
OBJECTIVE: The clinical presentation of acute schistosomiasis in travellers differs from those observed with chronic schistosomiasis in people from endemic areas. The objective of this study is to describe the main clinical and biological characteristics of the acute schistosomiasis in French travellers. METHODS: Retrospective study conducted in 42 hospital laboratories of parasitology in France, based on a questionnaire filled out for each case of schistosomiasis diagnosed in subjects non-originating from an endemic country and returning from of a stay in Africa, between 2000 and 2004. RESULTS: Seventy-seven cases of acute schistosomiasis diagnosed between 2000 and 2004 were reported by 15 of the 33 laboratories having taken part in the study. The patients were 26 years old on average and 60% were contaminated in West Africa. Seventy patients (91%) presented at least one symptom at the moment of the diagnosis, but only 44 (57%) presented sufficiently intense symptoms to justify a medical consultation spontaneously. The most frequently reported clinical signs were fever (44%), diarrhoea (40%), pruritus (25%), cough (21%) and hematuria (20%). Hypereosinophilia (82%), elevated liver enzymes and positive serology were respectively reported in 82, 23 and 90% of the cases. Ova were found in the urines or the stool in 60% of the cases. Eleven patients were hospitalized. DISCUSSION: Acute schistosomiasis must be evoked in patients returning from endemic country and presenting with non-specific symptoms; including patients whose bathes in contaminated water was limited to a short contact of the feet in a river. The high frequency of the asymptomatic or paucisymptomatic forms exposes the infected people to a delayed diagnosis and therefore to an evolution towards the chronic form of schistosomiasis. The increase in tourism towards the endemic areas could be accompanied by an increase in the frequency of the schistosomiasis, and encourages setting-up an active monitoring of acute schistosomiasis.
Acute Disease↗
[Use of nitrates in hospitalised elderly patients aged 65 and over].
BACKGROUND: Nitrates are frequently prescribed drugs, although their indications are limited. We studied nitrates' prescription in elderly patients hospitalised in the internal medicine ward of a French teaching hospital. METHODS: Hospitalised patients aged 65 years and more and receiving nitrates in their usual treatment were identified prospectively. A standardised questionnaire was used during a structured medical interview conducted by the same physician for all patients. Informations regarding nitrates' prescription were studied according to the actual recommendations for their use: angina in patients with contraindication to betablockers, acute myocardial infarction and acute pulmonary oedema. RESULTS: Among 256 hospitalised elderly patients, 49 (19% [IC95%: 15-25]) were under nitrates therapy, because of either angina pectoris, heart failure or unknown reason. Cardiologists prescribed nitrates in accordance with guidelines significantly more frequently than non-cardiologists. Transdermal treatment was used in 69% of patients. DISCUSSION: In hospitalised patients aged 65 years and more who are prescribed nitrates in their usual treatment, at least one quarter have no recommended indication for its use. As almost one fifth of patients are receiving nitrates in their usual treatment, the medicoeconomic impact of these useless prescriptions could be significant. Nitrates prescribing can be optimized by following guidelines for their use, and restraining from prescribing the transdermal treatment which is more costly and without evidence-based clinical benefit compared to the oral route.
Aged↗
[Risk-benefit assessment of hepatitis B vaccination in France, 2006].
PURPOSE: Rare and unexpected adverse events following hepatitis B immunization have been reported. This article aims to illustrate the risk-benefit assessment of hepatitis B immunization strategies, using the available evidence in medical literature. CURRENT EVENTS: i) Hepatitis B vaccination efficacy is high in infants, children and adolescents. It may be lower in adults and at risk populations; ii) Hepatitis B descriptive epidemiological data in France are scarce, fragmental, unprecise and changing according to the studied population strata. The incidence of symptomatic cases in the general population is below 5 per 100,000 since the year 2000. In France, it is estimated that about 300,000 adults are carriers of HBs antigen, and thus able to transmit the disease; iii) The actual French pharmacovigilance signal and the epidemiological studies may suggest the hypothesis of an association between the occurrence of central nervous system demyelinating diseases and hepatitis B vaccination. If this association exists, the relative risk is probably of less than 3. PERSPECTIVES: The lack of accuracy of risks estimates complicates the risk-benefit assessment of hepatitis B vaccination. Its perception is then influenced and distorted by subjective factors, underlying the need for research in communication about benefits and risks of immunizations. Although still debated, the hypothesis of a putative role of hepatitis B vaccine in the pathophysiology of demyelinating diseases should prompt to pursue experimental and epidemiological research to better understand the links between infectious environment and inflammatory chronic diseases.
Adult↗
[Reversible lower limb lymphedema as the first manifestation of cutaneous periarteritis nodosa].
INTRODUCTION: Cutaneous periarteritis nodosa is a localized form middle-sized arteriolitis. Its main clinical features are nodules, livedo reticularis and ulcers of the lower limbs. EXEGESIS: We reported a 45 year-old woman with distal lower limb lymphedema. Lymphedema initially spontaneously remitted but recurred nine months after, accompanied with nodules. Cutaneous periarteritis nodosa was diagnosed on histological findings and absence of extracutaneous manifestations. Lymphoscintigraphy showed functional lymphatic insufficiency. Treatment consisted of prednisone followed by colchicine and dapsone. After six months of follow-up, patient remained symptom-free. CONCLUSION: We report the first case of lower limb lymphedema associated with cutaneous periarteritis nodosa. Parallel course and unusual corticosensivity of lymphedema and nodules raised the problem of their non coincidental association.
Anti-Inflammatory Agents↗
[Prevalence and management of heart failure in France: national study among general practitioners of the Sentinelles network].
BACKGROUND: Epidemiological data on heart failure's epidemiology in France are scarce and mostly hospital based. The present study's objective is to estimate the prevalence of heart failure (HF) and its management, in subjects aged 60 years and older seen by the French general practitioners (GP). METHODS: A standardised questionnaire was mailed to 900 GPs of the Sentinelles network, requiring answers for any patient aged 60 years and more, seen on a randomly assigned single day of year 2002. National census and health insurance data were used to estimate prevalence. RESULTS: 434 GPs answered, reporting data for 1797 patients aged 60 years and more. The 214 patients with HF, aged 79 years on average, had been seen by a cardiologist in 95% of cases. Results of an echocardiography was available for 58% of HF patients. Compared to non-HF patients, patients with HF were significantly more dependent, more frequently requiring home visit of the GP and more frequently hospitalised (p < 0.001, age adjusted). All the 42% HF patients with a reported left ventricle ejection fraction lower than 40% were treated with an angiotensin converting enzyme inhibitor or an angiotensin receptor inhibitor. The prevalence of HF among patients aged 60 years and older was estimated at 11.9% in general practice (95% confidence interval: 10.5-13.5), and at 2.19% (1.9-2.5) in the general population. The prevalence increased with age, over 20% in persons aged 80 years and more. CONCLUSION: HF in patients aged 60 years and more seen in general practice in France is characterised by a high prevalence and medical consumption in terms of required number of hospitalisation and GP's home visit. For the GP, the diagnosis of HF relies on the cardiologist more than on an echocardiography. The therapeutic management seems to fit the actual recommendations.
Aged↗
[She follows what is current...].
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Aged↗
Lyme disease in France: a primary care-based prospective study.
To estimate the incidence of Lyme borreliosis in France, describe its clinical presentations, and assess its potential risk factors, we conducted a nationwide prospective study in the French Sentinelles Network, consisting of 1178 general practitioners (GPs). Of these, 875 (74%), i.e. 1.6% of all French GPs, participated in the study from May 1999 to April 2000. Eighty-six cases of Lyme disease were reported and validated, of which 77 (90%) consisted of erythema migrans. At national level, the incidence was estimated at 9.4/100,000 inhabitants. Compared to the French general population, Lyme disease patients were older (P<10(-4)), more were living in rural areas (P<10(-3)), and amongst the working population, more were farmers (P<10(-3)) and fewer, salaried workers (P<0.005). Cervidae density correlated strongly with the estimated regional incidence of Lyme disease (r=0.82). Both incidence data and identified risk factors can help to target measures for its prevention and treatment.
Adult↗
Clinical significance of tolerant strains of streptococci in adults with infective endocarditis.
OBJECTIVES: To compare the characteristics of patients with endocarditis due to tolerant and non-tolerant Streptococcus strains. PATIENTS AND METHODS: A retrospective nine-year study was conducted in a single tertiary-care hospital. The study included 24 cases of streptococcal endocarditis with known beta-lactam minimal inhibitory and bactericidal concentrations. RESULTS: Ten of the 24 patients concerned were infected with tolerant streptococcal strains, and 14 with non-tolerant strains. Bacterial tolerance was not associated with higher mortality or increased frequency of surgery. Fewer patients infected with tolerant than non-tolerant strains had serum bactericidal titers reaching success-predictive levels, and more of these experienced failure of initial antibiotic treatment and needed longer treatment. CONCLUSIONS: The results of this study strongly suggest that penicillin tolerance of the streptococci responsible for endocarditis has a clinical impact. Consequently, pending a larger prospective study addressing the problem of tolerance, it is clinically relevant to determine the minimal inhibitory and bactericidal penicillin concentrations for all streptococcal isolates causing endocarditis.
Adult↗
A mathematical model for evaluating the impact of vaccination schedules: application to Neisseria meningitidis.
A mathematical model is described which determines the impact of a schedule of vaccination on the time course of a certain class of diseases. The data are the demographic variables and parameters and age-dependent non-fatal and fatal case rates. Given the age- and time-dependent rates of vaccination including coverage and corresponding efficacies, various schedules may be distinguished by either the absolute numbers of cases and deaths avoided or the numbers of cases and deaths avoided per dose of vaccine. The model was applied to meningo-coccal serogroup C disease in France. The outcomes of six different vaccination schedules were examined. In absolute terms, a schedule in which all individuals aged between 2 and 20 years were vaccinated performed best, but this schedule and that in which only 1-year olds were vaccinated performed equally and best in terms of cases prevented, but not lives saved, per dose.
Adolescent↗
Varicella in non-immune persons: incidence, hospitalization and mortality rates.
This study was conducted to estimate the varicella morbidity and mortality rates per age group among the non-immune population in France. Morbidity and mortality data for the years 1990-9 were derived from nationwide databases and surveillance systems. An incidence/prevalence model was designed to quantify the non-immune population per age group. The incidence of varicella in the non-immune population peaks during childhood and again in the 25-35 years age group. For children aged 1-4 years, adults aged 25-34 years and those older than 65 years, the hospitalization rates are respectively 235, 1,438 and 8,154 per 100,000 cases, and the death rates are respectively 7, 104 and 5,345 per million cases. Case fatality or case hospitalization rates were not evenly distributed among adults and increased dramatically with age.
Adolescent↗
Vaccinations and multiple sclerosis.
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Case-Control Studies↗
French cardiovascular mortality did not increase during 1996 European football championship.
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Cardiovascular Diseases↗
Vitamin K in anticoagulation therapy.
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Anticoagulants↗
[Surgical decompression treatment of leprous neuritis at the Bom-Pastor Hospital (Brazilian Amazonia)].
PURPOSE: Only leprosy resource centres undertake surgery for neuritis. Patients' accessibility to this surgical procedure is poor because these centres are often far from their homes. The aim of our work is to study the feasibility of neuritis surgery in the field. METHODS: A surgeon trained in this surgery was recruited by Bom-Pastor hospital in Brazilian Amazonia, which is located 400 km away from the leprosy resource centre. Patients operated from May 1996 to December 1997 were enrolled in this retrospective study. RESULTS: A total of 45 operations were carried out during 17 procedures on 13 patients, among which 12 were multibacillary cases. The decompression surgery was performed with a median delay of 1 year after leprosy diagnosis and 3.5 months after the neuritis diagnosis. Among 17 operations, 14 were performed for painful neuritis of recent onset unsuccessfully treated with corticoids or recurring during the month after corticoids were withdrawn. The other three operations were performed for long-standing neuritis with paralysis and deformity. Pain was relieved in all the cases of recent neuritis, except for one patient who suffered from a serious steroid-dependant erythema nodosum leprosum. An improvement of motor function was observed in one out of three patients with long-standing neuritis. Adverse effects were few: a scar infection with a rapid recovery and a keloid scar. Two neurites recurred 2 and 10 months after the surgery. CONCLUSIONS: In an endemic leprosy region, field access to surgery for neuritis appears to prove real progress in the management of leprosy neuritis.
Adolescent↗
The control chart: an epidemiological tool for public health monitoring.
The objective of the authors is to apply the control chart, a statistical method for quality control used in industry, to public health surveillance. A pilot study was conducted during the 1998 World Football Cup (WFC) by 553 sentinel general practitioners (GPs) throughout France. The average number of cases of communicable, environmental and societal diseases relating to mass gatherings, and the total number of referrals to hospital reported daily by a GP, were plotted on a u-chart for each condition monitored. This average was beyond the statistical control limits if it fell outside the 99.7% confidence interval of the baseline incidences estimated before the WFC. Seven hundred and forty data points representing 262 279 medical encounters were plotted. Nineteen points exceeded the statistical control limits. None of these alerts was confirmed for two consecutive days. Control charts ensured that the level of the items chosen for general community health surveillance remained under control.
Anniversaries and Special Events↗
Postdischarge nosocomial infections in primary care.
OBJECTIVE: To study both surgical and nonsurgical nosocomial infections (NIs) seen by primary-care physicians (general practitioners [GPs]) in France. DESIGN: Ongoing surveillance of postdischarge NIs by an organized group of GPs, from August 1997 to July 1999. Both the GP who personally examined the case spontaneously presenting with NI and the responsible hospital physician or surgeon were interviewed by telephone. SETTING: 305 general practices from all French regions. RESULTS: 2,199 (29%) of 7,540 patients referred for hospitalization reconsulted the GP within 30 days of discharge. In 21 (1%) of the 2,199 cases, an NI was diagnosed by the GP and confirmed as plausible by the responsible hospital physician. We diagnosed an NI in 8 (1.3%) of the post-surgical patients and in 13 (0.8%) of the non-surgical cases within the cohort. We saw eight urinary tract infections, seven surgical-site infections, three soft-tissue infections, two respiratory tract infections, and one primary bloodstream infection. In 19 patients (90%), clinical signs of NI appeared within 7 days of discharge. Assuming that all 5,431 patients who were missed for follow-up did not experience any NI, an attack rate of 0.3 per 100 admissions may be estimated for the whole group. CONCLUSION: We diagnosed 1% of NIs following discharge from a hospital in a cohort of 2,199 patients, of which 1.3% were seen post-surgery and 0.8% following nonsurgical admissions. The percentage of postdischarge visits that were for an NI in nonsurgical patients warrants a major effort with feedback to the hospital physician to reduce infection rates.
Aftercare↗