Intra- and inter-rater consistency of dual assessment by radiologist and neurologist for evaluating DWI-ASPECTS in ischemic stroke.

OBJECTIVES: To estimate the intra -and inter-rater consistency of radiologist and neurologist working in pairs attributing DWI-ASPECTS (Diffusion Alberta Stroke Program Early CT Score) in patients with acute middle cerebral artery ischemic stroke referred for mechanical thrombectomy, intravenous thrombolysis or bridging therapy. METHODS: Five neurologists and 5 radiologists working in pairs and in hour period scored independently and in two reading sessions anonymized DWI-ASPECTS of 80 patients presenting with acute anterior ischaemic stroke in our center. We measured agreement between pairs using intraclass correlation coefficients (ICCs). A Fleiss kappa was used for dichotomized (0-6;7-10) and trichotomized (0-3;4-6;7-10) ASPECTS. The interrater distribution of the score in the trichotomized (0-3;4-6;7-10) ASPECTS was calculated. We determined the interrater (Cohen kappa) and intrarater (Fleiss kappa) agreement on the ASPECTS regions. RESULTS: The average DWI-ASPECTS was 6.35 (SD±2.44) for the first reading, and 6.47 (SD±2.44) for the second one. The ICC was 0.853 (95%CI, 0.798-0.896) for the interrater, and 0.862 (95%CI, 0.834-0.885) for the intrarater evaluation. Kappa coefficients were high for dichotomized (k=0.75) and trichotomized (k=0.64) ASPECTS. Evaluators agreement on the ASPECTS category (0-3), (4-6) and (7-10) was 88, 76 and 93% respectively. The anatomic region infarcted was well identified (k=0.70-0.77), except for the internal capsula (k=0.57). Interrater agreement was fair for M5 (k=0.37), moderate for internal capsula (0.52) and substantial for the other regions (0.60-0.79). CONCLUSIONS: Reliability of DWI-ASPECTS is good when determined by radiologist and neurologist working in pairs, which corresponds to our current clinical practice. However, discrepancies are possible for cut-off determination, which may impact the indication of thrombectomy, and for the determination of the exact infarcted region. Agreement to propose category (4-6) is lower than for (0-3) and (8-10) ASPECTS categories.

[Congenital undescended testis: Should open processus vaginalis have any impact on the elected surgical approach?] / Cryptorchidie : la présence d'un canal péritonéo-vaginal perméable devrait-elle influer dans le choix de la technique chirurgicale ?

PURPOSE: Compare the position of the undescended testis at clinical examination and under general anesthesia with the patency of an open processus vaginalis. PATIENTS AND METHODS: We included children from 2 to 18 years of age operated for a unilateral or bilateral undescended testis between January 2006 and April 2014 at the Annecy Genevois hospital, France. The analysis was conducted considering that the individual was the testis. Testicular position before surgery, under general anesthesia and patency of open processus vaginalis as a surgical finding were prospectively recorded. RESULTS: Three hundred and six children were included. The analysis was conducted over 401 testes. The position at clinical examination was significantly linked to a persistent open processus vaginalis (P=0.0045). Over the 282 testes considered as candidate for Bianchi's procedure, as to say intra- or supra-scrotal under general anesthesia, 154 had a persistent processus vaginalis (55%). CONCLUSION: There is a link between a persistent processus vaginalis and the location of the undescended testis which should encourage us not to neglect the inguinal approach, and eventually to question the relevance of Bianchi's procedure. LEVEL OF EVIDENCE: 4.

[Renal cell carcinoma: A 12-year retrospective study of epidemiologic, therapeutic and follow-up data]. / Étude rétrospective d'une population de carcinomes à cellules rénales sur 12ans : épidémiologie, prise en charge thérapeutique et impact sur la survie.

OBJECTIVE: To describe the evolution of epidemiology and management of renal cell carcinoma and their impact on overall and progression-free survivals. PATIENTS AND METHODS: We reviewed the files of consecutive patients with renal cell carcinoma in our center between January 2000 and December 2011. Patients with confirmed diagnosis on histology who underwent radical nephrectomy, partial nephrectomy or thermoablation were included. Benign tumors were excluded. Epidemiologic and therapeutic data during the period of study were compared. Overall and progression-free survivals divided in three periods were compared by Kaplan-Meier curves. RESULTS: Four hundred and forty-nine patients were included with a median age of 60 years old [21; 89], and median follow-up of 39 months. Tumor histology was clear cell carcinoma in 75.9% of cases. During the period of study, patients with ASA score upper than 3 increased from 20.4% to 47.8%, tumor size decreased from 58.4mm to 49.5mm and incidental tumor discovery increased from 59.1% to 71.6%. Nephron-sparing surgery increased from 19.7% to 44%. Overall survival and progression-free survival was not different during this period (P=0.071 and P=0.582). CONCLUSION: The increase in early incidental discovery of renal cell carcinoma allowed nephron-sparing surgery in spite of patients with more comorbidities, with stable overall and progression-free survivals in our series.

[Evaluation of HBA1C measurement on Architect CI8200 (Abbott Diagnostic). Comparison with HPLC D-10 Bio-Rad assay]. / Evaluation d'une technique de détermination de l'HBA 1C sur Architect CI8200 (Abbott Diagnostic). Comparaison avec la technique HPLC D-10 Bio-Rad.

The aim of this study is to present an evaluation of HbA(1c) Assay on Architect CI8200 (Abbott Diagnostic). The measurement includes Hb assay by colorimetry and HbA(1c) by immunoturbidimetry. The percentage of HbA(1c) is the report HbA(1c)/complete Hb with a conversion coefficient. Repetability (n = 30; CV: 1.15-1.91%) and reproductibility (n = 30; CV: 2.09-2.64%) are good. Abbott results cannot be returned above 12%. Comparison between HbA(1c) Abbott and HbA(1c) Bio-Rad is performed on 161 patients samples ranging from 4.7 and 12%. Results show a correlation coefficient of 0.9847 (N = 161) with a regression equation: [Abbott] = 1.02x [Bio-Rad]-0,636]. Differences between two methods are normally distributed. 95% of differences lie between limits (-0.61%; +0.61%). Such differences are clinically important and interchangability of two measurements can't be possible now because lack of agreement. We hope that IFCC standardization will reduce these differences. Presence of a jaundice and carbamylation of haemoglobin do not interfer with Abbott assay. Hemoglobin variants are not detected. Therefore, monitoring of diabetic patients with HbA(1c) is possible only if hemoglobinopathy has been identified before.

[Are pertussis vaccination guidelines applied to adults and health care workers?]. / La vaccination anticoquelucheuse de l'adulte et des professionnels de santé est-elle connue et appliquée?

UNLABELLED: The prevalence of pertussis in newborns led French health authorities to recommend using a booster dose at 13 years of age, and adding a booster dose for parents, siblings, and health care workers. OBJECTIVE: The aim of the study was to check if the new recommendations were applied by health care workers and if mothers still in the maternity ward were informed and agreed with these recommendations. METHOD: A questionnaire assessing knowledge, acceptance of the recommendations was sent to different health care workers and given to mothers in two maternity wards. RESULTS: Three hundred and seventy-five questionnaires filled out by health care workers were analyzed (298 general practitioners, 30 pediatricians, 24 obstetricians, 21 midwives) and 100 questionnaires by mothers. Only 1% of mothers and 55% of health care workers knew about the new recommendations, but only 8.3% of obstetricians and 4.8% of midwives. 92.6% of health care workers considered they were justified, but not applicable in 21.3%, 75% declared informing mothers systematically, and 14.5% documenting their pertussis vaccine status. The vaccination status was greater than 80% for diphtérie-tétanos-polio (dTP) in health care workers, 29.5% of these workers and 49% of mothers considered being vaccinated in a near future. CONCLUSION: Information, educational campaigns and specific actions are needed to apply the new recommendations which will warrant the success of targeted vaccination, in order to reduce pertussis in infants of more than six months of age.

[TIMMA: Ultrasonographic scale of carotid atherosclerosis by vascular neurologists]. / TIMMA : échelle échographique de la surcharge athéromateuse en carotide pratiquée par des neurologues vasculaires.

BACKGROUND: Carotid atherosclerosis is a powerful predictive factor of vascular risk at the individual patient level. Ultrasonography is a reference technique for the evaluation of this condition. However, its use in common practice remains difficult due to a lack of standardization and inter-operator variability. We present a new and simple technique for the assessment of carotid atherosclerosis; and evaluate the ability of vascular neurologists to obtain results consistent with those of an expert in vascular ultrasound. MATERIAL AND METHODS: The TIMMA scale is an acronym for the five classes of carotid atherosclerosis in French, VIMMA in English: very important, important, moderate, minimal and absent. Combined, the first two classes make up the group "significant atheroma" and the last three classes make up the group "no significant atheroma". This scale was evaluated in 38 patients (76 carotid arteries) suffering from ischemic stroke or transient ischemic attack by five operators who are competent in carotid echocardiography: one TIMMA-trained (40 hours of training) vascular neurologist physician (VNP), three VNPs informed on the measurement method (1 hour of information) and one specialized vascular physician (SVP) who was considered to be the reference examiner. We evaluated the concordance between the VNPs and the SVP in classifying patients, firstly into the significant or not atheroma group and, secondly, into the five TIMMA classes. RESULTS: The evaluation of the two-group clustering scale found a concordance between the informed VNPs and the SVP on 76 carotid arteries of 86% (kappa=0.7) and between the trained VNP and the SVP on 58 carotid arteries of 90% (kappa=0.8). The positive and negative predictive values for significant atheroma diagnosis were 100% and 81%, respectively, for the informed VNPs, and 100% and 80% for the trained VNP. The evaluation of the Five-Class Scale showed a concordance between the informed VNPs and the SVP of 46% (kappa=0.3), and between the trained VNP and the SVP of 74% (kappa=0.7). CONCLUSION: TIMMA allows VNPs who are competent in carotid ultrasonography to reproducibly identify subjects with significant carotid atheroma. The contribution of this scale to the determination of cardiovascular risk should be evaluated.

[Optimize the resuscitation of prehospital cardiac arrest in trauma patients: a prospective register's experience]. / Optimiser la réanimation des arrêts cardiaques traumatiques préhospitaliers : l'expérience d'un registre prospectif.

OBJECTIVES: Describe the epidemiology and the survival of patients with traumatic cardiac arrest (CA), and compare them to those with nontraumatic CA. Highlight the weaknesses in their care and consider ways to improve their survival. METHOD: Traumatic and nontraumatic CA are described using the Utstein style in the "réseau nord-alpin des urgences" registry. Regarding the traumatic CA, we focus on circumstances, types of injuries and specific resuscitation techniques used. RESULTS: From 1st January 2004 to 31st December 2005, prehospital medical teams provided care to 1552 victims of CA, 129 of whom were trauma patients (8.3%). Average age was 47.1 years; 74.4% were males. Blunt trauma occurred in 94.6%. None of the patients had chest tube insertion or thoracotomy on the scene. A return of spontaneous circulation was observed in 24.8%, the survival after 24h was of 3.9%, and 0.8% of patients remained alive 1 year following the accident. The topography of lesions responsible for the CA as well as the fact that these lesions are limited or multiorgan influence the survival. CONCLUSION: The survival of patients with prehospital traumatic CA is catastrophic and it is worse than that of patients with nontraumatic CA. However, a specific earlier and more adapted prehospital resuscitation could help improve this survival.

Transpedicular screwing of the seventh cervical vertebra: anatomical considerations and surgical technique.

The purpose of this study was first to assess the feasibility of C7 transpedicular screwing with a morphological study and secondly to evaluate the safety of such a surgical technique when guided only by posterior landmarks. Eighteen C7 vertebrae, harvested from fresh human cadavers, were included in this study. First the morphometry of C7 pedicle was performed on computed tomography with multiplanar reconstructions. Results of this quantitative anatomy were compared with the literature data. Secondly 30 pedicle screws, whose placement was guided only by anatomical features on the posterior face of the dorsal arch, were inserted in 15 C7 vertebrae. A second computed tomographic examination was done after the surgical procedure to check the screw placement in both planes. The average pedicular width was 6+/-1.2 mm and the average height was 5.8+/-1.1 mm. The pedicle angulation in the transverse plane was 33.3 degrees +/-6.6 degrees, the pedicle angulation in the sagittal plane was 4.3 degrees +/-4.5 degrees downward with reference to the lower endplate of C7. The average distance from the entry point of transpedicular screwing to the anterior cortex of the vertebral body was 29+/-3 mm. Concerning the safety of transpedicular screwing, 63% of screws were found entirely inside the pedicle without any violation of the pedicle cortex. Most of pedicle violations were observed in the transverse plane. No grade II violation of the pedicle was observed. Dimensions of the C7 pedicle are amply compatible with transpedicular fixation using 3.5 mm screws. Such a surgical technique seems to be an interesting option when posterior fixation of C7 is required. Nevertheless morphological guidelines appeared not to be sufficient to ensure safe transpedicular screwing. Laminoforaminotomy is strongly recommended, although it has not been evaluated in this study.