[Another way to take care of diabetic patients: diabetic pathway "diabaide"]. / Une autre prise en charge des patients diabétiques: la filière de soins coordonnée "diabaide".

The diabetic pathway project is based on the objective of bettering the care of diabetic patients, through a new organisation of the care which should be more based on collaboration, on the sharing of information and on the coordination of activities. This project concern 6000 patients. The diabetic pathway is organised into three groups of intervention. The group called "first intention" (patient, physician and pharmacist), the multidisciplinary group (team of specialized professionals in diabetes care) and the group of independent professionals. The patients care is based on common procedures and guidelines. The physician remains the agent of the patient.

[Dissemination of genetic counseling and prenatal diagnosis: impact of the physicians' knowledge]. / Diffusion du conseil génétique et du diagnostic prénatal: l'impact des connaissances des médecins.

This article presents a survey carried out among 2,549 doctors (general practitioners, pediatricians, obstetricians and gynecologists) practicing in two south of France "departements" (administrative subdivisions): Bouches-du-Rhône and Hautes-Alpes. The influence of socio-demographic and professional characteristics on knowledge of prenatal diagnosis indicators is studied here for each specialty. While knowledge among general practitioners is apparently a product of their formal education, among gynecologists and obstetricians the most important factor seems to be professional experience. In France, the GP is a central figure in referrals for genetic counselling and prenatal diagnosis, hence the importance of improving his training and possibilities of continuing education.

[J.M. Charcot's gerontology]. / La gérontologie de J.M. Charcot.

Charcot always took a deep interest in diseases of old age and he found a large field of research in the Salpêtrière where there were some 5 000 old people. In 1867 he published his "Lecons sur les maladies des vieillards et les maladies chroniques" with chapters especially devoted to gout and rheumatism. The book, with additions, was translated into English in 1881. Charcot was interested in the forms of fever and he compared them in the child, the adult and the aged. He recommended that in old people rectal temperature be measured since it may be high while skin and axillary temperature are normal. Charcot distinguished: 1) diseases specific to old age, e.g. senile marasmus, cerebral atrophy, senile tremor. 2) diseases met at any age but more severe in the aged, e.g. respiratory diseases; 3) diseases to which old people oppose less resistance, e.g. tuberculosis, typhoid fever. Among many studies of Charcot on diseases of old age, the present paper recalls those devoted to pneumonia, asthma, tuberculosis, arterial, i.e. aneurysmal, embolic, atheromatous diseases, diseases of the liver, digestive and urinary tracts. In all those papers as well as in his bedside teaching. Charcot insisted that pathology was the basis of clinical practice: "tant vaut le pathologiste, tant vaut le clinicien".

[The brain of Paul Broca (1824-1880). Correlation of pathological and computed tomography findings (author's transl)]. / Le cerveau de Paul Broca (1824-1880). Confrontation anatomo-pathologique et tomo-densitométrique.

This historical study briefly recalls the circumstances of Broca's death, and reports some new data concerning his autopsy, and an analysis of macroscopic, microscopic, and computed tomography appearances of his brain following its discovery by Huard. The authenticity of the origin of the brain was established, and the hypothesis the Broca's death was due to rupture of a vascular malformation or a cerebrovascular accident was confirmed.

[Therapeutic attitude to HIV infection: uncertain and variable scientific attitudes. 1998 national survey of physicians prescribing antiretroviral drugs]. / Attitudes thérapeutiques pour l'infection à VIH: incertitudes scientifiques et variabilités. Enquête nationale 1998 auprès des médecins prescripteurs d'antirétroviraux. Groupe PAMPA. Pratiques et Attitudes des Médecins Prescriteurs d'Antirétroviraux.

OBJECTIVES: Analyze the attitudes of French practitioners managing HIV infected patients towards multidrug antiretroviral therapies with protease inhibitors, open issues, and the official guidelines (Dormont report). METHODS: A telephone survey was conducted in February-March 1998 on a random sample of the nation file of hospital physicians prescribing antiretroviral drugs (response rate 87%, n = 483). RESULTS: The responding clinicians were in general agreement on defining virological efficacy at three months treatment as an undetectable viral load (86.5%). There was a general concensus on multidrug therapy with a protease inhibitor in case of primary infection (83.2%) or sexual exposure with risk of HIV transmission (83.2%). Inversely, only 43.7% abandoned PCP and toxoplasmosis prophylaxis in patients with CD4 counts above 350/mm3 taking tritherapy antiretroviral regimens. When asked to state their approach to a hypothetical case of an asymptomatic patient with a CD4 count of 450, 35.6% would not propose multidrug therapy with an antiprotease, 29.8% would only envisage such a regimen if the viral load was above 10,000 copies/ml, and finally 34.6% would prescribe a multidrug regimen with a protease inhibitor whatever the viral load. CONCLUSION: The variability observed in routine clinical practices would appear to be justified in light of the uncertainty about the long-term effects of the new antiretroviral drugs for HIV/AIDS.