[Screening for diabetic retinopathy using a three-field digital nonmydriatic fundus camera in the North of France]. / Dépistage de la rétinopathie diabétique par télémédecine en utilisant des rétinophotographies non mydriatiques dans un groupe hospitalier du Nord-Pas-de-Calais.

PURPOSE: To evaluate screening for diabetic retinopathy, using three-field nonmydriatic fundus photography, combined with telemedicine, in two hospitals. METHODS: Patients from the Endocrinology Department of Saint Philibert Hospital were screened consecutively from March 2007 to September 2008. Three 45 degrees digital images per eye examination were taken using a nonmydriatic fundus camera and sent by intranet to the Department of Ophthalmology of Saint Vincent de Paul Hospital for grading by two ophthalmologists. RESULTS: A total of 1147 patients (52% males, 48% females) were screened. The mean age was 60 years (range, 19-92 years). Most patients had type 2 diabetes (n=1000; 90%). The mean HbA1c was 8%. Microalbuminuria was detected in 239 patients (20.8%). Of these 1147 patients, 521 (45%) said they had never had a fundus examination before. Fundus photography of at least one eye could not be graded in 160 patients (14%). Diabetic retinopathy was detected in 187 patients (19%). Suspected macular edema (hard exudates within one disc diameter of the macular center) was found in 38 patients (3.8%). Referral to an ophthalmologist was required in 347 patients (30%) for diabetic retinopathy and unreadable photographs. During the period of the study, 107 patients had both three-field nonmydriatic photography and dilated funduscopy, which was used as reference. Agreement between the two readers was 0.97. CONCLUSIONS: Nonmydriatic photography combined with telemedicine is useful for screening for diabetic retinopathy and identifies patients requiring further complete eye examination. Good collaboration between the two centers is required to improve the follow-up after screening in the future.

[Fulvestrant use in clinical practice in France: a pharmacoepidemiologic study]. / Etude pharmacoépidémiologique sur l'utilisation de fulvestrant en pratique clinique en France.

The objective of the study was to assess the prescription patterns of fulvestrant in clinical practice in France through a retrospective observational study. Primary endpoint was treatment duration. Data from patients who completed fulvestrant therapy between January and May 2007 were collected between May and June 2007 in 50 centers selected among a representative study sample of 110 centers. Two hundred seventeen patients were included. For 98-99% of patients, baseline characteristics were consistent with the approved indication in terms of postmenopausal status, estrogen-receptor positive tumors and treatment for advanced disease. Overall, 94% of patients had received previous endocrine therapy: tamoxifen in 60% and aromatase-inhibitor (AI) in 90%, including 35% exposed to AI as the unique prior endocrine therapy. Median duration of fulvestrant therapy was six months, and fulvestrant was the ultimate hormone therapy in 89% of evaluable patients. Fulvestrant is prescribed in the real practice in post-menopausal patients with ER-positive tumors, after prior hormone therapy and for advanced disease in the vast majority of patients, according to drug labeling. Due to the growing population receiving AI after or instead of tamoxifen, most patients given fulvestrant in 2007 in France were previously exposed to AI.

[Hyperhomocysteinaemia and type 2 diabetes]. / Hyperhomocystéinémie et diabète de type 2.

OBJECTIVES: Hyperhomocysteinaemia is associated with cardiovascular events in nondiabetic individuals. The present study was aimed to explore the implication of hyperhomocysteinemia in development of cardiovascular events in patients with type 2 diabetes. DESIGN: A total of 185 patients with type 2 diabetes (115 women and 70 men, 30 to 93 years of age) have been included consecutively in the ambulatory unit at the Saint-Philibert Hospital. For each patient the concentration of homocysteine, cholesterol and triglyceride levels and HbA1c have been measured. In the studied population, 121 patients presented cardiovascular events (myocardial infarctus, peripheric arteriopathy, cerebrovascular accident). RESULTS: The patients with cardiovascular events were older, the concentration of homocysteine and creatinine were higher. The plasma homocysteine levels adjusted for age and creatinine levels were higher in patients with cardiovascular events than in patients without cardiovascular events (15.4 +/- 3.52 micromol/L and 13.13 +/- 2.26 micromol/L respectively; p = 2. 10(-5)). CONCLUSIONS: Hyperhomocysteinemia is an independant risk factor for cardiovascular events in type 2 diabetes, independent of age and renal function.

[Searching for prolactin microadenoma: scanner or MRI?]. / Recherche d'un microadénome à prolactine: scanner ou IRM?

Thirty three hyperprolactinemic women, aged 16-46 years, have been investigated by pituitary CT and MRI scans, searching for a microadenoma. The MRI scan with Gadolinium injection (MRI G+) appeared more efficient than the CT scan to detect a picture highly suggestive of a microprolactinoma (30/33 positive scans vs 21/33, respectively, p = 0.06). However, when the CT scan was performed optimaly (i.e. thin cuts, sequential imaging after iode injection, no artefact), its diagnostic potenty was close to the one of MRI G+, missing only 17.6% of lesions. All these were less than 5 mm in diameter. The indirect signs of microadenoma (focal convexity of the superior surface of pituitary, tilting of pituitary stalk, focal sella floor erosion or destruction) had a minimal value. Their sensitivity was 66.6% and 63.3 for convexity, and 63.3 and 46.6% for tilting of pituitary stalk, by MRI and CT scans, respectively. Therefore, they did not afford any help in our experience. Considering the cost and the limited accessibility of MRI, at least in our country, we advise to use CT scan as the primary morphologic means to detect a microadenoma.