Health resource use and costs of symptomatic knee and/or hip osteoarthritis.

BACKGROUND: Data on the economic consequences of hip and knee osteoarthritis (OA) are scarce. We aimed to estimate the annual direct and indirect costs for patients followed for hip and/or knee OA in the Knee and Hip Osteoarthritis Long term Assessment (KHOALA) cohort. METHODS: The KHOALA cohort, set up from 2007 to 2009, is a French multicenter study of 878 individuals with symptomatic knee/hip OA who were 40-75 years old. Resources used were collected annually for 5 years. Costs were assigned by using official sources and expressed in 2018 euros per patient. RESULTS: The mean annual total costs per patient over the 5-year study period were 2,180 ± 5,305€. The mean annual direct medical costs per patient were 2,120 ± 5,275€ and mean annual indirect costs per patient 180 ± 1,735€ for people of working age. Costs increased slightly over the study period. Drugs were the largest cost share, representing over 50% of all direct costs. However, the proportion attributable to OA drugs accounted for only 10.5% of drug costs. The second cost share was hospitalizations; hip and knee prosthetic surgery accounted for 27% of surgery hospitalization costs. Health professional visits were the third cost share, accounting for 3% of direct medical costs. The median costs induced could be as high as 2 billion €/year (IQR 0.7-4.3) in France. CONCLUSION: Hip and knee OA costs were substantial and increased over the study period in France. However, the costs attributable to OA represented only a small fraction of overall costs.

Calcineurin deficiency decreases inflammatory lesions in transforming growth factor beta1-deficient mice.

Transforming growth factor (TGF) beta1) is an immunoregulatory cytokine involved in self-tolerance and lymphocyte homeostasis. Tgfb1 knock-out (KO) mice develop severe multi-focal autoimmune inflammatory lesions due to [Ca(2+)]i deregulation in T cells, and die within 3 weeks after birth. Because the calcineurin inhibitor FK506 inhibits the hyperresponsiveness of Tgfb1(-/-) thymocytes, and because calcineurin Abeta (CNAbeta)-deficient mice do not reject allogenic tumours, we have generated Tgfb1(-/-) Cnab(-/-) mice to address whether CNAbeta deficiency prevents T cell activation and inflammation in Tgfb1(-/-) mice. Here we show that in Tgfb1(-/-) Cnab(-/-) mice inflammation is reduced significantly relative to that in Tgfb1(-/-) mice. However, both CD4(+) and CD8(+) T cells in double knock-out (DKO) mice are activated, as revealed by up-regulation of CD11a lymphocyte function-associated antigen-1 (LFA-1), CD44 and CD69 and down-regulation of CD62L. These data suggest that deficiency of CNAbeta decreases inflammatory lesions but does not prevent activation of autoreactive T cells. Also Tgfb1(-/-) T cells can undergo activation in the absence of CNAbeta, probably by using the other isoform of calcineurin (CNAalpha) in a compensatory manner. CNAbeta-deficient T cells undergo spontaneous activation in vivo and are activated upon anti-T cell receptor stimulation in vitro. Understanding the role of calcineurin in T cell regulation should open up new therapeutic opportunities for inflammation and cancer.

Quality-adjusted survival in a crossover trial of letrozole versus tamoxifen in postmenopausal women with advanced breast cancer.

BACKGROUND: Results from a phase III study of postmenopausal women with advanced breast cancer demonstrated longer time to disease progression for patients taking letrozole versus tamoxifen. This analysis compares the trade-offs between progression-free survival and toxicity. DESIGN: Quality-adjusted survival was calculated using Q-TWiST (quality-adjusted time without symptoms or toxicity). Survival curves were partitioned into three health states: toxicity (TOX), disease progression (PROG) and periods without toxicity or disease progression (TWiST). The utility-weighted sum of the health state durations was derived and compared. RESULTS: There was not a significant difference in mean duration of serious adverse events prior to progression between the letrozole (n=453) and tamoxifen (n=454) groups (2.2 and 2 months, respectively). For TWiST, the mean duration for letrozole was 11.5 months, versus 8.5 months for tamoxifen (P <0.001). The mean duration of PROG was 11.5 months for letrozole and 12.7 months for tamoxifen (P=0.047). Using utility weights of 0.5 for TOX and PROG resulted in a 2.5-month difference in quality-adjusted survival favoring letrozole (P <0.0001). CONCLUSIONS: The longer time to disease progression with letrozole versus tamoxifen was achieved without increased time with adverse events and resulted in more quality-adjusted survival for patients on letrozole.

Anatomical basis and results of the facial artery musculomucosal flap for oral reconstruction.

The facial artery musculomucosal (FAMM) flap is a newly designed buccal mucosal flap that was first described in 1992. The long rotational arc of this flap is particularly suitable for anterior palatal defects that are otherwise difficult to treat with local flaps. However, after the first clinical reports, some controversies arose about the reliability of this flap, so we conducted an anatomical study of the vascular pattern with a latex preparation in 10 cadavers. We studied the variations of the course of the facial artery and focused on the relationship between the facial artery and vein within the pedicle. We concluded that the flap is more an arterialized flap than an axial-pattern flap, and have given anatomical landmarks to optimize the survival rate. Our preliminary clinical results (five good results, one complete failure) are acceptable.

Study protocol: stability of morphine injected without preservative, delivered with a disposable infusion device.

BACKGROUND AND OBJECTIVE: Morphine hydrochloride, a major analgesic drug, is being increasingly administered using portable disposable infusion devices. The objective of this study was to investigate the stability of morphine in such a system at two concentrations (2.50 and 5.00 mg/ ml) over a 30-day period. METHOD: High-performance liquid chromatography of stored morphine solutions. RESULTS: The best stability was observed with disposable infusion devices filled with a morphine solution containing sodium metabisulphite as a preservative. No breakdown products were detected after 1 month of storage at room temperature, in light or darkness. On the other hand, 2.50 and 5.00 mg/ml morphine solutions without sodium metabisulphite, stored in the infusion device led to the formation of 0.205% and 0.235% of pseudomorphine, respectively, after 6 days of storage in the light, and 1.50% and 0.94% after 30 days storage. CONCLUSION: Morphine hydrochloride solutions stored in disposable infusion devices degraded very slowly, particularly when preserved with sodium metabisulphite. The solutions are stable over 5 days, the maximum period of storage normally required when using disposable infusers.

[Selected indications of embolization of vascular malformations of the face. Apropos of 2 cases]. / Indications raisonnées de l'embolisation dans les malformations vasculaires de la face. A propos de deux cas.

Interventional radiology has dramatically contributed to a better management of patients with a facial vascular malformation. Due to the extent of the lesion, these patients were formerly difficult to cure, but hyperselective embolisation can now overcome these problems with minimal risks. We present our therapeutic approach in 2 cases with favorable results and the choice of an embolization particle is discussed according to recent datas.

Roles for Texas physicians in the implementation of Education of Handicapped Act Amendments.

As a result of Public Law 99-457, there are increasing state efforts to provide special education services to handicapped students ages 3 and older, and to develop early intervention for those from birth to age 3 years. Physicians can make significant contributions to these efforts. This paper presents information about PL99-457 and discusses the potential roles for Texas physicians in the implementation of the law and in meeting the needs of developmentally at-risk infants, young children, and their families. Roles are described in the areas of clinical care, research, graduate and continuing education, and policy development.

Correction of selenium deficiency in hemodialyzed patients.

Selenium is an essential trace element important for glutathione peroxidase activity. Selenium deficiency has been found in association with skeletal and cardiac myopathy and may increase the risk for cardiovascular diseases and for cancer. We studied 39 hemodialysis patients and 15 control subjects. Plasma selenium, plasma glutathione peroxidase activity and erythrocyte glutathione peroxidase activity were lower than in controls (38 +/- 14 vs. 88 +/- 17 micrograms/liter (P less than 0.01); 153 +/- 32 vs. 334 +/- 41 IU/liter (P less than 0.01), 19 +/- 4 vs. 26 +/- 4 IU/g Hb (P less than 0.01), respectively). Plasma selenium and plasma glutathione peroxidase activity were strongly correlated with duration of dialysis. There was no correlation between plasma selenium and protein or calorie intakes. Plasma selenium was lower in patients dialyzed with highly permeable membranes (P less than 0.01). The total muscle mass, assessed by anthropometry, was lower in the patients who had the lowest plasma selenium (P less than 0.01) and plasma glutathione peroxidase activity (P less than 0.05). Interventricular septum hypertrophy, documented by echocardiography, was greater in patients with the lowest plasma selenium and plasma glutathione peroxidase activity (P less than 0.01). Twenty hemodialysis patients had oral supplementation of 500 micrograms/day of sodium selenite for three months, and then, 200 micrograms/day for the next three months. Plasma selenium increased as early as the first week and reached a plateau similar to the control levels after three weeks. Plasma glutathione peroxidase activity increased after two months but remained below controls. Erythrocyte glutathione peroxidase activity reached a higher value than controls after one month.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correction of selenium deficiency in patients with renal failure undergoing hemodialysis]. / Correction du déficit en sélénium chez des insuffisants rénaux hémodialysés.

Plasma selenium levels (p Se) as well as glutathione peroxidase activity in plasma (p GPx) and in erythrocytes (e GPx) were measured in 39 haemodialysis patients. Glutathione peroxidase is a selenium-dependent enzyme which protects cells against oxidation. The mean level values obtained were significantly lower in patients than in controls: p Se: 38 +/- 14 versus 88 +/- 17 micrograms/l; p GPx: 15 +/- 32 versus 334 +/- 41 IU/l; e GPx: 19 +/- 4 versus 26 +/- 4 IU/g Hb. These values were found to correlate significantly with the duration of dialysis and with the type of membrane utilized. The total muscular mass was significantly smaller in patients with the lowest p Se or p GPx values. At echocardiography, septal hypertrophy correlated with both p Se and p GPx. Twenty patients were supplemented with sodium selenite administered orally at the end of each haemodialysis session during 6 months. After this period, muscular mass and septal hypertrophy were decreased and the echocardiographic contractility parameters were improved, albeit not significantly.

[Aneurysms of the celiac trunk. Review of the literature. Personal deductions apropos of 2 cases]. / Anévrismes du tronc coeliaque. Revue de la littérature - Déductions personnelles à propos de 2 observations.

Aneurysm of the celiac trunk is the rarest lesion of this type reported in the digestive arterial system. Two cases are reported and the 78 lesions of a similar nature documented in the literature reviewed. The etiology at the present time is mainly atheroma in the over 50' s and dysplasia of the elastic tissue in young subjects. Clinical diagnosis is difficult since symptomatic forms are the cause of errors and latent forms frequent (41 p. 100 of cases). Preoperative angiography must be a complete investigation and allows study of splanchnic vascularization and the presence of collaterals. When there are no contraindications, surgical treatment can prevent progression to rupture. After resection or reduction of the aneurysm revascularization may be envisaged but is not essential: --in the first case reported the failure of revascularization proved its inutility, --whereas failure in the second case led to severe hepatic and gallbladder complications. Successful results have been obtained in 90 p. 100 of 41 cases operated upon since the initial surgical treatment performed by Shumaker in 1958 [47].

[External drainage during surgery for biliary lithiasis. Our present attitude (author's transl)]. / Le drainage externe dans la chirurgie de la lithiase biliaire. Notre attitude actuelle.

External biliary drainage, the "routine" manner of terminating surgery on the common bile duct, should now become almost obsolete as new methods for operation and exploration during surgery are perfected. A review of cases receiving biliary surgery over a period of 20 years showed that external biliary drainage was conducted in only 4 p. cent of operations on the common bile duct (excluding biliodigestive anastomoses). External biliary drainage should be employed only after due reflection : trans-cystic drainage, the "minor" form, will be indicated less and less as investigational methods during operation develop, while Kehr's drain, the "major" form, will occupy a limited but necessary place in certain cases, primarily in angiocholitis.

["Oddipathies" (author's transl)]. / Les "oddipathies".

The modern anatomy has notably increased the knowledge of details, in biliary surgery, mainly about the sphincter of Oddi, thanks to the use of an adequate radio diagnosis set in the operating room. The term of Odditis is too widely used. It must be replaced by Oddipathies, each disease being defined by its nature and its precise location. Medical and surgical therapy will be adapted to this millimetric scale.