Adherence to fracture liaison service programs in patients over 70: the hidden part of the iceberg.

Significant dropout rates have been observed throughout Fracture Liaison Service (FLS) programs, especially for elderly patients. In an FLS program set up specifically for patients over 70, the non-initiation of osteoporosis treatment was the only factor associated with poor adherence to the program. Neither age nor frailty factors affected adherence. INTRODUCTION: FLS programs are considered the most effective interventions for secondary prevention of osteoporotic fractures. Our objective was to identify risk factors for non-adherence to an FLS program set up specifically for patients over 70. METHODS: Our multifaceted, intensive program included five appointments over a 2-year period. One hundred sixty-seven patients (mean age 83.5 years) who presented with a recent fragility fracture were enrolled. Multivariable analysis was conducted to determine whether the demographic, clinical, frailty, and osteoporotic risk factors of the patients influenced their adherence to the program. RESULTS: About half of the patients did not attend the follow-up visits. According to the regression analysis, non-initiation of osteoporosis treatment was associated with poor adherence to the program (aHR 3.66). Demographic, clinical, dwelling, frailty factors, osteoporotic risk factors, fracture type, or densitometric scores were not associated with adherence. The first self-reported reason for withdrawal was the difficulty of attending several follow-up visits, and the second was the feeling of not being concerned. CONCLUSION: We observed that non-initiation of osteoporosis treatment was the only factor correlated with non-adherence to an FLS program. Thus, neither age nor frailty factors should result in patients not being included in FLS. Beyond the necessity of the osteoporosis treatment, good patient understanding of the relevance of all the interventions included in the program is the key.

Assessment of recurrence and complications following uncomplicated diverticulitis.

BACKGROUND: The natural history of sigmoid diverticulitis has been inferred from population-based or retrospective studies. This study assessed the risk of a recurrent attack following the first episode of uncomplicated diverticulitis. METHODS: Patients admitted between January 2007 and December 2011 with a first episode of uncomplicated sigmoid diverticulitis confirmed on computed tomography were enrolled in this prospective study. After successful medical management of the first episode, follow-up was conducted through yearly telephone interviews. Cox proportional hazards regression was performed to model the impact of various parameters on eventual recurrences and complications. RESULTS: During a median follow-up of 24 (range 3-63) months, 46 (16·4 per cent) of 280 patients experienced a second episode of diverticulitis. Six patients (2·1 per cent) subsequently developed complicated diverticulitis and four (1·4 per cent) underwent emergency surgery for peritonitis. In multivariable analysis, a raised serum level of C-reactive protein (over 240 mg/l) during the first attack was associated with early recurrence (hazard ratio 1·75, 95 per cent confidence interval 1·04 to 2·94; P = 0·035). CONCLUSION: Uncomplicated sigmoid diverticulitis follows a benign course with few recurrences and little need for emergency surgery. REGISTRATION NUMBER: NCT01015378 (http://www.clinicaltrials.gov).

[Anti-TNF-alpha monoclonal antibodies in the treatment of rheumatoid arthritis]. / Les anticorps monoclonaux anti-TNF-alpha dans le traitement de la polyarthrite rhumatoïde.

INTRODUCTION: Current slow-acting anti-rheumatic drugs available for rheumatoid arthritis can fail for certain severe cases; some are used empirically. Improvements in our knowledge of its pathogenesis and advances in molecular biology have made it possible to develop partially selective immunotherapy approaches. CURRENT KNOWLEDGE AND KEY POINTS: Tumor necrosis factor-alpha (TNF-alpha) is a critical inflammatory mediator in rheumatoid arthritis and may therefore be a useful target for specific immunotherapy. This article summarizes clinical studies using anti-TNF-alpha antibodies. It appears that there is good evidence for both safety and beneficial effects of anti-TNF-alpha antibodies in short-term treatment of rheumatoid arthritis. FUTURE PROSPECTS AND PROJECTS: It remains to be determined whether specific blockade of a single inflammatory mediator may be useful in long-term management. Therapeutic strategies aimed at concomitantly interfering with multiple pathogenic pathways are currently under investigation.

[Muscle cramps: reevaluation of the effectiveness of quinine salts]. / Crampes musculaires: réévaluation de l'efficacité des sels de quinine.

COMMONLY PRESCRIBED DRUGS: The official French regulatory indication for quinine salts simply states that they can be used as supplementary therapy for nighttime muscle cramps. This type of statement does not indicate a high level of proof of efficacy. Quinine salts are widely prescribed in developed countries. SECONDARY EFFECTS: Drug monitoring surveys have recorded severe adverse effects, particularly sometimes fatal thrombocytopenia. EFFICACITY REVISITED: In this context, we present a critical review of 10 comparative randomized double-blind clinical trials conducted since 1983 and of a meta-analysis published in 1995. The results of these studies are rather difficult to interpret and sometimes contradictory. When an effect is evidenced, it is incomplete and only concerns the number of cramps experienced with no effect on severity or duration. In addition, no precise information is available concerning dose, optimal treatment duration and relapse. Consequently, an irrefutable demonstration of the efficacy of this type of product is still lacking.

[Role of surgery in the treatment of dissections of the extracranial internal carotid artery. Apropos of a case, review of the literature]. / Place de la chirurgie dans le traitement des dissections de l'artère carotide interne extra-crânienne. A propos d'un cas, revue de la littérature.

The authors report about one operated case of spontaneous dissection of the extracranial internal carotid artery close to the bifurcation. The persistence of a floating thrombus in a 60% stenosis after a six-week treatment with heparin led to establishing the indication for surgery. The surgical indication remains exceptional, considering the natural history of dissections and the frequency of repatency of the arterial lumen. This type of surgery is mainly for sequellae such as stenosis, thrombi or saccular aneurysms, whose emboligenic potential leads to operating (exeresis and graft on the internal carotid artery) if the anatomical location of the lesion makes it possible.