Diagnosis of leprosy in a Nigerian migrant: implementation of surveillance measures in the current migration context.

BACKGROUND: In Italy, leprosy diagnosis is reported in immigrants from endemic countries or Italians who have stayed in endemic areas. We report the first leprosy case to be observed in a migrant from Nigeria in the Rimini district (Emilia-Romagna, Northern Italy). METHODS: After describing the tasks of the various health Institutions in the Italian integrated system for diagnosis, treatment, and surveillance of leprosy, we describe the management and outcomes of the leprosy case and of the patient's contacts. RESULTS: In April 2017, Multibacillary Lepromatose Leprosy was diagnosed in a 29-year-old Nigerian man who arrived in Rimini in July 2014 after a 2-year stay in Libya. The local Public Health Service implemented the epidemiological investigation and identified the patient's close contacts. The management of the case and the surveillance of the 13 identified contacts, 7 Italians and 6 migrants, highlighted some critical issues. The late diagnosis of the case, due to the lack of knowledge of exotic diseases by general practitioners and other health and social professionals, and the loss at follow up of the close contacts (5 out of 6 migrants), represented important obstacles to the full success of surveillance measures. CONCLUSIONS: Although in Italy there is a well codified system of notification and surveillance of leprosy, the recognising of cases and the tracing and follow up of contacts are made difficult by the particular conditions of the involved people. This represents a new challenge for the Italian Public Health Authorities which, in the current context of immigration, often uncontrolled, must know how to respond to the new needs, in close collaboration with the State Institutions responsible for registering migrants and those health and social professionals who could facilitate the access of foreign people to health services.

A National Analysis of Targeted Muscle Reinnervation Following Major Upper Extremity Amputation.

BACKGROUND: Post-amputation pain is a debilitating sequela of upper extremity (UE) amputation. Targeted muscle reinnervation (TMR) is a relatively novel treatment that can help prevent pain and improve quality of life. The purpose of this study is to evaluate national trends in the application of immediate TMR following UE amputations.   . METHODS: An analysis of the Nationwide Inpatient Sample database was conducted from 2016-2019. ICD-10 codes were used to identify encounters involving UE amputation with and without TMR. NIS weights were used to estimate national estimates of incidence. Patient-specific and hospital-specific factors were analyzed to assess associations with use of TMR. RESULTS: A total of 8,945 weighted encounters underwent UE amputation, and of those, only 310 (3.5%) received TMR. The majority of TMR occurred in urban hospitals (>95%). Younger patients (47 vs. 54, p=0.008) and patients located in New England were significantly more likely to receive TMR. There was no difference in total cost of hospitalization amongst patients who received TMR ($55,241 vs $59,027.8, p=0.683) but significantly shorter lengths of hospital stay when receiving TMR versus other management (10.6 vs. 14.8, p=0.012). CONCLUSIONS: TMR has purported benefits of pain reduction, neuroma prevention, and increased prosthetic control. Access to this beneficial procedure following UE amputation varies by demographics and geographic region. Given that TMR has not been shown to increase cost while simultaneously decreasing patient length of stay, increased efforts to incorporate this procedure into training and practice will help to ensure equitable care for amputation patients. .

Surgical management of popliteal artery entrapment syndrome.

Introduction: Popliteal artery entrapment syndrome (PAES) is a rare condition in which the popliteal artery becomes compressed by adjacent soft tissue structures causing progressive claudication. Due to its low incidence, this disorder and its surgical management is poorly described in the literature. This study presents our institutional data surrounding PAES management to further optimize care of this syndrome. Methods: This retrospective study gathered demographic, surgical, and outcome data of all patients with PAES who underwent surgical decompression at our institution from 2015 to 2022. Patients were identified using CPT and ICD-9/10 codes. Summary statistics were calculated, with Chi-squared and T-test used for subgroup analysis. Results: 50 surgical patients with PAES were identified. On average, they were young (mean age: 20.7 years), mostly female (78 %), and predominately white (68 %). The vast majority were physically active, with 13 of the 50 patients being runners (26 %). Medically, the cohort was otherwise healthy, with 74 % reporting no comorbidities. Diagnosis was often delayed, with patients on average seeing 4.5 physicians over 2.0 years prior to arriving at our institution for care. In addition to popliteal artery release, the second most performed procedure was fasciotomy (82 %). Postoperatively, there was significant long-term subjective improvement, with 91 % of patients reporting they would repeat the operation and 65 % reporting improved activity. Conclusion: PAES is a rare condition affecting the lower limb that requires a nuanced surgical approach. From diagnosis to outcome, we hope to better inform surgeons of PAES so that these patients may receive the highest quality care.

Hand and Wrist Amputation: A Demographic Analysis Using the National Inpatient Sample.

BACKGROUND: Traumatic hand and wrist amputations are rare but debilitating injuries. Surgical replantation of the hand provides a unique alternative to revision surgery but requires appropriate access to necessary medical resources. This study aims to understand the national practice of replantation of traumatic hand amputation and to determine whether disparities exist in accessing surgical treatment. METHODS: International Classification of Diseases, 10th Revision codes for replantation and revision amputation surgeries were used to gather data from the National Inpatient Sample from 2016 to 2019. Summary statistics were calculated on demographic, hospital, and outcome variables, with subanalysis performed for effect on replantation and revision rates. RESULTS: Seventy-two patients were identified. The average patient was 35 years old with a strong male predominance (90%). The racial distribution of the cohort roughly mirrored the demographic proportions of race in the US population. Fifteen (21%) patients underwent replantation. This rate was similar between sexes, races, and income brackets. Hand replantation was primarily performed at large bed size (87%), private not-for-profit (73%), and urban teaching hospitals (94%). The most common insurance status for these patients was private, followed by Medicaid, Medicare, and self-pay. Forty-seven patients underwent revision amputation (65%) with no association between demographic characteristics. The patients remained hospitalized for significantly longer periods (P = .0188) and paid significantly more (P = .0014) if replanted. The patients were most frequently discharged home (65%), followed by skilled nursing facilities (18%). CONCLUSION: This study describes the current state of hand amputation management and finds no evidence of sociodemographic factors influencing the surgical care provided.

Alzheimer CSF biomarkers in routine clinical setting.

OBJECTIVES: Our work was aimed to evaluate Alzheimer's disease diagnosis improvement using cerebrospinal fluid biomarkers (CSF) in neurological daily practice. MATERIALS AND METHODS: For this purpose, 150 patients clinically and neurochemically classified as having AD or cognitive impairment with or without other dementia type were included in the study. The following CSF peptides were studied, blindly to the clinical diagnosis: beta-amyloid(1-42) peptide (Aß(1-42)), Tau (T-tau), threonine-181 hyperphosphorylated tau protein (P-tau(181)), and beta-amyloid(1-40) peptide (Aß(1-40)). From these measurements, Innotest® Amyloid Tau Index (IATI) was calculated for each patient. RESULTS: This assessment allowed to separate 83 biochemical profiles of AD and 67 non-Alzheimer's disease (non-AD), both AD and non-AD categories match with clinical data amounting to 73% and 90%, respectively. Among mild cognitive impairment (MCI) patients, CSF biomarkers led to discriminate those who are likely to be AD. We devoted a special section to Aß(1-40) which is not a routine parameter but can help to confirm a pathological amyloid process as Aß(1-42)/Aß(1-40) ratio underlining the real decline of the Aß(1-42). CONCLUSIONS: The interest of biomarkers and their ability to solve awkward cases were carefully noticed all the more when a discrepancy between clinical and CSF biological data was involved. The final proposed algorithm allowed to identify pathogenic forms of AD according to the prevailing role of hyperphosphorylated tau or amyloid beta peptide.

Risk factors for a high somatic cell count at the first milk recording in a large sample of UK dairy herds.

The dry period is important for the cure of existing intramammary infection (IMI) and the acquisition of new IMI. Somatic cell count (SCC) at both the last milk recording before drying off and at the first milk recording following calving can be used on farm to describe the dynamics of IMI during the dry period. The aims were to quantify the association between the main risk factors collected from milk recording data and the occurrence of a high SCC in early lactation as well as to partition the observed variation into the prevalence of high SCC in within-herd and between-herd variation. Milk recording data collected between 2004 and 2006 from 2,000 herds in England and Wales were used. Cows with an SCC ≥200,000 cells/mL were classified as high, and other cows as low. The median prevalences of the high classification were 42 and 21% at the last milk recording before drying off and the first milk recording following calving, respectively. Cows classified high or producing more milk before drying off as well as cows of greater parity or recorded in early lactation were more likely classified high at the first recording following calving. Cows from herds in which the prevalences of the high classification or the probability of remaining or becoming high over the dry period were elevated during the previous year were more likely classified as high at the first recording following calving. Half of the variability in the proportion of cows with a high SCC after calving originated at the herd level. The other half was unexplained within herd, but by between-year variability. Most cow-level predictors were important in explaining individual cow performance, but accounted for little of the overall between-herd variability. Of the predictors identified as important at the cow level, only milk yield at drying off was important in explaining the between-herd variability.

Early lactation ratio of fat and protein percentage in milk is associated with health, milk production, and survival.

An observational study was conducted on 1,498 cows in 3 large Italian dairy farms. The objective of the study was to evaluate the prognostic value of early lactation fat-to-protein ratio in milk. In all 3 herds, an intensive herd health monitoring program was being practiced that included weekly visits and extensive data collection on health, reproduction, production, and culling. A milk sample was collected from all cows at approximately 7 d postpartum and the ratio of fat-to-protein percentage in this milk sample was measured. Animals with a fat-to-protein ratio in early lactation greater than 2.0 showed an increase in postpartum diseases such as retained placenta, left-displaced abomasums, metritis and clinical endometritis. We also observed a decrease in early lactation milk production but this was limited to cows in lactation 2 and higher when the fat-to-protein ratio was greater than 2.0 in the early postpartum milk sample. Finally, an increased risk of being culled from the herd was observed, with the risk of culling increasing with increasing fat-to-protein ratio in the early lactation milk sample. No effect of fat-to-protein ratio was found on the incidence of clinical mastitis in the 3 herds. From this study, we conclude that analyses of milk components in early postpartum (6-9 days in milk), particularly the ratio of fat-to-protein percentage, is a valuable indicator of lipo-mobilization and the negative energy balance status in postpartum cows. Because a single milk sample is sufficient to provide valuable information, we suggest that this is a valuable addition to herd health programs on dairy farms.

A prospective study on Shiga toxin-producing Escherichia coli in children with diarrhea in Paraná State, Brazil.

AIMS: To examine stool specimens from children with diarrhea from Paraná State, southern Brazil, for presence of STEC. METHODS AND RESULTS: A PCR screening assay for stx genes was used to examine a loopful of confluent colonies of 306 stool samples cultures. In six (1.96%) of them, DNA fragments of the expected size were observed, and the presence of stx was confirmed by DNA sequencing. Then up to 100 single colonies from each of the six stool cultures were analyzed using the same PCR protocol. However, stx-positive colonies were found only in two of the cultures. The E. coli strains belonged to serotypes O69:H11 and O178:H19, and presented genotypes stx(1)eae ehxA and stx(1) respectively. Shiga toxin production was confirmed using the VTEC Screen Seiken. Except ampicillin, they were susceptible to all the antimicrobials tested. CONCLUSIONS: These results show that STEC may be an important cause of diarrhea in children of Paraná State, and that they are present in low numbers in stools. The strains belonged to serotypes not commonly found associated with STEC and probably present low virulence. SIGNIFICANCE AND IMPACT OF STUDY: These results indicate that molecular methods are required to diagnosis of STEC infections.

Intermittent therapy for flare prevention and long-term disease control in stabilized atopic dermatitis: a randomized comparison of 3-times-weekly applications of tacrolimus ointment versus vehicle.

BACKGROUND: Intermittent dosing of a topical calcineurin inhibitor for preventing atopic dermatitis (AD) disease relapse in patients with stabilized AD has not been evaluated. OBJECTIVE: We sought to evaluate the long-term efficacy and safety of 3-times-weekly use of tacrolimus ointment in preventing AD disease relapse. METHODS: Adult and pediatric patients with moderate to severe AD who were clear of disease after up to 16 weeks of treatment with tacrolimus ointment were randomized in a double-blind fashion to 3-times-weekly treatment with either tacrolimus ointment (0.03% or 0.1%) or vehicle for 40 weeks. The primary end point was the number of flare-free treatment days. RESULTS: A total of 125 patients were randomized to tacrolimus and 72 patients to vehicle. The mean number of flare-free treatment days was 177 for tacrolimus and 134 for vehicle (P = .003). Median time to first relapse was 169 days for tacrolimus and 43 for vehicle (P = .037). LIMITATIONS: Generalizability to all patients seen in clinic may be limited because only patients who responded to tacrolimus ointment in the stabilization phase were randomized into the maintenance phase of the trial. CONCLUSIONS: Maintenance therapy with tacrolimus ointment was associated with significantly more flare-free days compared with vehicle, and a significantly longer time until first disease relapse.

Application of intravoxel incoherent motion (IVIM) magnetic resonance imaging in the evaluation of primitive brain tumours.

Intravoxel incoherent motion is a potential non-invasive diagnostic tool in brain tumours, without any clear guidelines for its evaluation yet. In our study, we compare intravoxel incoherent motion with dynamic susceptibility contrast magnetic resonance imaging in the quantification of tumour tissue blood perfusion in 28 patients affected by brain tumours, highlighting the issues encountered during the acquisition set-up and post-processing steps. Intravoxel incoherent motion is a new imaging tool and an alternative technique to dynamic susceptibility contrast-magnetic resonance imaging which is of considerable interest at present. This is partly because it does not require the use of a contrast agent and relies on the intrinsic properties of motion in the capillaries of the spins. Compared to dynamic susceptibility contrast-magnetic resonance imaging, the intravoxel incoherent motion technique is also characterised by better resolution because the gadolinium-based contrast agent bolus used in the standard technique results in a variation by more than 50% of the signal coming from the brain. Finally, intravoxel incoherent motion is more sensitive to the incoherent motion that originates from small capillary vessels, while the dynamic susceptibility contrast signal is also contaminated by the input from larger arteries and veins, which may result in an overestimation of the blood volume. Although there are limitations due to the heterogeneity of the sample considered in our study, intravoxel incoherent motion has been shown to be an accurate noninvasive radiological biomarker, useful to distinguish between low and high grade glial tumours.

A crosstalk between the Wnt and the adhesion-dependent signaling pathways governs the chemosensitivity of acute myeloid leukemia.

Relapses following chemotherapy are a major hindrance to patients' survival in acute myeloid leukemia (AML). To investigate the role of the hematopoietic niche in the chemoresistance of leukemic cells, we examined two pathways: one mediated by adhesion molecules/integrins, and the other by soluble factors of the morphogen Wnt pathway. In our study, both the adhesion of leukemic blasts to fibronectin and the addition of Wnt antagonists induced, independently, resistance of AML cells to daunorubicin in a cell survival assay. Using pharmacological inhibitors and siRNA, we showed that both resistance pathways required the activity of the glycogen synthase kinase 3beta (GSK3beta). Moreover, the AML cell protection downstream of GSK3beta was mediated by NF-kappaB. A link between the adhesion and the Wnt pathway was found, as adhesion of U937 on human osteoblasts, a component of the hematopoietic niche, triggered the secretion of the Wnt antagonist sFRP-1 and supported resistance to daunorubicin. The osteoblast-conditioned medium could also confer chemoresistance to U937 cells cultured in suspension, and this cell protective effect was abrogated after depletion of sFRP-1. In the context of this potential double in vivo resistance, modulators of the common signal GSK3beta and of its target NF-kappaB could represent important novel therapeutic tools.

Expression of beta-catenin by acute myeloid leukemia cells predicts enhanced clonogenic capacities and poor prognosis.

Activation of the Wnt/beta-catenin pathway has recently been shown to be crucial to the establishment of leukemic stem cells in chronic myeloid leukemia. We sought to determine whether beta-catenin was correlated to clonogenic capacity also in the acute myeloid leukemia (AML) setting. Eighty-two patients were retrospectively evaluated for beta-catenin expression by Western blot. beta-Catenin was expressed (although at various protein levels) in 61% of patients, and was undetectable in the remaining cases. In our cohort, beta-catenin expression was correlated with the clonogenic proliferation of AML-colony forming cells (AML-CFC or CFU-L) in methylcellulose in the presence of 5637-conditioned medium, and more strikingly with self-renewing of leukemic cells, as assessed in vitro by a re-plating assay. In survival analyses, beta-catenin appeared as a new independent prognostic factor predicting poor event-free survival and shortened overall survival (both with P<0.05). Furthermore, variations in beta-catenin protein levels were dependent on post-transcriptional mechanisms involving the Wnt/beta-catenin pathway only in leukemic cells. Indeed, beta-catenin negative leukemic cells were found to increase beta-catenin in response to Wnt3a agonist in contrast to normal counterparts. Altogether, our data pave the way to the evaluation of Wnt pathway inhibition as a new rationale for eradicating the clonogenic pool of AML cells.

[Double ileo-ileal and ileo-cecocolic intussusception due to submucous lipoma: case report]. / Doppia invaginazione ileo-ileale e ileo-ciecocolica da lipoma sottomucoso del tenue: case report.

Intestinal intussusception is a rare pathology in adults and counts for approximately 5-16% of all invaginations, according to literature. We report the case of a 54 years-old male affected by a double ileo-ileal and ileocecocolic invagination secondary to a submucosal intestinal lipoma. Because of a bowel obstruction symptomathology, the diagnosis was based on abdomen X-rays, abdominal ultrasound and multislice CT scan that showed a probable pre-operative diagnosis of intestinal intussusception. The diagnosis of double invagination was confirmed intraoperatively and was therefore performed a right colectomy extended to a long tract of ileum. Opening the specimen demonstrated the evidence of a submucosal lipoma on the head of the intussusceptum. After the description of this case, we proceed with review of the literature of adult intestinal invagination.

Postpartum uterine diseases and their impacts on conception and days open in dairy herds in Italy.

The objective of this study was to describe the incidence and the impact of postpartum uterine diseases in postpartum cows on future uterine status and reproductive performance in large Italian dairy herds. This study provides an important quantitative estimate of uterine and postpartum diseases incidence that afflict high-producing Italian dairy cows. The total number of cows included in the study was 1498 on three farms; all cows were followed from the dry period until 300 days postpartum. All farms used high-quality data collection systems and standard operating procedures: weekly herd health visits, monthly Dairy Herd Improvement Association visits, and, due to cheese-making milk quality requirements, a supplementary milk sample collected at 7 ± 3 days postpartum evaluated for milk components. Clinical metritis in primiparous cows did not change the time to the first artificial insemination (AI) or days open; conversely, clinical metritis in multiparous cows had impact on the time to first AI (hazard ratio: 0.66, P < 0.01) and resulted in a lower conception rate at first insemination and a increase in days open (odds ratio: 0.64, P < 0.05). Clinical endometritis had a strong deleterious effect on first AI conception rate (odds ratio: 0.34, P < 0.05) and days open across all lactations (hazard ratio: 0.68, P < 0.05). Persistent metritis, defined as the presence of both clinical metritis and clinical endometritis in the same animal in the same lactation, caused low conception rate both in the first-lactation and in older cows and had a strong negative effect on the proportion of pregnant cows at 300 days (P < 0.05). In conclusion, the impact of endometritis on fertility was true across lactation groups. A good management and precocious diagnosis of the pathologies is not resolutive to restore good fertility parameters, and understanding the immune response in first-lactation cows may be of value for developing alternative intervention protocols for older-lactation cows.

A robust and rapid xenograft model to assess efficacy of chemotherapeutic agents for human acute myeloid leukemia.

Relevant preclinical mouse models are crucial to screen new therapeutic agents for acute myeloid leukemia (AML). Current in vivo models based on the use of patient samples are not easy to establish and manipulate in the laboratory. Our objective was to develop robust xenograft models of human AML using well-characterized cell lines as a more accessible and faster alternative to those incorporating the use of patient-derived AML cells. Five widely used AML cell lines representing various AML subtypes were transplanted and expanded into highly immunodeficient non-obese diabetic/LtSz-severe combined immunodeficiency IL2Rγc(null) mice (for example, cell line-derived xenografts). We show here that bone marrow sublethal conditioning with busulfan or irradiation has equal efficiency for the xenotransplantation of AML cell lines. Although higher number of injected AML cells did not change tumor engraftment in bone marrow and spleen, it significantly reduced the overall survival in mice for all tested AML cell lines. On the basis of AML cell characteristics, these models also exhibited a broad range of overall mouse survival, engraftment, tissue infiltration and aggressiveness. Thus, we have established a robust, rapid and straightforward in vivo model based on engraftment behavior of AML cell lines, all vital prerequisites for testing new therapeutic agents in preclinical studies.

Estimation of the amyotrophic lateral sclerosis incidence by capture-recapture method in the Limousin region of France.

Amyotrophic lateral sclerosis (ALS) is a rapidly fatal degenerative neurological disease categorized among motor neuron diseases. In the literature, the incidence of ALS varies between 0.7 and 2.4 per 100, 000 inhabitants. A study using the capture-recapture method (multiple records system analysis) was undertaken in Limousin (France) ascertaining all patients having onset of definite or probable ALS during the period 1994-1995. Three information sources able to identify these new ALS cases were selected: the first source was a computerized database of the Neurology Department of the University Hospital of Limoges; the second source consisted of the neurologists of the Limousin region and neighboring provinces (county-sized regions); the third source grouped the hospitals of the Limousin region and neighboring provinces (county-sized regions). During this period, 46 new cases of ALS were seen, corresponding to an observed mean annual incidence of 3.2 (+/-0.6) per 100,000 inhabitants. After standardization for age, the annual incidence was 2.5 per 100,000 inhabitants. The number of new cases estimated by the capture-recapture method was 70, corresponding to an estimated mean annual incidence of 4.9 (+/-1.0) for 100,000 inhabitants. Hence, statistical modeling utilizing partially overlapping information sources permitted a more exhaustive compendium of the new cases of ALS and may be a truer reflection of actual disease incidence than has been previously reported.

Estimation of the prevalence of epilepsy in the Benin region of Zinvié using the capture-recapture method.

BACKGROUND: The prevalence of epilepsy was estimated in two villages of 3134 inhabitants, in Benin, in April and May 1997 using the capture-recapture method. METHODS: Information was obtained from (i) a door-to-door cross-sectional study, (ii) a non-medical source consisting of key informants (traditional practitioners, teachers, village leaders, and religious representatives) and (iii) a medical source through evaluation of medical records in health centres. In all the three situations, the diagnosis of epilepsy was confirmed by a neurologist. RESULTS: The door-to-door survey found 50 epileptics, i.e. a prevalence of 15.9 per 1000. The non-medical source found 26 patients. The medical source found only four patients. In total, 66 epileptics were found by combining the three sources, giving a prevalence of 21.1 per 1000. After application of the capture-recapture method, the estimated number of cases from the door-to-door survey and non-medical source was 105, and 110 cases when the medical source was considered as well. The respective prevalences were 33.5 per 1000, and 35.1 per 1000. CONCLUSIONS: The door-to-door survey has been usefully improved by using key informants. The epilepsy prevalence estimate found by capture-recapture is clearly higher than that found by traditional cross-sectional methods, and could better depict the frequency of epilepsy in Africa.

Intrafamilial clustering and 4-year follow-up of asymptomatic human T-cell leukaemia virus type I (HTLV-I) infection in Benin (West Africa).

BACKGROUND: Few data exist concerning familial human T-cell leukaemia virus type I (HTLV-I) carrier states and transmission in African countries. Two previous surveys performed in Benin in 1989 and 1990 using a three-level cluster sampling method allowed us to identify HTLV-I positive subjects. The evolution of HTLV-I within the families of these subjects is described over a 4-year period, 1991-1995. METHODS: Since 1991, 37 HTLV-I seropositive subjects, six subjects with indeterminate Western-Blot pattern, and their relatives have been followed up once a year clinically and biologically. RESULTS: Twenty-three mothers in the study group gave birth to 27 children between 1991 and 1995. Among the 13 infants born to the 12 seropositive mothers, two seroconverted before their second birthday. One adult woman whose husband was seropositive developed seropositivity 4 years after marriage. In March 1992, a family case-control study (proband study) was conducted. A seroprevalence of 27.5% was found among 138 relatives of 32 infected subjects and 1.4% among 142 relatives of 32 control subjects. CONCLUSIONS: There is clearly an intrafamilial clustering of HTLV-I in Benin. The annual incidence density of HTLV-I in this cohort is estimated at 6 per thousand.

[Quality of medical records in the "Medical Information System Program": application of the lot quality assurance sampling method]. / Qualité des données P.M.S.I. au CHU de Limoges: application de la méthode L.Q.A.S.

BACKGROUND: The aim of this study was to validate a new method of quality control of medical records of the "Medicalisation of Information System Program" (P.M.S.I.) in Limoges university hospital. METHODS: Lot quality assurance sampling (L.Q.A.S.), developed to meet industrial quality control needs, has been applied. This method allows to give an opinion on the quality of a lot from a sample randomised in this lot. Ten hospital units have been randomised. During three months, these medical units have recoded ten medical units abstracts (R.U.M.) which were randomised each month within their stays. If five or more R.U.M. had been modified on Principal Diagnosis (D.P.), Associated Significant Diagnosis (D.A.S.) or Diagnosis Related Group (D.R.G.), the lot was rejected. The hospital unit had then less 70% R.U.M. of good quality (alpha=5%). The global errors rates were compared to the results of usually performed quality control (1998). RESULTS: Nine hospital units were included. Hospital units which already had a low quality rate during the 1998 quality control had also an insufficient quality by L.Q.A.S. method. Among these, 33.7 [CI(95%): 21.6-45.8] R.U.M. have been modified. Medical units had a poorer data quality than surgical ones. No statistically significant difference was shown between 1998 errors rates and L.Q.A.S. rates, except for D.P. (p=0.002). CONCLUSION: L.Q.A.S. is easy to apply, could be repeated more frequently than usual controls, and allows to detect hospital units which require a faster action. This process could be applied to P.M.S.I., in which the search of quality is necessary because of the new cost model which includes secondary D.R.G.