Consequences of the new zolpidem prescription regulations: a cohort study from the French national healthcare database.

PURPOSE: To determine changes in the prevalence of zolpidem consumption since the change in the regulations of prescription. Formulations containing zolpidem were subject to the regulations of narcotics by the French decree of April 7, 2017. METHODS: Longitudinal cohort study using data from the representative French healthcare database. The main outcome was the prevalence of oral hypnotic drug reimbursement before and after April 2017. The secondary outcome was the change in prescription habits for zolpidem since the decree in long-term users and excessive users. RESULTS: A total of 81,174 individuals had at least one hypnotic drug reimbursement; among, whom 2143 had at least one reimbursement of zolpidem. Before the decree, 26% had at least one reimbursement of zolpidem, whereas it dropped to 18.4% after the decree. Among the 545 long-term users, the reimbursement of zolpidem was discontinued after the decree for 60.4% and 24.2% retained zolpidem as a treatment. The main replacement drug was zopiclone for 6.4% of them. Among the 1598 excessive users, the reimbursement of zolpidem was stopped after the decree for 16.5% and 56.3% retained zolpidem as a treatment. The main replacement drug was zopiclone for 12.1% of them. CONCLUSIONS: The French decree had a major impact on the reimbursement of oral zolpidem. Indeed, prescription of the hypnotic was discontinued for half of the long-term users of zolpidem, and just over one-sixth of the excessive users discontinued the prescription of zolpidem after the decree.

[Contribution of the combination of radiation and surgery in the treatment of invasive pharyngo-laryngeal carcinoma]. / L'apport de l'association radio-chirurgicale dans le traitement des carcinomes pharyngo-laryngés infiltrants.

On the basis of the retrospective analysis of 269 cases of pharyngo-laryngeal carcinoma, the authors recall that the degree of tumour invasion is one of the essential prognostic factors for this disease. The macroscopic appearance of the tumour should therefore play a determinant role in the choice of treatment, as invasive lesions are generally responsive to radiotherapy.

[Cancer of the oral cavity without palpable adenopathy: value of external irradiation exclusively]. / Cancers de la cavité buccale sans adénopathie palpable: valeur de l'irradiation externe exclusive.

Between 1970 and 1978, 99 patients with a squamous carcinoma of the buccal cavity without palpable lymphadenopathy were treated at the Bergonié Foundation by radiotherapy only and regularly followed up. All received a minimal dose of 40-50 Grays either to the primary node groups or the entire cervico-supraclavicular areas. Eight patients developed an isolated lymph node recurrence, in two cases only in the irradiated zone. The other 6 lymph node recurrences occurred either below the radiotherapy fields when the latter had been limited to the neck (4 cases) or at the posterior border of the field (2 cases). Secondary control was possible in two patients of the 8 by combined radiotherapy and surgery. Exclusive radiotherapy for lymph node areas up to a dose of 45-50 Grays thus protected 92% of patients from a lymph node recurrence. The methods of such irradiation and in particular the extent of radiotherapy fields are then discussed on the basis of the clinical aspects of the tumour.

[Squamous-cell carcinoma of the uvula and the soft palate. Analysis of a series of 71 cases seen at the Fondation Bergonié from 1971 to 1978 (author's transl)]. / Les cancers du voile du palais et de la luette. Analyse d'une série de 71 malades vus à la Fondation Bergonié de 1971 à 1978.

From January 1971 through december 1978, 71 patients with a squamous-cell carcinoma of the uvula and the soft palate have been seen at the Fondation Bergonié : 56 have been treated and followed. The primary tumor is often controlled by external radiation-therapy and/or interstitial therapy among the 12 failure observed, 5 were salvaged by a surgical procedure. The systematic irradiation of cervical lymph nodes areas allowed 94% of control, above the clavicles. However these good results in the loco-regional control are altered by a high rate of second primary and intercurrent death.

Hodgkin's disease treated by chemotherapy and large field irradiation. Hematologic effects.

The hematologic effects of combined chemotherapy and irradiation were analyzed in 70 patients with Hodgkin's disease stage I and II. The schedule used was as follows: one cycle of 15--21 days of chemotherapy immediately followed by irradiation, including mantle and lumboaortic fields. After a rest of one month, another cycle of the same chemotherapy was applied. The erythrocytes varied slightly; the leukocytes decreased during chemotherapy and were stable or increased slightly during irradiation. Platelets decreased slightly during chemotherapy and more markedly during irradiation. No major side effects were observed, and the regimen appeared well tolerated.

[Treatment of Hodgkin's disease, clinical stage I and II. Results obtained in 100 patients by combination of 1 or 2 cycles of chemotherapy with radiotherapy]. / Traitement des stades cliniques I et II de maladie de Hodgkin. Résultats obtenus chez 100 malades par l'association à la radiothérapie d'un ou deux cycles de chimiothérapie

The results obtained by chemo+radiotherapy in 100 patients with Hodgkin's disease at stage I or II as defined by clinical and radiological staging are analysed. All patients were treated by chemotherapy followed by radiotherapy; 74 received a complement chemotherapy after the radiotherapy. Statistical analysis emphasizes the usefulness of associating two cycles of chemotherapy with the classical radiotherapy. With this treatment which gives a constant remission rate of about 90% a long-term chemotherapy is no longer necessary and the interest of exploratory laparotomy becomes negligible.

[Significance of chemotherapy complementary to radiotherapy in stages I and II in Hodgkin's disease]. / Intérêt d'une chimiothérapie complémentaire de la radiothérapie dans les stades I et II de la maladie de Hodgkin

In a series of 118 cases of Hodgkin's disease in stage I and II successively treated by irradiation alone or by chemotherapy followed by irradiation or by chemotherapy + irradiation + chemotherapy, a retrospective analysis brings out the share of classical radiotherapy in the cures associated with chemotherapy, which in providing a remission rate of the order of 90 p. 100 renders superfluous the maintenance of a long course of chemotherapy and of negligible interest the performance of an exploratory laparotomy.