Traditional healers or bonesetters ("rebouteux") in France: A survey of their practice, profile, and customers.

BACKGROUND: In France, many people consult "bonesetters" for several medical reasons. Little is known about them. We aimed to investigate the practices of traditional healers in France as well as their profile and that of their customers. METHODS: This was a survey carried out in Metropolitan France. A 33-item questionnaire developed by a multidisciplinary group was sent to a sample of 148 traditional healers found on the Internet and by word of mouth. RESULTS: Of the 148 questionnaires sent, 89 (60.1 %) were returned and 67 (45.3 %) were analyzed: 51.5 % (n = 34) of respondents were men, and the mean (±standard deviation) age was 51.6 ±â€¯11.6 years. The respondents considered that they had received a gift of healing and were mainly magnetic healers (68.2 %). They became aware of this gift at a mean age of 19.9 ±â€¯14.1 years. The traditional healers practiced mainly in rural areas (54.5 %), at home (59.1 %), and used their hands to transmit energy (95.5 %). They advertised their practice mainly by word of mouth (89.4 %) and had a predominantly female clientele (78.1 %). Various diseases were treated, with the most frequent being subjective complaints (pain, stress, fatigue, insomnia) and dermatological complaints (eczema, accidental and post-herpes-zoster burns, psoriasis, and warts). Most respondents considered their activities to be complementary to conventional medicine, and 10.9 % considered them more effective. Some indicated that they did not consider themselves "healers" but rather "providers of relief". DISCUSSION: The results of this survey provide a better understanding of this network of local care that revolves around medicine.

Measurement of skin thickness and skin elasticity to evaluate the effectiveness of intensive decongestive treatment in patients with lymphoedema: a prospective study.

BACKGROUND: Complex decongestive physiotherapy (CDP) is used to treat patients with severe lymphoedema. The efficacy of CDP is usually quantified by calculating limb volume from repeated measurements of circumference at least 10 points before and after treatment of an affected limb. Measurement is time-consuming and operator-dependent. OBJECTIVES: To determine whether decreased dermal thickness is correlated with decreased volume after intensive CDP. METHODS: A consecutive series of patients admitted for intensive CDP were studied over a 6-month period. Before and after CDP, we measured circumference, dermal thickness elasticity and finally improvement in quality of life using a visual analogue scale (VAS). RESULTS: Thirty patients were included in the study. Only three patients were previously untreated. The average relative reduction in limb volume was 4% and the reduction in the dermal thickness was 15% (correlation: r = 0.37, P = 0.05). Viscoelasticity was decreased by 13%. VAS quality of life score was improved by 30%. CONCLUSION: Changes in dermal thickness are slightly correlated with volume changes before and after 5-day intensive CDP in a selected series of patients previously treated at home.

[Treatment of superficial bacterial cutaneous infections: a survey among general practitioners in France]. / Traitements des infections cutanées bactériennes superficielles. Enquête auprès des médecins généralistes du Cher.

BACKGROUND: Superficial bacterial skin infection and superinfection of skin diseases are usually treated by general practitioners using antiseptics or antibiotics. However, acquired resistance to biocidal agents, both systemic and topical, is growing. OBJECTIVES OF THE STUDY: Our aim was to assess the skill of GPs in clinical situations involving common skin infections. MATERIAL AND METHODS: On 16 June 2010, we sent a questionnaire to all GPs in a rural region of France (the Cher department) together with a stamped addressed envelope for the reply. The questionnaire contained seven pages of multiple-choice questions and five clinical cases, each one illustrated with a photograph (sty, furuncle, whitlow, colonized chronic wounds and impetigo). Anonymity of responses was guaranteed. Data was analysed using the Clinsight(®) software package. RESULTS: The response rate was 51% (102 responses). GPs reported little difficulty in treating these patients (median 3, range 1 to 8 on a scale of increasing difficulty from 0 to 10). The main results of the study are firstly the frequency of combination of at least one antiseptic with one antibiotic (46%); secondly, the frequency of combination of two antibiotics (20% of cases); thirdly, the frequent prescription of systemic antibiotics for chronic wounds colonized by Pseudomonas aeruginosa (61%). DISCUSSION: Our study shows the high frequency of prescriptions for combined therapy to treat superficial skin infections despite the fact that monotherapy with either an antiseptic or an antibiotic would probably suffice. It also shows the unnecessary prescription of antibiotics for colonization of a chronic wound. The study was limited in terms of size and design: it was a questionnaire rather than an analysis of prescriptions actually made in "real life", and the response rate was 51%. In addition, aside from impetigo, for which randomised studies and recommendations were given, the other surface infections (sty, folliculitis, whitlow) tend to be treated more empirically. CONCLUSION: Dissemination of recommendations regarding the respective role of antiseptics and antibiotics (and their route of administration, topical or systemic) in superficial skin infections would doubtless be useful for prescribers, and more rational use of these agents would help limit bacterial resistance.

Long-term successful healing of ulcerated necrobiosis lipoidica after topical therapy with becaplermin.

We report a case of chronic leg ulceration occurring in a patient with necrobiosis lipoidica (NL). After many topical treatments had failed to achieve healing, treatment with topical becaplermin was started, which resulted in rapid improvement and ultimately complete healing of the ulceration. Treatment of ulcerated NL is often disappointing. Many topical and systemic drugs have been tried. Becaplermin is a platelet-derived growth factor indicated for the treatment of neuropathic diabetic ulcers measuring < 50 mm in size. To our knowledge, this is only the second case reported in the literature of ulcerated NL successfully treated with becaplermin.

Contributions of SPECT/CT imaging to the lymphoscintigraphic investigations of the lower limb lymphedema.

Lymphoscintigraphy is a safe and reliable technique for investigating lymphedema. However, interpretation of delayed planar conventional imaging may be questionable due to the superimposition of soft tissues. Therefore, the aim of this retrospective study was to evaluate the contribution of single photon emission computed tomography/computed tomography (SPECT/CT) to lymphoscintigraphic investigation in a selected population with abnormal interstitial activity. Forty one patients with lower limb lymphedema either primary (n=17) or secondary (n=5), or associated with chronic venous insufficiency (n=19) underwent lymphoscintigraphy according to a standard protocol. SPECT/CT imaging that started immediately after planar imaging covered the part of the lower limbs with the most significant interstitial activity. The CT images were also analyzed separately to identify the typical honeycomb pattern of lymphedema. SPECT/CT identified additional abnormalities in vessels and soft tissues in 19 patients (46%). The additional information, primarily related to dermal collateralization of flow, dermal backflow, lymphangioma, and lymphorrhea, aided in understanding the physiopathology of edema and may have influenced management in 35 patients (85%). The honeycomb appearance of the soft tissues was noted on CT in most patients (90%). This study suggests that SPECT/CT is a promising addition to planar imaging in lymphoscintigraphic investigations of lymphedema.

Changes in the nail unit in patients with secondary lymphoedema identified using clinical, dermoscopic and ultrasound examination.

BACKGROUND: Secondary lymphoedema is characterized by lymphatic stasis that is often the result of a lymph node lesion. At advanced stages it may cause trophic changes in the skin. However, the presence of changes in the nail unit has not been reported to date. OBJECTIVES: The aim of this study was to determine the presence of nail abnormalities in cases of secondary lymphoedema. METHODS: This was a prospective study, conducted on patients with unilateral secondary lymphoedema. A comparative clinical and dermoscopic examination and 20-MHz high-resolution ultrasound imaging of the affected limb and the contralateral limb were performed. RESULTS: Thirty-three patients were included. On physical examination, hyperkeratosis of the lateral nail folds, friability of the nail surface, 'ragged' proximal nail folds and cuticle and apparent leuconychia were observed more frequently on the lymphoedematous limb. The ultrasound study of the nails of the thumb and the big toe did not reveal any differences in thickness of the different structures of the nail between the lymphoedema side and the opposite side. The nail matrix was longer on the lymphoedema side. CONCLUSIONS: Our study showed mild changes in the nail unit compatible with the xerosis often associated with severe lymphoedema. However, the study also showed frequent evidence of 'ragged' cuticles, which in these patients at high risk of erysipelas are entry points for bacteria. This should be taken into account when counselling patients with limb lymphoedema in order to prevent erysipelas.

[Knowledge and problems regarding the topical treatment of leg ulcers: survey among general practitioners in the Indre-et-Loire area]. / Connaissances et difficultés des médecins dans le traitement local des ulcères de jambe. Enquête auprès de médecins généralistes en Indre-et-Loire.

INTRODUCTION: The quantity of topical treatments for leg ulcers has increased over the last 15 years. OBJECTIVE: To determine the prescriptions for topical treatments and the problems in the management of leg ulcers using a questionnaire sent to general practitioners. MATERIAL AND METHODS: A questionnaire in 3 parts was sent to 95 general practitioners in the area working in 36 different districts with an explanatory letter. The first part was composed of 29 closed questions regarding prescription of topical treatment for leg ulcers. The second part, also closed, included 3 pictures showing a budding, a necrotic and a fibrinous ulcer. The physicians had to choose which treatment they would have prescribed and the frequency of dressings changes. The third part was composed of two open questions regarding the problems encountered. The survey started on May 1st and was closed on June 30th 2002. No reminders were sent. RESULTS: We received 52 replies, 49 of which were exploitable. Forty-five percent (43/95) did not reply. Occlusive dressings were widely prescribed (mainly hydrocolloid 38/49 and hydrocellular 28/49). Vaseline impregnated gauze were less prescribed (14/49). Dressings with balsam of Peru were prescribed often by 10 and occasionally by 27 general practitioners. Alginate or charcoal dressings were not always used appropriately. Antiseptics were prescribed by 10 physicians. Mechanical debridement of fibrinous or necrotic wounds was rarely used even for necrotic ulcers. Topical anesthetics were prescribed in 21 out of 33 cases of mechanical debridement. Some physicians referred care (n=4), others complained about lack of compliance (n=15), cost (n=14), local intolerance (n=10) and the excessively wide variety of dressings (n=10). We drew-up a synopsis with guidelines for treatment, which was sent to all the general practitioners who had participated in the survey. CONCLUSION: Forty-three of the 95 physicians approached did not reply. This poor response rate, which is common in this type of survey, may include physicians who are not at ease in the management of ulcers and this may bias the results. The physicians who replied to the survey knew the subject well but complained of the costs and variety of dressings. They were all eager to receive further information and guidelines.