[Clinical and paraclinical examination of non-traumatic optic neuropathy in the adult population]. / Examen clinique et paraclinique d'une neuropathie optique non traumatique de l'adulte.

Optic neuropathies (ON) occur in a variety of clinical presentations depending on their pattern of occurrence, their topography and the amount of functional visual impairment. Management of an ON requires a sequence of steps: confirm its existence (positive diagnosis): the diagnosis of ON is usually clinical and must be considered in the case of decreased visual acuity, change in color vision, visual field defect, relative afferent pupillary defect (RAPD), and absence of macular pathology; rule out differential diagnoses: determine the cause; etiologic diagnosis is sometimes complex and takes shape from clinical and paraclinical building blocks. The etiology may be vascular, inflammatory or demyelinating, infectious, toxic, vitamin-deficient, compressive (neoplastic or non-neoplastic), hereditary, congenital, traumatic or even pressure-related (glaucoma or advanced intracranial hypertension). Cerebral and orbital imaging with fine cuts of the optic nerves is often a mandatory examination, which is sometimes useful to repeat; identify therapeutic emergencies.

[Delays in the management of ocular complications of giant cell arteritis: A retrospective monocentric study of 33 patients]. / Délais de prise en charge des complications visuelles d'artérite à cellules géantes : étude rétrospective monocentrique de 33 patients.

INTRODUCTION: Ocular complications of giant cell arteritis (GCA) can lead to irreversible bilateral blindness and represent a therapeutic emergency. Recommendations for the management of GCA have recently been updated. The objective of the study was to evaluate delays in appropriate management of the ocular complications of GCA and its determinants. METHOD: Retrospective, monocentric study, conducted over the period January 2013-November 2018. All consecutive patients with a final diagnosis of GCA and related visual impairment (permanent visual loss and/or alteration of visual field) were included. RESULTS: Thirty-three patients were included (women: 21, men: 12; mean age at diagnosis: 79). Twenty-seven patients (82%) presented with symptoms suggestive of ACG prior to the visual complication, ranging from a few weeks to several months. Seventeen patients (52%) had a known biological inflammatory syndrome (median CRP at 64 mg/L) prior to hospital consultation. The median time from the onset of permanent ophthalmologic manifestations to appropriate corticosteroid management was 3 days (range: 0-134). Two of the 21 patients who consulted an out-of-hospital ophthalmologist received corticosteroid therapy before referral to hospital. Three patients (9%) were treated within 24 h of the onset of the disorders. CONCLUSION: There is a significant delay in the appropriate management of ophthalmological complications of ACG and deviations from current recommendations. Numerous actions must therefore be taken to improve the visual prognosis of patients with ACG, both preventively (i.e. early diagnosis and treatment of ACG before the possible occurrence of visual complications), and curatively (rapid recognition and immediate treatment of ocular complications). These elements support the relevance of specific fast-track pathways for GCA.

Validation of a deprivation index for public health: a complex exercise illustrated by the Quebec index.

INTRODUCTION: Despite the widespread use of deprivation indices in public health, they are rarely explicitly or extensively validated, owing to the complex nature of the exercise. METHODS: Based on the proposals of British researchers, we sought to validate Quebec's material and social deprivation index using criteria of validity (content, criterion and construct validity), reliability and responsiveness, as well as other properties relevant to public health (comprehensibility, objectivity and practicality). RESULTS: We reviewed the international literature on deprivation indices, as well as publications and uses of the Quebec index, to which we added factual data. CONCLUSION: Based on the review, it appears that the Quebec index responds favourably to the proposed validation criteria and properties. However, additional validations are required to better identify the contextual factors associated with the index.

TITRE: Valider un indice de défavorisation en santé publique : un exercice complexe, illustré par l'indice québécois. INTRODUCTION: Malgré l'usage répandu d'indices de défavorisation en santé publique, leur validation est rarement abordée de manière explicite ou élaborée, car il s'agit là d'un exercice complexe. MÉTHODOLOGIE: En nous fondant sur les propositions de chercheurs britanniques, nous avons cherché à valider l'indice québécois de défavorisation matérielle et sociale en utilisant des critères de validité (validité de contenu, validité sur critère et validité de construit), de fiabilité, de sensibilité et d'autres propriétés pertinentes en santé publique (intelligibilité, objectivité et praticabilité). RÉSULTATS: Nous avons passé en revue la littérature internationale sur les indices de défavorisation ainsi que les publications et les utilisations de l'indice québécois et nous avons ajouté des données factuelles. CONCLUSION: Après examen, il appert que l'indice québécois répond favorablement aux critères et propriétés de validation proposés. Des validations additionnelles s'imposent toutefois afin de mieux cerner les facteurs contextuels associés à cet indice.

Associations between disability prevalence and local-area characteristics in a general community-living population.

BACKGROUND: Disability is understood to arise from person-environment interactions. Hence, heterogeneity in local-area characteristics should be associated with local-area variation in disability prevalence. This study evaluated the associations of disability prevalence with local-area socioeconomic status and contextual features. METHODS: Disability prevalence was obtained from the Canada census of 2001 for the entire province of Québec at the level of dissemination areas (617 individuals on average) based on responses from 20% of the population. Data on local-area characteristics were urban-rural denomination, social and material deprivation, active and collective commuting, residential stability, and housing quality. Associations between local-area characteristics and disability prevalence were assessed using multilevel logistic regressions. RESULTS: Disability was associated with local-area socioeconomic status and contextual characteristics, and heterogeneity in these factors accounted for urban-rural differences in disability prevalence. Associations between contextual features and disability prevalence were confounded by local-area socioeconomic status. Some associations between local-area socioeconomic status and disability prevalence were moderated by contextual characteristics. The importance of this effect modification is greater when expressed in terms of the absolute magnitude of disability than in the relative likelihood of disability. CONCLUSION: Explanation of rural-urban differences by the contribution of other local-area characteristics is consistent with the conceptualization of urban-rural categories as the reflection of spatially varying ensembles of compositional and contextual factors. Although local-area socioeconomic status explains most variability in disability prevalence, this study shows that contextual characteristics are relevant to analyses of the spatial patterning of disability as they predict spatial variations of disability, sometimes in interaction with socioeconomic status. This study demonstrates that absolute and relative perspectives on effect modification may lead to differing conclusions.

Nanomedicine and society.

Nanomedicine is a reality of medical research and clinical practice, and it offers new and promising approaches to fundamental problems in medicine. Most prominent are the early detection of neoplastic disease and the individualized treatment of metastases. These potentially transformational developments require careful scrutiny of the potential impact of nanomedicine on society, so that the community can guide its deployment in keeping with the fundamental tenets of medical ethics.

Can excess maternal mortality among women of foreign nationality be explained by suboptimal obstetric care?

OBJECTIVES: To test the hypothesis that the risk of postpartum maternal death in France remains significantly higher for women of foreign nationality after individual characteristics are taken into account and to examine whether the quality of care received by the women who died differs according to nationality. DESIGN: A national case-control study. SETTING: Metropolitan France. POPULATION: A total of 267 women who died of maternal death from 1996 to 2001 as cases and a representative sample (n = 13 186) of women who gave birth in 1998 as controls. METHODS: Crude and adjusted odd ratios were calculated with multivariate logistic regression, and the quality of care for cases was compared according to nationality with chi-square tests or Fisher's exact tests. MAIN OUTCOME MEASURES: Odd ratio for postpartum maternal death associated with nationality and quality of care. RESULTS: After taking individual characteristics into account, the risk of postpartum maternal death was twice as high for foreign women. The odds ratio was 5.5 (95% CI: 3.3-9.0) for women from sub-Saharan Africa and 3.3 (95% CI: 1.7-6.5) for those from Asia, North and South America. There was no significant excess risk of postpartum maternal death for the other European and North Africa women. The risk of dying from hypertensive disorder or infection was four times higher for foreign women. Among women who died, care was more often considered not optimal for foreign women (78 versus 57%). CONCLUSIONS: The excess risk of postpartum maternal death persisted for foreign women after individual characteristics were taken into account and was especially important for some nationalities and for some causes of death, primarily hypertensive disorders. These results point to an immediate need to pay special attention to early enrollment in prenatal care, screening and prenatal management of hypertension, especially in women of sub-Saharan African nationality.

Material and social deprivation and health and social services utilisation in Québec: a local-scale evaluation system.

Very few studies have employed local-scale analyses to evaluate how well primary health care and social services reach the most socially and economically deprived individuals. This paper describes a project, conducted in close partnership with decision-makers and practitioners at selected local community service centres (in French, CLSCs) in Quebec, Canada, that developed a system for assessing primary care and social services utilisation by applying deprivation levels defined at the local scale (i.e., according to the distribution of deprivation in individual CLSC service areas). More than 25 years ago, Québec started setting up a province-wide network of publicly financed CLSCs whose mission was to offer first-line health and social services at the local level. Now approximately one Quebecer in four receives at least one service a year from a CLSC. The evaluation system presented in this article is built on deprivation profiles for each CLSC service area and comprises maps, relative indices of service utilisation, and an interpretation framework that facilitates the integration of new data into the decision-making and services planning processes. Study results show that deprivation levels, when defined using local perspectives, correspond more closely to decision-makers' perceptions, that relative indices are sensitive to key determinants of services provision and utilisation, and that the interpretation framework is useful for reassessing intervention strategies.

[Treatment of hypospadias apropos of 557 cases. Evolution of techniques in a care unit of pediatric surgery in a period of 18 years, and current indications]. / Traitement de l'hypospadias à propos de 557 cas. Evolution des techniques dans un service de chirurgie pédiatrique sur une période de 18 ans, et indications actuelles.

The authors report their experience with surgical treatment of hypospadias about 557 cases. From 1974 to 1981, only 84 cases were cured by classical procedures (Mathieu, Van der Meulen, Perlemutter, Duplay-Fèvre, Leveuf-Cendron), sometimes with Cahuzac uretroplasty). The age when correction depended from the type of hypospadias and several times were after necessary. From 1981 to 1992, 463 cases were operated, always between 18 month to two years of age, with only one operative with therapeutic indications are actually such proposed: distal meatotomy or modified MAGPI procedure for glandular hypospadias; Duplay uretroplasty for coronal form; Mathieu or onlay island flap for anterior and medial penil types without curvature; Mollard or Duckett uretroplasty for penil forms with chordee; Then, for posterior types, complementary posterior Duplay uretroplasty, or vesical ou buccal grafts.

["Traumatic" urethrorragias in young boys: can they be of an unusual etiology?]. / Urétrorragies "traumatiques" du jeune garçon: une étiologie peut-être non exceptionnelle?

The etiology of urethrorragias in the boy is usually unknown. The authors report one case related to a foreign body introduced into the urethra. Considering the urethroscopic findings, several publications about that type of urethral bleeding in the boy show that such a traumatic lesion is often found.

[Surgical results of uretero-vesical reimplantations in children. Apropos of 356 cases in 11 years (629 reimplanted ureters)]. / Résultats chirurgicaux des réimplantations urétéro-vésicales chez l'enfant. A propos de 356 cas en 11 ans (soit 629 uretères réimplantés).

629 ureteric reimplantations were performed in 356 children. Indications for reimplantation were 315 uni or bilateral ureteral reflux, 248 primary reflux and 67 secondary to ureteric duplication, ureterocele, vesical diverticula, neurogenic bladder, bladder neck obstruction, or ureteral obstruction, and 52 megaureters, 38 primary and 14 secondary megaureters. 61 reimplantations (14 megaureters) by Leadbetter-Politano, and 568 reimplantations (58 megaureters) by Cohen procedure were performed. 3 psoas hitching and 15 ureteroplasties, 14 Hendren and 1 Kalicinski procedures, were necessary. Primary results in reflux were 98.5% of success with Cohen operation and 100% with Leadbetter-Politano operation. Results were not so good in megaureter, 70% of success with Leadbetter-Politano operation and 75% with Cohen. Results were better with psoas hitching and ureteroplasty (86.5% of success).

[Urethroplasty technics. Apropos of 286 cases of hypospadia treated surgically. Indications, results and current therapeutic calendar]. / Techniques d'urétroplastie. A propos de 286 hypospadias opérés. Indications, résultats et calendrier thérapeutique actuel.

From 1957 to 1985, 286 urethroplasties for hypospadias repair were performed. Anterior hypospadias (235 cases) have been corrected with good result in 88% of cases (94.3% since 1974). Glandular or coronal hypospadias have been repaired by MAGPI procedure (65 cases, 1 fistula, 1 meatal stricture), and distal penile hypospadias by Mathieu's urethroplasty (32 cases, 1 fistula), since 1981. For subcoronal hypospadias, MAGPI procedure has been attempted and deserted to Mathieu's technique (19 cases, 4 fistulas). Posterior hypospadias (51 cases) were performed by two- or more-stage procedure before 1982. Then, 25 cases have been corrected by Duckett's procedure and 1 case with bladder mucosa graft. Immediate good result was obtained in 10 patients and 4 more after meatostomy for meatal stricture. 10 patients developed fistulas. A lower rate of fistula has been obtained by Duckett's operation personal modification. Most of hypospadias (80%) have been corrected from 2 to 4 years old, since 1981.

[Acute cholecystitis disclosing A virus hepatitis]. / Cholécystite aiguë révélatrice de l'hépatite à virus A.

Three children presenting with HAV hepatitis had an initial clinical onset suggestive of acute cholecystitis (pain and guarding in the right hypochondrium, fever and delayed jaundice) associated with important ultrasonographic abnormalities, also very suggestive of acute cholecystitis: bladder wall thickness greater than 10 mm (3 cases), the presence of 2 or 3 layers of different echogenicities (3 cases), presence of an ultrasonographic Murphy's sign (one case), contents of the gallbladder echogenic (one case). The authors discuss the hypothesis of an actual initial acute cholecystitis.

[Complications of pyelo-ureteral duplications in children and their surgical treatment. Apropos of 69 cases (78 pathogenic duplications)]. / Les complications des duplicités pyélo-urétérales chez l'enfant et leur traitement chirurgical. A propos de 69 observations (78 duplicités pathogènes).

The authors report their experience on the surgical treatment of 69 infants and children with pyelo-ureteral duplication. Urinary infection was the main revealing symptom (52 cases). Vesico-ureteral reflux was the major associated anomaly (39 cases) involving most often the lower pole ureter; the surgical correction of the reflux was performed according to the technique of Cohen with a favorable outcome in all cases. Because of poorly functioning and dysplastic upper renal segment, partial upper pole nephrectomy was performed in 8 among 12 cases of associated ectopic ureteral orifice and in 9 among 15 cases of associated ureterocele. A reimplantation of the ureter was made possible in 3 cases of ectopic ureteral orifice and in 5 cases of ureterocele with little corresponding renal lesions. With the experience of one neonate who died from septic shock following partial nephrectomy there were no other post-operative complications in this series.

[Current aspects of laparoschisis. Apropos of 22 cases]. / Aspects actuels du laparoschisis. A propos de 22 observations.

Study about 22 gastroschisis observed 17 years along allows to the authors to point out the elements of amelioration of prognostic and decrease of mortality. Antenatal diagnosis allows the hysterotomy at the end of gestation avoiding traumatic or infectious risks. Reanimation and transport are very important to bring the neonate in good conditions to the pediatric surgeon. The choice of surgical technics is only between primitive parietal closure or progressive reintegration (Schuster). Intestinal atresia must be cured in the same time, if possible. Finally, perisurgical nursing, antibiotherapy and recent parenteral nutrition method improved the prognosis. During the last 15 years, mortality has fallen from 80% to 10%.

[2 cases of congenital sternal cleft]. / A propos de deux cas de fissure sternale congénitale.

Two cases of upper sternal cleft are reported, the first operated on twenty nine months, the second on six weeks. The authors present a revision of the surgical technics proposed for correction of this rare malformation. The result is better and surgery easier when performed shortly after birth. There two cases had a facial angiomatosis associated.

[Recto-sigmoid cancer and polyps in children. Comments apropos of 2 cases of atypical juvenile polyps]. / Cancers recto-sigmoïdiens et polypes chez l'enfant. Commentaires à propos de 2 cas de polypes juvéniles atypiques.

The writers present a report of 2 observations of colo-rectal carcinoma, on a 19 month old infant with a mixed juvenile and adenomatous polyp situated at the recto-sigmoid junction and treated successfully by segmental colectomy, and on a 10 years old girl presenting a large colloid rectal carcinoma which occurred 6 years after resection of an atypical rectal juvenile polyp. After recalling the rarity and the gravity of colo-rectal carcinoma in childhood, the authors underline the importance of histological investigations in the juvenile polyposis which is usually benign; the possibility of histological aspects on separate polyps and sometimes on the same polyp explains the degeneration of some multiple juvenile polyps (several cases in the literature), or isolated polyp (first case described).