Incidence of salivary side effects after radioiodine treatment using a new specifically-designed questionnaire.

Sialadenitis is one of the common complications of radioiodine treatment for thyroid malignancy. The aim of this study was to evaluate the prevalence of radioiodine-induced sialadenitis and other side effects by using a self-administered questionnaire. From 1 January 2011 to 31 December 2012 all consecutive patients with a newly-established diagnosis of thyroid cancer who were treated with adjuvant radioiodine at La Timone University Hospital were sent a self-administered questionnaire on salivary complaints that had been specifically designed for this study. A total of 413 patients sent the questionnaire back, of whom 100 (24%) had experienced pain, 116 (28%) discomfort or swelling, and 147 (36%) dry mouth or xerostomia. This survey has highlighted the number of side effects of radioiodine treatment in a large group of patients and corroborates previous observations. Our new self-administered questionnaire may be useful to others for follow-up and research.

Quality of life in bimodal hearing users (unilateral cochlear implants and contralateral hearing aids).

The main objective was to evaluate the bimodal self-rated benefits on auditory performance under real conditions and the quality of life in two groups of cochlear-implanted adults, with or without a contralateral hearing aid. The secondary objective was to investigate correlations between the use of a hearing aid and residual hearing on the non-implanted ear. This retrospective study was realized between 2000 and 2010 in two referral centers. A population of 183 postlingually deaf adults, implanted with a cochlear experience superior to 6 months, was selected. The Speech, Spatial, and other Qualities of Hearing Scale were administered to evaluate the auditory performances, and the Nijmegen Cochlear Implant Questionnaire to evaluate the quality of life. The population was divided into two groups: a group with unilateral cochlear implants (Cochlear Implant-alone, n = 54), and a bimodal group with a cochlear implant and a contralateral hearing aid (n = 62). Both groups were similar in terms of auditory deprivation duration, duration of cochlear implant use, and pure-tone average on the implanted ear. There was a significant difference in terms of pure-tone average on low and low-to-mid frequencies on the non-implanted ear. The scores on both questionnaires showed an improvement in the basic sound perception and quality of social activities for the bimodal group. The results suggest that the bimodal stimulation (cochlear implant and contralateral hearing aid) improved auditory perception in quiet and the quality of life domain of social activities.

Responder and nonresponder patients exhibit different peripheral transcriptional signatures during major depressive episode.

To date, it remains impossible to guarantee that short-term treatment given to a patient suffering from a major depressive episode (MDE) will improve long-term efficacy. Objective biological measurements and biomarkers that could help in predicting the clinical evolution of MDE are still warranted. To better understand the reason nearly half of MDE patients respond poorly to current antidepressive treatments, we examined the gene expression profile of peripheral blood samples collected from 16 severe MDE patients and 13 matched controls. Using a naturalistic and longitudinal design, we ascertained mRNA and microRNA (miRNA) expression at baseline, 2 and 8 weeks later. On a genome-wide scale, we detected transcripts with roles in various biological processes as significantly dysregulated between MDE patients and controls, notably those involved in nucleotide binding and chromatin assembly. We also established putative interactions between dysregulated mRNAs and miRNAs that may contribute to MDE physiopathology. We selected a set of mRNA candidates for quantitative reverse transcriptase PCR (RT-qPCR) to validate that the transcriptional signatures observed in responders is different from nonresponders. Furthermore, we identified a combination of four mRNAs (PPT1, TNF, IL1B and HIST1H1E) that could be predictive of treatment response. Altogether, these results highlight the importance of studies investigating the tight relationship between peripheral transcriptional changes and the dynamic clinical progression of MDE patients to provide biomarkers of MDE evolution and prognosis.

Laparoscopic sacrocolpopexy for management of pelvic organ prolapse enhances quality of life at one year: a prospective observational study.

STUDY OBJECTIVE: Assessment of 1-year quality of life outcome of patients treated with laparoscopic sacrocolpopexy. DESIGN: A prospective multicenter observational study (Canadian Task Force classification II-3). SETTING: Four French medical centers. PATIENTS: A total of 94 women who underwent laparoscopic sacrocolpopexy for pelvic organ prolapse between June 2006 and May 2007 were included in the study. MEASUREMENTS AND MAIN RESULTS: Women attended a research clinic where they completed validated quality of life questionnaires and were examined. Women were assessed before and 1 year after surgery for the degree and impact of vaginal, urinary, and bowel symptoms with validated quality of life questionnaires, evaluation of sexual function with a validated questionnaire, and pelvic organ support was assessed by a Pelvic Organ Prolapse Quantification score. Mean age of the women was 58.8 years. Anatomic success occurred in 94% of women. Concomitant urinary continence surgery was performed in 39% of cases. All the scores of quality of life and sexuality were significantly improved at 1 year. CONCLUSIONS: Laparoscopic sacrocolpopexy for pelvic floor prolapse is a safe and effective treatment that has a positive impact on every aspect of quality of life (symptoms, social impact, sexual function) in the medium term.

[Relationship between insight and self-reported quality of life among shizophrenic patients]. / Influence des troubles de la conscience sur l'auto-évaluation de la qualité de vie des patients souffrant de schizophrénie.

BACKGROUND: Shizophrenia is a long-lasting condition with either episodic or continuous evolution that can result in physical, psychological, and social problems related to both the disease itself and the potential side-effects of treatments. These various aspects should be taken into account when assessing the outcome of medical management of patients suffering from schizophrenia. Subjective criteria, such as quality of life (QoL) measurements, should be considered an important focus for evaluation in this population. A major subgroup of patients with schizophrenia lacks insight of having a mental disorder or symptoms of a mental disorder. Studies on the relationship between insight and QoL have produced inconsistent results. While some studies found positive associations between insight and QoL, others found negative ones. Some possible explanations for the discrepancies between these findings can be expressed: differing patients' characteristics, heterogeneous insight or QoL measures, sample size and methodological differences. None of the previous research studies have looked at relationships between insight and QoL, as assessed respectively using the scale to assess unawareness of mental disorder (SUMD, a widely multidimensional insight questionnaire), and the S-QoL (a disease-specific patient-based instrument). AIM OF THE STUDY: The aim of this study was to assess the impact of insight into illness on the self-reported QoL as determined by schizophrenic patients, while taking into account the key confounding factors. METHODOLOGY: This study incorporated a cross-sectional design and took place in the psychiatric department of a French public university teaching hospital (Marseille, France). The inclusion criteria were: diagnosis of schizophrenia or schizoaffective disorder (DSM-IV-R), age over 18, native French speaker, agreement to participate. The following data were recorded: sociodemographic parameters (age, gender, marital status, education level, occupational activity), clinical data (in- or out-patient, clinical form), and psychopathology (Positive And Negative Syndrome Scale, PANSS). Insight was assessed using the Scale to assess Unawareness of Mental Disorder (SUMD), a standardised expert-rating scale based on a patient interview describing nine domains. The S-QoL is a self-administered disease-specific instrument validated from patients' views that includes 41 items and describes eight dimensions (psychological well-being, self-esteem, family relationships, relationships with friends, resilience, physical well-being, autonomy, and sentimental life), and yielding a global index score. RESULTS: One hundred and fifty-three patients were enrolled (mean age 37.6, standard deviation 11.2). Patients with good insight generally reported a lower global QoL score, whatever the insight domains. Insight of mental disorder is the most important domain affecting QoL levels. Psychological well-being, self-esteem, physical well-being, and autonomy scores were significantly lower for subjects with good insight. Multivariate analysis showed that insight of mental disorder is the only parameter linked to the S-QoL index. No links were found between other insight domains and S-QoL index. CONCLUSION: Patients with good insight might realise consequences of their mental illness with restrictions in daily living and alteration of their QoL, while patients with poor insight might partially overrate their QoL and present themselves as more competent.

[French validation of the Multiple Sclerosis International Quality of Life Questionnaire]. / Validation Française du Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL).

INTRODUCTION: Health-related quality of life (HRQL) measurements have become an important outcome both for population health assessment and for evaluating treatments and care management. HRQL indicators require completion of a well-validated questionnaire. Few specific questionnaires are available for French multiple sclerosis (MS) patients. The Multiple Sclerosis International Quality of Life questionnaire (MusiQoL), a self-administered and multidimensional questionnaire, was co-developed and validated in 17 countries, including France. We report the main results of the French clinical validity of this instrument. METHODS: The French patients were recruited between January 2004 and February 2005. The main inclusion criteria were: diagnosis of MS according to McDonald criteria, age over 18 years, having given informed consent. The self-administered survey materials that were completed by the patients included the MusiQoL, the generic HRQL questionnaire SF36, and one checklist of 14 MS-specific symptoms reported by the patients. MusiQoL comprises 31 items describing nine dimensions: activity of daily living (eight items), psychological well-being (four), symptoms (three), friends relationships (four), family relationships (three), satisfaction with health care (three), sentimental and sexual life (two), coping (two), and rejection (two). A global index score is computed. Patients were evaluated at inclusion (T0), and retested 21±7 days later (T1). At T0, an experienced neurologist collected sociodemographic data, clinical history related or unrelated to the MS condition, treatments. At T1, change in the patient's health status from T0 was reported. RESULTS: The analyses were performed with data from 179 subjects. The mean patient age was 44.1 years (SD: 11.5); there were 120 women and 59 men, 58.1% were unemployed, 13.6% had a tertiary educational level. MS clinical forms were 69 relapsing-remitting, 47 secondary-progressive, 37 primary-progressive, and nine clinically isolated syndrome. The EDSS median was 4.5 (25-75(th) percentiles: 2.5-6.0). The final French version showed satisfactory psychometric properties (external validity, internal consistency, reliability, reproducibility, and acceptability). CONCLUSION: The availability of a reliable and valid French version of MusiQoL, a self-administered and multidimensional questionnaire, co-developed in different countries, enables evaluation of QoL in French MS patients that are eligible for international multicenter studies.

[Immune profile of elderly patients admitted in a geriatric short care unit]. / Étude du profil immunitaire de sujets âgés hospitalisés en unité de court séjour gériatrique.

INTRODUCTION: Immunosenescence embraces the whole of age-induced changes observed in the immunomodulatory functions of a living organism, and is mostly characterized by a decrease in cell-mediated immunity and important modifications of the immunological repertoire. The impact of the pathology on ageing immunity is poorly understood and few data are available on the immunological status of old polypathological patients. METHODS: We report the results of a prospective study aiming at characterizing several established immunological parameters in patients of 75 years old or more, and admitted for diverse pathologies in a unit of acute geriatric ward. RESULTS: Among the 51 included patients (35 women and 16 men), 90% displayed poly-pathologies. We found a prevalence of 86% of immunological abnormalities, with lymphopenia among 41% of the patients (<1500/mm(3)) and abnormal lymphocytes phenotypes among 95% of the oldest patients (>85 years). A strong skewing towards memory T lymphocytes (CD45RO+) over naive T lymphocytes (CD45RA+) was found in 80% of the cases and inverted CD4/CD8 T cells ratio was observed in 12% of our patients. Vitamin D insufficiency (<30ng/ml), which is frequent among the patients (94%), is a predictive factor for T and B cell lymphopenia. CONCLUSION: Immunological abnormalities are frequent in this frail population and lymphopenia, in particular, could constitute a reinforcing factor of fragility. Vitamin D deficiency could also affect elderly patients' immunity.

Quality of life in a heterogeneous sample of caregivers of cancer patients: an in-depth interview study.

To establish the best approach to develop a quality of life (QoL) questionnaire for cancer-patient caregivers, this study attempts to identify primary domains of QoL in terms of their impact on a purposive sample of caregivers. Seventy-seven informal adult caregivers of cancer patients (breast cancer, paediatric haematological malignancies or melanoma) with different relationships with the patients (parents, children, spouses, siblings, and friends) were recruited at three specialised French centres and extensively interviewed. Caregivers' lives were altered in several domains: psychological well-being, leisure and everyday activities, relationships with institutional caregivers, occupation and finances, relationships with family and friends, physical well-being, and relationship with the patient. The relative importance of these domains varied mainly in association with the caregiver-patient relationship. Multiple correspondence analysis identified two isolated clusters: children, and, most significantly, friends and siblings. The latter groups emphasised the repercussions on their psychological well-being and their relationship with the patient, but were less willing to discuss the impact on their relationship with caregivers and on occupation, finances, leisure, and everyday activities. This study focuses on the caregiver's perspective and advocates the development of a short QoL core questionnaire. Additional modules should be cancer-specific or dedicated to specifics of the caregiver-patient relationship.

Validation of a professionals' satisfaction questionnaire with electronic medical records (PSQ-EMR) in psychiatry.

BACKGROUND: Electronic medical records (EMR) are currently being implemented in psychiatric hospitals throughout Europe. The perceptions of health care professionals can contribute important information that may predict their acceptance of and desired mode of use for EMR, thus guiding EMR implementation. AIMS: To develop a self-administered instrument designed to assess health care professionals' satisfaction regarding EMR in a psychiatric hospital, based only on the professional point of view, according to the psychometric standards. METHODS: The development was supervised by a steering committee and undertaken by three standard steps. Item generation was derived from 115 face-to-face interviews with health care professionals in a French, public, psychiatric hospital. The item-reduction process resulted in a 25-item questionnaire. The validation process was based on construct validity, reliability and some aspects of external validity. RESULTS: The final version of the questionnaire contained 25 items that described five dimensions, leading to a global score. The factor structure accounted for 72% of the total variance. Internal consistency was satisfactory (item-internal consistency over 0.40 and Cronbach's alpha coefficients ranged from 0.86 to 0.95). The scalability was satisfactory with INFIT statistics inside an acceptable range. Scores of dimensions were strongly positively correlated with visual analogue scale scores (all p < 0.001). External validity showed statistical associations between scores and age, gender, seniority in psychiatry and ward type. Participation rate was 66%. CONCLUSION: The availability of a reliable and valid questionnaire (professionals' satisfaction questionnaire with electronic medical records [PSQ-EMR]) concerning health care professionals' satisfaction regarding EMR in psychiatry, exclusively generated from interviews with health care professionals, enables legitimate feedback to be incorporated into EMR implementation in order to formulate a high-quality health care.

[Establishment of an electronic medical record in a psychiatric hospital: evolution of professionals' perceptions]. / Mise en place d'un dossier patient informatisé dans un établissement public de psychiatrie : évolution des perceptions des professionnels de santé

OBJECTIVE: The potential benefits of the application of an electronic medical record (EMR) in medical care are well recognized. However, if these benefits are to be accomplished, professionals must adopt and utilize EMR as a part of their practice. The aim of this study was to assess the evolution of the health care professionals' opinions of EMR and their use on a period of 1 year in a French Public Psychiatric Hospital. SETTING: Our institution is a 204-bed psychiatric hospital, employing 328 professionals and comprising three sectors: six units of complete hospitalisation (102 beds), one unit of week hospitalisation (15 beds), one unit of emergency (seven beds) and one unit of night hospitalisation (15 beds). Three extrahospital structures include the day hospitalisation (65 places), the medicopsychological centres (CMP) and the part-time therapeutic reception centres (CATTP) of the three sectors. METHODS: We conducted face-to-face, semi-structured interviews with health care professionals of a public psychiatric hospital on two occasions: 1 month after the establishment of the EMR (t0) and one year later (t1). All the solicited people agreed to participate in the investigation. The interviews were conducted until no new ideas emerged in the content analysis performed in real time, comprising 60 care professionals at t0 (10 psychiatrists, 42 nurses and eight paramedical professionals) and 55 at t1 (six psychiatrists, 42 nurses and seven paramedical professionals). Content analysis was performed by two members of the steering committee who were skilled in textual analysis. A descriptive analysis was also performed. The variables were described by proportions and means. The proportions were compared using the Chi-squared test or Fisher exact test where appropriate. A two-tailed p-value of greater than 0.05 was considered to indicate statistical significance. Statistical analyses were carried out using SPSS version. RESULTS: The proportion of EMR use remained stable and high (respectively 97% in 2007 and 93% in 2008). However, there was an increase in the proportion of pages used in 2008 (77% of the pages) compared to 2007 (58%) (p=0.02). The analysis of interviews highlighted some elements which explained the "under-utilization" of the EMR: "the record contains too many pages", "complete all the pages is sometimes hard", "It's difficult to have a global vision of the EMR". These difficulties are reported in an equivalent way between 2007 and 2008. For the "good users", the EMR had real strengths: "the EMR contains information recorded in a synthetic and precise way"; "the EMR provides complete and rapid information on the patient". There is an improvement of positive perceptions between 2007 and 2008; for example 38% of respondents in 2008 (against 18% in 2007) appreciated the multidisciplinary nature of the EMR and 51% in 2008 (against 40%) in 2007 appreciated the "centralisation of data". The general opinion on EMR had not changed between 2007 and 2008: 70% of professionals had a favourable opinion. Similarly, we did not find statistical difference between 2007 and 2008 on the perception of the impact of EMR on the quality of relationships between professionals and between professionals and patients. The impact on the quality of care remained high. In 2007, 72% of professionals reported that EMR could have a positive impact on the care of patients against 85% in 2008 (non significant). The main impact was the improvement of the continuity and coordination of care. The proportion of professionals who did not consider that EMR could deteriorate impact on professionals-patients relationships was not statistically different between in 2007 (44%) and 2008 (56%). Sixty-six percent of professionals in 2008 against 50% in 2007 did not consider that EMR deteriorates relationships between professionals (p=0.06). However, the rates of adverse opinions remained high in 2008 on the impact of EMR on relationships in general. This was directly related to the "loss of time in completing the EMR". However, in analysing the verbatim, there was a change of potential consequences of this loss of time. "The lack of availability for patients" was less expressed than "the loss of oral communication between professionals" which was reported more frequently. CONCLUSION: This study allowed us to identify the residual problems which each hospital could face, 1 year after setting up an EMR. This preliminary work constitutes the first step in the development of a measurement tool of the use and perception of the EMR by health care professionals.

Sacral neuromodulation in children with urinary and fecal incontinence: a multicenter, open label, randomized, crossover study.

PURPOSE: The clinical benefit of sacral neuromodulation is unclear due to the paucity of randomized trial data. The purpose of this study was to evaluate sacral neuromodulation for management of urinary and fecal incontinence in a pediatric population. MATERIALS AND METHODS: This multicenter, open label, randomized, crossover study included children older than 5 years. After trial stimulation of the S3 root a neuromodulator (InterStim) was implanted on the S3 foramen. Clinical examinations, voiding and bowel diaries, and urodynamic and manometric evaluations were performed at the beginning (t1) and end (t2) of the first period, and at the beginning (t3) and end (t4) of the second period. RESULTS: A total of 33 patients (24 boys) with a mean +/- SD age of 12.22 +/- 5.09 years were randomized. Etiologies were mainly of neurological origin. Incontinence was mixed urinary and fecal in 19 cases, urinary only in 9 and fecal only in 5. Cystometric bladder capacity increased during sacral neuromodulation (delta +24.27 ml vs -37.45 ml, p = 0.01). There was no significant change in other urodynamic or manometric parameters. Overall positive response rate was more than 75% for urinary (81%) and bowel (78%) function. Crossover analysis indicated that sacral neuromodulation is more effective than conservative treatment for both types of incontinence (p = 0.001). CONCLUSIONS: In a pediatric population sacral neuromodulation is effective for bladder and bowel dysfunction and should be considered before irreversible surgery.

Iodine biokinetics and radioiodine exposure after recombinant human thyrotropin-assisted remnant ablation in comparison with thyroid hormone withdrawal.

CONTEXT: A few prospective studies have evaluated the use of recombinant human TSH (rhTSH) for radioiodine remnant ablation. OBJECTIVE: Our objective was to compare the effects of the both TSH regimens on iodine biokinetics in the thyroid remnant, dosimetry, and radiation protection. DESIGN: We conducted a prospective randomized study. MATERIALS AND METHODS: Eighty-eight patients were enrolled for radioiodine ablation to either the hypothyroid or rhTSH arms. A whole-body scan was performed at 48 and 144 h after therapy. Dose rates were assessed at 24, 48, and 144 h. Urinary samples were obtained during the first 48 h. Thyroglobulin was assessed before and after therapy. Iodine biokinetics in the remnants were calculated from gamma-count rates. Radiation-absorbed dose was calculated using OLINDA software. Exposure estimation was based on a validated model. RESULTS: The effective half-life in the remnant thyroid tissue was significantly longer after rhTSH than during hypothyroidism (P = 0.01), whereas 48-h (131)I uptakes and residence times were similar. After therapy, thyroglobulin release (a marker of cell damage) was lower in the rhTSH arm. The mean total-body effective half-life and residence time were shorter in patients treated after rhTSH. Residence time was also lower for the colon and stomach. Absorbed dose estimates were lower in the rhTSH arm for the lower large intestine, breasts, ovaries, and the bone marrow. Dose rates at the time of discharge were lower in the rhTSH group with a reduction in cumulative radiation exposure to contact persons. CONCLUSIONS: In comparison with thyroid hormone withdrawal, rhTSH is associated with longer remnant half-life of radioactive iodine while also reducing radiation exposure to the rest of the body and also to the general public who come in contact with such patients.

[The ban on smoking in public places (Decree No. 2006-1386 of 15th November 2006): Impact over 12 months on smoking status of hospital nurses]. / Interdiction de fumer dans les lieux affectés à un usage collectif (décret no 2006-1386 du 15 novembre 2006) : impact à 12 mois sur le statut tabagique chez des infirmiers hospitaliers.

INTRODUCTION: In France, the decree No. 2006-1386 banned smoking in public places such as hospitals. The aim of our study was to describe the impact of the legislation on the smoking status of hospital nurses. METHODS: A descriptive study was undertaken in a university hospital of Marseilles, under the responsibility of the occupational medicine service. Between April and June 2008, a questionnaire was distributed to the nurses who had been working for more than one year. The following data were collected: demographic information, smoking status, behaviour and attitudes regarding smoking addiction, knowledge regarding existing preventive measures. RESULTS: Sixty-four percent of 715 eligible subjects responded; thirty percents reported themselves as current smokers, 25 % as ex-smokers and 45 % as non-smokers. Among the smokers, 68 % said that they had decreased their tobacco consumption during their working hours and 28 % their overall daily consumption. Among ex-smokers, 20 % declared that they were in the process of quitting. CONCLUSIONS: The nurses had decreased their tobacco consumption at work and these positive results should be confirmed over a long-term perspective. The preventive role of the occupational physician could be reinforced.

[Paced Auditory Serial Addition Test: normative data in a French population]. / Paced Auditory Serial Addition Test : données normatives dans une population française.

INTRODUCTION: The Paced Auditory Serial Addition Test (PASAT) is recognized as a sensitive measure of working memory, attention, and information processing speed in multiple sclerosis. The aim of this work was to provide normative data for PASAT in a healthy French population. OBSERVATIONS: A total of 360 subjects were recruited from volunteers (24 groups, 15 subjects per group, considering four age classes, three educational levels and gender). The PASAT was administered in a standardized way, by the same psychologist. CONCLUSION: Normative values were presented expressed as the means and standard deviations of T-score (Z-score*10+50).

Assessment of psychiatric inpatient satisfaction: a systematic review of self-reported instruments.

BACKGROUND: There is a growing concern about satisfaction with inpatient psychiatric services. There are currently numerous satisfaction instruments available to psychiatric inpatients, but little guidance on which among them to select. AIMS: To provide an overview of the psychometric properties and the content of satisfaction instruments available to psychiatric inpatients. METHODS: Systematic searches of Medline database to identify inpatient satisfaction questionnaires. Assessment of the instruments according to relevant psychometric properties. RESULTS: Fifteen satisfaction instruments were identified. The target population differed according to the instrument. Methods used to generate items were heterogeneous. These instruments were based on a mixed approach including patients' points of view, expert opinions, and literature reviews, causing the content of questionnaires to vary. Reliability and validity were not systematically tested. CONCLUSION: The validation of a common inpatient satisfaction instrument is a major challenge. Recommendations for the future development of satisfaction instruments may include: item generation based exclusively on the patient's point of view; a validation process on a large and representative population; and an instrument combining generic (core questionnaire) and specific (additional modules) approaches.

Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation (RRA) with recombinant human TSH (rhTSH): a randomized controlled study.

BACKGROUND: Recombinant human TSH (rhTSH) has become the modality of choice for radioiodine remnant ablation (RRA) in low-risk thyroid cancer patients. AIMS AND METHODS: The aims of the present prospective randomized study were to evaluate the impact of TSH stimulation procedure (hypothyroidism vs. rhTSH) on quality of life (QoL) of thyroid cancer patients undergoing RRA and to evaluate efficacy of both procedures. L-T4 was initiated in both groups after thyroidectomy. After randomization, L-T4 was discontinued in hypothyroid (hypo) group and continued in rhTSH group. A measure of 3.7 GBq of radioiodine was given to both groups. The functional assessment of chronic illness therapy-fatigue (FACIT-F) was administered from the early postoperative period to 9 months. Socio-demographic parameters, anxiety and depression scales were also evaluated (CES-D, BDI and Spielberger state-trait questionnaires). At 9 months, patients underwent an rhTSH stimulation test, diagnostic (131)I whole body scan (dxWBS) and neck ultrasonography. RESULTS: A total of 74 patients were enrolled for the study. There was a significant decrease in QoL from baseline (t0) to t1 (RRA period) in the hypothyroid group with significant differences in FACIT-F TOI (P < 10(-3)), FACT-G total score (P = 0.005) and FACIT-F total score (P = 0.003). By contrast, QoL was preserved in the rhTSH group. In the multivariate analysis, FACIT-TOI changes were only affected by the modality of TSH stimulation performed for RRA. From 3 to 9 months, changes of QoL scales and subscales were no longer statistically different in both groups of patients. Based on serum rhTSH-stimulated Tg alone (Tg < 0.8 microg/l, BRAHMS Tg Kryptor), no difference in ablation success was observed between rhTSH and hypothyroidism groups, 91.7% and 97.1%, respectively. A higher rate of persistent thyroid remnants was observed in the rhTSH arm, although in most cases uptake was < 0.1% and of no clinical significance. CONCLUSIONS: rhTSH preserves QoL of patients undergoing RRA with similar rates of ablation success compared to hypothyrodism. However, there is a wide heterogeneity in the clinical impact of hypothyroidism.

[Ankle injury without fracture in children: cast immobilization versus symptomatic treatment. Impact on absenteeism and quality of life]. / Traumatisme de la cheville sans fracture chez l'enfant : immobilisation plâtrée versus traitement symptomatique. Impact sur l'absentéisme et la qualité de vie.

UNLABELLED: Treatment methods for ankle injury in children are numerous and have comparable results. The impact on absenteeism and quality of life is an interesting criterion to consider in order to help doctors in their initial treatment choice. OBJECTIVE: The objective of this study was to compare two therapeutic strategies for ankle injury without fracture in children in terms of the impact on school absenteeism, parents' professional absenteeism, and quality of life. The strategies compared were cast immobilization of the ankle and a purely symptomatic treatment with no immobilization. MATERIALS AND METHOD: We conducted a prospective, comparative, and randomized study. The population comprised children between 8 and 15 years of age, consulting for a first episode of ankle injury in a pediatric-emergency department of a hospital center in Marseille, France. A clinical and radiographical report was systematically done. Children were seen after 1 week to provide the clinical monitoring, assess the child's and parents' absenteeism, and assess the quality of life. RESULTS: Sixty-two patients were studied. There was no difference in clinical progression after 7 days between the two treatment groups. Quality of life was also comparable. However, the children's absenteeism and the parents' absenteeism were higher in the casted group.

[Ankle injuries without fracture in children. Prospective study with magnetic resonance in 116 patients]. / Traumatismes de la cheville sans fracture chez l'enfant. Etude prospective par résonance magnétique de 116 patients.

PURPOSE OF THE STUDY: Appropriate assessment of ankle injuries in children and adolescents is a common emergency room problem. Many imaging techniques have been proposed, but with no consensus on the reality of anatomic lesions in ankles free of fractures, complicating the therapeutic decision. We analyzed the lesions observed with magnetic resonance imaging (MRI) in a large number of acute ankles in children. MATERIAL AND METHODS: This prospective study was conducted in a pediatric emergency room. The study population included all children aged eight to 15 years who presented an isolated injury of the ankle without fracture on the plain x-ray. History taking and physical examination were standardized. MRI was performed within three days of the initial physical examination. All the radiographic documents were examined by an experienced radiologist blinded to the results of the physical examination. RESULTS: During the study period, 116 patients were included. One hundred two MRI series were examined. Minor ligament injury was noted in 20 patients and ligament tear in five, including three with a closed distal tibial growth plate. Minor bone injury was noted in 42 patients and fracture in seven. None of these fractures were visible on the plain x-ray, even after knowledge of the MRI. Injuries were more frequent in boys. Injuries were more frequent when the pain was localized on the lateral aspect of the ankle and when there was an edema. DISCUSSION: Despite an abundant literature on ankle sprains, prospective studies are scarce in the pediatric population. We have found that MRI is particularly well-adapted for children because it allows a complete examination of anatomic lesions involving the bone or ligaments without the inconveniences of injections, pain, or radiation. Our clinical and imaging findings show that ankle sprains are real in children. We were however unable to identify any clinical factors predictive of ligament and/or bone injury. Other studies should be conducted to better understand the nosological context of ankle sprain in children and adolescents. Further study will enable a better evidence-based approach to individually adapted therapy.

Effect of thoracic epidural analgesia on gastric blood flow after oesophagectomy.

BACKGROUND: The oesophagectomy procedure includes the formation of a gastric tube to re-establish the continuity of the gastrointestinal tract. The effect of thoracic epidural analgesia (TEA) on gastric mucosal blood flow (GMBF) remains unknown in clinical practice. The aim of this prospective observational study was to assess the microcirculatory changes induced by TEA in the early post-operative course. METHODS: Eighteen consecutive patients who underwent radical oesophagectomy with en-bloc resection and two-field lymphadenectomy for oesophageal cancer, and benefited from TEA during the post-operative course, were studied prospectively, and compared with nine patients who declined the use of TEA in the same period (control group). GMBF was measured using a laser Doppler flowmeter in three consecutive time periods (before and after 1 and 18 h of TEA infusion). Post-operative monitoring also included the measurement of arterial pressure, cardiac output, gas exchange and intrathoracic blood volume index. RESULTS: After the first and 18th hour of infusion, TEA induced an increase in GMBF compared with baseline and the control group. The mean arterial pressure and intrathoracic blood volume index decreased after the first hour of TEA infusion with no influence on the cardiac index. CONCLUSIONS: This clinical study demonstrates that TEA improves the microcirculation of the gastric tube in the early post-oesophagectomy period. The clinical relevance of TEA in this setting should be validated in larger studies focusing on the clinical outcome following oesophagectomy.

[Radiography of scoliosis: comparative dosimetry between conventional technique and digital fluorography]. / Radiographie des scolioses: dosimétrie comparée entre la technique conventionnelle et la fluorographie numérique.

OBJECTIVE: Compare the irradiation delivered in conventional radiography and digital radiography by image intensifier during a scoliosis workup. PATIENTS AND METHODS: Our prospective randomized study included 105 patients, all of whom were identified according to sociodemographic parameters as well as criteria evaluating the quality of the full front spinal x-ray at PA incidence. The entry dose at the scapula and the exit dose in interorbital, thyroid, mammary, and hypogastric projection was measured by thermoluminescent dosimeters. RESULTS: The results of 71 girls and 28 boys, aged a mean 13.8 years with a mean weight of 47 kg were analyzed. At equal image quality, the entry dose was not significantly different between the two techniques; the mean exit dose reduction was 64% during digital acquisition. This reduction involved the interorbital (162%), mammary (43%), and thyroid (309%) regions. However, this system is more irradiating in the hypogastric region (34%). CONCLUSION: The dosimetric evaluation of the different imaging techniques used to explore the entirety of the spine should be part of radiologists' quality standard used to document their work and their choices.