[Comparison of the individual deprivation index of the French Health Examination Centres and the administrative definition of deprivation]. / Comparaison du score individuel de précarité des centres d'examens de santé, EPICES, à la définition socio- administrative de la précarité.

In French Health Examination Centres, populations in deprived situation were usually defined by administrative criteria The aim of the study was to investigate whether EPICES, a new individual index of deprivation, was more strongly related to health status than an administrative classification. The EPICES score was calculated on the basis of 11 weighted questions related to material and social deprivation. Participants were 197, 389 men and women, aged over 18, encountered in 2002 in French Health Examination Centres. Relationships between health status, health-related behaviours, access to health care, EPICES and the administrative classification of deprivation were analyzed by logistic regression. The associations between EPICES and the study variables were stronger than those observed for the administrative definition. The comparison also showed socially disadvantaged people with poor health identified by the EPICES score who were not by the administrative classification. These results showed that the EPICES score can be a useful tool to improve the identification of deprived people having health problems associated to deprivation.

[Myasthenic syndrome induced by lithium]. / Syndrome myasthénique induit par le lithium.

BACKGROUND: Lithium salts can induce a dysfunction of the neuromuscular junction. CASE REPORT: A patient given lithium for bipolar psychosis developed a state of major fatigue revealing a myasthenia syndrome which resolved progressively after lithium withdrawal. DISCUSSION: In the literature, we found 4 cases of neuromuscular junction disorders in patients treated with lithium. A myasthenia syndrome was induced by lithium in 3 cases and underlying myasthenia was disclosed by lithium in the last one. The long-term course in our patient was in favor of an induced syndrome rather than underlying myasthenia. We discuss the pathophysiological mechanisms. Lithium is a commonly prescribed drug. Clinicians should be aware of the possibility of neuromuscular junction disorder in patients taking lithium who develop muscle fatigue.

[Isolated truncular paralysis of the musculocutaneous nerve of the upper limb]. / Paralysies tronculaires isolées du nerf musculocutané au membre supérieur.

Isolated palsy of the musculocutaneous nerve, terminal branch of the lateral cord of the brachial plexus, is rare. It is responsible for sensory loss of the distal forearm and weakness of elbow flexion. It occurs after shoulder or clavicle surgery, trauma (fracture, dislocation, blows on the shoulder), violent exercice or extension of the forearm, prolonged positioning of the shoulder in extension-abduction-external rotation and phlebotomy. Different mechanisms such as stretching, compression or direct nerve injury are encountered. We report 5 cases with isolated musculocutaneous nerve palsy, including bilateral palsy caused by violent forearm extension. In other cases, mechanisms were an extensive stretching during surgery and compression caused by prolonged supine position. Different injury locations and causes described in literature are reviewed.

[Bilateral laryngeal movement disorder and synkinesia: value of botulism toxin. Apropos of a case]. / Trouble de la mobilité laryngée bilatérale et syncinésies: intérêt de la toxine botulique. A propos d'un cas.

Several years after a subtotal thyroidectomy complicated by bilateral vocal cord paralysis, the patient presented with progressive dyspnea due to laryngeal synkinesis. The impairement of the ventilation status, in spite of laser arytenoidectomy, followed by contralateral posterior transverse cordotomy, suggested a botulinum toxin injection in the intrinsic adductor laryngeal muscles. The rapid improvement in ventilation without phonatory impairement is discussed in the following report.

[Long term evaluation of sensation sequelae of bipedicled digital advancement island flaps. Comparison of clinical and electrophysiological results. Apropos of 13 cases]. / Evaluation à long terme des séquelles sensitives des lambeaux en îlot bipédiculés d'avancement digitaux. Confrontation des résultats cliniques et électriques. A propos de 13 cas.

Thirteen homodigital bipedicle island flaps for digital pulp amputation were reviewed to allow a better evaluation of sensory sequelae. A clinical and electrophysiological study of the sensory score of the pulp were compared to the contralateral normal digit and expressed in relative values. Sensory sequelae, even minor, are constant. The summated scores of dynamic and static 2 point discrimination test, appeared correlated to the electrophysiological amplitude modulations. This result seems particularly interesting as it adds another test for the objective evaluation of sensitivity.

A heart health assessment programme in general practice in County Kilkenny, Ireland.

The Kilkenny Faculty of the Irish College of General Practitioners and the Kilkenny Health Project have established a Health Assessment Programme (HAP) to standardise the examination and recording of coronary heart disease (CHD) risk factors in general practice. Criteria were agreed for classification and coding of demographic data, relevant medical history and risk behaviours. Height, weight and blood pressure are measured and venous blood sample is taken for total cholesterol estimation. The assessment is followed by appropriate counselling. The HAP was first targetted at men and women aged 40 to 49 years. During the first 16 months of the programme, 2102 assessments were carried out by 41 general practitioners, which represents 29% of the target group. Those taking part had a lower social class distribution when compared with participants in the KHP baseline survey in 1985. There were no significant differences between the two groups in smoking prevalence or in the distribution of body mass index. Median cholesterol was 5% lower in the HAP group than at the baseline survey. 16% of the HAP clients had diastolic blood pressures of 90 mm Hg or more. The HAP has demonstrated that it is feasible to measure CHD risk factors in a variety of general practice settings. The format facilitates a preventive orientation and has proved acceptable to patients.

[Malignant xanthogranuloma of the cervicofacial region. Optical and ultrastructural morphology. Apropos of 4 cases]. / Xanthogranulome malin de la région cervico-faciale. Morphologie optique et ultrastructurale. A propos de 4 observations.

The 4 cases of malignant xanthogranuloma reported here are peculiar because of their unusual localization in the cervico-facial area and of their good outcome (3 patients are alive without recurrence more than 6 years after chemotherapy and radiotherapy). Besides the histological study, the 4 cases were examined by immunohistochemical methods : vimentin was positive in 20 to 40% of cells and lysozyme in 5 to 15% of cells. In addition, one case was studied by electron microscope which showed the polymorphism of tumoral cells.