[Medico-legal risk in urology: Analysis of a portfolio of insured persons by a French insurance company between 2009 and 2018]. / Risque médico-légal en urologie : analyse d'un portefeuille d'assurés auprès d'une compagnie d'assurances française entre 2009 et 2018.

OBJECTIVE: Presentation of data collected on urology claims from the register of a French insurance company. MATERIAL AND METHOD: Compensation claims involving urologists covering the period 2009-2018 were identified and analyzed. RESULTS: A total of 37 files were found. Oncological and functional surgical interventions accounts for 78% of repair claims. Postoperative complications represent 76% of the cases. The most represented acts are total prostatectomy (5) and promonto-fixation (4). The average time of complaint is 28.6 months [1-144 months], the average duration of a procedure (opening-closing) is 32.8 months [12-72 months]. The Conciliation and Compensation Commissions (CCC) and the High Court Courts (HCC) were solicited respectively in 51% and 33% of the proceedings. An amicable agreement is found in 16% of cases. There was no criminal or disciplinary proceedings. The average cost of a closed urology file is 7836 € [0-31,120 €]. In total, 64.8% of the expertises confirm practices in the respect of the rules of the art. CONCLUSION: This series presents the first forensic analysis of a portfolio of urologists on a period of 9 years in French urology. There is a rate of responsibility retained against the practitioner in only 27% of cases. The low rate of faulty files, the absence of a conviction for breach of the duty to provide information and in connection with antibiotic prophylaxis seem to confirm that the practice of urology in France is of good quality, a further study on a longer period of time and on a larger cohort of urologists would allow a finer medico-legal approach. LEVEL OF EVIDENCE: 3.

[Medico-economic evaluation of a care management program for asthmatic patients]. / Evaluation médico-économique d'un programme de prise en charge de patients asthmatiques.

This study aimed at measuring the medico-economic interest of a care management programme established for asthmatic patients in the Amiens region ("Action Asthma Amieris") by using and comparing different evaluation tools. Three tools were used in parallel: 1) a questionnaire for collecting information on healthcare received was completed monthly by 305 patients recruited by 73 physicians between November 1998 and January 1999; 2) data issued by the national insurance fund for the years 1998 and 1999, for those patients included after January 1999; and 3) data on all hospitalisations for 1998 and 1999 in the University Hospital Centre obtained from the French hospital information database (PMSI). Data from the national insurance fund and from the PMSI are essential to evaluate costs, since the patients' statements proved to under-estimate the amount of healthcare administered and received. Following the implementation of this asthma care management programme, an increase of pharmaceutical expenses and a decrease in the number of hospitalisations for asthmatic patients were observed.

A retrospective comparison of frontal facial dimensions in alveolar-bone-grafted and nongrafted unilateral cleft lip and palate patients.

This retrospective study was undertaken to describe and compare frontal craniofacial dimensions in alveolar-bone-grafted and nongrafted complete unilateral cleft lip and palate (CUCLP) patients and in noncleft subjects with normal occlusions and good facial balance. Clinical data were obtained from the files of the Hospital for Sick Children, Toronto. Patients were eligible for inclusion if they had posteroanterior cephalograms (PA) taken at adulthood and no congenital anomalies other than CUCLP. A total of 86 adult Caucasian CULCP patients were studied, including 58 who had not received grafts, 28 who had received secondary alveolar bone grafts, and, for comparison, 60 noncleft Caucasian adults. The PA cephalometric radiographs were traced, digitized, and measured. Analysis of variance (ANOVA) was used to test for among-groups differences in the means of the ratios, proportions, and angular measures. Tukey-Kramer HSD procedure was used to conduct post-hoc pairwise comparisons following significant (p < or = 0.05) F-ratios from ANOVA. Sexual dimorphism was a common finding, with males demonstrating greater facial width. Despite primary surgical repairs, the anterior nasal spine in the nongrafted CUCLP patients was deviated to the noncleft side, and the alar base was depressed on the cleft side. The maxillary incisors close to the cleft site were irregularly inclined, and this irregularity was more severe in the nongrafted CUCLP patients. The long-term effects of secondary alveolar bone grafting on transverse craniofacial growth appears to be minimal and limited to the immediate area of the cleft.

[Tuberculosis and mycobacterioses in the AIDS era]. / La tuberculose et les mycobactérioses à l'ère du SIDA.

The emergence of the HIV infection has been concomitant with a halt, noticed as early as 1986, in the regression of tuberculosis. The resurgence of tuberculosis, and indeed of all mycobacterioses, is determined by the HIV-induced alteration of cell-mediated immunity, which encourages the development of tuberculous and non-tuberculous bacteria. These bacteria themselves have an immunosuppressant effect on CD4 lymphocytes and macrophages, thus contributing to the progress of the HIV infection. The HIV and tuberculous infections therefore constitute a kind of "diabolical duo", the degree of endemia of one of these two diseases being influenced by the other and reciprocally. The final result is a menace to all countries where tuberculosis is strongly endemic and where the HIV infection is spreading. Only one of these infections, tuberculosis, is within the reach of our therapeutic armentarium. Patients must be investigated for tuberculosis systematically and actively--even though this disease may be hidden by misleading clinical signs and symptoms of AIDS--in order to treat it and separate, at least partially, the diabolical duettists.

Features in hospitalized patients with symptom-detected or radiologically-detected pulmonary tuberculosis.

To compare features of tuberculosis detected either clinically or radiologically, we studied 498 patients hospitalized for tuberculosis. Tuberculosis was less frequently radiologically-detected in patients over 65 yrs old (p less than 0.01) and in directorial staff and inactive subjects (p less than 0.0001). Pleural effusion and radiological cavities were more frequent in the symptom-detected group, but half of the radiologically-detected patients had clinical symptoms which could have led to the diagnosis of tuberculosis, especially in alcoholics and office workers. Finally, 26% of the radiologically-detected patients had positive direct tuberculosis smears and should be considered contagious.

[Patients hospitalized with pulmonary tuberculosis presenting Koch's bacillus in direct sputum examination. Clinical, radiologic and bacteriologic characteristics]. / Malades hospitalisés pour tuberculose pulmonaire présentant des bacilles de Koch à l'examen direct de l'expectoration. Caractéristiques cliniques, radiologiques et bactériologiques.

To determine the influence of socio-economic, clinical and radiological factors on the detection of a Mycobacterium tuberculosis-positive direct sputum smear, we studied 531 patients hospitalized for pleuropulmonary tuberculosis over a 5 year period. M. tuberculosis positivity of the expectorate smear was found more frequently in clinically detected (43%) than in radiologically detected (26%) tuberculosis (P less than 0.001). On admission, a M. tuberculosis-positive sputum smear was more common in patients under 40 years old (P less than 0.02), blacks (P less than 0.05) and alcoholics (P = 0.001). M. tuberculosis positivity on direct sputum smears was more often associated with general (asthenia, sweating, fever greater than 38 degrees C) and functional respiratory symptoms (cough and sputum production) (P less than 0.003), bilateral diffusion of lung lesions and/or excavation on chest roentgenography (P less than 0.0001). Nevertheless, 21% of the asymptomatic radiologically detected tuberculosis patients had positive direct expectorate smears and should be considered contagious.

[Etiological factors of asthma and their relation with bronchial hyperreactivity]. / Les facteurs étiologiques de l'asthme et leurs relations avec l'hyperréactivité bronchique.

As asthma is nearly always associated with non-specific bronchial hyperreactivity, this factor has been considered to be an essential requirement for the development of symptomatic asthma. Some factors appear to be inducers of bronchial hyperreactivity and others promotors of asthmatic symptoms. In clinical practice, it is very difficult to classify aetiological factors as inducers or promotors: there is evidence to support the fact that the same factors may cause both bronchial hyperreactivity and asthmatic symptoms; conversely, the evidence for hereditary non-specific bronchial hyperreactivity is hardly convincing. These observations suggest that non- specific bronchial hyperreactivity is more a marker of bronchial asthma than a true aetiological factor.