[Adolescents at the Lenval's children's hospital emergency unit in Nice in 1999]. / Les adolescents aux urgences de l'hôpital Lenval pour enfants à Nice en 1999.

OBJECTIVE: The goal of this survey was to investigate adolescents' health through their utilization of a pediatric emergency unit. METHODS: Prospective survey performed one week of each month in 1999 concerning the adolescents' (12 to 18 years) visits to the Lenval's children emergency care unit in Nice. RESULTS: During the study period, 1,096 adolescents were examinated and accounting for 18.6% of the children admitted in the year. The main reasons for visits were injury-related visits (55.5%), non-accidental somatic complaints (38.7%), psychiatric disorders (5.5%), and psychosocial problems (0.4%). Most adolescent visits (68.6%) were not severe emergencies requiring hospital technical equipment support; about one-third of the visits (28.6%) were non urgent consultations; severe emergencies were fewer than 1%; there was no death. Compared with the other pediatrics age groups, adolescents more often used the hospital technical equipment (65.1% vs 45.4%), required a longer visit (62 +/- 33 vs 57 +/- 37 min), and had a higher hospitalization rate (13.4% vs 10.1%). CONCLUSIONS: Adolescent emergency care requires multidisciplinary skills, such as traumatologic, gynecologic, psychiatric, and psychosocial compentence. Two units, absent at Lenval at the time of this survey, seem to be important for good care: space for very short hospitalization in the emergency unit and an adolescent-specific unit in the pediatric ward.

Crisis intervention and affective disorders: a comparative cost-effectiveness study.

In recent years, psychiatric institutions have been increasingly urged to justify their clinical policies in order to ensure both effective treatment and efficient management. Assessment instruments for effectiveness and costs are essential to respond to these needs. The aim of this study was to determine the cost-effectiveness of treatments for major depressive disorders. We conducted a comparative pilot investigation of treatment costs in patients with a major depressive episode assigned to specialised out-patient crisis intervention, to specialised in-patient treatment and to standard mental hospital care. The study included 122 subjects. The inclusion criteron was a diagnosis of DSM-III-R major depressive episode. Costs were assessed by determining the average cost for each treatment and the modalities of payment systems. Treatment duration and costs were high, but specialised crisis intervention may considerably reduce the duration of hospitalisation and its associated costs. The average costs of treating major depression were about 4 times greater in the specialised hospital unit than in the standard hospital unit and the crisis intervention centre. The burden of payment was comparatively higher for the state and reduced for insurance companies when the treatment of major depressive disorders involved less in-patient care.

A new pacing algorithm for overdrive suppression of atrial fibrillation. Chorus Multicentre Study Group.

Constant rapid pacing may suppress arrhythmias, but it is usually poorly tolerated in the long term. We report a pilot study of a new pacing algorithm for overdrive suppression of atrial premature complexes (APCs) and atrial fibrillation (AF), which prevents postextrasystolic pauses and varies the pacing rate in response to the frequency of APCs. The algorithm was tested in a multiple crossover study for 24 hours in dual chamber pacemakers implanted in 70 patients. Comparison was made on ambulatory recordings between the number of atrial arrhythmias commencing with the algorithm active and inactive. In all cases, the algorithm functioned as designed. No patient was aware of its operation, and no malignant arrhythmias were induced. The 36 recordings that showed atrial arrhythmia were included for analysis. The effects of the algorithm were: APCs (estimated from pacemaker statistics) reduced in 18 patients, increased in 8 (P = 0.02); atrial salvos reduced in 12, increased in 4 (P = 0.041); and AF reduced in 11, increased in 8 (P = NS). In all patients with frequent AF (> 5 episodes in total), fewer episodes occurred when the algorithm was active. We conclude that the algorithm is safe and well tolerated, reduces atrial ectopic activity, and may reduce the frequency of sustained atrial fibrillation.

[Clinical experience with bromperidol in chronic psychoses]. / Experiencia clínica con Bromperidol en psicosis crónicas.

Bromperidol therapeutic efficacy, and tolerance was studied by means of a 3-month open trial on 25 chronic psychotic female inpatients from a room at San Juan ward for medium to extensive length of stay, The Braulio A. Moyano National Psychiatric Hospital, Buenos Aires. This drug was administered orally on a single 10- to 35 mg night dose. No effect whatsoever was observed on periodic catatonia. However, its being well-tolerated and effective on chronic psychotic patients, coupled to the "bonus" of a single daily dose, turns BP into a suitable alternative drug for Haloperidol when dealing with schizophrenia, and delusions with no deficitary evolution.

Experiencia clínica con Bromperidol en psicosis crónicas. / [Clinical experience with bromperidol in chronic psychoses]

Bromperidol therapeutic efficacy, and tolerance was studied by means of a 3-month open trial on 25 chronic psychotic female inpatients from a room at San Juan ward for medium to extensive length of stay, The Braulio A. Moyano National Psychiatric Hospital, Buenos Aires. This drug was administered orally on a single 10- to 35 mg night dose. No effect whatsoever was observed on periodic catatonia. However, its being well-tolerated and effective on chronic psychotic patients, coupled to the [quot ]bonus[quot ] of a single daily dose, turns BP into a suitable alternative drug for Haloperidol when dealing with schizophrenia, and delusions with no deficitary evolution.

[Genetic factors predisposing to autoimmune diseases. Study of HLA antigens in a family with pernicious anemia and thyroid diseases]. / Facteurs génétiques prédisposant aux maladies auto-immunes. Etude des antigènes HLA dans une famille avec anémie pernicieuse et maladies thyroïdiennes.

In a family including patients suffering from autoimmune disease (2 propositi: pernicious anemia and Graves' disease, pernicious anemia and autoimmune thyroiditis), we have determined common autoantibodies and tissue antigens (HLA) in 47 patients (26 males and 21 females) from 2 generations. In this family, we have found 4 cases of pernicious anemia, 5 cases of thyroid disease (2 Graves' disease), 3 women with repetitive abortions and 2 cases of melanoma. Patients with autoantibodies, often asymptomatic, are abnormally numerous (44% in generation II, 16% in generation III). A correlation with haplotype A1B8DR3 was found only for Graves' disease. Likelihood of forming autoantibodies appears to be of multifactorial origin. Its mode of transmission remains unknown.