[Comparative study in primary care of the stability of INR in patients treated with warfarin or fluindione for atrial fibrillation. The FLOWER study (FLuindione Or WarfarinE - Result INR)]. / Étude comparative en soins primaires du taux d'INR dans la cible thérapeutique chez des patients traités par warfarine ou fluindione pour une fibrillation atriale. L'étude FLOWER (FLuindione Or WarfarinE ­ Result INR).

INTRODUCTION: The aim of our study was to compare the time spent within the target INR or Time in Therapeutic Range (TTR) of patients treated with fluindione to that of patients treated with warfarin for non-valvular atrial fibrillation (NVAF) and followed in general practice, with the hypothesis of a better TTR with warfarin, which is the VKA most commonly prescribed in France. METHOD: Liberal nurses and general practitioners working in the Auvergne region recruited patients treated with fluindione or warfarin for NVAF. Patients' INRs (International Normalized Ratios) were recorded by medical analysis laboratories for 6 months. The primary endpoint was TTR, the secondary endpoint the number of hemorrhagic and/or thromboembolic events. RESULTS: Of the 342 participants with a mean age of 75.3 ± 9.8 years, 239 (70%) were treated with fluindione and 103 (30%) with warfarin. The mean number of INRs achieved per patient was 9.2 ± 4.0 in the fluindione group and 9.3 ± 4.0 in the warfarin group (p=0.73). The median TTR of fluindione was 81.9% [63.5; 94.1] and that of warfarin was 81.3% [65.6; 92.6] (p=0.98). Twenty-eight of 263 patients reported hemorrhage (10.6%) and 4 reported thromboembolic events (0.8%), with no significant difference between the groups. CONCLUSION: The TTRs of patients treated for NVAF with fluindione versus warfarin do not differ significantly over an observation period of 6 consecutive months in a patient population comparable to that of the publications in this field. However, these TTRs are significantly higher than those reported in the literature, with no difference between the two treatments. The TTRs of patients treated for VANF with fluindione versus warfarin do not differ significantly over a 6-month observation period in a patient population comparable to that of the publications in this indication.

[Correspondence between general practitioners and cardiologists: Consensus from a study Delphi]. / Contenu des courriers échangés entre médecins généralistes et cardiologues : consensus d'après une étude Delphi.

AIM OF THE STUDY: To obtain a consensus from a panel of experts (GP and cardiologists) on the elements to appear on the correspondence sent by GP at the patient's first consultation with the cardiologist and on the response of the cardiologist. METHOD: A list of proposals concerning the content of the exchanges between the GP and the cardiologist was established by a scientific council of three GPs and one cardiologist, based on a review of the literature and their practices. This list was submitted for evaluation to a panel of GP and cardiologists experts using the modified RAND/UCLA Delphi method. RESULTS: Twenty nine experts (16 MG and 13 cardiologists) participated in the two evaluation rounds. For the contents of the letter written by the GP, 11 themes have reached consensus: administrative data, reason for consultation, history of the disease, recent constants, current treatments, current or previous pathologies and cardiovascular risk factors, physical activity, psychosocial context, test results, question asked to the cardiologist, cardiologist's perimeter of action. For the contents of the letter of the cardiologist's response, 11 themes were agreed: administrative data, reason for consultation, previous information, clinical examination, ECG, ultrasound, other complementary examinations, answer to the question asked by the GP, dietary treatments, proposed treatments, proposal for follow-up and management. CONCLUSION: This study have reached consensus on the elements to appear on the letters exchanged between the GP and the cardiologist.

[Screening for chronic obstructive pulmonary disease by electronic mini-spirometry in general practice]. / Dépistage de la broncho-pneumopathie chronique obstructive par minispirométrie électronique en médecine générale.

INTRODUCTION: Screening for COPD is currently considered to be insufficient. Electronic mini-spirometers allow screening for COPD in general practice. OBJECTIVES: To assess the prevalence of COPD in a population of at-risk patients in general practice (GP) and to identify the high-risk factors for the disease. METHODS: A cross-sectional study was performed in a GP setting. Patients aged between 40 and 75years with a history of smoking, occupational exposure to toxic substances or chronic respiratory symptoms were offered airflow assessments by electronic mini-spirometry. For any value of FEV1/FEV6 less than 70 %, screening for COPD was considered as positive. RESULTS: Of the 778 patients seen during routine consultations, 273 (35.1 %) fulfilled the inclusion criteria. The test was positive in 128 of the eligible patients (46.9 %). The prevalence of proven COPD (ratio<70 %) was 13.9 % (38 patients). The high-risk factors were age over 60years (P=0.03), body mass index over 28 (P=0.04), smoking history of more than 30pack-years (P<0.0001), presence of clinical signs (P<0.0001) and industrial exposure to toxic substances (P=0.03). CONCLUSIONS: Targeted screening of patients with risk factors for COPD can be performed in a GP setting. An electronic mini-spirometer is a reliable and inexpensive screening tool.

[Assessment of topical steroid treatment for childhood phimosis: review of the literature]. / Évaluation de l'efficacité des dermocorticoïdes pour le traitement du phimosis de l'enfant à travers une analyse de la littérature.

OBJECTIVES: Questions concerning nonretractile foreskin are frequently asked by parents in infant consultations. Topical steroid treatment could be a less expensive and less traumatizing alternative to surgery. AIM: To assess the effectiveness of topical steroid therapy in boys with phimosis. METHODS: Literature review. All randomized controlled trials were selected, using the following research sources: Medline, Cochrane Library, Pascal, Embase, Blackwell Science, Google, Google scholar, SUDOC, international register of trials, and congress abstracts. Unpublished trials were also searched. The trials were analyzed using the ANAES guide from a therapeutic article. RESULTS: Seven randomized controlled trials (n=714 patients) were in accordance with the inclusion criteria. The patients were between 1 and 12 years old. The treatment lasted for 4-8 weeks. The success rate at the end of the study was higher with the steroid (53.8-95%) than with the placebo (6.25-52%), P<0.05 for 6 randomized control trials. DISCUSSION: According to the ANAES criteria, the level of scientific evidence is low (gradeC) because of the lack of power in clinical trials and numerous methodological shortcomings and biases, even when examining both randomized control trials and nonrandomized trials. Only a few local side effects were noted. CONCLUSION: The use of topical steroids can be recommended in first-intention treatment before surgery for the management of phimosis.

[Benign cysts of the ovary. Homogeneous experience in 22 cases observed in 10 years]. / Kystes bénins de l'ovaire. Expérience homogène de 22 cas recueillis en 10 ans.

The authors present their experience with benign ovarian cysts based upon a series of 22 cases. Occurrence age displayed 2 peaks neonatal and para-pubertal. Ultrasound and coelioscopic examination would help in the management of such functional cysts where spontaneous regression must be weighted with potential complications.