[Thermal treatment in arterial diseases: an expensive placebo or an effective therapy?]. / Le traitement thermal des maladies artérielles: un placebo coûteux ou une thérapeutique à part entière?

Each year, Royat (Auvergne) receives about 20,000 patients (80 per cent with intermittent claudication), treated by thermal gas (99.5 per cent of CO2). CO2 therapy is dispensed with thermal water or with dry gas (general or local immersion and local subcutaneous injections of gas) during 3 weeks. Local vasodilator effects of CO2 have been demonstrated with several methods in Royat. Physiological and therapeutic effects of thermal CO2 therapy, also used in Germany and Central Europe, were precisely reported during the Consensus Congress of Fribourg in Brisgau (1989); more particularly, this treatment seems provide a reduced ability of haemoglobin to fix oxygen, and therefore a release of oxygen within the cells. Patients with peripheral arterial disease (stage 2) have a walking distance increased and post-exercise ankles' pressures improved after a thermal course of treatment in Royat, while a control group has no significant changes. The discussion will concern also the socio-economic aspects of thermal treatment of arterial diseases.

Consequences of intravascular catheter sepsis.

Intravascular (IV) catheter sepsis is a widely recognized complication of IV therapy or monitoring, but little emphasis has been placed on the morbidity and cost associated with this infection. To assess the consequences of IV catheter sepsis, we examined the medical records of 94 patients with 102 episodes of IV catheter sepsis due to percutaneously inserted catheters. Major complications occurred in 33 (32%) of the episodes and included septic shock (12 episodes), sustained sepsis (12), suppurative thrombophlebitis (7), metastatic infection (5), endocarditis (2), and arteritis (2). One patient died due to sepsis, and hospital stay was clearly prolonged in 15 episodes. The risk of major complications was highest in episodes of IV catheter sepsis caused by Candida, Pseudomonas aeruginosa, Staphylococcus aureus, or multiple pathogens, and the most severe complications were usually caused by S. aureus. The hospital cost of IV catheter sepsis was assessed by reviewing medical and billing records to identify extra medical care and then multiplying charges for that care by the appropriate cost-to-charge ratio. The average cost per episode, adjusted to 1991 dollars, was $3,707 for all episodes and $6,064 for episodes caused by S. aureus. The morbidity and cost associated with IV catheter sepsis warrant substantial efforts to minimize the incidence of this complication and especially to prevent cases due to S. aureus.