Comparative study of clinical and ultrasonographic evaluation of lateral collateral ligament sprains of the ankle.

AIM: Clinical examination is sometimes insufficient to assess the severity of lateral collateral ligament (LCL) sprain of the ankle, making it difficult to choose the most appropriate treatment. The aim of this study was to compare the assessment of clinical signs and the ultrasonographic findings in recent LCL sprain of the ankle. METHODS: This was a retrospective cross-sectional study. Spearman's rank correlation test and multiple regression analysis were used to assess correlations between clinical signs and type of ligament injury. Fisher's linear discriminant analysis was used to determine most contributive signs in ligament tear diagnosis. RESULTS: No single clinical sign was correlated with the severity of ligament injury as revealed by ultrasonography in the 34 patients analyzed. Careful assessment of all the usual clinical signs of severity seems to better guide the diagnosis of the presence or absence of ligament tearing. CONCLUSIONS: These results confirm the lack of correlation between clinical examination and the anatomic injury in distension or partial tearing of the anterior talofibular ligament. They raise questions about the usefulness of clinical classifications and suggest a broadening of the indications for ultrasonographic exam in ambiguous situations, particularly for athletes showing few signs of severe injury, in order to ensure optimal treatment and a faster recovery.

[Isokinetic dynamometer measurement of shoulder rotational strength in healthy elite athletes (swimming, volley-ball, tennis): comparison between dominant and nondominant shoulder]. / Mesure de la force des muscles rotateurs de l'épaule chez des sportifs sains de haut niveau (natation, volley-ball, tennis) par dynamomètre isocinétique: comparaison entre épaule dominante et non dominante.

OBJECTIVE: To compare lateral rotator (LR) and medial rotator (MR) muscle strength of both shoulders in a sport involving asymmetrical movements (tennis), symmetrical movements (swimming), and symmetrical and asymmetrical movements (volley-ball). MATERIALS AND METHODS: Retrospective study of 42 healthy elite athletes (18 women: 14 tennis players, 19 swimmers and 9 volleyball players. We evaluated the strength of LR and MR of both shoulders by Cybex Norm isokinetic dynamometer, in the concentric mode, in the modified Davies position, at 2 different speeds (60 degrees and 180 degrees s(-1)) and analysed peak torque of LR and MR and LR/MR ratios. RESULTS: TENNIS: The MR peak torque of the dominant shoulder was significantly higher than that of the non-dominant shoulder. The LR/MR ratio of the dominant shoulder was significantly lower than the non dominant shoulder in women. SWIMMING: The LR strength and LR/MR ratio of the dominant shoulder was higher than the non dominant side in men at 60 degrees/second. Both shoulders showed comparable strength in women. VOLLEYBALL: Shoulder muscular strength was symmetrical. CONCLUSION: The higher strength of MR muscles in the dominant shoulder of tennis players (asymmetrical movements) has been reported in the literature. Athletes show asymmetrical shoulder strength in swimming, a symmetrical sport and similar LR and MR strength in both shoulders in volleyball, a sport with asymmetrical movements. To our knowledge, these results have never been reported before.

Long-term and high-dose piracetam treatment of Alzheimer's disease.

Preclinical research suggests that piracetam (a nootropic drug) may improve cognitive functions, but previous studies have failed to demonstrate a clear benefit for the treatment of Alzheimer's disease (AD). We report a 1-year, double-blind, placebo-controlled, parallel-group study with a high dose of piracetam (8 g/d per os) in 33 ambulant patients with early probable AD. Thirty subjects completed the 1-year study. No improvement occurred in either group, but our results support the hypothesis that long-term administration of high doses of piracetam might slow the progression of cognitive deterioration in patients with AD. The most significant differences concerned the recall of pictures series and recent incident and remote memory. The drug was well-tolerated.

Pain infirmity and psychotropic drugs in oncology.

The treatment of cancer pain by psychotropic drugs is a method which has been employed for a long time [8] and in which the results obtained have appeared very interesting from the beginning: there is a high percentage of success, rapid action, absence of addiction, and although there are sometimes unpleasant side-effects, they are reversible when the treatment is stopped. Even after several years of application, this therapy still sets some unsolved problems. Some consider that psychotropics are not real analgesics, but that they work on the emotional reaction rather than on the pain itself [3]. Still others consider that the results are obtained only at the price of a state of prostration of the patient similar to that obtained after lobectomy. Finally, this procedure is reproached as having unpredictable results and indications difficult to define. We think that what has, up to now, prevented these types of problems from being solved has been the absence of a really objective evaluation of the pain in the patients observed. We have wrestled with this problem for several years [1,2], and offer the following hypothesis: what is important in considering chronic pain is, above all, the infirmity conferred upon the patient. If "pain" in the broad sense of the term lends itself to objective evaluation with difficulty, it is not the same with respect to infirmity. A method of evaluation of the physical disability intended for routine practice in a cancer center has been used on a series of 100 patients. The results obtained in this series have been analyzed and give the answer to questions such as mechanism of action, indications of psychotropic drugs and prognosis of cancer pain.

Valpromide increases amplitude of heart rate circadian rhythm in remitted bipolar and unipolar disorders. A placebo-controlled study.

The aim of this study was to investigate for the effects of valpromide on heart rate circadian rhythm in remitted recurrent unipolar and bipolar disorders (DSM-III-R). It consisted of a comparative, randomized, double-blind, repeated cross-over study of valpromide versus placebo over four four-week periods. The primary evaluation criteria was heart rate (HR). Secondary criteria comprised motor activity (MA) and the Bech and Rafaelsen mania assessment scale, Horne and Ostberg questionnaire, Montgomery and Asberg depression rating scale, Spiegel questionnaire, a sleep diary, and Clinical Global Impression. Fifteen patients were included, giving 60 one-month periods (30 valpromide periods and 30 placebo periods). Cosinor analysis of HR and MA data revealed a difference in amplitude (P = 0.037, analysis of variance, one-tailed test). The clinical sleep study shows that the duration of sleep was greater with valpromide than with placebo (P = 0.007, one-tailed test). Similarly, evaluation of the quality of sleep by patients themselves showed valpromide to be superior to placebo (P = 0.045, one-tailed test). The results of analysis of the Spiegel questionnaire also confirm the superiority of valpromide over placebo. Safety and compliance were comparable for the active drug and the placebo. In conclusion, the relatively small sample size requires cautious interpretation of this study. Nevertheless, these initial results show a definite effect of valpromide on a biological rhythm that leads one to suppose that it may be effective through a 'synchronizing' effect.

[Approach to the prognosis of myocardial infarct from the initial hemodynamic examination]. / Approche du pronostic de l'infarctus du myocarde à partir de l'exploration hémodynamique initiale

Hemodynamic investigations (right and left heart catheterization, cardiac output measurement) were performed in 132 patients with acute myocardial infarction. Retrospective study of the first 100 patients allowed determination of prognostic indices. A new statistical method is proposed which was used prospectively in the 32 following patients and resulted in an error of prediction of about 3 per cent. The establishment of prognosis from hemodynamic data is a necessary condition prior to new therapeutic approaches of cardiac failure in acute myocardial infarction.

Late progression of radiographic changes in Canari chrysotile mine and mill exworkers.

The present radiological status of 133 exworkers (mean age: 58 +/- 0.7 yr) of the chrysotile mine of Canari (Corsica) was compared to that recorded in 1965, when the mine was closed. The mean time since first exposure is 27 +/- 0.4 yr, and the mean time since termination of asbestos exposure equals 16 +/- 0.3 yr. This study showed an evolution of radiographic changes: in 1965 only 14% of the subjects had grade 1/1 or more parenchymal fibrosis, and 6% had bilateral pleural lesions; in 1979 these percentages reached 40% and 27%, respectively. Subjects who had a given parenchymal change in 1965 (e.g., 1/1 grade lesions) were older and had a more intensive dust exposure and tobacco consumption than exminers who developed the same parenchymal changes much later. A progression of parenchymal changes was observed in 39% of the subjects with normal findings in 1965, and in 63% of the subjects with grade 1/1 or more changes in 1965. Those who progressed (46% of the cohort) were older, had a longer exposure, and a more intensive dust exposure and cigarette smoking than nonprogressors.

Respiratory symptoms and air pollution changes in children: the Gardanne Coal-Basin Study.

The influence of daily changes in sulfur dioxide (SO2) levels on the induction of respiratory symptoms was studied during the 1983-1984 winter in 450 children, aged 9 to 11 yr, living in the Gardanne coal-basin, France. In this area, SO2 originates mainly from a coal-fueled power plant. The mean SO2 level during the winter was 22 micrograms/m3 in low-pollution areas and 93 micrograms/m3 in polluted areas, with daily SO2 levels up to 356 micrograms/m3. Children completed a daily diary about respiratory symptoms. In the polluted communities only we demonstrated a significant association between daily SO2 levels (after controlling for temperature and respirable particle variations) and prevalence of upper and lower respiratory symptoms. However, in each polluted town, and for each respiratory symptom, there was no evidence for either a latency period or a delay in the effects of pollutants. Mean daily temperature was also closely correlated with upper and lower respiratory symptoms in most of the polluted and some low-pollution communities. In a second step, the prevalence of respiratory symptoms in each town was compared, during two 2-wk periods, with air pollution levels; higher prevalences were found during the pollution period. In conclusion, moderate daily changes in SO2 levels induce a significant but transient increase in the prevalence of respiratory symptoms in children.

[Randomized study during a year of early combination of L-dopa/lisuride in Parkinson disease]. / Etude randomisée sur une année de l'association précoce L-dopa/lisuride dans la maladie de Parkinson.

The tolerance and efficacy of dopatherapy associated to lisuride or placebo were compared in 74 de novo patients with Parkinson's disease in a prospective randomized trial. Only non depressed and non demented patients, previously treated with low doses of levodopa during less than one year, were included in this study. Mean age was 59 (range 36-68). After 12 months, the mean dosage of levodopa was higher in the placebo group than in the lisuride group (318 +/- 121 and 274 +/- 74 mg daily respectively). We observed a different decrease in the Unified Parkinson's Disease Rating Scale with better scores in the lisuride group than in the placebo group, especially for the motor items (p less than 0.001) and the daily living (p less than 0.0001). The tolerance was similar in the two groups. This trial will be continued in open conditions over a period of 4 years to appreciate the incidence of motor fluctuations in the two groups.

[The Psychotic Anxiety Scale (PAS). Evaluation of inter-rater reliability and correspondence factorial analysis]. / Psychotic Anxiety Scale (PAS). Evaluation de la fidélité intercotateurs et analyse factorielle des correspondances.

We recently proposed the first scale for evaluating anxiety in psychotics: the "Psychotic Anxiety Scale" (PAS). The first version of this scale was tested in 45 psychotic patients. The multiple correspondence factorial analysis revealed that 4 factors account for respectively 50%, 18%, 17% and 10% of the variance. This scale thus evaluates anxiety along 4 axes: severity of the symptomatology, evolution in time, hetero-aggressiveness and self-aggressiveness. This analysis supports the hypothesis of the lack of specificity for the anxiety in psychotics, but distinguishes the nevrotic anxiety from the psychotic anxiety. The inter-rater reliability was assessed by a method which compared a rater with the others along 2 axes: the severity, and the profile of the assessment. The interrater reliability was unsatisfactory for only three items. They have been modified and a new version of the PAS is proposed.

Efficacy of the acaricide: acardust for the prevention of asthma and rhinitis due to dust mite allergy, in children.

A double blind, randomized, comparative study versus placebo, was done during 6 months in 32 children, aged 4-12 years, who suffer from either allergic asthma or rhinitis or both, slept in a bedroom rich in dust mite, have well documented allergy solely to house dust mite (H.D.M.), and a condition severe enough to require continuous medication. After thorough cleaning, their bedrooms were sprayed on day 0 and day 90 with the total content of a canister containing either Acardust or Placebo. Rooms were cleaned regularly throughout the study period. Each child completed an individual daily score card (scales from 0-3) for asthma, and rhinitis symptoms, medication taken, and any additional symptoms. Peak flow was recorded twice weekly. All the children were examined every month (at the clinic) when also PFF, FEVI, doctor's and patient's opinion of clinical symptoms were recorded according to the same scale (0-3) and dust samples from child's bedroom were examined for H.D.M. antigen content. At day 0, 90 and 180, total IgE and dust mite specific IgE determination was done. At the end of the study, patient's and doctor's opinion about the spray's efficacy were recorded on a scale from 0-3. The results were in favor of Acardust for asthma, according to patient's opinion (p = 0.001), doctor's opinion (p = 0.04) and individual score cards (p = 0.03), and for nasal secretion (p = 0.01), sneezing and lacrimation (p = 0.02); concurrent medication dropped significantly (p = 0.01) in the Acardust group. No side-effects were reported. We consider Acardust a safe and valuable preventive treatment in H.D.M. allergy.

[Multicenter hospital study on the efficacy of Zyrtec (R) (cetirizine) compared to a placebo, in the treatment of perennial allergic rhinitis in 254 adolescents aged 12-15]. / Etude multicentrique hospitalière sur l'efficacité de Zyrtec (cétirizine) comparé à un placebo, dans le traitement des rhinites allergiques perannuelles de 254 adolescents de 12 à 15 ans.

In this multicenter parallel group randomized trial 254 teenagers, aged 12-15, suffering from perennial allergic rhinitis were investigated. Four evaluations (D-10, D0, D15, D30) were performed according to the following design: a 10-day run-in period (D-10, D0) to determine/establish the patient eligibility and to perform an allergologic checkup. The decision to include the patient was made at D0 according to selection criteria. a 30-day treatment period (D0 to D30). The patient received either cetirizine 10 mg once a day or placebo given in a double blind way according to randomization. Efficacy was assessed at each visit with a nasal symptom score (sneezing, rhinorrhea, obstruction, pruritus) and an ocular symptom score (watery eyes, conjunctival pruritus, red eyes). In addition, an objective evaluation was performed by means of anterior rhinoscopy. Global evaluations by the investigator and the patient on visual analog scales were assessed. Side effects were recorded. At baseline there was no significant difference between the two groups. At day 15 and day 30, all symptoms, subjective as well as objective, were significantly improved in the cetirizine group. Tolerance was good with no significant difference between cetirizine and placebo.

[Multicenter study on the efficacy of Zyrtec (Cetirizine) in the treatment of perennial allergic rhinitis in 875 adolescents]. / Etude multicentrique sur l'efficacité de Zyrtec (Cétirizine) dans le traitement des rhinites allergiques perannuelles de 875 adolescents.

875 adolescents of both sexes, aged between 12 and 15 years, who had presented with a perennial allergic rhinitis, were included in an open study that was conducted by pediatricians and allergologists on the efficacy of ZYRTEC (CETIRIZINE). There were four evaluations in the study, at Day-10, D 0, D15 and D30 and it was conducted according to the following plan: A first period (D-10 to D 0) to establish the eligibility of the subjects to be tested, and to establish the clinical allergic history, before definitive inclusion at D 0. A second period, of therapy, of 30 days, during which the subjects took a 10 mg tablet of ZYRTEC as a daily dose. Efficacy was evaluated at each visit by scores of intensity of major symptoms (sneezing, nasal discharge, nasal obstruction, nasal pruritus) and secondary symptoms (ocular score ... ) of rhinitis, as well as anterior rhinoscopy. The patients made an auto-evaluation of symptoms at different times. Analysis of the different parameters showed a real efficacy of ZYRTEC, for 30 days of treatment, in young patients. Furthermore, the tolerance of the product is excellent. This study has shown an overall improvement in the symptoms of perennial allergic rhinitis in patients who were treated with ZYRTEC in conditions similar to those of usual medical practice by pediatricians and allergologists.

[Clinical and spirometric repercussions of chronic exposure to air pollutants in children in the region of the Gardanne coal-basin]. / Répercussions cliniques et spirométriques d'une exposition chronique aux polluants atmosphériques chez des enfants de la région du bassin de Gardanne.

Our goal was to evaluate the long-term effects of exposure to air pollutants in schoolchildren living in the Gardanne coal-basin. The group consisted of 193 children 9 to 11 years old, 128 living in polluted communities, 65 in low polluted communities. The protocol included a standardized questionnaire and a spirometric evaluation. The prevalence of pulmonary and E.N.T. symptoms was higher in the polluted communities, but a statistically significant difference was only observed for the symptom "wheezing in the chest". The spirometric values, FEV1 and FVC, were very similar in both areas. It is likely that spirometric abnormalities will appear later in those schoolchildren. Indeed, in the same area, studies performed in groups of housewives have demonstrated a higher prevalence of respiratory symptoms, as well as spirometric abnormalities in subjects living in high polluted communities.