Evolution of the French public's knowledge and attitudes regarding postoperative pain, cancer pain, and their treatments: two national surveys over a six-year period.

Unlabelled: Pain management has become a notable feature of public health policy and mass media communication in France over the past few years. To assess the evolution of the knowledge and attitudes of the French population with respect to pain management and morphine use, telephone surveys using similar questionnaires were conducted in 1990 (n = 1001) and 1996 (n = 1006). The proportion of respondents who would take pain management adequacy into consideration when selecting a surgical facility increased from 52% to 81% (P < 0.

Diurnal variations in keratometry and refraction with intracorneal ring segments.

Purpose: To study refraction variations during the day in eyes with intrastromal corneal ring segments (ICRS) to correct low myopia.

Setting: Monticelli Clinic, Marseille, France.

Methods: Thirteen eyes with ICRS were included in the study; the ICRS was explanted from 3 eyes because of undercorrection.

[Access to health services: difficulties encountered by refugees residing on Ile-de-France. Charity and full-coverage health care: two divergent concepts?].

Theoretically, since 1992, 100% of socially underprivileged persons residing in France have unlimited access to health care. However, before they become fully integrated into the society, many refugees in various legal situations do not have access to health care. The mechanisms behind this exclusion unmask the difficulties the health care system has in managing the underprivileged population.

[Reliability and validity of the French version of the first part of the Appropriateness Evaluation Protocol (AEPf): pertinent criteria of hospitalization stay].

Background: The Appropriateness Evaluation Protocol (AEP) is a tool used to identify hospitalization days that are appropriate with respect to simple technical criteria, and the reasons for hospitalization days that do not meet these criteria. The goal of the study was to validate the clinical criteria of AEPf, required for identifying the reasons which explain these inappropriate hospital days.

Methods: The validity of a French version of criteria of appropriateness (AEPf) was assessed in a sample of 502 hospital days in medical and surgical wards of six French teaching hospitals.

[Diurnal variations of refraction and keratometry after intracorneal rings].

Unlabelled: Within a European evaluation, we participated in the study of ICRS on low myopia. During the period of observation, subjective refraction variations in the day were underlined. This phenomenon remains to be specified.

Transcatheter arterial embolization for intractable epistaxis secondary to gunshot wounds.

Purpose: To evaluate the efficacy of transcatheter arterial embolization for intractable epistaxis secondary to gunshot wounds.

Materials And Methods: Seven patients with intractable epistaxis secondary to penetrating trauma (gunshot wounds) were studied with angiography and subsequently underwent embolization with particles (polyvinyl alcohol, gelatin sponge) and/or microcoils. Clinical follow-up included standard hemodynamic monitoring, serial hematocrit determinations, and clinical observation for recurrent bleeding.

Chordal force distribution determines systolic mitral leaflet configuration and severity of functional mitral regurgitation.

Objectives: The purpose of this study was to investigate the impact of the chordae tendineae force distribution on systolic mitral leaflet geometry and mitral valve competence in vitro.

Background: Functional mitral regurgitation is caused by changes in several elements of the valve apparatus. Interaction among these have to comply with the chordal force distribution defined by the chordal coapting forces (F(c)) created by the transmitral pressure difference, which close the leaflets and the chordal tethering forces (FT) pulling the leaflets apart.

[Research-action on medical and social management of uninsured pregnant women].

Introduction: Perinatal morbidity is increased among women without health insurance and/or receiving poor antenatal care. The objectives of this study were to estimate the prevalence of such situations, to analyze underlying social conditions, to identify possible means to secure health insurance and to assess the impact of the absence of health insurance on antenatal care and pregnancy outcomes.

Material And Methods: All pregnant women without health insurance during one calendar year were included.

The value of internal carotid systolic velocity ratio for assessing carotid artery stenosis with Doppler sonography.

Objective: The purpose of this study was to assess the value of the ratio between the internal carotid systolic velocity (ICSV) at the carotid bulb and the distal internal carotid systolic velocity (DICSV) for the detection of carotid artery stenosis.

Subjects And Methods: Two hundred eleven patients were enrolled in a prospective study comparing several Doppler measurements with carotid angiography. The following spectral measurements were obtained with Doppler sonography: ICSV/DICSV ratio, ICSV, ICSV/common carotid systolic velocity (CCSV) ratio, and internal carotid (end) diastolic velocity (ICDV).

Validation of the three-dimensional acquisition mode in positron emission tomography for the quantitation of [18F]fluoro-DOPA uptake in the human striata.

Three-dimensional (3D) positron emission tomography (PET) is attractive for [18F]fluoro-DOPA studies, since the sensitivity improvement is maximal for radioactive sources located in central planes, which is usually the case for the human striata. However, the image quantitation in that mode must be assessed because of the nearly threefold increase in scattered coincidences. We report the results of [18F]fluoro-DOPA studies performed on six normal volunteers.

Lateralization of speech and auditory temporal processing.

To investigate the role of temporal processing in language lateralization, we monitored asymmetry of cerebral activation in human volunteers using positron emission tomography (PET). Subjects were scanned during passive auditory stimulation with nonverbal sounds containing rapid (40 msec) or extended (200 msec) frequency transitions. Bilateral symmetric activation was observed in the auditory cortex for slow frequency transitions.

Prophylactic carotid endarterectomy without arteriography in patients without hemispheric symptoms: surgical morbidity and mortality and long-term follow-up.

Between January 1980 and December 1992, 75 prophylactic carotid endarterectomies (CE) were performed on 72 asymptomatic patients presenting high-grade stenosis of the internal carotid artery (ICA). In all patients preoperative assessment consisted of continuous Doppler or duplex scanning. There were 33 women and 39 men with a mean age of 66 +/- 7 years.

Renal artery dissection causing renal infarction in otherwise healthy men.

Arterial dissection is usually associated with pathological states such as malignant hypertension, severe atherosclerosis, severe trauma, Marfan syndrome, or Ehlers-Danlos syndrome. However, we report three cases in which renal artery dissection occurred in otherwise healthy, normotensive men. In two cases, the onset of symptoms of renal artery dissection was coincident with an unusual degree of physical activity.

A three-component force vector cell for in vitro quantification of the force exerted by the papillary muscle on the left ventricular wall.

Recent clinical studies indicate that functional mitral regurgitation, which is a common complication in patients who suffer from ischemic heart disease, is related to an increase in the tethering forces acting on the mitral valve leaflets. Alterations in the valvular assembly, displacement of the papillary muscles or dilatation of the mitral valve annulus can disrupt the normal force balance on the mitral leaflets and result in an abnormal coaptation geometry with incomplete mitral leaflet closure. The force balance imposed on the mitral leaflets is created by the coapting forces generated by the transmitral pressure difference and the tethering forces at the leaflet attachments.

Renal chromophobe cell carcinoma and oncocytoma. A comparative morphologic, histochemical, and immunohistochemical study of 124 cases.

Background: Renal oncocytoma has several features that overlap with other renal neoplasms, including the eosinophilic subtype of chromophobe cell carcinoma. In fact, strict criteria for renal oncocytoma have not been well defined and remain a matter of controversy. Ultrastructural studies or sophisticated methods such as flow cytometry and cytogenetic techniques can be of great use in distinguishing the two tumors, but are difficult to propose as routine methods because of their limited availability.

Integrated mechanism for functional mitral regurgitation: leaflet restriction versus coapting force: in vitro studies.

Background: Functional mitral regurgitation in patients with ischemic or dilated ventricles has been related to competing factors: altered tension on the leaflets due to displacement of their papillary muscle and annular attachments, which restricts leaflet closure, versus global ventricular dysfunction with reduced transmitral pressure to close the leaflets. In vivo, however, geometric changes accompany dysfunction, making it difficult to study these factors independently. Functional mitral regurgitation also paradoxically decreases in midsystole, despite peak transmitral driving pressure, suggesting a change in the force balance acting to create a regurgitant orifice, with rising transmitral pressure counteracting forces that restrict leaflet closure.

Renal artery origins: best angiographic projection angles.

Purpose: To determine the best projection angles for imaging the renal artery origins in profile.

Materials And Methods: A mathematical model of the anatomy at the renal artery origins in the transverse plane was used to analyze the amount of aortic lumen that projects over the renal artery origins at various projection angles. Computed tomographic (CT) angiographic data about the location of 400 renal artery origins in 200 patients were statistically analyzed.

Update on the use of percutaneous nephrostomy/balloon dilation for the treatment of renal transplant leak/obstruction.

Purpose: Retrospective evaluation of the efficacy of percutaneous nephrostomy and nephroureteral stent placement for treatment of post-transplant ureteral leak, and percutaneous nephrostomy and balloon dilation for treatment of post-transplant ureteral obstruction.

Patients And Methods: Data were reviewed for all patients who underwent percutaneous therapy for complications after renal transplantation between January 1985 and June 1995. A total of 61 patients with complications (leak, n = 17; obstruction, n = 44) had been treated.

Toward quality improvement in a French hospital: structures and culture.

This paper describes the evolution of quality improvement efforts over the past decade in a 600-bed French teaching hospital, after reviewing some characteristics of the French hospital system. The sequential attempts to improve drug dispensation illustrate the evolution of quality improvement efforts. Initial studies conducted in voluntary medical wards led to the modification of traditional prescription forms.