Exercise-Induced Vasculitis: A Review with Illustrated Cases.

Although exercise-induced vasculitis (EIV) is usually misdiagnosed, it is not uncommon. Occurring mostly after prolonged exercise, especially in hot weather, EIV is an isolated cutaneous vasculitis with stereotypical presentation. This article reviews the clinical characteristics, treatments, and outcomes of EIV based on the published literature.

[Qualitative and quantitative evaluation of an internal medicine assistance line dedicated to the diagnosis and treatment of diseases for general practice].

Purpose: Clinical reasoning and treatment challenges within the scope of general practice led to the development of an internal medicine assistance line provided by Nantes University Hospital. The primary outcome of this study was to describe callers' profile, their requests and answers provided.

Methods: A prospective, cross-sectional, observational, descriptive study was undertaken.

Thrombin Generation Assay in Hospitalized Nonsurgical Patients: A New Tool to Assess Venous Thromboembolism Risk?

Background: Assessment of venous thromboembolism (VTE) risk is important to determine optimal primary prophylaxis in hospitalized patients. The Padua score helps to recognize patients with high VTE risk, but quantifying a VTE risk is often challenging in medical patients. Thrombin generation assay (TGA) reflects the pro-/anticoagulant balance and thus could help to better quantify VTE risk in medical hospitalized patients.

Effect of Extrinsic and Intrinsic Stressors on Clinical Skills Performance in Third-Year Medical Students.

Background: Both enhancements and impairments of clinical performance due to acute stress have been reported, often as a function of the intensity of an individual's response. According to the broader stress literature, peripheral or extrinsic stressors (ES) and task-contingent or intrinsic stressors (IS) can be distinguished within a stressful situation. The objective of this study was to assess the impact of IS and ES on clinical performance.

Cold climate could be an etiologic factor involved in Raynaud's phenomenon physiopathology. Epidemiological investigation from 954 consultations in general practic.

Aim: The physiopathology of Raynaud's phenomenon (RP) is not currently fully resolved. The cold seems to be not only an important factor triggering attacks, but also inducing RP. The aims of this study were to assess the prevalence of RP in Nantes urban district, and study the relationship between RP prevalence and cold climate.

e-Learning versus lecture-based courses in ECG interpretation for undergraduate medical students: a randomized noninferiority study.

Objective: An ECG is pivotal for the diagnosis of coronary heart disease. Previous studies have reported deficiencies in ECG interpretation skills that have been responsible for misdiagnosis. However, the optimal way to acquire ECG interpretation skills is still under discussion.

Effect of stress on clinical reasoning during simulated ambulatory consultations.

Background: The goal of this study was to examine the impact of subjective and physiological stress responses on medical students' diagnostic reasoning and communication skills.

Method: A prospective randomized quantitative study was undertaken, looking at ambulatory consultations in internal medicine. On the first day (baseline day), volunteer year 6 students (n = 41) participated in a simulated ambulatory consultation with standardized patients (SPs).

[Superior vena cava syndrome induced by pacemaker probes, 12 years after introduction].

Superior vena cava syndrome is a rare disease, most often found to result from a malignant process, which causes extrinsic compression of the superior vena cava. In recent years, there has been an increase of superior vena cava syndrome related to medical devices (implantable site, pacemaker [PM], central venous line for parenteral nutrition..

[Validation of a screening tool toward a geriatric comprehensive assessment during a non geriatric consultation: the geriatric warning test].

Comprehensive geriatric assessment (CGA) is a validated method but is time consuming and must be performed by several professional. It is useful to elaborate a screening tool, which allows the elderly to CGA. The aim of this study is to validate the Geriatric Warning Test (GWT), a 6-questions form: 1) Did your patient consult or did hospitalize for a fall in the last 3 months? 2) Did your patient lose weight or did he loose the appetite? 3) Has your patient difficulties to see or listen? 4) Does your patient need help in the everyday life? 5) Has your patient a change of the cognitive functions? 6) Does your patient need a geriatric evaluation for one or several any reason that those cited previously? During a prospective observational study, a doctor non-geriatrician practitioner informed the GWT during a consultation of vascular medicine.

Stress responses in medical students in ambulatory and in-hospital patient consultations.

Context:  Little is known about health professionals' responses to acute stressors encountered in the clinical environment. The goal of this study was to measure the subjective and physiological stress responses of medical students to consultations in familiar (in-hospital) and unfamiliar (ambulatory) settings. We hypothesised that: (i) providing a consultation in an unfamiliar setting would result in increased stress responses in medical students, and (ii) some differences in stress responses according to gender might become apparent.

[Description of the mental processes occurring during clinical reasoning].

Clinical reasoning is a highly complex system with multiple inter-dependent mental activities. Gaining a better understanding of those cognitive processes has two practical implications: for physicians, being able to analyse their own reasoning method may prove to be helpful in diagnostic dead end; for medical teachers, identifying problem-solving strategies used by medical students may foster an appropriate individual feed-back aiming at improving their clinical reasoning skills. On the basis of a detailed literature review, the main diagnostic strategies and their related pattern of mental processes are described and illustrated with a concrete example, going from the patient's complaint to the chosen solution.

Exploring how students think: a new method combining think-aloud and concept mapping protocols.

Objectives: A key element of medical competence is problem solving. Previous work has shown that doctors use inductive reasoning to progress from facts to hypotheses and deductive reasoning to move from hypotheses to the gathering of confirmatory information. No individual assessment method has been designed to quantify the use of inductive and deductive procedures within clinical reasoning.

[Antithrombin homozygous type II HBS deficiency (99Leu-Phe) associated with recurrent arterial thrombosis].

Antithrombin (AT) is a natural anticoagulant and serine protease inhibitor. Hereditary AT deficiencies are uncommon and are associated with a higher risk of venous thrombo-embolism (VTE) compared to other thrombophilias. They are either quantitative (type I) or qualitative (type II) and various mutations have been reported.

[Orofacial manifestations of systemic sclerosis: A study of 30 consecutive patients].

Introduction: The face is frequently involved in systemic sclerosis. The main stomatologic manifestations include limited mouth opening, xerostomia, skin atrophy, trigeminal neuralgia. The objective of this study was to describe oral and facial manifestations observed in scleroderma patients from our cohort.

Immobilization and the risk of venous thromboembolism. A meta-analysis on epidemiological studies.

Background: The thrombogenic burden of immobilization remains unknown especially in the medical setting. Most of epidemiological studies estimating the link between risk factors and venous thromboembolism (VTE) have not been designed to evaluate immobilization. The aim of this work was to estimate the risk of VTE in medical bedridden patients by a systematic review and a meta-analysis.

[Necrotizing hand-foot skin reaction induced by antiangiogenic in a patient with Thevenard neuroacropathy].

Antiangiogenic agents are an innovative oral chemotherapy prescribed in metastatic renal cancer and gastrointestinal stromal tumors (GIST). These molecules have several side effects. A woman, with moderate hypertension and severe Thevenard's ulceromutilating acropathy, presented renal cancer with lung metastasis.

[Venous leiomyosarcoma mimicking deep venous thrombosis: contribution of positron emission tomography].

Leiomyosarcomas are rare malignant mesenchymal tumors. We report the case of a 55-year-old man with a lung metastasis from an iliofemoral leiomyosarcoma mimicking a deep venous thrombosis (DVT). Vascular leiomyosarcoma occurs in the wall of large vessels, and usually presents as unexplained DVT.

Lethal limb ischaemia in leukaemia. Case report and review of the literature.

Several disturbances of the coagulation system are associated with malignancies of the hematopoietic system. The primary mechanisms of these are disseminated intravascular coagulation and hyperviscosity. As such, bleeding or thrombotic events are often encountered and, occasionally, they may even be the inaugural symptom of leukaemia.

D-dimers, thrombin-antithrombin complexes, and risk factors for thromboembolism in hospitalized patient.

Introduction: There is lack of data about the correlation between hemostatic markers and the clinical and biological risk factors (RFs) for venous thromboembolism (VTE) in medical inpatients without suspicion of acute VTE.

Material And Methods: To evaluate the coagulation activation status in patients with current known RFs for VTE, the authors measured 2 markers of hypercoagulability, thrombin antithrombin (TAT) complexes and D-dimers, at day 1 in 165 patients hospitalized in internal medicine wards without suspected acute VTE. All known RFs for VTE were systematically assessed at admission and classified in a chronological way as permanent or transient.

[Orofacial manifestations of systemic sclerosis: a study of 30 consecutive patients].

Introduction: The face is frequently involved in systemic sclerosis. The main stomatologic manifestations include limited mouth opening, xerostomia, skin atrophy, trigeminal neuralgia. The objective of this study was to describe oral and facial manifestations observed in scleroderma patients from our cohort.

[Abdominal aortic involvement in active giant cell (temporal) arteritis: a study of 20 patients by Doppler ultrasonography and computed tomographic angiography].

Objective: This study used Doppler ultrasonography and computed tomographic angiography (CTA) to assess the prevalence of abdominal aortic lesions that suggested abdominal aortitis at diagnosis of giant-cell or temporal arteritis (GCA). We also evaluated the contribution of these 2 techniques to diagnosis.

Methods: This single-center study included patients admitted to the internal medicine department of the Nantes (France) University Hospital, between May 1999 and May 2002 at the time of their diagnosis with biopsy-proven GCA.

Chronic erythropoietin treatment decreases post-infarct myocardial damage in rats without venous thrombogenic effect.

Objectives: Whereas administration of erythropoietin (EPO) acutely after myocardial infarction (MI) reduces infarct size and chronic EPO therapy attenuates post-MI remodeling, the safety of chronic EPO therapy following MI is unknown. Therefore, we examined the thrombogenic effects of a chronic EPO therapy after MI.

Methods: Rats underwent coronary occlusion followed by reperfusion.

Aortic involvement in recent-onset giant cell (temporal) arteritis: a case-control prospective study using helical aortic computed tomodensitometric scan.

Objective: The prevalence of the involvement of large vessels in giant cell arteritis (GCA) is 3-13%. Aortitis is the most serious complication of GCA. Computed tomodensitometric (CT) scan allows analysis of both the aortic wall and endoluminal part of the aorta.

[Risk of venous thromboembolism in the course of acute medical illness. Part 1: Basic research, clinical models, descriptive and analytic epidemiology].

Purpose: Some acute medical illnesses are associated with an increased risk of venous thromboembolism. This risk is difficult to assess in medical patients on account of the multiplicity of their pathologies, leading to potential interactions between numerous risk factors.

Current Knowledge And Key Points: A rational analysis of the risk of venous thrombosis in acute medical setting may be derived from pathogenic models and be based on elementary risk factors for venous thromboembolism classified as transient, permanent, major and intermediate factors.