21 research outputs found
Thromboses veineuses profondes des membres inférieurs, prise en charge initiale à domicile (enquête auprès des médecins des urgences médicales de Paris)
No full textPARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Chute de la personne âgée (quel bilan poue quels objectifs ?)
No full textPARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF
Peripheral arterial disease versus other localizations of vascular disease: The ATTEST study
No full textObjectiveDespite the increased cardiovascular morbidity and mortality risk of patients with peripheral arterial disease, previous worldwide studies have documented undertreatment of cardiovascular risk factors in such patients.MethodThe ATTEST study was an observational cross-sectional epidemiologic study. Patients (n = 8475) were selected by 3020 general practitioners in France who were asked to include the first three patients with at least one site of proven atherothrombotic disease (peripheral arterial disease of the lower limbs for two patients and coronary artery disease or ischemic stroke for the third patient). We designed the ATTEST study to compare medical management of patients with peripheral arterial disease, including pharmacologic treatment, cardiovascular tests, and physician’s assessment of future cardiovascular and amputation risks, with patients with coronary artery disease or ischemic stroke.ResultsOnly 13% of the patients with peripheral arterial disease (n = 3811) received angiotensin converting enzyme inhibitors, statins, and antiplatelet agents vs 30% of the patients with coronary artery disease or ischemic stroke (n = 4664). This undertreatment of the population with peripheral arterial disease was associated with a too-optimistic physician’s assessment of future cardiovascular risk: only 27% of the general practitioners predicted a 5-year cardiovascular risk >20%. Conversely, amputation risk prediction was greatly overestimated: only 44% of the practitioners predicted a 5-year amputation risk <5%.ConclusionsPatients with atherothrombotic disease recruited from primary care practices were not adequately tested and treated, especially the patients with peripheral arterial disease. To improve the medical management of patients with peripheral arterial disease, there is a need for epidemiologic and clinical education of physicians
Prevalence of unknown peripheral arterial disease in patients with coronary artery disease: Data in primary care from the IPSILON study
No full textSummaryBackgroundPeripheral arterial disease (PAD) is a marker of increased risk of cardiovascular events and of poor prognosis in patients with coronary artery disease (CAD). The prevalence of unknown PAD among patients with CAD varies between studies according to the mode of diagnosis.AimsTo evaluate the prevalence of unknown PAD, diagnosed using the ankle-brachial index (ABI), in patients from the IPSILON study with a CAD diagnosis; to assess the profile of these patients; and to determine predictors of PAD.MethodsIPSILON was an observational, cross-sectional study. General practitioners measured ABI in 5679 consecutive adults aged 55 years or over with signs or symptoms suggestive of PAD (21.3%), a history of an atherothrombotic event (42.1%) or two or more cardiovascular risk factors (36.6%). This analysis focuses on the subgroup of patients with CAD and no other known overt atherothrombotic disease.ResultsA total of 1340 patients presented with isolated CAD. PAD (ABI<0.90) was diagnosed in 26.6% of these patients; 16.2% were asymptomatic. Older age, symptoms suggestive of PAD and cardiovascular risk factors were found to be independent predictors of PAD in multivariable analysis.ConclusionOver 26% of patients with CAD present with unknown PAD, as diagnosed using ABI measurement. More than half of these patients are asymptomatic. Screening for PAD in patients with CAD will allow detection of a subpopulation at particularly high cardiovascular risk. An aggressive medical treatment strategy could help to improve their outcome
Intestinal parasites of dogs (Canis lupus familiaris) in Svalbard (Norway): Low prevalence and limited transmission with wildlife
No full textThe domesticated dogs (Canis lupus familiaris Linnaeus, 1758) are widely kept on all continents and could share the parasites with free-living animals. To understand the transmission of intestinal parasites between dogs kept on the four dog stations and wildlife in Svalbard, 170 faecal samples of dogs and 203 of wildlife included arctic fox (Vulpes lagopus Linnaeus, 1758, n=62); Svalbard reindeer (Rangifer tarandus platyrhynchus Vrolik, 1829, n=106); sibling vole (Microtus levis Miller, 1908, n=63); pink-footed goose (Anser brachyrhynchus Baillon, 1834, n=30); little auk (Alle alle Linnaeus, 1758, n=49) and black-legged kittiwake (Risa tridactyla Linnaeus, 1758, n=18) were individually screened for the presence of intestinal parasites using microscopy and PCR/sequencing methods. Additionally, the results of the study were compared with previous studies performed in the same area. Roundworm Toxascaris leonina Linstow, 1902 was found microscopically and by PCR in a dog (n=1). The specific DNA of three species of parasitic protists was detected in dogs from different yards. Phylogenetic analyses revealed the presence of Cryptosporidium canis Fayer, Trout, Xiao, Morgan, Lal and Dubey, 2001 (n=1), Encephalitozoon cuniculi Levaditi, Nicolau and Schoen, 1923 genotype II (n=4) and dog specific Enterocytozoon bieneusi Desportes, Le Charpentier, Galian, Bernard, Cochand-Priollet, Lavergne, Ravisse and Modigliani, 1985 genotypes (n=12). This study showed overall a low prevalence of intestinal parasites in dogs in Svalbard and possible but minimal transmission with wildlife.The presentation of the authors' names and (or) special characters in the title of the pdf file of the accepted manuscript may differ slightly from what is displayed on the item page. The information in the pdf file of the accepted manuscript reflects the original submission by the author
042 Patients with recent history of ACS: frequency and characteristics of symptomatic and asymptomatic PAD in a French office based study (CALIPSO)
No full textBackgroundIn ACS patients, presence of a peripheral arterial disease (PAD) or a low ankle brachial index (ABI) is associated with a higher CV risk in either symptomatic or asymptomatic PAD patients than ACS patients without PAD.ObjectiveTo determine the frequency and describe symptomatic and asymptomatic PAD patients, diagnosed by clinical examination and ABI measurement, in French population with recent history of ACS.MethodsA 2-stage observational survey was conducted by 422 office-based cardiologists: 1) a registry part to provide a nationally representative overview and to estimate the prevalence of PAD and proportion of normal or low ABI in the overall.2) a detailed part to asses and compare patients issued from registry with symptomatic or asymptomatic PAD and without PAD.Results374 office based cardiologists recorded in the registry 2030 patients with a recent history of ACS and selected 1135 patients for the detailed part of the study.Main characteristics of the registry patients were: mean age 66 years, 75% male, 30.3% STEMI, 22.7% NSTEMI and 47.1% UA. The prevalence of PAD in the registry population was 35.9% and between them 401 (55.1%) were symptomatic: intermittent claudication (321), history of angioplasty or bypass (221), amputations (12). Mean value of ABI measurement in the registry was 0.93 CI [0.92-0.94] with 32.3% less than 0.9.In the detailed part of the study, the mean age was 65.7 years and 77.7% of patients were male. ACS characteristics: STEMI 32.1%, NSTEMI 22.4% and UA 45.5%. 624 patients were selected without PAD and 511 with PAD. Within these patients, 55.4% were symptomatic: intermittent claudication (20.3%), had a history of angioplasty or bypass (12.6%), or amputations (0.4%). Mean value of ABI for 1131 patients in the detailed study was 0.9 [0.89-0.91] and 42% had a low ABI (<0.9).ConclusionsPAD is highly prevalent (35.9%) in patients with recent history of ACS and almost one half of these patients are asymptomatic
Diagnostic terminology for reporting thyroid fine needle aspiration cytology: European Federation of Cytology Societies thyroid working party symposium, Lisbon 2009.
No full textA European Federation of Cytology Societies (EFCS) working party of 28 members from 14 European countries met at the European Congress of Cytology in Lisbon in September 2009, with two observers from the USA, to discuss the need for standardising thyroid FNA nomenclature in the light of the National Institute of Cancer (NCI) recommendations resulting from the State of the Science conference in Bethesda in 2007. The data were obtained through two questionnaires sent by email and a transcript of the live discussion at the congress, which is presented in full. The surveys and discussion showed that there were currently no national terminologies for reporting thyroid FNA in the different European countries except in Italy and the UK. Personal, 'local', surgical pathology and descriptive terminologies were in use. All but one of the working party members agreed that thyroid FNA reporting should be standardised. Whilst almost a third would adopt the NCI Bethesda terminology, which offers the advantages of a 'risk of cancer' correlation and is linked to clinical recommendations, more than half favoured a translation of local terminology as the first step towards a unified nomenclature, as has been done recently in the UK. There was some disagreement about the use of: a) the six-tiered as opposed to four or five-tiered systems, b) the use of an indeterminate category and c) the 'follicular neoplasm' category, which was felt by some participants not to be different from the 'suspicious of malignancy' category. The conclusions will be passed to the different national societies of cytology for discussion, who will be asked to map their local terminologies to the Bethesda classification, observe its acceptance by clinicians and audit its correlation with outcome
