[Clinical photography by smartphone in plastic surgery and protection of personal data: Development of a secured platform and application on 979 patients]. / Photographie clinique par smartphone en chirurgie plastique et protection des données personnelles : développement d'une plateforme sécurisée et application sur 979 patients.

BACKGROUND: The clinical photography in plastic and reconstructive surgery has known a numerical breakthrough. The storage of online data, massive means of analysis such as facial recognitions algorithms poses a serious issue when it comes to the protection of personal data. We will assess a platform's benefits in connection with the computerized medical record, which will allow keeping the photos filed and centralized in a smart and secure manner. METHOD: We interviewed 300 plastic surgeons about the role of smartphone in their clinical practice. Concomitantly, we developed an innovative platform called Surgeon©, a secure way to index, file and send photographs with a smartphone on our hospital's server. Each photographic sequence was qualified using a specific form. We then collected prospectively, between May 1st 2017 and March 30th 2018, the number of patients photographed, the number of sequences and photographs taken and the average number of sequences per patient. RESULTS: Out of 86 French plastic surgeons surveyed, 81% say that they could not go on with their daily practice today without their smartphone. Photographs taken were stored in their smartphones (50%) or synced with virtual storage (25.6%). A majority (80.2%) would use a dedicated secured smartphone application. Our application allowed us to photograph 979 patients, or 2345 sequences and 8112 photographs, with an average of 2.28 sequences per patient. CONCLUSION: Thanks to its ergonomics and security, this platform can be set up in a hospital ward and beyond.

[Demonstration of a communication between the ankle joint and the subchondral synovial cyst of the tibial medial malleolus. Contribution of noninvasive imaging]. / Démonstration d'une communication entre articulation et kyste synovial sous-chondral de la malléole tibiale interne. Apport de l'imagerie non invasive.

The authors report a case of an intraosseous cyst located in the distal end of the tibia. A typical subchondral defect with a narrow opening in the ankle joint was well defined by CT scan and MRI. The diagnostic value of noninvasive techniques and differential diagnosis are specified after a review of the literature.

[Management of patients with risk of sudden death. The amiodarone example]. / Prise en charge des patients à risque de mort subite. L'exemple de l'amiodarone.

The multifactorial pathogenesis of sudden death explains, on the one hand, the inadequacy of an unilateral approach to its mechanism and, on the other hand, the failure of its prevention. Antiarrhythmics have been widely used clinically after myocardial infarction in the hope of reducing mortality due to arrhythmias and/or global mortality. Since the publication of the CAST study, the arrhythmia hypothesis, according to which the suppression of asymptomatic arrhythmias would decrease mortality, has been disproved. Class Ic antiarrhythmic agents were associated with a higher mortality rate than placebo. Class IV antiarrhythmics have not been shown to improve survival in the post-infarction period though the results are not definitive because of the great difference between drugs of this class. For the moment, only Class II antiarrhythmics have been shown to be beneficial including patients with low ejection fractions. The Class III antiarrhythmics and, in particular, amiodarone, have been shown to have a beneficial effect in the prevention of sudden death and a recent meta-analysis has demonstrated a 33% increase in survival with amiodarone. Three large scale prospective trials are currently under way and their results should confirm the positive impression already gained: EMIAT (European Myocardial Infarction Amiodarone Trial) will include 1,500 patients after myocardial infarction with poor left ventricular function (EF < 40%); CAMIAT (Canadian Myocardial Infarction Amiodarone Trial) will include 1,200 patients with myocardial infarction and asymptomatic arrhythmias (> 10 VES per hour); VA320 is an American trial under way in Veteran Administration Centres; 720 patients with dilated cardiomyopathy (EF < or = 40%) and arrhythmias (> 10 VES per hour) have been included.(ABSTRACT TRUNCATED AT 250 WORDS)

Sustained-release diltiazem and prevention of cardiovascular risk in hypertensive patients.

The prevention of coronary disease in hypertensive patients will see progress in the years to come. It is clearly too much, however, to expect this progress to come exclusively from the application of new therapies, as the incidence of coronary disease in hypertensive patients depends on several factors, which are, essentially, the persistence and severity of hypertension and the major cardiovascular risk factors associated with arterial hypertension, including hypercholesterolemia, diabetes, and nicotine abuse. Which new solutions to this problem can a novel therapy for arterial hypertension using calcium antagonists in general and diltiazem in particular thus provide? The majority of patients consulting their doctor for arterial hypertension also present with other risk factors associated with increased blood pressure, mostly hypercholesterolemia and diabetes. The antihypertensive efficacy of diltiazem can no longer be doubted; moreover, diltiazem monotherapy with single daily doses is of great advantage for compliance in hypertensive patients. As diltiazem has been in use for more than 10 years and its dosage has been gradually diminished, the risk of a new long-term iatrogenic pathological process is becoming less and less conceivable. Sustained-release diltiazem is effective as monotherapy at single daily doses of 300 mg as evidenced by an effect/dose study in 105 patients: DBP = -17 mm Hg with 300 mg (72% of the patients responded to this dosage).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of sustained-release diltiazem on blood pressure and serum lipids: a multicenter, randomized, placebo-controlled study.

A randomized, double-blind dose-response study on the antihypertensive action of sustained-release diltiazem was performed in four parallel groups. The aim of the trial was to evaluate the antihypertensive efficacy of sustained-release diltiazem and its dose-dependent clinical and biological tolerance. The four homogeneous groups consisted of 25 patients each who had presented with mild to moderate hypertension (diastolic blood pressure of 95-115 mm Hg) in the supine position. The study protocol comprised three successive periods: a placebo period lasting 14 days to verify the persistence of arterial hypertension under placebo; a first therapeutic period during which each of the 25 patients of the four groups received a single daily dose every morning at 9 a.m. of a capsule containing 0.240, 300, or 360 mg of sustained-release diltiazem over a period of 28 days; and a second therapeutic period during which the patients of the four groups received 240, 300, 360, and 300 mg, respectively. All other antihypertensive treatment had been suspended at least 15 days before the initial period under placebo. The results were evaluated with respect to clinical parameters such as systolic blood pressure, diastolic blood pressure, and heart rate, which were measured at 9 a.m. 24 h after the last administration of the drug on days 14, 28, and 56. The plasma serum levels of diltiazem were measured on days 28 and 56, the biological parameters, including measurements of hepatic and renal function as well as lipid and glucose levels, on days 14 and 56, and electrocardiography was performed on days 14, 28, and 56.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative study on monotherapy with sustained-release diltiazem 300 mg and enalapril 20 mg in mild to moderate arterial hypertension.

The antihypertensive efficacy of sustained-release diltiazem 300 mg at a single daily dose was evaluated and compared to that of enalapril 20 mg at a single daily dose, and to a combination therapy of enalapril 20 mg with sustained-release diltiazem 300 mg in patients with mild to moderate arterial hypertension (supine diastolic blood pressure between 95 and 115 mm Hg). After a washout period and a placebo period, each lasting 2 weeks, 96 patients were randomized in this double-blind study to three parallel groups that were treated for 28 days. In the groups treated with diltiazem, enalapril, or the combination of both, the drop in arterial blood pressure was 20, 11, and 19 mm Hg for supine diastolic blood pressure (supine DBP): 18, 12, and 19 mm Hg for standing diastolic blood pressure (standing DBP); 22, 20, and 23 mm Hg for supine systolic blood pressure (supine SBP); and 21, 19, and 24 mm Hg for standing systolic blood pressure (standing SBP), respectively. The reduction in DBP was significantly more pronounced in the group treated with sustained-release diltiazem 300 mg than in the group treated with enalapril 20 mg. Cardiac tolerance was good for patients treated with sustained-release diltiazem 300 mg alone or the combination therapy: no orthostatic hypotension or lengthening of the PR interval in the electrocardiogram was observed. Although side effects of sustained-release diltiazem 300 mg occurred more frequently, they were not severe and disappeared immediately when treatment was suspended.

Efficacy and tolerance of sustained-release diltiazem 300 mg and a diuretic in the elderly.

A randomized, double-blind, parallel study has been performed to compare the antihypertensive action and clinical and biological tolerance of monotherapy with two different substances: sustained-release diltiazem 300 mg and a diuretic combining 25 mg of hydrochlorothiazide and 50 mg of triamterene (HCT-T). Antihypertensive treatment was suspended at least 15 days before initiation of a placebo period that lasted 14 days and allowed confirmation of persisting hypertension. Eighty-five patients who were at least 65 years old were included in the study: 42 in the group treated with sustained-release diltiazem 300 mg and 43 in the group treated with a diuretic. All of them presented with mild to moderate arterial hypertension, characterized by supine diastolic blood pressures (supine DBP) of 95-115 mm Hg. Duration of treatment was 3 months. After 1 and 3 months, efficacy and tolerance of the antihypertensive treatment were evaluated. On day 30, a significant decrease (p less than 0.0001) in the main parameter, i.e., supine DBP, as well as other parameters such as standing diastolic blood pressure (standing DBP), supine systolic blood pressure (supine SBP), and standing systolic blood pressure (standing SBP) was observed. Blood pressure was reduced by 18, 16, 28, and 26 mm Hg, respectively, in the sustained-release diltiazem 300 mg group and by 13, 12, 21, and 18 mm Hg, respectively, in the diuretic group. Moreover, on day 90, blood pressure values were maintained in the diuretic-treated group, whereas an additional significant reduction in supine DBP (p less than 0.002) was noted in the sustained-release diltiazem 300 mg-treated group (-4.8 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)