Epidemiology of the vascular assessment and correlation of the WIfI Classification in lower limb amputee patients at Martinique university hospital in 2018.

BACKGROUND: The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients. MATERIAL AND METHODS: We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique. RESULTS: Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients. CONCLUSION: A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.

Interest of an auto-adjustable nighttime compression sleeve (MOBIDERM® Autofit) in maintenance phase of upper limb lymphedema: the MARILYN pilot RCT.

PURPOSE: Breast cancer-related lymphedema (BCRL) is a debilitating condition. The recommended treatment is based on decongestive lymphedema therapy (DLT) with two separate phases: a short-term intensive phase to reduce lymphedema volume and a long-term maintenance phase to stabilize it. Optimizing compression therapy and compliance during maintenance phase are key factors for long-term control of lymphedema. The primary objective of this pilot prospective open-label randomized study was to assess the benefit of a new auto-adjustable nighttime arm sleeve (MOBIDERM® Autofit) on lymphedema volume during the maintenance phase after the intensive phase. METHODS: Forty women with BRCL were consecutively enrolled and randomized (D0) for 1 month in 1:1 ratio either in night-use group: with MOBIDERM® Autofit (on top of a daytime compression hosiery), or in no night-use group: without MOBIDERM® Autofit (daytime hosiery alone). From Day 31 to Day 90, all patients were fitted with MOBIDERM® Autofit. Primary endpoint was lymphedema volume variation between Day 0 and Day 30. Secondary endpoints were compliance, quality of life (LYMQOL arm questionnaire), functional symptoms (heaviness, limb use limitation, pain), sleep quality, and safety. RESULTS: In ITT population, between Day 0 and Day 30, mean lymphedema volume increase was higher in no night-use group with 92.9 mL (i.e., 3.2%) than in night-use group with 46.7 mL (i.e., 1.80%), p = 0.757. Between Day 30 and Day 90, all patients fitted with MOBIDERM® Autofit, lymphedema volume remained stable in both groups. The device improved functional symptoms and function domain of the LYMQOL arm questionnaire. MOBIDERM® Autofit was worn overnight almost 85% of the nights. It was well accepted by the patients and no adverse reaction leading to permanent device discontinuation occurred. CONCLUSIONS: Our results suggest that MOBIDERM® Autofit offers clinical benefits during maintenance phase of lymphedema treatment and enhances patient's self-management.

Fetal lactic dehydrogenase variation in normal pregnancy and in cases of severe intra-uterine growth restriction.

Physiological and pathological fetal levels of lactic dehydrogenase (LDH), including its five different iso-enzymes are still poorly known. Our objectives were to compare total LDH levels and its five iso-enzymes between a control group of healthy fetuses and a group of fetuses with severe intra-uterine growth restriction (IUGR), and to determine the biochemical associations and the prognostic value of elevated LDH activity in fetuses with IUGR. Total LDH levels, haematologic values and liver enzyme activities were measured in 108 healthy fetuses from 17 to 37 weeks of gestation and in 44 fetuses with severe IUGR. Total fetal LDH in plasma from the healthy fetuses were constant throughout pregnancy (mean (SD)= 305.09 (46.97)). Total LDH values in plasma significantly increased in cases of IUGR (p=0.003), and the degree of increase was significantly correlated with fetal erythroblastosis (n =44, r=0.80, p<0.001). LDH 5 significantly decreased in the IUGR group (p=0.03). Total LDH values strictly above 400 IU/l (a value equal to the mean+2 SD in the healthy fetus group) were found to be significantly associated with thrombocytopenia (p<0.001), erythroblastosis (p=0.008) and an increase in AST value (p=0.03). These results suggest that the fetal LDH value in plasma is a useful biological marker for severe chronic distress.

Prenatal diagnosis by FISH of a 22q11 deletion in two families.

We report on prenatal diagnosis by FISH of a sporadic 22q11 deletion associated with DiGeorge syndrome (DGS) in two fetuses after an obstetric ultrasonographic examination detected cardiac anomalies, an interrupted aortic arch in case 1 and tetralogy of Fallot in case 2. The parents decided to terminate the pregnancies. At necropsy, fetal examination showed characteristic facial dysmorphism associated with congenital malformations, confirming full DGS in both fetuses. In addition to the 22q11 deletion, trisomy X was found in the second fetus and a reciprocal balanced translocation t(11;22) (q23;q11) was found in the clinically normal father of case 1. These findings highlight the importance of performing traditional cytogenetic analysis and FISH in pregnancies with a high risk of having a deletion.

[Prognostic value of beta-2-microglobulin in Hodgkin disease in young adults]. / Valeur pronostique de la bêta-2-microglobuline dans la maladie de Hodgkin de l'adulte jeune.

From 1977 to 1989, we measured serum beta-2-microglobulin (beta 2-MG) levels from 64 unselected and untreated patients, between 18 to 50-year-old, affected by Hodgkin's disease. Serum beta 2-MG level was measured by radioimmunoassay (Phadebas beta 2 microtest). Then, all patients received a chemotherapy such as MOPP or alternating MOPP/ABVD followed or not by radiotherapy. Elevated serum beta 2-MG level (> 2.4 mg/l) is associated with advanced stage disease (stage III-IV), presence of systemic symptoms and bulky tumor. Nevertheless, a multivariate analysis shows that the serum beta 2-MG level is the most significant prognostic indicator for disease free survival. The prognostic value of serum beta 2-MG is demonstrated for myeloma and non Hodgkin's lymphoma. A few authors have evaluated the prognostic impact of serum beta 2-MG in Hodgkin's disease. This study requires confirmation by multicentric and prospective trial.

A program for automatic acquisition and processing of electroretinograms obtained in vivo in albino rats.

A program sequence has been developed on a microcomputer that affords automatic acquisition and processing of electroretinogram (ERG) obtained in vivo in dark-adapted albino rats. A 50-Hz digital filter and an averaging summation remove the background noise.

[PS2 as a prognostic factor in 1065 cases of human breast cancer. A multicenter study]. / Rôle pronostique de la protéine pS2 dans 1065 cas de cancer du sein. Etude multicentrique.

pS2 protein assay was performed with Elsa-pS2 kit (CIS-Biointernational) on a group of 1,065 patients with operable breast cancer who underwent breast surgery in the years 1982 through 1990. The median follow-up was 57 months. This group included exclusively infiltrating ductal carcinoma with primary surgery. Age mean was 58 yr; T0-T1, 33.6%; T2-T4, 66.4%; Differentiation grade I, 29%; node negative, 53%; estrogen receptor (ER) positive, 62.4%; progesterone receptor (PR) positive, 55.2%; mean tumor size, 2.4 cm; local recurrence, 5.2%; metastasis, 17.5%. pS2 values varied from 0.1 to 707 ng/mg of cytosol protein (median, 5.6; mean 24.5; 95th percentile 112 ng/mg p). There was no significant relationship between the mean level of pS2 and age, tumor size, nodal status, whereas pS2 was related to histological grade (P < 10(-3)), ER (P < 10(-5)), and PR (P < 10(-5)). By using 2 ng/mg p as pS2 cutoff, 77/391 (19.7%) of ER+PR+ tumors were pS2-, and 122/345 (35.4%) of ER-PR-tumors were pS2+; with this cutoff, a strong relationship existed between pS2 and overall survival, but not between pS2 and relapse-free survival. With Cox multivariate analysis, pS2 protein was classified after lymph node status, histological size, ER, differentiation grade, age, clinical stage, PR. In patients with axillary lymph node involvement (N+), pS2 status could discriminate between good and bad prognosis, specially for patients with small tumors (< 2 cm) and with less than seven invaded nodes. This study showed that pS2 protein was a poor prognostic factor in comparison with classical factors.

An experimental evaluation of an AIDS educational intervention for WIC mothers.

The purpose of this study is to determine which of two educational approaches have the greater effect on the AIDS/human immunodeficiency virus (HIV) knowledge and attitudes of women participating in the Women, Infants, and Children (WIC) Program. A modified version of the Centers for Disease Control's (CDC) 1989 Health Risk Survey was administered to 217 women, who were then randomly assigned to either a control group receiving the usual written material, a nurse-educated group, or a videotape-educated group. The questionnaires were repeated immediately after and 2 months after the intervention. Chi square, Kruskall-Wallis ANOVA, and a repeated measures ANOVA were used for data analysis. Ninety-five percent of the subjects were black and the mean age was 25.8 years (+/- 5.9). The control group had significantly lower (p < or = 0.003) AIDS knowledge scores at both posttests, with the lowest knowledge level at 2 months. The videotape group had a greater (p < or = 0.048) intent to reduce risky behaviors at the initial posttest. Tolerance towards AIDS patients was significantly (p < or = 0.025) greater in the videotape and nurse groups. Both videotape and nurse education programs increased knowledge and influenced attitudes and behavioral intent. The more efficient videotape program had similar effects as the nurse program, and may be more generalizable to other populations.

Serum erythropoietin in small for gestational age fetuses.

Serum erythropoietin (Epo) concentration was compared prenatally in adequate (AGA) and small for gestational age (SGA) fetuses. Fifty-four percutaneous umbilical blood samplings were paired with maternal blood and assessed for Epo, hematocrit and reticulocyte count. Seventeen fetuses were growth-retarded (SGA) on the basis of ultrasonic biometry and birth weight. Controls (AGA; n = 37) underwent cordocentesis for risk of toxoplasmosis, maternal age or malformations (CNS, GI, heart). No cytogenetic abnormality or infections was found in the 54 fetuses. Linear and polynomial regressions were fitted to determine correlations between parameters. Nonparametric Mann-Whitney test was used for comparison between groups. Gestational age at sampling was similar in AGA and SGA. The SGA fetuses had a higher Epo concentration than controls (p < 0.001). Fetal AGA Epo increased significantly throughout pregnancy (p < 0.01) but did not correlate with maternal Epo (p > 0.05). An inverse correlation was found between fetal reticulocyte count and Epo concentration (p < 0.02). The mechanism of high Epo level in SGA fetuses may involve low pO2 and hemoconcentration.

Biodistribution and metabolism of orally administered mitozolomide in mice.

The disposition and metabolism of two 14C-labeled species of Mitozolomide (Mz) were studied in healthy and in B16 melanoma-bearing mice after po administration of a 40 mg/kg dose. Urine was the main elimination route of the radioactivity derived from [14C]chloroethyl Mz whereas a major part of the radiocarbon was recovered as 14CO2 in the expired air of mice given C]tetrazin Mz, indicating an extensive metabolism of the drug. Subsequent studies conducted only with the [14C]chloroethyl species, showed that total radioactivity and Mz were rapidly distributed to plasma and tissues but that Mz levels decreased more rapidly than those of total radioactivity, thus indicating an early metabolism of the drug. It is noteworthy that B16 melanoma concentrated Mz and/or metabolites to the same extent as normal tissues except the brain. Elimination of Mz from all tissues including the tumor was first order with a t 1/2 ranging from 1.52 to 2.03 hr. In the part of the study related to disposition, pharmacokinetic parameters did not significantly differ between control and B16-bearing mice. In the other part related to metabolic fate, we showed that among the urinary excretion products, unchanged Mz represented about one third of the eliminated radioactivity. Eight metabolites were separated by HPLC and five identified as degradation products of alkylated glutathione, namely thiodiacetic acid and its sulfoxide, S-carboxymethylcysteine and N-acetyl derivatives of S-carboxymethylcysteine and S-hydroxyethylcysteine.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation of a school-based AIDS/HIV education program for young adolescents.

This study evaluated the efficacy of a school-based AIDS/human immunodeficiency virus (HIV) education program on 6th and 7th grade students. Using a quasi-experimental pretest-posttest control group design, a control group and an education group (intervention I) received both pretest and posttest questionnaires and a second education group (intervention II) was posttested only. Students were evaluated using a modified version of the Centers for Disease Control's Health Risk Survey. Students who received AIDS education were less likely (p < or = 0.0001) than the control group to report that they had changed their behavior to avoid getting AIDS, but thought they had a greater (p < or = 0.0002) chance of acquiring AIDS as an adult. In the intervention I group, males who had never received prior AIDS instruction were more worried about acquiring AIDS as an adult (p < or = 0.013). In the intervention II group, the education had a significant impact on the level of knowledge about AIDS/HIV infection (p < or = 0.0003) and the degree of tolerance toward students with AIDS (p < or = 0.0008), but the effect was not greater than the learning that occurred in the other 2 groups from testing alone. Students who were pretested were also less worried that they had been exposed to AIDS (p < or = 0.0001), more worried that they would die if they acquired AIDS (p < or = 0.05), and less likely to think AIDS patients should be isolated (p < or = 0.0005). Although this AIDS education program appeared to be moderately successful in this group of younger adolescents, significant learning also occurred fro testing alone.

[Kinetics of erythropoietin blood levels from D-1 to D-29 in kidney transplantation]. / Cinétique de l'érythropoïétinémie de J-1 à J29 en transplantation rénale.

This study of serum erythropoietin levels and reticulocytes counts in the first month after kidney transplantation shows that the erythropoietin peak is efficient only when serum creatinine level at the time of the peak is under 200 mumol/l.

An evaluation of a school-based AIDS/HIV education program for high school students.

The effect of a 1-hr school-based AIDS/HIV education program on the knowledge and attitudes of high school students was evaluated with a modified version of the Centers for Disease Control Health Risk Survey. One urban and one suburban school each were randomly assigned to an educational intervention (n = 535) or a control group (n = 659). All students received a posttest 2 weeks after the intervention. Knowledge was based on responses to 12 true-false questions (pretest alpha = .76, posttest alpha = 0.81). Principal components analysis was used to develop three attitude scales and risk-taking behavior was assessed by self-report. Data were analyzed with Kruskall-Wallis analysis of variance (ANOVA) and multivariate ANOVA. The groups did not differ in knowledge level at pretest. At posttest the education group had significantly (p < or = 0.006) higher knowledge even after controlling for the effects of previous AIDS education (p < or = 0.019), gender (p < or = 0.007), and Hispanic ethnicity (p < or = 0.048). After the education program, students were less worried about exposure to the AIDS virus, but were more worried (p < or = 0.048) about AIDS acquisition during their adult life. Although single school-based AIDS/HIV education programs may increase knowledge, more extensive education may be needed to change the behavior and attitudes of older high school students.

Attitudinal and behavioral correlates of condom use in urban adolescent males.

To determine correlates of condom use in adolescent males, we administered a sexual behavior questionnaire to 105 urban males attending a general adolescent clinic. The mean age was 16.5 +/- 1.6 years, and all reported heterosexual activity during the prior 3 months. Condom use was significantly (p less than 0.05) associated with perceived hassle of use (Spearman's rho = -0.40), perception of girlfriend's attitude toward condoms (rho = -0.36), self-confidence in correct use (rho = 0.26), younger age (rho = 0.25), reported degree of exposure to sexually transmitted disease (STD) education (rho = 0.23), perceived condom safety (rho = 0.23), and perceived risk of STD if not wearing a condom (rho = 0.21). Using stepwise multiple regression, four variables explained a significant amount of variation in condom use: perceived hassle of use, perceived girlfriend's attitude toward condom use, age, and self-confidence in correct use (adjusted R2 = 0.28, p less than 0.001). Intention to use free condoms was significantly (p less than 0.05) associated with past use (rho = 0.63), girlfriend's attitude toward use (rho = -0.46), self-confidence in correct use (rho = 0.36), perceived hassle (rho = -0.31), and degree of exposure to STD education (rho = 0.25). Three variables in a regression model explained a significant amount of variation in intent to use free condoms: self-reported past use, girlfriend's attitude, and self-confidence in correct use (adjusted R2 = 0.51, p less than 0.001).

High school students' knowledge of HIV/AIDS and perceived risk of currently having AIDS.

Factors associated with AIDS knowledge and perceived risk of currently having HIV infection among adolescents were examined. A modified version of the Centers for Disease Control's Health Risk Survey was administered to 11th and 12th grade students (N = 2,483) in homerooms from nine schools in one southeastern community. Knowledge was based on cumulative responses to 12 questions. Many adolescents incorrectly answered seven questions. Based on multivariate analysis of variance, lower AIDS knowledge was associated with no prior school-based AIDS education (p less than or equal to 0.0001), previous IV drug use (p less than or equal to 0.0001), male gender (p less than or equal to 0.0001), and being Black or "other" ethnic group (p less than or equal to 0.0001). Based on interaction effects, Hispanics not receiving AIDS education in school (p less than or equal to 0.0001) and Black and "other" ethnic group IV drug users (p less than or equal to 0.0011) had a lower AIDS knowledge. When controlling for AIDS knowledge level (p less than or equal to 0.0001), higher perceived risk of current infection with HIV was associated with previous IV drug use (p less than or equal to 0.0001) and male gender (p less than or equal to 0.0001). However, previous IV drug users who never received AIDS education (p less than or equal to 0.0001) or were from Black or "other" ethnic group (p less than or equal to 0.008) had higher perceived risks of presently having HIV infection.

Findings from the preparticipation athletic examination and athletic injuries.

This study investigated the relationships between the findings from a standardized preparticipation athletic examination, the sport played, and athletic injuries requiring treatment by a physician and/or requiring the athlete to miss one or more games. Of public high school students receiving a preparticipation athletic examination during the 1989-1990 academic year, 674 (56%) either completed a telephone interview or returned a mailed questionnaire at the end of the academic year. The sample consisted of 408 (60.5%) blacks and 243 (36.1%) whites; 470 (69.7%) of the subjects were males. The subjects ranged in age from 13 to 20 years (mean +/- SD, 16.1 +/- 1.2 years), and participated in at least 10 school sports. Injuries were reported by 29.5% of the athletes. The highest proportion of athletes injured occurred among male football (36.3%), female basketball (33.3%), male baseball (19.4%), male soccer (17.2%), and female track and field (15.8%) participants. Responses by the athletes and their parents on the standardized health history were significantly associated with injuries in several specific areas. Knee injuries were associated with previous knee injuries, knee surgery, and history of injuries requiring medical treatment. Ankle injuries were associated with previous ankle injuries and previous injuries requiring medical treatment. Both arm and other leg injuries were associated with previous fractures. Male athletes with either abnormal knee or ankle findings from the physical examination were more likely to injure the knee or ankle, respectively. However, the sensitivities and positive predictive values of these relationships are weak. These data suggest that the preparticipation athletic examination may not predict certain athletic injuries and that additional prevention efforts for specific body areas of injury are needed in certain sports.

Adolescents' attrition from school-sponsored sports.

This study investigated reasons for adolescents' attrition from school-sponsored sports teams and the relationship between attrition and intention to participate in organized and nonorganized sports in the future. Of 674 high school student athletes, 26% dropped off at least one team in 1989-1990, and overall attrition increased to 29.8% when attrition from more than one sport was considered. Attrition was higher among black students, students reporting an athletic injury, those injured playing football, and those sustaining a knee injury. Injury was cited as the most frequent reason for attrition, followed by being cut from the team, "other reasons," needing to get a job, inconvenient game or practice schedule, and needing more time to study, although the main reason for attrition also varied by sport. When athletes were classified according to externally precipitated attrition, athlete-initiated attrition, or completion of the sports season, no differences were noted in the three groups' intent to engage in organized sports in the future. However, the group with externally precipitated attrition expressed a stronger intent to engage in nonorganized sports in the future than the other two groups.