A reappraisal of the presence of small or large fiber neuropathy in patients with erythromelalgia.

OBJECTIVE: To assess the contribution of large and small nerve fiber alteration in erythromelalgia (EM). METHODS: Thirty-three EM patients were included and underwent clinical evaluation based on EM severity score, DN4, and Utah Early Neuropathy Scale (UENS) score. Neurophysiological evaluation consisted in nerve conduction studies (NCS) for large nerve fibers and specific tests for small nerve fibers: electrochemical skin conductance, cold and warm detection thresholds, and laser evoked potentials. Finally, the evaluation of vascular changes was based on the presence of clinical feature of microvascular disorders and the measurement of the Toe Pressure Index (TPI). RESULTS: While 28 patients (85%) had vascular alteration on TPI or clinical features, 23 patients (70%) had small-fiber neuropathy on neurophysiological tests, and only 10 patients (30%) had large fiber neuropathy on NCS. Regarding clinical scores, there was no difference between groups (presence or absence of large- or small-fiber neuropathy or microvascular disorder) except for a higher UENS score in patients with large fiber neuropathy. CONCLUSION: Peripheral neuropathy, mostly involving small nerve fibers, is almost as common as microvascular changes in EM, but remains inconstant and not related to a specific neuropathic pattern or higher clinical severity. SIGNIFICANCE: The association of neuropathic and vascular factors is not systematic in EM, this syndrome being characterized by different pathophysiological mechanisms leading to a common clinical phenotype.

Peripheral arterial disease and systematic detection of circulating tumor cells: rationale and design of the DETECTOR prospective cohort study.

BACKGROUND: Smoking is a strong risk factor for cancer and atherosclerosis. Cancer mortality, especially from lung cancer, overtakes cardiovascular (CV) death rate in patients with peripheral arterial disease (PAD). Only a few patients with lung cancer after PAD management may benefit from surgical excision. Circulating tumor cells (CTC) associated with low-dose chest CT (LDCT) may improve early cancer detection. This study focuses on a screening strategy that can address not only lung cancer but all tobacco-related cancers in this high-risk population. METHODS: DETECTOR Project is a prospective cohort study in two French University hospitals. Participants are smokers or former smokers (≥30 pack-years, quitted ≤15 years), aged ≥55 to 80 years, with atherosclerotic PAD or abdominal aortic aneurysm. After the first screening round combining LDCT and CTC search on a blood sample, two other screening rounds will be performed at one-year interval. Incidental lung nodule volume, volume doubling time and presence of CTC will be taken into consideration for adapted diagnostic management. In case of negative LDCT and presence of CTC, a contrast enhanced whole-body PET/CT will be performed for extra-pulmonary malignancy screening. Psychological impact of this screening strategy will be evaluated in population study using a qualitative methodology. Assuming 10% prevalence of smoking-associated cancer in the studied population, a total of at least 300 participants will be enrolled. DISCUSSION: Epidemiological data underline an increase incidence in cancer and related death in the follow-up of patients with PAD, compared with the general population, particularly for tobacco-related cancers. The clinical benefit of a special workup for neoplasms in patients with PAD and a history of cigarette smoking has never been investigated. By considering CTCs detection in this very high-risk selected PAD population for tobacco-induced cancer, we expect to detect earlier pulmonary and extra-pulmonary malignancies, at a potentially curable stage. TRIAL REGISTRATION: The study was registered in the French National Agency for Medicines and Health Products Safety (No N° EUDRACT_ID RCB: 2016-A00657-44) and was approved by the ethics Committee for Persons Protection (IRB number 1072 and n° initial agreement 2016-08-02; ClinicalTrials.gov identifier NCT02849041).

Foot gangrene in patients with end-stage renal disease: a case control study.

The prevalence of peripheral arterial disease (PAD) in patients with end-stage renal disease (ESRD) is high, with an annual risk of amputation estimated at 13%, and indications for limb revascularization in patients combining ESRD with stage IV PAD (foot gangrene) are still controversial. This case-controlled study compared survival, limb salvage, and quality of life in a group of patients hospitalized for foot gangrene according to their renal status (ESRD versus no renal insufficiency). All patients with ESRD hospitalized for foot gangrene (n = 16) from 1996 to 2002 were compared with a control group with normal creatininemia (n = 24) hospitalized for foot gangrene due to peripheral atherosclerotic arterial disease. The 2 groups were matched for age, sex ratio, and number with diabetes mellitus. After a mean follow-up of 467 +/-410 days, patients with ESRD had a more severe prognosis as regards mortality (68.7% vs 12.5%, p = 0.0005) and major amputation (31% versus 8%, p = 0.09). The ESRD group was characterized by more frequent extensive arterial calcifications (16/16 vs 13/24, p = 0.002), owing to a higher level of the calcium phosphorus product (3.54 +/-1.2 vs 2.4 +/-0.6, p = 0.0023), and by impaired microcirculatory perfusion, as indicated by a lower oxygen pressure (TcPO(2)) (15.6 +/-12 mm Hg vs 26 +/-16, p = 0.07). ESRD implies a poor prognosis in patients with stage IV peripheral arterial disease.

[Audit on antibiotic prescriptions in a department of infectious diseases]. / Audit des prescriptions antibiotiques dans un service de maladies infectieuses. A prospective and observational survey.

OBJECTIVES: France is one of the countries that prescribe the most antibiotics. The inappropriate use of antibiotics participates in the emergence of multi-resistant bacteria. This study was aimed at assessing the adequation of antibiotic prescriptions in a hospital department of internal medicine-infectious diseases. METHODS: Over a two-month period, all the antibiotics treatments were analysed prospectively. The adequation of the treatments was analysed at first with regard to the various consensus conferences of the French-speaking Society of infectious diseases (Société de pathologie infectieuse de langue française (Spilf)) and then with regard to the bacteriological results. RESULTS: One hundred and five prescriptions were analysed during the study period. Thirty-five percent of prescriptions were inadequate with regard to the criteria used. In 22 cases the prescription was excessive, in 8 cases it was unjustified and in 5 cases it was inappropriate. Moreover, in univariate analysis, 3 factors were correlated with inadequation: prescriptions drawn-up by a non-infectious disease practitioner (OR =3.45, IC 95% 1.34-9.09, p=0.008), prescriptions drawn-up by junior in the department (OR =4.10, IC 95% 1.54-11.08, p=0.003) and prescriptions pour respiratory infections (OR=2.58, IC 95% 1.03-6.48, p =0.04). CONCLUSION: This study conducted in a department of infectious diseases reveals the persisting high rate of inappropriate prescriptions, confirming the need to develop control and retro-control strategies regarding the prescription of antibiotics in order to control the diffusion of multi-resistant bacteria.