Papillomavirus vaccination in France according to 2008 to 2012 Vaccinoscopie(®) data.

UNLABELLED: Vaccination against human papillomavirus infections (HPV), introduced in the French vaccinal schedule in 2007, was recommended until the end of 2012 for 14-year-old girls, with a catch-up policy until 23years of age. We followed the evolution of this vaccine coverage rate (VC) during these 5years in the Vaccinoscopie(®) survey. METHOD: We present the analysis of data collected in 2012 from a sample of 1136 mothers of girls 14 to 16years of age. They answered a self-administered questionnaire on Internet and reported all vaccinations mentioned in their daughter's health record. RESULTS: In 2012, respectively 12.9%, 33.6%, and 48.1% of girls 14, 15 and 16years of age had begun HPV vaccination (≥1 dose received) and respectively 4.3%, 23.6%, and 40.5% of them had received a complete vaccination schedule (3 doses), i.e. 31.7% of 14-16-year-old girls had started the vaccination schedule and 22.9% were fully vaccinated. VC for ≥1 dose had decreased between 2009 and 2012 (-14 points in 14-year-old girls, -16 points in 15-year-old girls, and -11 points between 2009 and 2012 in 16-year-old girls). Regional VCs were heterogeneous. CONCLUSION: HPV VC is clearly insufficient. It is essential that physicians concerned by HPV vaccination be mobilized and take every opportunity to inform, reassure, and vaccinate teenage girls. HPV vaccination has been recommended for girls between 11 and 14years of age since 2013, which could help improve adherence to vaccination.

Evolution of hepatitis B vaccine coverage rates in France between 2008 and 2011.

UNLABELLED: High vaccine coverage rates were reached for hepatitis B vaccination in teenagers nearly two decades ago (1995), but controversy sharply decreased the rate of vaccination in France, requiring high remobilization in its favor and careful monitoring of vaccine coverage rates. We report the results of Vaccinoscopie(®) survey which has monitored the yearly evolution of vaccine coverage rates since 2008. METHOD: A representative national sample of 5250 mothers was recruited in 2011: 3000 mothers of infants (1000 for each of the following age range: 0-11 months, 12-23 months, and 24-35 months of age) and 2250 mothers of teenagers. They all answered a self-administered questionnaire on the Internet and reported all vaccinations included in their child's health record. RESULTS: In 2011, 82.4% (CI 95%: 77.6-87.1) of infants 6-8 months of age were given hepatitis B vaccination before six months of age and 71.9% (CI 95%: 66.3-77.5) of children 24-26 months of age were fully immunized before 24 months of age. France should reach its objectives for infants thanks to the hexavalent vaccine, but this is not the case for teenagers since in 2011, at 14-16 years of age, only 55.4% (CI 95%: 53.3-57.4) had started their vaccination schedule and 37.4% (CI 95%: 35.4-39.4) were fully vaccinated. CONCLUSION: This recent data, specially concerning teenagers, should lead to corrective measures rapidly to reach vaccine coverage targets for this vaccination.

[Annual trends (2008-2011) in early childhood vaccination coverage for the French population: the Vaccinoscopie(®) study]. / Vaccinoscopie(®) : étude de l'évolution annuelle entre 2008 et 2011 de la couverture vaccinale des enfants de moins de 7ans dans la population française.

UNLABELLED: Assessing vaccination coverage (VC) is a critical part of adherence to immunization guidelines and beyond vaccine effectiveness can fill possible gaps and optimize VC. The aim of this study was to measure annual VC trends (2008-2011) among children 0-6years of age. METHODS: An Internet survey was conducted using a self-administrated questionnaire to a representative sample (quota method) of mothers reporting their child's immunization record. RESULTS: Diphtheria-tetanus-poliomyelitis-pertussis VC (complete schedule) was 96.0% at 6 years of age in 2010. Hepatitis B VC (≥1 dose) in the 6- to 11-month-old population increased from 54.6% in 2008 to 80.5% in 2011, but only 34.7% of 6-year-old had received a complete schedule in 2010. Pneumococcal conjugate vaccine VC (complete schedule) increased to 92.7% in the 24- to 35-month-old population. Measles-mumps-rubella (MMR) VC (2 injections) increased in 24- to 35-month-olds from 60.3% in 2008 to 81.0% in 2011. In 2011, 64.2% of 24- to 35-month-olds had received a second dose of MMR vaccine before 25 months vs. 45.4% in 2008. BCG VC in 12- to 35-month-olds was 73.2% in Île-de-France, where vaccination is recommended in all children vs. 15.5% elsewhere (vaccination only recommended in high-risk children). CONCLUSION: This study shows a significant improvement of VC in young French children. However, outreach efforts should continue to be made, especially to adolescent and adult populations, in whom VC is very low.

[Rectus abdominis free flap breast reconstruction. A series of 23 cases]. / Reconstruction mammaire par lambeau libre de grand droit de l'abdomen. A propos d'une série de vingt-trois cas.

Free TRAM flap breast reconstruction was performed in 23 patients from july 1993 through november 1995 at the Saint-Louis Hospital in Paris. The surgical team was composed of eight different surgeons. In all cases a delayed breast reconstruction procedure was performed. All patients in this series had previously received radiation therapy and 82.6% patients presented with excess body weight. Decision to perform a free flap procedure was confirmed peroperatively under two conditions. Adequate caliber of the donor and recipient vessels was required, allowing the anastomoses to be performed without magnification in most cases. Preservation of the thoraco-dorsal vessels was the rule so as to allow later use of a latissimus dorsi flap if necessary. Thus in 8 of the 31 cases in which a free flap was initially indicated a pedicled flap was actually performed so as to satisfy the above conditions. All procedures were performed by two surgical teams working simultaneously. Flap harvest met local tissue requirements in all cases. A lateral strip of rectus abdominis muscle and fascia was preserved when this appeared feasible. The abdominal wall was reinforced by prosthetic means in 82.6% of cases. The average operative time was 9 hours. Results were considered satisfactory or very satisfactory in most cases. The complication rate was 39.1%. Among the complications noted were 1 case of partial flap necrosis, 1 case of fat necrosis, 1 abdominal hernia, 1 abdominal bulge (both abdominal complications occurred in patients in whom no prosthetic material was used for abdominal repair). This complication rate also includes revision of the microsurgical anastomoses in 2 cases; in both cases the flap survived completely. This study tends to suggest that the free TRAM flap for breast reconstruction is a reliable technique. It is the authors' belief that it should replace the bipedicled TRAM flap since it combines ample flap vascularization with minimal rectus harvest.

Kinetics of adriamycin injected proximal to a tumor: a comparative study between venous and arterial injections.

A kinetic study of plasma concentration of Doxorubicin (Adriamycin) was performed in 25 cases of malignant melanoma of the extremity with malignant adenopathy, treated with the same dose (20 mg per m2). Drug concentration was measured using a radioimmunoassay, with good intra-assay and inter-assay reproducibility. The kinetic analysis used the multiple compartmental method and a simulation of the plasma curves. Adriamycin injected intravenously quickly leaves the plasma into an exchangeable compartment with a slow plasma return and subsequent prolonged mean duration of the plasma half life at a low concentration. Thus, the intravenous perfusion results in a high plasma concentration only during the time of infusion. After intra arterial injection proximal to the tumor, a fraction variable (average 35%) is not released back into the circulation, or released very slowly. This local sequestration (important in terms of local concentration) explains the efficiency and the potential local toxicity of this method of administration. The rapid release of about 70% of the drug into the plasma, with kinetics similar to that observed after intravenous infusion, allows for no significant reduction of systemic toxicity.

Significance of bone-marrow scintigraphy in aplastic anemia: concise communication.

Tc-99m colloid and In-111 transferrin were used in a semiquantitative scintigraphic study of bone-marrow activity in 76 patients with aplastic anemia, the majority of which were severe cases. The results are compared with other known prognostic parameters and with a predictive index formulated from a prior multi-parametric analysis performed in 352 cases. In 47 cases parallel abnormality of Tc and In uptakes was noted and was well correlated with other prognostic factors. Indium uptake is apparently a good indicator of the severity of aplasia; extension of active erythroid tissue, demonstrated with this method, is correlated with prognosis. In nine cases, excessive In uptake is explained by dyserythropoiesis associated with granulo- and thrombocytopenia (Fanconi's anemia in most cases). In 20 of our patients, TcSC uptake was excessive compared with that of In and with other prognostic factors. Statistically, this phenomenon carries an unfavorable prognosis but its physiological meaning remains to be defined.