[Interobserver variation of the Global Assessment Scale. Study of 59 patients at admission to a general adult psychiatric unit]. / Etude de la fidélité interjuges du score EGF. Application à 59 patients lors de leur admission dans un pavillon de psychiatrie générale adulte.

UNLABELLED: In France, an analysis of the evaluation of psychiatric activity was done by a work group representing thirteen hospitals spread over the entire country. The group just recently published their final report in the form of an experimentation protocol for the description of psychiatric activity. The proposed methodology leads to some modifications of the existing data collection based on individual patient information sheets "fiche par patient", more particularly concerning new items such as the Global Assessment Scale (GAS or Axis V of DSM III-R): our first impression was that this new type of evaluation seemed to us somewhat subjective. We therefore decided to analyze the reliability of the score established by psychiatrists not familiar with its use. In the beginning the GAS score was evaluated in clinical cases (patients seen at their admission by two or three psychiatrists and scored afterwards independently), then in theoretical cases (34 cases types taken from the Health-Sickness Rating Scale of Luborsky) with the objective to improve the consensus between clinicians. RESULTS: The clinical case studies made in an adult psychiatry pavilion permitted evaluating 59 patients at admission, of which 25 by three judges and respectively 40, 28 and 41 by pairs. The global accuracy of the score obtained with the clinical cases seems satisfactory for a discipline such as psychiatry (Kappa of Cohen's coefficient = 0.51, p < 0.001 for 25 patients by three judges--Kappa = 0.45, p < 0.001 for the 109 pairs of evaluations). The more detailed study of the classes obtained a satisfactory consensus for the scores below 40 and above 60 (K = 0.46 to 0.59) but not entirely satisfactory for the scores in the mid range of the scale between 40 and 60 (K = 0.22 to 0.29) which represents 39% of the patients in the study; this is improved by grouping into larger classes this part of the scale and it is therefore advisable to use it that way. For the 34 theoretical cases taken from the Luborsky HSRS evaluated independently by three judges the results obtained are clearly not as good (global Kappa = 0.29, p < 0.01). That is perhaps due to the fact that these "case types" don't use the descriptive patient models generally used in France. Keeping in mind that the mid range of the scale should be interpreted prudently, the GAS scale can nevertheless be credited with a certain global objectivity in the case of neutral study. Would it be the same if the GAS study could influence the allocation of resources? Taking into account all the clinical practices in mental health, the question of how all the data of this type evaluation could be recorded and updated should also examined.

[Apropos of a familial case of adrenoleukodystrophy related to X chromosome diagnosed prenatally]. / A propos d'une observation familiale d'adrénoleucodystrophie liée à l'X avec réalisation d'un diagnostic anténatal.

The juvenile type of adrenoleukodystrophy is a X linked genetic disorder involving the central nervous system and the adrenal cortex. It is associated with an abnormal metabolism of saturated very long chain fatty acids. The basic defect remains unknown and there is presently no effective treatment. The authors report a familial observation which illustrates the efficacy of the techniques of identification of heterozygote females carriers and of prenatal diagnosis from trophoblast biopsy.

[Familial adrenoleukodystrophy]. / A propos d'une observation familiale d'adrenoleucodystrophie.

Adrenoleucodystrophy (ALD) is an X-linked hereditary disease concerning very long chain fatty acid (VLCFA) metabolism. It affects cerebral white matter and adrenal cortex. In the adult form, (adrenomyeloneuropathy) we also find hypogonadism. The enzymatic anomaly, yet unknown, takes place in the peroxisome. The illness is diagnosed by plasma VLCFA amount determination. We actually have no efficient treatment. Prenatal diagnosis is possible, using both biochemical assays and linkage analysis to a DNA probe.

[Cardiac angioscintigraphy at equilibrium coupled with isoproterenol perfusion. Method of diagnosing chronic coronary insufficiency]. / Angioscintigraphie cardiaque à l'équilibre couplée à la perfusion d'isoprotérénol. Méthode diagnostique de l'insuffisance coronaire chronique.

The effects of isoproterenol (IPNA) on global and regional left ventricular wall motion were studied by cardiac angioscintigraphy at equilibrium performed under basal conditions, during IPNA administration (per IPNA) and 10 minutes after (post IPNA) in 50 patients classified by coronary angiography as coronary (C) (n = 37) and non-coronary (NC) patients (n = 13), 5 reference subjects (REF) and 8 non-coronary pathology. The effects were assessed from variations of global LV function and from indices of regional wall function (12 regional ejection fractions - REF). The IPNA perfusion was well tolerated, even in patients with severe coronary lesions. 1. Diagnosis of myocardial dysfunction due to coronary artery disease: it was possible to separate the patients into C and NC groups according to the variations in EF, end systolic (ESV) and REF, especially post IPNA: NC group: per IPNA: 12/13 NC patients showed an increase in EF (+10.7%), a decrease in ESV (-41%) and increased or stable REFs. Post IPNA: 10/13 had raised EF (+4.6%), 9/13 had a reduced ESV (-17.4%) and 10/13 had stable or increased REF. C group: per IPNA: 15/37 C patients showed decreased EF, 12/37 had increased ESV and 15/37 had a decrease in at least two ref greater than or equal to 5%. Post IPNA: 25/37 had decreased EF, 21/37 increased ESV, 34/37 had at least two reduced REFs. These results show that decreased ref post IPNA (sensitivity 91.9%, specificity 66.9%) was a better indicator of coronary artery disease than VEF (sensitivity 68%, specificity 54%), increased ESV (sensitivity 57%, specificity 77%) or ECG changes (sensitivity 54%, p 0.05; specificity 91%, p less than 0.1). 2. Diagnosis of the extent of coronary artery disease: the post IPNA abnormal ref were situated in zones compatible with the coronary lesions: 10/13 single vessel disease (2 false negatives, 1 false localisation); 8/11 double vessel disease (1 false negative, 2 single vessel disease); 5/10 triple vessel disease (2 single vessel and 3 double vessel disease); 2/3 left main stem disease (1 single vessel disease). The study of REF demonstrated at least 2 diseased zones in 15/24 patients with multiple diseased vessels. Independently, the diagnosis of multivessel disease may be suspected by the fall in EF per IPNA (4/13 single vessel cases compared to 11/24 multivessel disease) and, more generally, by the fact that the EF and ZSV per and post IPNA appear more pathological with respect to the reference group when the coronary lesions are most diffuse.(ABSTRACT TRUNCATED AT 400 WORDS)

[Determination of left ventricular volume by cardiac angio-scintigraphy at equilibrium. Comparison with a radiologic method]. / Détermination des volumes ventriculaires gauches par angio-scintigraphie cardiaque à l'équilibre. Confrontation à la méthode radiologique.

Cardiac angioscintigraphy at equilibrium was performed after in vitro red cell labelling in the left anterior oblique and anterior views. A syringe of 10 ml labelled blood was placed on the patient's chest over the left ventricle and in contact with the camera's collimator in the LAO incidence. This syringe plays a dual part: as a direct reference for left ventricular radio-activity and as a marker for measuring the distance between the centre of gravity of the LV and the collimator by Links' method. The correction factor for absorption varies with each individual. An algorithm integrating this data automatically calculates the EDV in millilitres (ml) and the end diastolic and systolic volumes from the ejection fraction (EF) determined by an independent method. The study group was 100 patients (91 men, 9 women; 81 coronary, 11 valvular heart and 8 other diseases) with radiological EDV ranging from 107 to 1 283 ml and radiological EF ranging from 14 to 75 p. 100. A very significant correlation was observed between the radiological and scintigraphic EDV with a regression line close to that of identity: EDVs = 1.05 . EDVR-5 ml (or -3 ml/m2); SD = 48 ml; r = 0.953; p less than or equal to 0.001. The mean deviation between the methods was 35.7 ml (median 24 ml) or 13.7 p. 100 (median 9.4 p. 100) of EDVR. A large discrepancy (over 90 ml or 30 p. 100) was observed in only 7 patients, 4 of whom had severe mitral regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)