Design of a national and regional survey among French general practitioners and method of the first wave of survey dedicated to vaccination.

OBJECTIVES: France is currently facing a vaccine-hesitancy crisis. We conducted a questionnaire-based telephone interview with a large sample of general practitioners (GPs) as they play a crucial role in the vaccination process. Our main objectives were to study the GPs' vaccination behaviors when it comes to their own vaccination and that of their relatives, and the vaccine recommendations made to their patients. We also aimed to understand their opinion related to the severity of vaccine-preventable diseases and to assess their trust in various sources of information. Finally, we enquired about their opinion in terms of vaccination-related tools that could help them in their daily practice. The article aimed to present the design of this panel and survey. PATIENTS AND METHODS: Four samples of GPs (one national and three regional) were selected among all the French GPs (metropolitan France) using random sampling. Five cross-sectional surveys should be conducted with that panel. The mean targeted sample size is 2350 GPs for each survey. The survey dedicated to vaccination was conducted by telephone or on the Internet. RESULTS: GPs were included in the survey between December 2013 and February 2014. The national sample included 1582 GPs (response rate: 46%) and the three regional samples included 1297 GPs (response rate: 44%). The survey dedicated to vaccination was conducted between April and July 2014; the national sample response rate was 92% (1582/1712). CONCLUSION: The results of the first wave of surveys, conducted on a large sample of French GPs, provide important information to guide the French vaccination policy.

As well as physiological states, pathological states and therapeutical problems may be a gushing spring for biological theory--and conversely.

New class of therapies, including bipolar therapies (BPT) and "paradoxical" unipolar therapies (PUT) were firstly proposed in relation to a clinical insight and to some results of biological investigations, then they gave rise to mathematical modeling which brought a justification of these therapies, at least from a theoretical point of view. After recalling the mathematical model for the regulation of agonistic antagonistic couples, and reporting the fundamental types of control simulation by means of it, we point out the validity of therapeutical applications inferred from this model. These therapy modalities, including BPT and PUT, now concern the following diseases: astrocytomas, epilepsia and trials on multiple sclerosis. Even if such attempts are in their early stage, noticeably for the last case where biological changes have mainly been studied, it seems that a large span of treatments is open to BPT and PUT. Improvement of these techniques in the future depends, in our opinion, on a parallel working on the dynamics of the mathematical model and the dynamics, perceived by clinical insight and confirmed by biological investigations, of the body reactions to such strategies. Justification of BPT and PUT was given, by resorting to the notion of "pathological homeostasis" which, too often, intervenes in order to nullify the effects of unilateral (not paradoxical) therapies. This research has elicited some therapies which use two agents with antagonistic effects or only an agent with effects similar to the agent already in excess in the body--in both cases at nearly physiological doses.

Cyclic alternating pattern as a provocative factor in nocturnal paroxysmal dystonia.

PURPOSE: We made a polygraphic study of 6 patients with nocturnal paroxysmal dystonia (NPD) in which the cyclic alternating pattern (CAP) parameters were compared with those of a group of age- and sex-matched controls. METHODS: All patients met the requirements for NPD diagnosis, characterized by generalized stereotyped movements (dystonic-dyskinetic), with a 1-min centered duration but with no clear evidence of epileptic abnormalities in the waking EEG and during nocturnal recordings. RESULTS: Besides the major events, the NPD polysomnograms also showed shorter, repeated episodes of shorter duration (generally <20 s) consisting of abrupt movements involving one or more body segments. Overall, the motor events in patients with NPD were closely related to periods of unstable non-REM (NREM) sleep, as evidenced by the sequences of CAP, and began during an A phase. According to the conventional scoring parameters, NPD and controls differed only in sleep latency (+14 min in the NPD patients: p < 0.04). However, the architecture of sleep in the group with NPD was characterized by prolonged and irregular NREM/REM cycles. In addition, the NPD recordings showed significantly higher values of CAP rate (p < 0.0001). When major motor attacks were suppressed by medication, sleep was characterized by a decrease in the excessive amounts of CAP rate and by a more regular architecture. CONCLUSIONS: The modulatory role of CAP on nocturnal motor events is reported.

[Intraforaminal lumbosacral neurinoma]. / Neurinomes lombo-sacrés intra-foraminaux.

Twelve cases of intra-foraminal localization of lumbosacral neurinoma are reported including 9 schwannomas, 2 neurifibromas and 1 melanotic schannoma. According to their extension, they are classified in type II strictly intra-foraminal and extra-arachnoïdal: N = 6, type I-II, extending into the subarachnoïdal space; N = 5, type II-III, extending out of the spine. There were 7 men and 5 women with mean age of 49.5 years and a 5.2 years delay before diagnosis. The most common, though not permanent, symptom was radiculalgia; a generally weak sensorimotor deficit was noticed in 4 cases and hypoesthesia in two cases. Diagnosis was sometimes doubtful using myelography for the oldest cases, but is now made easily with CT scan and M.R.I. Microsurgery allows to dissect out the tumor inside the perineural sheath and to preserve the nervous root in most cases even in extra-arachnoïdal forms (N = 8). However, in cases of neurofibromas and of large tumors, the root had to be divided (N = 4) with rather surprisingly no new post-operative deficits. Intra-foraminal localization of lombo-sacral neurinomas is rare but now easily identified; it should be cured surgically with the goal, often reached, of maximum preservation of the nervous root.

[The timing of crisis and day-night distribution of paroxysmal EEG activities: a study on 197 epileptic patients]. / Horaires des crises et répartition nycthémérale des activités EEG paroxystiques: étude chez 197 épileptiques.

The purpose of the present study was to determine whether paroxysmal EEG activity (PA) occurs randomly over time and whether seizures arise at time of maximum PA. 204 ambulatory recordings (A/EEG) in 197 adult epileptic outpatients have been were included. The patients' seizures were grouped according to ILAE classification: Simple partial seizures; complex partial seizures (CPS), isolated or secondarily generalized; idiopathic generalized seizures: epilepsy with myoclonic absences, generalized tonic-clonic seizures (GTCS) on awakening, GTCS with photo-sensitivity; undetermined epilepsies: "grand mal morpheique", epilepsies with generalized PA without photosensitivity or with All recordings were performed with a 8-channel 24 h cassette recorder system (Medilog 9,000). The video play-back speed used was 20 times the recording speed to allow good detection, characterization and localization of PA. Counting was accomplished by visual analysis. No PA during A/EEG was noted in 24.5 p. 100 of all cases. A diurnal distribution in wakefulness was found in 59 p. 100 of idiopathic generalized epilepsies, PA usually occurring on awakening whatever the specific time of day; in 27 p. 100 of CPS and 20 p. 100 of undetermined epilepsies, with peak PA occurrence at late morning and 6 pm. During resting-state and afternoon-naps, PA occurrence was mainly seen in CPS. PA occurring only in overnight sleep was observed in 17 p. 100 of CPS and 20 p. 100 of undetermined epilepsies. PA distribution pattern in both CPS and undetermined epilepsies suggests an ultradian rhythm (time-dependent). On the other hand, PA pattern in idiopathic generalized epilepsies support the hypothesis of a circadian rhythm linked to sleep/wake--or light/dark--cycle (state-dependent).

[The transcranial Doppler in the adult. Preliminary results in 31 patients]. / Le Doppler transcrânien chez l'adulte. Résultats préliminaires chez 31 patients.

Non-invasive transcranial Doppler US investigation in adult patients was first described by Aaslid et al. (1982). The apparatus consists in a 2 MHz bidirectional pulsed Doppler with spectrum analyser. Middle and anterior cerebral arteries were insonated by transtemporal exploration, basilar artery by occipital foramen. The criteria of identification were: position and angulation of the probe, direction of the flow, depth of sample volume. The authors present a first series of 31 patients, all with cervical CW Doppler and B-mode Echo. The percentage of identification was: MCA 72%; ACA 69%; BA 54%. Some clinical cases are illustrated. The interest of the method is emphasized in spite of constraints depending on probe position and anatomical variability of the circle of Willis: ambulatory and non-invasive methods; assessment of intracranial blood flow in various conditions: cerebral ischemia and infarction, intracerebral angioma; complementarity with other non-invasive and non-expensive techniques: EEG and cervical US investigation.

[Value of cassette-recorded long-term 8-channel EEG monitoring--ambulatory recording in known epileptics]. / Intérêt de l'EEG de longue durée sur cassette avec 8 dérivations--enregistrement ambulatoire chez des épileptiques connus.

The authors insist on the real improvement of ambulatory EEG recording due to the new 8-channel cassette recorder (Medilog 9000*). They emphasized: (1) its maniability with full independence of patients and physiological sleep recordings at home; (2) its viability, the same as conventional EEG with 8-channel montages; (3) its performant video-screen replay system, with easy paper transcription. The results in 50 ambulatory epileptic patients out of the 100 examinations actually realized in the EEG laboratory with this new device are detailed. Most interesting, in addition to sleep recording, is recognizing the number and the time repartition of paroxysmal discharges every 24 h; increasing the chances of recording randomly occurring seizures and the future chronobiological studies. The indications in epileptic seizures are myoclonic and 'temporal' epilepsies and also, with one channel for ECG recording, the diagnosis of attack of uncertain etiology.

[Value of cassette-recorded long-term 8-channel EEG monitoring in status epilepticus--technical note]. / Interêt de l'EEG de longue durée enregistré sur cassette avec 8 dérivations dans les états de mal épileptiques--note technique.

Prolonged EEG-taped recording is a significant recent improvement in technique, with the 8 channels providing the possibility of exploration of the whole scalp. First used for ambulatory monitoring, it was also tested in comatose patients with status epilepticus. The advantages are: the the good quality of the EEGs even after recording continuously for many days, and without drawback for intensive nursing; the help in recognizing infraclinical seizures, often misunderstood by the nursing staff, and the control of treatment; the participation in prospective chronobiological studies.

[Echotomography of the carotid bifurcation (author's transl)]. / Examen de la bifurcation carotidienne par échotomographie.

Echotomography examinations of carotid bifurcation were conducted in 19 patients, with a real-time apparatus (71 crystals, 7 MHz). Serial transversal sections plus two or more longitudinal sections enabled identification by Echo-B of the three carotid arteries, and thus the bifurcation, in 37 instances. Arteriography was performed in 11 patients (21 carotid arteries). Correlation between Echo-B and arteriographic findings was good in 10 cases (including 1 case of occlusion and 2 of stenosis). There were 3 false negatives but no false positives. Echo-B did not detect the bifurcation on either side in one patient. The method is non-invasive, painless, and can be repeated without risk. It enables the detection of stenotic and occlusive lesions with a certain degree of reliability. It is also of value for demonstrating the presence of atheromatous plaques, and to some extent, irregularities in the arterial wall or variations of its diameter. It allows new perspectives for long-term following of patients after medical or surgical treatment.

[Oculomotor lesions and myeloma: a case with a CT scan study (author's transl)]. / Les atteintes oculo-motrices au cours des myélomes. A propos d'un cas étudié par tomodensitométrie.

A 62 year-old woman presented with a unilateral, incomplete ophthalmoplegia, and pain in the territory of the ophthalmic branch of the trigeminal nerve. She had an IgG gamma 2-lambda 2 type myeloma. Opacification by phlebography of the cavernous sinus on the affected side was not possible, neither through the ophthalmic vein nor through the anastomotic coronal veins. This suggested invasion of the sella turcica. Combined radiotherapy and chemotherapy led to rapid and almost total recovery. The lesion recurred 15 months later. Then there was a bilateral oculomotor palsy involving both external recti, and exophthalmos. CT Scan demonstrated a marked increase in size of the external recti. Special features in this case were the oculomotor paralysis and its occurrence as the initial sign of the disease, and its secondary localization in the orbits with bilateral muscle lesions.

[Computed tomography in multiple sclerosis]. / La tomodensitométrie dans la sclérose en plaques.

Sixty patients with multiple sclerosis were examined by computed tomography using an Acute 200 Pfizer apparatus (matrix: 256 X 256; sections: 8 mm thick). In 48 cases iodine contrast medium was injected prior to examination, and in 6 cases the examination was repeated after several months. Abnormal C.T. readings were found in three quarters of the patients; increased image density in 10 patients, reduced density in 10 other cases; isolated cerebral atrophy in 26 patients, associated in 10 other cases with increased or reduced density of the image. Increased densities were seen mainly during acute episodes, then tended to isodensities or low densities. Though these different images are not specific, their association, the absence of mass effect and the absence of correlation between their location and the clinical signs, are elements in favor of the diagnosis of multiple sclerosis. Regions of increased density probably represent active foci of demyelinization and their investigation could be of value during long-term follow-up of these patients.

[Value of metrizamide myelography with tomodensitometry for study of the cervical spine]. / Intérêt de la myélographie-métrizamide avec tomodensitométrie, pour l'étude du rachis cervical.

52 metrizamide myelographies practiced with tomodensitometry were studies (23 normal cases); 6 cervicarthrosic myelopathies; 2 intra medullar tumors; 1 extra medullar tumor; 19 syringomyelias). The technical procedures are discussed for the different diseases. This test has proven highly interesting for the study of syringomyelias and tumors. It allows the presence of narrow canals to be demonstrated, but does not yet indicate discal hernias. The role of tomodensitometry, in relation to other exams, is demonstrated.