[Advocate for a secondary prevention assessment of coronary artery disease]. / Plaidoyer pour un bilan de prévention secondaire de la coronaropathie.

Secondary prevention is paramount in patients who are survivors of an acute coronary syndrome. Cardiac rehabilitation has proven to be effective for several decades in the long-term implementation of preventive measures. Despite this evidence, prescription and real participation in these programs remain limited for a many reasons, including the patient, physician, health care system. Recent statistics are a major regional disparity in prescription that leads to inequality in access to care. A reflection is therefore necessary on the organization of the course of care of the patient after an acute coronary syndrome. The secondary prevention plan that we are proposing here is based on a secondary prevention assessment that allows the patient to be guided in rehabilitation or in an alternative proposal.

[VIVOPTIM: Feedback of an e-Health experimental program of primary prevention of cardiovascular risk on 30 to 70 years old volunteers]. / VIVOPTIM : retour d'expérience d'un programme expérimental de e-santé et de prévention primaire du risque cardiovasculaire global chez des sujets volontaires âgés de 30 à 70 ans.

Today by the e-health and the telemedicine, many people are more and more interested by the improvement of disease knowledge on cardiovascular diseases and associated risk factors, personalized self management support follow-up and e-Health monitoring. MGEN is a not-for-profit complementary health insurance gave itself the ways to use the new digital tools in health. MGEN developed an original and personalized program VIVOPTIM for the primary prevention of the cardiovascular risks for their members. The VIVOPTIM Pilot program is based upon digital services and was experimented by November 2015 to December, 2017 with 8000 members of the MGEN, from 30 to 70 years old and resident in two French areas (Occitanie and Bourgogne Franche-Comté). The assessment of the experiment VIVOPTIM e -health program was positive for the personalized cardiovascular support and for their health. Therefore, the MGEN generalized the VIVOPTIM program of cardiovascular prevention, to the whole France on July 11th, 2018.

[Abdominal aorta aneurysms discovered in cardiac rehabilitation]. / Anévrismes de l'aorte abdominale découverts en réadaption cardiaque.

We reported two cases of unusual discovery of asymptomatic surgical abdominal aortic aneurysm (AAA) after a coronary artery bypass graft and a valve surgery. Attending cardiac rehabilitation, the patients were transferred for prompt surgery. Beyond these observations, it is of great importance that screening of AAA could be done during echocardiography.

[Cardiac rehabilitation in "sports" patients]. / La réadaptation cardiaque des patients « sportifs ¼.

BACKGROUND: Cardiac rehabilitation (CR) addresses for the greater part a middle-aged sedentary population. Nevertheless, some patients referred in CR are active or sportive, and care for these patients is less known. AIM OF THE STUDY: To compare the results of CR between a little or not active population and an active or athletic population. PATIENTS AND METHODS: Every patient referred in a CR department in Loire-Atlantique between 2010 and 2016 were included either in the group 1 (sedentary or little active) or in the group 2 (at least once a week physical training).) RESULTS: Among 2916 patients included, 2288 patients did two exercise tests, the functional capacity in the group 1 (n=2117) increased from 4.7±1.2 to 5.6±1.3 METs versus 6.5±1.7 to 7.6±1.8 METs in the group 2 (n=171), the gain was similar in both groups from 19±13% to 18±14% (P=0.16). The 6minutes Walking Test respectively increased from 445±91 to 517±89 versus 518±87 to 603±73 meters with a gain of 18±18 versus 18±16% (P=0.93). The prognosis is yet to be best in the group 2 in accordance to a best maximal functional capacity (P<0.01). CONCLUSION: Cardiac rehabilitation is useful in active or athletic patients and should be prescribed based on the current recommendations.

[The daily living activities of the cardiac patient: Monocentre study]. / Les activités de la vie quotidienne du patient cardiaque: étude monocentrique.

BACKGROUND: The main aim of cardiac rehabilitation is for the patient to sustain physical activity at home. The daily living activities (DLA) are important to take into account. AIM OF THE STUDY: Analyze the DLA of patients in CR. PATIENTS AND METHODS: One thousand seven hundred and eighty patients (mean age: 60.9±11 years) followed a CR programme between 2010 and 2015. They were tested for several DLA with their cardiac frequency (CF). The observed CF was included in the Karvonen's formula, used for the prescription of physical activity. RESULTS: The coefficient of Karvonen was situated between 0.54 to 0.69, which was compatible with the prescribed physical training. Nevertheless, when the maximal exercise capacity was less than 5 METs, the coefficients were higher (0.53-0.89). CONCLUSION: It was useful to test the cardiac patients for DLA during a CR programme. The use of Karvonen's formula allowed to compare these exercises with recommended physical training. We must be prudent when the maximal physical capacity is less than 5 METs.

Colchicine for postoperative pericardial effusion: a multicentre, double-blind, randomised controlled trial.

OBJECTIVES: Pericardial effusion is common after cardiac surgery. Growing evidence suggests that colchicine may be useful for acute pericarditis, but its efficacy in reducing pericardial effusion volume postoperatively has not been assessed. METHODS: This randomised, double-blind, placebo-controlled study conducted in 10 centres in France included 197 patients at high risk of tamponade (ie, with moderate to large-sized persistent effusion (echocardiography grades 2, 3 or 4 on a scale of 0-4)) at 7-30 days after cardiac surgery. Patients were randomly assigned to receive colchicine, 1 mg daily (n=98), or a matching placebo (n=99). The main end point was change in pericardial effusion grade after 14-day treatment. Secondary end points included frequency of late cardiac tamponade. RESULTS: The placebo and the colchicine groups showed a similar mean baseline pericardial effusion grade (2.9±0.8 vs 3.0±0.8) and similar mean decrease from baseline after treatment (-1.1±1.3 vs -1.3±1.3 grades). The mean difference in grade decrease between groups was -0.19 (95% CI -0.55 to 0.16, p=0.23). In total, 13 cases of cardiac tamponade occurred during the 14-day treatment (7 and 6 in the placebo and colchicine groups, respectively; p=0.80). At 6-month follow-up, all patients were alive and had undergone a total of 22 (11%) drainages: 14 in the placebo group and 8 in the colchicine group (p=0.20). CONCLUSIONS: In patients with pericardial effusion after cardiac surgery, colchicine administration does not reduce the effusion volume or prevent late cardiac tamponade. CLINICAL TRIAL REG NO: NCT01266694.

[Cardiac rehabilitation after myocardial infarction in France: still not prescribed enough]. / La réadaptation cardiaque après infarctus du myocarde en France : un taux d'abstention trop élevé

Despite well-documented benefits for patients after myocardial infarction, cardiac rehabilitation is underutilized in most countries. In France, a recent study showed a participation rate of 22.7 %, with huge regional disparities for unknown reasons. In this paper, we analyze some demographic particularities for explaining these curious results. Then, we review in the literature the complex factors influencing patient's referral in cardiac rehabilitation (patient's believes, role of the physician, health system's organization…), and the best ways of improving cardiac rehabilitation rate or finding adequate alternatives.

[Nutritional education of the coronary patient in practice]. / L'éducation nutritionnelle du patient coronarien en pratique.

BACKGROUND: The Mediterranean diet is one of the food models which showed its ability at the patient at high cardiovascular risk in numerous cohort studies and two major interventional studies: Lyon Heart Study in 1999 and PREDIMED in 2013. AIM OF THE STUDY: Propose a practical assistance in the analysis of the dietary habits of the coronary patient with a simplified food frequency questionnaire. PATIENTS AND METHODS: Hundred coronary patients followed a program of cardiac rehabilitation and benefited from a nutritional education. The analysis of their dietary habits was made with the questionnaire of frequency of consumption of Rennes upon their arrival and 6months later. We have coded again these data by means of a simplified questionnaire with 15 items and compared the results and their evolution in 6months. RESULTS: On studied 200 questionnaires, the score of Rennes was 10.6±4.5 and the simplified score 8.2±3.4 with a coefficient of correlation of Pearson r=0.94 (0.91-0.95) at risk P<0.0001. Initial scores were respectively 8.0±4.4 and 6.3±3.4 (r=0.93) and the scores at 6months 13.1±2.9 and 10.1±2.2 (r=0.86). The evolution of the scores of 100 patients were respectively 14.2±11.7% and 12.6±11% (P<0.26). CONCLUSION: The use of a simplified questionnaire allows to analyze the dietary habits of the coronary patient and to estimate their evolution during a therapeutic educational program.

[Effects of a cardiac rehabilitation programme in coronary patient according to age]. / Effets d'un programme de réadaptation chez le coronarien en fonction de l'âge.

BACKGROUND: Benefits of cardiac rehabilitation (CR) are well established in coronary heart disease. The effects according to age are less known, especially in France. AIM OF THE STUDY: Evaluation at 6 months of a CR programme in three groups of patients with different age. PATIENTS AND METHODS: Two hundred and two coronary patients were included in the CR department in Machecoul between 2007 and 2009. They attended the CR programme and were examined at six months. Patients were divided into three groups: group 1, n=103 (<65 years), group 2, n=71 (65 to 75 years) and group 3, n=28 (>75 years). We analysed the exercise capacity (exercise stress testing and six minutes walk-test or 6MWT), two questionnaires (dietary and physical activity) and bio-clinical data. RESULTS: Exercise capacity improved respectively by 24, 27 and 18% (P<0.004 between G2 and G3). The 6MWT improved by 19, 22 and 25% (P<0.01 between G1 and G3). At 6 months, the 6MWT remain stable, the dietary and physical activity scales improved in the three groups, the body mass index (BMI) was unchanged, HDL cholesterol increased, smoking prevalence was respectively 16, 0 and 0% and medical treatment were optimal in 90, 82 and 79% (NS). CONCLUSION: If the impact of CR was almost similar in the three groups, a more prolonged physical training seems desirable in patients over 75 years.

[The coronary patient six months after cardiac rehabilitation: rehabilitation evaluation research (RER study)]. / Le patient coronarien six mois après la réadaptation cardiaque : recherche sur l'évaluation de la réadaptation (étude RER).

AIMS OF THE STUDY: The aims of the study are to elaborate and test, in a coronary population admitted in a cardiac rehabilitation (CR) department, an evaluative method 6 months after a cardiac rehabilitation programme, with emphasis on modified cardiac risk factors. PATIENTS AND METHODS: Every coronary patient admitted in the CR department in Machecoul between 2007 October and 2009 October, who's home were not over 50 km far away and without mental inability, were included. At the start of the programme, he was suggested to complete the training course by a phone interview at 3 months and a multidisciplinary consult at 6 months. It used dietary and physical activity questionnaires, and a 6-minute walk test (6mnWT). RESULTS: Two hundred and two patients were included (mean age 63,4 ± 10 years, 93% men), 17% after an acute coronary syndrome, 23% after angioplasty and 75% after coronary artery bypass graft. The cardioprotective dietary score increased from 7.8 ± 4.3 to 12.7 ± 3 (on a scale from-17 to+19) and the physical activity score from 15.4 ± 7.7 to 19.5 ± 4.8 (on a scale from 5 to 40). The 6mnWT increased in CR (from 431 ± 90m to 511 ± 91m) and was maintained at 6 months (513 ± 88m). The European recommendation goals were achieved by 76% of patients for LDL (<1g/L), 64% for blood pressure (<140/90), 82% for a BMI less than 30 and 36% a BMI less than 25, 67% central obesity (<102cm by men and 88 cm by women) and 82% for no smoking. Four non-fatal cardiac events and seven vascular events were reported by a mean delay of 190 ± 30 days. CONCLUSION: A six monthly evaluation of CR programme can be used in a cardiac rehabilitation department routinely activity.

[Ultrasound measurement of left internal mammary artery grafts. Interest and limits in cardiac rehabilitation]. / Exploration ultrasonographique des pontages mammaires internes gauches : intérêt et limites en réadaptation cardiaque.

OBJECTIVE: The aim of the study is to demonstrate the feasibility, interest and limits of ultrasound exploration of left internal mammary artery grafts in cardiac rehabilitation. METHODS: From January 2000 to December 2008, 1434 patients entered in cardiac rehabilitation underlying coronary artery bypass graft, were studied by transthoracic doppler echocardiography in left internal mammary artery graft, from supraclavicular fossa. RESULTS: One thousand two hundred and fifty-nine grafts were recorded (87.8 %); the diameter was 2.6 +/- 0.3 mm, the peak systolic velocity 46.3 +/- 17.7 cm/s, the peak diastolic velocity 34.0 +/- 13.4 cm/s, the diastolic/systolic (D/S) peak velocity ratio 0.77 +/- 0.26 and the mean blood flow 64.3 +/- 34.5 ml/min. The D/S peak ratio is lower in the presence of high blood pressure or diabetes, is higher in men, with sequential graft or when left ventricle ejection fraction is low. It tends to increase by sportsmen. CONCLUSION: Transthoracic echo-doppler assessment of internal mammary artery grafts is easily useful and allows to establish a "functional identity card" of the graft in postoperative period, which will be used like a reference for the follow-up.

[Prosthetic rehabilitation with dental implant in cleft lip and palate: a ten-year retrospective study]. / Réhabilitation implantaire des fentes labiopalatines: étude rétrospective sur dix ans.

INTRODUCTION: Two problems need to be faced during cleft lip and palate surgical treatment to gain a functional and esthetic result: restoration of the maxillary bone defect and the missing lateral incisor tooth, which may be replaced by an implant. The aim of our study was to demonstrate that it is possible to successfully place a dental implant after obtaining adequate bone graft volume. PATIENTS AND METHOD: 12 consecutively treated patients were studied, 7 with unilateral and 5 with bilateral clefts, mean age 21.5 years, with an average follow-up of 5.5 years (range: 1-10 years). Various types of autogenous or alogenous bone grafts were performed to provide adequate bone volume for immediate or secondary implant placement. We studied the number of bone grafts needed to reach this target, and the number of implants placed, focusing on lateral incisor tooth replacement. RESULTS: Enough cleft bone volume for the implant was obtained in 9 out of 12 cases (75%). All endosseous implants placed in bone graft were successfully restored, 8 out of them for lateral incisor. Some surgical cases are described. DISCUSSION: Global improving of cleft lip and palate surgical treatment by implantology is now feasible. Maxillary defect bone grafting, often in several stages, is strictly necessary to place an implant but also to obtain a good cosmetic result in cleft repair. Length, direction, and cervical implant position have to be considered too. Reconstruction of mucosal anatomy also contributes to the end result.

[The best of cardiac rehabilitation in 2006]. / L'essentiel de l'année 2006 en réadaptation cardiaque et cardiologie du sport.

The meta-analysis showing the benefits of physical training revisited: Taylor examined only the cardiac rehabilitation trials of exercise intervention alone (versus usual care) and demonstrated that cardiac mortality is 28 % reduced and exercise appears to have an independent mortality benefit. An economic evaluation of cardiac rehabilitation: a systematic review of 15 economic evaluations. Evidence to support the cost-effectiveness of supervised cardiac rehabilitation compared with usual care in myocardial infarction and heart failure was identified. But further well-designed trials are required. Pronostic value of some variables determined by exercise testing entering cardiac rehabilitation and after physical training. A beneficial effect of physical training versus usual care on BNP and neurohormones in patients with chronic heart disease. Patients on beta blockers after myocardial infarction: determination of a more accurate training heart frequency derived from the classical Karvonen's formula. The combination of trimetazidine with exercise training provides greater improvements in functional capacity, left ventricular function and the endothelium-dependent relaxation of the brachial artery than exercise training alone in patients with ischaemic cardiomyopathy referred for cardiac rehabilitation. Guidelines for resistance exercise after cardiac event: a new paradigm less restrictive, safe and efficient to accelerate patients' return to daily activities. Recommendations for participation in leisure-time physical activity and competitive sports for patients with ischaemic heart disease: the result of consensus among experts from the ESC study group of sports cardiology.

[Benefits and risks of exercise training in coronary artery disease patients]. / Reconditionnement a l'effort des patients coronariens stables: bénéfices et risques.

Cardiac rehabilitation programs improve vital and functional prognosis in patients suffering from stable angina or after myocardial infarction. The studies focusing on the balance risks/benefits of cardiac rehabilitation are relatively old; therefore, the patients included in these studies are different from today's patients mainly because of different management of the acute phases and of modifications of the medical treatment in stable angina (ABCDE protocols). The authors present the preliminary results of a French multicentric register focusing on complications during cardiac rehabilitation conducted on behalf of the French Society of Cardiology. Complications are rare: one resuscitated cardiac arrest/1.3 millions exercise training hours and no death was reported. It must be highlighted that, in some patients, the antianginal medical treatment must be reinforced in order to allow exercise training without myocardial ischaemia.

[Best of functional evaluation and cardiac rehabilitation in 2005]. / L'essentiel de l'anné 2005 en évaluation fonctionnelle et réadaptation des cardiaques.

The latest in cardiac rehabilitation has been impacted by: The East German PET publication which showed fewer ischaemic events and progression of the atheromatous disease in symptomatic and stable coronary patients who carry out regular physical exercise in comparison with patients who underwent angioplasty with stenting. Two meta-analyses updated the data showing the benefits of physical training: a 20% reduction in global mortality in coronary disease and 35% in cardiac failure. Two French studies reporting reassuring data for our daily practice: the serious complications of cardiac rehabilitation are exceptionally rare: the register for 2003 with data from 65 French centres, over 25,000 patients and 743,000 patient/exercise hours. Physical training two weeks after mitral valvuloplasty is not harmful for the valve repair and is beneficial in terms of exercise capacity for the patient. Epidemiological studies showing that women and elderly patients are, unfortunately, often excluded from programmes of cardiac rehabilitation.

[Complex polydactyly of the limbs: mirror foot. Report of two cases and review of literature]. / Polydactylie complexe des membres: le pied en miroir. A propos de deux cas et revue de la littérature.

Polydactyly is the most common congenital limb anomaly occurring both as an isolated defect or as part of a syndrome. However mirror foot is an exceptional abnormality (14 cases reported). The authors describe two sporadic cases of mirror foot. The first case presents a mirror polydactyly of the left foot, an hexadactyly of the right foot and a central polysyndactyly of both hands. The second case presents a mirror polydactyly of both feet. Mirror foot is a very rare defect. Both sporadic and familiar cases have been reported. This malformation can affect one or both feet. Some cases are associated with other congenital anomalies. The definition of mirror foot is warying according to the authors and the review of literature shows an important variability in the patterns of mirror polydactyly. Mirror duplication of hands and feet result of aberrant positioning of the zone of polarizing activity in relation to the apical ectodermal ridge during limb bud development. Different genes encoding limb pattern have been described.

[Congenital quintus varus supraductus: surgical procedure]. / Quintus varus supraductus congénital : technique chirurgicale.

Quintus varus supraductus is a congenital malformation that associates a hyperextension, a varus and an external rotation of the fifth toe coming over the fourth. The goal of this study is to explain an easy, reproducible and efficient surgical procedure to correct that malformation. Our procedure is only about soft tissues. It comprises a fifth toe extensor tenolysis, a circular capsulotomy and lateral ligament section of the fifth metacarpophalangeal articulation. The glenoid plaque is desinserted only if the peroperative reduction did not seem sufficient. The stabilization is achieved through a cutaneous plasty of modified BUTLER, with a cutaneous lengthening VY plasty. Exceptionally, an axial broaching of the articulation has been done. On about 20 children, aged 4-17 years, operated with this procedure, we have noticed a complete and definitive correction in 19 patients. Only one patient showed an incomplete resurgence, but without any functional disturbance. We did not notice any failure. This procedure seems efficient, and all the more interesting that it is technically easy to perform.

[Do we need a chart of quality for websites related to cosmetic surgery?]. / Faut-il une charte de qualité pour les sites Internet de chirurgie esthétique ?

UNLABELLED: Convergence of medicine and Internet may be one of the most remarkable transformations in the health care business. Following the path led by the United States, the number of French websites related to cosmetic surgery is growing rapidly. In this study, we intend to assess the quality of French websites dedicated to cosmetic surgery regarding good quality criteria currently available and recommendations suggested by the French Medical Association. MATERIALS AND METHODS: We browsed the main French search engines on the Web that initially answering the following question: how many webpages are available regarding cosmetic surgery and what are the best referenced websites. For each website, we surveyed the following data: author's name and qualification, date of creation and last update, sources of information, level of interactivity, and adherence to a chart of quality such as HON. RESULTS: Eighty-five websites were surveyed and assessed. Forty-five French websites were active websites dedicated to cosmetic surgery. Websites are mainly hosted by private clinics (18 sites = 40%), with informative content. We found that no website adheres to any chart of quality, and the French Society for Plastic Surgery (SOF.C.P.R.E.) is never mentioned. Intrinsic quality criteria for websites (author's identification, last update, sources of information, confidentiality) are only partially present. DISCUSSION: We recall the key statistics regarding e-health business in the world, the various charts of quality available for medical websites, and recommendations provided by the French Medical Association. We suggest that websites should be available as a service (for information to the patient, for managing the office, for setting up medical records) rather than a poor personal webpage or a showcase. CONCLUSION: The quality of websites for cosmetic surgery is poor; however, as in the USA, the number of web surfers on medical sites is growing. Online presence of our speciality should evolve. To improve medical websites, collective awareness is required. We recommend using a specific chart of quality, with recommendations rather than constraints.

[Protocol of cleft lip and palate by Saint-Vincent-de-Paul team]. / Fentes labiales et palatines: la prise en charge de l'équipe de Saint-Vincent-de-Paul.

The treatment of cleft lip and palate at Saint-Vincent-de-Paul hospital is realized by a multidisciplinary team. The calendar of the primary treatment is adapted according to the eventual antenatal diagnosis: it may be early and in two sessions, or late at 4 months but in one session. The calendar of the secondary treatment is more classical.