Clinical evaluation, dose-finding and acceptability of AERODIOL, the pulsed estrogen therapy for treatment of climacteric symptoms.

S21400 (AERODIOL) is a new intranasal formulation of 17beta-estradiol. It provides a pulsed estrogen therapy that ensures sufficient estrogenisation of tissues to treat estrogen deficiency symptoms, particularly those of the menopause. This multicentric study was designed to determine dose-range, efficacy and acceptability of S21400. One hundred and thirty four women were allocated a daily dose of 100-900 microg for 12 weeks. The doses of 100, 600 and 900 microg were given in two daily administrations, the doses of 200, 300 and 450 microg were given in one and two daily administrations. Oral progestogen was added the last 10-14 days of each cycle of estrogen therapy in all non-hysterectomized women. S21400 showed a dose-effect relationship and provided adequate estrogenisation in more than 80% of patients receiving a dose ranging from 200 to 600 microg daily. Hormonal impregnation was judged sufficient in 23% of women receiving the lowest dose (100 microg). It was often considered excessive for daily doses of 900 microg (36%). After 12 weeks of treatment, efficacy was similar whether the total daily dose was given in one or two administrations. Treatment was well tolerated and accepted, with only minor nasal events (prickling, sneezing). It was perceived by 92% of patients as good or excellent and 81% chose to continue the nasal treatment when it was offered to them. An initial dose of 300 microg per day provides an optimal efficacy/tolerability ratio. In summary, the pulsed estrogen therapy with AERODIOL in one daily administration offers a safe, well accepted and highly effective treatment to alleviate climacteric symptoms. It can be adapted easily to ensure optimal clinical efficacy.

[The obstetrical ultrasonographer and the law. Toward a medical consensus in prenatal diagnosis]. / L'échographiste obstétrical et le juge. Pour un consensus médical en diagnostic anténatal.

Ultrasonographers are being held to account more and more often. They are blamed for failures in diagnosis, and in particular "for false negatives". Having been taken off its pedestal, our profession seems now to have been put into the dock by a population that equates the right to treatment (encouraged by our health assurance system) with the right ot a cure and with duty by the medical profession to provide a mean to achieve the cure and good results. All forms of imaging of diagnostic interpretation are particularly vulnerable to the misunderstanding of the rights of the patient. The doctor's responsibility in civil law can be invoked when he has made a mistake, and when that mistake results in injury to the patient or her infant and where there is an obvious causal link between the mistake and the injury. The injuries that can be said to arise in the field of antenatal diagnosis are very broad-ranging, as the cases described in this article show. Comparisons between the state of affairs in France and in North America are made. The following can be involved: death of the fetus or of the newborn, emotional trauma for the parents, loss of opportunity, which is a "new" injury accepted several times since 1965 and now brought up more and more often in civil actions. This loss has not yet appeared in the penal system.(ABSTRACT TRUNCATED AT 250 WORDS)