L’incidence de l’IRCT en 2011

This chapter provides a set of indicators on incident patients with renal replacement therapy. In 2011, in 25 French regions (99% population), 9 248 patients started a treatment by dialysis (incidence of dialysis: 149 per million inhabitants) and 334 patients with a pre-emptive graft without previous dialysis (incidence of pre-emptive graft: 5 per million inhabitants). One patient among two are over 70 years old at renal replacement therapy initiation. As in 2010, incidence rate seems to stabilize.     

Prévalence de l’IRCT en 2011

This chapter describes temporal and geographical variations of ESRD prevalence in France. This indicator assesses health needs of ESRD patients on dialysis or living with functional transplant. It does not include patients on conservative treatment. On December 31, 2011, 70 300 patients were receiving a renal replacement therapy in one of the 25 regions contributing to the registry, 39 200 (56%) on dialysis and 31 100 (44%) living with a functional renal transplant. The overall crude prevalence was 1091 pmh. It was 1.6 higher in males. Prevalence was subject to regional variations with 5 regions (3 overseas) above the national rate. Renal transplant share varied from 33% in Nord-Pas-de-Calais to 53% in Pays de Loire, and from 16 to 25% in overseas regions.The overall sex and age standardised prevalence was 40, 567 and 483 pmh respectively for peritoneal dialysis, haemodialysis and transplantation, with marked regional variations. The study of temporal variations for 18 regions contributing to the registry since 2007 demonstrated a +4% increase in standardised prevalence of ESRD patients with a functional transplant vs +2% increase for dialysis, resulting in a decreasing gap between dialysis and transplantation prevalence, due to an increase number of renal transplant and a longer survival of transplanted patients. Such an evolution should prompt the nephrological community and health authorities to anticipate changes in the ESRD healthcare organisation and to adapt them to the regional context.     

Flux entre modalités de traitement de l’IRCT

This chapter provides indicators to describe the outcome of prevalent and incident patients in the various modalities of treatment.Among the 36 849 patients on dialysis at 31/10/2010, 79% were already on RRT at 31/12/2009. Respectively 91%, 85% and 93% of the patients on HD in-center, HD self-care unit and peritoneal dialysis were in the same modality of treatment the year before. Among the 29 758 patients with a functioning graft at 31/12/2010, 98% were already on RRT at 31/12/2009, 95% of them with a functioning graft.72%, 72% and 74% of the patients with in-center HD, outcenter HD and self-care unit were in the same modality of treatment at 31/12/2011. But 37% of the patients on PD at 31/12/2010 were not on PD at 31/12/2011.In 2011, new patients represented 89% of the entries in peritoneal dialysis. Renal transplantation represented 10% of the outcomes of the HD patients in self-care unit or at home.     

Prise en charge initiale de l’incontinence anale

Initial management of fecal incontinence only requires medical treatment. Simple advices to regulate bowel movement (mucilages, rectal evacuation, loperamide). Transit disorders, and interestingly dyschesia, are frequently associated to fecal incontinence. In case of inefficacy, investigations are needed, guided by ethiopathology of incontinence wich can be suspected by medical interview and clinical exam.     

État des lieux de l’activité de publications en neurochirurgie en France

Bibliometrics are methods used to quantitatively analyze the scientific literature. The application of bibliometrics in neurosurgery is emerging and has not yet been studied in the French neurosurgical community. In France, the most used statistical method is named SIGAPS; the scores are based on the position of the author and the impact factor of the journal. The SIGAPS score, which can be calculated for a research team or an individual, impacts the public financial support of university hospitals in France. We analyzed retrospectively the publication productivity and the SIGAPS score of university neurosurgery departments in France for the period 2009–2016. This was supplemented by a list of current academic research protocols granted by the Minister of Health. The SIGAPS score is higher in large university hospitals even though all teams are dedicated to publishing more in the traditional neurosurgery journals (Neurosurgery, Journal of Neurosurgery, World Neurosurgery, J Neuro-oncology, Neuro oncology, Eur Spine J). Of note, the national Neurochirurgie journal (publishing in French and English) is progressively improving its impact factor (0.8). The most common themes are functional neurosurgery, neuro-oncology and spine. There are 14 on-going national multicenter research programs, 4 of them focused on the health economics of treatment innovations. These data provide the most accurate available snapshot of the scholarly efforts of all the French university neurosurgery departments. It is based on a national statistics method (SIGAPS). For future evaluation, it should be combined with internationally available parameters such as the h-index and m-quotient. Publication productivity has broad implications for the success of both academic departments and individual faculty members and their financial support.     

Indications actuelles de l’azathioprine en néphrologie

Azathioprine is an immunosuppressive agent belonging to the antimetabolite family whose action blocks purine synthesis. It inhibits lymphocyte proliferation. In recent years, several trials have clarified the role of this compound used for three main indications: lupus glomerulonephritis, necrotizing vasculitis associated with antineutrophil cytoplasmic antibodies and renal involvement, and kidney transplantation. This review of the literature details practical conditions for the use of azathioprine in these three situations.     

Les bisphosphonates en dehors de l’ostéoporose

Apart from postmenopausal and glucocorticoid-induced osteoporosis, bisphosphonates have been increasingly used during the last decade in the treatment of several bone diseases. For some well-established indications, bisphosphonates are nowadays the first choice medication: Paget’s disease, prevention of bone complications in tumoral osteolysis (multiple myeloma, metastatic carcinomas). In some selected patients, the scarcity (fibrous dysplasia) or severity (osteogenesis imperfecta) of the disease, as well as promising data in the literature, justify such a treatment. By contrast, there are many non validated indications, in which the use of bisphosphonates should not be recommended on the basis of our current knowledge: algoneurodystrophy, acute pain syndrome following a vertebral crush fracture, non corticosteroid-treated inflammatory arthritides…     

Comparaison des effets de l’aprotinine et de l’acide tranexamique sur le saignement en chirurgie cardiaque

ObjectivesTo compare the efficacy of aprotinin (APR) and tranexamic acid (TRA) in reducing blood loss and transfusion requirements after cardiac surgery under extracorporeal circulation (ECC).Study designRandomized controlled trial.PatientsOne hundred and four adults undergoing either coronary artery bypass grafting (CABG) (n = 55), or aortic valve replacement (AVR) (n = 49), allocated into three groups.Methodsa) APR !roup (23 CABG and 20 AVR) recei· ved aprotinin, 2 × 10⁶ KIU (280 mg) after induction, followed by an infusion 0.5 × 106 KIU·h⁻¹ (70 mg·h⁻¹) until chest closure, with a supplement to the oxygenator prime of 2 × 10⁶ KW ; b) TRA group (22 CABG and 19 AVR) received tranexamic aeid, 15 mg·kg⁻¹ between the injection of heparin (400 IU·kg⁻¹) and the beginning of ECC, 15 mg·kg⁻¹ after protamin injection (1.3 mg/100 IU of heparin); c:) CTR group (10 CABG and 10 AVR), the control group, was not treated w1th an antifibrinolytic agent. The amount of blood collected from the chest tube drainage was measured at admission to ICU, as weil as 4, 8 and 18 h after the insertion of drains and at the time of their removal. Packed red cells where given when the haematocrit was under 20% during ECC, 25% at the end of surgery and 30% alter extubation.ResultsThe blood loss was lower in APR group (834 ± 448 mL) than in TRA group (1015 ± 409 mL) (P = 0.009), and in CTR group (1416 ± 559 ML) (P = 0.004). The rates of transfused patients in groups APR, ATR and CTR were 35,37 and 60% respectively and the numbers of units administered per patient were 0.8, 0.8 and 1.7 respectively. In AVR cases, APR and TRA had a similar efficacy. In CABG cases, only aprotinin decreased post-operative bleeding. However there was no difference between APR and TRA concerning the transfusion requirements. In CABG cases the ECC was of shorter duration and blood loss was 1127 ± 540 mL vs 894 ± 422 mL in AVR cases (P = 0.03).ConclusionsBoth APR and TRA decrease blood loss. APR is more efficient after CABG than TRA as far as blood loss is concerned, whereas the transfusion requirements are similar. As APR is about 100 times more expensive and carries a risk for allergie reactions, its use in a high dose regimen is only recommended for reoperations, in patients treated with salicylates and in case of sepsis.     

Profil hormonal chez l’homme en cas d’infertilité au laboratoire de radio immunologie de l’institut des radioisotopes de Niamey

ObjectiveThe aim of this study was to determine the sociodemographic parameters and hormonal profile of infertile man.Patients and methodsWe included in our study, all patients presenting with infertility dating back at least two years, with abnormal semen analysis. These patients came to radio immunological laboratory assays for determination of FSH, LH, PRL and testosterone in the assessment of infertility.ResultsThe age of the patients ranged from 25 years to 64 years with an average age of 44.5 years. Employees are the most represented with a frequency of 63.93%, with 54.41% had consulted a primary infertility, followed by traders in 15.63% and 70% for primary infertility. The hormonal assessment was abnormal in 86% of cases (55/64). A rise in FSH was observed in 36% of patients, the LH was elevated in 31.25% of patients, 48.44% in PRL. 12 patients (18.75%) had low testosterone Among the endocrinopathies suspected, the hypogonadism hypergonadotrophic is the most represented with a frequency of 32.8%, testicular deficiencies are found in 12.5% of cases, hypogonadism hypogonadotrophic in 10.93% of cases, hyperprolactinemia isolated in 18.75% of cases and obstructive causes in 14 04% of cases.ConclusionThere are many endocrinopathies that can induce male infertility. They can be congenital or acquired and can concern several stages, hypothalamus, pituitary and testis. It's important to diagnose thoses endocrinopathies, because some of them are accessible to treatment.     

Coût de la prise en charge de l’IRCT en France en 2007 et impact potentiel d’une augmentation du recours à la dialyse péritonéale et à la greffe

IntroductionThis study estimates the costs for the national health insurance in 2007 of the patients with end-stage renal disease (ESRD) according to therapies modalities.MethodData for all patients covered by the general health insurance scheme (77% of the French population) from hospital discharge and outpatients reimbursement databases were linked. ESRD therapies were identified using an algorithm mainly based on discharge diagnosis and immunosuppressive drugs refunds.ResultsExtrapolated to all French population at the end of 2007, 60,900 patients had an ESRD therapy: 30,900 were treated on haemodialysis (HD) (51%), 2600 on peritonea dialysis (DP) (4%) and 27,300 had a kidney transplant (45%). Patients with dialysis therapies had more often complementary universal coverage for low earners. According to the French regions, patient treated with DP were between 0 to 26% and 19 to 57% for those with a transplant. The total refund cost for National Health Insurance was four billion € of which 77% for HD. Annual mean costs per patient were 64 k€ for DP, 89 k€ for HD, 86 k€ for the year of transplantation and 20 k€ for the following years. A 25% increase of DP would allow a decrease of the annual cost of 155 millions € and 900 transplantations more each year during 10 years a decrease of 2.5 billions €ConclusionThe increase of ESRD prevalence and its total cost require patients and professionals information and formation about the less expensive and more autonomous therapies and others alternatives facing the lack of kidney transplants from deceased donors.     

Prise en charge des patients avant l’initiation d’un traitement de suppléance de l’insuffisance rénale chronique terminale en 2013 en France

This study evaluated the management of patients with end-stage renal disease prior to initiation of renal replacement therapy. Among the 51 million national health insurance general scheme beneficiaries (77% of the population), persons 18 years and older, starting dialysis or undergoing preemptive renal transplantation in 2013, were included in this study. Data were derived from the French national health insurance system (SNIIRAM). In this population of 6674 patients (median age: 68 years), 88% initiated renal replacement therapy by haemodialysis, 8% by peritoneal dialysis, and 4% by renal transplantation. During the year preceding initiation of dialysis, 76% of patients had been hospitalised with at least one diagnostic code for renal disease in 83% of cases, 16% had not received any reimbursements for serum creatinine assay and 32% had not seen a nephrologist; 87% were taking at least one antihypertensive drug (60% were taking at least a renin-angiotensin system inhibitor) and 30% were taking a combination of 4 or more classes of antihypertensive drugs. For patients initiating haemodialysis in a haemodialysis centre, 39% had undergone a procedure related to arteriovenous fistula and 10% had been admitted to an intensive care unit. This study, based on the available reimbursement data, shows that, despite frequent use of the health care system by this population, there is still room for improvement of screening and management of patients with end-stage renal disease and preparation for renal replacement therapy.     

Organisation de l’exploration morphologique d’une maladie de Crohn (MC) en 2009

The utility of morphological digestive explorations available depends on whether we take into consideration the initial phase of Crohn’s disease, its evolution or a search for disease complications. For assessing the diagnosis, endoscopical examinations are an indisputable step. Videocapsule endoscopy and entero-MRI can identify intestinal lesions, but these are confirmed even more with push or double balloon enteroscopy. Radiological explorations should be avoided as much as possible when carrying out cold lesion morphology assessments of CD. Abdominal CT-scan is the best exploration to perform, in an emergency, in a suspected case of digestive complications.