204 Overdrive ventricular pacing in patients with permanent atrial arrhythmias and sleep apnea

BackgroundIn contrast to its efficacy in patients with heart failure (HF) and central (C) sleep apnea (SA), cardiac pacing is ineffective in obstructive SA. We examined whether overdrive ventricular pacing (OVP) has an effect on SA in pacemaker recipients with permanent atrial arrhythmias.MethodsAn apnea-hypopnea index (AHI) ≥ 15 was confirmed in 28 of 38 patients screened by finger oximetry during ventricular pacing at a backup rate of 40 bpm (BUV40). These 28 patients were randomly assigned in a crossover design to BUV40 versus OVP at 20 bpm above the mean heart rate measured during screening oximetry.ResultsAHI ≥ 30 and CSA were observed in 61% and 79% of patients, respectively. In 21 patients (19 with CSA) with a ≥ 5 OVP-induced decrease or no change in AHI, left ventricular ejection fraction (LVEF) was 40±16%, versus 55±18% (p=0.04) in 7 patients (3 with CSA, p=0.02) with a ≥ 5 OVP-induced increase in AHI. In 13 patients with histories of HF decompensation, AHI decreased from 32.8±12.9 during BUV40 to 24.9±16.5 during OVP, versus increased from 37.6±11.0 to 39.0±11.5 in 15 patients without histories of HF decompensation (p=0.02 vs. patients with histories of decompensated HF). In 9 patients with LVEF ≤ 35%, AHI decreased from 37.3±14.7 during BUV40 to 28.4±17.9 during OVP, versus from 34.5±10.7 to 34.4±14.3 in 19 patients with LVEF >35%, (p=0.04 vs. patients with LVEF ≤ 35%).ConclusionsIn patients with permanent atrial tachyarrhythmias, AHI decreased significantly during OVP in patients with a) histories of decompensated HF and CSA, or b) LVEF ≤ 35%, and increased or was unchanged by OVP in patients without these characteristics

Prise en charge psychoéducative pour sevrage de benzodiazépines en cure thermale (et enquête auprès de médecins généralistes)

International audienceThe prevalence of benzodiapezine (BZD) consumption is assessed as 18.6% over 12 months and 11.3% over 30 days [1]. Within the framework of a transversal study with general practitioners (GP), 2000 GP representatives were picked by drawing lots. 300 provided information on 997 BZD-treated patients (15.6% patients/GP). 4.2% of the patients revealed the association of a length of treatment greater than recommended, with a notification to reduce or stop treatment by BZD, and others had expressed their wish to stop the treatment altogether. The weekly number of patients can be estimated at 47,189 for whom BZD withdrawal has been indicated. At the close of this work, a group of experts offered to draw up a procedure on in-care for BZD withdrawal in spa therapy for groups of 6 to 12 patients, stable regular BZD over-consumers for at least 3 months. This protocol associates daily crenotherapy treatment, personalized psychotherapeutic follow-up, consistent medical care and psycho-educative workshops. It is completed by a post-cure 6-month follow-up. There is an experimental phase under way in 2010 and 2011

Demand patterns for HIV-tests in general practice: information collected by sentinel networks in 5 European countries.

This study describes a 1 year international data collection on the demand pattern for HIV-antibody tests in general practice recorded by 6 sentinel networks in 5 European countries. The purpose of the recording was to evaluate the use of HIV-antibody testing by general practitioners and the demand for testing among the general population. Sentinel networks of general practitioners are a possible and available instrument for monitoring the perception of the HIV-test, and indirectly of the threat of the HIV-epidemic by the public and by the general practitioners (GPs). Differences were found between the countries in the frequency of testing, the person asking the test and the reason for testing. Possible explanatory factors, such as differences in the routine testing of specific groups, differences in the training and in the role of the GP, differences in the characteristics of prevention policy, are discussed. The European comparison also offers the opportunity to reflect on common medical practice in dealing with demands for HIV-tests. (aut. ref.

Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma.

International audienceRCC ipsilateral recurrence risk after NSS is significantly associated with tumour size >4cm, tumour bilaterality (synchronous or asynchronous), and PSM. Careful follow-up should be advised in patients presenting with such characteristics