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Picard M.,CHU Sainte Justine | Paradis L.,CHU Sainte Justine | Nguyen M.,CHU Sainte Justine | Begin P.,CHU Sainte Justine | And 2 more authors.
Allergy and Asthma Proceedings | Year: 2012

The practice of elective penicillin skin testing could be compromised by the fact that patients, their parents, or their physicians remain reluctant to reuse penicillin-class antibiotics (PCAs) despite a negative evaluation by an allergist. This study addresses reuse of PCAs in a pediatric population after negative penicillin skin testing and drug challenge and factors associated with its reluctance. All children evaluated for a history of penicillin allergy at the CHU Sainte-Justine Allergy Clinic between January 1998 and June 2000 with negative skin testing and drug challenge were included in the study. A telephone survey was conducted between May and October 2002 to assess the perception of the initial reaction by the parents, subsequent use of antibiotics, and antibiotic-related adverse reactions. Among the 200 children selected, parents of 170 (85%) children completed the survey. Since the allergist evaluation, 130 (76%) children had received antibiotics. PCA was used in 59 (45%) children. Parents of 24 (18%) children refused PCAs because they still feared an adverse reaction. They were more likely to have been very frightened by their child's allergic reaction than other parents whose children had used PCAs (p = 0.008). Although elective penicillin skin testing is useful and safe in the pediatric population, a significant proportion of parents still refuse PCAs even though they are needed. Identification of parents that were very frightened by their children's allergic reactions and additional reassurance could improve this situation. Copyright © 2012, OceanSide Publications, Inc.

Infante-Rivard C.,McGill University | Rivard G.-E.,CHU Sainte Justine | Derome F.,CHU Sainte Justine | Winikoff R.,CHU Sainte Justine | And 2 more authors.
Haemophilia | Year: 2012

Radiosynoviorthesis (RS) is an intra-articular injection of a radioactive colloid for the treatment of synovitis administered most often to patients with rheumatoid arthritis or haemophilia. Although highly cost-effective in comparison with surgical or arthroscopic synovectomy, the risk of cancer associated with this treatment is not well known. We evaluated the incidence of cancer in a group of patients treated with RS. A cohort of 2412 adult patients with a variety of underlying conditions (mainly rheumatoid arthritis) and treated with at least one RS between January 1976 and December 2001, was recruited from two centres in Montréal. Cancer incidence and mortality data for cohort members over that time period were obtained from regulatory agencies using linkage. Background rates for all and specific types of cancer were obtained for the provincial (Québec) and national (Canada) population according to age, gender and calendar period categories. Category-specific rates in the cohort were compared with rates in similar categories from the general population generating standardized incidence ratios (SIR). The effects of specific isotope doses and of number of RS treatments were analysed using a Cox-regression model. No increase in the risk of cancer was observed (SIR 0.96; 95% confidence interval 0.82-1.12). There was no dose-response relationship with the amount of radioisotope administered or number of RS treatments. The study provides some indication for the safety of the procedure but homogenous diagnostic groups of younger patients (such as haemophilic patients) receiving RS will need more evaluation. © 2012 Blackwell Publishing Ltd.

Villeneuve E.,CHUM | Nam J.L.,University of Leeds | Bell M.J.,Sunnybrook Health science Center | Deighton C.M.,Royal Derby Hospital | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Background: Despite the importance of timely management of patients with inflammatory arthritis (IA), delays exist in its diagnosis and treatment. Objective: To perform a systematic literature review to identify strategies addressing these delays to inform an American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) taskforce. Methods: The authors searched literature published between January 1985 and November 2010, and ACR and EULAR abstracts between 2007-2010. Additional information was obtained through a grey literature search, a survey conducted through ACR and EULAR, and a hand search of the literature. Results: (1) From symptom onset to primary care, community case-finding strategies, including the use of a questionnaire and autoantibody testing, have been designed to identify patients with early IA. Several websites provided information on IA but were of varying quality and insufficient to aid early referral. (2) At a primary care level, education programmes and patient self-administered questionnaires identified patients with potential IA for referral to rheumatology. Many guidelines emphasised the need for early referral with one providing specific referral criteria. (3) Once referred, early arthritis clinics provided a point of early access for rheumatology assessment. Triage systems, including triage clinics, helped prioritise clinic appointments for patients with IA. Use of referral forms standardised information required, further optimising the triage process. Wait times for patients with acute IA were also reduced with development of rapid access systems. Conclusions: This review identified three main areas of delay to care for patients with IA and potential solutions for each. A co-ordinated effort will be required by the rheumatology and primary care community to address these effectively.

Kotowski M.,CHUM | Kotowski M.,University of Lausanne | Naggara O.,University of Paris Descartes | Darsaut T.E.,CHUM | And 7 more authors.
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2013

Background and purpose: Surgical clipping of unruptured intracranial aneurysms (UIAs) has recently been challenged by the emergence of endovascular treatment. We performed an updated systematic review and meta-analysis on the surgical treatment of UIAs, in an attempt to determine the aneurysm occlusion rates and safety of surgery in the modern era. Methods: A detailed protocol was developed prior to conducting the review according to the Cochrane Collaboration guidelines. Electronic databases spanning January 1990-April 2011 were searched, complemented by hand searching. Heterogeneity was assessed using I2, and publication bias with funnel plots. Surgical mortality and morbidity were analysed with weighted random effect models. Results: 60 studies with 9845 patients harbouring 10 845 aneurysms were included. Mortality occurred in 157 patients (1.7%; 99% CI 0.9% to 3.0%; I2=82%). Unfavourable outcomes, including death, occurred in 692 patients (6.7%; 99% CI 4.9% to 9.0%; I2=85%). Morbidity rates were significantly greater in higher quality studies, and with large or posterior circulation aneurysms. Reported morbidity rates decreased over time. Studies were generally of poor quality; funnel plots showed heterogeneous results and publication bias, and data on aneurysm occlusion rates were scant. Conclusions In studies published between 1990 and 2011, clipping of UIAs was associated with 1.7% mortality and 6.7% overall morbidity. The reputed durability of clipping has not been rigorously documented. Due to the quality of the included studies, the available literature cannot properly guide clinical decisions.

Labrosse J.M.,Center Hospitalier Of Luniversite Of Montreal Chum | Cardinal E.,Center Hospitalier Of Luniversite Of Montreal Chum | Leduc B.E.,CHUM | Duranceau J.,University of Montreal | And 3 more authors.
American Journal of Roentgenology | Year: 2010

OBJECTIVE. The objective of our study was to evaluate the effectiveness of ultrasoundguided corticosteroid injection for the treatment of gluteus medius tendinopathy. SUBJECTS AND METHODS. We prospectively evaluated 54 consecutive patients (48 women, six men; mean age, 54.7 years; mean body mass index, 26 kg/m2) with a clinical diagnosis of gluteus medius tendinopathy. Pain assessment using a 10-cm visual analog scale (VAS) was obtained as part of the initial clinical evaluation of all patients. A hip ultrasound study was performed followed by a gluteus medius peritendinous ultrasound-guided injection of 30 mg of triamcinolone combined with 3 mL of bupivacaine 0.5% using an anterior oblique coronal plane. One month after treatment, participants were reassessed clinically, and they were asked to quantify their pain using the VAS pain score and their satisfaction with the outcome of the injection using a 4-point rating scale (very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied). Statistical analysis included a paired Student's t test (comparison of pain levels before and after treatment, p = 0.05) and a multivariate analysis of covariance. RESULTS. There was a 55% average reduction of pain level before versus after treatment (mean VAS pain score, 6.4 vs 2.9 cm, respectively; p < 0.001). One month after treatment, 72% of the patients showed a clinically significant improvement in pain level, which was defined as a reduction in the VAS pain score of ≥ 30%. Seventy percent of patients were satisfied with the results of the intervention. No correlation was shown between treatment outcome and any of the clinical variables or ultrasound findings. CONCLUSION. Our study shows that a peritendinous ultrasound-guided corticosteroid injection may be an effective treatment of gluteus medius tendinopathy. © American Roentgen Ray Society.

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