B Acad Nat Med Paris
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B Acad Nat Med Paris · Apr 2007
Comparative Study Historical Article[Controlled randomized clinical trials].
It is generally agreed that the first comparative clinical trial in history was done by James Lind in 1747, in the treatment of scurvy. The general bases of modern experimental medicine were published by Claude Bernard in 1865. However, it is the development of new drugs and the evolution of methodological concepts that led to the first randomized controlled clinical trial, in 1948, which showed that the effects of streptomycin on pulmonary tuberculosis were significantly different from those of a placebo. ⋯ Controlled clinical trials are lacking in various fields of biomedical research, either because drug companies consider them unprofitable, or because they concern public health issues that are outside the scope of the private sector In such cases, controlled clinical trials must be undertaken and funded by the public sector Today, only North American institutions such as NIH and the National Heart Blood and Lung Institute are capable of sponsoring such trials. This creates a potential problem for extrapolation to European patient populations, which may be different. Large controlled clinical trials must start to be sponsored by public funding in Europe if European practitioners are to receive the evidence-based results they need to rationalize their medical practice.
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B Acad Nat Med Paris · Apr 2007
Historical Article[The Pharo School: a century of teaching in tropical medicine].
1907-2007: one hundred years separate this year's intake from the first students to enroll at the Pharo School. 1907: in February, the first class, called the "Marseillaise", entered the new School of Colonial Medicine (Ecole d'application du Service de santé des troupes coloniales), where they received theoretical and practical training in tropical medicine. 2007: the latest class, recruited through a national examination, will join the Tropical Medicine Institute of the Army health service in May, for the first autonomous training program in supervised ambulatory primary care. The past hundred years have seen many upheavals. After the colonial period and the two world wars, followed by decolonization and technical assistance for young independent nations, globalization has brought the continents together, shrunk distances, and led to an intermingling of populations. ⋯ It can be completed by diplomas in different disciplines (epidemiology, medical biology, special surgeries, pediatrics, vaccination, combating malaria, etc.), possibly during continuous medical training. Cutting-edge training will be reserved for physicians who are called on to practice far from their university or hospital base, in isolated or difficult situations. Thus, a hundred years after their peers of the old "Marseillaise", the 2007 Pharo class will be first to take a diploma in overseas medical missions--the latest in a series of change intended to keep pace with a rapidly changing world
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B Acad Nat Med Paris · Mar 2007
[Whole-body ultrasound in the ICU. A visual approach to the critically ill].
Sonography is a non invasive method allowing prompt diagnosis at the bedside, especially when sophisticated diagnostic tools are unavailable, as in the critical care setting. In particular, the lung, a vital organ, is fully accessible, and the signs are simple and standardized. ⋯ The clinical relevance of these diagnoses, and especially the interstitial syndrome, is discussed. Sonography also allows cost savings and avoids unnecessary irradiation.
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B Acad Nat Med Paris · Mar 2007
Review Comparative Study[Essential thrombocythemia. Contribution of the V617F JAK2 mutation to the pathophysiology, diagnosis and outcome].
An increased platelet number in blood depends on a limited spectrum of causes, which aren't always simple to identify. Secondary thrombocytosis is a reactive process in relation with acute or chronic inflammatory diseases, or asplenia. The infrequent inherited thrombocytoses disorders are suspected when similar cases are observed in the same family. ⋯ Disease stratification and treatment strategy are targeted on the evaluation and prevention of vascular complications. Acute leukaemia or myelodysplasia, and other clonal progressions like myelofibrotic transformation, are infrequent and delayed events. However, according to the present data, the risk of fibrotic progression or of leukaemic transformation is not related to the mutation status of ET patients.
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B Acad Nat Med Paris · Mar 2007
Review Comparative Study[Intraepithelial lesions and neoplasia associated with human papillomavirus infection].
Anogenital lesions induced by human papillomaviruses (HPV) are due to both high-risk HPV types involved in carcinogenesis of the cervix (and also, to a lesser extent, of the vulva, anus and vagina) and to low-risk HPV types that cause external genital warts in the perianal region, perineum, vulva and vagina (less often the cervix). Cervical cancer is thus virus-induced, and there is a continuum from intraepithelial lesions to invasive cancer. This offers the opportunity to screen cervical smears for cytological abnormalities or to detect high-risk HPV infection by molecular methods. Although the causal link between human genital papillomavirus infection and cervical neoplasia is well established, the role of beta-HPV in non melanoma skin cancers is unclear.