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SummaryThe current D-Dimer ELISA methods provide high sensitivity and negative predictive value for the diagnosis of deep vein thrombosis but these methods are not suitable for emergency or for individual determination. We have evaluated the performance of 3 newly available fast D-Dimer assays (Vidas D-Di, BioMerieux; Instant IA D-Di, Stago; Nycocard D-Dimer, Nycomed) in comparison with 3 classic ELISA methods (Stago, Organon, Behring) and a Latex agglutination technique (Stago). One-hundred-and-seventy-one patients suspected of presenting a first episode of deep vein thrombosis were investigated. A deep vein thrombosis was detected in 75 patients (43.8%) by ultrasonic duplex scanning of the lower limbs; in 11 of them the thrombi were distal and very limited in size (<2 cm). We compared the performance of the tests by calculating their sensitivity, specificity, positive and negative predictive value for different cut-off levels and by calculating the area under ROC curves. The concordance of the different methods was evaluated by calculating the kappa coefficient. The performances of the 3 classic ELISA and of the Vidas D-Di were comparable and kappa coefficients indicated a good concordance between the results provided by these assays. Their sensitivity slightly declined for detection of the very small thrombi. Instant IA D-Di had a non-significantly lower sensitivity and negative predictive value than the 4 previous assays; however its performance was excellent for out-patients. As expected, the Latex assay had too low a sensitivity and negative predictive value to be recommended. In our hands, Nycocard D-Dimer also exhibited low sensitivity and negative predictive value, which were significantly improved when the plasma samples were tested by the manufacturer. Thus significant progress has been made, allowing clinical studies to be planned to compare the safety and cost-effectiveness of D-Dimer strategy to those of the conventional methods for the diagnosis of venous thrombosis.

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Although the main source of dietary calcium is dairy products, the calcium contained in mineral water, which is as available as that of milk, could provide a valuable source of calcium. We analyzed the data from the EPIDOS multicenter study to evaluate the relationship between both dietary calcium and that supplied by drinking water and bone density measured at the femoral neck by dual-energy X-ray absorptiometry. The study included 4434 women over 75 years of age who had not received any treatment likely to interfere with calcium metabolism. A significant correlation was found between total calcium intake and bone density at the femoral neck (r = 0.10, p < 0.001). After adjustment for the main variables influencing bone density, an increase of 100 mg/day in calcium from drinking water was associated to a 0.5% increase in femoral bone density, while a similar increase in dietary calcium from other sources only led to a 0.2% increase; however, this difference was not significant. The consumption of calcium-rich mineral water may be of interest, especially in older women who consume little calcium from dairy products. (J Bone Miner Res 1999;14:829-833)

To assess the prevalence of hepatitis C virus (HCV) infection, a community-based study was performed in eastern Gabon on 1172 subjects over 5 years of age. The prevalence of antibodies to HCV (anti-HCV) detected using second-generation enzyme-linked immunosorbent assay (ELISA) and confirmed by an immunoblot assay (RIBA 2), was 6.5%. Anti-HCV prevalence increased with age but was related to neither sex nor ethnic group. Among 30 subjects with positive ELISA results, 14 had HCV viraemia as shown by the polymerase chain reaction (11/12 RIBA positive, 2/15 RIBA negative, 1/3 RIBA indeterminate). We conclude that HCV is highly endemic in western equatorial Africa and that a high proportion of the population may be viraemic.

Objectives : The aim of the population-based study presented here was to evaluate quality of life (QOL) among bladder cancer survivors at least five years after diagnosis, ascertain the long term effects of treatments, and investigate important pathological and sociodemographic factors influencing the QOL of such survivors. Methods : A Functional Assessment of Cancer Therapy (FACT) questionnaire with a bladder-specific option (FACT-Bl), was sent by mail to patients randomly selected from the database of the Isère and Tarn cancer registries in France. Ninety-five valid completed questionnaires were returned by 78 males and 17 females, with a median age of 72 years (range, 33-90). The pathological information contained in the completed questionnaires was examined. Results : Of the 95 patients (76 with a superficial tumor, 17 with an invasive tumor), 20 had undergone total cystectomy. Total cystectomy clearly deteriorates the autonomy of survivors (ECOG-PSR), as well as their scores on the bladder cancer-specific sub-scale in sexuality-related questions. Survivors claimed impotency and loss of sexual interest after the cystectomy. In contrast, neither the type of treatment nor the time from the most recent major treatment were score-modifying factors. Negative psychological effects of treatments in the long-term were not observed. Rather, patients' QOL was affected by their autonomy in daily life and by old age. In addition, familial situation had a critical impact on emotional and Familial/Social Well-being. Conclusion : The present study showed the long-term negative effect of total cystectomy on survivors. Survivor autonomy and other sociodemographic backgrounds were also determinants of their QOL. The maintenance of good health, sexual function and active family relationships should be promoted so that patients can lead full lives after treatment.

These results demonstrated that the differences in intention in prescribing between psychiatrists and general practitioners can be explained by a different approach to prescription since psychiatrists place more importance on human and clinical factors (patients' and colleagues' opinions) than general practitioners, who referred more to 'official' data (university, hospital and registered indications).