Nickel

26) Scoliose structurale évolutive( dont l'angle est egal ou supérieur à 25° ) jusqu'à maturation rachidienne. Progressive Scoliosis (where the angle is equal or more than 25°) up to spinal maturity. Permanent lateral deviation of the spine with rotation of the vertebral bodies. Cause uncertain but may run in families usually diagnosed in middle childhood though some scolioses are apparent at birth due to Spina bifida, cerebral palsy etc. Tends to progress, the 25° angle is an indication of severity. Basis of treatment is to obtain by the end of growth a spine as straight and balanced as possible, by use of plasters, corsets, surgery. Exemption for scolioses of 25° and above and for infantile scolioses of a smaller angle requiring orthopaedic treatment.

25) Sclérose en Plaques Invalidante Mutiple Sclerosis.  A chronic inflammatory disease of the Central Nervous System whereby the fatty sheaths around the nerve are destroyed resulting in loss of transmission of the "nerve/electrical"  impulses. Usually occurs with  "attacks" of loss of sensation ( most common)  or muscle weakness, maybe speech problems or eye signs.This may be transitory  so a diagnosis may not be made. May be months or even years before the next attack. gradually becomes more progressive with less remissions. During attacks neurological symptoms may be severe requiring hospitalisation. Exemption for 6 months following any attack and each new attack gaining a similar exemption but as the disease progresses to possibly cause severe disability exemption will be  granted      

24) Recto-colite hémorragique et Maladie de Crohn évolutive Ulcerative Colitis   and Crohn's Disease 1) Ulcerative Colitis - Chronic Inflammatory Bowel Disease ( not to be confused with irritable bowel syndrome) affects colon/ rectum but is also a systemic disease so other organs may be affected. Clinical diagnosis +/- endoscopy(sigmoidoscopy) May be mild to very severe requiring hospitalisation and surgery, may require partial or total colectomy ( the latter amounting to a cure)  If disease is widespread it carries a risk of cancer. Exemption depending on severity, initially for 1 year when reassessed. If quiescent and improvement shown on endoscopy  may no longer be exempt even if on continued specific medication. 2) Crohn's Disease - Chronic Inflammatory Bowel Disease,  can affect the entire digestive tract. Also systemic so may affect other parts of the body - esp eyes/ joints. Diagnosis - by clinical, radiology and biopsy. Symptoms are diarrhoea and abdominal pain -  May be strictures (obstructions) in the intestines with abscesses and perforations. Surgery may be required to remove affected lengths of bowel. there is no cure, people experience remissions and "flares". Treatment - treat acute episodes and maintain remissions - surgery - anti inflammatory and immunosuppressive medication. Also carries an increased risk of bowel cancer. All Crohn's disease is exempt unless very mild and not requiring regular treatment nor showing signs of recurring after 2 years. * Although both conditions do carry an increased incidence of bowel cancer - these patients tend to have more frequent investigations than the general population and it is likely that their cancer will be diagnosed and treated early *            

23) Psychose, Trouble grave de la personnalité, Arriérations Mentale. Psychosis, Severe personality disorders, Mental Retardation ( this term is  no longer used  in UK/US and Learning Difficulties, Severe mental impairment - Intellectual and Developmental Disabilities are current terminologies) A huge range of disorders,  not easily classified, with crossing-over between "psychiatric " and "neurological" causes. 1) Psychosis. - Severe mental disorder - derangement of personality and loss of contact with reality. It is really a symptom of other disorders Includes - Schizophrenia, Bipolar disorder,Unipolar disorder( severe clinical depression) Delerium. Initial exemption of 6 months as condition assessed with renewal though some acute psychoses will not be covered. 2) Severe Personality disorders -  Behaviour that deviates markedly from expectations of individual's culture. A very broad range of disorders. e;g Histrionic, obsessional, phobic,anxiety,etc etc. 3) Mental Impairment. This group includes the developmental disabilities manifesting in childhood - cerebral palsy, autism, Down's etc etc and also the dementias occuring in older age group no matter what the cause , e.g Alzheimer's,  Pick's disease, senile dementia. Exemption depends on severity, many minor or transitory problems will not be exempt. Alcohol and drug dependency can produce a number  of neurological - psychological  problems - psychosis - dementia - personality disorder - depression etc * This somewhat oversimplifies a very large and varied group of  disorders       

Gardian Thanks for your support - I am just sorry it is taking much longer than I thought it would !! Psychosis today - !!

22) Polyarthrite Rhumatoide Evolutive Grave Rheumatoid Arthritis - Chronic inflammatory auto-immune disease affecting many of the joints in the body Painful condition causing destruction of the joints and loss of mobilty with increasing disability.Slow onset usually affecting small joints of hands and feet and may progress to larger joints. The inflammatory changes can affect other organs - liver, lungs, heart etc. Diagnosis is made from a list of 7 criteria of which 4 are necessary to confirm. Some have mild symptoms but for the majority of sufferers the disease steadily progresses to substantial functional disability. A number of advances are being made in drug  treatments along with the importance of  rest and physical activity. There are many other chronic arthritic diseases e.g psoriatic arthritis which also have exemption and others still such as Crohn's disease which are listed separately.      

21) Périartérite Noueuse, Lupus Erythémateux Aigue Disséminé, Sclérodermie Généralisée Evolutive. Periarteritis Nodosa,   Systemic Lupus Erythematosus,   Progressive Systemic Scleroderma. Auto-immune Chronic Inflammatory Connective Tissue Diseases 1) Periarteritis Nodosa -Covers a large number of diseases that affect the small arteries -Because many organs may be affected the clinical signs are very varied. It is a serious disorder requiring immuno-suppressives and steroid treatment, a lot will depend on the specific organ damage. * If limited just to skin lesions it may not be exempt 2) Systemic(disseminated) Lupus Erythematosus. A serious disease with a varied presentation affecting many organs of the body- heart, lungs, kidneys, liver, brain, skin and therefore can produce a large range of symptoms   Probably genetic predisposition with environmental triggers. Periods of remission and illness (flares) Treatment is symptomatic and huge advances have been made in the understanding of this disease *Discoid lupus which is mainly confined to skin and Drug Induced Lupus ( many drugs can produce symptoms of lupus) are not exempt* 3) Progressive Systemic Scleroderma -A serious and rare disease causing thickening and tightening of connective tissue. Outcome depends on organs involved e.g severe lung /kidney involvement. The diffuse and CREST types are exempt * Localised scleroderma - usually (but not always ) confined to the skin - rarely develops into the systemic scleroderma and may not be exempt.  

20) Paraplégie Paraplegia. Impairment in nerve function of lower body- loss of ability to move/feel both legs and lower trunk. Multiple causes - Lesions of the peripheral nerves - Spinal cord ( the level of injury is important ).Brain lesions  and congenital disorders Commonest cause is due to trauma   *Whatever the cause exemption is granted when the condition is "disabling" Some situations are reversible in which case the exemption will be removed, others of course may lead to a progressive and permanent disability requiring prolonged care and support.  

19) Néphropathie chronique grave et Syndrome néphrotique pur primitif Chronic Renal (Kidney) Disease - Primary Nephrotic syndrome 1) Chronic Renal Disease - including Glomerulonephritis, Pyelonephritis, Interstitial Nephritis, Hereditary and Congenital Kidney Disease. A progressive loss of renal function. Usual underlying causes are Diabetes - Hypertension - Glomerulonephritis. They are considered severe based on various clinical /biological examinations e;g permanent hypertension problems with metabolism Therapy consists of treating the primary cause -(if possible) and/or treating the secondary  effects in an attempt to slow down the progress which in turn may lead to kidney failure requiring dialysis or transplant. *  chronic renal disease is exempt 2) Primary Nephrotic Syndrome. A disorder of the kidneys whereby they "leak" large amounts of protein into the urine. Treatment consists of supportive measures and immunosuppressives ( steroids) Prognosis - can be mild and with long remissions or lead to renal failure * may be exempt depending on severity  

18) Mucoviscidose Cystic Fibrosis or Mucoviscoidosis. It is an  autosomal recessive inherited  disease of the mucus and sweat glands causing progressive disability.  Can be diagnosed prior to birth  or by a sweat test or genetic testing . Affects pancreas, gastrointestinal tract, liver, lungs  Mucus is thick and sticky allowing recurrent breathing problems and chest infections. Progresses to eventual lung failure. Treatments have improved with life expectancy now in the 30s. Once diagnosis is confirmed  exemption is granted ( diagnosis may not be made in milder cases until adolescence )  

17) Maladies métaboliques héréditaires nécessitant un traitement prolongé spécialisé. Hereditary metabolic diseases requiring long term specialist treatment. This group concerns "monogenic" inherited diseases - i.e where there is only one defective gene, for the disease to be apparent it is usually transmitted as an autosomal recessive ( each parent transmits  a defective gene) This is a large group of rare disorders all relating to disorders of metabolism e.g metabolism of proteins, lipids, haemoglobin, metals, hormones etc etc Exempt but subject to frequent reviews to assess progress      

16) Maladie de Parkinson Parkinson's Disease. A degenerative disorder of the central nervous system comprising  Tremor - Rigidity - Akinesia (slow/absence of movement) and Postural Instability   " TRAP".   Diagnosis based on medical history and neurological examination. 1-2% of people over 65 In mild cases there may be only minor motor disruptions whilst in others there may be severe disability. No cure but effective antiparkinson's medication plus many other regimes ( yoga, tai chi, Alexander lessons, speech therapy etc etc)  Exemption is granted according to the severity of the condition - in mild cases, well controlled on antiparkinson medication  they may be no exemption. In rapidly developing Parkinson's with incapacity, requiring  increasing medication and support,  exemption will be granted.          

Half Way Yipppeeeeee!!!!!!!!!!  

15) Lèpre Leprosy or Hansen's Disease Chronic Infectious disease caused by a bacterium. 2 forms - Paucibacillary and Multibacillary. Enormous progress has been made in the elimination of Leprosy thanks to mutli drug therapy Exempt.

14) Insuffisance repiratoire chronique grave Severe Chronic Respiratory Disease. Many disease processes can result in chronic respiratory disease (diseases of the airways and structures of the lung). Apart from any severe clinical picture there are strict criteria which are to be met to gain exemption. These include  analysis of the oxygen carrying capacity of the blood. Results of Pulmonary ( Lung) Functions Test - spirometry. *e.g Asthma - Must show 1)Permanent clinical evidence of dyspnoea ( difficulty in breathing). 2)Persistent evidence of obstruction even under treatment. and 3) requiring prolonged daily medication ( bronchodilators.) Severe but short-lived episodes e.g following trauma/operations are not included nor are some chronique broncho-pulmonary infections unless they fall into the above criteria.

13) Infarctus du Myocarde datant de moins de 6 mois Myocardial infarction (Heart Attack) dating less than 6 months Exemption if clinical diagnoses is supported by confirmation of tissue necrosis (death) by means of ECH /Echocardiography and enzyme analysis. Exemption is for 6 months from date of infarct and may be renewed once. * Due to the possible effects after a heart attack exemption may be granted because other ALDs come in to play e.g coronary insufficiency and ischaemia. Heart failure etc etc.    

12) Hypertension artérielle sévère Severe (arterial) Hypertension There are strict clinical guidlines for the measurement of blood pressure in order to claim exemption. There have to be 2 out of 3 conditions present 1) Arterial pressure of 180/105 taken at 3 successive consultations with or without other clinical signs 2) Arterial pressure  above 140/90 ( but below 180/105) over several successive consultations WITH associated clinical signs such as abnormalities of an ECG,  ventricular hypertrophy, myocardial ischaemia, retinal haemorrhages etc. 3) Continuous  anti- hypertensive medication at least 2 types for at least 3 months *exemption can be renewed over the course of the disease.      

10) Hémoglobinopathie homozygote Homozygotic Haemoglobinopathies Range of genetically inherited disorders of Haemoglobin Thalassaemia and Sickle Cell Anaemia The pattern of inheritance determines the severity of the condition - If one normal "gene" and one defective "gene" are inherited the result can be benign - if two defective "genes" are inherited (homozygotic) then the disease will be severe and gain exemption.   11) Hémophilie Haemophilia -Genetically inherited disorder of blood coagulation Several types depending on which of the factors necessary for clotting are affected. Sex-linked so females carry the disease and males are affected. Some spontaneous haemophilias can occur. Also included are some other diseases of clotting mechanism e.g Von Willebrands disease *These are all exempt.  

9) Forme grave d'une affection neuromusculaire (dont Myopathie) Severe neuromuscular disorders ( including myopathies) A somewhat disparate group 1) Primary muscular disorders - myopathies - particularly the muscular dystrophies 2) Myaesthenias 3) Peripheral Nervous System diseases -   Polyneuritis, Multiple neuritis, degenerative neuropathies and a number of specific syndromes. 4) Neurodegenerative diseases - e.g Amyotrophic lateral sclerosis, Syringomyelia 5) Hereditary Ataxias - conditions causing progressive loss of coordination, speech etc e.g Friedreich's Ataxia 6) Severe Epilepsy - exemption depending on criteria such as - number/frequency of seizures, whether controlled by one or more medications and how the ability to -work/drive/ participate in sports and everyday living may be affected. *A very large group of disorders with symptoms ranging from mild to severe, exemption is given accordingly.    

8) Diabète insulo-dépendant ou non-insulo-dépendant ne pouvant être équilibré par le seul régime Insulin Dependent Diabetes Type 1 - Non Insulin Dependent Diabetes Type 2 They are now simply referred to as Type 1 and Type 2 diabetes ( also in France) Type 1 Diabetes - usually  diagnosed in childhood and adolescence occurs because the pancreas is producing too little or no insulin. Accounts for approx 10% of diabetes Type 2 Diabetes - usually diagnosed after the age of 40 ( although seen now in younger age groups) and more common in overweight people. Insulin may still be produced but the cells become resistant to its effect. Accounts for approx 90% of diabetes. The initial treatment for Type 2 is to follow a diet (weight loss) and exercise as this can stabilize sugar levels, exemption may not therefore be granted during this early stage of the disease. Type 1 and established Type 2 both have exemption and due to the large range of other conditions that may arise secondary to the diabetes (eyes /blood vessels /neurological problems /increased incidence of infections etc) these treatments  may also be exempt. Some other conditions may lead to diabetes (Secondary Diabetes) e.g pancreatic disease / Endocrine disorders/ Steroid medication etc. This will also gain exemption.                      

7) Déficit immunitaire primitif grave nécessitant un traitement prolongé et infection par le virus de l'immuno-déficience humaine Primary Immunodeficiency disorders requiring prolonged treament and Infection with Human Immuno-Deficiency Virus (HIV) 1) Primary Immunodeficiency disorders are usually genetic so often diagnosed at an early age. Part of the immune system is lacking or not functioning correctly. Infections occur early, as may auto-immune diseases ( where the immune system attacks the body's own tissues.) There is a vast range of very well documented disorders from severe to mild requiring a wide range of treatment from stem cell transplant to antibiotics. * Much progress has been made in the treament of these disorders - exemption may be given, renewable at 2 yearly intervals depending on progress. * Some "minor" disorders do not seem to attract any exemption 2) Infection with Human Immuno-deficiency Virus HIV Infection. Exemption is granted following seropositive diagnosis. Exemption is also given for 2 years to a child born to a seropositive mother. May of course lead to Acquired Immunodeficiency Syndrome - AIDS,  if one or more  - from a list of 20 or so specific pathologies is also present.  

6) Maladies chroniques actives du foie et cirrhoses Chronic Active Liver Disease and Cirrhosis Chronic active liver disease - serious disorder that may progress to Cirrhosis Causes - excessive alcohol intake, infection with Viruses - Hepatitis B / Hepatitis C, certain metabolic disorders ( e.g Wilson's Disease) Biliary cirrhosis. Genetic disorders. "chronic" refers to a duration of 6 months of persistant abnormal biological findings. Cirrhosis - Replacement of liver tissue by scar tissue leading to progressive loss of liver function ( generally irreversible) Those conditions  likely to cause "portal hypertension" ( raised blood pressure in the liver veins) and/or liver failure and requiring long term treatment are exempt! * there are pages and pages on liver diseases - but the chronic ones including cirrhosis all seem to be exempt.       

Ah Bless   Not going to be 8 years old next week by any chance???

5) Cardiopathie congénitale mal tolérée , insuffisance cardiaque grave et valvulopathie grave Congenital Heart Disease, Severe Cardiac Insufficiency or Heart Failure, Severe Heart Valve defects 1) Congenital Heart Disease - Structural defects of the heart and heart related blood vessels ( aorta, pulmonary artery) causing a malfunction of the heart. There are those that cause "cyanosis" i.e "blue" colour because the defect allows deoxygenated blood to pass round the body. They are diagnosed in infancy and are all exempt. *"Hole in the heart" all ventricular defects are exempt. *Some mild atrial defects either surgically corrected or not, as long as no residual problems exist are NOT exempt. *Mild Pulmonary stenoses  are NOT exempt It seems in general if the defect causes symptoms it will be exempt 2) Severe Cardiac Insufficiency - Heart failure - The "severity" of the condition relies on  a classification by the New York Heart Association, taking into account response to physical exercise,breathlessness,palpitations and this decides whether there is exemption or not. If the signs of heart failure diminish no longer requiring medication or strict surveillance then it is no longer exempt. 3) Severe Heart Valve Defects - All heart valve defects carry an exemption - UNLESS in the mild cases where physical exertion does not provoke tiredness, palpitations or dyspnoea ( problems with breathing) this type of lesion may be seen on an ultrasound examination. All patients having surgical treatment of their heart valves are exempt, including any treatment for prophylaxis against infection and any anticoagulant therapy.      

[quote user="cooperlola"]This is great, Nickel.  Can we nick it for the site when you've done?... [Www][/quote]   If I ever get there --- 4 down 26 to go !!!