Channel function reconstitution and re-animation: a single-channel strategy in the postcrystal age

PubMed Central

Oiki, Shigetoshi

2015-01-01

The most essential properties of ion channels for their physiologically relevant functions are ion-selective permeation and gating. Among the channel species, the potassium channel is primordial and the most ubiquitous in the biological world, and knowledge of this channel underlies the understanding of features of other ion channels. The strategy applied to studying channels changed dramatically after the crystal structure of the potassium channel was resolved. Given the abundant structural information available, we exploited the bacterial KcsA potassium channel as a simple model channel. In the postcrystal age, there are two effective frameworks with which to decipher the functional codes present in the channel structure, namely reconstitution and re-animation. Complex channel proteins are decomposed into essential functional components, and well-examined parts are rebuilt for integrating channel function in the membrane (reconstitution). Permeation and gating are dynamic operations, and one imagines the active channel by breathing life into the ‘frozen’ crystal (re-animation). Capturing the motion of channels at the single-molecule level is necessary to characterize the behaviour of functioning channels. Advanced techniques, including diffracted X-ray tracking, lipid bilayer methods and high-speed atomic force microscopy, have been used. Here, I present dynamic pictures of the KcsA potassium channel from the submolecular conformational changes to the supramolecular collective behaviour of channels in the membrane. These results form an integrated picture of the active channel and offer insights into the processes underlying the physiological function of the channel in the cell membrane. PMID:25833254

Channel function reconstitution and re-animation: a single-channel strategy in the postcrystal age.

PubMed

Oiki, Shigetoshi

2015-06-15

The most essential properties of ion channels for their physiologically relevant functions are ion-selective permeation and gating. Among the channel species, the potassium channel is primordial and the most ubiquitous in the biological world, and knowledge of this channel underlies the understanding of features of other ion channels. The strategy applied to studying channels changed dramatically after the crystal structure of the potassium channel was resolved. Given the abundant structural information available, we exploited the bacterial KcsA potassium channel as a simple model channel. In the postcrystal age, there are two effective frameworks with which to decipher the functional codes present in the channel structure, namely reconstitution and re-animation. Complex channel proteins are decomposed into essential functional components, and well-examined parts are rebuilt for integrating channel function in the membrane (reconstitution). Permeation and gating are dynamic operations, and one imagines the active channel by breathing life into the 'frozen' crystal (re-animation). Capturing the motion of channels at the single-molecule level is necessary to characterize the behaviour of functioning channels. Advanced techniques, including diffracted X-ray tracking, lipid bilayer methods and high-speed atomic force microscopy, have been used. Here, I present dynamic pictures of the KcsA potassium channel from the submolecular conformational changes to the supramolecular collective behaviour of channels in the membrane. These results form an integrated picture of the active channel and offer insights into the processes underlying the physiological function of the channel in the cell membrane. © 2015 The Authors. The Journal of Physiology © 2015 The Physiological Society.

Dextroamphetamine (but Not Atomoxetine) Induces Reanimation from General Anesthesia: Implications for the Roles of Dopamine and Norepinephrine in Active Emergence

PubMed Central

Kenny, Jonathan D.; Taylor, Norman E.; Brown, Emery N.; Solt, Ken

2015-01-01

Methylphenidate induces reanimation (active emergence) from general anesthesia in rodents, and recent evidence suggests that dopaminergic neurotransmission is important in producing this effect. Dextroamphetamine causes the direct release of dopamine and norepinephrine, whereas atomoxetine is a selective reuptake inhibitor for norepinephrine. Like methylphenidate, both drugs are prescribed to treat Attention Deficit Hyperactivity Disorder. In this study, we tested the efficacy of dextroamphetamine and atomoxetine for inducing reanimation from general anesthesia in rats. Emergence from general anesthesia was defined by return of righting. During continuous sevoflurane anesthesia, dextroamphetamine dose-dependently induced behavioral arousal and restored righting, but atomoxetine did not (n = 6 each). When the D1 dopamine receptor antagonist SCH-23390 was administered prior to dextroamphetamine under the same conditions, righting was not restored (n = 6). After a single dose of propofol (8 mg/kg IV), the mean emergence times for rats that received normal saline (vehicle) and dextroamphetamine (1 mg/kg IV) were 641 sec and 404 sec, respectively (n = 8 each). The difference was statistically significant. Although atomoxetine reduced mean emergence time to 566 sec (n = 8), this decrease was not statistically significant. Spectral analysis of electroencephalogram recordings revealed that dextroamphetamine and atomoxetine both induced a shift in peak power from δ (0.1–4 Hz) to θ (4–8 Hz) during continuous sevoflurane general anesthesia, which was not observed when animals were pre-treated with SCH-23390. In summary, dextroamphetamine induces reanimation from general anesthesia in rodents, but atomoxetine does not induce an arousal response under the same experimental conditions. This supports the hypothesis that dopaminergic stimulation during general anesthesia produces a robust behavioral arousal response. In contrast, selective noradrenergic stimulation causes

Dextroamphetamine (but Not Atomoxetine) Induces Reanimation from General Anesthesia: Implications for the Roles of Dopamine and Norepinephrine in Active Emergence.

PubMed

Kenny, Jonathan D; Taylor, Norman E; Brown, Emery N; Solt, Ken

2015-01-01

Methylphenidate induces reanimation (active emergence) from general anesthesia in rodents, and recent evidence suggests that dopaminergic neurotransmission is important in producing this effect. Dextroamphetamine causes the direct release of dopamine and norepinephrine, whereas atomoxetine is a selective reuptake inhibitor for norepinephrine. Like methylphenidate, both drugs are prescribed to treat Attention Deficit Hyperactivity Disorder. In this study, we tested the efficacy of dextroamphetamine and atomoxetine for inducing reanimation from general anesthesia in rats. Emergence from general anesthesia was defined by return of righting. During continuous sevoflurane anesthesia, dextroamphetamine dose-dependently induced behavioral arousal and restored righting, but atomoxetine did not (n = 6 each). When the D1 dopamine receptor antagonist SCH-23390 was administered prior to dextroamphetamine under the same conditions, righting was not restored (n = 6). After a single dose of propofol (8 mg/kg i.v.), the mean emergence times for rats that received normal saline (vehicle) and dextroamphetamine (1 mg/kg i.v.) were 641 sec and 404 sec, respectively (n = 8 each). The difference was statistically significant. Although atomoxetine reduced mean emergence time to 566 sec (n = 8), this decrease was not statistically significant. Spectral analysis of electroencephalogram recordings revealed that dextroamphetamine and atomoxetine both induced a shift in peak power from δ (0.1-4 Hz) to θ (4-8 Hz) during continuous sevoflurane general anesthesia, which was not observed when animals were pre-treated with SCH-23390. In summary, dextroamphetamine induces reanimation from general anesthesia in rodents, but atomoxetine does not induce an arousal response under the same experimental conditions. This supports the hypothesis that dopaminergic stimulation during general anesthesia produces a robust behavioral arousal response. In contrast, selective noradrenergic stimulation causes

A Rodent Model of Dynamic Facial Reanimation Using Functional Electrical Stimulation

PubMed Central

Attiah, Mark A.; de Vries, Julius; Richardson, Andrew G.; Lucas, Timothy H.

2017-01-01

Facial paralysis can be a devastating condition, causing disfiguring facial droop, slurred speech, eye dryness, scarring and blindness. This study investigated the utility of closed-loop functional electric stimulation (FES) for reanimating paralyzed facial muscles in a quantitative rodent model. The right buccal and marginal mandibular branches of the rat facial nerve were transected for selective, unilateral paralysis of whisker muscles. Microwire electrodes were implanted bilaterally into the facial musculature for FES and electromyographic (EMG) recording. With the rats awake and head-fixed, whisker trajectories were tracked bilaterally with optical micrometers. First, the relationship between EMG and volitional whisker movement was quantified on the intact side of the face. Second, the effect of FES on whisker trajectories was quantified on the paralyzed side. Third, closed-loop experiments were performed in which the EMG signal on the intact side triggered FES on the paralyzed side to restore symmetric whisking. The results demonstrate a novel in vivo platform for developing control strategies for neuromuscular facial prostheses. PMID:28424583

[Taxonomic characteristics and mixed communities of wound infection agents in patients of reanimation and surgical departments of a hospital].

PubMed

Men'shikova, E D; Kiselevskaia-Babinina, I V; Men'shikov, D D; Godkov, M A

2012-01-01

Study of taxonomical structure ofwound infection agents, prevalence of mixes, and detection of character of their possible connection with the results of various microorganisms population interaction in septic wounds. A microbiological study of material from patients with wound infection (WI), 582 of those were cured in reanimation and intensive therapy departments (RITD; group 1) and 1455 - in surgical departments (SD; group 2), was performed. Taxonomic membership and ability to coexist was determined in 4129 microorganisms strains. Etiological role of the agents was evaluated by using values of consistency rate (CR). Species that were present in more than 50% of samples were considered consistent, in 25 to 50%--additional, and in less than 25%--random. Frequency rates (FR) were also determined, that is the fraction of a certain species (genus) of the microorganism (in %) from all the isolated cultures that correspond to 100%. For the determination of the significance of individual species of the agent in the structure of mixed microorganism populations, FR - their fraction (%) in mixed population from the number of strains of this species that correspond to 100% - was calculated. A significant part of the microorganisms strains, more frequently in reanimation department (65.5%), caused wound suppuration in populations mixed with other species of the agents. In reanimation and surgical departments consistent species of wound infection agents were not detected. A leading etiological role of Staphylococcus aureus (FR 19.2% and 23.9%) was determined, and FR of S. aureus strains in mixes was 64.6% in RITD and 46.8% in SD. The parameters ofotheragents of WI in the comparison groups were similar. However FR among mixes in RITD were significantly higher for streptococci that do not belong to S. pyogenes species (72,5%), and also nonfermentative microorganisms (67,2%), and in SD - in Klebsiella pneumoniae mixes. For agents of wound infection especially in RITD, low

Pratique de l’électroconvulsivothérapie dans un hôpital universitaire Tunisien

PubMed Central

Mechri, Anwar; Zaafrane, Hana; Khalifa, Monia Hadj; Toumi, Samir; Zaafrane, Férid; Gaha, Lotfi

2018-01-01

Les objectifs de cette étude étaient de décrire les modalités pratiques de l’électroconvulsivothérapie (ECT) à l’hôpital universitaire de Monastir (Tunisie). Il s'agit d'une étude rétrospective portant sur tous les patients traités par ECT à l’hôpital universitaire de Monastir entre 2002 et 2013. Le nombre des patients était de 80 patients (60 hommes et 20 femmes, d’âge moyen de 42,1±15,7 ans), représentant 1,4% de l’ensemble des patients hospitalisés en psychiatrie durant la période d’étude. Le nombre total des séances d’ECT était de 784. Le diagnostic principal était le trouble dépressif majeur isolé ou récurrent chez 50% des patients. La majorité des patients (78,8%) avait reçu une seule cure d’ECT avec un nombre moyen de séances de 8,1 ± 4,9. Le produit anesthésique le plus utilisé était le propofol (97,4%). L’énergie délivrée était comprise entre 40 et 80 joules dans 71% des cas et elle était positivement corrélée à l’âge des patients. La durée moyenne de la crise motrice était de 22,3 ± 7,2 secondes et elle était négativement corrélée à l’âge des patients. Le taux de réponse le plus élevé a été constaté au niveau des scores de dépression (64,3%). Des effets indésirables immédiats ont été mentionnés chez 51,2% des patients. Enfin, 20% des patients poursuivaient des séances d’ECT d’entretien avec un rythme uni ou bimensuel. La pratique de l’ECT à l’hôpital universitaire de Monastir reste peu développée en termes de nombre des patients et des séances d’ECT. Des efforts doivent être déployés pour promouvoir l’utilisation de cette méthode. PMID:29632628

Occurrence des traumatismes alvéolo-dentaires aux cliniques universitaires de Kinshasa: deuxième partie, étude préliminaire de 93 cas

PubMed Central

Foche, Adelin Nzudjom; Bushabu, Fidele Nyimi; Mana, Charles Mfutu; Haruna, Ramazani; Masin, Steve Sekele; Nsudila, Monique; Alifi, Paul Bobe; Muinamiyi, Pierre Muyembi; Burley, Jean Paul Sekele Isourady

2018-01-01

Introduction L'objectif de cette étude était d'analyser les caractéristiques épidémiologiques cliniques des fractures alvéolo-dentaires aux cliniques universitaires de Kinshasa/RDC. Méthodes Étude transversale de 7 ans, réalisée dans le département d'odontostomatologie, service de stomatologie et de chirurgie maxillo-faciale/cliniques universitaires de Kinshasa de Janvier 2007 à Décembre 2014. Résultats Sur les 93 dossiers colligés, le sexe masculin était prédominant (66,7%) et l'âge le plus prévalent se situait entre 20 ans et 29 ans. Les causes les plus fréquentes ont été les agressions/rixes (52,7%) et la luxation dentaire a été le type des lésions la plus fréquente avec 52,7%. La RX retro-alvéolaire été réalisée dans 75,7%, et le blocage mono-maxillaire fut le type de traitement le plus réalisé (60,2%). Conclusion L'analyse de profil clinique des traumatismes alvéolo-dentaires aux cliniques universitaires de Kinshasa est celui d'un adulte jeune de sexe masculin, présentant des luxations dentaires des maxillaires dont les causes sont les agressions/rixes. PMID:29875931

The split hypoglossal nerve versus the cross-face nerve graft to supply the free functional muscle transfer for facial reanimation: A comparative study.

PubMed

Amer, Tarek A; El Kholy, Mohamed S

2018-05-01

Long-standing cases of facial paralysis are currently treated with free functional muscle transfer. Several nerves are mentioned in the literature to supply the free muscle transfer. The aim of this study is to compare the split hypoglossal nerve and the cross-face nerve graft to supply the free functional muscle transfer in facial reanimation. Of 94 patients with long-standing, unilateral facial palsy, 49 were treated using the latissimus dorsi muscle supplied by the split hypoglossal nerve, and 45 patients were treated using the latissmus dorsi muscle supplied by healthy contralateral buccal branch of the facial nerve. The excursion gained by the free muscle transfer supplied by the split hypoglossal nerve (mean 19.20 ± 6.321) was significantly higher (P value 0.001) than that obtained by the contralateral buccal branch of the facial nerve (mean 14.59 ± 6.245). The split hypoglossal nerve appears to be a good possible option to supply the free vascularised muscle transfer in facial reanimation. It yields a stronger excursion in less time than the contralateral cross-face nerve graft. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Lengthening temporalis myoplasty: a surgical tool for dynamic labial commissure reanimation.

PubMed

Guerreschi, Pierre; Labbe, Daniel

2015-04-01

Lengthening temporalis myoplasty (LTM), first described by Labbé in 1997, ensures the transfers of the entire temporal muscle from the coronoid process to the upper half of the lip without interposition of aponeurotic tissue. The temporal muscle changes function because it is entirely mobilized toward another effector: the labial commissure. Thanks to brain plasticity, the muscle loses its chewing function, and after 6 months of speech rehabilitation it acquires its new smiling function. We describe technical points especially the coronoid process approaches both through an upper temporal fossa approach and a lower nasolabial fold approach. Rehabilitation starts 3 weeks after the surgery following a standardized protocol to move from a mandibular smile to a voluntary, then spontaneous, smile in three steps. The LTM is the main part of a one-stage global treatment of the paralyzed face. It constitutes a dynamic palliative treatment usually started at the sequelae stage, 18 month after the outcome of a peripheral facial paralysis. This one-stage procedure is a reproducible and relevant surgical technique in the difficult treatment of peripheral facial paralysis. It allows implementing an active muscle transfer to reanimate the labial commissure and re-create a mobile nasolabial fold. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Race, embodiment and later life: Re-animating aging bodies of color.

PubMed

Rajan-Rankin, Sweta

2018-06-01

This theoretical essay examines the intersections between race, ethnicity and old age from an inter-disciplinary lens. Drawing on cultural gerontology (especially embodied aging studies) and post-colonial perspectives on aging, it explores how an emphasis on the body and embodiment can serve as a conceptual lens for understanding racialized aging bodies. A tentative framework for analysis is proposed. The concept of exile explores how bodies of color and older bodies are denigrated through the hegemonic (white, youth-centered, masculinist) gaze. Re-animation can take place by transcending double-consciousness: 'seeing beyond' the dominant gaze. Othering and otherness are explored in relation to both raced and aging bodies. The limits of ethnic aging are scrutinized at an epistemic level, simultaneously informing, and obscuring the understanding of lived experiences of racialized ethnic minorities in old age. Visible and invisible difference provide a way of unpacking the simultaneous hypervisibility of older (female) bodies of color, and their invisibility in institutional and policy discourses. De-coloniality is considered, by exploring ways to resist hegemonic power through embodied ways of knowing. This article concludes by exploring how recent methodological innovations - especially the visual and sensory turn - can offer new ways of understanding the lived experiences of aging bodies of color. Copyright © 2018 The Author. Published by Elsevier Inc. All rights reserved.

Intraoperative muscle electrical stimulation for accurate positioning of the temporalis muscle tendon during dynamic, one-stage lengthening temporalis myoplasty for facial and lip reanimation.

PubMed

Har-Shai, Yaron; Gil, Tamir; Metanes, Issa; Labbé, Daniel

2010-07-01

Facial paralysis is a significant functional and aesthetic handicap. Facial reanimation is performed either by two-stage microsurgical methods or by regional one-stage muscle pedicle flaps. Labbé has modified and improved the regional muscle pedicle transfer flaps for facial reanimation (i.e., the lengthening temporalis myoplasty procedure). This true myoplasty technique is capable of producing a coordinated, spontaneous, and symmetrical smile. An intraoperative electrical stimulation of the temporal muscle is proposed to simulate the smile of the paralyzed side on the surgical table. The intraoperative electrical stimulation of the temporalis muscle, employing direct percutaneous electrode needles or transcutaneous electrical stimulation electrodes, was utilized in 11 primary and four secondary cases with complete facial palsy. The duration of the facial paralysis was up to 12 years. Postoperative follow-up ranged from 3 to 12 months. The insertion points of the temporalis muscle tendon to the nasolabial fold, upper lip, and oral commissure had been changed according to the intraoperative muscle stimulation in six patients of the 11 primary cases (55 percent) and in all four secondary (revisional) cases. A coordinated, spontaneous, and symmetrical smile was achieved in all patients by 3 months after surgery by employing speech therapy and biofeedback. This adjunct intraoperative refinement provides crucial feedback for the surgeon in both primary and secondary facial palsy cases regarding the vector of action of the temporalis muscle and the accuracy of the anchoring points of its tendon, thus enhancing a more coordinated and symmetrical smile.

[Proven and innovative operative techniques for reanimation of the paralyzed face].

PubMed

Frey, M; Michaelidou, M; Tzou, C-H J; Hold, A; Pona, I; Placheta, E

2010-04-01

This overview on the currently most effective reconstructive techniques for reanimation of the unilaterally or bilaterally paralysed face includes all important techniques of neuromuscular reconstruction as well as of supplementary static procedures, which contribute significantly to the efficiency and quality of the functional overall result. Attention is paid to the best indications at the best time since onset of the facial palsy, depending on the age of the patient, the cause of the lesion, and the compliance of the patient for a long-lasting and complex rehabilitation programme. Immediate neuromuscular reconstruction of mimic function is favourable by nerve suture or nerve grafting of the facial nerve, or by using the contralateral healthy facial nerve via cross-face nerve grafting as long as the time since onset of the irreversible palsy is short enough that the paralysed mimic muscles can still be reinnervated. For the most frequent indication, the unilateral irreversible and complete palsy, a three-stage concept is described including cross-face nerve grafting, free functional gracilis muscle transplantation, and several supplementary procedures. In patients with limited life expectancy, transposition of the masseteric muscles is favoured. Bilateral facial palsy is treated by bilateral free gracilis muscle transplantation with the masseteric nerve branches for motor reinnervation. Functional upgrading in incomplete lesions is achieved by cross-face nerve grafting with distal end-to-side neurorrhaphy or by functional muscle transplantation with ipsilateral facial nerve supply. (c) Georg Thieme Verlag KG Stuttgart-New York.

Issue des accouchements sur utérus cicatriciel dans un hôpital universitaire au Burkina

PubMed Central

Dembélé, Adama; Tarnagda, Zekiba; Ouédraogo, Jean Louis; Thiombiano, Oumarou; Bambara, Moussa

2012-01-01

Certains auteurs ont tendance à privilégier la césarienne comme méthode de prise en charge d'une parturiente porteuse d'un utérus cicatriciel. D'autres auteurs préconisent un accouchement par voie basse quand des paramètres cliniques précis sont observés. Le but de cette étude est d'analyser la prise en charge et l'issue des accouchements sur utérus cicatriciel au Centre Hospitalier Universitaire Souro Sanou de Bobo-Dioulasso et de la comparer aux différentes approches recommandées. Nous avons menés une étude transversale dans le Département de Gynécologie d'Obstétrique et de Médecine de la Reproduction du Centre Hospitalier Universitaire Sanou Souro de Bobo Dioulasso du 1er août 2006 au 1er août 2007 et a concerné 252 parturientes ayant un utérus cicatriciel parmi 4256 accouchements déroulés pendant la même période. Les accouchements sur utérus cicatriciels ont représenté 5,92 % de l'ensemble des accouchements dans notre département. La moyenne d'âge des patientes était de 26,2 ans et la parité moyenne de 4,3. Une césarienne d'emblée a été pratiquée chez 44% des parturientes ayant un utérus cicatriciel et 56 % parmi elles ont fait l'objet d'une épreuve utérine. Sur l'ensemble des épreuves utérines, 61% des parturientes ont accouché par voie basse. La mortalité maternelle était nulle et La mortalité périnatale était relativement importante. Les conditions d'acceptabilité de la voie basse ont été les mêmes chez toutes les patientes et un check liste a été proposé pour une meilleure prise en charge. L'épreuve utérine en salle d'accouchement doit être la règle à chaque fois que cela est possible chez une parturiente porteuse d'utérus cicatriciel. L’établissement d'un check liste pour accouchement par voie basse sur utérus cicatriciel facilite les prises de décision. PMID:23133695

Epithéliomas basocellulaires de la face: prise en charge chirurgicale, à propos de 45 cas et revue de la literature

PubMed Central

Ennouhi, Mohamed Amine; Moussaoui, Abdenacer

2014-01-01

L’épithélioma basocellulaire est de loin la tumeur épithéliale maligne la plus répandue. L'atteinte faciale représente plus de 65% des cas et constitue un facteur de risque de récidive. L'objectif de notre travail est de rappeler les principes et modalités du traitement chirurgical. Sur une période de douze mois, nous avons pris en charge quarante-cinq patients atteints de carcinomes basocellulaires de la face. Le traitement chirurgical comprend deux volets: -carcinologique: emportant la tumeur et une marge de tissu sain; -et une chirurgie réparatrice faisant appel à la suture cutanée directe; greffes ou lambeaux loco -régionaux. L'examen histologique systématique des pièces opératoires permet la confirmation du diagnostic, le typage histologique et l'appréciation de la qualité de l'exérèse chirurgicale. Les résultats esthétiques sont jugés satisfaisants. Quant aux résultats carcinologiques, nous déplorons quatre récidives. Le traitement chirurgical des épithéliomas basocellulaires est le seul garant de la guérison. Au niveau de la face, il faut trouver le meilleur compromis entre impératifs carcinologiques et esthétiques. L'amélioration des résultats passe par: la prévention, le dépistage précoce des lésions, la collaboration étroite des anatomo-pathologistes et la création de comités de concertation pluri -disciplinaire pour la prise en charge des cas difficiles. PMID:25709738

PreSSUB II: The prehospital stroke study at the Universitair Ziekenhuis Brussel II

PubMed Central

Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; De Keyser, Jacques; Dupont, Alain; De Wit, Liesbet; Putman, Koen; Brouns, Raf

2015-01-01

Rationale Stroke is a time-critical medical emergency requiring specialized treatment. Prehospital delay contributes significantly to delayed or missed treatment opportunities. In-ambulance telemedicine can bring stroke expertise to the prehospital arena and facilitate this complex diagnostic and therapeutic process. Aims This study evaluates the efficacy, safety, feasibility, reliability and cost-effectiveness of in-ambulance telemedicine for patients with suspicion of acute stroke. We hypothesize that this approach will reduce the delay to in-hospital treatment by streamlining the diagnostic process and that prehospital stroke care will be improved by expert stroke support via telemedicine during the ambulance transportation. Design PreSSUB II is an interventional, prospective, randomized, open-blinded, end-point, single-center trial comparing standard emergency care by the Paramedic Intervention Team of the Universitair Ziekenhuis Brussel (control) with standard emergency care complemented with in-ambulance teleconsultation service by stroke experts (PreSSUB). Study Outcomes The primary efficacy endpoint is the call-to-brain imaging time. Secondary endpoints for the efficacy analysis include the prevalence of medical events diagnosed and corrected during in-ambulance teleconsultation, the proportion of patients with ischemic stroke receiving recanalization therapy, the assessment of disability, functional status, quality of life and overall well-being. Mortality at 90 days after stroke is the primary safety endpoint. Secondary safety analysis will involve the registration of any adverse event. Other analyses include assessment of feasibility and reliability and a health economic evaluation. PMID:27847888

Use of Gastrointestinal Anastomosis Stapler for Harvest of Gracilis Muscle and Securing It in the Face for Facial Reanimation: A Novel Technique

PubMed Central

Shridharani, Sachin M.; Stapleton, Sahael M.; Redett, Richard J.; Magarakis, Michael; Rosson, Gedge D.

2010-01-01

Background: The primary objective of this study is to report a novel technique that uses the gastrointestinal anastomosis (GIA) stapler for harvesting and securing the gracilis muscle in facial reanimation surgery. Methods: We conducted a retrospective chart review with 18 consecutive patients who underwent gracilis muscle flap transfer with or without the use of a GIA stapler. Results: Of 11 operations with the GIA stapler, one patient developed a hematoma (donor site) and another required drainage of an abscess (recipient site). Of 8 operations without the use of the stapler, one patient had total flap failure and three required drainage of an abscess (2 recipient sites and 1 donor site). These differences trended toward improvement but were not statistically different. Conclusions: The use of the GIA stapler is a fast, safe technique. Larger studies are, however, warranted to further examine this novel approach in order to test precisely what factors of increased efficiency occur, the amount of suture pull-through, and overall tension capable of being applied to the secured staple line. PMID:20396379

Épidémiologie descriptive de la carcinose péritonéale d’origine digestive à l’Hôpital Universitaire Ibn Rochd de Casablanca (2008-2010)

PubMed Central

Benlahfid, Mohammed; Erguibi, Driss; Elhattabi, Khalid; Bensardi, Fatimazahra; Khaiz, Driss; Lafriekh, Rachid; Rebroub, Dounia; Fadil, Abdelaziz; Aboussaouira, Touria

2017-01-01

Introduction La carcinose péritonéale est une diffusion inéluctablement terminale chez les patients atteints de cancers abdominaux. C'est le signe d'une maladie avancée ou d'une ré-évolution le plus souvent associée à un pronostic sombre. Environ deux tiers de l'ensemble des carcinoses péritonéales sont d'origine digestive et un tiers d'origine non digestive. Méthodes Il s'agit d'une étude rétrospective descriptive menée entre janvier 2008 et décembre 2010, dans le but de dresser le profil épidémiologique et les facteurs de risques de la carcinose péritonéale d'origine digestive au Centre Hospitalier Universitaire de Casablanca. Résultats Quarante-sept cas de carcinose péritonéale d'origine digestive ont été recensées (22 femmes, 25 hommes) ce qui représente une prévalence de 6.19% et un nombre moyen de 15.6 cas par an. L'âge était le facteur de risque essentiel dans notre série avec un âge moyen de 55.55 ans ±12.32. Les antécédents familiaux présentaient aussi un facteur de risque à prendre en considération. Conclusion A travers notre étude, nous avons conclus que les principaux facteurs de risque de la carcinose péritonéale d'origine digestive au Centre Hospitalier Universitaire Ibn Rochd Casablanca, sont l'âge et les antécédents familiaux. PMID:28979636

Drying bacterial biosaline patterns capable of vital reanimation upon rehydration: novel hibernating biomineralogical life formations.

PubMed

Gómez Gómez, José María; Medina, Jesús; Hochberg, David; Mateo-Martí, Eva; Martínez-Frías, Jesús; Rull, Fernando

2014-07-01

Water is the fundamental molecule for life on Earth. Thus, the search for hibernating life-forms in waterless environments is an important research topic for astrobiology. To date, however, the organizational patterns containing microbial life in extremely dry places, such as the deserts of Earth, the Dry Valleys of Antarctica, or Mars analog regolith, have been poorly characterized. Here, we report on the formation of bacterial biosaline self-organized drying patterns formed over plastic surfaces. These emerge during the evaporation of sessile droplets of aqueous NaCl salt 0.15 M solutions containing Escherichia coli cells. In the present study, scanning electron microscopy (SEM) and energy dispersive X-ray spectrometry (EDS) analyses indicated that the bacterial cells and the NaCl in these biosaline formations are organized in a two-layered characteristic 3-D architectural morphology. A thin filmlike top layer formed by NaCl conjugated to, and intermingled with, "mineralized" bacterial cells covers a bottom layer constructed by the bulk of the nonmineralized bacterial cells; both layers have the same morphological pattern. In addition, optical microscopic time-lapsed movies show that the formation of these patterns is a kinetically fast process that requires the coupled interaction between the salt and the bacterial cells. Apparently, this mutual interaction drives the generative process of self-assembly that underlies the drying pattern formation. Most notably, the bacterial cells inside these drying self-assembled patterns enter into a quiescent suspended anhydrobiotic state resistant to complete desiccation and capable of vital reanimation upon rehydration. We propose that these E. coli biosaline drying patterns represent an excellent experimental model for understanding different aspects of anhydrobiosis phenomena in bacteria as well as for revealing the mechanisms of bacterially induced biomineralization, both highly relevant topics for the search of life in

Sequelles de Brulures au Centre Hospitalier Universitaire Ibn Rochd de Casablanca: Aspects Epidemio-Cliniques

PubMed Central

Chafiki, N.; Fassi Fihri, J.; Boukind, E.H.

2007-01-01

Summary Il s'agit d'une étude épidémiologique des séquelles de brûlures à propos de 100 cas colligés au service de chirurgie réparatrice et de brûlés du centre hospitalier universitaire Ibn Rochd (Casablanca). Les adultes représentent 55% de la population étudiée, l'âge moyen global est de 20 ans. Le sexe féminin est le plus touché avec 61% des cas. Les brûlures survenues à domicile sont les plus fréquentes avec 80%. L'agent causal le plus incriminé est la petite bouteille de butane avec 44,4%. Plus de la moitié de la population brûlée (55%) sont accueillis initialement au niveau d'hôpitaux régionaux. Le délai de cicatrisation moyen de 7 mois et 11 jours et par conséquent les séquelles mineures (dyschromie dans 90% des cas et prurit dans 49% des cas) et majeures (rétractions dans 86% et l'hypertrophie dans 51%) sont fréquentes. La répartition globale des séquelles montre une prédominance du segment cervicocéphalique avec 89% des cas et des membres supérieurs dans 82% des cas. Les différents aspects anatomocliniques essentiels ont été décrits au niveau de chaque segment corporel. Nos résultats ont été comparés aux données de la littérature, ce qui nous amène à considérer qu'une large campagne de prévention couplée à une meilleure prise en charge initiale, précoce, bien conduite et multidisciplinaire permet non seulement de réduire le nombre de séquelles mais aussi de diminuer leur sévérité. PMID:21991060

Eyelid reanimation with gold weight implant and tendon sling suspension: evaluation of excursion and velocity using the FACIAL CLIMA system.

PubMed

Hontanilla, Bernardo; Marre, Diego

2013-04-01

This study aims to analyse the efficacy of static techniques, namely gold weight implant and tendon sling, in the reanimation of the paralytic eyelid. Upper eyelid rehabilitation in terms of excursion and blinking velocity is performed using the automatic motion capture system, FACIAL CLIMA. Seventy-four patients underwent a total of 101 procedures including 58 upper eyelid gold weight implants and 43 lower eyelid tendon suspension with 27 patients undergoing both procedures. The presence of lagophtalmos, eye dryness, corneal ulcer, epiphora and lower lid ptosis/ectropion was assessed preoperatively. The Wilcoxon signed-rank test was used to compare preoperative versus postoperative measurements of upper eyelid excursion and blinking velocity determined with FACIAL CLIMA. Significance was set at p <0.05. FACIAL CLIMA revealed significant improvement of eyelid excursion and velocity of blinking (p < 0.001). Eye dryness improved in 49 patients (90.7%) and corneal ulcer resolved without any further treatment in 12 (85.7%) of those with a gold weight inserted. Implant extrusion was observed in 8.6% of the cases. Of the patients with lower lid tendon suspension, correction of ptosis/ectropion and epiphora was achieved in 93.9% and 91.9% of cases, respectively. In eight patients (18.6%), further surgery was needed to adjust tendon tension. The paralytic upper and lower eyelid can be successfully managed with gold weight implant and tendon suspension. The FACIAL CLIMA system is a reliable method to quantify upper eyelid excursion and blinking velocity and to detect the exact position of the lower eyelid. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Evaluation de la formation des résidents en chirurgie générale et digestive en Tunisie

PubMed Central

Mahmoudi, Ammar; Noomen, Faouzi; Nasr, Mohamed; Zouari, Khadija; Hamdi, Abdelaziz

2015-01-01

Introduction De nombreux moyens sont mis à disposition des résidents en chirurgie générale et digestive pour assurer leur formation théorique et pratique. Cependant, le niveau d'utilisation de ces différents outils et leur impact sur la formation des résidents n'ont jamais été évalués. L'objectif de notre étude était d’étudier l’état des lieux des moyens de formation utilisés par les résidents pour évaluer leurs degrés de satisfaction et leurs propositions en vue d'améliorer leur formation. Méthodes Un questionnaire anonyme a été distribué aux résidents de chirurgie générale et digestive de l'année 2012-2013. Ce questionnaire portait sur les caractéristiques démographiques, les ressources pédagogiques, ainsi que le cursus médical et universitaire. Une évaluation de la formation ainsi qu'un recueil des propositions faites en vue d'améliorer leurs formations étaient réalisées. Résultats Cinquante résidents sur 83 ont répondu au questionnaire. L'orientation de carrière la plus fréquente était l'hospitalo-universitaire dans 70% des cas. La pratique quotidienne et l'internet étaient les deux ressources pédagogiques les plus utilisées. La formation chirurgicale était jugée satisfaisante par seulement 10% des répondants. Parmi l'ensemble des propositions faites, l'apprentissage sur simulateur chirurgical, l'existence d'un ouvrage national de référence, et l'institution d'un tutorat par un chirurgien senior recueillaient plus de 80% d'avis favorable. Conclusion La majorité des résidents jugent leur formation non satisfaisante. Une meilleure information sur les ressources déjà existantes, un renforcement du compagnonnage et un accès plus large à un apprentissage sur simulateur chirurgical permettraient de diminuer ce sentiment d'insatisfaction. PMID:26587174

Etude de la prévalence des infections nosocomiales et des facteurs associes dans les deux hopitaux universitaires de Lubumbashi, République Démocratique du Congo: cas des Cliniques Universitaires de Lubumbashi et l’Hôpital Janson Sendwe

PubMed Central

Kakupa, Danny Kasongo; Muenze, Prosper Kalenga; Byl, Baudouin; Wilmet, Michèle Dramaix

2016-01-01

en évidence cinq germes responsables d’une infection nosocomiale chez les patients infectés : Escherichia coli (11,9%), Staphylococcus aureus (6,8%), Pseudomonas aeruginosa (5,1%), Shigella spp (5,1%) et Salmonela typhi (1,7%). L’examen microbiologique n’a été réalisé que dans 31,0 % (n=59). La cefotaxime, céphalosporine de 3ème génération était l’antibiotique le plus prescrit (37,9%), suivi de l’amoxicilline (19,6%) et l’ampicilline (16,3%) en monothérapie. La bi et la trithérapie ont été également prescrites. La voie parentérale était la plus utilisée pour administrer un anti-infectieux. La prévalence d’infections nosocomiales différait significativement entre les deux hôpitaux universitaires ; la prévalence d’une infection nosocomiale acquise est de 22,2% aux Cliniques Universitaires de Lubumbashi et 13,1% à l’hôpital Sendwe. Conclusion Dans notre travail, la prévalence globale des infections nosocomiales était de 34,5%. Les infections du site opératoire étaient les plus fréquentes (27,1%). L’Escherichia coli était le germe le plus fréquent soit 11,9%. PMID:28154630

Free gracilis transfer for smile in children: the Massachusetts Eye and Ear Infirmary Experience in excursion and quality-of-life changes.

PubMed

Hadlock, Tessa A; Malo, Juan S; Cheney, Mack L; Henstrom, Douglas K

2011-01-01

Free muscle transfer for facial reanimation has become the standard of care in recent decades and is now the cornerstone intervention for dynamic smile reanimation. We sought to quantify smile excursion and quality-of-life (QOL) changes in our pediatric free gracilis recipients following reanimation. We quantified gracilis muscle excursion in 17 pediatric patients undergoing 19 consecutive pediatric free gracilis transplantation operations, using our validated SMILE program, as an objective measure of functional outcome. These were compared against excursion measured the same way in a cohort of 17 adults with 19 free gracilis operations. In addition, we prospectively evaluated QOL outcomes in these children using the Facial Clinimetric Evaluation (FaCE) instrument. The mean gracilis excursion in our pediatric free gracilis recipients was 8.8 mm ± 5.0 mm, which matched adult results, but with fewer complete failures of less than 2-mm excursion, with 2 (11%) and 4 (21%), respectively. Quality-of-life measures indicated statistically significant improvements following dynamic smile reanimation (P = .01). Dynamic facial reanimation using free gracilis transfer in children has an acceptable success rate, yields improved commissure excursion, and improves QOL in the pediatric population. It should be considered first-line therapy for children with lack of a meaningful smile secondary to facial paralysis.

Development and Pilot Testing of 24/7 In-Ambulance Telemedicine for Acute Stroke: Prehospital Stroke Study at the Universitair Ziekenhuis Brussel-Project.

PubMed

Valenzuela Espinoza, Alexis; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Fernandez Tellez, Helio; Dupont, Alain; Putman, Koen; Brouns, Raf

2016-01-01

In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Successful execution of the project involved the development and validation of a novel stroke scale, design and creation of specific hardware and software solutions, execution of field tests for mobile internet connectivity, design of new care processes and information flows, recurrent training of all professional caregivers involved in acute stroke management, extensive testing on healthy volunteers, organisation of a 24/7 teleconsultation service by trained stroke experts and 24/7 technical support, and resolution of several legal issues. In all, it took 41 months of research and development to confirm the safety, technical feasibility, reliability, and user acceptance of the PreSSUB approach. Stroke-specific key information can be collected safely and reliably before and during ambulance transportation and can adequately be communicated with the inhospital team awaiting the patient. This paper portrays the key steps required and the lessons learned for successful implementation of a 24/7 expert telemedicine service supporting patients with acute stroke during ambulance transportation to the hospital. © 2016 S. Karger AG, Basel.

Étude descriptive du processus d’évaluation et de documentation de la douleur postopératoire dans un hôpital universitaire

PubMed Central

Bergeron, Dave A; Leduc, Geneviève; Marchand, Serge; Bourgault, Patricia

2011-01-01

Plusieurs études démontrent que les patients reçoivent souvent un traitement insatisfaisant de la douleur en contexte postopératoire. Le but de la présente étude descriptive était d’examiner et d’analyser diverses données ayant trait au soulagement de 40 patients après une intervention chirurgicale non urgente. Les patients ont rempli un journal de douleur afin d’évaluer le niveau d’intensité et de désagrément engendré par la douleur durant les trois premières journées postopératoires. Une analyse du dossier a permis de vérifier la documentation de l’évaluation de la douleur par le personnel infirmier. Les résultats indiquent que la douleur en contexte postopératoire est peu et inadéquatement évaluée et peu documentée par le personnel infirmier. Lorsque la douleur est évaluée selon une échelle numérique, les infirmières ont tendance à la sous-évaluer en comparaison avec l’évaluation notée par les patients. Pour la première journée postopératoire, l’intensité moyenne de la douleur documentée par les infirmières est de 1,57 (±0,23) sur une échelle numérique de 0 à 10, alors que l’intensité moyenne documentée par les patients est de 3,82 (±0,41). Cette étude fait ainsi ressortir qu’il n’y a pas de corrélation significative entre l’intensité de la douleur documentée par l’infirmière et celle notée par le patient, ce qui peut expliquer en partie un soulagement non optimal. PMID:21499582

Qualité de vie et vécu de la maladie, avant et après hystérectomie vaginale, chez les femmes admises au Centre Hospitalier Universitaire de Brazzaville

PubMed Central

Mbongo, Jean Alfred; Mouanga, Alain; Miabaou, Didace Massamba; Nzelie, Aya; Iloki, Léon Hervé

2016-01-01

Toute maladie est un mal en soi qu’il faut éradiquer car elle altère souvent de façon significative la qualité de la vie. L’hystérectomie vaginale est indiquée pour les patientes qui présentent certaines affections gynécologiques graves, elle est donc bénéfique mais, peut également avoir une répercussion néfaste sur la qualité de vie de la femme. Ainsi nous avons voulu explorer le vécu de la maladie et de l’hystérectomie vaginale (HV) des femmes avant et après l’intervention chirurgicale. Nous avons effectué une étude prospective qualitative, à recueil clinique sur une période de 12 mois; qui a concerné les femmes, ayant subi une hystérectomie vaginale. Celles n’ayant pas accepté de participer à l’étude, ou n’ayant pas de contact téléphonique n’ont pas été incluses. Pendant la maladie, le vécu des femmes a été: l’inconfort sexuel 26/40 (65%); les saignements génitaux 12/40 (30%); les douleurs pelviennes 13/40 (32,5%). En Post-opératoire, ont été noté les dyspareunies transitoires30/40 (75%) ; les céphalées secondaires à l’anesthésie 4/40 (10%). Le vécu psychologique a été dominé avant l’HV par la peur de la chirurgie chez toutes les patientes, les troubles du sommeil 38/40 (95%), l’angoisse 30 /40(75%), un sentiment de honte lié aux difficultés à accomplir l’acte sexuel en raison du prolapsus 26/40(65%) et/ ou en raison des saignements génitaux, dus au fibrome utérin 14/40(35%). Le sentiment de la perte de féminité était déclaré par 26/40 femmes porteuses de prolapsus utérin (65%), la modification de l’estime de soi 26/40 (65%). Ces appréciations subjectives ont été améliorées avec l’HV, contre balançant la perte de leur organe de reproduction. Aucune information n’a été donnée par les femmes à leurs proches et aux membres de la famille avant la chirurgie, traduisant ainsi leur sentiment de gène ou de honte. L’arrêt des symptômes a été observé dans tous les

Le syndrome de Pepper: à propos de deux cas observés au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso)

PubMed Central

Kam, Madibèlè; Douamba, Sonia; Nagalo, Kisito; Dao, Lassina; Kouéta, Fla; Lougué, Claudine; Yé, Diarra

2017-01-01

Le syndrome de Pepper est une forme métastatique hépatique du neuroblastome. C’est une entité spécifique du nourrisson de moins de six mois qui a la particularité de pouvoir régresser de façon spontanée avec un pronostic favorable dans 80% des cas. A cause de sa rareté, nous rapportons deux cas du syndrome de Pepper observés au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso). Il s’agissait de deux nourrissons de sexe féminin chez qui la symptomatologie de la maladie se traduisait par une augmentation du volume abdominal, une hépatomégalie et des signes de lutte respiratoire. L'échographie a permis de poser le diagnostic par l’aspect nodulaire du foie dans les deux cas et la détermination de la tumeur primitive dans un cas. Le dosage des catécholamines urinaires a confirmé un cas. L’évolution était fatale chez les deux patientes du fait des complications de compression par le foie, des complications de la chimiothérapie dans l’un des cas et l’absence de traitement dans l’autre cas. PMID:29599887

Douleurs induites par les soins: la réalité au Centre Hospitalier Universitaire de Befelatanana Antananarivo, Madagascar

PubMed Central

Mahavivola, Ernestho-Ghoud Indretsy; Olivah, Razanaparany Miarisoa Mireille; Mihary, Dodo; Hendriniaina, Rakotoharivelo; Lalao, Randriamboavonjy Rado; Henintsoa, Rakotonirainy Oliva; Fahafahantsoa, Rapelanoro Rabenja

2014-01-01

La douleur induite par les soins correspond à la douleur survenant lors des actes à visé diagnostique et/ou thérapeutique. A notre connaissance, nous n'avons pas encore des données disponibles pour les douleurs induites par les soins à l'Hôpital de Befelatanana. Nos objectifs étaient de décrire le profil épidémiologique de la douleur induite par les soins, d'identifier les principaux facteurs influençant sur l'intensité de la douleur et leurs retentissements chez les patients. Il s'agissait d'une étude rétrospective, transversale type un jour donné menée dans les douze services de Médecines au Centre Hospitalier Universitaire de Befelatanana en Novembre 2013. Cent deux patients ont été retenus dans l’étude et trois cent vingt trois actes douloureux étaient enregistrés. La fréquence de la douleur induite par les soins était de 69,86%. Le genre féminin prédominait dans 52% des cas (n = 53) avec un sex-ratio à 0,92. L’âge moyen était de 46 ans. Les ponctions vasculaires étaient l'acte prédominant dans 49,54% (n = 109) des cas. Les infirmiers réalisaient les soins dans 47,05% (n = 48) des cas. L'information verbale était la mesure préventive utilisée dans 57,84% des cas (n = 59). Le transport par marche à pied et au dos représentait 16,67% des cas (n = 17). Les patients naïfs des gestes étaient plus anxieux. Ces patients gardaient de mauvais souvenir dans 64,71% des cas (n = 66). La fréquence de douleur induite par les soins était trop élevée. Un effort important est nécessaire pour réduire la douleur induite par les soins PMID:25932071

Infection respiratoire aigüe et statut nutritionnel chez les enfants de 0-5 ans: cas des cliniques universitaires de Lubumbashi, République Démocratique du Congo

PubMed Central

Ngombe, Léon Kabamba; Mbombo-Ditunga; Kameya, Nduwa; Malingo, Aimé Abasiko; Kayomb, Nathalie Kaj; ea Ngolomba, Jean Ngolomba; Nday, David Kakez; Numbi, Luboya

2014-01-01

Les auteurs rapportent les données d'une étude rétrospective de 153 dossiers d'enfants hospitalisés dans le service de pédiatrie des Cliniques Universitaires de Lubumbashi/RD Congo pour IRA. En ce qui nous concerne, les IRA chez les enfants de moins de 5 ans représentent 26,11% de l'effectif, dont 17,75% âgés de moins d'un an. Le sexe masculin est légèrement prédominant (85 contre 68) et près de 70% des enfants ont un statut nutritionnel précaire. La répartition mensuelle connaît des pics en mars et octobre. Les diagnostiques notifiés sont: rhinite(16,3%),Amygdalite(5,9%),Otite Moyenne Aigue(0,7%),Laryngite (3,3%), Rhinopharyngite (39,2%), Pharyngite (6,5%), Bronchite (7,2%), Bronchopneumonie (5,9%), Pneumonie(2,6%) et Bronchiolite (12,4%).Tous les cas ont bien évolués sous traitement. Le but de ce travail est de déterminer la fréquence des IRA et le statut nutritionnel des enfants ayant été admis dans le service des pédiatries aux C.U.L. PMID:25995789

Comparison of hemihypoglossal nerve versus masseteric nerve transpositions in the rehabilitation of short-term facial paralysis using the Facial Clima evaluating system.

PubMed

Hontanilla, Bernardo; Marré, Diego

2012-11-01

Masseteric and hypoglossal nerve transfers are reliable alternatives for reanimating short-term facial paralysis. To date, few studies exist in the literature comparing these techniques. This work presents a quantitative comparison of masseter-facial transposition versus hemihypoglossal facial transposition with a nerve graft using the Facial Clima system. Forty-six patients with complete unilateral facial paralysis underwent reanimation with either hemihypoglossal transposition with a nerve graft (group I, n = 25) or direct masseteric-facial coaptation (group II, n = 21). Commissural displacement and commissural contraction velocity were measured using the Facial Clima system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using a paired sample t test. Then, mean percentages of recovery of both parameters were compared between the groups using an independent sample t test. Onset of movement was also compared between the groups. Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I but not in group II. Mean percentage of recovery of both parameters did not differ between the groups. Patients in group II showed a significantly faster onset of movement compared with those in group I (62 ± 4.6 days versus 136 ± 7.4 days, p = 0.013). Reanimation of short-term facial paralysis can be satisfactorily addressed by means of either hemihypoglossal transposition with a nerve graft or direct masseteric-facial coaptation. However, with the latter, better symmetry and a faster onset of movement are observed. In addition, masseteric nerve transfer avoids morbidity from nerve graft harvesting. Therapeutic, III.

Contribution des avortements et des grossesses extra-utérines dans la mortalité maternelle dans trois hôpitaux universitaires de Yaoundé

PubMed Central

Kamga, Danielle Victoire Tiako; Nana, Philip Njotang; Fouelifack, Florent Ymele; Fouedjio, Jeanne Hortence

2017-01-01

Introduction L'organisation mondiale de santé (OMS) estime que chaque année dans le monde 585 000 femmes meurent de complications liés à la grossesse, à l'accouchement, aux suites de couche et à l'avortement (ce dernier contribuant pour 13% des décès maternels). La GEU est responsable de 10% de mortalité maternelle au premier trimestre de la grossesse. Le taux de mortalité maternelle reste élevé au Cameroun, estimé à 782 pour 100 000 naissances vivantes selon EDS-MICS 2011. La contribution de ces deux entités dans la mortalité maternelle étant peu documentée dans notre pays, nous avons entrepris de réaliser cette étude avec pour objectif d'évaluer la contribution des avortements et des GEU dans la mortalité maternelle au Cameroun. Méthodes il s'agissait d'une étude rétrospective et analytique. Nous avons colligé tous les dossiers des patientes enceintes et décédées avant la 28ème semaine de grossesse, dans trois hôpitaux universitaires: Hôpital Central de Yaoundé (HCY), Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY), Centre Hospitalier et Universitaire (CHU), sur la période allant du 1er juin 2011 au 31 mai 2016, soit sur cinq ans. Les données étaient compilées sur une fiche technique préétablie et testée, saisies en utilisant le logiciel CS pro 6.2 et analysées par le logiciel SPSS 20. Les tests statistiques de comparaison utilisés étaient le Khi 2 et le test de Fischer en fonction des effectifs. Le seuil de significativité était retenu pour P < 005. Résultats Tous avons enregistré 524 décès maternels pour 31116 naissances vivantes, soit un taux de mortalité maternelle (TMM) de 1538.9/100 000 naissances vivantes. Sur les 524 décès maternels, 414 dossiers étaient exploitables, parmi lesquels, 100 (soit 24.2%) concernaient les avortements et 24 (soit 5.8%) concernaient les grossesses extra-utérines, ces 2 entités contribuaient ainsi pour 30% de décès maternels (124 dossiers sur 414). L

La réparation sphinctérienne directe: points techniques, indications et résultats

PubMed Central

Laalim, Said Ait; Hrora, Abdelmalek; Raiss, Mohammed; Ibnmejdoub, Karim; Toughai, Imane; Ahallat, Mohammed; Mazaz, Khalid

2013-01-01

L'incontinence anale est un handicap physique, psychique et social majeur qui a de nombreuses causes différentes. Les méthodes actuellement disponibles pour améliorer les symptômes de cette incontinence sont les méthodes médicales et de rééducation d'une part et les méthodes chirurgicales d'autre part. Quatre techniques chirurgicales répondent à ces objectifs pour la plupart des malades: la sphinctérorraphie, la neuromodulation des racines sacrées, et les deux techniques de substitution que sont le sphincter artificiel et la graciloplastie dynamisée. La réparation sphinctérienne directe est la technique la plus utilisée dans le traitement chirurgical de l'incontinence anale (IA) par lésion sphinctérienne. Cette technique est envisageable chez les malades ayant une incontinence fécale en rapport avec des lésions limitées du sphincter anal externe. La technique chirurgicale est simple (myorraphie par suture directe ou en paletot) et bien codifiée. Les résultats fonctionnels sont imparfaits et se dégradent avec la durée du suivi. Une continence parfaite après réparation sphinctérienne est rarement acquise de façon durable: le malade candidat à cette approche thérapeutique doit en être averti. PMID:23504542

La Greffe de Peau dans le Traitement des Sequelles de la Main Brulee. A Propos de 152 Cas - Experience du Service de Chirurgie Plastique du Centre Hospitalier Universitaire Ibn-Sina, Rabat, Maroc

PubMed Central

El Mazouz, S.; Fejjal, N.; Hafidi, J.; Cherkab, L.; Mejjati, H.; Belfqih, R.; Gharib, N.; Abbassi, A.

2010-01-01

Summary La main est fréquemment exposée aux brûlures, entraînant des séquelles esthétiques et fonctionnelles. Le traitement de ces séquelles est surtout chirurgical et consiste en la greffe de peau, dont le type dépend de la localisation de la brûlure et du type des séquelles. Dans ce travail rétrospectif, nous rapportons une série de 152 cas de brûlures des mains colligés au service de chirurgie plastique du Centre Hospitalier Universitaire Ibn-Sina de Rabat sur une période de dix ans, allant de 1998 à 2007. Les indications thérapeutiques dépendent du type de séquelles et de la localisation de la brûlure. En tout, 97 patients ont bénéficié d'une greffe cutanée, dont 76% par greffe de peau totale, 21% par greffe de peau demi-épaisse et 3% par peau fine. Les séquelles des brûlures des mains posent un problème thérapeutique majeur, malgré la diversité des procédés chirurgicaux, d'où l'intérêt de la prévention. PMID:21991196

Lengthening Temporalis Myoplasty: Objective Outcomes and Site-Specific Quality-of-Life Assessment.

PubMed

Panciera, Davide Thomas; Sampieri, Claudio; Deganello, Alberto; Danesi, Giovanni

2017-12-01

Objective Evaluate outcomes of the lengthening temporalis myoplasty in facial reanimations. Study Design Case series with planned data collection. Setting Ospedali Riuniti, Bergamo, and AOUC Careggi, Florence, Italy. Subjects and Methods From 2011 to 2016, 11 patients underwent lengthening temporalis myoplasty; demographic data were collected for each. Pre- and postoperative photographs and videos were recorded and used to measure the smile angle and the excursion of the oral commissure, according to the SMILE system (Scaled Measurements of Improvement in Lip Excursion). All patients were tested with the Facial Disability Index, and they also completed a questionnaire about the adherence to physiotherapy indications. Results All patients demonstrated a significant improvement in functional parameters and in quality of life. On the reanimated side, the mean z-line and a-value, measured when smiling, significantly improved in all patients: from 22.6 mm (95% CI, 20.23-25.05) before surgery to 30.9 mm (95% CI, 27.82-33.99) after surgery ( P < .001) and from 100.5° (95% CI, 93.96°-107.13°) to 111.6° (95% CI, 105.63°-117.64°; P < .001), respectively. The mean postoperative dynamic gain, passing from rest to a full smile at the reanimated side, was 3.1 mm (95% CI, 1.30-4.88) for the z-line and 3.3° (95% CI, 1.26°-5.29°) for the a-value. The Facial Disability Index score increased from a preoperative mean of 33.4 points (95% CI, 28.25-38.66) to 49.9 points (95% CI, 47.21-52.60) postoperatively ( P < .001). Conclusions The lengthening temporalis myoplasty can be successfully used for smile reanimation, with satisfying functional and quality-of-life outcomes.

Torsion d'annexe en cours de grossesse: à propos d'un cas à l'Hôpital Central de Yaoundé, Cameroun

PubMed Central

Fouedjio, Jeanne Hortence; Fouogue, Jovanny Tsuala; Fouelifack, Florent Ymele; Nangue, Charlette; Sando, Zacharie; Enow Mbu, Robinson

2014-01-01

Les kystes ovariens sont dans la majorité des cas asymptomatiques et peuvent être de découverte fortuite lors d'une échographie. Ils ne deviennent symptomatiques que lorsque survient une complication. Nous présentons un cas de torsion d'annexe gauche diagnostiqué à 8 semaines et 4 jours de grossesse. Nous avons réalisé une annexectomie Suivie de l'administration de progestérone retard à la dose 500 mg par jour. L'évolution a été marquée par la survenue d'un avortement au cinquième jour post opératoire. L'analyse anatomopathologique de la masse chirurgicale a conclu à une apoplexie ovarienne. L'ablation chirurgicale du corps jaune au premier trimestre de la grossesse pose le problème du maintien de celle - ci et devrait être présente à l'esprit des praticiens avant toute chirurgie pelvienne pendant cette période. PMID:24932350

Contemporary solutions for the treatment of facial nerve paralysis.

PubMed

Garcia, Ryan M; Hadlock, Tessa A; Klebuc, Michael J; Simpson, Roger L; Zenn, Michael R; Marcus, Jeffrey R

2015-06-01

After reviewing this article, the participant should be able to: 1. Understand the most modern indications and technique for neurotization, including masseter-to-facial nerve transfer (fifth-to-seventh cranial nerve transfer). 2. Contrast the advantages and limitations associated with contiguous muscle transfers and free-muscle transfers for facial reanimation. 3. Understand the indications for a two-stage and one-stage free gracilis muscle transfer for facial reanimation. 4. Apply nonsurgical adjuvant treatments for acute facial nerve paralysis. Facial expression is a complex neuromotor and psychomotor process that is disrupted in patients with facial paralysis breaking the link between emotion and physical expression. Contemporary reconstructive options are being implemented in patients with facial paralysis. While static procedures provide facial symmetry at rest, true 'facial reanimation' requires restoration of facial movement. Contemporary treatment options include neurotization procedures (a new motor nerve is used to restore innervation to a viable muscle), contiguous regional muscle transfer (most commonly temporalis muscle transfer), microsurgical free muscle transfer, and nonsurgical adjuvants used to balance facial symmetry. Each approach has advantages and disadvantages along with ongoing controversies and should be individualized for each patient. Treatments for patients with facial paralysis continue to evolve in order to restore the complex psychomotor process of facial expression.

State of the art in treatment of facial paralysis with temporalis tendon transfer.

PubMed

Sidle, Douglas M; Simon, Patrick

2013-08-01

Temporalis tendon transfer is a technique for dynamic facial reanimation. Since its inception, nearly 80 years ago, it has undergone a wealth of innovation to produce the modern operation. The purpose of this review is to update the literature as to the current techniques and perioperative management of patients undergoing temporalis tendon transfer. The modern technique focuses on the minimally invasive approaches and aesthetic refinements to enhance the final product of the operation. The newest techniques as well as preoperative assessment and postoperative rehabilitation are discussed. When temporalis tendon transfer is indicated for facial reanimation, the modern operation offers a refined technique that produces an aesthetically acceptable outcome. Preoperative smile assessment and postoperative smile rehabilitation are necessary and are important adjuncts to a successful operation.

[Fatal amnioinfusion with previous choriocarcinoma in a parturient woman].

PubMed

Hrgović, Z; Bukovic, D; Mrcela, M; Hrgović, I; Siebzehnrübl, E; Karelovic, D

2004-04-01

The case of 36-year-old tercipare is described who developed choriocharcinoma in a previous pregnancy. During the first term labour the patient developed cardiac arrest, so reanimation and sectio cesarea was performed. A male new-born was delivered in good condition, but even after intensive therapy and reanimation occurred death of parturient woman with picture of disseminate intravascular coagulopathia (DIK). On autopsy and on histology there was no sign of malignant disease, so it was not possible to connect previous choricarcinoma with amniotic fluid embolism. Maybe was place of choriocarcinoma "locus minoris resistentiae" which later resulted with failure in placentation what was hard to prove. On autopsy we found embolia of lung with a microthrombosis of terminal circulation with punctiformis bleeding in mucous, what stands for DIK.

Récidive de mélanome malin unguéal achromique: à propos d'un cas

PubMed Central

Benyass, Youssef; Chafry, Bouchaib; Koufagued, Kaldadak; Bouabid, Salim; Benchebba, Driss; Chagar, Belkacem

2015-01-01

Le mélanome malin unguéal représente 1,8 à 8,1% des mélanomes malins cutanés. Sa prise en charge s'adresse aujourd'hui aux praticiens de différentes spécialités. L'acte chirurgical initial est une étape incontournable du traitement curatif. La biopsie de la lésion doit être complète, afin de déterminer de façon exacte la profondeur de l'envahissement en cas de malignité. Nous rapportons un cas de mélanome malin achromique à localisation unguéal chez une femme. La chirurgie initiale consistait en une amputation transphalangienne proximale. L’évolution après deux ans était marquée par une récidive avec extension vers le carpe. Ayant subie une reprise chirurgicale avec une exérèse large. Le traitement des récidives est palliatif et vise à apporter un confort de vie au patient. Le principe du traitement fait appel à l'exérèse chirurgicale des lésions. Des alternatives thérapeutiques sont à l’étude. PMID:26977229

Traitement des séquelles de brûlures de la main dans les pays à ressources limitées ; notre expérience en république démocratique du Congo

PubMed Central

Kibadi, K.; Moutet, F.

2015-01-01

Summary Les séquelles de brûlures de la main sont encore fréquentes dans les pays à ressources limitées. Trente-deux patients, représentant 38 mains, ont été admis et traités, entre le 1er décembre 2010 et le 1er mai 2014 aux Cliniques Universitaires de Kinshasa en République Démocratique du Congo (RDC). nous avons observé 22 patients (69 %) dans le groupe de jeunes (patients âgés de moins de 18 ans), et 10 patients (31 %) chez les adultes (18 à 59 ans). Aucun patient dans le groupe de seniors (60 ans et plus) n’a été observé. Dans le groupe de jeunes, la tranche d’âge de 1 à 5 ans a été la plus atteinte avec 13 malades (40 %). l’accident à la maison était le plus fréquent (72 %). le mécanisme de la brûlure était le plus souvent thermique par flammes (51 %) ou par liquide chaud (34 %). les rétractions et brides sont les lésions le plus observées (84 %). la rétraction dorsale globale « main en griffe» est observée chez 40 % de patients traités, associée à des cicatrices hypertrophiques et chéloïdiennes dans 84 % de cas. Chez les 32 mains traitées chirurgicalement, des excision-greffes ont été réalisées dans 43,7 %, des lambeaux locaux dans 43,7 % et des lambeaux à distance dans 12,5 % de cas. A la sortie de l’hôpital, 84 % de « bons » résultats ont été observés. le suivi a été de 18 mois. le traitement des séquelles de brûlures de la main est possible dans ces pays, exemple de la rDC. Mais les défis à surmonter dans ces pays sont nombreux : la faible accessibilité aux techniques actuelles de la chirurgie plastique, la prise en charge initiale inadéquate des brûlures, la pauvreté. PMID:26668560

Phrenic Nerve Stimulation: Technology and Clinical Applications.

PubMed

Abdunnur, Shane V; Kim, Daniel H

2015-01-01

Phrenic nerve stimulation is a technique used to reanimate the diaphragm of patients with central nervous system etiologies of respiratory insufficiency. Current clinical indications include congenital central hypoventilation syndrome, spinal cord injury above C4, brain stem injury, and idiopathic severe sleep apnea. Presurgical evaluation ensures proper patient selection by validating the intact circuit from the phrenic nerve through alveolar oxygenation. The procedure involves placing leads around the phrenic nerves bilaterally and attaching these leads to radio receivers in a subcutaneous pocket. The rate and amplitude of the current is adjusted via an external radio transmitter. After implantation, each patient progresses through a conditioning phase that strengthens the diaphragm and progressively provides independence from the mechanical ventilator. Studies indicate that patients and families experience an improved quality of life and are satisfied with the results. Phrenic nerve stimulation provides a safe and effective means for reanimating the diaphragm for certain patients with respiratory insufficiency, providing independence from mechanical ventilation. © 2016 S. Karger AG, Basel.

Facteurs associés à la tuberculose chez l'enfant au Centre Hospitalier Universitaire Mère-Enfant de Tsaralalàna, Antananarivo: une étude cas-témoins

PubMed Central

Randriatsarafara, Fidiniaina Mamy; Vololonarivelo, Barbara Elyan Edwige; Rabemananjara, Nambinina Nirina Gaby; Randrianasolo, Jean Baptiste Olivier; Rakotomanga, Jean de Dieu Marie; Randrianarimanana, Vahiniarison Dieudonné

2014-01-01

Introduction A Madagascar, la tuberculose reste un problème de santé publique majeur, l'incidence s’élevant à 16% depuis 2009. Le présent travail a pour objet d'identifier les facteurs de risque de tuberculose chez l'enfant. Méthodes Nous avons mené une étude rétrospective de type cas-témoins sur les facteurs de risque de la tuberculose chez les enfants de 0 à 15 ans au Centre Hospitalier Universitaire Mère-Enfant de Tsaralalàna, de Janvier 2009 à Décembre 2011. Les enfants diagnostiqués de tuberculose dont le diagnostic a été retenu par des éléments de certitude ou par le score pédiatrique de la tuberculose représentent les cas. Les enfants hospitalisés durant la même période, non tuberculeux et de même âge, sont classés témoins. L'Odds Ratio quantifie les associations. Résultats Au total, 91 cas et 173 témoins ont été inclus. Parmi les cas, 73,62% présentent une malnutrition. De fortes associations sont démontrées avec: la malnutrition sévère (OR=6 (IC95% 2,43-15,61 (p<10-5))); le contage tuberculeux (OR=4,71 (IC95% 1,76-12,7 (p=0,003))); la non vaccination par le BCG (OR=4,21 (IC95% 1,99-8,99 (p < 2.10-5))); le niveau intellectuel maternel bas (OR=4,17 (IC95% 0,67-28,14 (p=0,06))); la taille de la fratrie à partir de 5 (OR=4,5). Des associations faibles sont retrouvées pour les autres facteurs étudiés. Les cas présentent une létalité de 18,7% contre 6,3% chez les témoins (p<10-5); 64,7 % des décès sont dus aux formes méningées. Conclusion La tuberculose reste un fléau chez les enfants, avec une lourde responsabilité de la pauvreté rassemblant presque tous les facteurs sus-cités. PMID:25838852

Epidemiologic Overview of Synkinesis in 353 Patients with Longstanding Facial Paralysis under Treatment with Botulinum Toxin for 11 Years.

PubMed

Salles, Alessandra Grassi; da Costa, Eduardo Fernandes; Ferreira, Marcus Castro; Remigio, Adelina Fatima do Nascimento; Moraes, Luciana Borsoi; Gemperli, Rolf

2015-12-01

Patients with longstanding facial paralysis often exhibit synkinesis. Few reports describe the prevalence and factors related to the development of synkinesis after facial paralysis. Botulinum toxin type A injection is an important adjunct treatment for facial paralysis-induced asymmetry and synkinesis. The authors assessed the clinical and epidemiologic characteristics of patients with sequelae of facial paralysis treated with botulinum toxin type A injections to evaluate the prevalence of synkinesis and related factors. A total of 353 patients (age, 4 to 84 years; 245 female patients) with longstanding facial paralysis underwent 2312 botulinum toxin type A injections during an 11-year follow-up. Doses used over the years, previous treatments (electrical stimulation, operations), and how they correlated to postparalysis and postreanimation synkinesis were analyzed. There was a significant association between cause and surgery. Most patients with facial paralysis caused by a congenital defect, trauma, or a tumor underwent reanimation. There were no sex- or synkinesis-related differences in the doses used, but the doses were higher in the reanimation group than in the no-surgery group. Synkinesis was found in 196 patients; 148 (41.9 percent) presented with postparalysis synkinesis (oro-ocular, oculo-oral) and 58 (16.4 percent) presented with postreanimation synkinesis. Ten patients presented with both types. This study determined the high prevalence (55.5 percent) of synkinesis in patients with longstanding facial paralysis. Postparalysis synkinesis was positively associated with infectious and idiopathic causes, electrical stimulation, facial nerve decompression, and no requirement for surgery. Postreanimation synkinesis was present in 28.2 percent of reanimated patients and was significantly associated with microsurgical flaps, transfacial nerve grafting, masseteric-facial anastomosis, and temporalis muscle transfers.

Pseudotumeur cardiaque révélant une maladie de Behçet

PubMed Central

Nya, Fouad; Abdou, Abdessamad; Bamous, Mehdi; Moutakiallah, Younes; Atmani, Noureddine; Seghrouchni, Aniss; Houssa, Mahdi Ait; Boulahya, Abdellatif

2017-01-01

La thrombose intracardiaque est une complication rare de la maladie de Behçet (MB), qui peut se présenter comme une tumeur intracardiaque. Sa découverte précède, dans la moitié des cas, le diagnostic de MB. La mortalité élevée peut être en rapport avec des complications post-chirurgicales et/ou une atteinte associée des artères pulmonaires. Nous rapportons l’observation d’un jeune patient de 29 ans, aux antécédents d’aphtose bipolaire, qui a bénéficie d’une intervention chirurgicale après la découverte d’une tumeur de l’atrium et du ventricule droits. Il s’agissait d’un thrombus à l’examen anatomopathologique et dans les suites opératoires nous avons diagnostiqué une MB. L’évolution a été favorable sous traitement médical associant une corticothérapie, de la colchicine et des antivitamines K (AVK). La découverte d’une masse intracardiaque chez un sujet jeune doit faire évoquer le diagnostic de thrombus cardiaque et de maladie de Behçet, même en l’absence de facteur ethnique ou géographique prédisposant. PMID:28533874

Cosmopolitanism and Education: A View from the Ground

ERIC Educational Resources Information Center

Hansen, David T.

2010-01-01

Background/ Context: In recent years, scholars the world over in both the social sciences and humanities have reanimated the ancient idea of cosmopolitanism. They discern in the idea ways in which people today can respond creatively to rapid social, political, cultural, and economic transformations. Scholars in this burgeoning field have examined…

Prévalence et caractéristiques des effets indésirables des antihypertenseurs chez les patients suivis en ambulatoire au Centre Hospitalier Universitaire Yalgado Ouédraogo

PubMed Central

Millogo, Georges Rosario Christian; Zongo, Ragomzingba Frank Edgard; Benao, Anita; Youl, Estelle Noëla Hoho; Bassoleth, Blaise Alexandre Bazona; Ouédraogo, Moussa; Zabsonré, Patrice; Guissou, Innocent Pierre

2018-01-01

La prise en charge médicamenteuse de l'hypertension artérielle (HTA) entraine des effets indésirables qui peuvent être gênants et ainsi influencer l'observance du patient. Nous avons étudié ces effets indésirables dans le service de cardiologie du Centre hospitalier universitaire Yalgado Ouédraogo afin de déterminer leurs fréquences et leurs caractéristiques. Il s'agissait d'une étude transversale de juillet à septembre 2015 chez les patients suivis en ambulatoire pour HTA. Les données ont été obtenues à partir de l'interrogatoire, des carnets de suivi des patients et des fiches de consultations. Au total 278 patients ont été inclus. La population d'étude incluait 69,1% de femmes. L'âge moyen était de 52,2 ans avec des extrêmes de 23 et 86 ans. Quatre vingt et sept virgule huit pourcent (87,8%) vivaient en milieu urbain. Le tabagisme, la dyslipidémie et les antécédents familiaux d'HTA représentaient respectivement 9%, 35,6% et 57,2%. Au plan thérapeutique, 43,2% étaient sous monothérapie, 35,6% sous bithérapie à l'initiation du traitement. Les inhibiteurs calciques (59,7%) étaient la classe thérapeutique la plus utilisée. La prévalence globale des effets indésirables était de 60,1%. Les inhibiteurs calciques étaient impliqués dans 53,6% suivis des diurétiques (48,6%) dans la survenue de l'effet indésirable. La prévalence spécifique par molécule était 28,1% pour l'amlodipine et 24,5% pour l'hydrochlorothiazide. La diurèse excessive (13,7%), la toux (12,9%) et les vertiges (11,5%) étaient les effets indésirables les plus fréquemment évoqués par les patients. Le système nerveux central et périphérique et le système ostéo-musculaire étaient les systèmes les plus atteints. Les effets indésirables sont un déterminant majeur de l'adhésion aux traitements antihypertenseur, car leur impact sur la vie quotidienne des patients peut s'avérer significatif. PMID:29875965

L'Infection Nosocomiale en Reanimation des Brules

PubMed Central

Siah, S.; Belefqih, R.; Elouennass, M.; Fouadi, F.E.; Ihrai, I.

2009-01-01

Summary L'infection nosocomiale bactérienne étant l'une des principales causes de morbidité et de mortalité chez le brûlé, nous avons réalisé une étude rétrospective portant sur 84 patients hospitalisés au sein du service de réanimation des brûlés de l'Hôpital Militaire d'Instruction Mohammed V de Rabat, sur une période de 3 ans, du premier janvier 2001 au 31 décembre 2003. Les critères d'infection nosocomiale étaient ceux du Center for Disease Control d'Atlanta de 1988. Les taux d'incidence ont été calculés. La population infectée a été comparée à celle non infectée. L'écologie bactérienne du service a été décrite comme aussi l'antibiotype. Il ressort de cette étude la survenue de 87 infections nosocomiales chez 27 patients. L'incidence cumulative était de 103 infections pour 1000 jours de traitement. Pour ce qui est des caractéristiques des infections bactériennes, les sites infectés étaient la peau (77%), le sang (13,8%), les voies urinaires (8%) et les poumons (1,1%). Les principaux germes étaient: Staphylococcus sp. (33,3%), Pseudomonas aeruginosa (23%), Enterococcus faecalis et Acinetobacter (8%). Les staphylocoques étaient méticillo-résistants dans 22,2% des cas. Le Pseudomonas et l'Acinetobacter étaient multirésistants (60%). Dans notre étude les facteurs prédictifs de survenue des infections nosocomiales que nous avons retenus après l'étude comparative des populations infectées et non infectées ont été l'âge, le body mass index, l'abbreviated burn severity index et le remplissage initial. En isolant ces paramètres, nous avons pu établir une équation à valeur prédictive de survenue d'infection nosocomiale chez le patient brûlé. PMID:21991158

The Visible Heart® project and free-access website 'Atlas of Human Cardiac Anatomy'.

PubMed

Iaizzo, Paul A

2016-12-01

Pre- and post-evaluations of implantable cardiac devices require innovative and critical testing in all phases of the design process. The Visible Heart ® Project was successfully launched in 1997 and 3 years later the Atlas of Human Cardiac Anatomy website was online. The Visible Heart ® methodologies and Atlas website can be used to better understand human cardiac anatomy, disease states and/or to improve cardiac device design throughout the development process. To date, Visible ® Heart methodologies have been used to reanimate 75 human hearts, all considered non-viable for transplantation. The Atlas is a unique free-access website featuring novel images of functional and fixed human cardiac anatomies from >400 human heart specimens. Furthermore, this website includes education tutorials on anatomy, physiology, congenital heart disease and various imaging modalities. For instance, the Device Tutorial provides examples of commonly deployed devices that were present at the time of in vitro reanimation or were subsequently delivered, including: leads, catheters, valves, annuloplasty rings, leadless pacemakers and stents. Another section of the website displays 3D models of vasculature, blood volumes, and/or tissue volumes reconstructed from computed tomography (CT) and magnetic resonance images (MRI) of various heart specimens. A new section allows the user to interact with various heart models. Visible Heart ® methodologies have enabled our laboratory to reanimate 75 human hearts and visualize functional cardiac anatomies and device/tissue interfaces. The website freely shares all images, video clips and CT/MRI DICOM files in honour of the generous gifts received from donors and their families. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.

Extensive actinomycosis of the face requiring radical resection and facial nerve reconstruction.

PubMed

Iida, Takuya; Takushima, Akihiko; Asato, Hirotaka; Harii, Kiyonori

2006-01-01

We present a case of extensive actinomycosis of the face, which appeared after dental surgery. Since antibiotic therapy was ineffective, the lesion was radically resected, and the skin, soft tissue and facial nerve were reconstructed using a free rectus abdominis musculocutaneous flap and simultaneously harvested intercostal nerves. Successful reanimation of the face was achieved 14 months postoperatively.

The Quest for Reliable Epidemiological Data on Suicide: The Padua Sample.

ERIC Educational Resources Information Center

De Leo, Diego; And Others

This study was a preliminary step in gathering reliable data on suicides and suicide attempts in Padua, Italy. Data were collected from the first aid department of the Padua general hospital, 67 general practitioners in the city, staff of a night-time and holiday home-call medical service, the reanimation department of the Padua general hospital,…

Translations on USSR Science and Technology, Biomedical Sciences, Number 5

DTIC Science & Technology

1977-07-18

arteriovenous and arterial aneurysms. Methods have been further developed for conservative therapy of patients with ischemic cerebral damage...reanimation therapy , anesthesiological support for operations, etc. Soviet neurosurgery has vast experience at its disposal, experience acquired...tions , and physiotherapeutic methods, and work therapy all enter into it, and much else." Together with G. P. Kaplin I entered one of the hospital

Reanimating the arm and hand with intraspinal microstimulation

NASA Astrophysics Data System (ADS)

Zimmermann, Jonas B.; Seki, Kazuhiko; Jackson, Andrew

2011-10-01

To date, there is no effective therapy for spinal cord injury, and many patients could benefit dramatically from at least partial restoration of arm and hand function. Despite a substantial body of research investigating intraspinal microstimulation (ISMS) in frogs, rodents and cats, little is known about upper-limb responses to cervical stimulation in the primate. Here, we show for the first time that long trains of ISMS delivered to the macaque spinal cord can evoke functional arm and hand movements. Complex movements involving coordinated activation of multiple muscles could be elicited from a single electrode, while just two electrodes were required for independent control of reaching and grasping. We found that the motor responses to ISMS were described by a dual exponential model that depended only on stimulation history. We demonstrate that this model can be inverted to generate stimulus trains capable of eliciting arbitrary, graded motor responses, and could be used to restore volitional movements in a closed-loop brain-machine interface.

Freeze, Wait, Reanimate: Cryonic Suspension and Science Fiction

ERIC Educational Resources Information Center

Shoffstall, Grant

2010-01-01

This essay takes as its chief point of departure Jacques Ellul's contention that imaginative treatments of malevolent technology in antitechnological science fiction, by way of inviting rejection, refusal, dismissal, or condemnation, conspire in facilitating human acceptance of and adjustment to technology as it otherwise presently is. The author…

Les formes graves de la grippe A(H1N1) 2009 chez la femme enceinte: expérience du centre hospitalier universitaire de Fès, Maroc et revue de la littérature

PubMed Central

Adnane Berdai, Mohamed; Labib, Smael; Harandou, Mustapha

2012-01-01

Introduction Le but de cette étude est de décrire les caractéristiques épidémiologiques, cliniques, paracliniques ainsi que l’évolution des femmes enceintes ou en post partum atteintes de formes graves de Grippe A(H1N1) 2009. Méthodes C’est une étude prospective observationnelle monocentrique, menée au sein de notre service de réanimation mère et enfant au centre hospitalier universitaire Hassan II à Fès, sur une période de 3 mois, allant de novembre 2009 à janvier 2010. Résultats L’âge moyen était de 28 ans, dans 85% des cas la grossesse se situaient au troisième trimestre, le syndrome grippal était constant, la SpO2 initiale était en moyenne de 86%. A la radiographie thoracique, un syndrome alvéolaire bilatéral était toujours présent. L’infection virale était confirmée dans tous les cas par la polymerase chain reaction. Chez 3 patientes la PaO2/FiO2 était inférieure à 300. L’Oseltamivir était l’antiviral utilisé chez toutes les parturientes. Un syndrome de détresse respiratoire aigu a été développé chez 28% des parturientes, elles ont été ventilées artificiellement avec des niveaux de pressions expiratoires positives à 14 +/- 1 cmH2O. L’évolution était favorable dans 71% des cas, cependant, 2 décès ont été déplorés. Conclusion Les résultats rejoignent les données de la littérature, à savoir, un risque accru pour la femme enceinte de développer une forme grave, une présentation clinique similaire au reste de la population, l’intérêt de la vaccination et d’un traitement antiviral précoce et le rôle de l’ECMO dans le traitement des hypoxémies réfractaires. PMID:22514770

Surgical Approaches to Facial Nerve Deficits

PubMed Central

Birgfeld, Craig; Neligan, Peter

2011-01-01

The facial nerve is one of the most commonly injured cranial nerves. Once injured, the effects on form, function, and psyche are profound. We review the anatomy of the facial nerve from the brain stem to its terminal branches. We also discuss the physical exam findings of facial nerve injury at various levels. Finally, we describe various reconstructive options for reanimating the face and restoring both form and function. PMID:22451822

Evaluation des résultats après traitement des lésions intra épithéliales du col utérin par la cryothérapie: étude préliminaire au Centre Hospitalier Universitaire de Yaoundé: A propos de 21 cas

PubMed Central

Ndoua, Claude Cyrille Noa; Tebeu, Pierre Marie; Kemfang, Jean Dupont; Kasia, Jean Marie

2015-01-01

Nous rapportons les résultats d'une série de 21 cas de prise en charge par cryothérapie de lésions intra-épithéliales cervicales au Centre Hospitalier et Universitaire (CHU) de Yaoundé. Notre objectif principal était d’évaluer les résultats préliminaires de la prise en charge des lésions précancéreuses éligibles pour la cryothérapie. Il s'agissait d'une étude transversale descriptive qui s'est étalée sur 24 mois. Etaient inclus dans l’étude toutes les femmes traitées par cryothérapie. Nous avons exclu les patientes traitées par une autre méthode, les patientes perdues de vue et les dossiers incomplets. Le statut cervical a été déterminé à 6 semaines, 6 mois et 12 mois. Les complications précoces et tardives ont également été répertoriées. Au total 95.2% des lésions étaient cicatrisées à 6 semaines. A 6 mois, toutes les lésions avaient disparu et au 12ème mois, la guérison était effective chez 95.2% des patientes. Les saignements et l'hydrorrhée étaient les principales complications tardives avec des fréquences respectives de 66.7% et 95.2%. Aucun cas de sténose cervicale n'a été répertorié. La cryothérapie peut être utilisée comme méthode de traitement pour des lésions précancéreuses du col. PMID:26140068

Reconstruction of facial nerve after radical parotidectomy.

PubMed

Renkonen, Suvi; Sayed, Farid; Keski-Säntti, Harri; Ylä-Kotola, Tuija; Bäck, Leif; Suominen, Sinikka; Kanerva, Mervi; Mäkitie, Antti A

2015-01-01

Most patients benefitted from immediate facial nerve grafting after radical parotidectomy. Even weak movement is valuable and can be augmented with secondary static operations. Post-operative radiotherapy does not seem to affect the final outcome of facial function. During radical parotidectomy, the sacrifice of the facial nerve results in severe disfigurement of the face. Data on the principles and outcome of facial nerve reconstruction and reanimation after radical parotidectomy are limited and no consensus exists on the best practice. This study retrospectively reviewed all patients having undergone radical parotidectomy and immediate facial nerve reconstruction with a free, non-vascularized nerve graft at the Helsinki University Hospital, Helsinki, Finland during the years 1990-2010. There were 31 patients (18 male; mean age = 54.7 years; range = 30-82) and 23 of them had a sufficient follow-up time. Facial nerve function recovery was seen in 18 (78%) of the 23 patients with a minimum of 2-year follow-up and adequate reporting available. Only slight facial movement was observed in five (22%), moderate or good movement in nine (39%), and excellent movement in four (17%) patients. Twenty-two (74%) patients received post-operative radiotherapy and 16 (70%) of them had some recovery of facial nerve function. Nineteen (61%) patients needed secondary static reanimation of the face.

Tumeur de Frantz: deux nouveaux cas

PubMed Central

Bellarbi, Salma; Sina, Mohamed; Jahid, Ahmed; Zouaidia, Fouad; Bernoussi, Zakia; Mahassini, Najat

2013-01-01

A travers cet article, nous détaillons les caractéristiques clinico-pathologiques et discutons l'histogenèse de la tumeur de Frantz. Deux patients opérés pour tumeur de Frantz. Ils ont eu un traitement chirurgical seul. L'étude morphologique était couplée à un examen immuno-histochimique (IHC) utilisant les anticorps anti CD10, anti- vimentine, anti-énolase neuronale spécifique (NSE), anti-synaptophysine, anti-chromogranine A et anti-cytokératine. Un immuno-marquage à l'anti-oestrogène et l'anti-progestérone a été réalisé dans un cas. Il s'agissait d'une femme âgée de 45ans et d'un garçon de 12 ans. Les aspects échographiques et scannographiques étaient non spécifiques. Une exérèse chirurgicale complète a été réalisée dans les deux cas. L'analyse histologique évoquait une tumeur de Frantz. Le diagnostic a été retenu après étude immuno-histohimique. L'évolution était favorable sans récidive avec respectivement un recul de 18 et 16 mois. La tumeur de Frantz est une entité rare. Son diagnostic repose sur l'examen anatomopathologique complété par l'étude immuno-histochimique. Son pronostic est excellent après résection chirurgicale. PMID:23503717

Le diverticule de l'urètre féminin: à propos de 18 cas

PubMed Central

Statoua, Mouad; El Ghanmi, Jihad; Karmouni, Tarik; El Khader, Khalid; Koutani, Abdellatif; Attya, Ahmed Iben

2014-01-01

Le diverticule de l'urètre ou poche sous urétrale est une affection rare, d’étiopathogénie non clairement établie, le diagnostique est clinique confirmé par l'urétrocystographie et le traitement est principalement chirurgicale consistant en une diverticulectomie par voie transvaginale. Nous rapportons l'expérience de notre service dans la prise en charge de cette affection en présentons une étude rétrospective sur une durée de 14 ans (entre 2000 et 2014) où on a pris en charge 18 patientes qui présentait un diverticule de l'urètre, l’âge moyen était de 36 ans, une symptomatologie urinaire ramenait les patientes à consulter où le diagnostic de DU a été posé par examen clinique confirmé en précisant ses caractéristiques en urétrocystographie, la prise en charge était chirurgicale et consistait en une diverticulectomie par voie transvaginale. Les suites post-opératoire était simples, la sonde vésicale retirée en moyenne 5,8 jours après l'intervention, on n'a noté aucune complication chez toute nos patientes, hormis un cas de récidives repris. Devant des troubles mictionnels récidivants de la femme, il est indispensable de rechercher un diverticule uréthral à l'examen clinique. La diverticulectomie transvaginale est l'intervention de choix offrant les meilleurs résultats. PMID:25400845

D'une ouverture de la voyelle /epsilon/ en finale absolue en francais quebecois : analyse acoustique et perceptive

NASA Astrophysics Data System (ADS)

Riverin-Coutlee, Josiane

Cette contribution est consacree a l'ouverture du /epsilon/ en finale absolue, un phenomene phonetique repute etre en declin en francais quebecois et caracteristique de locuteurs âges, peu scolarises, issus de milieux populaires et s'exprimant en situation de communication informelle. Une analyse acoustique de 480 voyelles /epsilon/ issues de la parole formelle de 40 jeunes etudiants universitaires originaires des centres urbains de Saguenay et de Quebec revele toutefois que le phenomene est encore bien vivant en francais quebecois et qu'il est plus frequent chez les locuteurs de Saguenay, une tendance validee auditivement par accord inter-juges. Les resultats d'un test de discrimination et d'identification mene aupres de 26 etudiants universitaires originaires de ces deux memes villes indiquent que les auditeurs naifs de Saguenay semblent moins sensibles a la variation et moins enclins a juger de l'origine geographique d'un locuteur a partir de sa prononciation de la voyelle /epsilon/ en fin de mot.

Une étude rétrospective sur l'incidence de l'insuffisance rénale chronique dans le service de Médecine Interne et Néphrologie du Centre Hospitalier Universitaire d'Antananarivo

PubMed Central

Ramilitiana, Benja; Ranivoharisoa, Eliane Mikkelsen; Dodo, Mihary; Razafimandimby, Evanirina; Randriamarotia, Willy Franck

2016-01-01

L'insuffisance rénale chronique est un problème de santé publique au niveau mondial. Dans les pays développés, cette affection survient essentiellement chez les sujets âgés, mais en Afrique, elle s'installe plutôt chez les sujets jeunes actifs. C'est une affection de lourde prise en charge dans un pays à faible revenu à cause de ses coûts. Notre but est de décrire les aspects épidémiologiques des nouveaux cas d'insuffisance rénale chronique à Madagascar. Il s'agit d'une étude rétrospective descriptive de 3 ans partant du 1er janvier 2007 au 31 décembre 2009 dans le service de Médecine Interne et Néphrologie du Centre Hospitalier Universitaire d'Antananarivo portant sur 239 patients diagnostiqués comme une insuffisance rénale chronique. L'incidence était de 8,51% parmi les patients hospitalisés dans le service. L’âge moyen des patients était de 45,4 ans avec des extrêmes de 16 et 82 ans et un sex-ratio de 1,46. Le principal antécédent était l'hypertension artérielle (59,8%). L'insuffisance rénale chronique était terminale dans 75,31% des cas (n=180). Les causes de l'insuffisance rénale chronique étaient dominées par la glomérulonéphrite chronique (40,1%), la néphroangiosclérose (35,5%). L'hémodialyse était réalisée chez 3 patients (1,26%), aucun patient n’était pas programmé pour une greffe rénale. Le taux de mortalité dans le service était de 28,87%. L'insuffisance rénale chronique est une maladie de pronostic redoutable et handicapante qui affecte les sujets jeunes à Madagascar. Son traitement reste inaccessible dans la majorité des patients. L'accent doit donc être mis principalement sur la prévention notamment une bonne prise en charge précoce des infections, de l'hypertension artérielle et du diabète pour réduire ses impacts négatifs sur la santé communautaire et publique. Le projet de la transplantation rénale - donneur vivant, traitement efficace et moins coûteux par rapport à l

Des Diplomes Algeriens Partlent de la Formation Universitair.

ERIC Educational Resources Information Center

Boubekeur, Farid

1999-01-01

This evaluation of higher education in Algeria was performed by means of open-ended interviews with eight graduates of the University of Constantine. From the beginning of the 1980s, it was found that all disciplines, including Economics, Law, Library Science, and Psychology, showed failures in academic training. A change of direction towards…

School Choice Options Limit Access to Higher Education for Various Groups of Students in Quebec

ERIC Educational Resources Information Center

Labrosse, Julie; Gaudreault, Marco; Picard, France

2017-01-01

The choice of selected school options by pupils in secondary school, particularly mathematics and physical sciences, have implications for future educational pathways in higher education [Felouzis, G. (1997). "L'efficacité des enseignants, Sociologie de la relation pédagogique." Paris: Presses Universitaires de France; Moreau, G. (2005).…

Communiquer en milieu interculturel (Communicating in an Intercultural Environment).

ERIC Educational Resources Information Center

Yanaprasart, Patchareerat, Ed.

2002-01-01

The articles, written in French, in this issue refer to research and intercultural practices with regard to confrontational situations between two or more cultural systems. The titles are as follows: "La culture universitaire comme culture en soi" (The University Culture as a Culture in Its Own Right) (Aline Gohard-Radenkovic);…

Pedicled Temporalis Muscle Flap for Craniofacial Reconstruction: A 35-Year Clinical Experience with 366 Flaps.

PubMed

Spanio di Spilimbergo, Stefano; Nordera, Paolo; Mardini, Samir; Castiglione, Giusy; Chim, Harvey; Pinna, Vittore; Brunello, Massimo; Cusino, Claudio; Roberto, Squaquara; Baciliero, Ugo

2017-02-01

In the past 130 years, the temporalis muscle flap has been used for a variety of different indications. In this age of microsurgery and perforator flaps, the temporalis muscle flap still has many useful applications for craniofacial reconstruction. Three hundred sixty-six temporalis muscle flaps were performed in a single center between 1978 and 2012. The authors divided the cases into two series-before and after 1994-because, after 1994, they started to perform free flap reconstructions, and indications for reconstruction with a temporalis muscle flap were changed RESULTS:: In the series after 1994, flaps were most commonly used for reconstruction of defects in the maxilla, mandible, and oropharynx, in addition to facial reanimation and filling of orbital defects. Complications included total flap necrosis (1.6 percent) and partial flap necrosis (10.7 percent). The rate of material extrusion at the donor site decreased after porous polyethylene was uniformly used for reconstruction from 17.1 to 7.9 percent. The pedicled temporalis muscle flap continues to have many applications in craniofacial reconstruction. With increasing use of free flaps, the authors' indications for the pedicled temporalis muscle flap are now restricted to (1) orbital filling for congenital or acquired anophthalmia; (2) filling of unilateral maxillectomy defects; and (3) facial reanimation in selected cases of facial nerve palsy. Therapeutic, IV.

Surgical and conservative methods for restoring impaired motor function - facial nerve, spinal accessory nerve, hypoglossal nerve (not including vagal nerve or swallowing)

PubMed Central

Laskawi, R.; Rohrbach, S.

2005-01-01

The present review gives a survey of rehabilitative measures for disorders of the motor function of the mimetic muscles (facial nerve), and muscles innervated by the spinal accessory and hypoglossal nerves. The dysfunction can present either as paralysis or hyperkinesis (hyperkinesia). Conservative and surgical treatment options aimed at restoring normal motor function and correcting the movement disorders are described. Static reanimation techniques are not dealt with. The final section describes the use of botulinum toxin in the therapy of dysphagia. PMID:22073058

[Hemorrhagic syndrome after transfusion of incompatible blood].

PubMed

Fedorova, Z D; Bsryshev, B A; Khanin, A Z; Chuslov, A G

1979-11-01

The patients were observed by a reanimation-hematological team of the Leningrad emergency service. It has been established that the hemorrhagic syndrome is the main one deterimining the unity of pathogenesis and clinical picture of the hemotransfusional complication. Phase character of the changes in the homeostasis system during the transfusion of incompatible blood was noted. The express diagnosis of the disorders and a scheme of the sequence of administration of hemostatic drugs are proposed. Mortality among such patients was reduced.

Prise en charge des traumatismes graves du rein

PubMed Central

Lakmichi, Mohamed Amine; Jarir, Redouane; Sadiki, Bader; Zehraoui; Bentani; Wakrim, Bader; Dahami, Zakaria; Moudouni; Sarf, Ismail

2015-01-01

Les traumatismes graves du rein de grade III, IV et V selon la classification de l'Amercan Society for Surgery For Trauma (ASST) sont plus rares et se retrouvent dans 5% des cas en moyenne. Leur prise en charge est souvent délicate, nécessitant alors des centres expérimentés dotés de moyen adéquats d'imagerie (scanner spiralé). Cependant, durant ces dernières années, la prise en charge de ces traumatismes a évolué vers une attitude de moins en moins chirurgicale grâce à l’évolution des techniques de la radiologie interventionnelle, de l'endourologie et des moyens de surveillance aux urgences et de réanimation. L'objectif de cette étude est d’évaluer notre expérience dans la prise en charge des traumatismes rénaux de haut grade. Notre étude rétrospective porte sur 25 cas de traumatismes grave du rein de grade III, IV et V selon la classification de l'ASST, colligés entre Janvier 2002 et Juin 2009 au service d'urologie du centre Hospitalier Universitaire Mohammed VI, Université Cadi Ayyad de Marrakech, Maroc. Nous avons étudié les données épidémiologiques, les signes cliniques et biologiques à l'admission (état de choc hémorragique, taux d'hémoglobine), les données radiologiques (échographie et scanner), les lésions associées, la prise en charge thérapeutique et les complications. L’âge moyen de nos patients était de 24,9 ans 15 et 58 ans, avec une prédominance masculine (sex-ratio = 7, 3). Le rein droit était intéressé dans 15 cas (60%). Le traumatisme rénal était fermé dans 15 cas, et ouvert par arme blanche dans 10 cas. Huit patients se sont présentés en état de choc hémorragique (32%). Une anémie inférieur à 10g /100ml a été observée dans 10 cas (40%). L'uroscanner fait systématiquement à l'admission a retrouvé un grade III (10 cas), grade IV (13 cas) et grade V (2 cas). La prise en charge a consisté en une exploration chirurgicale avec néphrectomie chez 2 cas de Grade IV pour une instabilité h

Automatic three-dimensional quantitative analysis for evaluation of facial movement.

PubMed

Hontanilla, B; Aubá, C

2008-01-01

The aim of this study is to present a new 3D capture system of facial movements called FACIAL CLIMA. It is an automatic optical motion system that involves placing special reflecting dots on the subject's face and video recording with three infrared-light cameras the subject performing several face movements such as smile, mouth puckering, eye closure and forehead elevation. Images from the cameras are automatically processed with a software program that generates customised information such as 3D data on velocities and areas. The study has been performed in 20 healthy volunteers. The accuracy of the measurement process and the intrarater and interrater reliabilities have been evaluated. Comparison of a known distance and angle with those obtained by FACIAL CLIMA shows that this system is accurate to within 0.13 mm and 0.41 degrees . In conclusion, the accuracy of the FACIAL CLIMA system for evaluation of facial movements is demonstrated and also the high intrarater and interrater reliability. It has advantages with respect to other systems that have been developed for evaluation of facial movements, such as short calibration time, short measuring time, easiness to use and it provides not only distances but also velocities and areas. Thus the FACIAL CLIMA system could be considered as an adequate tool to assess the outcome of facial paralysis reanimation surgery. Thus, patients with facial paralysis could be compared between surgical centres such that effectiveness of facial reanimation operations could be evaluated.

Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis.

PubMed

Panossian, Andre

2016-04-01

Free muscle transfer for dynamic smile reanimation in facial paralysis is not always predictable with regard to cosmesis. Hospital stays range from 5 to 7 days. Prolonged operative times, longer hospital stays, and excessive cheek bulk are associated with free flap options. Lengthening temporalis myoplasty offers single-stage smile reanimation with theoretical advantages over free tissue transfer. From 2012 to 2014, 18 lengthening temporalis myoplasties were performed in 14 children for smile reconstruction. A retrospective chart review was completed for demographics, operative times, length of hospital stay, and perioperative complications. Fourteen consecutive patients with complete facial paralysis were included. Four patients underwent single-stage bilateral reconstruction, and 10 underwent unilateral procedures. Diagnoses included Möbius syndrome (n = 5), posterior cranial fossa tumors (n = 4), posttraumatic (n = 2), hemifacial microsomia (n = 1), and idiopathic (n = 2). Average patient age was 10.1 years. Average operative time was 410 minutes (499 minutes for bilateral lengthening temporalis myoplasty and 373 for unilateral lengthening temporalis myoplasty). Average length of stay was 3.3 days (4.75 days for bilateral lengthening temporalis myoplasty and 2.8 for unilateral lengthening temporalis myoplasty). Nine patients required minor revisions. Lengthening temporalis myoplasty is a safe alternative to free tissue transfer for dynamic smile reconstruction in children with facial paralysis. Limited donor-site morbidity, shorter operative times, and shorter hospital stays are some benefits over free flap options. However, revisions are required frequently secondary to tendon avulsions and adhesions. Therapeutic, IV.

The undead in culture and science

PubMed Central

Nugent, Connie; Berdine, Gilbert; Nugent, Kenneth

2018-01-01

ABSTRACT The undead have a significant role in mythology, religion, folklore, and literature. In the 1800s, the word zombie was used to describe reanimated corpses in the Caribbean who often worked on plantations doing long, arduous field work. The movie White Zombie was released in 1932 and exploited this folklore, but it ignored the fact that zombies represent one outcome in Vodou religious beliefs regarding death and the migration of spirits following death. The interest in zombies eventually led to sociological and medical investigations into zombification. Wade Davis reported that powders used by malevolent priests (bokors) contained tetrodotoxin, which could cause the neurologic changes underlying the zombie phenotype. Recent clinical studies have indicated that synthetic cannabinoids and synthetic cathinones can cause bizarre zombie-like behavior. According to Haitian folklore, zombies can develop when bokors reanimate someone who suddenly died from an acute illness or who was purposely poisoned. Recent studies in molecular biology suggest that the sequence of programmed cell death can be reversed when the stressor is removed and that cells, tissues, and bodies (at least in Drosophila flies) can recover. These scientific studies would support the remote possibility that the near dead might recover under certain circumstances but have residual neuropsychological dysfunction. Alternatively, the bokors could maintain control of their victims using drugs with properties similar to those of synthetic cannabinoids. The concept of zombification needs to be considered in the context of culture, religion, and science. PMID:29706835

The undead in culture and science.

PubMed

Nugent, Connie; Berdine, Gilbert; Nugent, Kenneth

2018-04-01

The undead have a significant role in mythology, religion, folklore, and literature. In the 1800s, the word zombie was used to describe reanimated corpses in the Caribbean who often worked on plantations doing long, arduous field work. The movie White Zombie was released in 1932 and exploited this folklore, but it ignored the fact that zombies represent one outcome in Vodou religious beliefs regarding death and the migration of spirits following death. The interest in zombies eventually led to sociological and medical investigations into zombification. Wade Davis reported that powders used by malevolent priests (bokors) contained tetrodotoxin, which could cause the neurologic changes underlying the zombie phenotype. Recent clinical studies have indicated that synthetic cannabinoids and synthetic cathinones can cause bizarre zombie-like behavior. According to Haitian folklore, zombies can develop when bokors reanimate someone who suddenly died from an acute illness or who was purposely poisoned. Recent studies in molecular biology suggest that the sequence of programmed cell death can be reversed when the stressor is removed and that cells, tissues, and bodies (at least in Drosophila flies) can recover. These scientific studies would support the remote possibility that the near dead might recover under certain circumstances but have residual neuropsychological dysfunction. Alternatively, the bokors could maintain control of their victims using drugs with properties similar to those of synthetic cannabinoids. The concept of zombification needs to be considered in the context of culture, religion, and science.

Hypoglossal-facial-jump-anastomosis without an interposition nerve graft.

PubMed

Beutner, Dirk; Luers, Jan C; Grosheva, Maria

2013-10-01

The hypoglossal-facial-anastomosis is the most often applied procedure for the reanimation of a long lasting peripheral facial nerve paralysis. The use of an interposition graft and its end-to-side anastomosis to the hypoglossal nerve allows the preservation of the tongue function and also requires two anastomosis sites and a free second donor nerve. We describe the modified technique of the hypoglossal-facial-jump-anastomosis without an interposition and present the first results. Retrospective case study. We performed the facial nerve reconstruction in five patients. The indication for the surgery was a long-standing facial paralysis with preserved portion distal to geniculate ganglion, absent voluntary activity in the needle facial electromyography, and an intact bilateral hypoglossal nerve. Following mastoidectomy, the facial nerve was mobilized in the fallopian canal down to its bifurcation in the parotid gland and cut in its tympanic portion distal to the lesion. Then, a tensionless end-to-side suture to the hypoglossal nerve was performed. The facial function was monitored up to 16 months postoperatively. The reconstruction technique succeeded in all patients: The facial function improved within the average time period of 10 months to the House-Brackmann score 3. This modified technique of the hypoglossal-facial reanimation is a valid method with good clinical results, especially in cases of a preserved intramastoidal facial nerve. Level 4. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Localisation humérale d'une tumeur à cellules géantes récidivantes (à propos d'un cas)

PubMed Central

Nader, Youssef; Serghini, Issam; Koulali, Idrissi Khalid; Salahi, Hicham; Galwia, Farid

2015-01-01

Les auteurs rapportent un cas de localisation rare d'une tumeur à cellules géantes au niveau de la palette humérale du coude droit chez un militaire de 36 ans de sexe masculin, la radio standard montrait une image kystique ne soufflant pas la corticale. L'examen anatomo-pathologique a permis d’ établir le diagnostic et le traitement a fait appel: au début a une Exérèse chirurgicale totale et une greffe osseuse par un greffon iliaque de la totalité de la palette huméral qui s'est compliquée à 6 mois de recule d une récidive locale. PMID:25995809

[Psychobiosocial interventions for autism].

PubMed

Bölte, S

2011-05-01

A multitude of interventions is offered for the treatment of autism spectrum disorders (ASD). However, only few have demonstrated scientific evidence, and even the evaluated methods need further examination of their mechanisms and scope. This article provides a brief summary of the premises and principles of successful psychobiosocial ASD intervention. ABA, TEACCH, PECS, social skills and cognitive training are described as examples for established approaches to ASD. Training of μ-suppression using neurofeedback and reanimation of the fusiform gyrus and amygdala using computer-aided facial affect recognition training are introduced as neurobiologically based ASD interventions.

[Do you mean benchmarking?].

PubMed

Bonnet, F; Solignac, S; Marty, J

2008-03-01

The purpose of benchmarking is to settle improvement processes by comparing the activities to quality standards. The proposed methodology is illustrated by benchmark business cases performed inside medical plants on some items like nosocomial diseases or organization of surgery facilities. Moreover, the authors have built a specific graphic tool, enhanced with balance score numbers and mappings, so that the comparison between different anesthesia-reanimation services, which are willing to start an improvement program, is easy and relevant. This ready-made application is even more accurate as far as detailed tariffs of activities are implemented.

Mind, brain, body, and soul: a review of the electrophysiological undercurrents for Dr. Frankenstein.

PubMed

Kaplan, Peter W

2004-01-01

Mary Shelley's Frankenstein is perhaps the most famous work of medical science fiction. She and her husband, the poet Percy Shelley, were aware of nascent neuroscience experimentation and the effects of electricity on neuromuscular function. Such experiments generated theories of voluntary, involuntary, and unconscious neuromuscular function; animal electricity; and the anima--the human vital principle. In Germany and Italy, investigators were performing bizarre electrical experiments on animals and humans to "reanimate" lifeless limbs and bodies. These demonstrations and theories find expression in Frankenstein and provide models for Dr. Frankenstein and his creation.

[Nursing process in advanced cardiopulmonary resuscitation].

PubMed

Lucio Peña, Gerardo; Fuentes Leonardo, Ana María

2002-01-01

The process male nurse is a systematic and organized method to offer effective and efficient cares guided to the achievement of solving real problems of health, reducing the incidence and the duration. It is organized and systematic for that consists of five sequential and interrelated steps: Valuation, diagnostic, planning, execution and evaluation, in which are carried out interrelated actions, thought to maximize the long term results. The nurse process is based on the notion that the success of the cares is measured by the degree of effectiveness and the degree of satisfaction and the patient's progress. Applying this method in the Advanced Cardiac Live Support (ACLS) the identification of a cardiovascular or cardiopulmonary urgency was achieved that implies advanced treatment of the air road, defibrillation and appropriate medications to the circumstances. The ACLS challenges the nurses in charge from the patient's attention to make decisions quick low pressure and in dramatic scenes. Reason why it develops the flowing process male nurse in the advanced cardiopulmonary reanimation due to the incidence of these events in the National Institute of Cardiology Ignacio Chávez, which should guarantee the benefit of services in basic and advanced cardiopulmonary reanimation for personal with a high formation level in all the units of intensive cares and services of hospitalization in integrated form and stratified this way to avoid that it progresses to situations that cause the death or leave irreversible sequels since in the central nervous system the time it is a factor critical for the treatment of this events.

Tribe Building

DTIC Science & Technology

2010-04-01

9 All literacy rates are from “The world factbook”, CIA. 10 "Dictionnaire critique de la sociologie ", Boudon...Economie et Société, I, Plon, Paris, p. 298. 17 Ibid, p. 291. Sociologie des religions, Gallimard, Paris, p.374-375. 18 Georges Balandier... Sociologie actuelle de l’Afrique noire, Presses Universitaires de France, Paris, 1963, p. 390. 19 Kilcullen, The accidental guerrilla,op. cit., p. 50

Ventricule droit à double chambre (VDDC) isolé: à propos d'un cas au CNHU, Cotonou, Bénin

PubMed Central

Adjagba, Philippe Mahouna; Sonou, Arnaud; Tossa, Léhila Bagnan; Codjo, Léopold; Hounkponou, Murielle; Moutaïrou, Salimatou Assani; Kpossou, Yasmine Eyissè; Moussé, Latif; Tchabi, Yessoufou; Sacca, Jeanne Vehounkpé; Houénassi, Martin Dèdonougbo

2017-01-01

Le ventricule droit à double chambre (VDDC) est une malformation cardiaque rare dans laquelle le ventricule droit est divisé en deux chambres par une bande musculaire anormale. Il est associé dans 80 à 90% à d'autres malformations. L'expression clinique est variée et dépend de l'importance de l'obstruction intraventriculaire. Nous rapportons l'observation d'une adolescente de 16 ans, présentant une forme isolée de VDDC révélée par des syncopes à répétition. Le diagnostic est fait par l'échocardiographie Döppler. La résection chirurgicale de la bande musculaire anormale a été faite avec succès. PMID:28748009

Forme pseudo tumorale d'une pneumopathie chronique à éosinophiles d’évolution fatale

PubMed Central

Hammoune, Nabil; El Guendouz, Faycal; Elhaddad, Siham; Janah, Hicham; Hommadi, Abdelaziz

2015-01-01

La pneumopathie chronique idiopathique à éosinophile est une pathologie rare, de cause inconnue, caractérisée par des opacités pulmonaires périphériques, une éosinophilie périphérique >1000/mm3 et /ou une éosinophilie alvéolaire >25%. Le diagnostic est difficile à cause de la non spécificité des signes cliniques et radiologiques. Le traitement se base essentiellement sur la corticothérapie. L’évolution est généralement favorable. Nous rapportons un cas de cette entité rare dans sa forme pseudotumorale sans hyperéosinophilie, de diagnostic tardif suite à l’étude histologique de la lobectomie chirurgicale et d’évolution fatale. PMID:26113897

Contemporary management of Bell palsy.

PubMed

Jowett, Nate; Hadlock, Tessa A

2015-04-01

Bell palsy (BP) is the most common diagnosis in acute and chronic facial palsy. Although most patients fully recover, more than one-quarter will have residual dysfunction. Of these, nearly half will demonstrate severe limitations in facial expression. Though significant attention has been paid to acute management and prognosis, a paucity of literature exists addressing management of the long-term sequelae of BP. This article describes contemporary use of physical therapy, injectables, and static and dynamic surgical procedures in facial reanimation of acute and chronic BP. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[The complex approach to the rehabilitation of post-stroke patients with movement disorders in the early rehabilitation period].

PubMed

Khabirov, F A; Khaĭbullin, T I; Grigor'eva, O V

2011-01-01

We studied 110 patients, aged 34-71 years, in the early rehabilitation period after stroke who were admitted to a rehabilitation neurologic department of Kazan. The rehabilitation approach was based on the combination of several methods: kinesitherapy, transcranial magnetic stimulation and cerebrolysin treatment. This complex reanimation allowed to achieve the marked functional restoration of movement abilities in many cases that was correlated with the normalization of brain bioelectric activity (the increase of alpha-rhythm spectral power, the decrease of slow-wave EEG components). The combined use of these three methods was more effective than a combination of any two of them.

Annihilation and Reanimation of a Tornado in the Improved Tornado Tube

ERIC Educational Resources Information Center

Bednarek, Stanislaw

2016-01-01

Some new experiments using an improved version of the "tornado tube" are described here. The improved tornado tube consists of two plastic transparent bottles whose openings are connected with a ball valve, available at most hardware stores. After being filled with fluid and inverting, this tube allows demonstration of the generation,…

[Neurologic-psychiatric follow-up studies of reanimated tetanus patients (author's transl)].

PubMed

Samtleben, T

1977-01-21

During a study of sequela of intensive care therapy eight patients with longterm respirator treatment for severe tetanus infection were studied by neurologic-psychiatric examination two years or more after discharge from the hospital. Two out of four patients with permanent damage suffered from ankylosis of the hip joint caused by myositis ossificans. One patient showed hyperaesthetic-emotional syndrom and IQ-reduction caused by cardiac arrest. Two further patients were resuscitated from cardiac arrest without persisting psycho-physiological injury. A 70 year old man suffered from cardiopulmonary injury, lack of initiative and fatigability. None of the patients complained of depressing memories and all emphazised their pleasure of being alive. The permanent damage fation and not to the tetanus toxin per se. Improved techniques for tetanus patients on curare and artificial respiration may result in better therapeutical results in the future.

[Phenomenological anthropological social psychiatry--paving the way for a theoretical reanimation].

PubMed

Thoma, Samuel

2012-11-01

This article tries to link the present lack of theoretical discussion within German Social Psychiatry with a loss of phenomenological and anthropological thought. The so-called Phenomenological Psychiatry used to play a very important role in German psychiatry during the 50 ies until the 70 ies and had strong influences on the first reformers of German psychiatry, such as Walter Ritter von Baeyer, Heinz Häfner, Caspar Kulenkampff, Karl Peter Kisker and Erich Wulff. Their reforms were not only founded by a social criticism put forth by theories such as marxism (Basaglia, Wulff) or structuralism (Foucault) but also by a concrete notion of what it is like to suffer from mental illness and what kind of needs are linked to such suffering. This very notion was given by the phenomenological approach. Finally the article tries to give reasons for today's reciprocal loss of connection of the phenomenological and the socio-psychiatric school. © Georg Thieme Verlag KG Stuttgart · New York.

Re-animation of muscle flaps for improved function in dynamic myoplasty.

PubMed

Stremel, R W; Zonnevijlle, E D

2001-01-01

The authors report on a series of experiments designed to produce a skeletal muscle contraction functional for dynamic myoplasties. Conventional stimulation techniques recruit all or most of the muscle fibers simultaneously and with maximal strength. This approach has limitations in free dynamic muscle flap transfers that require the muscle to contract immediately after transfer and before re-innervation. Sequential stimulation of segments of the transferred muscle provides a means of producing non-fatiguing contractions of the muscle in the presence or absence of innervation. The muscles studied were the canine gracilis, and all experiments were acute studies in anesthetized animals. Comparison of conventional and sequential segmental neuromuscular stimulation revealed an increase in muscle fatigue resistance and muscle blood flow with the new approach. This approach offers the opportunity for development of physiologically animated tissue and broadening the abilities of reconstructive surgeons in the repair of functional defects. Copyright 2001 Wiley-Liss, Inc.

Facial reanimation with masseteric nerve: babysitter or permanent procedure? Preliminary results.

PubMed

Faria, Jose Carlos Marques; Scopel, Gean Paulo; Ferreira, Marcus Castro

2010-01-01

The authors are presenting a series of 10 cases of complete unilateral facial paralysis submitted to (I) end-to-end microsurgical coaptation of the masseteric branch of the trigeminal nerve and distal branches of the paralyzed facial nerve, and (II) cross-face sural nerve graft. The ages of the patients ranged from 5 to 63 years (mean: 44.1 years), and 8 (80%) of the patients were females. The duration of paralysis was no longer than 18 months (mean: 9.7 months). Follow-up varied from 6 to 18 months (mean: 12.6 months). Initial voluntary facial movements were observed between 3 and 6 months postoperatively (mean: 4.3 months). All patients were able to produce the appearance of a smile when asked to clench their teeth. Comparing the definition of the nasolabial fold and the degree of movement of the modiolus on both sides of the face, the voluntary smile was considered symmetrical in 8 cases. Recovery of the capacity to blink spontaneously was not observed. However, 8 patients were able to reduce or suspend the application of artificial tears. The authors suggest consideration of masseteric-facial nerve coaptation, whether temporary (baby-sitter) or permanent, as the principal alternative for reconstruction of facial paralysis due to irreversible nerve lesion with less than 18 months of duration.

Bibliography on Future Trends in Terrorism

DTIC Science & Technology

1998-09-01

Bernhard Restel, et alia. "La police en interfaces: Colloque universitaire de l’Institut Suisse de Police," Revue Internationale de Criminologie et...Convenzione di Ginevra per l’Istituzione di una Corte Penale Internazionale sul Terrorismo : Un document da tornare a leggere," Il Politico, [Rome], 62...The author, who is president of Peru , points out that terrorist organizations in Peru have struggled for a decade to erode the democratic system and

Traitement chirurgical initial des brûlures de la main de l’enfant. Revue

PubMed Central

Goffinet, L.; Breton, A.; Gavillot, C.; Barbary, S.; Journeau, P.; Lascombes, P.; Dautel, G.

2015-01-01

Summary Trente cinq revues concernant la prise en charge chirurgicale de la main brûlée de l’enfant sont indexées dans Pub- Med. Elles portent sur l’indication de la cicatrisation dirigée versus chirurgie, les techniques et délais d’instauration des traitements par excision-greffe, le calendrier et la nature du traitement de réadaptation et la surveillance. L’enfant présente un risque accru de brides cicatricielles, nécessitant un suivi médico-chirurgical attentif et prolongé. L’objet de cet article est de rapporter les spécificités chirurgicales de la prise en charge de ces brûlures. Cette revue de la littérature, réalisée au moyen de la base PubMed (publication entre 2005 et 2011) à partir des mots-clés « hand AND/OR child AND/OR burn » retrouve 67 publications utiles au sein de 171 références. Les données rapportées ont été comparées aux ouvrages de références français et américains. Des données contradictoires sont rapportées concernant la délai de l’excision et de la greffe, avec seulement deux études comparatives comportant de nombreux biais. L’état de la science n’apporte pas d’éléments de preuve suffisant en raison d’un manque de puissance statistique des études, mais de nombreux avis d’expert explorant chaque type d’indication permet d’établir une stratégie claire, guidant les indications thérapeutiques. Il apparaît donc indispensable de réaliser des études prospectives incluant ces patients depuis le suivi initial jusqu’au suivi à long terme, pour augmenter le niveau de preuve de cette stratégie. PMID:27279807

Peut-on améliorer la motivation des étudiants en médecine pour un cours fondamental de physiologie en intégrant à l’exposé magistral quelques méthodes pédagogiques actives?

PubMed Central

Bentata, Yassamine; Delfosse, Catherine

2017-01-01

La motivation des étudiants est une condition essentielle à l’apprentissage et la perception qu’a l’étudiant de la valeur qu’il accorde à une activité est l’une des trois composantes majeures de cette motivation. Comment amener les étudiants à percevoir l’utilité et l’intérêt de leurs cours universitaires tout en suscitant leur motivation ? L’objectif de l’étude est de déterminer la perception de la valeur attribuée par les étudiants au cours fondamental de physiologie et d’évaluer l’impact de l’intégration de quelques méthodes d’apprentissage actif aux exposés magistraux sur la motivation des étudiants du premier cycle des études médicales dans une jeune faculté. Cette étude prospective, a concerné les étudiants de deuxième année de médecine (PCEM2). Nous avons procédé initialement à une appréciation de la perception de la motivation des étudiants pour les cours universitaires via un premier questionnaire, après nous avons intégré deux activités pédagogiques: l’étude de cas et la réalisation de carte conceptuelle aux exposés magistraux du module de physiologie et à la fin nous avons évalué via un deuxième questionnaire l’impact de ces deux activités sur la motivation des étudiants. 131 et 109 étudiants ont rempli et rendu respectivement le 1er et le 2ème questionnaire parmi les 249 étudiants inscrits en PCEM2. La motivation de nos étudiants à l’égard de leurs cours universitaires était globalement très favorable, même si la motivation pour le cours de physiologie (70,8%) était légèrement moins importante que pour l’ensemble des cours (80%). Nos étudiants avaient apprécié les deux activités proposées et seulement 13% (pour l’étude de cas) et 16,8% (pour la carte) ne se montraient pas satisfaits. 40,9% des étudiants avaient réalisé une carte conceptuelle et la qualité de ces productions, jugée sur l’identification des concepts et des liens inter concepts, �

[Refusal of care in the intensive care: how makes decision?].

PubMed

Borel, M; Veber, B; Villette-Baron, K; Hariri, S; Dureuil, B; Hervé, C

2009-11-01

Decision-making bringing to an admission or not in intensive care is complex. The aim of this study is to analyze with an ethical point of view the making decision process leading to the refusal and its consequences. It is proposed a setting in prospect through the principles of beneficence, non-maleficience, respect for autonomy, justice, and the Leonetti law. Prospective study in surgical reanimation at the University Hospital of Rouen over 9 months (November 2007-September 2008). Systematic collection for each non-admitted patient of the general characters, the methods of decision making, immediate becoming and within 48 h Constitution of two groups: patients for whom an admission in intensive care could be an unreasonable situation of obstinacy, and patients for whom an admission in reanimation would not be about unreasonable if it occurred. One hundred and fifty situations were analyzed. The potentially unreasonable character of an admission does not involve necessarily a refusal of care in intensive care. The question of the lack of place and equity in the access to the care is real but relative according to the typology of the patients. The research of the respect of the autonomy of the patient is difficult but could be facilitated. The Leonetti law does not appear to be able to be a framework with the situation of refusal of care in intensive care. It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.

Outcome of different facial nerve reconstruction techniques.

PubMed

Mohamed, Aboshanif; Omi, Eigo; Honda, Kohei; Suzuki, Shinsuke; Ishikawa, Kazuo

There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. To evaluate the efficacy and safety of different facial nerve reconstruction techniques. Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Cervical intraspinal microstimulation evokes robust forelimb movements before and after injury

NASA Astrophysics Data System (ADS)

Sunshine, Michael D.; Cho, Frances S.; Lockwood, Danielle R.; Fechko, Amber S.; Kasten, Michael R.; Moritz, Chet T.

2013-06-01

Objective. Intraspinal microstimulation (ISMS) is a promising method for reanimating paralyzed limbs following neurological injury. ISMS within the cervical and lumbar spinal cord is capable of evoking a variety of highly-functional movements prior to injury, but the ability of ISMS to evoke forelimb movements after cervical spinal cord injury is unknown. Here we examine the forelimb movements and muscles activated by cervical ISMS both before and after contusion injury. Approach. We documented the forelimb muscles activated and movements evoked via systematic stimulation of the rodent cervical spinal cord both before injury and three, six and nine weeks following a moderate C4/C5 lateralized contusion injury. Animals were anesthetized with isoflurane to permit construction of somatotopic maps of evoked movements and quantify evoked muscle synergies between cervical segments C3 and T1. Main results. When ISMS was delivered to the cervical spinal cord, a variety of responses were observed at 68% of locations tested, with a spatial distribution that generally corresponded to the location of motor neuron pools. Stimulus currents required to achieve movement and the number of sites where movements could be evoked were unchanged by spinal cord injury. A transient shift toward extension-dominated movements and restricted muscle synergies were observed at three and six weeks following injury, respectively. By nine weeks after injury, however, ISMS-evoked patterns were similar to spinally-intact animals. Significance. The results demonstrate the potential for cervical ISMS to reanimate hand and arm function following spinal cord injury. Robust forelimb movements can be evoked both before and during the chronic stages of recovery from a clinically relevant and sustained cervical contusion injury.

[Resuscitation of vital activity after cold arrest of respiration by physiological methods without rewarming the body].

PubMed

Ivanov, K P

2014-01-01

The arrest of respiration during deep hypothermia means death, though at a low temperature the heart may rhythmically contract for 30-40 minutes more. The attempts of rewarming only shorten the time before the heart arrest. Calcium ions (Ca2+) are believed to accumulate in the nervous cells in cold. An excess of these ions inhibits the metabolism. Moreover it stimulates the cell proteases, which destroy the cell membranes. The aim of the study was to make the the attempts to develop the methods of stimulating the respiration and heart without rewarming the body. The work was carried out on wite rats 250-320g in weight. We introduced disodium salt of ethylenediaminetetraacetic acid into the animals. The second method of blocking the mechanisms of the cold death was artificial respiration. Ethylenediaminetetraacetic acid reacts with calcium ions, decreases their quantity in the blood, and, consequently, in a complex manner in the cell protoplasm. Artificial respiration not only increases the flow of oxygen into an organism but also decreases the lowest temperature threshold of the cold death of an organism. A decrease in the surviving threshold by 1.5-1.8 degrees C is very important from the point of view of reanimation of an organism since to preserve life in the critical period of reanimation each 0.5 degrees C are important. Prolongation of minimal frequency of heart contractions and maintaining a minimal arterial blood pressure in an overcooled organism given the body temperature of 11-12.5 degrees C is a special problem of great interest associated with many physiological and biological parameters.

Schwannome bénin du nerf grand sciatique, à propos de 2 cas

PubMed Central

Chahbouni, Mohammed; Eloukili, Issam; Berrady, Mohamed Ali; Lamrani, Moulay Omar; Kharmaz, Mohamed; Ismail, Farid; Mahfoud, Mustapha; El Bardouni, Ahmed; Berrada, Mohamed Saleh; El Yaacoubi, Mouradh

2014-01-01

Les tumeurs primitives des nerfs périphériques représentent 1 à 2% des tumeurs des tissus mous. Les schwannomes sont en règle des tumeurs isolées de taille modérée et de croissance lente. Il convient de distinguer le schwannomes bénin et le neurofibrome des tumeurs malignes survenant généralement au cours d'une maladie de Recklinghausen. L'IRM permet d'orienter le diagnostic en mettant en évidence une tumeur de même signal que le tissu musculaire. Le traitement idéal de ces tumeurs consiste en une énucléation chirurgicale avec dissection soigneuse des faisceaux nerveux avoisinants. Nous rapportons deux cas d'un schwannome bénin développé aux dépens du nerf grand sciatique. PMID:25489357

Postparalysis Facial Synkinesis: Clinical Classification and Surgical Strategies

PubMed Central

Chang, Tommy Nai-Jen; Lu, Johnny Chuieng-Yi

2015-01-01

Background: Postparalysis facial synkinesis (PPFS) can occur after any cause of facial palsy. Current treatments are still inadequate. Surgical intervention, instead of Botox and rehabilitation only, for different degrees of PPFS was proposed. Methods: Seventy patients (43 females and 27 males) with PPFS were enrolled since 1986. They were divided into 4 patterns based on quality of smile and severity of synkinesis. Data collection for clinically various presentations was made: pattern I (n = 14) with good smile but synkinesis, pattern II (n = 17) with acceptable smile but dominant synkinesis, pattern III (n = 34) unacceptable smile and dominant synkinesis, and pattern IV (n = 5) poor smile and synkinesis. Surgical interventions were based on patterns of PPFS. Selective myectomy and some cosmetic procedures were performed for pattern I and II patients. Extensive myectomy and neurectomy of the involved muscles and nerves followed by functioning free-muscle transplantation for facial reanimation in 1- or 2-stage procedure were performed for pattern III and many pattern II patients. A classic 2-stage procedure for facial reanimation was performed for pattern IV patients. Results: Minor aesthetic procedures provided some help to pattern I patients but did not cure the problem. They all had short follow-up. Most patients in patterns II (14/17, 82%) and III (34/34, 100%) showed a significant improvement of eye and smile appearance and significant decrease in synkinetic movements following the aggressively major surgical intervention. Nearly, all of the patients treated by the authors did not need repeated botulinum toxin A injection nor require a profound rehabilitation program in the follow-up period. Conclusions: Treatment of PPFS remains a challenging problem. Major surgical reconstruction showed more promising and long-lasting results than botulinum toxin A and/or rehabilitation on pattern III and II patients. PMID:25878931

Facial neuroma masquerading as acoustic neuroma.

PubMed

Sayegh, Eli T; Kaur, Gurvinder; Ivan, Michael E; Bloch, Orin; Cheung, Steven W; Parsa, Andrew T

2014-10-01

Facial nerve neuromas are rare benign tumors that may be initially misdiagnosed as acoustic neuromas when situated near the auditory apparatus. We describe a patient with a large cystic tumor with associated trigeminal, facial, audiovestibular, and brainstem dysfunction, which was suspicious for acoustic neuroma on preoperative neuroimaging. Intraoperative investigation revealed a facial nerve neuroma located in the cerebellopontine angle and internal acoustic canal. Gross total resection of the tumor via retrosigmoid craniotomy was curative. Transection of the facial nerve necessitated facial reanimation 4 months later via hypoglossal-facial cross-anastomosis. Clinicians should recognize the natural history, diagnostic approach, and management of this unusual and mimetic lesion. Copyright © 2014 Elsevier Ltd. All rights reserved.

Intérêt de l’algorithme rocuronium - sugammadex dans la laryngoscopie directe en suspension

PubMed Central

El jaouhari, Sidi Driss; Meziane, Mohamed; Ahtil, Redouane; Bensghir, Mustapha; Haimeur, Charki

2017-01-01

La laryngoscopie directe en suspension est un geste chirurgical diagnostique et/ou thérapeutique des lésions endo-laryngées. Sa gestion anesthésique est compliquée. Différentes techniques anesthésiques peuvent être proposées. Malgré les contraintes, les curares gardent tout leur intérêt. L’association rocuronium et sugammadex est envisageable, elle permet une inversion rapide du bloc neuromusculaire profond et par conséquent une réduction de la morbidité postopératoire. Nous rapportons un cas d’une laryngoscopie directe en suspension réalisée sous anesthésie générale dont l’utilisation de l’association rocuronium-sugammadex a permis une facilité du geste chirurgicale, une sécurité pour le patient et un confort pour l’anesthésiste. PMID:28690746

Reanimating the Vital Center: Challenges and Opportunities in the Regional Talent Development Pipeline

ERIC Educational Resources Information Center

Austin, John

2012-01-01

The mighty heartland of the United States, the American Midwest, is certainly struggling economically. This region was the epicenter of America's industrial revolution, the arsenal of democracy in World War II, and the builder of the great blue-collar middle class that personified the American Dream. This important region made America a global…

Acute repair of traumatic pan-brachial plexus injury: technical considerations and approaches.

PubMed

Abou-Al-Shaar, Hussam; Karsy, Michael; Ravindra, Vijay; Joyce, Evan; Mahan, Mark A

2018-01-01

Particularly challenging after complete brachial plexus avulsion is reestablishing effective hand function, due to limited neurological donors to reanimate the arm. Acute repair of avulsion injuries may enable reinnervation strategies for achieving hand function. This patient presented with pan-brachial plexus injury. Given its irreparable nature, the authors recommended multistage reconstruction, including contralateral C-7 transfer for hand function, multiple intercostal nerves for shoulder/triceps function, shoulder fusion, and spinal accessory nerve-to-musculocutaneous nerve transfer for elbow flexion. The video demonstrates distal contraction from electrical stimulation of the avulsed roots. Single neurorrhaphy of the contralateral C-7 transfer was performed along with a retrosternocleidomastoid approach. The video can be found here: https://youtu.be/GMPfno8sK0U .

[Botulism, a clinical diagnosis].

PubMed

Delbos, Valérie; Abgueguen, Pierre; Fanello, Serge; Brenet, Olivier; Alquier, Philippe; Granry, Jean-Claude; Pichard, Eric

2005-03-26

Foodborne botulism results from the effect of a neurotoxin produced by a sporulated anaerobic bacillus called Clostridium botulinum. The mode of contamination occurs through the consumption of foodstuff, already contaminated by the neurotoxin. Following an incubation period that varies from 2 hours to 8 days, the symptoms start with intestinal problems. Then paralysis of the cranial nerve pairs sets in, classically manifested by diplopia, dysphagia, dysphonia, areactive mydriasis and ptosis. The onset of motor disorders occurs in descending order with possible involvement of the respiratory muscles, hence requiring reanimation measures and sometimes mechanical ventilation. The diagnosis of botulism is clinical. Identification of the botulinum toxin in the blood or faeces of the patients or in the contaminating food stuff confirms the diagnosis.

[Respect and tutelage of children in Christianity].

PubMed

Leone, Salvino; Lo Giudice, Milena

2005-01-01

Christian religion, since its beginning, has been strongly interested about infant world, in defending and promoting it. Evangelic stories show Jesus' attention for children even against his disciples and the current culture of that very time that didn't consider them in a special way. Some of healing miracles and most of reanimation ones have, as characters, just children or young people. This particular care has continued after in ecclesial life by the creation of many charitable institutions for children and, recently, also in an sort of re-arrangement of Christian thought about bioethical problems, most of which are really shared with not Christian world. Nevertheless some of them present several patterns (an-encephaly, neonatal care, assisted reproduction, etc.) involving some specific considerations discussed by Authors.

Une urgence médico-chirurgicale rare: l’abcès épidural rachidien (à propos de 03 cas)

PubMed Central

Saqui, Abderrazzak El; Aggouri, Mohamed; Benzagmout, Mohamed; Chakour, Khalid; Chaoui, Mohamed El Faiz

2017-01-01

Les infections de l’espace épidural sont de mieux en mieux connues grâce au développement de la neurochirurgie, notamment l’IRM. Les abcès épiduraux rachidiens représentent une pathologie rare mais éminemment grave sur le plan fonctionnel, avec un risque vital potentiel. Nous rapportons trois cas d’abcès épidural rachidien tous diagnostiqués chez des patients de sexe masculin, le premier âgé de 52 ans le deuxième de 57 ans et le troisième de 63ans. Deux patients ont été admis aux urgences neurochirurgicales pour un tableau de compression médullaire lente évoluant dans un contexte infectieux, et le dernier se plaignait d’une sciatique S1 droite rebelle au traitement avec des fuites urinaires. Aucune porte d’entrée n’a été identifiée dans le bilan initial. Tous les patients ont été opérés par voie d’abord postérieure avec décompression médullaire/radiculaire et évacuation de l’abcès épidural. L’étude bactériologique a trouvé un germe pyogène justifiant une antibiothérapie adaptée dans les trois cas. L’évolution a été favorable dans deux cas. Par contre un patient est décédé trois jours en post-opératoire par un sepsis sévère. PMID:28533868

Insulinome de haut grade découvert après 5 ans d’hypoglycémies graves

PubMed Central

Anoun, Nadia; Hasnaoui, Hamza; Hassani, Firdaous Ameziane; Idrissi, Mehdi Bourakkadi; Ousadden, Abdelmalek; Ouahabi, Hanan El; Taleb, Khalid Ait

2017-01-01

Les tumeurs endocrines fonctionnelles du pancréas sont des lésions rares, parmi lesquelles les insulinomes sont les plus fréquents. La majorité des patients atteints d'insulinome ont entre 30 et 60 ans et 59% d'entre eux sont des femmes. La plupart des insulinomes sont sporadiques, alors que 10% sont développés chez des patients atteints de NEM. Le diagnostic repose sur la clinique et sur le bilan biologique. Le bilan d'imagerie préopératoire (Echo-endoscopie, TDM, IRM) est essentiel localisant la tumeur dans plus de 80% des cas. Le traitement de référence est l'exérèse chirurgicale de la tumeur. Nous rapportons ici un cas d'insulinome de haut grade développé sur la face antérieure de la queue du pancréas chez une patiente de 50 ans. PMID:28979651

Une fistule recto-vaginale rentrant dans le cadre d'un syndrome de Currarino

PubMed Central

Idrissi, Mounia Lakhdar; Babakhoya, Abdeladim; Bouabdellah, Youssef; Hida, Mostapha

2011-01-01

Le syndrome de Currarino (SC) est défini par une triade rassemblant une malformation ano-rectale, une agénésie sacrée et une tumeur pré-sacrée. Nous rapportons le cas d'une fille de 4 ans et demi ayant été admise en consultation de gastro-entérologie pédiatrique pour constipation avec issue de selle à travers un orifice vulvaire. La radiographie du rachis avait montré une agénésie sacrée. Le fistulo-scanner a mis en évidence une fistule recto-vaginale et l'IRM pelvienne a confirmé l'agénésie sacrée et a retrouvé une méningocèle antérieure. La découverte d'une malformation ano-rectale doit faire chercher une autre anomalie de la triade de Currarino. Cette affection, rare, nécessite une prise en charge médico-chirurgicale assez complexe. PMID:22384297

[The treatment of extremity bone fractures in the cases of combined injuries].

PubMed

Peshekhonov, E V; Galin, V I; Zudilin, A V; Zubok, D N

2006-12-01

The experience of treatment of 76 injured with fractures of two or more extremities in combination with affection of other anatomical areas (head, abdomen, breast, pelvis) was summarized. The extrafocal osteosynthesis was preferable because this method is characterized by low traumatism, minimal blood loss, adequate reposition, stable immobilization and possibility of early load in the apparatus of external fixation. Immersed osteosynthesis is used with great caution as it can cause the development of fat embolism. One-stage operations were performed in 26.3% victims. Their treatment periods were significantly shorter than during the multi-stage operations. One-stage operations for polytrauma have the following advantages over the multi-stage operations: single narcosis, simplified treatment in reanimation department, one post-operation period, quick rehabilitation and economic benefit. The extrafocal osteosynthesis causes less purulent complications.

Facial Nerve Trauma: Evaluation and Considerations in Management

PubMed Central

Gordin, Eli; Lee, Thomas S.; Ducic, Yadranko; Arnaoutakis, Demetri

2014-01-01

The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm. PMID:25709748

Etiologie Rare de Sinusites Nosocomiales en Milieu de Reanimation - A Propos d'une Observation

PubMed Central

Messadi, A.A.; Oueslati, S.; Thabet, L.; Bousselmi, K.; Menif, E.

2006-01-01

Summary Les sinusites nosocomiales ne sont pas rares en réanimation. Elles surviennent en général dans les suites d'une intubation nasotrachéale voire même orotrachéale. Le tubage gastrique peut être à lui seul à l'origine d'une sinusite nosocomiale. Nous rapportons le cas d'une patiente hospitalisée qui a été victime de brûlures étendues chez qui la sonde nasogastrique a été à l'origine d'une pansinusite dont l'issue a été fatale. PMID:21991055

[Community pharmacy and general internal medicine are at the same crossroads: some opportunities should be seized].

PubMed

Bugnon, O; Buchmann, M

2012-11-28

The medicines give some symptoms relief and save lives every day. However, the responsible use of medicines is not definitively attained for the modern health systems. The shortcomings in this area are the cause of major negative clinical outcomes for the patients and the cause of additional cost for the health financing system. The two centenarians, as the International Pharmaceutical Federation (FIP) and the "Policlinique Médicale Universitaire (PMU)" in Lausanne, preview the solutions from now on for reversing this trend, such as the interdisciplinary collaborative approaches, the introduction of adequate financial incentives and the strengthening of education and research in community medicine, pharmacy and health.

Instability patterns in a miscible core annular flow

NASA Astrophysics Data System (ADS)

D'Olce, Marguerite; Martin, Jerome; Rakotomalala, Nicole; Salin, Dominique; Talon, Laurent

2006-11-01

Laboratoire FAST, batiment 502, campus universitaire, 91405 Orsay Cedex (France). Experiments are performed with two miscible fluids of equal density but different viscosities. The fluids are injected co-currently and concentrically into a cylindrical pipe. The so-obtained base state is an axisymmetric parallel flow, for which the ratio of the flow rates of the two fluids monitors the relative amount (and so the radius) of the fluids. Depending on this relative amount and on the total flow rate of the fluids, unstable axisymmetric patterns such as mushrooms and pearls are observed. We delineate the diagram of occurrence of the two patterns and characterize the instabilities.

An ESA Robotic Package to Search for Life on Mars

NASA Technical Reports Server (NTRS)

Westall, F.; Brack, A.; Clancy, P.; Hofmann, B.; Horneck, G.; Kurat, G.; Maxwell, J.; Ori, G. G.; Pillinger, C.; Raulin, F.

1999-01-01

Similarities in the early histories of Mars and Earth suggest that life may have arisen on Mars as it did on Earth. The early life forms on Mars were probably simple organisms, similar to terrestrial prokaryotes. In fact, given the early deterioration of the Martian climate, it is unlikely that life on Mars could ever have reached more sophisticated evolution. Based on the present knowledge of Mars, the possibility of extant life at the surface is small. However, given the adaptability of terrestrial prokaryotes under adverse conditions, it is not excluded. Any extant life is hypothesized to reside in the permafrost in a dormant state until "reanimated" by impact-caused hydrothermal activity. Using this rationale, a group of European scientists worked together to conceive a hypothetical strategy to search for life on Mars. A possible configuration for a lander/rover is outlined.

Re-Animating the Mathematical Concept: A Materialist Look at Students Practicing Mathematics with Digital Technology

ERIC Educational Resources Information Center

Chorney, Sean

2017-01-01

This paper proposes a philosophical approach to the mathematical engagement involving students and a digital tool. This philosophical proposal aligns with other theories of learning that have been implemented in mathematics education but rearticulates some metaphors so as to promote insight and ideas to further support continued investigations…

Combat Fluid Resuscitation Interoperable Capability (Capacite Interoperable de Liquides de Reanimation en Situation de Combat)

DTIC Science & Technology

2010-10-01

biological samples from 120 patients (generating > 1 million data points) for the determination of biomarkers. An independent Data Safety and...total of 2,184 patients (853 Shock patients and 1,331 TBI patients). Concurrently, DRDC analyzed over 500 biological samples obtained from 120...Center for Biologics Evaluation and Research and Office of Blood Research and Review. The FDA also reviewed the plan for community notification and

Physostigmine and Methylphenidate Induce Distinct Arousal States During Isoflurane General Anesthesia in Rats.

PubMed

Kenny, Jonathan D; Chemali, Jessica J; Cotten, Joseph F; Van Dort, Christa J; Kim, Seong-Eun; Ba, Demba; Taylor, Norman E; Brown, Emery N; Solt, Ken

2016-11-01

Although emergence from general anesthesia is clinically treated as a passive process driven by the pharmacokinetics of drug clearance, agents that hasten recovery from general anesthesia may be useful for treating delayed emergence, emergence delirium, and postoperative cognitive dysfunction. Activation of central monoaminergic neurotransmission with methylphenidate has been shown to induce reanimation (active emergence) from general anesthesia. Cholinergic neurons in the brainstem and basal forebrain are also known to promote arousal. The objective of this study was to test the hypothesis that physostigmine, a centrally acting cholinesterase inhibitor, induces reanimation from isoflurane anesthesia in adult rats. The dose-dependent effects of physostigmine on time to emergence from a standardized isoflurane general anesthetic were tested. It was then determined whether physostigmine restores righting during continuous isoflurane anesthesia. In a separate group of rats with implanted extradural electrodes, physostigmine was administered during continuous inhalation of 1.0% isoflurane, and the electroencephalogram changes were recorded. Finally, 2.0% isoflurane was used to induce burst suppression, and the effects of physostigmine and methylphenidate on burst suppression probability (BSP) were tested. Physostigmine delayed time to emergence from isoflurane anesthesia at doses ≥0.2 mg/kg (n = 9). During continuous isoflurane anesthesia (0.9% ± 0.1%), physostigmine did not restore righting (n = 9). Blocking the peripheral side effects of physostigmine with the coadministration of glycopyrrolate (a muscarinic antagonist that does not cross the blood-brain barrier) produced similar results (n = 9 each). However, during inhalation of 1.0% isoflurane, physostigmine shifted peak electroencephalogram power from δ (<4 Hz) to θ (4-8 Hz) in 6 of 6 rats. During continuous 2.0% isoflurane anesthesia, physostigmine induced large, statistically significant decreases in BSP

Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland

PubMed Central

Lelubre, Mélanie; Kamal, Susan; Genre, Noëllie; Celio, Jennifer; Gorgerat, Séverine; Hugentobler Hampai, Denise; Bourdin, Aline; Berger, Jerôme; Bugnon, Olivier; Schneider, Marie

2015-01-01

The Community Pharmacy of the Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire, PMU), University of Lausanne, developed and implemented an interdisciplinary medication adherence program. The program aims to support and reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic monitors (MEMS, Aardex MWV) and a report to patient, physician, nurse, and other pharmacists. This program has become a routine activity and was extended for use with all chronic diseases. From 2004 to 2014, there were 819 patient inclusions, and 268 patients were in follow-up in 2014. This paper aims to present the organization and program's context, statistical data, published research, and future perspectives. PMID:26839879

[The Gang of Six Demands more Freedom. Juvenile Offenders Interned in Saint-Jean-de-Dieu, Mid-20th Century].

PubMed

Desmeules, Martin; Thifault, Marie-Claude

In recent years, we have worked with many psychiatric records kept by the Archive Services of the Institut universitaire en santé mentale de Montréal (IUSMM). The proposed article is focused on the February 12th 1959 document Assemblée des médecins located within the records of six illegitimate children admitted to the Hôpital Saint-Jean-de-Dieu in the late 1950s. Our study, inspired by the work of historian Roy Porter and his approach from below, contributes to the historical discourse seeking to incorporate patient's voices, in this case, a gang of young offenders identified by a life course shaped by repeated institutional experience.

Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland.

PubMed

Lelubre, Mélanie; Kamal, Susan; Genre, Noëllie; Celio, Jennifer; Gorgerat, Séverine; Hugentobler Hampai, Denise; Bourdin, Aline; Berger, Jerôme; Bugnon, Olivier; Schneider, Marie

2015-01-01

The Community Pharmacy of the Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire, PMU), University of Lausanne, developed and implemented an interdisciplinary medication adherence program. The program aims to support and reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic monitors (MEMS, Aardex MWV) and a report to patient, physician, nurse, and other pharmacists. This program has become a routine activity and was extended for use with all chronic diseases. From 2004 to 2014, there were 819 patient inclusions, and 268 patients were in follow-up in 2014. This paper aims to present the organization and program's context, statistical data, published research, and future perspectives.

[Anaphylactic shock due to patent blue: four case report and review of literature].

PubMed

Lucas, N; Interne, S Benay; Laine, P; Nicolie, B; Fondrinier, E

2010-04-01

Description of four cases of anaphylactic shock with blue dye injection (bleu patenté V Guerbet 2.5%) during sentinel node biopsy for breast cancer. Women with breast carcinoma and combined approach with radioactive tracer and blue patent injection. Four cases were observed, which means an incidence of 0.57%. We report one case of grade II anaphylactic reaction and three cases of grade III requiring active reanimation and adrenaline perfusion. One patient developed a pulmonary embolism during the postoperative period, but no death was observed. We find an incidence of 1.06% of allergy but only 0.25% of anaphylactic shock (grade III). These rare but serious cases must weigh up the benefits and risks of using blue dye. We suggest using blue dye injection only in case of radioisotope detection failure. Of course, this approach must be evaluated. (c) 2009 Elsevier Masson SAS. All rights reserved.

Comparison of hemihypoglossal-facial nerve transposition with a cross-facial nerve graft and muscle transplant for the rehabilitation of facial paralysis using the facial clima method.

PubMed

Hontanilla, Bernardo; Vila, Antonio

2012-02-01

To compare quantitatively the results obtained after hemihypoglossal nerve transposition and microvascular gracilis transfer associated with a cross facial nerve graft (CFNG) for reanimation of a paralysed face, 66 patients underwent hemihypoglossal transposition (n = 25) or microvascular gracilis transfer and CFNG (n = 41). The commissural displacement (CD) and commissural contraction velocity (CCV) in the two groups were compared using the system known as Facial clima. There was no inter-group variability between the groups (p > 0.10) in either variable. However, intra-group variability was detected between the affected and healthy side in the transposition group (p = 0.036 and p = 0.017, respectively). The transfer group had greater symmetry in displacement of the commissure (CD) and commissural contraction velocity (CCV) than the transposition group and patients were more satisfied. However, the transposition group had correct symmetry at rest but more asymmetry of CCV and CD when smiling.

The benefits of the Atlas of Human Cardiac Anatomy website for the design of cardiac devices.

PubMed

Spencer, Julianne H; Quill, Jason L; Bateman, Michael G; Eggen, Michael D; Howard, Stephen A; Goff, Ryan P; Howard, Brian T; Quallich, Stephen G; Iaizzo, Paul A

2013-11-01

This paper describes how the Atlas of Human Cardiac Anatomy website can be used to improve cardiac device design throughout the process of development. The Atlas is a free-access website featuring novel images of both functional and fixed human cardiac anatomy from over 250 human heart specimens. This website provides numerous educational tutorials on anatomy, physiology and various imaging modalities. For instance, the 'device tutorial' provides examples of devices that were either present at the time of in vitro reanimation or were subsequently delivered, including leads, catheters, valves, annuloplasty rings and stents. Another section of the website displays 3D models of the vasculature, blood volumes and/or tissue volumes reconstructed from computed tomography and magnetic resonance images of various heart specimens. The website shares library images, video clips and computed tomography and MRI DICOM files in honor of the generous gifts received from donors and their families.

[Post traumatic injuries of the duodenum and/or pancreas. Perioperative management].

PubMed

Beye, M D; Kane, O; Diouf, E; Ndoye, M D; Ndiaye, P I; Fall, B; Sall, B K

2002-01-01

The duodenal and/or pancreatic lesions rarely occur during abdominal contusions, this, because of the deep and retroperitoneal position of the duodeno-pancreatic entity. These lesions occur mostly in the young adults and occur mostly on violent trauma, hence the high frequency of associated lesions. Their management is well codified and the prognosis depends on the degree of pancreatic damage. The authors reporting of 3 cases of duodenaland or post-traumatic lesion, in a retrospective study. The after therapeutic management necessitated a pre-operative reanimation, simple duodenal suturing in the 3 cases with relearning gastrotomy, alimentation jejenostomy and closing of thepyloric sphincter,with association of cholostomy in one of the cases. The pancreatic lesions of type contusion observed in 2 cases necessitated simple drainage of the pancreatic sector without resection. The evolution was favourable in 2 cases. One case of death was noted in a patient who developed acute pancreatis.

Ostéogenèse imparfaite: à propos de quatre cas à Ouagadougou (Burkina Faso)

PubMed Central

Kaboré, Aïssata; Cissé, Aissata; Yonaba, Caroline; Savadogo, Hamidou; Ouédraogo, Sylvie Armelle; Dao, Lassina; Kaboret, Sonia; Nagalo, Kisito; Koueta, Fla; Bandré, Emile; Yé, Diarra; Kam, Ludovic

2015-01-01

L'ostéogenèse imparfaite (OI) regroupe un ensemble d'affections constitutionnelles de gravité variable dû à une anomalie de la production du collagène et de la matrice de l'os entraînant une fragilité osseuse. La présente étude rapporte quatre cas d'ostéogenèse imparfaite suivis aux Centres Hospitaliers Universitaires Charles de Gaulle et Yalgado Ouédraogo. Le but de ce travail était d'analyser les aspects cliniques, thérapeutiques et évolutifs de la maladie. Cette étude souligne la nécessité d'améliorer la prise en charge de cette maladie rare mais non exceptionnelle et handicapante. PMID:26834922

[Health disparities: local realities and future challenges].

PubMed

Bodenmann, P; Green, A R

2012-11-28

Since 1887, the Policlinique Médicale Universitaire (PMU) has brought care to vulnerable populations who are at risk of poor physical, mental and social health. These include marginalised Swiss natives and immigrant communities (asylum seekers, undocumented immigrants). These patients are at risk of health disparities given their poor access to the health care system and lack of adapted quality care. Clinical approach must address these potential disparities, reinforced by a research describing them in order to explain their cause, and propose possible solutions, and a medical training addressing these topics from the undergraduate to the attending level. Through those holistic clinical approach, robust research and improved medical training, health providers will contribute to give quality care to all citizens, without exception!

[The organizational aspects of treating light casualties in modern warfare (2)].

PubMed

Nechaev, E A; Maksimov, G K; Agapov, V K; Golov, Iu S

1993-07-01

The experience gathered by Medical Service during the war in Afghanistan and during liquidation of the consequences of various disasters and accidents has shown that the most rational method of treatment of minor wounded near the combat area or zone of disaster was a two-staged (and sometimes a three-staged) management system. At the combat tactical zone it is expedient to render the secondary surgical care and reanimation procedures of vital cases, and also provide treatment of minor wounded who could be returned to their ranks in 10 days. For this purpose it is necessary to integrate the sections of medical triage and minor wounded treatment into organic structure of the Brigade medical company and Divisional hospital. As for Army Medical Brigade it must have in its structure a hospital for minor wounded who could be returned to their ranks in 20 days. All the wounded who have to be treated more than 20 days must be evacuated to the Front hospital for minor wounded.

Dynamic properties of successful smiles

PubMed Central

Helwig, Nathaniel E.; Sohre, Nick E.; Ruprecht, Mark R.; Guy, Stephen J.; Lyford-Pike, Sofía

2017-01-01

Facial expression of emotion is a foundational aspect of social interaction and nonverbal communication. In this study, we use a computer-animated 3D facial tool to investigate how dynamic properties of a smile are perceived. We created smile animations where we systematically manipulated the smile’s angle, extent, dental show, and dynamic symmetry. Then we asked a diverse sample of 802 participants to rate the smiles in terms of their effectiveness, genuineness, pleasantness, and perceived emotional intent. We define a “successful smile” as one that is rated effective, genuine, and pleasant in the colloquial sense of these words. We found that a successful smile can be expressed via a variety of different spatiotemporal trajectories, involving an intricate balance of mouth angle, smile extent, and dental show combined with dynamic symmetry. These findings have broad applications in a variety of areas, such as facial reanimation surgery, rehabilitation, computer graphics, and psychology. PMID:28658294

PubMed

Thielker, Jovanna; Bendella, Habib; Gaudin, Robert A; Grosheva, Maria; Volk, Fabian Gerd; Guntinas-Lichius, Orlando

2018-06-01

There are numerous reasons for facial palsy, which range from idiopathic palsy (Bell's palsy) to destruction of the facial nerve by a malignant salivary gland tumor. If the chance of spontaneous recovery is low or there is no drug therapy available, surgery is a therapeutical option. Recently, larger studies were published by specialized centers which enable a more individualized therapeutical concept to achieve tone, symmetry and movement of the paralyzed face based on a detailed preoperative assessment. An important therapy target is the improvement of patient´s quality of life. In the present article, we systematically review the important diagnostic steps and, directly derived from this, the indications for surgical options for reanimation of the mimic function. Furthermore, we provide an overview about a variety of postoperative adjuvant measures as well as on new objective assessment tools to evaluate the therapy results. © Georg Thieme Verlag KG Stuttgart · New York.

[Sudden cardiac death in individuals with normal hearts: an update].

PubMed

González-Melchor, Laila; Villarreal-Molina, Teresa; Iturralde-Torres, Pedro; Medeiros-Domingo, Argelia

2014-01-01

Sudden death (SD) is a tragic event and a world-wide health problem. Every year, near 4-5 million people experience SD. SD is defined as the death occurred in 1h after the onset of symptoms in a person without previous signs of fatality. It can be named "recovered SD" when the case received medical attention, cardiac reanimation effective defibrillation or both, surviving the fatal arrhythmia. Cardiac channelopathies are a group of diseases characterized by abnormal ion channel function due to genetic mutations in ion channel genes, providing increased susceptibility to develop cardiac arrhythmias and SD. Usually the death occurs before 40 years of age and in the autopsy the heart is normal. In this review we discuss the main cardiac channelopathies involved in sudden cardiac death along with current management of cases and family members that have experienced such tragic event. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

How scientific concepts come to matter in early childhood curriculum: rethinking the concept of force

NASA Astrophysics Data System (ADS)

de Freitas, Elizabeth; Palmer, Anna

2016-12-01

The aim of this article is to investigate how new materialist philosophies of matter can help us study the emergence of scientific thought in young children's activities. We draw extensively on the work of Gilles Deleuze to help us understand scientific concepts as concrete universals. In particular, we show how the concept of force is re-animated through this approach, becoming less deterministic, and more inflected with chance and indeterminism. We show how this approach to concepts moves beyond constructivist socio-cultural theories of learning, and reveals how concepts are `material articulations of the world' intra-acting with all other matter and meaning. Finally, we discuss video data and artifacts from an ongoing ethnographic project in Stockholm entitled `Children's relations to the city'. Our analysis of the classroom video data from this project shows how concepts are not timeless transcendent abstractions, but part of an unfolding event and learning assemblage. Thus the article contributes to research on conceptual change in children, with particular focus on scientific concepts.

[The organizational benefits of the Kaizen approach at the Centre Hospitalier Universitaire de Sherbrooke (CHUS)].

PubMed

Comtois, Jonathan; Paris, Yvon; Poder, Thomas G; Chaussé, Sylvain

2013-01-01

The purpose of this study was to calculate the cost savings associated with using the kaizen approach in our hospital. Originally developed in Japan, the kaizen approach, based on the idea of continuous improvement, has considerable support in North America, including in the Quebec health care system. This study assessed the first fifteen kaizen projects at the CHUS. Based on an economic evaluation, we showed that using the kaizen approach can result in substantial cost savings. The success of the kaizen approach requires compliance with specific prerequisites. The future of the approach will depend on our ability to comply with these prerequisites. More specifically, such compliance will determine whether the approach is merely a passing fad or a strategy for improving our management style to promote greater efficiency.

Traitement intra-artériel des métastases hépatiques de cancer colorectal

PubMed Central

Pellerin, O.; Geschwind, J.-F.

2015-01-01

Le cancer colorectal représente un problème majeur de santé publique. Son incidence annuelle mondiale est d’environ un million de cas et la mortalité annuelle est de plus de 500 000 cas par an. Le foie est l’organe le plus fréquemment touché par les métastases. Leur survenue est observée dans 40 à 60% des cas (contemporaines dans 25% des cas). Bien que la résection chirurgicale soit le seul traitement curatif, nombre de patients ne peuvent en bénéficier en raison de l’importante diffusion des métastases hépatiques. Chimiothérapies et biothérapies systémiques sont les options conventionnelles de la prise en charge des métastases hépatiques multiples. C’est dans ces situations cliniques que les thérapies intra-artérielles peuvent jouer un rôle important. Dans cet article, nous présenterons les différentes thérapies endovasculaires applicables aux métastases hépatiques de cancers colorectaux, avec leurs indications, résultats et complications éventuelles. PMID:21944243

La perforation stercorale du côlon: à propos d'un cas et revue de la littérature

PubMed Central

Mahmoudi, Ammar; Maâtouk, Mezri; Noomen, Faouzi; Nasr, Mohamed; Zouari, Khadija; Hamdi, Abdelaziz

2015-01-01

Affection rare, la perforation stercorale du côlon touche des malades âgés souvent fragiles ayant une longue histoire de constipation chronique et sévère. Elle constitue une urgence chirurgicale dont le pronostic, souvent sombre, dépend du terrain et de la rapidité de la prise en charge. Nous rapportons le cas d'une perforation stercorale du côlon survenu chez une patiente âgée de 74 ans. La symptomatologie clinique était celle d'une péritonite aiguë évoluant depuis quatre jours. Le diagnostic n’était posé qu'en peropératoire. Le geste avait consisté en une intervention de Hartmann. Les suites étaient malheureusement marquées par un état de choc septique résistant aboutissant au décès de la patiente à J 2 postopératoire. Le diagnostic de perforation stercorale du côlon, souvent difficile et retardé, doit être connu par tous les médecins qui prennent en charge une population de patients de plus en plus âgés. PMID:26958112

Kyste épidermoïde du quatrième ventricule: à propos d’un cas

PubMed Central

El Saqui, Abderrazzak; Aggouri, Mohamed; Benzagmout, Mohamed; Chakour, Khalid; Chaoui, Mohamed El Faiz

2017-01-01

Les kystes épidermoïdes sont des tumeurs bénignes rares développées à partir d'inclusions ectodermiques. Ils siègent habituellement au niveau de l'angle ponto-cérébelleux, la région para-sellaire et la fosse temporale. Leur siège au niveau du quatrième ventricule est exceptionnel. Nous rapportons le cas d'une patiente de 47 ans admise pour un syndrome d'hypertension intracrânienne associé à des troubles de la marche. Le diagnostic de kyste épidermoïde du V4 fut évoqué sur les données de l'IRM en séquences de diffusion puis confirmé en per opératoire et en histologie. L'exérèse chirurgicale a été subtotale en raison d'une adhérence de la capsule à la partie supérieure du plancher du V4. Après un recul de 36 mois, la patiente ne manifeste aucun signe de ré-évolution tumorale. PMID:28690753

Discovering the African freshwater "torpedo": legendary Ethiopia, religious controversies, and a catfish capable of reanimating dead fish.

PubMed

Piccolino, Marco; Finger, Stanley; Barbara, Jean-Gaël

2011-07-01

The electric catfishes of African rivers and lakes, once depicted on Egyptian tomb art, have been largely overlooked in histories and reviews of electric fish biology and animal electricity. This article examines how Westerners, especially Dominican and Jesuit missionaries, discovered them in Ethiopia and other parts of Africa at the beginning of the seventeenth century. What transpired took place against the backdrop of tales involving the Bible, Prester John's mythical empire, and imaginary animals with fabulous powers. In effect, how they were found is related to attempts to convert Ethiopian Christians to true Catholicism, hopes of discovering great riches, and opportunities to trade, and not with the efforts of skilled natural philosophers to document and conduct experiments on the wildlife of this continent. Nevertheless, the early descriptions by Europeans circulated, and during the next century these catfishes began to be used in experiments that helped to make animal electricity a reality.

Dzhida Ore District: Geology, Structural and Metallogenic Regionalization, Genetic Types of Ore Deposits, Geodynamic Conditions of Their Formation, Forecast, and Outlook for Development

NASA Astrophysics Data System (ADS)

Gordienko, I. V.; Gorokhovsky, D. V.; Smirnova, O. K.; Lantseva, V. S.; Badmatsyrenova, R. A.; Orsoev, D. A.

2018-01-01

Based on complex structural, rheological, and metallogenic studies, taking into account the results of earlier subject-specific, prospecting, mapping, and exploration works, it has been established that the geological structure of the district was caused by the ensimatic evolution of the Vendian-Early Paleozoic Dzhida island-arc system, in which oceanic and island-arc complexes served as a melanocratic basement for Late Paleozoic-Mesozoic active within-plate (riftogenic) processes, which gave rise to the formation of ore deposits and occurrences of strategic mineral commodities (Mo, W, Au, Pt, Ag, and rare elements, including REE). Mantle plumes and flows of deep-seated transmagmatic solutions (ore-forming fluids) played a critical role in these processes, the significance of which increases in upper crustal swarms of dikes and fault systems. The forecasts and development prospects of the Dzhida ore district envisage the expansion of geological prospecting and exploration, scientific research, and technological testing of ore for insight into strategic mineral commodities, as well as reanimation of mining within the areas of the Dzhida's large territorial and industrial complex (TIC) in eastern Siberia.

Learning spinal manipulation: A best-evidence synthesis of teaching methods.

PubMed

Stainsby, Brynne E; Clarke, Michelle C S; Egonia, Jade R

2016-10-01

The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance.

Learning spinal manipulation: A best-evidence synthesis of teaching methods*

PubMed Central

Stainsby, Brynne E.; Clarke, Michelle C.S.; Egonia, Jade R.

2016-01-01

Objective: The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. Methods: For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. Results: Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. Conclusions: Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance. PMID:26998630

[Intensive care anaesthesia practice in the prison environment. Can a prisoner benefit from ambulatory anaesthesia].

PubMed

Manaouil, C; Montpellier, D; Sannier, O; Defouilloy, C; Radji, M; Jardé, O; Dupont, H

2010-01-01

Ambulatory anaesthesia is an anesthesia allowing the return of the patient home the same day. Even if the ambulatory hospitalization can, in theory, be applied to a prisoner as to every patient, caution is essential in such approach. Every anaesthetist reanimator doctor practicing in public hospitals may give care to patient prisoners while he is far from dominating all features of the prison world and while he must put down his therapeutic indications. The ambulatory anaesthesia in prison environment does not guarantee full security for the patient. Procedures could be set up between hospital complexes, caretakers practicing within penal middle (Unit of Consultation and Ambulatory Care [UCAC]) the prison service and hospital, the prefecture, to identify possible ambulatory interventions for a patient prisoner and to set up all guarantees of patient follow-up care in his return in prison environment. The development of interregional secure hospital units (ISHU) within teaching hospitals, allows an easier realization of interventions to the prisoners, but exists only in seven teaching hospitals in France. Copyright 2009 Elsevier Masson SAS. All rights reserved.

A proposal for new neurorehabilitative intervention on Moebius Syndrome patients after 'smile surgery'. Proof of concept based on mirror neuron system properties and hand-mouth synergistic activity.

PubMed

Ferrari, Pier Francesco; Barbot, Anna; Bianchi, Bernardo; Ferri, Andrea; Garofalo, Gioacchino; Bruno, Nicola; Coudé, Gino; Bertolini, Chiara; Ardizzi, Martina; Nicolini, Ylenia; Belluardo, Mauro; Stefani, Elisa De

2017-05-01

Studies of the last twenty years on the motor and premotor cortices of primates demonstrated that the motor system is involved in the control and initiation of movements, and in higher cognitive processes, such as action understanding, imitation, and empathy. Mirror neurons are only one example of such theoretical shift. Their properties demonstrate that motor and sensory processing are coupled in the brain. Such knowledge has been also central for designing new neurorehabilitative therapies for patients suffering from brain injuries and consequent motor deficits. Moebius Syndrome patients, for example, are incapable of moving their facial muscles, which are fundamental for affective communication. These patients face an important challenge after having undergone a corrective surgery: reanimating the transplanted muscles to achieve a voluntarily control of smiling. We propose two new complementary rehabilitative approaches on MBS patients based on observation/imitation therapy (Facial Imitation Therapy, FIT) and on hand-mouth motor synergies (Synergistic Activity Therapy, SAT). Preliminary results show that our intervention protocol is a promising approach for neurorehabilitation of patients with facial palsy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Specimen plastic containers used to store expressed breast milk in neonatal care units: a case of precautionary principle.

PubMed

Blouin, Mélissa; Coulombe, Martin; Rhainds, Marc

2014-05-09

Breast milk is the only milk that meets both the nutritional and immunitary needs of infants. Since breastfeeding is widely promoted, public health measures to preserve the nutritional qualities of expressed breast milk (EBM) should be applied in hospital care settings. The Health Technology Assessment Unit (HTAU) of the Centre hospitalier universitaire de Québec was requested by the Neonatal Care Unit to assess the acceptability of a plastic specimen container, designed to harvest tissues and body fluids, for storing collected EBM. An evidence-based public health perspective approach was taken to evaluate the safety of the specimen container. The HTAU recommended that plastic specimen containers no longer be used for storing EBM and that other options should be evaluated for neonatal care units. These recommendations are in accordance with the public health precaution principle and with legal considerations.

Syndrome coronarien aigue suite à une injection accidentelle intraveineuse de Bupivacaine

PubMed Central

Koita, Siriman Abdoulaye; Bouhabba, Najib; Salaheddine, Fjouji; Bensghir, Mustapha; Charki, Haimeur

2015-01-01

Les erreurs médicamenteuses constituent une complication très redoutable en anesthésie. La fréquence des erreurs médicamenteuses par administration serait de l'ordre 1/10 000 à 1/1000. Nous rapportons un cas d'injection accidentelle de bupivacaine en intraveineuse directe. Il s'agissait d'un jeune patient classé ASA I qui était prévu pour cure chirurgicale d'une hydrocèle unilatérale sous rachianesthésie. Une injection de 12,5 mg de bupivacaine et 25 µg de fentanyl étaient injectés après un reflux net du liquide céphalorachidien sans incident. Après installation de la rachianesthésie, le début de l'intervention était autorisé sans incidents. Une sédation de confort était décidée. Juste après apparaissait des troubles de rythme à type tachycardie ventriculaire avec une élévation de taux de troponines en post opératoire. L’évolution était marquée par une normalisation de la troponine au troisième jour post opératoire et sorti de l'hôpital au cinquième jour. PMID:26889325

Nouveautes Dans la Reconstruction Cutanee: Cultures de Cellules et Substituts Dermiques et Revue de la Litterature

PubMed Central

Koch, N.; Erba, P.; Benathan, M.; Raffoul, W.

2010-01-01

Summary La prise en charge de patients souffrant de brûlures profondes et étendues reste un défi important pour les chirurgiens reconstructeurs. Ceci est d'autant plus vrai que les grands progrès réalisés dans la réanimation assurent actuellement la survie de patients brûlés sur plus de 90% de leur surface corporelle. De ce fait la reconstruction moderne a dû innover et est devenue une chirurgie complexe nécessitant un plan stratégique impliquant des matériaux et des méthodes chirurgicales multiples adaptées à chaque situation clinique. Ce type de prise en charge nécessite aussi la collaboration étroite et coordonnée de plusieurs équipes hautement spécialisées. Le taux de survie ainsi que de la qualité de vie de ces patients sont alors nettement améliorés. De même nous observons clairement que le nombre de complications secondaires telles que les rétractions et les instabilités cicatricielles ont également diminué de façon significative. Mots-clés: brûlure, greffe, culture, substitut dermique, reconstruction PMID:21991212

Anévrisme de l'artère fémorale superficielle lié à une infection à salmonelle

PubMed Central

Mrad, Melek Ben; Hammamia, Mohammed Ben; Miri, Rim; Derbel, Bilel; Koubaa, Mohammed Ali; Ziadi, Jalel; Khayati, Adel

2015-01-01

Les anévrismes infectieux de l'axe fémoro-poplité sont rares et d’évolution silencieuse. Ils surviennent surtout chez les sujets immunodéprimés. Leur traitement fait appel souvent à l'exclusion chirurgicale associée ou non à un geste de revascularisation. Nous rapportons le cas d'un patient opéré pour un anévrisme de l'artère fémorale superficielle, lié à une infection à salmonelle, il a eu une résection de l'anévrysme et une revascularisation par greffe veineuse. Ce patient a été repris par la suite à deux reprise pour rupture du greffon veineux. Pour cette raison, nous étions contraints à une explantation du pontage et une ligature des 2 bouts de l'artère sans revascularisation. Malgré l'absence de revascularisation, l’évolution a été favorable sous couverture d'une une antibiothérapie adaptée. En cas d'anévrysme infectieux de l'axe fémoro-poplité par infection à salmonelle, le rétablissement de la continuité artérielle, même avec un greffon veineux, peut exposer au risque de rupture artérielle. PMID:26955409

Epidemiology and Antibiotic Resistance Phenotypes of Diarrheagenic Escherichia Coli Responsible for Infantile Gastroenteritis in Ouagadougou, Burkina Faso

PubMed Central

Konaté, Ali; Dembélé, René; Guessennd, Nathalie K.; Kouadio, Fernique Konan; Kouadio, Innocent Kouamé; Ouattara, Mohamed Baguy; Kaboré, Wendpoulomdé A. D.; Kagambèga, Assèta; Cissé, Haoua; Ibrahim, Hadiza Bawa; Bagré, Touwendsida Serge; Traoré, Alfred S.; Barro, Nicolas

2017-01-01

The emergence and persistence of multidrug-resistant (MDR) diarrheagenic Escherichia coli (DEC) causing acute diarrhea is a major public health challenge in developing countries. The aim of this study was to evaluate the resistance phenotypes of DEC isolated from stool samples collected from children less than 5 years of age with acute diarrhea living in Ouagadougou/Burkina Faso. From August 2013 to October 2015, this study was carried out on 31 DEC strains of our study conducted in “Centre Médical avec Antenne Chirurgicale (CMA)” Paul VI and CMA of Schiphra. DEC were isolated and identified by standard microbiological methods and polymerase chain reaction (PCR) method was used to further characterize them. Antimicrobial susceptibility testing was done based on the disk diffusion method. DEC isolates were high resistant to tetracycline (83.9%), amoxicillin (77.4%), amoxicillin clavulanic acid (77.4%), piperacillin (64.5%), and colistin sulfate (61.3%). The most resistant phenotype represented was the extended spectrum β-lactamase (ESBL) phenotype (67.7%). Aminoglycosides were 100% active on enteroinvasive E. coli (EIEC) and enterohemorrhagic E. coli (EHEC). All the DEC isolates exhibited absolute (100%) sensitivity to ciprofloxacin. Monitoring and studying the resistance profile of DEC to antibiotics are necessary to guide probabilistic antibiotic therapy, especially in pediatric patients. PMID:29034106

Molecular Characterization of Diarrheagenic Escherichia Coli in Children Less Than 5 Years of Age with Diarrhea in Ouagadougou, Burkina Faso

PubMed Central

Konaté, Ali; Dembélé, René; Kagambèga, Assèta; Soulama, Issiaka; Kaboré, Wendpoulomdé A. D.; Sampo, Emmanuel; Cissé, Haoua; Sanou, Antoine; Serme, Samuel; Zongo, Soumanaba; Zongo, Cheikna; Fody, Alio Mahamadou; Guessennd, Nathalie K.; Traoré, Alfred S.; Gassama-Sow, Amy; Barro, Nicolas

2017-01-01

Diarrheagenic Escherichia coli (DEC) is important bacteria of children’s endemic and epidemic diarrhea worldwide. The aim of this study was to determine the prevalence of DEC isolated from stool samples collected from children with acute diarrhea living in Ouagadougou, Burkina Faso. From August 2013 to October 2015, stool samples were collected from 315 children under 5 years of age suffering from diarrhea in the “Centre Médical avec Antenne Chirurgicale (CMA)” Paul VI and the CMA of Schiphra. E. coli were isolated and identified by standard microbiological methods, and the 16-plex PCR method was used to further characterize them. Four hundred and nineteen (419) E. coli strains were characterized, of which 31 (7.4%) DEC pathotypes were identified and classified in five E. coli pathotypes: 15 enteroaggregative E. coli (EAEC) (48.4%), 8 enteropathogenic E. coli (EPEC) (25.8%) with 4 typical EPEC and 4 atypical EPEC, 4 enteroinvasive E. coli (EIEC) (12.9%), 3 enterohemorrhagic E. coli (EHEC) 9.67%, and 1 enterotoxigenic E. coli (ETEC) 3.2%. The use of multiplex PCR as a routine in clinical laboratory for the detection of DEC would be a useful mean for a rapid management of an acute diarrhea in children. PMID:29034111

Comparison of Direct Side-to-End and End-to-End Hypoglossal-Facial Anastomosis for Facial Nerve Repair.

PubMed

Samii, Madjid; Alimohamadi, Maysam; Khouzani, Reza Karimi; Rashid, Masoud Rafizadeh; Gerganov, Venelin

2015-08-01

The hypoglossal facial anastomosis (HFA) is the gold standard for facial reanimation in patients with severe facial nerve palsy. The major drawbacks of the classic HFA technique are lingual morbidities due to hypoglossal nerve transection. The side-to-end HFA is a modification of the classic technique with fewer tongue-related morbidities. In this study we compared the outcome of the classic end-to-end and the direct side-to-end HFA surgeries performed at our center in regards to the facial reanimation success rate and tongue-related morbidities. Twenty-six successive cases of HFA were enrolled. In 9 of them end-to-end anastomoses were performed, and 17 had direct side-to-end anastomoses. The House-Brackmann (HB) and Pitty and Tator (PT) scales were used to document surgical outcome. The hemiglossal atrophy, swallowing, and hypoglossal nerve function were assessed at follow-up. The original pathology was vestibular schwannoma in 15, meningioma in 4, brain stem glioma in 4, and other pathologies in 3. The mean interval between facial palsy and HFA was 18 months (range: 0-60). The median follow-up period was 20 months. The PT grade at follow-up was worse in patients with a longer interval from facial palsy and HFA (P value: 0.041). The lesion type was the only other factor that affected PT grade (the best results in vestibular schwannoma and the worst in the other pathologies group, P value: 0.038). The recovery period for facial tonicity was longer in patients with radiation therapy before HFA (13.5 vs. 8.5 months) and those with a longer than 2-year interval from facial palsy to HFA (13.5 vs. 8.5 months). Although no significant difference between the side-to-end and the end-to-end groups was seen in terms of facial nerve functional recovery, patients from the side-to-end group had a significantly lower rate of lingual morbidities (tongue hemiatrophy: 100% vs. 5.8%, swallowing difficulty: 55% vs. 11.7%, speech disorder 33% vs. 0%). With the side-to-end HFA

The Axillary Approach to Raising the Latissimus Dorsi Free Flap for Facial Re-Animation: A Descriptive Surgical Technique

PubMed Central

Butler, Daniel; Grobbelaar, Adriaan

2015-01-01

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time. PMID:25606493

The axillary approach to raising the latissimus dorsi free flap for facial re-animation: a descriptive surgical technique.

PubMed

Leckenby, Jonathan; Butler, Daniel; Grobbelaar, Adriaan

2015-01-01

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.

La médecine générale perçue par les étudiants de la faculté de médecine de Sousse (Tunisie)

PubMed Central

Zedini, Chekib; Limam, Manel; El Ghardallou, Mariem; Mallouli, Menel; Mestiri, Tarek; Bougmiza, Iheb; Ajmi, Thouraya; Mtiraoui, Ali

2014-01-01

Introduction Les étudiants en début du cursus suivent la même formation hospitalo-universitaire, cependant, ils sont peu nombreux à choisir délibérément la médecine générale comme discipline d'exercice médical. Notre objectif est de préciser auprès des étudiants en médecine, les facteurs qui déterminent le choix de la médecine générale comme carrière et leur vision de cette discipline. Méthodes Etude descriptive transversale menée auprès d'un échantillon d’étudiants inscrits à la faculté de médecine de Sousse (Tunisie) pour l'année universitaire 2012-2013. Le recueil des données a été pratiqué par l'intermédiaire d'un questionnaire conçu pour les fins de ce travail. La saisie et l'analyse des données ont été effectuées par le logiciel SPSS 18.0. Résultats Notre étude a porté sur 388 étudiants dont 69,5% étaient du genre féminin. L’âge moyen était de 22,1 ± 2,8 ans. Cent étudiants (25,8%) avaient un parent cadre de santé sans que cela n'ait une influence sur le choix de carrière. A l'entrée à la faculté, seulement 7,1% (n = 27) voulaient faire de la médecine générale leur carrière. Le changement de choix vers la médecine générale est statistiquement différent à l'entrée et à la sortie de la faculté chez les internes finissants. Conclusion Afin d'attirer davantage les étudiants vers la médecine générale, il serait judicieux d'adopter des changements majeurs touchant l'enseignement théorique et pratique et de modifier les conditions de travail en fonction des attentes des générations futures. PMID:25852793

Outcome-dependent coactivation of lip and tongue primary somatosensory representation following hypoglossal-facial transfer after peripheral facial palsy.

PubMed

Rottler, Philipp; Schroeder, Henry W S; Lotze, Martin

2014-02-01

A hypoglossal-facial transfer is a common surgical strategy for reanimating the face after persistent total hemifacial palsy. We were interested in how motor recovery is associated with cortical reorganization of lip and tongue representation in the primary sensorimotor cortex after the transfer. Therefore, we used functional magnetic resonance imaging (fMRI) in 13 patients who underwent a hypoglossal-facial transfer after unilateral peripheral facial palsy. To identify primary motor and somatosensory tongue and lip representation sites, we measured repetitive tongue and lip movements during fMRI. Electromyography (EMG) of the perioral muscles during tongue and lip movements and standardized evaluation of lip elevation served as outcome parameters. We found an association of cortical representation sites in the pre- and postcentral gyrus (decreased distance of lip and tongue representation) with symmetry of recovered lip movements (lip elevation) and coactivation of the lip during voluntary tongue movements (EMG-activity of the lip during tongue movements). Overall, our study shows that hypoglossal-facial transfer resulted in an outcome-dependent cortical reorganization with activation of the cortical tongue area for restituded movement of the lip. Copyright © 2012 Wiley Periodicals, Inc.

Airway management in newborn with Klippel-Feil syndrome.

PubMed

Altay, Nuray; Yüce, Hasan H; Aydoğan, Harun; Dörterler, Mustafa E

2016-01-01

Klippel-Feil syndrome (KFS) has a classical triad that includes short neck, low hair line and restriction in neck motion and is among one of the congenital causes of difficult airway. Herein, we present a 26-day, 3300g newborn with KFS who was planned to be operated for correction of an intestinal obstruction. She had features of severe KFS. Anesthesia was induced by inhalation of sevoflurane 2-3% in percentage 100 oxygen. Sevoflurane inhalation was stopped after 2min. Her Cornmack Lehane score was 2 and oral intubation was performed with 3.5mm ID non-cuffed endotracheal tube in first attempt. Operation lasted for 45min. Following uneventful surgery, she was not extubated and was transferred to the newborn reanimation unit. On the postoperative third day, the patient died due to hyperdynamic heart failure. This case is the youngest child with Klippel-Feil syndrome in literature and on whom oral intubation was performed. We also think that positioning of this younger age group might be easier than older age groups due to incomplete ossification process. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Tumeur d'Abrikossoff juxta axillaire: une localisation rare d'une tumeur très rare, à propos d'un cas

PubMed Central

Amourak, Sarah; Bouzoubaa, Wael; Jayi, Sofia; Alaoui, Fatimazahra Fdili; Chaara, Hikmat; Melhouf, Moulay Abdelilah

2015-01-01

Décrite pour la première fois en 1926 par Abrikossoff, les tumeurs à cellules granuleuses (TCG) sont bénignes et uniques dans la grande majorité des cas. Les principales localisations sont la cavité orale, puis les tissus sous-cutanés de la tête et du cou et les seins. La pathogenèse a été longtemps débattue, après avoir proposé initialement une origine musculaire striée les études récentes sont en faveur d'une origine neurogène schwannienne confirmées par une étude immunohistochimique. Le traitement de la tumeur à cellules granuleuses est un traitement chirurgical, il permet un diagnostic de certitude par l'examen anatomo-pathologique de la pièce d'exérèse qui doit rechercher les limites d'exérèse et la présence de critères de malignité. Leur évolution est souvent favorable si la résection chirurgicale est complète. Nous rapportons ici le cas d'une tumeur d'Abrikossoff à localisation juxta axillaire et nous profitons de faire une revue de la littérature afin de mettre le point sur cette entité rare. PMID:26328001

Ptosis congénital: expérience d'un centre de soins tertiaires Marocain et mise au point

PubMed Central

Handor, Hanan; Hafidi, Zouheir; Bencherif, Moulayzahid; Amrani, Youssef; Belmokhtar, Adil; Laghmari, Mina; Daoudi, Rajae

2014-01-01

Le ptosis congénital constitue la malposition palpébrale la plus fréquente de l'enfant. Le but de ce travail est de rapporter l'expérience de notre service dans la prise en charge de cette affection. Cette étude analyse les données épidémiologiques, cliniques et thérapeutiques des patients opérés pour ptosis congénital dans notre service entre Janvier 2005 et Décembre 2012. 44 patients (48 yeux) ont été opérés. La médiane d'âge était de 10 ans et une prédominance masculine a été retrouvée. Le ptosis était unilatéral et isolé dans 40 cas (90,90 %), bilatéral et associé à un syndrome de blépharophimosis dans 3 cas et à un syndrome de fibrose congénitale des muscles oculomoteurs dans un cas. Une amblyopie a été notée dans 11 cas (25%). La résection du muscle releveur de la paupière supérieure était la technique chirurgicale la plus utilisée (81,81%). Les résultats postopératoires étaient bons dans 33 cas (75%). PMID:25767669

L'endométriose pariétale cicatricielle après césarienne: une entité rare

PubMed Central

El Fahssi, Mohammed; Lomdo, Massama; Bounaim, Ahmed; Ali, Abdelmounaim Ait; Sair, Khalid

2016-01-01

L'endométriose de la paroi est une entité clinique rare, dont la physiopathologie demeure imprécise. Elle survient le plus souvent après une intervention chirurgicale gynécologique ou obstétricale. Nous rapportons le cas d'une patiente présentant une douleur cyclique, au niveau de la cicatrice de césarienne, Avec à l'examen clinique une masse de 5cm localisée au niveau de la fosse iliaque droite. la tomodensitométrie montre une masse de densité tissulaire de 45mm de grand axe. D'où la décision d'excision large de la lésion dont l’étude anatomopathologique confirme le diagnostic d'endométriose pariétale. Les suites postopératoires étaient simples avec un recul de 20 mois sans récidive de la masse ni de la douleur. A travers notre cas, nous insisterons sur les caractéristiques de cette pathologie, ce qui permettra au praticien de comprendre l'intérêt du diagnostic et de la prise en charge précoce de cette affection ainsi que la possibilité de sa prévention au cours de chaque chirurgie gynécologique ou obstétricale. PMID:27642418

Le carcinome neuro-endocrine cutané primitif: à propos d'un nouveau cas et revue de la littérature

PubMed Central

Boukind, Samira; Elatiqi, Oumkeltoum; Dlimi, Meriem; Elamrani, Driss; Benchamkha, Yassine; Ettalbi, Saloua

2015-01-01

Le carcinome neuro- endocrine cutané primitif (CNEC) est une tumeur cutanée rare et agressive du sujet âgé, favorisée par le soleil et l'immunodépression. Elle est caractérisée par une évolution agressive avec un fort taux de récidive, une évolution ganglionnaire régionale et un risque de métastases à distance. Nous rapportons un cas de cette tumeur chez un patient âgé de 67 ans sous forme d'un placard nodulaire hémorragique mesurant 16 /14 cm. Le patient a bénéficié d'une exérèse chirurgicale large avec couverture de la perte de substance par un lambeau musculo-cutané du muscle grand dorsal, un curage ganglionnaire axillaire et une radiothérapie adjuvante. Après un recul de 2 ans et 2 mois, le patient est toujours vivant sans métastase ni récidive. La littérature étant pauvre, la prise en charge diagnostique et thérapeutique est controversée et donc hétérogène. Globalement le pronostic est mauvais, et certains paramètres corrélés au pronostic sont précisés. PMID:26185585

[Observational study of outpatient unit duration of stay depending on the route of administration (intravenous vs subcutaneous) for a targeted therapy].

PubMed

Despiau, Frédéric; Zagala, Yann; Delord, Jean-Pierre; Montastruc, Marion; Lacaze, Jean-Louis; Ferrand, Régis; Bombail, Marie

2017-10-01

New routes of administration available for some targeted therapies, especially subcutaneous injections, have an impact not only on the patients' daycare experience, but also on the unit's organization. This observational study conducted on 48 voluntary patients at the Institut universitaire du cancer Toulouse-Oncopole shows that the mean duration of the outpatient unit stay is diminished by one hour when a subcutaneous injection is used instead of an intravenous route. This duration decrease is mainly caused by an 82% average reduction in treatment duration. However, the waiting times before and after the treatment itself are not significantly impacted. Organizational methods related to the treatment prescription and preparation remain indeed the same. Anticipated prescription is not noticeably impacted either. This reduction of the duration of stay will truly be obtained if the whole unit's organization is adapted. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

[Continuing education in ethics: from clinical ethics to institutional ethics].

PubMed

Brazeau-Lamontagne, Lucie

2012-01-01

The mandate of the Ethics Committee of the Conseil de médecins, dentistes et pharmaciens (CMDP) at the Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec is three-fold: to guide the clinical decision; to address the institutional ethical function; to create the program for continuing education in ethics (Formation éthique continue or FEC). Might FEC be the means of bridging from individual ethics to institutional ethics at a hospital? To take the FEC perspectives considered appropriate for doctors and consider them for validation or disproving in the context of those of other professionals. Situate the proposed FEC mandate in a reference framework to evaluate (or triangulate) the clinical decision and the institutional ethic. CONVICTION: Sustainable professional development for doctors (DPD) includes ethics; it cannot be ignored. Without constant attention to upgrading one's abilities in professional ethics, these suffer the same fate as other professional aptitudes and competences (for example, techniques and scientific knowledge): decay.

Fourth International Conference: Modern Vaccines/Adjuvants Formulation--Impact on Future Development: May 15-17 2013, CHUV, Lausanne, Switzerland.

PubMed

Tupin, Emmanuel

2013-09-01

On the 15-17th of May 2013, about 120 scientists, postdoctoral fellows and professors representing renowned academic institutes and senior scientists and executives from small biotechs, contract research organizations (CROs) and Big Pharma companies, gathered at the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland for the 4th international conference on Modern Vaccines and Adjuvants Formulation. Despite this relative small number, the speakers and attendees covered together a very broad field of expertise. Indeed, experts in microbiology, immunology, biochemistry, formulation, virus and nanoparticle characterization, vaccine production, quality control as well as regulatory professionals attended the conference and were able to present their works and discuss new developments within the field of vaccine and adjuvant development, characterization and approval process. This broad diversity was a highpoint of the conference and allowed for a stimulating environment and underlined the complexity of the challenges that the field currently faces in order to develop better or completely new vaccines and adjuvants.

PubMed Central

LABBÈ, D.; BUSSU, F.; IODICE, A.

2012-01-01

SUMMARY Long-standing peripheral monolateral facial paralysis in the adult has challenged otolaryngologists, neurologists and plastic surgeons for centuries. Notwithstanding, the ultimate goal of normality of the paralyzed hemi-face with symmetry at rest, and the achievement of a spontaneous symmetrical smile with corneal protection, has not been fully reached. At the beginning of the 20th century, the main options were neural reconstructions including accessory to facial nerve transfer and hypoglossal to facial nerve crossover. In the first half of the 20th century, various techniques for static correction with autologous temporalis muscle and fascia grafts were proposed as the techniques of Gillies (1934) and McLaughlin (1949). Cross-facial nerve grafts have been performed since the beginning of the 1970s often with the attempt to transplant free-muscle to restore active movements. However, these transplants were non-vascularized, and further evaluations revealed central fibrosis and minimal return of function. A major step was taken in the second half of the 1970s, with the introduction of microneurovascular muscle transfer in facial reanimation, which, often combined in two steps with a cross-facial nerve graft, has become the most popular option for the comprehensive treatment of long-standing facial paralysis. In the second half of the 1990s in France, a regional muscle transfer technique with the definite advantages of being one-step, technically easier and relatively fast, namely lengthening temporalis myoplasty, acquired popularity and consensus among surgeons treating facial paralysis. A total of 111 patients with facial paralysis were treated in Caen between 1997 and 2005 by a single surgeon who developed 2 variants of the technique (V1, V2), each with its advantages and disadvantages, but both based on the same anatomo-functional background and aim, which is transfer of the temporalis muscle tendon on the coronoid process to the lips. For a

A comprehensive approach to long-standing facial paralysis based on lengthening temporalis myoplasty.

PubMed

Labbè, D; Bussu, F; Iodice, A

2012-06-01

Long-standing peripheral monolateral facial paralysis in the adult has challenged otolaryngologists, neurologists and plastic surgeons for centuries. Notwithstanding, the ultimate goal of normality of the paralyzed hemi-face with symmetry at rest, and the achievement of a spontaneous symmetrical smile with corneal protection, has not been fully reached. At the beginning of the 20(th) century, the main options were neural reconstructions including accessory to facial nerve transfer and hypoglossal to facial nerve crossover. In the first half of the 20(th) century, various techniques for static correction with autologous temporalis muscle and fascia grafts were proposed as the techniques of Gillies (1934) and McLaughlin (1949). Cross-facial nerve grafts have been performed since the beginning of the 1970s often with the attempt to transplant free-muscle to restore active movements. However, these transplants were non-vascularized, and further evaluations revealed central fibrosis and minimal return of function. A major step was taken in the second half of the 1970s, with the introduction of microneurovascular muscle transfer in facial reanimation, which, often combined in two steps with a cross-facial nerve graft, has become the most popular option for the comprehensive treatment of long-standing facial paralysis. In the second half of the 1990s in France, a regional muscle transfer technique with the definite advantages of being one-step, technically easier and relatively fast, namely lengthening temporalis myoplasty, acquired popularity and consensus among surgeons treating facial paralysis. A total of 111 patients with facial paralysis were treated in Caen between 1997 and 2005 by a single surgeon who developed 2 variants of the technique (V1, V2), each with its advantages and disadvantages, but both based on the same anatomo-functional background and aim, which is transfer of the temporalis muscle tendon on the coronoid process to the lips. For a comprehensive

[Therapeutic itinerary and radiological features of positive microscopy tuberculosis patients at Centre Hospitalier National Universitaire de Fann (CHNUF), Dakar].

PubMed

Kombila, U D; Ndiaye, E H M; Fafa Cisse, M; Diouf, N F; Sagne, J M; Dia, S; Kone, S; Kane, Y D; Toure, N O

2017-10-01

The long diagnostic delay is responsible for the extension of radiological lesions and spread of TB in the community. These radiological lesions can leave significant scars responsible for respiratory disability. The aim of the study is to characterize radiologic features according to tuberculosis diagnostic delay. We conducted a prospective cross-sectional study, about 66 patients with positive sputum. The average diagnostic delay was 16 (±15) weeks; whether 22 (±14.1) weeks in the female gender versus 14.6 (±14.3) weeks in the male gender (P=0.10). The first care use was respectively health centers (62.1%), drugstores (51.9%), and traditional medicine (28.7%). Only 27.2% of patients used the marabouts care. Bilateral radiographic abnormalities in bivariate analysis were associated with consultation at the health center (66.7% versus 33.3%; P<0.031), as is the extension of the lesions (70.2% versus 29.8% RP=1.66 [1.05 to 2.91]; P<0.03). Lake of knowledge of the symptoms of TB was associated with the use of marabouts care (12.5% versus 87.5; PR=0.35 [0.11 to 1.08], P<0.04). These results should prompt consideration in an emergency, appropriate control interventions, advocacy, patient information and medical personnel on the reality of tuberculosis to prevent its spread often causing respiratory disability with radological effects. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Tumeur stromale du mésentère: à propos d'un cas rare et revue de la littérature

PubMed Central

Seck, Mamadou; Ka, Ibrahima; Cissé, Mamadou; Touré, Alpha Oumar; Thiam, Ousmane; Gueye, Mohamadou Lamine; Dieng, Madieng; Touré, Cheikh Tidiane

2015-01-01

Les tumeurs stromales du mésentère sont des sarcomes rares du tube digestif. Nous rapportons un cas rare de tumeur stromale dans sa localisation mésentérique. Il s'agit d'un patient admis aux urgences pour abdomen aigu. La tomodensitométrie a objectivé un kyste abcédé du mésentère. L'exploration chirurgicale a retrouvé une tumeur du mésentère. Une exérèse monobloc de la tumeur a été réalisée. L'histologie avec immunohistochimie de la pièce opératoire a mis en évidence une tumeur stromale à risque intermédiaire de malignité. Un traitement adjuvant à base d'imatinib a été ensuite instauré. L’évolution a été simple, sans récidive, avec un recul de 8 mois. Au plan pronostique, selon les critères de Fletcher et de l'AFIP (Armed Forces Institute of Pathology), la tumeur était classée à un risque élevé de récidive. Les tumeurs stromales du mésentère sont exceptionnelles surtout dans leur présentation clinique d'abdomen aigu. Le diagnostic repose sur l'immunohistochimie et le traitement des formes localisées sur la chirurgie, associée à l'imatinib en traitement adjuvant. PMID:26587154

Phrenic Nerve Transfer for Reconstruction of Elbow Extension in Severe Brachial Plexus Injuries.

PubMed

Flores, Leandro P; Socolovsky, Mariano

2016-09-01

Background Restoring elbow extension is an important objective to pursue when repairing the brachial plexus in patients with a flail arm. Based upon the good results obtained using the phrenic nerve to restore elbow flexion and shoulder stability, we hypothesized that this nerve could also be employed to reconstruct elbow extension in patients with severe brachial plexus injuries. Methods A retrospective study of 10 patients in which the phrenic nerve targeted the radial nerve (7 patients) or the branch to the long head of the triceps (3 patients) as a surgical strategy for reconstruction of the brachial plexus. Results The mean postoperative follow-up time was 34 months. At final follow-up, elbow extension graded as M4 was measured in three patients, Medical Research Council MRC M3 in five patients, and M2 in one patient, while one patient experienced no measurable recovery (M0). No patient complained or demonstrated any signs of respiratory insufficiency postoperatively. Conclusions The phrenic nerve is a reliable donor for reanimation of elbow extension in such cases, and the branch to the long head of the triceps should be considered as a better target for the nerve transfer. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Dual Nerve Transfers for Restoration of Shoulder Function After Brachial Plexus Avulsion Injury.

PubMed

Chu, Bin; Wang, Huan; Chen, Liang; Gu, Yudong; Hu, Shaonan

2016-06-01

The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83° of shoulder abduction and 54.00° of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV.

[Intra-alveolar hemorrhage: rare presentation of fat pulmonary embolism].

PubMed

Ketata, W; Msaad, S; Bahloul, N; Marouen, F; Ayoub, A

2010-11-01

Fat embolism syndrome is a severe complication of long bone fractures, corresponding to the obstruction of small vessels by microdroplets of fat, originating from medulla ossium. Pulmonary involvement, present in 90% cases, makes the severity of the disease. We report the case of a 22-year-old man who presented, two days after industrial accident causing an opened tibial fracture, acute dyspnea with hemoptysis. Angio-CT-scan didn't show any proximal vascular obstruction, but parenchymal sections showed diffuse, bilateral and multifocal hyperdensities predominating at the periphery. Broncho-alveolar lavage brought a hemorrhagic liquid, with a high macrophage content and lipid inclusions in macrophages. Exams for the etiologic diagnosis of intra-alveolar hemorrhage were negative: renal function, 24-hour proteinuria, antinuclear antibodies, antineutrophil cytoplasmic antibodies. The diagnosis of intra-alveolar hemorrhage secondary to fat embolism was established. The outcome was spontaneously favorable. The occurrence of intra-alveolar hemorrhage in the course fat embolism is rarely reported. Its pathogenic mechanisms are not understood. It is mandatory to eliminate the other causes of alveolar hemorrhage before holding the diagnosis of fat embolism. Treatment is only symptomatic, based on respiratory reanimation. Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Knowledge levels of intensive care nurses on prevention of ventilator-associated pneumonia.

PubMed

Akın Korhan, Esra; Hakverdioğlu Yönt, Gülendam; Parlar Kılıç, Serap; Uzelli, Derya

2014-01-01

Ventilator-associated pneumonia constitutes a significant concern for ventilated patients in the intensive care unit. This study was planned to evaluate the knowledge of nurses working in general intensive care units concerning evidence-based measures for the prevention of ventilator-associated pneumonia. This study design is cross-sectional. It was carried out on nurses working in the general intensive care units of anesthiology and re-animation clinics. Collection of research data was performed by means of a Nurse Identification Form and a Form of Evidence-Based Knowledge concerning the Prevention of Ventilator-Associated Pneumonia. Characterization statistics were shown by percentage, median and interquartile range. Chi-square and Wilcoxon tests and Kruskal-Wallis tests were used as appropriate. The median value of total points scored by nurses on the questionnaire was 4.00 ± 2.00. The difference between the nurses' education levels, duration of work experience and participation in in-service training programmes on ventilator-associated pneumonia prevention and the median value of their total scores on the questionnaire was found to be statistically significant (p < 0.05). The conclusion of the study was that critical care nurses' knowledge about ventilator-associated pneumonia prevention is poor. © 2013 British Association of Critical Care Nurses.

Eyelid reconstruction: the state of the art.

PubMed

Verity, David H; Collin, J Richard O

2004-08-01

The goals of eyelid reconstruction are corneal protection, restoration of the integrity of the lid lamellae, and improvement of facial symmetry. Inadequate reconstruction may lead to corneal exposure and sight-threatening keratopathy; in the younger patient, visual deprivation and amblyopia may also follow. The purpose of this review is to describe new materials and approaches used in reconstructing the damaged eyelid. Although the surgical principles of lid reconstruction remain unchallenged, new materials and techniques have emerged. These include the use of both autogenous and cadaveric acellular dermis in the management of lower eyelid retraction, and amniotic membrane transplantation in the management of tarsal conjunctival disease. Recent work on upper facial nerve branch reinnervation in the animal model may also offer hope for eyelid reanimation after facial palsy. The lid surgeon requires a sound knowledge of the principles involved in reconstructing the respective lamellae of the lid. Anterior lamellar reconstruction carries a significant risk of ectropion, and large defects may require several interposition flaps for optimum skin texture and color reconstruction. New materials (autogenous and cadaveric) for posterior lid reconstruction may reduce donor site morbidity and surgical time, but they may contract significantly after surgery. Recent experience with amniotic membrane transplantation may improve the prognosis for patients with entropion and symblepharon caused by conjunctival cicatricial changes.

Establishing an Anaesthesia and Intensive Care partnership and aiming for national impact in Tanzania.

PubMed

Ulisubisya, Mpoki; Jörnvall, Henrik; Irestedt, Lars; Baker, Tim

2016-03-18

Anaesthesia and Intensive Care is a neglected specialty in low-income countries. There is an acute shortage of health workers - several low-income countries have less than 1 anaesthesia provider per 100,000 population. Only 1.5% of hospitals in Africa have the intensive care resources needed for managing patients with sepsis. Health partnerships between institutions in high and low-income countries have been proposed as an effective way to strengthen health systems. The aim of this article is to describe the origin and conduct of a health partnership in Anaesthesia and Intensive Care between institutions in Tanzania and Sweden and how the partnership has expanded to have an impact at regional and national levels.The Muhimbili-Karolinska Anaesthesia and Intensive Care Collaboration was initiated in 2008 on the request of the Executive Director of Muhimbili National Hospital in Dar es Salaam. The partnership has conducted training courses, exchanges, research projects and introduced new equipment, routines and guidelines. The partnership has expanded to include all hospitals in Dar es Salaam. Through the newly formed Life Support Foundation, the partnership has had a national impact assisting the reanimation of the Society of Anaesthesiologists of Tanzania and has seen a marked increase of the number of young doctors choosing a residency in Anaesthesia and Intensive Care.

Penetrating gunshot wound to the head: transotic approach to remove the bullet and masseteric-facial nerve anastomosis for early facial reanimation.

PubMed

Donnarumma, Pasquale; Tarantino, Roberto; Gennaro, Paolo; Mitro, Valeria; Valentini, Valentino; Magliulo, Giuseppe; Delfini, Roberto

2014-01-01

Gunshot wounds to the head (GSWH) account for the majority of penetrating brain injuries, and are the most lethal. Since they are rare in Europe, the number of neurosurgeons who have experienced this type of traumatic injury is decreasing, and fewer cases are reported in the literature. We describe a case of gunshot to the temporal bone in which the bullet penetrated the skull resulting in the facial nerve paralysis. It was excised with the transotic approach. Microsurgical anastomosis among the masseteric nerve and the facial nerve was performed. GSWH are often devastating. The in-hospital mortality for civilians with penetrating craniocerebral injury is very high. Survivors often have high rate of complications. When facial paralysis is present, masseteric-facial direct neurorraphy represent a good treatment.

[Henri Ellenberger, Henri Ey and the Traité de Psychiatrie in the "Encyclopédie Médico-Chirurgicale": an American career under the auspices of the "Evolution Psychiatrique"].

PubMed

Delille, Emmanuel

2006-01-01

Henri Ellenberger, psychiatrist and historian, experienced a decisive period in his career in the early fifties of the last century. Educated in France, intern at Sainte-Anne Hospital, he was working in Switzerland after the war and then tried to move to the United States. It was during his participation in the French group "l'Evolution Psychiatrique" that he happened to contribute to the treatise of psychiatry (1955) of the French medical and surgical encyclopaedia ("EMC") and organise an observation trip to the United States. He was supported at that time by Henri Ey, key figure of French psychiatry. While going back to his career, we would like to emphasise on his comments about the "Psychotherapy of schizophrenia". Even though later Ellenberger became a well-known researcher in North America, it is more a question for us to discuss the scientific ambition he had in this particular context of a French learned society as a member of "l'Evolution Psychiatrique" and as a psychiatrist formerly intern from the "Hôpitaux psychiatriques de la Seine" (Parisian district).

Ostéo-arthrite tuberculeuse tarsienne: à propos d’un cas

PubMed Central

Yacoubi, Hicham; Erraji, Moncef; Abdelillah, Rachid; Abbassi, Najib; Abdeljawad, Najib; Daoudi, Abdelkrim

2012-01-01

Nous rapportons le cas d’une patiente de 45 ans sans antécédents médicaux particuliers, qui a présenté une atteinte inflammatoire du pied gauche, sans notion de traumatisme ni de fièvre, avec apparition secondaire d’une fistule cutanée purulente à la face externe du cou de pied. Les radiographies standards et la Tomodensitométrie de la cheville mettaient en évidence une ostéite calcanéenne avec atteinte articulaire subtalienne. Une biopsie chirurgicale associée à une excision des tissus inflammatoires et nécrotiques et l’ablation du trajet fistuleux, ont été réalisées. L’analyse histologique montrait une image de granulome épithélio-giganto-cellulaire avec une nécrose caséeuse et les prélèvements bactériologiques (retrouvaient Mycobacterium tuberculosis. Une chimiothérapie antituberculeuse a été administrée pendant 12 mois. À 24 mois, la patiente ne présentait pas de récidive mais une arthropathie dégénérative secondaire subtalienne. Il nous semble intéressant de rappeler que tout tableau clinique traînant ou toute lésion osseuse suspecte et de présentation atypique doit faire évoquer le diagnostic de tuberculose afin d’éviter des retards de diagnostic. Ceci permet une prise en charge thérapeutique précoce de la pathologie. PMID:22655098

Schwannome benin primitif retrovesical: une tumeur très rare à propos d'un cas

PubMed Central

Beddouche, Ali; Fahsi, Othemane; Kallat, Adil; El Bote, Hicham; Ziani, Idriss; El Sayegh, Hachem; Iken, Ali; Benslimane, Lounis; Nouini, Yassine

2016-01-01

Le schwannome est une tumeur le plus souvent bénigne, d'origine nerveuse se développant à partir des cellules de la gaine de Schwann. C'est une tumeur très rare tant par sa fréquence que par sa localisation rétrovésicale. L'examen anatomopathologique et immunohistochimique confirme le type histologique ainsi que le caractère bénin ou malin du schwannome. En raison des récidives, et du risque de transformation maligne, l'exérèse doit être complète. Nous rapportons le cas d'un patient âgé de 39 ans, admis pour une douleur pelvienne chronique à type de pesanteur, des signes irritatifs du bas appareil urinaire, et des troubles de transit. L'imagerie (échographie, TDM, IRM) a révélé la présence d'une masse pelvienne rétrovésicale, à paroi fine, latéralisée à gauche, mesurant 68x70x70 mm, exerçant un effet de masse sur la vessie et le sigmoïde. L'intervention chirurgicale menée par une laparotomie médiane a permis l'exérèse d'une masse retrovésicale bien encapsulée. L'examen anatomopathologique et immunohistochimique ont conclu à un schwannome bénin. La récidive et la transformation maligne bien que rare après chirurgie impose une surveillance post opératoire clinique et tomodensitométrique annuelle. PMID:27217902

La plastie en rail dans le traitement des brides rétractiles du creux poplite

PubMed Central

Achbouk, A.; Khales, A.; Bourra, K.; Tourabi, K.; Ababou, K.; Ihrai, H.

2011-01-01

Summary Les Auteurs décrivent le cas d’un patient âgé de 45 ans atteint de brûlures thermiques par flammes suite à la déflagration d’une bonbonne de gaz. Les lésions initiales intéressaient les quatre membres (en particulier, le genou) et le tronc. La prise en charge initiale a consisté en une excision-greffe précoce des membres. L’évolution a été marquée par la survenue de cicatrices hypertrophiques au niveau des zones non greffées et à la bordure de la greffe ainsi que la survenue de brides rétractiles. Devant l’handicap fonctionnel engendré par la bride à cause de la limitation importante de l’extension, le patient a été admis pour cure chirurgicale. Grâce à la technique en rail décrite, le patient a pu récupérer une fonction normale du genou. Les suites ont été simples avec une durée d’hospitalisation d’un mois. Le résultat esthétique est relativement satisfaisant. La technique en rail est un moyen parmi l’arsenal thérapeutique qui permet de traiter la bride du creux poplité. Sa simplicité, sa facilité technique et son résultat satisfaisant ainsi que ses suites simples permettent de la rendre une technique très prisée dans le traitement de ce type de bride. PMID:21991240

Les ruptures traumatiques du tendon quadricipital: à propos de 3 cas

PubMed Central

Benyass, Youssef; Chafry, Bouchaib; Koufagued, Kaldadak; Bouabid, Salim; Chagar, Belkacem

2015-01-01

Les ruptures traumatiques du tendon quadricipital sont rares, elles surviennent préférentiellement après 40 ans, suite à un traumatisme indirect chez le sportif (flexion contrariée du genou) ou traumatisme banal chez le sédentaire. La tendinopathie préexistante est fréquente. La rupture est le plus souvent totale et siège au corps du tendon 60% des cas ou décallotement quadricipital au bord supérieur de la rotule (40% des cas). Le diagnostic est essentiellement clinique. Les examens complémentaires (échographie et imagerie par résonance magnétique) sont utiles et appuient le diagnostique, mais sont souvent faussement rassurants hormis la radiographie qui montre une rotule basse. Le traitement essentiellement chirurgical associé à la rééducation fonctionnelle donne des résultats largement meilleurs. Le délai d'intervention est un facteur pronostic très important. Les auteurs rapportent 03cas de rupture de tendon quadricipital. L’âge moyen est de 50ans. Ils ont été traités chirurgicalement et revus régulièrement, avec un recul de 16 mois pour apprécier l’évolution. Les résultats ont été très bons chez 02 cas et bon chez 01 cas. L'amélioration a été très nette selon les critères: marche, douleur et reprise d'activité physique. PMID:26985261

[Persistence of Pseudomonas aeruginosa strains in patients of Federal Scientific Center of Transplantology and Artificial Organs].

PubMed

Avetisian, L R; Voronina, O L; Chernukha, M Iu; Kunda, M S; Gabrielian, N I; Lunin, V G; Shaginian, I A

2012-01-01

Study genetic diversity of P. aeruginosa strains persisting in patients of Federal Scientific Center of Transplantology and Artificial Organs, and main factors facilitating persistence of strains in the hospital. 136 P. aeruginosa strains isolated from patients of the center for 3 years 6 months were genotyped by RAPD-PCR and MLST methods and studied for antibiotics resistance and presence of integrons. Genetic diversity of strains persisting in hospital was established. Strains of main genotypes ST235, ST446, ST598 were isolated from patients of various surgical departments. Patients were shown to be colonized by these strains during stay in reanimation and intensive therapy department (RITD) of the hospital. Strains of dominant genotype 235 were isolated from 47% of examined patients during more than 3 years. Only genotype 235 strains contained integron with cassettes of antibiotics resistance genes blaGES5 and aadA6 in the genome. The data obtained show that over the period of observation in the center 1 clone of P. aeruginosa that belonged to genotype 235 dominated. This clone was endemic for this hospital and in the process of prolonged persistence became more resistant to antibiotics. Colonization of patients with these strains occurs in RITD. This confirms the necessity of constant monitoring of hospital microflora for advance detection of potentially dangerous epidemic hospital strains able to cause hospital infections.

Surgical management of facial nerve paralysis in the pediatric population.

PubMed

Barr, Jason S; Katz, Karin A; Hazen, Alexes

2011-11-01

In the pediatric patient population, both the pathology and the surgical managements of seventh cranial nerve palsy are complicated by the small size of the patients. Adding to the technical difficulty is the relative infrequency of the diagnosis, thus making it harder to become proficient in the management of the condition. The magnitude of the functional and aesthetic deficits these children manifest is significantly troubling to both the patient and the parents, which makes immediate attention, treatment, and functional restoration essential. A literature search using PubMed (http://www.pubmed.org) was undertaken to identify the current state of surgical management of pediatric facial paralysis. Although a multitude of techniques have been used, the ideal reconstructive procedure that addresses all of the functional and cosmetic needs of these children has yet to be described. Certainly, future research and innovative thinking will yield progressively better techniques that may, one day, emulate the native facial musculature with remarkable precision. The necessity for surgical intervention in children with facial nerve paralysis differs depending on many factors including the acute/chronic nature of the defect as well as the extent of functional and cosmetic damage. In this article, we review the surgical procedures that have been used to treat pediatric facial nerve paralysis and provide therapeutic facial reanimation. Copyright © 2011 Elsevier Inc. All rights reserved.

The realization of absolute beauty: an interpretation of the fairytale Snow White.

PubMed

Takenaka, Nanae

2016-09-01

This paper interprets the fairytale Snow White (Bruder Grimm 1857) in terms of the realization of absolute beauty. Jung's understanding that 'in myths and fairytales, as in dreams, the soul speaks about itself' (Jung 1945, para. 400), underpins such an approach. From this perspective a fantasy image is not about us, not about our unconsciousness, but is essentially about itself. The idea of absolute beauty first arises in the Queen's mind as a wish. Despite the Queen's strong desire to be named as the most beautiful person in the world, her mirror reflects that it is actually her daughter Snow White who is the fairest. Snow White might be regarded in the language of Giegerich as her internal other. Effectively they are separated into the Real that conceives the idea of absolute beauty and the Ideal that embodies it. The exchange that takes place between the two - mediated by mirror and window - generates the corpse of surpassing beauty that never decays but lies inaccessible behind the glass coffin. However the loving and penetrating gaze of the Prince, representing masculinity, succeeds in reanimating Snow White. Thus the Prince as the Other that is completely external and unknown to both the Queen and Snow White, specifically to their femininity, facilitates the realization of absolute beauty as the Ideal in the Real. © 2016, The Society of Analytical Psychology.

The Attitudes and Behaviors of Anaesthesiology and Reanimation Specialists in Anaesthesia Care Applications Outside the Operating Room in Turkey: A Survey Study

PubMed Central

Yıldız, Mehmet; İyilikçi, Leyla; Duru, Seden; Hancı, Volkan

2014-01-01

Objective We aimed to investigate the attitudes and behaviors of anaesthesiologists in “non-operating room anaesthesia” applications, which can be described as anaesthesia applications performed outside the operating room, and their reflection on practice all over Turkey. Methods Our study was conducted between November 5, 2012 and January 7, 2013 with the approval of the Research Ethics Board. Survey data were obtained through distributing printed questionnaires to be completed either by hand or via the web. The questionnaire consisted of 38 questions. The data obtained were analyzed with the Statistical Package for Social Sciences (SPSS) program. Results A total of 500 anaesthesiologists replied to our survey; 93% of anaesthesia specialists reported that there was a request that the anaesthesia and anaesthesia outside the operating room was given in their institution. Among anaesthesiologists, 56% reported that there were other sections that can provide sedation other than the anaesthesiology department in their institutions. Anaesthesia care team members; equipment; anaesthetic techniques; monitoring methods; and hypnotic, analgesic, and antagonist agents had statistically significant differences according to the participants’ institutions. Equipment used in the anaesthesia practice outside the operating room, anaesthesia, and monitoring methods had statistically significant differences according to geographical distribution (p<0.05). Conclusion Outside the operating room, anaesthesia practices and security measures are compliant with the standards set by the guidelines, the key to the prevention of complications. In our study, the current status of anaesthetic procedures outside the operating room in our country have been analyzed. PMID:27366420

Bathymetry, Chirp and Deep Crustal Structure of the Santos Basin SÃO Paulo Ridge Complex (sbspr)

NASA Astrophysics Data System (ADS)

Aslanian, D.; Klingelhoefer, F.; Moulin, M.; Schnurle, P.; Rabineau, M.; Afilhado, A.; Roest, W. R.; Feld, A.; Evain, M.; Rochat, A.; Rousic, D.; Rigoti, C. A.; Capechi, E.; Bochenek, G.; Viana, A. R.; Magnavita, L. P.; Szatmari, P.; Neto, M.; Soares, J. P.; Fuck, R. A.; Paula Ribas, M.; De Lima, M.; Corela, C.; Duarte, J.; Matias, L. M.; OBS Team of Sanba Cruise

2011-12-01

The SanBa (Santos Basin- Seismic Research experiment) research experiment is a joint project of the Department of Marine Geosciences (IFREMER: Institut Français de Recherche pour l'Exploitation de la MER, France), the Laboratory of "Oceanic Domain" (Institut Universitaire et Européen de la Mer, France), the Faculdade de Ciências da Universidade de Lisboa (Lattex and CGUL, Portugal), the Universidade de Brasilia (Brazil) and PETROBRAS. Its aim is to test hypotheses that have been proposed such as the existence of failed rift and a micro-block (Moulin et al., GSL submitted) or the presence of exhumed mantle on its south-eastern part (Zalan et al., AAPG 2009). Six wide-angle seismic data were acquired together with coincident deep frequency reflection seismic data during the SanBa cruise in Dec 2010 - Jan. 2011 (total > 850 Nm). Chirp and Bathymetry were also acquired during the cruise. The preliminary results suggest a very thin crust (< 5km) in the center and in the south-eastern part of the SBSPR. Both refraction and reflection data present a clear signal of the Moho in the distalmost part of the study area, which seems to preclude the exhumed mantle hypothesis."

Attitude towards reciprocity as a motive for oocyte donation.

PubMed

Pennings, Guido; Ravel, Célia; Girard, Jean-Maxime; Domin-Bernhard, Mathilde; Provoost, Veerle

2018-06-01

Finding out whether patients would be motivated by reciprocity when considering donating oocytes to others. This is a prospective monocentric study in the CECOS of the Centre Hospitalier Universitaire (CHU) of Rennes (France) on the opinion of patients regarding reciprocity. Couples who had a child with donor sperm were asked whether they would consider oocyte donation as a way of giving something back. Twenty six couples and one man answered the questionnaire. About half of the respondents (49%) felt that they should contribute to the system from which they benefitted. Although the patients would benefit from a reduction in waiting time, this advantage was only important for one in four persons. The only items on which the answers between men and women were significantly different concerned the results of the donation: women would think more often about the potential recipient and the child and they more often wanted to know whether children were born from their donation. The results show that beside altruism, reciprocity may be an important moral reason for people to donate gametes. Copyright © 2018 Elsevier B.V. All rights reserved.

Standards for University Libraries = Normes pour les bibliotheques universitaires = Richtwerte fur Universitatsbibliotheken = Normas de bibliotecas universitarias. IFLA Professional Reports No. 10.

ERIC Educational Resources Information Center

Lynch, Beverly P., Ed.

This statement prepared by the International Federation of Library Associations' Section of University Libraries and Other General Research Libraries presents standards of general principles designed to accomplish the following: (1) provide a means by which the quality of the library serving a university can be assessed; (2) offer guidance for…

Pour une gestion amelioree des ressources humaines dans les departements universitaires--Les possibilites offertes par la modulation des taches des professeurs.

ERIC Educational Resources Information Center

Desrosiers, Jean-Yves

1991-01-01

Task modulation is being examined as a means for improved utilization of human resources and greater flexibility within departments of Quebec universities. In this paper (written in French), a definition for this concept is proposed, the literature is reviewed, and prerequisite and other conditions critical to successful implementation are…

Tuberculose pelvi-péritoneale pseudotumorale: à propos de quatre cas

PubMed Central

Saadi, Hanane; Mamouni, Nissrine; Errarhay, Sanaa; Bouchikhi, Chahrazed; Banani, Abdelaziz; Ammor, Hicham; Sqalli, Nadia; Tizniti, Siham; Benmajdoube, Karim; Maazaze, Khalid; Fatmi, Hind; Amarti, Afaf

2012-01-01

La tuberculose pelvienne pseudo tumorale est une maladie infectieuse curable. Son tableau clinique est souvent trompeur simulant une tumeur ovarienne ou tubaire. Le but de notre travail est de préciser les caractéristiques cliniques, biologiques et radiologiques de cette pathologie et sa prise en charge. Nous rapportons une étude rétrospective à propos de quatre observations. L’âge moyen de nos patientes est de 24 ans (16 ans, 40 ans), trois parmi elles étaient célibataires. Le motif de consultation est dominé par les douleurs abdominopelviennes chroniques. Les résultats des explorations radiologiques (échographie pelvienne associé à la TDM ou IRM pelvienne) ont été en faveur d'une tumeur ovarienne dans trois cas et d'un hydrosapinx bilatéral pour un cas. L'ascite a été présente dans tous les cas. Le dosage de la Ca 125 a été élevé. La prise en charge a été l'exploration chirurgicale soit par c'lioscopie ou laparotomie. Deux cas ont bénéficié seulement des biopsies et deux patientes ont eu une salpingectomie bilatérale devant l'aspect pseudo tumoral très suspect. L’étude histologique a confirmé des lésions graulomateuses avec nécrose caséeuse. Le traitement par les antibacillaires a été instauré selon le protocole 2ERHZ/ 4RH. La tuberculose pelvienne pseudo tumorale est l'apanage de la femme jeune. Son pronostic est lié à l'infertilité séquellaire. PMID:23330043

Méningiome en plaque sphéno-orbitaire: à propos d'un cas avec revue de la littérature

PubMed Central

Abdellaoui, Meriem; Andaloussi, Idriss Benatiya; Tahri, Hicham

2015-01-01

Le méningiome intra osseux est une variété des méningiomes ectopiques dans lequel les cellules méningothéliales envahissent la paroi osseuse et entraînent une hyperostose. Le méningiome en plaque, variante macroscopique des méningiomes intra osseux, est une tumeur rare et survient fréquemment au niveau de la région sphéno-orbitaire ce qui le confond avec les tumeurs osseuses primitives. Nous rapportons le cas d'une patiente de 50 ans qui présente une exophtalmie avec cécité unilatérale gauche d'installation progressive depuis un an. L'examen trouve une exophtalmie axile, indolore et non réductible ainsi qu'une limitation de la motilité oculaire dans tous les sens du regard. La palpation montre une masse temporale gauche dure et adhérente à l'os. L'examen du fond d’œil trouve un œdème papillaire gauche. Le scanner montre une lésion ostéocondensante temporo-sphéno-orbitaire gauche avec envahissement locorégional. Le diagnostic préopératoire fut une tumeur osseuse essentiellement maligne primitive ou secondaire. L’étude histologique a révélée un méningiome meningothélial de type en plaque. La patiente a bénéficié d'une exérèse avec reconstruction chirurgicale. Aucune récidive n'a été notée après 1 an de recul. PMID:26327996

Offset fémoral et le fonctionnement de la hanche dans la prothèse totale de la hanche

PubMed Central

Rachid, Abdelillah; Moncef, Erraji; Najib, Abbassi; Abdeljaouad, Najib; Abdelkarim, Daudi; Hicham, Yacoubi

2014-01-01

L'offset fémoral est l’élément pronostic le plus important dans l'arthroplastie de la hanche. Sa restauration est devenue de plus en plus une obligation. Toute modification de la valeur native de l'offset retenti sur la qualité du fonctionnement clinique de la hanche. Le but de notre travail était d’évaluer le fonctionnement clinique de la hanche en fonction de la valeur de l'offset fémoral après une arthroplastie. C'est une étude rétrospective effectuée entre 2010 et 2013, comportant 27 patients ayant bénéficiés d'une arthroplastie totale de la hanche. Les patients ayant eu un geste chirurgicale antérieur sur la même hanche ou sur la hanche controlatérale ont été exclus. Les mesures ont été effectuées sur des radiographies standards de la hanche en rotation interne d'environ 15°, avec un agrandissement à 100%. Les résultats cliniques étaient évalués au moyen du score de WOMAC qui était en moyenne de 15,2 points, et le score de Merle d'Aubigné-Postel avec une moyenne de 15 points. Deux autres tests ont été évalués dans notre étude qui sont le step et le hop test. Les meilleurs résultats fonctionnels ont été obtenus chez les patients ayant eu une latéralisation de la tige fémoral avec un offset augmenté. PMID:25400835

L'endométriose de la paroi abdominale: à propos d'un cas rare

PubMed Central

Jayi, Sofia; Laadioui, Meriem; Bouguern, Hakima; Chaara, Hikmat; Melhouf, Aabdelilah

2013-01-01

L'endométriose de la paroi est une entité clinique rare, dont la physiopathologie demeure imprécise. Elle survient le plus souvent après une intervention chirurgicale gynécologique ou obstétricale. Nous rapportons le cas d'une patiente présentant une douleur cyclique, au niveau de la cicatrice de césarienne. Avec à l'examen clinique une masse de 3 cm localisée au niveau de la fosse iliaque droite. L'échographie-doppler a objectivé une image d'allure tissulaire, polylobée, à vascularisation centrale, mesurant 32/16 mm, évoquent une masse endométriosique ou une tumeur des parties molles. D'où la décision d'excision de la lésion, au cours de laquelle on a découvert une masse dure de 3/2 cm, en sous aponévrotique accolée au muscle grand droit de l'abdomen. L'étude anatomopathologique a confirmé le diagnostic d'endométriose pariétale. Les suites postopératoires étaient simples avec un recul de 2 ans et demie sans récidive de la masse ni de la douleur. A travers notre cas, nous insisterons sur les caractéristiques de cette pathologie notamment pronostic, ce qui permettra au praticien de comprendre l'intérêt du diagnostic et prise en charge précoce de cette entité - pour laquelle on ne pense jamais assez devant une masse pariétale - et de sa prévention au cours de chaque chirurgie gynécologique ou obstétricale. PMID:24171068

Apport de la biopsie radioguidée dans le diagnostic histopathologique des tumeurs de l'enfant: expérience de l'Hôpital d'Enfant de Rabat

PubMed Central

El Ochi, Mohamed Réda; Bellarbi, Salma; Rouas, Lamiae; Lamalmi, Najat; Malihy, Abderrahmane; Alhamany, Zaitouna; Cherradi, Nadia

2015-01-01

La biopsie radioguidée constitue une alternative à la biopsie chirurgicale invasive et à la cytologie pour le diagnostic des tumeurs pédiatriques. L'intérêt de notre étude est d’évaluer la valeur diagnostique des biopsies radioguidées examinées au laboratoire d'anatomopathologie de l'hôpital d'Enfants de Rabat (HER). L’étude a porté sur 78 biopsies radioguidées recueillies dans notre laboratoire entre janvier 2008 et décembre 2011. l’âge moyen des patients était de 5 ans et 10 mois avec une prédominance masculine (65,4%). La tumeur était abdominale dans 80% des cas, thoracique dans 15% cas, thoracique et abdominale dans 2,5% et sacrée dans 1,2%. Les biopsies étaient écho-guidées dans 90% des cas et scannoguidées dans 10% des cas. Le diagnostic histopathologique était posé dans 89% des cas. L'immuno-histochimie a été indiquée dans 35% des cas. Les diagnostics les plus fréquents étaient: tumeurs neuroblastiques (42 cas), lymphomes non hodgkiniens (10 cas), rhabdomyosarcomes (6 cas), autres (sarcome d'Ewing, néphroblastomes, tumeur myofibroblastique inflammatoire, maladies de Hodgkin, leucémie aiguë, hépatoblastome et ostéosarcome). Dans notre série, la biopsie radioguidée a permis un diagnostic histopathologique certain dans 89% des cas. Elle nécessite une étroite collaboration entre clinicien, radiologue et anatomopathologiste pour discuter son indication, afin de diminuer le nombre de biopsies peu ou non représentatives. PMID:26587165

Instruments to assess patient comfort during hospitalization: A psychometric review.

PubMed

Lorente, Sonia; Losilla, Josep-Maria; Vives, Jaume

2018-05-01

To analyse the psychometric properties and the utility of instruments used to measure patient comfort, physical, social, psychospiritual and/or environmental, during hospitalization. There are no systematic reviews nor psychometric reviews of instruments used to measure comfort, which is considered an indicator of quality in health care associated with quicker discharges, increased patient satisfaction and better cost-benefit ratios for the institution. Psychometric review. MEDLINE, CINAHL, PsycINFO, Web of Knowledge, ProQuest Thesis&Dissertations, Google. We limited our search to studies published between 1990-2015. The psychometric analysis was performed using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN), along with the Quality Criteria for Measurement Properties. The utility of the instruments was assessed according to their cost-efficiency, acceptability and educational impact. Protocol registration in PROSPERO, CRD42016036290. Instruments reviewed showed moderate methodological quality and their utility was poorly reported. Thus, we cannot recommend any questionnaire without reservations, but the Comfort Scale, the General Comfort Questionnaire and their adaptations in adults and older patients, the Psychosocial Comfort Scale and the Incomfort des Patients de Reanimation are the most recommendable instruments to measure comfort. The methodology of the studies should be more rigorous and authors should adequately report the utility of instruments. This review provides a strategy to select the most suitable instrument to assess patient comfort according to their psychometric properties and utility, which is crucial for nurses, clinicians, researchers and institutions. © 2017 John Wiley & Sons Ltd.

Mobbing Exposure of Anaesthesiology Residents in Turkey

PubMed Central

Aykut, Gülnihal; Efe, Esra Mercanoğlu; Bayraktar, Selcan; Şentürk, Sinem; Başeğmez, İrem; Özkumit, Özlem; Kabak, Elmas; Yavaşçaoğlu, Belgin; Bilgin, Hülya

2016-01-01

Objective In recent years, psychological problems that are caused by working conditions, like burn out syndrome, are more commonly observed. In our study, we aimed to evaluate mobbing exposure, factors causing mobbing and precautions for mobbing in residency students who are educated in anaesthesiology and reanimation clinics in Turkey. Methods After obtaining consent from the ethics committee, we sent our questionnaires to the secretariats of the departments by postal mail. Completed questionnaires were collected in our department’s secretariat blindly and randomly mixed. One hundred and one participants were returned the questionnaires. Data was statistically analysed in SPSS 21.0 software programme. Results During residency programme, sated to have experienced mobbing one or more time. Interestingly, 5.9% participants complained of physical mobbing. Mobbing exposure was more common in females. The most serious new onset psychosomatic symptoms stated during residency were committing suicide (2%), addiction (16%), severe depression (18%), panic attack (8%), more accidents (7%) and tendency of violence (15%). In mobbing group there was statistically significant dissatisfaction rate. Conclusion In professions where mobbing is common, incidences of psychiatric diseases and suicide attempts are high are increased. Who are under risk for experiencing mobbing should be noticed carefully to ensure good judgement and problems should be inspected objectively in a detailed manner. Anesthesiology societies and other medical professional societies should establish mobbing committees. Thus, mobbing problems can be resolved and healthy career oppurtunities can be presented to residents. PMID:27909591

Mobbing Exposure of Anaesthesiology Residents in Turkey.

PubMed

Aykut, Gülnihal; Efe, Esra Mercanoğlu; Bayraktar, Selcan; Şentürk, Sinem; Başeğmez, İrem; Özkumit, Özlem; Kabak, Elmas; Yavaşçaoğlu, Belgin; Bilgin, Hülya

2016-08-01

In recent years, psychological problems that are caused by working conditions, like burn out syndrome, are more commonly observed. In our study, we aimed to evaluate mobbing exposure, factors causing mobbing and precautions for mobbing in residency students who are educated in anaesthesiology and reanimation clinics in Turkey. After obtaining consent from the ethics committee, we sent our questionnaires to the secretariats of the departments by postal mail. Completed questionnaires were collected in our department's secretariat blindly and randomly mixed. One hundred and one participants were returned the questionnaires. Data was statistically analysed in SPSS 21.0 software programme. During residency programme, sated to have experienced mobbing one or more time. Interestingly, 5.9% participants complained of physical mobbing. Mobbing exposure was more common in females. The most serious new onset psychosomatic symptoms stated during residency were committing suicide (2%), addiction (16%), severe depression (18%), panic attack (8%), more accidents (7%) and tendency of violence (15%). In mobbing group there was statistically significant dissatisfaction rate. In professions where mobbing is common, incidences of psychiatric diseases and suicide attempts are high are increased. Who are under risk for experiencing mobbing should be noticed carefully to ensure good judgement and problems should be inspected objectively in a detailed manner. Anesthesiology societies and other medical professional societies should establish mobbing committees. Thus, mobbing problems can be resolved and healthy career oppurtunities can be presented to residents.

Administration of Luteinizing Hormone Releasing Hormone Agonist for Synchronization of Estrus and Generation of Pseudopregnancy for Embryo Transfer in Rats

PubMed Central

Borjeson, Tiffany M; Pang, Jassia; Fox, James G; García, Alexis

2014-01-01

In the past decade, the use of genetically engineered rats has increased exponentially; therefore, the ability to perform embryo transfer (ET) in rats to rederive, reanimate, or create mutant rat lines is increasingly important. However, the successful generation of pseudopregnant female rats for ET represents a limiting factor. We here evaluated the subcutaneous administration of 40 µg luteinizing hormone releasing hormone agonist (LHRHa) for estrus synchronization during the development and implementation of a rat ET program. Our first experiment assessed endogenous estrus cycling patterns by examining vaginal cytology without administration of LHRHa in 5-wk-old peripubertal Sprague–Dawley female rats. These rats then received LHRHa at approximately 7 wk of age; 57% of the rats were synchronized in proestrus or estrus as assessed by vaginal cytology 96 h later. In a second experiment, 8-wk-old virgin, unmanipulated Sprague–Dawley female rats received LHRHa; 55% were synchronized in proestrus or estrus 96 h later. Copulatory plugs were confirmed in 28% and 82% of the rats that had been synchronized in the first and second experiments, respectively, and mated with vasectomized male rats. Embryo transfer surgery was performed, and live pups were born from both fresh and cryopreserved transgenic rat embryos. Our results indicate that subcutaneous administration of 40 µg LHRHa followed by examination of vaginal cytology 96 h later is an effective technique to generate multiple pseudopregnant recipient rats for use in an ET program. PMID:24827564

[Lengthening temporalis myoplasty: Technical refinements].

PubMed

Guerreschi, P; Labbé, D

2015-10-01

First described by Labbé in 1997, the lengthening temporalis myoplasty (LTM) ensures the transfer of the entire temporal muscle from the coronoid process to the upper half of the lip without interposition of aponeurotic tissue. Thanks to brain plasticity, the temporal muscle is able to change its function because it is entirely mobilized towards another effector: the labial commissure. After 6 months of speech rehabilitation, the muscle loses its chewing function and it acquires its new smiling function. We describe as far as possible all the technical points to guide surgeons who would like to perform this powerful surgical procedure. We show the coronoid process approaches both through an upper temporal fossa approach and a lower nasolabial fold approach. Rehabilitation starts 3 weeks after the surgery following a standardized protocol to move from a mandibular smile to a voluntary smile, and then a spontaneous smile in 3 steps. The LTM is the main part of a one-stage global treatment of the paralyzed face. It constitutes a dynamic palliative treatment usually started at the sequelae stage, 18 months after the outcome of a peripheral facial paralysis. This one-stage procedure is a reproducible and relevant surgical technique in the difficult treatment of peripheral facial paralysis. An active muscle is transferred to reanimate the labial commissure and to recreate a mobile nasolabial fold. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Facial paralysis for the plastic surgeon.

PubMed

Kosins, Aaron M; Hurvitz, Keith A; Evans, Gregory Rd; Wirth, Garrett A

2007-01-01

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis.The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain.With respect to facial paralysis, surgeons tend to focus on the surgical, or 'hands-on', aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper.

Treatment outcomes of open pelvic fractures associated with extensive perineal injuries.

PubMed

Hasankhani, Ebrahim Ghayem; Omidi-Kashani, Farzad

2013-12-01

The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries. We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis. The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia. Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.

Direct Coaptation of the Phrenic Nerve With the Posterior Division of the Lower Trunk to Restore Finger and Elbow Extension Function in Patients With Total Brachial Plexus Injuries.

PubMed

Wang, Shu-feng; Li, Peng-cheng; Xue, Yun-hao; Zou, Ji-yao; Li, Wen-jun; Li, Yucheng

2016-02-01

To overcome the mismatch in nerve sizes in phrenic nerve transfer to the radial nerve for elbow and finger extension reanimation for patients with total brachial plexus injuries (TBPI), a selective neurotization procedure was designed. To investigate the long-term results of phrenic nerve transfer to the posterior division of the lower trunk with direct coaptation in restoring elbow and finger extension after TBPI. Phrenic nerve was transferred to and directly coapted with the posterior division of the lower trunk in 27 patients with TBPI. Seven patients were <18 years old (adolescent group), and the remaining 20 patients ≥18 years (adult group). Postoperative mean follow-up period was 54 ± 9 months (range, 48-85 months). The motor function attained M3 or greater in 81.5% of patients for elbow extension and in 48% of patients for finger extension. The percentage of patients who regained M3 or greater muscle power of finger extension in the adolescent group and the adult group was 71.4%, and 40%, respectively. Meanwhile, 85.7% in the adolescent group and 80% in the adult group achieved M3 or greater muscle power of elbow extension. There were no significant differences between the 2 groups. The elbow extension and finger extension were synchronous contractions and did not become independent of respiratory effort. This procedure simultaneously and effectively restores the function of elbow and finger extension in patients after TBPI. However, the patients could not do elbow and finger extension separately.

Facial paralysis for the plastic surgeon

PubMed Central

Kosins, Aaron M; Hurvitz, Keith A; Evans, Gregory RD; Wirth, Garrett A

2007-01-01

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis. The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain. With respect to facial paralysis, surgeons tend to focus on the surgical, or ‘hands-on’, aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper. PMID:19554190

Botulinum toxin in the management of facial paralysis.

PubMed

Cabin, Jonathan A; Massry, Guy G; Azizzadeh, Babak

2015-08-01

Complete flaccid facial paralysis, as well as the synkinetic and hyperkinetic sequelae of partial recovery, has significant impact on quality of life. Patients suffer from functional deficiencies, cosmetic deformity, discomfort and social consequences leading to emotional distress. Despite an extensive and sophisticated array of available interventions for facial reanimation, most patients have persistent issues that require consistent follow-up. In long-term management, botulinum toxin (BT) injection remains a critical tool in the treatment of the facial paralysis patient, particularly in the case of synkinesis, hyperkinesis and imbalance. We review the recent scientific literature and highlight key principles and developments in the use of BT in the management of facial paralysis, including less common applications for acute facial paralysis, hyperlacrimation and pseudoptosis. We reviewed the literature for the latest advances in the use of BT in facial paralysis, including applications and technique, as well as measurement tools and adjunct exercises. We also share our experience in treating our own patient population. BT continues to be a well tolerated and effective tool in the long-term management of facial paralysis, specifically in treating synkinesis, imbalance and hyperkinesis, as well as hyperlacrimation and pseudoptosis. Consistent measurement tools and adjunct neuromuscular retraining are crucial in the successful deployment of BT. Controversy exists as to whether BT should be used to manage facial paralysis during the acute phase, and whether BT application to the nonparalyzed face can improve long-term recovery in the paralyzed side.

L’embolie pulmonaire au centre hospitalier universitaire Campus de Lomé (Togo): étude rétrospective à propos de 51 cas

PubMed Central

Pessinaba, Soulemane; Atti, Yaovi Dodzi Molba; Baragou, Soodougoua; Pio, Machihude; Afassinou, Yaovi; Kpélafia, Mohamed; Goeh-Akué, Edem; Damorou, Findibé

2017-01-01

Introduction L’objectif était d’étudier les aspects épidémiologiques, cliniques et évolutifs de l’embolie pulmonaire au CHU Campus de Lomé. Méthodes C’est une étude rétrospective, analytique et descriptive sur une période de 39 mois (1erNovembre 2011- 31 Janvier 2015). Etaient inclus, tous les dossiers des patients hospitalisés dans le service de cardiologie du CHU Campus pour une EP. Résultats La prévalence de l’EP était de 3,1%. Le sex ratio femme/homme était de 2,2. L’âge moyen des patients était de 52,7 ± 14,4 ans. Les facteurs de risque de MTEV étaient dominés par: l’obésité (54,9%), l’alitement (25,5%) et le long voyage (17,6%). Les principaux symptômes étaient: dyspnée (98,0%), douleur thoracique (78,4%) et toux (60,8%). Le score de Wells était élevé dans 29,4%. L’ECG notait: tachycardie (78,4%), HVD (49,0%), aspect S1Q3T3 (47,1%) et bloc droit (39,2%). L’échodoppler cardiaque transthoracique montrait une dilatation cavitaire droite et thrombus intra ventriculaire droit dans 5,6%. L’angioscanner thoracique était normal dans 9,8% et objectivait un embole dans 82,4%. Le traitement était fait d’HBPM à dose curative avec relais par un AVK. Une thrombolyse était effectuée chez 8 malades. L’évolution était favorable dans 86,3%. Le taux de létalité était de 13,7%. Conclusion La prévalence de l’EP est relativement faible chez nous mais probablement sous estimée. L’EP pose un problème thérapeutique au Togo à cause du coût élevé des examens complémentaires et de la thrombolyse. La prévention reste donc l’arme efficace. PMID:28904659

La fibroscopie digestive haute chez 2795 patients au centre hospitalier universitaire-campus de Lomé: les particularités selon le sexe

PubMed Central

Lawson-Ananissoh, Laté Mawuli; Bouglouga, Oumboma; Bagny, Aklesso; Kaaga, Laconi; Redah, Datouda

2014-01-01

Introduction Notre étude consistera à rapporter les indications et les lésions objectivées à la fibroscopie digestive haute et relever les particularités selon le sexe. Méthodes Étude rétrospective, descriptive sur des résultats de compte-rendu de la fibroscopie digestive haute menée en unité d'endoscopie digestive du service d'hépato-gastro-entérologie du CHU Campus de Lomé du 15 Mai 2009 au 31 Décembre 2013. Résultats La fibroscopie digestive haute a été réalisée chez 2795 patients dont 1188 hommes et 1607 femmes. L’âge moyen était de 40,65 ans (Extrêmes: 5 et 93 ans). La fibroscopie digestive haute était normale chez les femmes que chez les hommes avec une différence statistiquement significative (p = 0,000). Les principales indications étaient: les épigastralgies chez les femmes (p = 0,000); les hémorragies digestives hautes (p = 0,000) et l'hypertension portale (p = 0,000) chez les hommes; 3485 lésions pathologiques ont été observées. La pathologie inflammatoire prédominait (56,3%), la pathologie ulcéreuse (13,89%), la pathologie tumorale (2,01%). Les varices et la candidose œsophagiennes étaient significativement notées chez les hommes. Les ulcérations gastriques (p = 0,000), le reflux biliaire duodéno-gastrique (p = 0,017) étaient plus retrouvés chez les femmes et la gastropathie hypertensive beaucoup plus chez les hommes (p = 0,000). Que les lésions duodénales soient inflammatoires ou ulcéreuses associées ou non à une sténose bulbaire, elles étaient plus fréquentes chez les hommes. Conclusion De manière générale, il y avait une prédominance des lésions inflammatoires chez les femmes, les lésions tumorales et ulcéreuses chez les hommes PMID:25852805

Les implications du phénomène des médecins hospitaliers

PubMed Central

Lehmann, François; Brunelle, Yvon; Dawes, Martin; Boulé, Richard; Bergeron, Rénald

2007-01-01

RÉSUMÉ OBJECTIF Évaluer l’impact de 2 systèmes de soins hospitaliers par une revue de la littérature. QUALITÉ DES DONNÉES Il reste des zones nébuleuses car plusieurs des études sont opportunistes, signalant une expérience isolée ou de simples avant-après. Peu sont vraiment expérimentales et toutes ont été menées dans des milieux universitaires, limitant ainsi leur validité externe. MESSAGE PRINCIPAL Les données supportent l’utilisation de médecins hospitaliers qui consacrent un minimum de 2 mois par année à ce travail et qui sont alors à plein temps sur les étages. Les coûts sont plus souvent qu’autrement réduits et l’enseignement est amélioré. Point de repère important de la qualité des soins, la mortalité est égale dans les 2 systèmes de soins. CONCLUSION Certaines questions demeurent sans réponse dont le choix de la meilleure formation en vue de préparer les résidents au travail hospitalier et la façon de maintenir les compétences acquises. PMID:18077751

Prevalence and clinical features of hypoadrenocorticism in Great Pyrenees dogs in a referred population: 11 cases

PubMed Central

Decôme, Magali; Blais, Marie-Claude

2017-01-01

Naturally occurring hypoadrenocorticism (Addison’s disease) is uncommon, with an estimated prevalence in the canine population between 0.06% and 0.28%. This retrospective study evaluated the prevalence and clinical features of hypoadrenocorticism in Great Pyrenees (GP) dogs presented to the Centre Hospitalier Universitaire Vétérinaire of the University of Montreal between March 2005 and October 2014. During this period, 100 dogs were diagnosed with hypoadrenocorticism, representing 0.38% [95% confidence interval (CI): 0.26% to 0.5%] of the canine population studied. The highest prevalence was observed in GP (9.73%, 95% CI: 9.12% to 10.35%, P < 0.0001), followed by West Highland white terriers (4.66%, 95% CI: 4.24% to 5.09%, P < 0.0001), Great Danes (1.87%, 95% CI: 1.6% to 2.14%, P < 0.0001), standard poodles (1.76%, 95% CI: 1.5% to 2.02%, P = 0.0001), Saint Bernards (1.72%, 95% CI: 1.47% to 1.98%, P = 0.018), and Jack Russell terriers (1.48%, 95% CI: 1.24% to 1.72%, P = 0.003). Although most clinical features were nonspecific, Great Pyrenees dogs were more frequently presented with anemia, azotemia, and eosinophilia, or with hypotension and cachexia compared with dogs of other breeds. PMID:28966360

Universal entanglement crossover of coupled quantum wires

NASA Astrophysics Data System (ADS)

Vasseur, Romain; Jacobsen, Jesper; Saleur, Hubert

2014-03-01

We consider the entanglement between two one-dimensional quantum wires (Luttinger Liquids) coupled by tunneling through a quantum impurity. The physics of the system involves a crossover between weak and strong coupling regimes characterized by an energy scale TB, and methods of conformal field theory therefore cannot be applied. The evolution of the entanglement in this crossover has led to many numerical studies, but has remained little understood, analytically or even qualitatively. This is, in part, due to the fact that the entanglement in this case is non-perturbative in the tunneling amplitude. We argue that the correct universal scaling form of the entanglement entropy S (for an arbitrary interval containing the impurity) is ∂S / ∂lnL = f(LTB) . In the special case where the coupling to the impurity can be refermionized, we show how the universal function f(LTB) can be obtained analytically using recent results on form factors of twist fields and a defect massless-scattering formalism. Our results are carefully checked against numerical simulations. This work was supported by the the French ANR (ANR Projet 2010 Blanc SIMI 4 : DIME), the US DOE (grant number DE-FG03-01ER45908), the Quantum Materials program of LBNL (RV) and the Institut Universitaire de France (JLJ).

High School Students Are a Target Group for Fight against Self-Medication with Antimalarial Drugs: A Pilot Study in University of Kinshasa, Democratic Republic of Congo.

PubMed

Kabongo Kamitalu, Ramsès; Aloni, Michel Ntetani

2016-01-01

Aim. To assess the self-medication against malaria infection in population of Congolese students in Kinshasa, Democratic Republic of Congo (DRC). Methods. A cross-sectional study was carried out in University of Kinshasa, Kinshasa, Democratic Republic of Congo. Medical records of all students with malaria admitted to Centre de Santé Universitaire of University of Kinshasa from January 1, 2008, to April 30, 2008, were reviewed retrospectively. Results. The median age of the patients was 25.4 years (range: from 18 to 36 years). The majority of them were male (67.9%). Artemisinin-based combination treatments (ACTs) was the most used self-prescribed antimalarial drugs. However, self-medication was associated with the ingestion of quinine in 19.9% of cases. No case of ingestion of artesunate/artemether in monotherapy was found. All the medicines taken were registered in DRC. In this series, self-prescribed antimalarial was very irrational in terms of dose and duration of treatment. Conclusion. This paper highlights self-medication by a group who should be aware of malaria treatment protocols. The level of self-prescribing quinine is relatively high among students and is disturbing for a molecule reserved for severe disease in Congolese health care policy in management of malaria.

Prophylactic ampicillin versus cefazolin for the prevention of post-cesarean infectious morbidity in Rwanda.

PubMed

Mivumbi, Victor N; Little, Sarah E; Rulisa, Stephen; Greenberg, James A

2014-03-01

To evaluate the efficacy of ampicillin versus cefazolin as prophylactic antibiotics prior to cesarean delivery in Rwanda. In a prospective, randomized, open-label, single-site study conducted between March and May 2012, the effects of prophylactic ampicillin versus cefazolin were compared among women undergoing cesarean delivery at the Centre Hospitalier Universitaire de Kigali, Rwanda. Postoperatively, participants were evaluated daily for infectious morbidity while in the hospital. Follow-up was done by phone and by appointment at the hospital within 2 weeks of delivery. During the study period, there were 578 total deliveries and 234 cesarean deliveries (40.4%). Overall, 132 women were enrolled in the study and randomized to receive either ampicillin (n=66) or cefazolin (n=66). No women were lost to follow-up. The overall infection rate was 15.9% (21/132). The infection rate in the ampicillin group and the cefazolin group was 25.8% (17/66) and 6.1% (4/66), respectively. Implementing a universal protocol in Rwanda of prophylactic cefazolin prior to cesarean delivery might reduce postoperative febrile morbidity, use of postoperative antibiotics, and number of postoperative days in hospital. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Participatory evaluation and process use within a social aid organization for at-risk families and youth.

PubMed

Jacob, Steve; Ouvrard, Laurence; Bélanger, Jean-François

2011-05-01

Participatory evaluation has been developing over the last several years, particularly in the social sector. Concurrently, research on the effects of evaluation has evolved significantly. Recently, one type of result has been the object of particular attention: the effects and lessons directly attributable to the evaluative process, or process use. Analyses generally underline the direct link between participatory approaches and this type of result. However, few empirical studies testing this concept are available. Our analysis aims to enrich evaluative research on this theme and is founded on a case study of a participatory evaluation project on practices carried out in a social services organization (Centre Jeunesse de Québec--Institut universitaire [Québec Youth Centre--University Institute, Canada]). The results of our analysis show that the evaluative process favours participant learning and has had several direct and indirect effects on the practices of the involved clinical teams. The results also demonstrate the existence of a link between the intensity of actor participation (individuals, groups) and process use. Both constraining factors and factors favourable to participation and the development of the evaluative process are identified, and avenues for improvement are suggested to accentuate the effects of process use. Copyright © 2010 Elsevier Ltd. All rights reserved.

Les Cicatrices Retractiles Post-Brulures Du Membre Inferieur Chez L’Enfant

PubMed Central

Sankale, A.A.; Manyacka Ma Nyemb, P.; Coulibaly, N.F.; Ndiaye, A.; Ndoye, M.

2010-01-01

Summary Il s'agit d'une étude faisant ressortir les aspects épidémiologiques, cliniques et thérapeutiques des séquelles de brûlures du membre inférieur chez l'enfant, à propos de 42 cas colligés au service de chirurgie infantile de l'Hôpital Aristide Le Dantec (Sénégal). L'âge moyen retrouvé est de 5 ans et 3 mois, et le sex-ratio garçons/filles de 1,8/1. La brûlure thermique est causée par une flamme dans 33% des cas, par un liquide chaud dans 21% des cas, et par des braises dans 21% des cas. Les cicatrices rétractiles intéressent le genou et le creux poplité dans 47% des cas et le pied dans 45% des cas. Elles sont bilatérales dans 21% des cas, et concernent une autre localisation associée dans 21% des cas. Quant aux brides, 21% ont bénéficié d'une chirurgie, avec un délai moyen de 3 ans et 2 mois après la brûlure. Cette procédure chirurgicale consiste en une plastie en Z dans 91% des cas, à laquelle est associée une greffe de peau dans 54% des cas. Une rééducation fonctionnelle est pratiquée chez 54% des opérés. Parallèlement aux données de la littérature, nos résultats montrent que l'optimisation de la prise en charge passe par une meilleure prévention des accidents domestiques et une bonne codification thérapeutique. PMID:21991202

Délire dermatozoïque: à propos d'un cas

PubMed Central

Jawaher, Masmoudi; Ines, Feki; Rim, Sallemi; Imen, Baati; Abdellaziz, Jaoua

2013-01-01

Le délire dermatozoïque est un délire particulier survenant chez les personnes âgées et caractérisé par la présence d'un délire hallucinatoire essentiellement cénesthésique, avec la conviction d’être infesté par des petites bêtes. Ce délire aboutit à des lésions de grattage pouvant être graves, mais sans aucune étiologie organique, et leurrant souvent le dermatologue. Notre observation est originale, par le fait que le patient a été adressé par un ophtalmologue, et faisant étendre le champ du diagnostic à plusieurs spécialités, s'occupant des patients âgés. il s'agit d'un patient âgé de 67 ans, ayant présenté da façon concomitante à une intervention chirurgicale et au mariage de son dernier fils, un délire hallucinatoire avec une conviction d’être attaqué par des moustiques lui suçant le sang. Des lésions d'excoriation cutanée ont été secondaires à ce délire, et ont été à l'origine d'une consultation psychiatrique. L’évolution après six mois de traitement a été marquée par l'enkystement du délire et l'amélioration des lésions cutanées. Réputé rare, le délire dermatozoïque pourrait être déroutant si on ne fait pas le diagnostic positif. Tout clinicien peut être confronté dans sa pratique à ce type de syndrome. Sa compréhension facilite une prise en charge adéquate, basée essentiellement sur un soutien psychologique et un traitement neuroleptique. PMID:24570786

Caractérisation de la flore bactérienne des péritonites communautaires opérées au Burkina Faso

PubMed Central

Sanou, Mahamoudou; Ky, Armand; Ouangre, Edgard; Bisseye, Cyrille; Sanou, Adama; Nagalo, Bolni Marius; Sanou, Drissa; Simporé, Jacques; Sangare, Lassana; Traore, Rasmata

2014-01-01

Introduction La péritonite communautaire est une urgence chirurgicale récurrente chez l'adulte qui constitue une préoccupation majeure pour le chirurgien et l'anesthésiste-réanimateur dans sa prise en charge. L'objectif de cette étude était d’établir non seulement le profil bactériologique des péritoniques communautaires opérées dans le service de chirurgie générale et digestive du CHU-YO mais aussi d’évaluer la sensibilité aux antibiotiques des souches bactériennes isolées à partir de ces dernières. Méthodes Cent six (106) patients ont été recrutés dans cette étude et des prélèvements bactériologiques préopératoires ont été effectués dont 63 se sont révélés positifs. Résultats Sur les 63 prélèvements positifs, 78 germes ont été isolés soit une moyenne de 1,2 germe par échantillon. Escherichia coli été le germe le plus fréquemment isolé (33,3%), suivi des anaérobies (11,5%), Streptococcus sp (9%), Klebsiella pneumoniae (6,4%) et Staphylococcus sp (5,1%). Les antibiotiques les plus efficaces sur les bactéries identifiées dans les péritonites communautaires étaient respectivement l'imipenème (100%), la colistine (100%), la céftriaxone (100%), et la ciprofloxacine (65,4%) Conclusion Le profil de sensibilité des bactéries identifiées dans les principales péritonites communautaires aux antibiotiques montre une augmentation inquiétante du nombre de souches résistantes, notamment à l'association amoxicilline/acide clavulanique PMID:25360201

La matério-vigilance dans un Centre Hospitalo-Universitaire du Centre-Est tunisien: enquête auprès des médecins

PubMed Central

Mahjoub, Mohamed; Jedidi, Maher; Masmoudi, Tasnim; Bouafia, Nabiha; Njah, Mansour

2016-01-01

Introduction Pour la meilleure gestion des risques en milieu hospitalier et l’amélioration de la qualité et la sécurité de nos soins, le CHU de Sousse (Tunisie), a mis en place, suite aux recommandations de l’ANCSEP (Agence Nationale de Contrôle Sanitaire et Environnementale des Produits) un système de matério-vigilance (MV). En Tunisie l’absence d’un cadre réglementaire organisant la MV est l’obstacle majeur à l’implication des soignants à ce système. L’objectif de cette étude est de déterminer les connaissances, attitudes et pratiques des médecins du CHU quant à la mise en place du système de MV. Méthodes Etude descriptive de type CAP (connaissances, attitudes et pratiques) transversale auprès de tous les médecins titulaires exerçant au CHU de Sousse (Tunisie) qui sont utilisateurs des dispositifs médicaux (DMs) lors de leur pratique d’activité de soin. Un questionnaire auto-administré, préétabli et pré-testé a été établi. Saisie et l’analysée des données par logiciel SPSS20.0. Résultats Le taux de réponse de 51,9 % (183/95), un manque des connaissances relatif à la MV a été rapporté. Plus de la moitié des répondants ne connaissent pas le correspondant local de son établissement et l’existence d’un formulaire standardisé de signalement. Concernant les attitudes, 89,5 % notifient l’intérêt de mise en place du système de MV et 37,5 % reconnaissent que le signalement doit émaner du soignant constatant l’incident. Pour les pratiques, la majorité confirment l’absence d’une gestion organisée de la maintenance des DMs dans leurs services. 90,5 % expriment leurs souhaits de recevoir une information mais peu d’entre eux expriment leurs désirs de suivre une formation (57,9 %). Conclusion Un manque d’information et de formation dans un domaine pourtant sensible et devant être lourdement réglementé est soulevé. La promulgation de textes réglementaires est nécessaire afin de promouvoir le secteur des DMs et garantir la sécurité sanitaire du patient et de l’utilisateur. PMID:28293376

Giovanni Aldini: from animal electricity to human brain stimulation.

PubMed

Parent, André

2004-11-01

Two hundred years ago, Giovanni Aldini published a highly influential book that reported experiments in which the principles of Luigi Galvani (animal electricity) and Alessandro Volta (bimetallic electricity) were used together for the first time. Aldini was born in Bologna in 1762 and graduated in physics at the University of his native town in 1782. As nephew and assistant of Galvani, he actively participated in a series of crucial experiments with frog's muscles that led to the idea that electricity was the long-sought vital force coursing from brain to muscles. Aldini became professor of experimental physics at the University of Bologna in 1798. He traveled extensively throughout Europe, spending much time defending the concept of his discreet uncle against the incessant attacks of Volta, who did not believe in animal electricity. Aldini used Volta's bimetallic pile to apply electric current to dismembered bodies of animals and humans; these spectacular galvanic reanimation experiments made a strong and enduring impression on his contemporaries. Aldini also treated patients with personality disorders and reported complete rehabilitation following transcranial administration of electric current. Aldini's work laid the ground for the development of various forms of electrotherapy that were heavily used later in the 19th century. Even today, deep brain stimulation, a procedure currently employed to relieve patients with motor or behavioral disorders, owes much to Aldini and galvanism. In recognition of his merits, Aldini was made a knight of the Iron Crown and a councillor of state at Milan, where he died in 1834.

Critical appraisal of organ procurement under Maastricht 3 condition.

PubMed

Puybasset, L; Bazin, J-E; Beloucif, S; Bizouarn, P; Crozier, S; Devalois, B; Eon, B; Fieux, F; Gisquet, E; Guibet-Lafaye, C; Kentish, N; Lienhart, A; Nicolas-Robin, A; Otero Lopez, M; Pelluchon, C; Roussin, F; Beydon, L

2014-02-01

The ethics committee of the French Society of Anesthesia and Intensive Care (Sfar) has been requested by the French Biomedical Agency to consider the issue of organ donation in patients after the decision to withdraw life-supportive therapies has been taken. This type of organ donation is performed in the USA, Canada, the United Kingdom, the Netherlands and Belgium. The three former countries have published recommendations formalizing procedures and operations. The French Society of Anesthesia and Intensive Care (Société française d'anesthésie et de reanimation [Sfar]) ethics committee has considered this issue and envisioned the different aspects of the whole process. Consequently, it sounded a note of caution regarding the applicability of this type of organ procurement in unselected patients following a decision to withdraw life-supportive therapies. According to French regulations concerning organ procurement in brain-dead patients, the committee stresses the need to restrict this specific way of procurement to severely brain-injured patients, once confirmatory investigations predicting a catastrophic prognosis have been performed. This suggests that the nature of the confirmatory investigation required should be formalized by the French Biomedical Agency on behalf of the French parliamentarians, which should help preserve population trust regarding organ procurement and provide a framework for medical decision. This text has been endorsed by the Sfar. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Early nerve repair in traumatic brachial plexus injuries in adults: treatment algorithm and first experiences.

PubMed

Pondaag, Willem; van Driest, Finn Y; Groen, Justus L; Malessy, Martijn J A

2018-01-26

OBJECTIVE The object of this study was to assess the advantages and disadvantages of early nerve repair within 2 weeks following adult traumatic brachial plexus injury (ATBPI). METHODS From 2009 onwards, the authors have strived to repair as early as possible extended C-5 to C-8 or T-1 lesions or complete loss of C-5 to C-6 or C-7 function in patients in whom there was clinical and radiological suspicion of root avulsion. Among a group of 36 patients surgically treated in the period between 2009 and 2011, surgical findings in those who had undergone treatment within 2 weeks after trauma were retrospectively compared with results in those who had undergone delayed treatment. The result of biceps muscle reanimation was the primary outcome measure. RESULTS Five of the 36 patients were referred within 2 weeks after trauma and were eligible for early surgery. Nerve ruptures and/or avulsions were found in all early cases of surgery. The advantages of early surgery are as follows: no scar formation, easy anatomical identification, and gap length reduction. Disadvantages include less-clear demarcation of vital nerve tissue and unfamiliarity with the interpretation of frozen-section examination findings. All 5 early-treatment patients recovered a biceps force rated Medical Research Council grade 4. CONCLUSIONS Preliminary results of nerve repair within 2 weeks of ATBPI are encouraging, and the benefits outweigh the drawbacks. The authors propose a decision algorithm to select patients eligible for early surgery. Referral standards for patients with ATBPI must be adapted to enable early surgery.

Cryoethics: seeking life after death.

PubMed

Shaw, David

2009-11-01

Cryonic suspension is a relatively new technology that offers those who can afford it the chance to be 'frozen' for future revival when they reach the ends of their lives. This paper will examine the ethical status of this technology and whether its use can be justified. Among the arguments against using this technology are: it is 'against nature', and would change the very concept of death; no friends or family of the 'freezee' will be left alive when he is revived; the considerable expense involved for the freezee and the future society that will revive him; the environmental cost of maintaining suspension; those who wish to use cryonics might not live life to the full because they would economize in order to afford suspension; and cryonics could lead to premature euthanasia in order to maximize chances of success. Furthermore, science might not advance enough to ever permit revival, and reanimation might not take place due to socio-political or catastrophic reasons. Arguments advanced by proponents of cryonics include: the potential benefit to society; the ability to cheat death for at least a few more years; the prospect of immortality if revival is successful; and all the associated benefits that delaying or avoiding dying would bring. It emerges that it might be imprudent not to use the technology, given the relatively minor expense involved and the potential payoff. An adapted and more persuasive version of Pascal's Wager is presented and offered as a conclusive argument in favour of utilizing cryonic suspension.

Bilateral Facial Paralysis: A 13-Year Experience.

PubMed

Gaudin, Robert A; Jowett, Nathan; Banks, Caroline A; Knox, Christopher J; Hadlock, Tessa A

2016-10-01

Bilateral facial palsy is a rare clinical entity caused by myriad disparate conditions requiring different treatment paradigms. Lyme disease, Guillain-Barré syndrome, and leukemia are several examples. In this article, the authors describe the cause, the initial diagnostic approach, and the management of long-term sequelae of bilateral paralysis that has evolved in the authors' center over the past 13 years. A chart review was performed to identify all patients diagnosed with bilateral paralysis at the authors' center between January of 2002 and January of 2015. Demographics, signs and symptoms, diagnosis, initial medical treatment, interventions for facial reanimation, and outcomes were reviewed. Of the 2471 patients seen at the authors' center, 68 patients (3 percent) with bilateral facial paralysis were identified. Ten patients (15 percent) presented with bilateral facial paralysis caused by Lyme disease, nine (13 percent) with Möbius syndrome, nine (13 percent) with neurofibromatosis type 2, five (7 percent) with bilateral facial palsy caused by brain tumor, four (6 percent) with Melkersson-Rosenthal syndrome, three (4 percent) with bilateral temporal bone fractures, two (3 percent) with Guillain-Barré syndrome, one (2 percent) with central nervous system lymphoma, one (2 percent) with human immunodeficiency virus infection, and 24 (35 percent) with presumed Bell palsy. Treatment included pharmacologic therapy, physical therapy, chemodenervation, and surgical interventions. Bilateral facial palsy is a rare medical condition, and treatment often requires a multidisciplinary approach. The authors outline diagnostic and therapeutic algorithms of a tertiary care center to provide clinicians with a systematic approach to managing these complicated patients.

Bell's palsy: a summary of current evidence and referral algorithm.

PubMed

Glass, Graeme E; Tzafetta, Kallirroi

2014-12-01

Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical management remains the best way to improve outcomes. Reconstructive surgery can improve long term disfigurement. However, acute and surgical options are time-dependent. As family practitioners see, on average, one case every 2 years, a summary of this condition based on common clinical questions may improve acute management and guide referral for those who need specialist input. We formulated a series of clinical questions likely to be of use to family practitioners on encountering this condition and sought evidence from the literature to answer them. The lifetime risk is 1 in 60, and is more common in pregnancy and diabetes mellitus. Patients often present with facial pain or paraesthesia, altered taste and intolerance to loud noise in addition to facial droop. It is probably caused by ischaemic compression of the facial nerve within the meatal segment of the facial canal probably as a result of viral inflammation. When given early, high dose corticosteroids can improve outcomes. Neither antiviral therapy nor other adjuvant therapies are supported by evidence. As the facial muscles remain viable re-innervation targets for up to 2 years, late referrals require more complex reconstructions. Early recognition, steroid therapy and early referral for facial reanimation (when the diagnosis is secure) are important features of good management when encountering these complex cases. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Upper-limb muscle responses to epidural, subdural and intraspinal stimulation of the cervical spinal cord

NASA Astrophysics Data System (ADS)

Sharpe, Abigail N.; Jackson, Andrew

2014-02-01

Objective. Electrical stimulation of the spinal cord has potential applications following spinal cord injury for reanimating paralysed limbs and promoting neuroplastic changes that may facilitate motor rehabilitation. Here we systematically compare the efficacy, selectivity and frequency-dependence of different stimulation methods in the cervical enlargement of anaesthetized monkeys. Approach. Stimulating electrodes were positioned at multiple epidural and subdural sites on both dorsal and ventral surfaces, as well as at different depths within the spinal cord. Motor responses were recorded from arm, forearm and hand muscles. Main results. Stimulation efficacy increased from dorsal to ventral stimulation sites, with the exception of ventral epidural electrodes which had the highest recruitment thresholds. Compared to epidural and intraspinal methods, responses to subdural stimulation were more selective but also more similar between adjacent sites. Trains of stimuli delivered to ventral sites elicited consistent responses at all frequencies whereas from dorsal sites we observed a mixture of short-latency facilitation and long-latency suppression. Finally, paired stimuli delivered to dorsal surface and intraspinal sites exhibited symmetric facilitatory interactions at interstimulus intervals between 2-5 ms whereas on the ventral side interactions tended to be suppressive for near-simultaneous stimuli. Significance. We interpret these results in the context of differential activation of afferent and efferent roots and intraspinal circuit elements. In particular, we propose that distinct direct and indirect actions of spinal cord stimulation on motoneurons may be advantageous for different applications, and this should be taken into consideration when designing neuroprostheses for upper-limb function.

Investigation of the activation of the temporalis and masseter muscles in voluntary and spontaneous smile production.

PubMed

Steele, Jessica E; Woodcock, Ian R; Murphy, Adrian D; Ryan, Monique M; Penington, Tony J; Coombs, Christopher J

2018-07-01

Masticatory muscles or their nerve supply are options for facial reanimation surgery, but their ability to create spontaneous smile has been questioned. This study assessed the percentage of healthy adults who activate the temporalis and masseter muscles during voluntary and spontaneous smile. Healthy volunteer adults underwent electromyography (EMG) studies of the temporalis and masseter muscles during voluntary and spontaneous smile. Responses were repeated three times and recorded as negative, weakly positive, or strongly positive according to the activity observed. The best response was used for analysis. Thirty healthy adults (median age: 34 years, range: 25-69 years) participated. Overall, 92% of the masseter muscles were activated during voluntary smile (22% strong, 70% weak). Seventy-seven percent of the masseter muscles were activated in spontaneous smile (12% strong, 65% weak). The temporalis muscle was activated in 62% of responses in voluntary smile (15% strong, 47% weak) and in 45% of responses in spontaneous smile (13% strong, 32% weak). No significant difference was found for males vs females or closed vs open mouth smiles. There was no significant difference in responses between voluntary and spontaneous smiles for the temporalis and masseter muscles, and their use in voluntary smile did not predict activity in spontaneous smile. Our study has shown that masseter and temporalis are active in a high proportion of healthy adults during voluntary and spontaneous smiles. Further work is required to determine the relationship between preoperative donor muscle activation and postoperative spontaneous smile, and whether masticatory muscle activity can be upregulated with appropriate training. Copyright © 2018. Published by Elsevier Ltd.

[Assessment of hygiene practices in anaesthesia between 1998 and 2007 in Lorraine].

PubMed

Anselme, S; Boileau, S; Vedel, M; Muller, C; Blech, M-F; Bouaziz, H

2009-01-01

To study the assessment of hygiene practices in anaesthesia in Lorraine between 1998 and 2007, after recommendations from the French Society of Anaesthesia and Reanimation (SFAR) in December 1997, and different local actions. Two surveys performed at a nine-year interval in Lorraine hospitals. Questionnaires about risk infection management and hygiene practices were sent by post to all anaesthetists, nurse anaesthetists and recovery room nurses in 1998 (n=279) and in 2007 (n=259). Between the two surveys multidrug-resistant bacteria signalling, movements of the staff in operating rooms, septic isolation protocol and management of single-use disposable anaesthesia material have been improved (p<0.05). Central venous catheters are less performed in recovery rooms and rings wearing decreased by 16% (p<0.05). Wearing of nonsterile gloves for peripheral venous catheter and intubation is not generalized (p<0.05). About half of the hospitals have cleanup procedures of anaesthesia furniture. Washing of hands by anaesthesia staff is not sometimes respected but it's more frequent for medicine preparation and between two operations. A good skin disinfection (cleaning - rinsing - drying - antiseptic) is more recurrent in 2007 (61.4%) than in 1998 (41.9%) for arterial catheter. Wearing of glasses for intubation is each times rare, about 15%. Hygiene practices in anaesthesia in Lorraine have been improved between the two surveys by recommendations from the Sfar and the work of the Antenne Régional de Lorraine (audits, manuals, formations). Promising progress has been made but some points must still be worked on.

[Urinary ascites, uroperitoneum and urinary peritonitis in children: management of nine case reports in Madagascar].

PubMed

Raherinantenaina, F; Rambel, A H; Rakotosamimanana, J; Rajaonanahary, T M A; Rajaonera, T; Rakototiana, F A; Hunald, F A; Andriamanarivo, M L; Rantomalala, H Y H; Rakoto Ratsimba, H N

2013-10-01

To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Attitudes towards end-of-life issues in intensive care unit among Italian anesthesiologists: a nation-wide survey.

PubMed

Cortegiani, Andrea; Russotto, Vincenzo; Raineri, Santi Maurizio; Gregoretti, Cesare; Giarratano, Antonino; Mercadante, Sebastiano

2018-06-01

The aim of this paper is to collect data on the practice of palliative care, withholding and withdrawal of life-sustaining therapies, and management of end of life (EOL) in Italian intensive care units (ICUs). Web-based survey among Italian anesthesiologists endorsed by the Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI). The survey consists of 27 close-ended and 2 open-ended questions. Eight hundred and five persons responded to the full list of questions. The highest proportion of respondents was of 36-45 years of age (34%) and catholic (66%). Almost 70% of responders declared that palliative/supportive care are applied in their ICU in case of futility of intensive treatments. Decision on withdrawing/withholding of life-sustaining treatments resulted from team consensus in most cases (58%). In more than 70% of responders' ICUs, there is no collaboration with palliative/supportive care experts. Systematic recording of most frequent symptoms experienced by critically ill patients (e.g., pain, dyspnea, thirst) was not common. Vasopressors, extracorporeal therapies, blood component transfusions and invasive monitoring were the most commonly modified/interrupted measures in case of futility. Almost 85% of respondents have not received training in palliative/supportive care. The proportion of respondents whose institution has a palliative care team and who had training in palliative care was not homogenous across the country. These data suggest that training in palliative care and its clinical application should be implemented in Italy. Efforts should be made to improve and homogenize the management of dying patients in ICU.

Off the shelf cellular therapeutics: Factors to consider during cryopreservation and storage of human cells for clinical use.

PubMed

Woods, Erik J; Thirumala, Sreedhar; Badhe-Buchanan, Sandhya S; Clarke, Dominic; Mathew, Aby J

2016-06-01

The field of cellular therapeutics has immense potential, affording an exciting array of applications in unmet medical needs. One of several key issues is an emphasis on getting these therapies from bench to bedside without compromising safety and efficacy. The successful commercialization of cellular therapeutics will require many to extend the shelf-life of these therapies beyond shipping "fresh" at ambient or chilled temperatures for "just in time" infusion. Cryopreservation is an attractive option and offers potential advantages, such as storing and retaining patient samples in case of a relapse, banking large quantities of allogeneic cells for broader distribution and use and retaining testing samples for leukocyte antigen typing and matching. However, cryopreservation is only useful if cells can be reanimated to physiological life with negligible loss of viability and functionality. Also critical is the logistics of storing, processing and transporting cells in clinically appropriate packaging systems and storage devices consistent with quality and regulatory standards. Rationalized approaches to develop commercial-scale cell therapies require an efficient cryopreservation system that provides the ability to inventory standardized products with maximized shelf life for later on-demand distribution and use, as well as a method that is scientifically sound and optimized for the cell of interest. The objective of this review is to bridge this gap between the basic science of cryobiology and its application in this context by identifying several key aspects of cryopreservation science in a format that may be easily integrated into mainstream cell therapy manufacture. Copyright © 2016 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

The Magnetic Levator Prosthesis for Temporary Management of Severe Blepharoptosis: Initial Safety and Efficacy

PubMed Central

Houston, Kevin E.; Tomasi, Matteo; Amaral, Christina; Finch, Nicole; Yoon, Michael K.; Lee, Hang; Paschalis, Eleftherios I.

2018-01-01

Purpose We further optimized and evaluated the safety of the magnetic levator prosthesis (MLP) for temporary management of severe blepharoptosis, and compared efficacy and comfort against the ptosis crutch. Methods The interpalpebral fissure (IPF) of participants (n = 12) with ptosis was measured during attempted eyelid opening, volitional closing, and spontaneous closing with no device, ptosis crutch, or the MLP. A 10-point scale documented comfort. Additionally, a 20 minute and then 1 week trial of the MLP was offered. Safety measures were skin erythema rating, change in visual acuity, and change in corneal staining. Results The MLP and crutch opened the eye (IPF 11.2 and 9.3 mm), but the MLP allowed better volitional closure (IPF 1.0 vs. 4.9 mm, P = 0.009), but was no better in allowing spontaneous blink (IPF 7.5 vs. 7.7 mm, P = 0.722). Both devices were equally comfortable (both median 8/10 comfort, P = 0.46). With extended use, opening with the MLP showed IPF 9.24 mm at 20 minutes and 9.46 mm at 1 week, and volitional closure was IPF 0.95 and 0.52 mm, respectively. Closure on spontaneous blink improved with extended wear to IPF 5.14 and 5.18 mm, respectively (P = 0.002). Two participants exhibited moderate skin erythema and one had increased corneal staining without change in acuity. Conclusions The MLP is safe and feasible for temporary correction of severe ptosis. Translational Relevance First group data in patients showing successful reanimation of the eyelid with magnetic force. PMID:29367892

Lambeaux autofermants pour le traitement des brulures electriques du scalp par haut voltage

PubMed Central

Hafidi, J.; El Mazouz, S.; El Mejatti, H.; Fejjal, N.; Gharib, N.E.; Abbassi, A.; Belmahi, A.M.

2011-01-01

Summary Les brûlures électriques par haut voltage sont responsables de gros dégâts tissulaires en immédiat et dans les jours suivant l’accident du fait de la chaleur importante dégagée par effet joule et de la thrombose microvasculaire évolutive. Les pertes de substances du scalp secondaires à ces brûlures nécessitent une couverture par lambeaux vu la destruction du périoste et du calvarium en regard. De juin 1997 à juin 2008, 15 patients ont été traités pour des pertes de substance du scalp secondaires à des brûlures électriques par haut voltage de diamètre allant de 8 à 11 cm et siégeant dans la région tonsurale. Ces patients ont été opérés dans la première semaine suivant l’accident. Les pertes de substance du scalp de taille moyenne secondaires à ces brûlures peuvent être couvertes per primam de façon fiable par des lambeaux locaux axialisés et multiples. Nous relatons l’expérience du Service de Chirurgie Plastique du Centre Hospitalier Universitaire Ibn-Sina, Rabat, Maroc, dans la gestion et la prise en charge de ces brûlures. PMID:22262963

[Skin grafting in the treatment of hand burns sequelae in relation to 152 cases. Report from Department of Plastic Surgery, University Hospital Ibn Sina].

PubMed

El Mazouz, S; Fejjal, N; Hafidi, J; Cherkab, L; Mejjati, H; Belfqih, R; Gharib, N; Abbassi, A

2010-03-31

La main est fréquemment exposée aux brûlures, entraînant des séquelles esthétiques et fonctionnelles. Le traitement de ces séquelles est surtout chirurgical et consiste en la greffe de peau, dont le type dépend de la localisation de la brûlure et du type des séquelles. Dans ce travail rétrospectif, nous rapportons une série de 152 cas de brûlures des mains colligés au service de chirurgie plastique du Centre Hospitalier Universitaire Ibn-Sina de Rabat sur une période de dix ans, allant de 1998 à 2007. Les indications thérapeutiques dépendent du type de séquelles et de la localisation de la brûlure. En tout, 97 patients ont bénéficié d'une greffe cutanée, dont 76% par greffe de peau totale, 21% par greffe de peau demi-épaisse et 3% par peau fine. Les séquelles des brûlures des mains posent un problème thérapeutique majeur, malgré la diversité des procédés chirurgicaux, d'où l'intérêt de la prévention.

Intensification of heat transfer across falling liquid films

NASA Astrophysics Data System (ADS)

Ruyer-Quil, Christian; Cellier, Nicolas; Stutz, Benoit; Caney, Nadia; Bandelier, Philippe; Locie Team; Legi Team

2017-11-01

The wavy motion of a liquid film is well known to intensify heat or mass transfers. Yet, if film thinning and wave merging are generally invoked, the physical mechanisms which enable this intensification are still unclear. We propose a systematic investigation of the impact of wavy motions on the heat transfer across 2D falling films on hot plates as a function of the inlet frequency and flow parameters. Computations over extended domains and for sufficient durations to achieve statistically established flows have been made possible by low-dimensional modeling and the development of a fast temporal solver based on graph optimizations. Heat transfer has been modeled using the weighted residual technique as a set of two evolution equations for the free-surface temperature and the wall heat flux. This new model solves the shortcomings of previous attempts, namely their inability to capture the onset of thermal boundary layers in large-amplitude waves and their limitation to low Prandtl numbers. Our study reveals that heat transfer is enhanced at the crests of the waves and that heat transfer intensification is maximum at the maximum of density of wave crests, which does not correspond to the natural wavy regime (no inlet forcing). Supports from Institut Universitaire de France and Région Auvergne-Rhones-Alpes are warmly acknowledged.

[Hospital infections in the maternity department at Brest Hospital over a period from 2000 to 2005].

PubMed

Rouzic, N; Faisant, M; Scheydeker, J-L; Collet, M; Lejeune, B

2008-03-01

Hospital infections are at stake in terms of public health. They are responsible for increase in morbidity and involve the community in high costs. Epidemiologic surveillance has been initiated in the departments of gynecology, obstetrics and maternity with a view to making out the rate of hospital-acquired infections and the risk factors associated to them. It is an incidence survey over a period from 2000 to 2005. Surveillance slips are filled in for every childbirth. All suspicions of hospital infections are analysed in morbidity reviews every trimester. A request to the Medical Information Department of the hospital has allowed to look for variables which were not mentioned on the initial questionnaire and so carry out a more complete analysis. The number of hospital infections amounts to 118 over 9526 childbirths, corresponding to an incidence rate of 1.24%. After vaginal delivery the encountered risk factors are: episiotomy or perineal trauma, epidural anesthesia, urinary infection and the use of tools. After a caesarean section the risk factors are: general anesthesia and lack of antibioprophylaxy. The rate of hospital infections in the maternity department at Brest's centre hospitalier universitaire (CHU) during the considered period and the observed tendency to a decreasing of hospital infections over the same period apparently denotes the interest of surveillance in matter of hospital infections in maternity.

Time trend of clinical cases of Lyme disease in two hospitals in Belgium, 2000-2013.

PubMed

De Keukeleire, Mathilde; Vanwambeke, Sophie O; Kabamba, Benoît; Belkhir, Leila; Pierre, Philippe; Luyasu, Victor; Robert, Annie

2017-12-05

As several studies indicated an increase in Lyme disease (LD), notably in neighbouring countries, concerns have arisen regarding the evolution of Lyme disease in Belgium. In order to confirm or infirm the increase of LD in Belgium, we focused on hospital admissions of patients diagnosed with LD between 2000 and 2013 based on hospital admission databases from two hospitals in Belgium. Hospital databases are a stable recording system. We did a retrospective analysis of the medical files of patients hospitalized with Lyme disease in two Belgian hospitals between 2000 and 2013. The annual number of cases of LD for the two studied Belgian hospitals remained stable between 2000 and 2013, ranging from 1 for the Cliniques universitaires Saint-Luc to 15 for the the Clinique Saint-Pierre. No increasing trend were noted in the estimated annual incidence rate but the average estimated annual incidence rate was higher for the hospital Saint-Pierre (8.1 ± 3.7 per 100,000 inhabitants) than Saint-Luc (2.2 ± 1.5 per 100,000 inhabitants). The number of hospital cases of LD peaked between June and November. Based on hospital admissions with LD, no increasing trend was observed for the period 2000-2013 in the two studied Belgian hospitals. This is in line with other studies carried out in Belgium.

La formation aux techniques du travail universitaire et la notion de tache (Training in the Techniques of Academic Work and the Notion of Task).

ERIC Educational Resources Information Center

Phillips, M. K.

1981-01-01

Discusses questions concerning training students in techniques of academic work and use of the English language in this context. These questions, currently researched at the English Language Center of King Abdulaziz University, focus on the notion of task as a minimal pedagogic unit, and on task-objective coordination criteria. Societe Nouvelle…

Reconstructive procedures for impaired upper airway function: laryngeal respiration

PubMed Central

Müller, Andreas

2005-01-01

The larynx is the "bottleneck" of the human airway. For this reason, the effects of stenosing laryngeal pathologies on the vital factor respiratory gas exchange are particularly critical. Internal stabilization is a prerequisite for recovery of the laryngeal respiratory function in severe forms of inspiratory collapse (laryngomalacia). Effective laser surgery techniques have been developed to this end in recent years. Glottis-dilating surgery in cases of bilateral vocal cord motion impairment is now moving in the direction of endoscopic laser cordotomy or cordectomy, whereas arytenoidectomy and open surgical procedures are now used only rarely due to higher secondary morbidity rates. In individual cases, in particular if functional recovery is expected, temporary laterofixation of a vocal cord using an endoscopic suturing technique can be a helpful approach. Extensive laryngeal defects can be covered by means of composite grafts with mucosal lining, a supporting skeleton and their own vascularization. Autologous transplantation of the larynx, with its complex surgical and immunological problems, has become a manageable procedure. The problems of post-transplantation reinnervation and risk assessment of immunosuppression-induced recurrence of the tumor are still under consideration. Reanimation of the bilaterally paralyzed larynx by means of neurorrhaphy (neurosuture), neural grafting and, more recently, functional electrostimulation (pacemaker) represents a challenge for the coming years. In most cases of paralysis of the recurrent laryngeal nerve, a part of the muscles is maintained by synkinetic reinnervation when therapy is carried out, which however also prevents effective vocal cord movement due to simultaneous activity of agonists and antagonists. Modulation of reinnervation by means of electrostimulation and modern genetic therapy approaches justify hopes of better outcomes in the future. PMID:22073057

Electrophysiological Assessment of a Peptide Amphiphile Nanofiber Nerve Graft for Facial Nerve Repair.

PubMed

Greene, Jacqueline J; McClendon, Mark T; Stephanopoulos, Nicholas; Álvarez, Zaida; Stupp, Samuel I; Richter, Claus-Peter

2018-04-27

Facial nerve injury can cause severe long-term physical and psychological morbidity. There are limited repair options for an acutely transected facial nerve not amenable to primary neurorrhaphy. We hypothesize that a peptide amphiphile nanofiber neurograft may provide the nanostructure necessary to guide organized neural regeneration. Five experimental groups were compared, animals with 1) an intact nerve, 2) following resection of a nerve segment, and following resection and immediate repair with either a 3) autograft (using the resected nerve segment), 4) neurograft, or 5) empty conduit. The buccal branch of the rat facial nerve was directly stimulated with charge balanced biphasic electrical current pulses at different current amplitudes while nerve compound action potentials (nCAPs) and electromygraphic (EMG) responses were recorded. After 8 weeks, the proximal buccal branch was surgically re-exposed and electrically evoked nCAPs were recorded for groups 1-5. As expected, the intact nerves required significantly lower current amplitudes to evoke an nCAP than those repaired with the neurograft and autograft nerves. For other electrophysiologic parameters such as latency and maximum nCAP, there was no significant difference between the intact, autograft and neurograft groups. The resected group had variable responses to electrical stimulation, and the empty tube group was electrically silent. Immunohistochemical analysis and TEM confirmed myelinated neural regeneration. This study demonstrates that the neuroregenerative capability of peptide amphiphile nanofiber neurografts is similar to the current clinical gold standard method of repair and holds potential as an off-the-shelf solution for facial reanimation and potentially peripheral nerve repair. This article is protected by copyright. All rights reserved.

Outcomes of Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release.

PubMed

Jacobson, Joel; Rihani, Jordan; Lin, Karen; Miller, Phillip J; Roland, J Thomas

2011-01-01

Lesions of the temporal bone and cerebellopontine angle and their management can result in facial nerve paralysis. When the nerve deficit is not amenable to primary end-to-end repair or interpositional grafting, nerve transposition can be used to accomplish the goals of restoring facial tone, symmetry, and voluntary movement. The most widely used nerve transposition is the hypoglossal-facial nerve anastamosis, of which there are several technical variations. Previously we described a technique of single end-to-side anastamosis using intratemporal facial nerve mobilization and parotid release. This study further characterizes the results of this technique with a larger patient cohort and longer-term follow-up. The design of this study is a retrospective chart review and the setting is an academic tertiary care referral center. Twenty-one patients with facial nerve paralysis from proximal nerve injury at the cerebellopontine angle underwent facial-hypoglossal neurorraphy with parotid release. Outcomes were assessed using the Repaired Facial Nerve Recovery Scale, questionnaires, and patient photographs. Of the 21 patients, 18 were successfully reinnervated to a score of a B or C on the recovery scale, which equates to good oral and ocular sphincter closure with minimal mass movement. The mean duration of paralysis between injury and repair was 12.1 months (range 0 to 36 months) with a mean follow-up of 55 months. There were no cases of hemiglossal atrophy, paralysis, or subjective dysfunction. Direct facial-hypoglossal neurorrhaphy with parotid release achieved a functional reinnervation and good clinical outcome in the majority of patients, with minimal lingual morbidity. This technique is a viable option for facial reanimation and should be strongly considered as a surgical option for the paralyzed face.

[End-of-life in specialized medical pediatrics department: A French national survey].

PubMed

Ravanello, Alice; Desguerre, Isabelle; Frache, Sandra; Hubert, Philippe; Orbach, Daniel; Aubry, Régis

2017-03-01

In France, most of children die in the hospital. This national survey aimed to achieve better understanding of end-of life care in specialized medical pediatrics departments for children facing the end-of-life, identify the available resources, put forward the difficulties encountered by professionals and describe end-of-life paths of children who died in these departments. This study is based on a nationwide survey conducted among all existing specialized medical pediatrics departments (onco-haematology, neurology, reanimation) in France in 2015. Among 94 specialized medical pediatrics departments in France, 53 participated in our survey (response rate=56%). At the time of the survey, 13% of inpatients were facing the end-of-life. Regarding training, 13% of departments did not have personnel trained in palliative care and 21% did not set up any professional support. However, when taking care of a child's end of life in 2014, 77% of these departments solicited a regional resource team of pediatric palliative care. This survey helps describe 225 end-of-life paths of children decease of a terminal illness in the specialized pediatrics departments. Seventy-two percent suffered from refractory symptoms before their death, 64% were concerned by a terminal sedation and 75% by a limitation of life-sustaining treatment decision. End-of-life care is a reality for specialized pediatrics departments. The frequency of major and refractory symptoms often requires the completion of sedation. The resources of service are acceptable but some deficiencies have been noted especially concerning training and support for caregivers, adaptation of premises or family support. Copyright © 2017. Published by Elsevier SAS.

Effect of low-flow anesthesia education on knowledge, attitude and behavior of the anesthesia team.

PubMed

Hanci, Volkan; Yurtlu, Serhan; Ayoğlu, Hilal; Okyay, Rahşan Dilek; Erdoğan, Gülay; Abduşoğlu, Mustafa; Sayin, Esin; Turan, Işil Ozkoçak

2010-08-01

The aim of this study was to evaluate the effect of education on the knowledge, attitude and behavior of anesthesiology staff and residents towards low-flow anesthesia. The staff and residents in the Department of Anesthesia and Reanimation, Zonguldak Karaelmas University were given theoretical and practical training in delivering low-flow anesthesia. To evaluate their attitudes and behaviors toward low-flow anesthesia, we collected data during the 6 months before training, during the first 3 months after training, and at 4-6 months after training. Anesthesia follow-up records, operation time, volatile anesthetic agent used, and the amount (in liters) of fresh gas low mid-anesthesia were recorded in all three stages. A total of 3,158 patients received general anesthesia and inhalation anesthesia was used in 3,115 of these patients. Our study group consisted of 2,752 patients who had no absolute or relative contraindications to low-flow anesthesia. While the mean fresh gas flow was 4.00 +/- 0.00 L/min before training, this level dropped to 2.98 L/min in the first 3 months after training, and to 3.26 L/min in the following 3 months. The mean fresh gas flow was significantly lower at the two post-training assessments than before training (p < 0.05). In conclusion, low-flow anesthesia may be used more frequently if educational seminars are provided to anesthetists. The use of low-flow anesthesia may increase further by allocating more time to this technique in anesthesia training programs provided at regular intervals. Copyright 2010 Elsevier. Published by Elsevier B.V. All rights reserved.

Pratique de l’analgésie péridurale auprès de 20 parturientes au Centre Hospitalier Universitaire Sylvanus Olympio de Lomé (Togo)

PubMed Central

Egbohou, Pilakimwé; Mouzou, Tabana; Sama, Hamza Doles; Tchétike, Pikabalo; Assénouwé, Sarakawabalo; Akala-Yoba, Gnimdou; Tomta, Kadjika

2017-01-01

Etude prospective et descriptive sur la pratique de l’analgésie péridurale (APD) obstétricale au CHU Sylvanus Olympio (CHU SO) de Lomé. Etude menée de février à juin 2014. Après accord des gestantes choisies au hasard et en l’absence de contre-indication à l’issue de la consultation d’anesthésie, faite au 8ème mois de la grossesse, des femmes ont été retenues pour l’étude. Sur 29 gestantes retenues, 20 (69%) ont bénéficiées de l’APD. Age moyen 30,6±6,6 ans, primigestes : 35%, multipares 50%, Obèses (BMI>30): 25%. Nombre moyen de ponctions: 1,2±0,5; reflux de sang dans le cathéter: 5%, brèche dure-mérienne : 0. Délai moyen d’installation: 8,5 ±2,2mn. Quantité moyenne de bupivacaine isobare à 0,125%: 28,8±8ml; Echelle Numérique à T10min < 3 pour toutes les parturientes. Bloc moteur: 0. Hypotension: 1cas (5%). Mode d’accouchement: voie basse: 19 (95%), césarienne: 1 (5%). Détresse respiratoire à la naissance du nouveau né: 0. Note de satisfaction: 9,8±0,5 /10. L’APD obstétricale est possible au CHU Sylvanus Olympio de Lomé. En attendant sa vulgarisation à toutes les parturientes par la disponibilité des moyens humains et matériels, la réaliser pour ses indications médicales serait un premier pas. PMID:28451033

Sensitivity of Daily Doses of Biologically Active Radiation, To Ozone Changes In Southern French Alps

NASA Astrophysics Data System (ADS)

de La Casinière, A.; Touré, M. L.; Masserot, D.; Lenoble, J.; Cabot, T.; Pinedo Vega, J. L.

Global UV irradiance spectra we re recorded each half an hour between sunrise and sunset, along the year 2000 in Briançon (1300m asl) at the CEMBREU (Centre Européen Médical Bioclimatique de Recherche et d'Enseignement Universitaire), a site of the French spectral UV network in Southern Alps. From these spectra are retrieved atmospheric transmissivities corresponding to daily doses of various biologically active radiation. A transmissivity is defined as the ratio of the ground level value of a daily dose to the extra -atmospheric value of this daily dose. The daily doses studied relate to UVB, erythema, DNA damage, and plant damage. Multiple linear correlations of the various transmissivities with the three predictors (daily sunshine fraction), µmin (cosine of the daily minimum SZA), and (daily total ozone column) assumed to be independent variables, are done for year 2000. These correlations permit to assess the mean sensitivities of the various transmissivities, to changes in for different cloud cover conditions in Briançon. The variations of each sensitivity is studied as a function of , µmin and . Comparing the results obtained with those given in the literature, we find for = 1 (that is for a strong probability of clear sky conditions) and SZA min = 45°, a radiation amplification factor (RAF) of the erythemal daily dose equal to 1.1 when = 285 DU, and to 1.4 when = 315 DU.

Adjusting Pulse Amplitude During Transcutaneous Electrical Nerve Stimulation Does Not Provide Greater Hypoalgesia.

PubMed

Bergeron-Vézina, Kayla; Filion, Camille; Couture, Chantal; Vallée, Élisabeth; Laroche, Sarah; Léonard, Guillaume

2018-03-01

Transcutaneous electrical nerve stimulation (TENS) is an electrotherapeutic modality commonly used in rehabilitation to relieve pain. Adjusting pulse amplitude (intensity) during TENS treatment has been suggested to overcome nerve habituation. However, it is still unclear if this procedure leads to greater hypoalgesia. The aim of this study was to determine if the hypoalgesic effect of TENS is greater when pulse amplitude is adjusted throughout the TENS treatment session in chronic low-back pain patients. Randomized double-blind crossover study. Recruitment and assessment were conducted at the Clinique universitaire de réadaptation de l'Estrie (CURE) of the Faculty of Medicine and Health Sciences of the Université de Sherbrooke. Twenty-one volunteers with chronic low-back pain were enrolled and completed this investigation. Each patient received two high-frequency TENS treatments on two separate sessions: (1) with adjustment of pulse amplitude and (2) without pulse amplitude adjustment. Pain intensity and unpleasantness were assessed before, during, and after TENS application with a 10 cm visual analog scale. Both TENS conditions (with and without adjustment of intensity) decreased pain intensity and unpleasantness when compared with baseline. No difference was observed between the two stimulation conditions for both pain intensity and unpleasantness. The current results suggest that adjustment of pulse amplitude during TENS application does not provide greater hypoalgesia in individuals with chronic low-back pain. Future studies are needed to confirm these findings in other pain populations.

Normative data and discriminant validity of Rey's Verbal Learning Test for the Greek adult population.

PubMed

Messinis, Lambros; Tsakona, Ioanna; Malefaki, Sonia; Papathanasopoulos, Panagiotis

2007-08-01

The present study sought to establish normative and discriminant validity data for Rey's Auditory Verbal Learning Test [Rey, A. (1964). L 'examen clinique en psychologie [Clinical tests in psychology]. Paris: Presses Universitaires de France; Schmidt, M. (1996). Rey auditory verbal learning test: A handbook. Los Angeles, CA: Western Psychological Services] using newly adapted learning lists for the Greek adult population. Applying the procedure suggested by Geffen et al. [Geffen, G., Moar, K. J., O'Hanlon, A. P., Clark, C. R., & Geffen, L. N. (1990). Performance measures of 16-86-year-old males and females on the auditory verbal learning test. The Clinical Neuropsychologist, 4, 45-63] we administered the test to 205 healthy participants, aged 18-78 years and two adult patient groups (long-term cannabis users and HIV symptomatic patients). Stepwise linear regression analyses showed that the variables age, education and gender contributed significantly to most trials of the RAVLT. Performance decreased in an age-dependent manner from young adulthood. Women, young adults and higher educated participants outperformed men, older adults and less educated individuals. The test appears to discriminate adequately between the performance of long-term heavy cannabis users and HIV seropositive symptomatic patients and matched healthy controls, as both patient groups performed more poorly than their respective control group. Normative data stratified by age, gender and education for the Greek adult population is presented for use in research and clinical settings.

Psychosocial determinants of nurses' intention to practise euthanasia in palliative care.

PubMed

Lavoie, Mireille; Godin, Gaston; Vézina-Im, Lydi-Anne; Blondeau, Danielle; Martineau, Isabelle; Roy, Louis

2016-02-01

Most studies on euthanasia fail to explain the intentions of health professionals when faced with performing euthanasia and are atheoretical. The purpose of this study was to identify the psychosocial determinants of nurses' intention to practise euthanasia in palliative care if it were legalised. A cross-sectional study using a validated anonymous questionnaire based on an extended version of the Theory of Planned Behaviour. A random sample of 445 nurses from the province of Quebec, Canada, was selected for participation in the study. The study was reviewed and approved by the Ethics Committee of the Centre hospitalier universitaire de Québec. The response rate was 44.2% and the mean score for intention was 4.61 ± 1.90 (range: 1-7). The determinants of intention were the subjective (odds ratio = 3.08; 95% confidence interval: 1.50-6.35) and moral (odds ratio = 2.95; 95% confidence interval: 1.58-5.49) norms. Specific beliefs which could discriminate nurses according to their level of intention were identified. Overall, nurses have a slightly positive intention to practise euthanasia. Their family approval seems particularly important and also the approval of their medical colleagues. Nurses' moral norm was related to beneficence, an ethical principle. To our knowledge, this is the first study to identify nurses' motivations to practise euthanasia in palliative care using a validated psychosocial theory. It also has the distinction of identifying the ethical principles underlying nurses' moral norm and intention. © The Author(s) 2014.

Terbinafine Resistance of Trichophyton Clinical Isolates Caused by Specific Point Mutations in the Squalene Epoxidase Gene

PubMed Central

Yamada, Tsuyoshi; Maeda, Mari; Alshahni, Mohamed Mahdi; Tanaka, Reiko; Yaguchi, Takashi; Bontems, Olympia; Salamin, Karine; Fratti, Marina

2017-01-01

ABSTRACT Terbinafine is one of the allylamine antifungal agents whose target is squalene epoxidase (SQLE). This agent has been extensively used in the therapy of dermatophyte infections. The incidence of patients with tinea pedis or unguium tolerant to terbinafine treatment prompted us to screen the terbinafine resistance of all Trichophyton clinical isolates from the laboratory of the Centre Hospitalier Universitaire Vaudois collected over a 3-year period and to identify their mechanism of resistance. Among 2,056 tested isolates, 17 (≈1%) showed reduced terbinafine susceptibility, and all of these were found to harbor SQLE gene alleles with different single point mutations, leading to single amino acid substitutions at one of four positions (Leu393, Phe397, Phe415, and His440) of the SQLE protein. Point mutations leading to the corresponding amino acid substitutions were introduced into the endogenous SQLE gene of a terbinafine-sensitive Arthroderma vanbreuseghemii (formerly Trichophyton mentagrophytes) strain. All of the generated A. vanbreuseghemii transformants expressing mutated SQLE proteins exhibited obvious terbinafine-resistant phenotypes compared to the phenotypes of the parent strain and of transformants expressing wild-type SQLE proteins. Nearly identical phenotypes were also observed in A. vanbreuseghemii transformants expressing mutant forms of Trichophyton rubrum SQLE proteins. Considering that the genome size of dermatophytes is about 22 Mb, the frequency of terbinafine-resistant clinical isolates was strikingly high. Increased exposure to antifungal drugs could favor the generation of resistant strains. PMID:28416557

Terbinafine Resistance of Trichophyton Clinical Isolates Caused by Specific Point Mutations in the Squalene Epoxidase Gene.

PubMed

Yamada, Tsuyoshi; Maeda, Mari; Alshahni, Mohamed Mahdi; Tanaka, Reiko; Yaguchi, Takashi; Bontems, Olympia; Salamin, Karine; Fratti, Marina; Monod, Michel

2017-07-01

Terbinafine is one of the allylamine antifungal agents whose target is squalene epoxidase (SQLE). This agent has been extensively used in the therapy of dermatophyte infections. The incidence of patients with tinea pedis or unguium tolerant to terbinafine treatment prompted us to screen the terbinafine resistance of all Trichophyton clinical isolates from the laboratory of the Centre Hospitalier Universitaire Vaudois collected over a 3-year period and to identify their mechanism of resistance. Among 2,056 tested isolates, 17 (≈1%) showed reduced terbinafine susceptibility, and all of these were found to harbor SQLE gene alleles with different single point mutations, leading to single amino acid substitutions at one of four positions (Leu 393 , Phe 397 , Phe 415 , and His 440 ) of the SQLE protein. Point mutations leading to the corresponding amino acid substitutions were introduced into the endogenous SQLE gene of a terbinafine-sensitive Arthroderma vanbreuseghemii (formerly Trichophyton mentagrophytes ) strain. All of the generated A. vanbreuseghemii transformants expressing mutated SQLE proteins exhibited obvious terbinafine-resistant phenotypes compared to the phenotypes of the parent strain and of transformants expressing wild-type SQLE proteins. Nearly identical phenotypes were also observed in A. vanbreuseghemii transformants expressing mutant forms of Trichophyton rubrum SQLE proteins. Considering that the genome size of dermatophytes is about 22 Mb, the frequency of terbinafine-resistant clinical isolates was strikingly high. Increased exposure to antifungal drugs could favor the generation of resistant strains. Copyright © 2017 American Society for Microbiology.

[Clinical laboratory medicine: continuous amelioration with a book of objectives and satisfaction survey].

PubMed

Reix, Nathalie; Agin, Arnaud; Bahram, Seiamak; Dali-Youcef, Nassim; Grucker, Daniel; Jaulhac, Benoît; Lepiller, Quentin; Lessinger, Jean-Marc; Mauvieux, Laurent; Monier, Laurie; Schramm, Frédéric; Stoll-Keller, Françoise; Vallat, Laurent; Ludes, Bertrand; Candolfi, Ermanno; Filisetti, Denis

2015-01-01

We report in this publication the use of two educational tools, a questionnaire of satisfaction and a training book, to improve the training of students during their internship in clinical laboratory at the "Pôle de biologie des Hôpitaux universitaires de Strasbourg" in France. First, the ongoing training was assessed by the interns with a questionnaire measuring satisfaction. The analysis of this questionnaire identified four key points to improve: 1) define the teaching objectives, 2) organize the training with a schedule, 3) revise certain teaching methods and 4) ensure better integration of the students in the team of medical biologists. After this assessment, we implemented a training book to answer these four points. Indeed, the training book presents the objectives, the schedule of training, and how to validate the educational objectives. A new assessment was performed again using the same methodology. Results showed an improvement in student satisfaction from 74 to 88 %. The questionnaire of satisfaction and the training book are presented in this article. The aim of the assessment of training combined with the training book is to incite the actors of the training (students and teachers) to continually improve the training. The objectives of the Pôle de Biologie are to obtain an 80 % satisfaction rate during the 6 months trainings and to reduce or eliminate dissatisfaction, and finally to ensure the validation by students of 80 to 100 % of their predetermined objectives.

The DSM5/RDoC debate on the future of mental health research: implication for studies on human stress and presentation of the signature bank.

PubMed

Lupien, S J; Sasseville, M; François, N; Giguère, C E; Boissonneault, J; Plusquellec, P; Godbout, R; Xiong, L; Potvin, S; Kouassi, E; Lesage, A

2017-01-01

In 2008, the National Institute of Mental Health (NIMH) announced that in the next few decades, it will be essential to study the various biological, psychological and social "signatures" of mental disorders. Along with this new "signature" approach to mental health disorders, modifications of DSM were introduced. One major modification consisted of incorporating a dimensional approach to mental disorders, which involved analyzing, using a transnosological approach, various factors that are commonly observed across different types of mental disorders. Although this new methodology led to interesting discussions of the DSM5 working groups, it has not been incorporated in the last version of the DSM5. Consequently, the NIMH launched the "Research Domain Criteria" (RDoC) framework in order to provide new ways of classifying mental illnesses based on dimensions of observable behavioral and neurobiological measures. The NIMH emphasizes that it is important to consider the benefits of dimensional measures from the perspective of psychopathology and environmental influences, and it is also important to build these dimensions on neurobiological data. The goal of this paper is to present the perspectives of DSM5 and RDoC to the science of mental health disorders and the impact of this debate on the future of human stress research. The second goal is to present the "Signature Bank" developed by the Institut Universitaire en Santé Mentale de Montréal (IUSMM) that has been developed in line with a dimensional and transnosological approach to mental illness.

Preovulatory uterine flushing with saline as a treatment for unexplained infertility: a randomised controlled trial protocol.

PubMed

Maheux-Lacroix, Sarah; Dodin, Sylvie; Moore, Lynne; Bujold, Emmanuel; Lefebvre, Jessica; Bergeron, Marie-Ève

2016-01-06

In vitro fertilisation (IVF) is the treatment of choice for unexplained infertility. Preovulatory uterine flushing could reduce intrauterine debris and inflammatory factors preventing pregnancy and constitute an alternative to IVF. Our objective is to assess the efficacy of preovulatory uterine flushing with physiological saline for the treatment of unexplained infertility. We will perform a randomised controlled trial based on consecutive women aged between 18 and 37 years consulting for unexplained infertility for at least 1 year. On the day of their luteinising hormone surge, 192 participants will be randomised in two equal groups to either receive 20 mL of physiological saline by an intrauterine catheter or 10 mL of saline intravaginally. We will assess relative risk of live birth (primary outcome), as well as pregnancy (secondary outcome) over one cycle of treatment. We will report the side effects, complications and acceptability of the intervention. This project was approved by the Ethics committee of the Centre Hospitatlier Universitaire de Quebec (no 2015-1146). Uterine flushing is usually well tolerated by women and would constitute a simple, affordable and minimally invasive treatment for unexplained infertility. We plan to communicate the results of the review by presenting research abstracts at conferences and by publishing the results in a peer-reviewed journal. NCT02539290; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Bases anatomiques des lésions de l’artère pudendale externe lors de la chirurgie des varices du membre pelvien

PubMed Central

Gaye, Magaye; Ndiaye, Assane; Dieng, Papa Adama; Ndiaye, Aynina; Ba, Papa Salmane; Diatta, Souleymane; Ciss, Amadou Gabriel; Ndoye, Jean Marc Ndiaga; Diop, Mamadou; Ndiaye, Abdoulaye; Ndiaye, Mouhamadou; Dia, Abdarahmane

2016-01-01

Introduction L’artère pudendale externe est une branche collatérale de l’artère fémorale commune qui est destinée à la vascularisation du pénis ou du clitoris. Ses rapports avec la crosse de la grande veine saphène et de ses afférences, dans le trigone fémoral, sont très étroits. Cette situation fait qu’elle est souvent lésée lors de la crossectomie et de l’éveinage de la grande veine saphène. Ces lésions peuvent être à l’origine d’une dysfonction sexuelle. Méthodes Il s’agit d’une dissection de 22 régions inguinales chez 13 hommes et 9 femmes qui ont bénéficié d’un abord chirurgical du trigone fémoral. La distribution et les rapports de l’artère pudendale externe par rapport à la crosse de la grande veine saphène sont étudiés. Résultats L’artère pudendale externe unique est la plus fréquente. Toutes les artères pudendales externes ont pour origine l’artère fémorale commune. Le rapport le plus fréquent est le sous croisement de la crosse de la grande veine saphène par une artère pudendale externe unique. Par ailleurs, on a un précroisement, un croisement alterné et des rapports avec la veine fémorale commune et des afférences de la crosse de la grande veine saphène. Certaines techniques chirurgicales exposent plus ou moins à une lésion de l’artère pudendale externe. Conclusion Ce travail confirme les données antérieures mais montre encore quelques particularités sur les rapports entre la crosse de la grande veine saphène et l’artère pudendale externe. PMID:27795794

Les séquelles de brûlures cervicales: aspects épidémiologique, clinique et thérapeutique au Maroc

PubMed Central

Rafik, Amine; Chabak, Hakim; Diouri, Mounia; Bahechar, Naïma; Chlihi, Abdessamad

2015-01-01

Les séquelles de brûlures cervicales représentent une entité fréquente des séquelles de brûlure, elles affectent la fonction, l'esthétique et l’état psychologique des patients et peuvent être de traitement difficile. Il s'agit d'une étude rétrospective étalée sur 5 ans de Mars 2009 au Octobre2014, réalisée au centre national des brûlés et de chirurgie plastique au CHU Ibn Rochd Casablanca. Nous avons analysé les caractéristiques épidémiologiqueset cliniques ainsi que les indications et les résultats thérapeutiques chez 300 patients présentant des rétractions cervicales post-brûlure, suivis dans notre formation. Les jeunes femmes étaient le plus souvent touchées (56%). la brûlure thermique par flamme de butane dans le cadre d'accident domestique était l’étiologie la plus fréquente (91%).75% des patients ont été pris en charge dans un délai de 18 mois après avoir présenté une incapacité fonctionnelle. Les brides cervicales modérées et sévères sont les plus fréquentes et représentent respectivement 60% et 16% des cas. Le traitement chirurgical a fait appel aux greffes cutanées dans 67%des cas, aux plasties locales dans 24%des cas et aux lambeaux dans 24% des cas, les résultats sont jugés bons dans 75%des cas et moyens dans 18% des cas, tandis que les cas restants (7%) ont nécessité une reprise chirurgicale. Le traitement des brides cervicales doit être associé à un programme de rééducation adapté, afin d'assurer la pérennité des résultats fonctionnels et esthétiques. PMID:26301017

Cancers biliaires: aspects épidémiologiques cliniques et thérapeutiques à propos de 20 cas

PubMed Central

Ka, Ibrahima; Faye, Magatte; Diop, Papa Saloum; Faye, Amadou Bocar Niang Aliou Coly; Ndoye, Jean Marc; Fall, Babacar

2018-01-01

Les cancers des voies biliaires se répartissent en deux localisations principales: les cancers de la vésicule biliaire qui sont des adénocarcinomes et les cholangiocarcinomes de localisations intra et extra-hépatiques. Il s'agit étude rétrospective portant sur 20 cas de cancers biliaires entre Janvier 2006 et Octobre 2014 à la clinique chirurgicale de l'Hôpital Général de Grand- Yoff. Il s'agissait de 40% de cancer de la vésicule biliaire, 60% de cancer de la voie biliaire principale. Le sex-ratio était de 1. L'âge moyen de nos patients était de 58,1 ans. Le délai diagnostique moyen était de 3,77 mois. La symptomatologie était dominée par le syndrome ictérique et les douleurs de l'hypochondre droit. Tous les patients avaient présenté un syndrome de cholestase biologique. L'échographie abdominale a été réalisée dans 65% des cas, la TDM abdominale dans 85% des cas et L'IRM dans 35% des cas. Les formes avancées étaient prédominantes dans notre série (n=19).La majorité de nos patients a bénéficié d'une chirurgie palliative. Le geste le plus pratiqué était la dérivation biliaire chez 50% des patients. On notait une prédominance des cholangiocarcinomes. La morbidité opératoire globale était de 43,75%. La mortalité globale toutes localisations confondues était de 31,25%. La moyenne de survie est de 4 mois et demi. Les cancers des voies biliaires sont d'expression multiforme, se différenciant essentiellement en un cholangiocarcinome intra, extrahépatique et adénocarcinome de la vésicule biliaire dont l'évolution est globalement différente mais le pronostic spontanément mauvais. PMID:29662598

Identification et prise en charge des femmes ayant des antécédents familiaux de cancer du sein

PubMed Central

Heisey, Ruth; Carroll, June C.

2016-01-01

Résumé Objectif Résumer les meilleures données portant sur les stratégies d’identification et de prise en charge des femmes qui présentent des antécédents familiaux de cancer du sein. Sources d’information Une recherche a été effectuée sur PubMed à l’aide des mots-clés anglais suivants : breast cancer, guidelines, risk, family history, management et magnetic resonance imaging screening, entre 2000 et 2016. La plupart des données sont de niveau II. Message principal Une bonne anamnèse familiale est essentielle lors de l’évaluation du risque de cancer du sein afin d’identifier les femmes qui sont candidates à une recommandation en counseling génétique pour un éventuel test génétique. On peut sauver des vies en offrant aux femmes porteuses d’une mutation au gène BRCA des interventions chirurgicales de réduction des risques (mastectomie bilatérale prophylactique, salpingo-ovariectomie bilatérale). Il faut encourager toutes les femmes qui présentent des antécédents familiaux de cancer du sein à demeurer actives et à limiter leur consommation d’alcool à moins de 1 verre par jour; certaines femmes sont admissibles à la chimioprévention. Il faut offrir aux femmes dont le risque à vie de cancer du sein est de 20 à 25 % ou plus un dépistage poussé par imagerie par résonance magnétique en plus d’une mammographie. Conclusion Une vie saine et la chimioprévention (chez les candidates) pourraient réduire l’incidence du cancer du sein; le dépistage poussé pourrait entraîner une détection plus précoce. Le fait d’aiguiller des femmes porteuses d’une mutation au BRCA vers la chirurgie de réduction des risques sauve des vies. PMID:27737991

Hématome sous capsulaire de foie compliquant une pré-éclampsie: à propos de 6 cas

PubMed Central

Mamouni, Nisrine; Derkaoui, Ali; Bougern, Hakima; Bouchikhi, Chehrazad; Chaara, Hikmat; Banani, Abdelaziz; Abdelilah, Melhouf Moulay

2011-01-01

L'hématome sous capsulaire du foie (HSCF) est une complication rare mais gravissime de la grossesse. Devant une symptomatologie clinique souvent non spécifique et un tableau biologique retardé, son diagnostic est basé essentiellement sur les moyens de l'imagerie (échographie, TDM, IRM). Son traitement est fonction de l'intégrité ou non de la capsule de Glisson. Nous rapportons les observations de 6 patientes, à travers une étude rétrospective s’étalant sur la période du Janvier 2005 à Octobre 2008, incluant tous les cas de preeclampsie colligés au service de gynécologie obstétrique du CHU Hassan II. Durant la période d’étude, L'incidence de l'hématome sous capsulaire de foie chez les patientes préeclamptiques admises durant la période d’étude est de 1,49 %. Aucune des patientes n'a benificié d'un suivi prénatal au sein de notre formation. La moyenne d’âge des patientes est de 37,6 ans avec des extrêmes allant de 33 à 45 ans. La gestité moyenne était de 4,8 avec une parité moyenne de 4,5.l'hematome sous capsulaire est survenu en post partum chez tous nos cas avec un délai moyen de 4 jours et des extrêmes allant de J0 et J10 du post partum .Toutes les patientes ont présenté un HELLP syndrome concomitant à la survenue de cette complication gravissime.Le diagnostic positif s'est basé sur les données échographiques dans 5 cas (hemoperitoine –HSCF).l’équipe a opté pour une abstention thérapeutique avec surveillance armée chez 2 cas et l'exploration chirurgicale a été indiquée chez quatre patientes en instabilité hemodynamique.Nous avons déploré deux cas de décès maternel. PMID:22145072

[Office surgery: organization, legislative, and medico-legal problems. Personal experience].

PubMed

Pepe, N; Actis Dato, G M; Vennarecci, G; Anselmo, A

1993-11-01

The authors approach the subject of office surgery by underlining the advantages of this procedure. In particular, they focus attention on the anesthesiological and legislative problems. Depending on the setting used for surgery and the duration of hospitalisation, ambulatorial surgery can be divided into: day-hospital, office surgery, one-day surgery, short-stay surgery, same-day surgery, The authors report their own experience relating to 103 cases with relative complications. A total of 103 operations of medium-to- major ambulatorial surgery were performed (100 females and 3 males, mean age 36.8). One week prior to surgery all patients attended a medical out-patient examination in order to fill in medical records and be prescribed routine hematochemical tests, chest X-ray and ECG. The preoperative anesthesiological evaluation was made at the time of surgery. All patients received antibiotic prophylactic treatment. Postoperative complications were reported above all following neuroleptoanalgesia and amounted to a total of 5 cases: nausea (4 cases) associated with vomit (1 case), and postural hypotension (1 case). No infective complications were observed. The authors emphasise the importance of a careful preoperative selection of patients; an out-patient structure equipped with the appropriate instrument and machinery for surgery and the constant presence of anesthetists to ensure correct anesthesia (local, neuroleptoanalgesic, peridural general), reanimation and postoperative care. The aims of ambulatorial surgery are, in broad terms, the safety of procedures, convenience for the patient and organisational and economic savings for health structures. Ambulatorial surgery has an extremely high acceptance rate by patients. Lastly, the authors also report the juridical and bureaucratic problems faced by ambulatorial surgery and look forward to its wider diffusion. In the future office surgery might represent an important contribution to surgical therapeutic

Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA)

PubMed Central

Solé, Dirceu; Ivancevich, Juan Carlos; Borges, Mario Sánchez; Coelho, Magna Adaci; Rosário, Nelson A; Ardusso, Ledit Ramón Francisco; Bernd, Luis Antônio Guerra

2011-01-01

OBJECTIVES: The aims of the Online Latin American Survey of Anaphylaxis (OLASA) were to identify the main clinical manifestations, triggers, and treatments of severe allergic reactions in patients who were seen by allergists from July 2008 to June 2010 in 15 Latin American countries and Portugal (n = 634). RESULTS: Of all patients, 68.5% were older than 18 years, 41.6% were male, and 65.4% experienced the allergic reaction at home. The etiologic agent was identified in 87.4% of cases and predominantly consisted of drugs (31.2%), foods (23.3%), and insect stings (14.9%). The main symptom categories observed during the acute episodes were cutaneous (94.0%) and respiratory (79.0%). The majority of patients (71.6%) were treated initially by a physician (office/emergency room) within the first hour after the reaction occurred (60.2%), and 43.5% recovered in the first hour after treatment. Most patients were treated in an emergency setting, but only 37.3% received parenteral epinephrine alone or associated with other medication. However, 80.5% and 70.2% were treated with corticosteroids or antihistamines (alone or in association), respectively. A total of 12.9% of the patients underwent reanimation maneuvers, and 15.2% were hospitalized. Only 5.8% of the patients returned to the emergency room after discharge, with 21.7% returning in the first 6 hours after initial treatment. CONCLUSION: The main clinical manifestations of severe allergic reactions were cutaneous. The etiologic agents that were identified as causing these acute episodes differed according to age group. Following in order: drugs (31.2%), foods (23.3% and insect stings (14.9%) in adults with foods predominance in children. Treatment provided for acute anaphylactic reactions was not appropriate. It is necessary to improve educational programs in order to enhance the knowledge on this potentially fatal emergency. PMID:21808856

Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA).

PubMed

Sole, Dirceu; Ivancevich, Juan Carlos; Borges, Mario Sanchez; Coelho, Magna Adaci; Rosario, Nelson A; Ardusso, Ledit Ramón Francisco; Bernd, Luis Antônio Guerra

2011-01-01

The aims of the Online Latin American Survey of Anaphylaxis (OLASA) were to identify the main clinical manifestations, triggers, and treatments of severe allergic reactions in patients who were seen by allergists from July 2008 to June 2010 in 15 Latin American countries and Portugal (n =634). Of all patients, 68.5% were older than 18 years, 41.6% were male, and 65.4% experienced the allergic reaction at home. The etiologic agent was identified in 87.4% of cases and predominantly consisted of drugs (31.2%), foods (23.3%), and insect stings (14.9%). The main symptom categories observed during the acute episodes were cutaneous (94.0%) and respiratory (79.0%). The majority of patients (71.6%) were treated initially by a physician (office/emergency room) within the first hour after the reaction occurred (60.2%), and 43.5% recovered in the first hour after treatment. Most patients were treated in an emergency setting, but only 37.3% received parenteral epinephrine alone or associated with other medication. However, 80.5% and 70.2% were treated with corticosteroids or antihistamines (alone or in association), respectively. A total of 12.9% of the patients underwent reanimation maneuvers, and 15.2% were hospitalized. Only 5.8% of the patients returned to the emergency room after discharge, with 21.7% returning in the first 6 hours after initial treatment. The main clinical manifestations of severe allergic reactions were cutaneous. The etiologic agents that were identified as causing these acute episodes differed according to age group. Following in order: drugs (31.2%), foods (23.3% and insect stings (14.9%) in adults with foods predominance in children. Treatment provided for acute anaphylactic reactions was not appropriate. It is necessary to improve educational programs in order to enhance the knowledge on this potentially fatal emergency.

Outcomes of Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release

PubMed Central

Jacobson, Joel; Rihani, Jordan; Lin, Karen; Miller, Phillip J.; Roland, J. Thomas

2010-01-01

Lesions of the temporal bone and cerebellopontine angle and their management can result in facial nerve paralysis. When the nerve deficit is not amenable to primary end-to-end repair or interpositional grafting, nerve transposition can be used to accomplish the goals of restoring facial tone, symmetry, and voluntary movement. The most widely used nerve transposition is the hypoglossal-facial nerve anastamosis, of which there are several technical variations. Previously we described a technique of single end-to-side anastamosis using intratemporal facial nerve mobilization and parotid release. This study further characterizes the results of this technique with a larger patient cohort and longer-term follow-up. The design of this study is a retrospective chart review and the setting is an academic tertiary care referral center. Twenty-one patients with facial nerve paralysis from proximal nerve injury at the cerebellopontine angle underwent facial-hypoglossal neurorraphy with parotid release. Outcomes were assessed using the Repaired Facial Nerve Recovery Scale, questionnaires, and patient photographs. Of the 21 patients, 18 were successfully reinnervated to a score of a B or C on the recovery scale, which equates to good oral and ocular sphincter closure with minimal mass movement. The mean duration of paralysis between injury and repair was 12.1 months (range 0 to 36 months) with a mean follow-up of 55 months. There were no cases of hemiglossal atrophy, paralysis, or subjective dysfunction. Direct facial-hypoglossal neurorrhaphy with parotid release achieved a functional reinnervation and good clinical outcome in the majority of patients, with minimal lingual morbidity. This technique is a viable option for facial reanimation and should be strongly considered as a surgical option for the paralyzed face. PMID:22451794

Large Intratemporal Facial Nerve Schwannoma without Facial Palsy: Surgical Strategy of Tumor Removal and Functional Reconstruction.

PubMed

Yetiser, Sertac

2018-06-08

 Three patients with large intratemporal facial schwannomas underwent tumor removal and facial nerve reconstruction with hypoglossal anastomosis. The surgical strategy for the cases was tailored to the location of the mass and its extension along the facial nerve.  To provide data on the different clinical aspects of facial nerve schwannoma, the appropriate planning for management, and the predictive outcomes of facial function.  Three patients with facial schwannomas (two men and one woman, ages 45, 36, and 52 years, respectively) who presented to the clinic between 2009 and 2015 were reviewed. They all had hearing loss but normal facial function. All patients were operated on with radical tumor removal via mastoidectomy and subtotal petrosectomy and simultaneous cranial nerve (CN) 7- CN 12 anastomosis.  Multiple segments of the facial nerve were involved ranging in size from 3 to 7 cm. In the follow-up period of 9 to 24 months, there was no tumor recurrence. Facial function was scored House-Brackmann grades II and III, but two patients are still in the process of functional recovery.  Conservative treatment with sparing of the nerve is considered in patients with small tumors. Excision of a large facial schwannoma with immediate hypoglossal nerve grafting as a primary procedure can provide satisfactory facial nerve function. One of the disadvantages of performing anastomosis is that there is not enough neural tissue just before the bifurcation of the main stump to provide neural suturing without tension because middle fossa extension of the facial schwannoma frequently involves the main facial nerve at the stylomastoid foramen. Reanimation should be processed with extensive backward mobilization of the hypoglossal nerve. Georg Thieme Verlag KG Stuttgart · New York.

Serum levels of Selenium and C-reactive protein in comatose patients with severe traumatic brain injury during the first week of hospitalization: case-control study.

PubMed

Belatar, Bahia; Laidi, Fatna; Abidi, Abdelah El; Eljaoudi, Rachid; Mamouch, Fouzia; Kabbaj, Saad; Maazouzi, Wajdi

2018-01-01

Mortality and morbidity related to traumatic brain injuries still remain high in patients. Many authors reported the importance of Selenium in maintaining the integrity of brain functions. This fact is supported by clinical evidence that therapy with selenium supplementation could help patients suffering from brain disorders like neurodegenerative diseases. The aim of our study was to assess the relationship between Selenium concentration in serum and evolution of comatose patients with severe traumatic brain injury, in the first week of admission, and the correlation between selenium and C-reactive protein. This case-control study was conducted with 64 comatose patients with TBI, in the Department of Anesthesiology and Reanimation, IbnSina University Hospital and Hospital of specialties in Rabat-Morocco, and healthy volunteers recruited in Blood transfusion center of Rabat. Blood sampling was collected from TBI patients, in the first week (3h after admission and each 48h during one week), and from healthy volunteers one time. Concentration of Se in serum was determined by electrochemical atomic absorption spectrometry. Statistical analysis was performed using Statistical software (SPSS) and the cases and controls were compared using the Mann-Whitney U test. A P-value < 0.05 was considered to be statistically significant. Comparison selenium concentration in the first day (D0), third day (D2) and fifth day according to the death and survival statue in patients did not show statistical significance (p > 0.05). Selenium concentration of D0 in patients and Selenium concentration in control group also did not show statistical significance (p > 0.05). Similarly, we did not report a correlation between selenium and C-reactive protein. According to our data selenium and CRP may not play a role in progression of coma state in patients with severe traumatic brain injury.

[CHARACTERISTICS OF COMBINED ANESTHESIA WITH EPIDURAL COMPONENTE DEPENDING ON VEGETATIVE NERVOUS SYSTEM TYPE].

PubMed

Hasanov, F J; Aslanov, A A; Muradov, N F; Namazova, K N

2016-01-01

The research objective was to study the characteristics of combined anesthesia with epidural componente (CAEC) depending on vegetative nervous system type (VNS) in patients who underwent large scale traumatic surgical operations on abdominal cavity organs. The scientific research was conducted in Anaesthesiology--Reanimation Department of the Scientific Surgical Centre named after acad. MA. Topchubashev, the Ministry of Health of the Azerbaijan Republic. The research objects were 69 patients who underwent operations in conditions of CAEC due to different serious surgical pathologies of abdominal cavity organs. VNS type was identified based on electroencephalogram, Cerdo Vegetative Index (CVI), Hildebrandt coefficient (HC) and single neurophysiological tests. The patients were divided into three groups depending on VNS type: I--normotonics--17 patients (24.7%), II--sympathatonics--25 patients (36.2%), and III--vagotonics--27 patients (39.1%). Blood adrenocorticotropic hormone (ACTH) and cortisol concentration were studied in 3 stages: I -preoperative, II--operation traumatic stage, III--the 1st postoperative days. The other indicators (heart rate, systolic blood pressure--SBP, dyastolic blood pressure--DBR average blood pressure--BP ave., pulse oximetry SpO₂, ECG, gases in blood and acid-base balance, electrolytes, blood glucose level, myocardium oxygen demand--MOD) were registered after 20 minutes and the 2nd day after operation besides the above stages. The research results indicated that it is possible to define the vegetative nervous system type superiority based on complex of single tests data, EEG, ECG, Cerdo Vegetative Index, Hildebrandt coefficient. CAEC can be considered optimun alternative of general anesthesia ensuring neurohumoral and hemodynamic stability in large scale, traumatic operations on abdominal cavity organs. Clinical course of CAEC is characterized by firmer hemodynamic and humoral stability in patients with functional balance of

Fifteen-year survey of one-stage latissimus dorsi muscle transfer for treatment of longstanding facial paralysis.

PubMed

Takushima, Akihiko; Harii, Kiyonori; Asato, Hirotaka; Kurita, Masakazu; Shiraishi, Tomohiro

2013-01-01

Neurovascular free muscle transfer is one of the main reconstructive options for established or long-standing facial paralysis. The two-stage gracilis muscle transfer combined with the cross-face nerve graft (two-stage method) has been supplanted by one-stage reconstruction using the latissimus dorsi muscle (LD) at our institution. This study retrospectively evaluated the results of one-stage LD transfer. Between September 1993 and December 2008, 344 patients (133 males, 211 females; age range, 5-75 years) with unilateral facial paralysis underwent 351 one-stage LD transfers. Patients were evaluated with a custom grading scale. Differences in grading scale score were compared according to age, past surgical history and the duration from operation to neuromuscular recovery. Contraction of the transferred muscle was recognised in 305 (87.0%) transfers. The duration until neuromuscular recovery ranged from 3 to 16 months (average ± standard deviation: 6.48 ± 1.92 months). The grading scale was significantly lower in middle-age group than in younger and elder groups (P < 0.01). Duration until neuromuscular recovery was significantly different when comparing the younger group and the oldest group. There was no difference in grading scale score or in duration until neuromuscular recovery when comparing the patients with a past surgical history and those without. The grading scale negatively correlated with the duration until neuromuscular recovery. The results are consistent and statistical analysis revealed the versatility of the one-stage LD transfer. Although we believe the two-stage method is still a good option for facial reanimation, the one-stage method is advantageous regarding the shorter period of recovery and little donor-site morbidity. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

[Euthanasia and other decisions at the end of life (Proposal for a more transparent terminology and some thoughts on the legal framework of medical treatment)].

PubMed

Vadász, Gábor

2010-10-24

Indication of euthanasia is only one of several medical decisions at the end of life. Precise definition of this topic related to the clinical events happening around the sick-bed is not complete in the legal and medical literature. The present review attempts to classify the different end of life events with the aim of clarifying which of these do not belong to the concept of passive euthanasia. Euthanasia is not a legal category. The everyday expressions of active and passive euthanasia are simplifications, which cover actions of different purposes. Use of these in medical and legal literature can be confusing and misleading. We differentiate decisions at the end of life on basis of their purpose. Based on the definition and category of the Hungarian Doctors' Chamber, euthanasia is the act or the lack of action in order to mercifully shorten or end the life of a suffering fellow-man to help him. Concepts of active, passive and forced euthanasia are defined. The terms of indirect and intermediate euthanasia are not used in order to avoid misunderstanding. Help and participation of non-professionals in the implementation cannot be completely excluded from the concept of euthanasia, and we believe euthanasia is not merely related to doctors. We outline those medical decisions at the end of life which do not belong to the category of passive euthanasia, namely: withdrawal of ineffective and life sustaining treatments, letting go of the patient, contra-indication of therapy escalation, use of palliative therapy, pain-relieving treatment, compromise medicine, consideration of reanimation and choosing cost-effective therapy. We touch upon the subject of the living will, why it cannot be applied, and its relation to active and passive euthanasia. With reference to the legal regulation of life saving and life sustaining treatment, we deal with the expected spirit of medical legislation.

Energy status of pig donor organs after ischemia is independent of donor type.

PubMed

Stadlbauer, Vanessa; Stiegler, Philipp; Taeubl, Philipp; Sereinigg, Michael; Puntschart, Andreas; Bradatsch, Andrea; Curcic, Pero; Seifert-Held, Thomas; Zmugg, Gerda; Stojakovic, Tatjana; Leopold, Barbara; Blattl, Daniela; Horki, Vera; Mayrhauser, Ursula; Wiederstein-Grasser, Iris; Leber, Bettina; Jürgens, Günther; Tscheliessnigg, Karlheinz; Hallström, Seth

2013-04-01

Literature is controversial whether organs from living donors have a better graft function than brain dead (BD) and non-heart-beating donor organs. Success of transplantation has been correlated with high-energy phosphate (HEP) contents of the graft. HEP contents in heart, liver, kidney, and pancreas from living, BD, and donation after cardiac death in a pig model (n=6 per donor type) were evaluated systematically. BD was induced under general anesthesia by inflating a balloon in the epidural space. Ten hours after confirmation, organs were retrieved. Cardiac arrest was induced by 9V direct current. After 10min of ventricular fibrillation without cardiac output, mechanical and medical reanimation was performed for 30min before organ retrieval. In living donors, organs were explanted immediately. Freeze-clamped biopsies were taken before perfusion with Celsior solution (heart) or University of Wisconsin solution (abdominal organs) in BD and living donors or with Histidine-Tryptophan-Ketoglutaric solution (all organs) in non-heart-beating donors, after perfusion, and after cold ischemia (4h for heart, 6h for liver and pancreas, and 12h for kidney). HEPs (adenosine triphosphate, adenosine diphosphate, adenosine monophosphate, and phosphocreatine), xanthine, and hypoxanthine were measured by high-performance liquid chromatography. Energy charge and adenosine triphosphate-to-adenosine diphosphate ratio were calculated. After ischemia, organs from different donor types showed no difference in energy status. In all organs, a decrease of HEP and an increase in hypoxanthine contents were observed during perfusion and ischemia, irrespective of the donor type. Organs from BD or non-heart-beating donors do not differ from living donor organs in their energy status after average tolerable ischemia. Copyright © 2013 Elsevier Inc. All rights reserved.

The REAnimation Low Immune Status Markers (REALISM) project: a protocol for broad characterisation and follow-up of injury-induced immunosuppression in intensive care unit (ICU) critically ill patients.

PubMed

Rol, Mary-Luz; Venet, Fabienne; Rimmele, Thomas; Moucadel, Virginie; Cortez, Pierre; Quemeneur, Laurence; Gardiner, David; Griffiths, Andrew; Pachot, Alexandre; Textoris, Julien; Monneret, Guillaume

2017-06-21

The host response to septic shock is dynamic and complex. A sepsis-induced immunosuppression phase has recently been acknowledged and linked to bad outcomes and increased healthcare costs. Moreover, a marked suppression of the immune response has also been partially described in patients hospitalized in intensive care unit (ICU) for severe trauma or burns. It has been hypothesized that immune monitoring could enable identification of patients who might most benefit from novel, adjunctive immune-stimulating therapies. However, there is currently neither a clear definition for such injury-induced immunosuppression nor a stratification biomarker compatible with clinical constraints. We set up a prospective, longitudinal single-centre clinical study to determine the incidence, severity and persistency of innate and adaptive immune alterations in ICU patients. We optimized a workflow to describe and follow the immunoinflammatory status of 550 patients (septic shock, severe trauma/burn and major surgery) during the first 2 months after their initial injury. On each time point, two immune functional tests will be performed to determine whole-blood TNF-α production in response to ex vivo lipopolysaccharide stimulation and the T lymphocyte proliferation in response to phytohaemagglutinin. In addition, a complete immunophenotyping using flow cytometry including monocyte HLA-DR expression and lymphocyte subsets will be obtained. New markers (ie, levels of expression of host mRNA and viral reactivation) will be also evaluated. Reference intervals will be determined from a cohort of 150 age-matched healthy volunteers. This clinical study will provide, for the first time, data describing the immune status of severe ICU patients over time. Ethical approval has been obtained from the institutional review board (no 69HCL15_0379) and the French National Security agency for drugs and health-related products. Results will be disseminated through presentations at scientific meetings and publications in peer-reviewed journals. Clinicaltrials.gov Registration number: NCT02638779. Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[The impartiality of ignorance? - A controversy between Paul Julius Möbius and Julius Wagner-Jauregg on the symptoms of reanimated persons after a suicide attempt through self-hanging].

PubMed

Engmann, B; Steinberg, H

2014-05-01

Between 1891 and 1893 the famous Austrian and German neuropsychiatrists Julius Wagner-Jauregg and Paul Julius Möbius disputed in leading German and Austrian medical journals about mental and physiological changes and symptoms in people who after strangulation could be revived in time to survive. Their dispute even touched personal issues. For the study, the original sources were studied and contrasted with relevant secondary sources. The dispute was mainly about two opposing concepts: On the one hand, Wagner-Jauregg supported an organic, neurological concept; on the other hand a psychoreactive-symptoms concept represented by Möbius and elaborated by him first in his concept of hysteria. The study elaborates these factual differences in completely different approaches to psychiatry and - at least in the case of Möbius - how a medical theory was embedded into a pre-existing philosophical system. The dispute studied discusses a philosophical problem which has remained incompletely understood until the present day - the relationship of body and mind. Hence the study on this dispute is more than just an interesting aspect in the history of sciences, but rather the illustration of a meeting of two opponents in a still relevant discussion. © Georg Thieme Verlag KG Stuttgart · New York.

Evolution de la reanimation transfusionnelle du blesse hemorragique grave au sein des forces militaires americaines (Evolution of US Military Transfusion Support for Resuscitation of Trauma and Hemorrhagic Shock)

DTIC Science & Technology

2013-04-15

Trauma Registry; Fresh whole blood; 1:1:1 component therapy; Platelet:RBC; FFP:RBC; Freeze-dried plasma; Tranexamic acid ∗ Auteur correspondant. Adresse e...Effects of tranexamic acid on death, vascular occlu- sive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a...randomised, placebo-controlled trial. Lancet 2010;376:23–32. [74] Morrison JJ, et al. Military application of tranexamic acid in trauma emer- gency

Insuffisance aortique syphilitique: à propos d’un cas

PubMed Central

Yaméogo, Aimé Arsène; Andonaba, Jean-Baptiste; Nikiéma, Zakari; Zabsonré, Patrice

2012-01-01

La syphilis tertiaire et ses complications cardiovasculaires sont devenues rares dans les pays développés mais restent encore préoccupante dans nos pays. Les atteintes cardiovasculaires portent fréquemment sur la racine et l’arche aortique. Nous rapportons ici un cas d’insuffisance aortique syphilitique chez un patient de 70 ans admis dans le service de cardiologie du centre hospitalier universitaire de Bobo-Dioulasso. L’examen clinique retrouvait une insuffisance cardiaque globale stade III, un frémissement et un souffle diastolique d’insuffisance aortique importante confirmé à l’échocardiographie Doppler, associés à des douleurs précordiales angineuses. L’examen cutané montrait des lésions à type de gommes syphilitiques à localisations multiples. L’électrocardiogramme objectivait une hypertrophie ventriculaire gauche avec un indice de Sokolov à 49 millimètre et le télécoeur une cardiomégalie avec un index cardio-thoracique à 0,70. La sérologie était positive pour le RPR à 1/8 et le TPHA à 1/640. L’évolution clinique sous la pénicillino-thérapie surveillée et le traitement spécifique de l’insuffisance cardiaque a été favorable. La découverte d’une insuffisance aortique chez les sujets de plus de 60 ans dans nos pays devrait faire rechercher une syphilis tertiaire par une sérologie pour une prise en charge adéquate. PMID:23024828

Perspectives, perceptions and experiences in postoperative pain management in developing countries: A focus group study conducted in Rwanda

PubMed Central

Johnson, Ana P; Mahaffey, Ryan; Egan, Rylan; Twagirumugabe, Theogene; Parlow, Joel L

2015-01-01

BACKGROUND: Access to postoperative acute pain treatment is an important component of perioperative care and is frequently managed by a multidisciplinary team of anesthesiologists, surgeons, pharmacists, technicians and nurses. In some developing countries, treatment modalities are often not performed due to scarce health care resources, knowledge deficiencies and cultural attitudes. OBJECTIVES: In advance of a comprehensive knowledge translation initiative, the present study aimed to determine the perspectives, perceptions and experiences of anesthesia residents regarding postoperative pain management strategies. METHODS: The present study was conducted using a qualitative assessment strategy in a large teaching hospital in Rwanda. During two sessions separated by seven days, a 10-participant semistructured focus group needs analysis was conducted with anesthesia residents at the Centre Hospitalier Universitaire de Kigali (Kigali, Rwanda). Field notes were analyzed using interpretative and descriptive phenomenological approaches. Participants were questioned regarding their perspectives, perceptions and experiences in pain management. RESULTS: The responses from the focus groups were related to five general areas: general patient and medical practice management; knowledge base regarding postoperative pain management; pain evaluation; institutional/system issues related to protocol implementation; and perceptions about resource allocation. Within these areas, challenges (eg, communication among stakeholders and with patients) and opportunities (eg, on-the-job training, use of protocols, routine pain assessment, participation in resource allocation decisions) were identified. CONCLUSIONS: The present study revealed the prevalent challenges residents perceive in implementing postoperative pain management strategies, and offers practical suggestions to overcoming them, primarily through training and the implementation of practice recommendations. PMID:26448971

Correlation study between osteoporosis and hematopoiesis in the context of adjuvant chemotherapy for breast cancer.

PubMed

Schyrr, Frédérica; Wolfer, Anita; Pasquier, Jérôme; Nicoulaz, Anne-Laure; Lamy, Olivier; Naveiras, Olaia

2018-02-01

This retrospective study attempts to establish if a correlation exists between osteoporosis and hematopoiesis before and after adjuvant chemotherapy in the context of non-metastatic breast cancer. Osteoporosis is interpreted both as a direct marker of osteoblastic decline and as an indirect marker of increased bone marrow adiposity within the hematopoietic microenvironment. Patients from the "Centre du Sein" at CHUV (Centre Hospitalier Universitaire Vaudois) undergoing adjuvant chemotherapy were included in this study. Evolution of blood counts was studied in correlation with the osteoporosis status. Toxicity of chemotherapy was coded according to published probability of febrile neutropenia. One hundred forty-three women were included: mean age 52.1 ± 12.5 years, mean BMI (body mass index) 24.4 ± 4.1. BMD (bone mineral density) scored osteoporotic in 32% and osteopenic in 45%. Prior to chemotherapy, BMD was positively correlated with neutrophil (p < 0.001) and thrombocyte (p = 0.01) count; TBS (trabecular bone score) was not correlated with blood count. After the first cycle of chemotherapy, an increase of one point in TBS correlated with a decrease of 57% on the time to reach leucocyte nadir (p = 0.004). There was a positive correlation between BMD and risk of infection (p < 0.001). Our data demonstrates an association between osteoporosis and lower blood counts in a younger cohort than previously published, extending it for the first time to neutrophil counts in females. Our results suggest that the healthier the bone, the earlier the lowest leucocyte count value, prompting further research on this area.

Awareness of cytomegalovirus and risk factors for susceptibility among pregnant women, in Montreal, Canada.

PubMed

Wizman, Sarah; Lamarre, Valérie; Coic, Lena; Kakkar, Fatima; Le Meur, Jean-Baptiste; Rousseau, Céline; Boucher, Marc; Tapiero, Bruce

2016-03-15

Advances in diagnostic and therapeutic modalities for congenital cytomegalovirus (CMV) infection have generated a mounting interest in identifying mothers susceptible to CMV. The objectives of this study were to evaluate the prevalence and socio-demographic determinants of CMV susceptibility and CMV awareness, among pregnant women, in Montreal, Quebec. Between April and December 2012, women delivering at Centre Hospitalier Universitaire Sainte Justine were recruited for the study. Stored serum from the first trimester of pregnancy was tested for CMV IgG. Knowledge about CMV and socio-demographic characteristics were collected via standardized questionnaire. Four hundred and ninety one women were enrolled in the study. Overall, 225 mothers (46%) were seronegative for CMV, and 85% (n = 415) were unaware of CMV or the associated risks in pregnancy. Significant risk factors for CMV seronegative status included Canadian vs. foreign born (aOR 6.88, 95% CI 4.33-10.94), and high vs. low family income (aOR 4.68, 95% CI 2.09-10.48). Maternal employment status was the only significant predictor of CMV unawareness, with unemployed mothers at the highest risk (aOR 85.6, 95% CI 17.3-421.3). Nearly half of pregnant women studied were at risk of primary infection, and yet, the majority was unaware of potential risks associated with CMV. Canadian born mothers and those with a high socioeconomic status were more likely to be CMV seronegative. Increased education about CMV infection, through public health interventions and obstetrician/pediatric counseling, is needed for all pregnant women.

[The prevention of voice disorders in the actor: protocol and follow-up nine months of professional theater].

PubMed

Ormezzano, Y; Delale, A; Lamy-Simonian, A

2011-01-01

In July 2009, at the beginning of this work, 26 theses addressing professional principles of voice were listed in the database of SUDOC (Système Universitaire de Documentation): 9 related to voices of teachers (about 900,000* professionals in France), 14 theses relating to singers (7500** professionals), and only 3 about the voice of actors (20 000*** professional actors in France in 2006). The latter pertaining to concerning rookie actors (sensibilisation vocale auprès du comédien débutant Bichet, Linda, Bordeaux II, 2006), the mechanical larynx (étude des mécanismes laryngés dans la voix projetée: cas particulier des comédiennes Guerin, Mélanie, Paris VI, 2009), vocal fatigue (Fatigue vocale après une tâche d'utilisation prolongée de la voix chez le comédien Canaan Baggioni, Brigitte, Aix-Marseille II, 2009). Professional actors are plentiful; their training in vocal technique is very heterogeneous, or non-existent: it is not a prerequisite to have a degree to work as an actor! This lack of vocal technique is associated with risk factors specific to the acting profession: numerous travels in air-conditioned vehicles, unsuitable workplaces; dusty or poorly heated, irregular working patterns, excessive demands from directors... All this makes the actors highly susceptible to voice disorders. The protocol for the prevention of voice disorders presented here is holistic and ecological. This work also examines the effectiveness of such a preventive protocol aimed at theatre comedians.

Detection of figure and caption pairs based on disorder measurements

NASA Astrophysics Data System (ADS)

Faure, Claudie; Vincent, Nicole

2010-01-01

Figures inserted in documents mediate a kind of information for which the visual modality is more appropriate than the text. A complete understanding of a figure often necessitates the reading of its caption or to establish a relationship with the main text using a numbered figure identifier which is replicated in the caption and in the main text. A figure and its caption are closely related; they constitute single multimodal components (FC-pair) that Document Image Analysis cannot extract with text and graphics segmentation. We propose a method to go further than the graphics and text segmentation in order to extract FC-pairs without performing a full labelling of the page components. Horizontal and vertical text lines are detected in the pages. The graphics are associated with selected text lines to initiate the detector of FC-pairs. Spatial and visual disorders are introduced to define a layout model in terms of properties. It enables to cope with most of the numerous spatial arrangements of graphics and text lines. The detector of FC-pairs performs operations in order to eliminate the layout disorder and assigns a quality value to each FC-pair. The processed documents were collected in medic@, the digital historical collection of the BIUM (Bibliothèque InterUniversitaire Médicale). A first set of 98 pages constitutes the design set. Then 298 pages were collected to evaluate the system. The performances are the result of a full process, from the binarisation of the digital images to the detection of FC-pairs.

Le ciment brûle toujours

PubMed Central

Lebreton, T.; Fontaine, M.; Le Floch, R.

2017-01-01

Summary Les brûlures chimiques par ciment représentent une cause fréquente de corrosion cutanée en France. Elles nécessitent fréquemment un traitement chirurgical. Notre étude rétrospective concerne tous les patients admis pour une brûlure par ciment dans le service entre 2004 et 2016. Quarante-neuf patients âgés de 21 à 71 ans ont été pris en charge dans le centre des brûlés du Centre Hospitalier Saint Joseph Saint Luc à Lyon entre 2004 et 2016. La population concernée était majoritairement masculine, relativement jeune (44 ans en moyenne) et professionnellement active. Les brûlures survenaient principalement dans le cadre d’accidents domestiques (78%). Elles étaient profondes et atteignaient majoritairement les membres inférieurs, de façon bilatérale. La surface brûlée représentait 3% de la surface cutanée totale. Presque tous les patients (98%) ont nécessité une prise en charge chirurgicale pour excision et autogreffe de peau mince. Un seul patient a bénéficié d’une cicatrisation dirigée. Le délai moyen entre la brûlure et la chirurgie était de 13 jours et la durée moyenne d’hospitalisation de 8 jours. Sept patients ont nécessité une prise en charge en centre de rééducation à leur sortie du service. Cette étude confirme la sévérité des brûlures chimiques par ciment. Elle met également en avant l’impact que peut avoir ce type de brûlure en terme de retentissement socio-économique dans une population de patients majoritairement jeune et active. Elle insiste sur le fait que des mesures doivent être prises afin d’informer cette population rarement professionnelle sur les risques encourus lors du mésusage du ciment. La réglementation actuelle, classant le ciment comme irritant, ne prend pas en compte son caractère corrosif et devrait être amendée. PMID:28592929

Evaluation des prescriptions antibiotiques au service des urgences de l’Hôpital Militaire d’Instruction Mohammed V (HMIMV)

PubMed Central

Elbouti, Anass; Rafai, Mostafa; Chouaib, Naoufal; Jidane, Said; Belkouch, Ahmed; Bakkali, Hicham; Belyamani, Lahcen

2016-01-01

Cette étude à pour objectifs de décrire les pratiques des prescriptions, évaluer leur pertinence et leur conformité aux règles d’utilisations et étudier les facteurs susceptibles de les influencer. Il s’agit d’une étude transversale d’évaluation des prescriptions antibiotiques portant sur 105 patients réalisée au service des urgences médico-chirurgicales de l’H.M.I.Med V de Rabat sur une période d’un mois. Le recueil des données était fait à l’aide d’un questionnaire rapportant les données démographiques et anamnestiques, les antécédents, la notion d’allergie, les données spécifiques de l’examen clinique, les données para cliniques, la prescription détaillée de l’antibiotique. Les données récoltées ont été ensuite évaluées par un médecin référent, chargé d’indiquer les éventuelles erreurs de traitement. Parmi les infections ayant motivé la prescription des antibiotiques, les affections des systèmes respiratoires et urinaires étaient au premier rang, les familles d’antibiotiques les plus couramment employées sont les pénicillines, les quinolones et les céphalosporines. 74 prescriptions soit (70,5%) étaient à la fois pertinentes et conformes contre 9 prescriptions soit (8,6%) justifiées mais non pertinentes et 6 prescriptions soit (5,7%) étaient jugées injustifiées par le médecin référent par absence d’infection. Les évaluations des pratiques médicales sont rarement menées dans les établissements de santé; c’est dans ce cadre que nous avons voulu nous inscrire en produisant cette étude afin d’améliorer la pertinence de nos prescriptions antibiotiques et d’optimiser leur conformité aux différentes recommandations. PMID:28292124

Etude des connaissances, attitudes et pratiques en matière de réintégration sociale des femmes victimes de fistule obstétricale: région de l'Extrême-nord, Cameroun

PubMed Central

Martin, Sanou Sobze; Adogaye, Sali Ben Béchir; Rodrigue, Mabvouna Biguioh; Maurice, Douryang; Vivaldi, Teikeu Tessa Vladimir; Amede, Saah Fopa Michael; Marie, Ovaga Eyenga Landry; Meriam, Ausseil Sandra; Colizzi, Vittorio; Gianluca, Russo

2015-01-01

Introduction La fistule obstétricale est un orifice entre le vagin et la vessie ou le rectum, voire les deux. Ses impacts sont des conséquences anatomo-fonctionnelles et sociales. On estime à plus de 19 000 le nombre de femmes qui souffrent de fistule obstétricale au Cameroun. Méthodes Il s'agissait d'une étude transversale descriptive conduite dans trois districts de santé de la région de l'Extrême-nord. Vingt-huit femmes victimes de fistules obstétricales, quarante-deux membres de leur entourage et vingt-quatre agents de santé ont été interviewés entre Novembre et Décembre 2013. Trois types de questionnaires ont été utilisés. Les données ont été analysées dans Epi Info version 7.1.4.0. Les moyennes et les fréquences ont été calculées avec un intervalle de confiance à 95%. Résultats 46,4% des femmes victimes de fistule obstétricales interviewées avaient subi une intervention chirurgicale réparatrice parmi lesquelles, 61,5% bénéficiaient de la réintégration. Le fonds de commerce (62,5%) était l'aide la plus reçue. Vingt-deux membres de l'entourage savaient pourquoi on fait la réintégration. Selon eux, les considérations socioculturelles (68,2%), sont la principale barrière de la réintégration. D'après les agents de santé, le suivi psychosocial (58,3%) est la principale activité de la réintégration dans les centres de prise en charge de la fistule. Conclusion La prise en charge des fistules obstétricales au Cameroun souffre de manque de réintégration sociale. Ceci expliquerait en partie la persistance de cette pathologie. Un accent devrait être mis sur l'appui matériel, financier et sur le suivi psychosocial des femmes victimes de fistule obstétricale. PMID:26113915

Les aspects des frottis cervico-vaginaux chez les femmes vivants avec le VIH suivies à Thiès/Sénégal et association avec le degré d'immunodépression

PubMed Central

Bammo, Mariama; Dioussé, Pauline; Thiam, Marietou; Diop, Madoky Maguatte; Berthe, Adama; Faye, Flugence Abdou; Diallo, Thierno Abdoul Aziz; Sarr, Fatou Seck; Dione, Haby; Toure, Papa Souleymane; Diop, Bernard Marcel; Ka, Mamadou Mortalla

2015-01-01

De nombreuses études ont démontré que les femmes infectées par le VIH ont un risque accru de survenue de néoplasies cervicales intra épithéliales. L'association entre les deux affections étant bidirectionnelle, l'objectif était de décrire les anomalies cervicales chez les femmes séropositives au virus de l'immunodéficience humaine (VIH), de rechercher des facteurs associés et de proposer des recommandations en termes de suivi de ces femmes. Il s'agissait d'une étude transversale, multicentrique recensant l'ensemble des frottis cervico-vaginaux (FCV) et des colposcopies des patientes infectées par le VIH entre 2012 et 2014 dans les services de dermatologie de Thiès et de Mbour. Les données étaient recueillies et analysées par le logiciel EPI Info 2012 version 3.5.4. Les tests statistiques ont été effectués avec un seuil de significativité p <0,05. Etaient inclus 125 patientes. L’âge moyen était de 38,98 ± 10.2 ans [20-77]. Il n'y avait aucun signe d'appels dans 82.4%. Le FCV était normal dans 32.8%, inflammatoire dans 44.8%. Les anomalies cytologiques concernaient 22,4% dont, ASC-H (suspicion de lésions de haut grade: 2.4%), LSIL (lésions de bas grade: 8.8%), HSIL (lésions de haut grade: 4%). Leur majorité (60.7%) avaient un taux de CD4 < 500 et étaient au stade 3 de l'OMS dans 64.3%; la biopsie montrait une dysplasie sévère chez 37.5% des patientes ayant pu réaliser cet examen. Deux patientes ont bénéficié d'un traitement curatif notamment l'exérèse chirurgicale. La survenue de dysplasies cervicales même précoces semble être associée à un stade avancé de l'infection VIH. Un dépistage et un traitement précoces sont absolument nécessaires. PMID:26834915

L’enclouage centromédullaire dans les fractures complexes de l’extrémité supérieure de l’humérus: résultats préliminaire à propos de 6 cas

PubMed Central

Jamal, Louaste; Cherrad, Taoufik; Bousbaa, Hicham; Wahidi, Mohammed; Amhajji, Larbi; Rachid, Khalid

2016-01-01

L’enclouage centromédullaire antérograde s’est imposé comme un des traitements de référence des fractures céphalotubérositaires à deux, trois et quatre fragments. Nous présentons une étude rétrospective de 06 patients ayant bénéficié d’un enclouage centromédullaire depuis janvier 2012. Le Recul moyen est de 12 mois, l’âge moyen était de 57 ans. Evaluation clinique se basait sur le score de Constant et Murley, en brut et pondéré en fonction de l’âge et du sexe, avec un comparatif avec le coté sain. Le bilan radiologique nous a permis d’évaluer la consolidation osseuse, l’apparition d’Ostéonécrose de la tête ou arthrose post traumatique. Surveille aussi l’Etat des tubérosités avec l’existence ou non d’ostéolyse du trochiter. Elle recherche aussi les critères de bonne réduction à savoir l’angle calotte céphalique et l’axe diaphysaire (αF) sur les clichés de face. Tous les patients ont été traités selon la même technique chirurgicale. Le score de Constant et Murley sur l’ensemble des patients était de 64.13 points. Le score pondéré en fonction de l’age et du sexe était de 73%. Les mobilités articulaires étaient en moyenne sur l’ensemble des patients 116° en élévation antérieure, 99.9° en élévation latérale, et 42° en rotation externe. Angle αF moyen s’élève à 42°. Tous les patients présentaient des critères de bonne réduction à savoir αF. L’enclouage centromédullaire permet une synthèse osseuse simple et au prix d’un abord limité avec des résultats fonctionnels très prometteurs. La comminution fracturaire et l’ostéoporose peuvent limiter ces indications. PMID:28250878

Pratique anesthésique à Lubumbashi: indications, types de chirurgie et types de patient

PubMed Central

Kabey, Alain Kabey a; Lubanga, Muyumba; Tshamba, Mundongo; Kaut, Mukeng; Kakambal, Kaij; Muteya, Manika; Manzanza, Kilembe; Kalal, Kapend

2015-01-01

Introduction Cette étude a pour objectif de décrire la pratique anesthésique dans un pays à faible revenu et où le plateau technique anesthésique est moins équipé. Méthodes Une étude descriptive transversale a été menée durant l'année 2013. L'enquête a concerné les pratiques anesthésiques, les indications chirurgicales et les caractéristiques des malades. L'encodage et l'analyse des données ont été réalisées grâce aux logiciels Epi Info 3.5.3 et Excel 2010. Résultats Nous avons enregistré 2358 patients dont l’âge médian était de 29 + 15 ans, avec 81,5% âgés de 11 à 50 ans. Parmi eux, 67,3% des malades étaient du sexe féminin. Dans ensemble, 62,5% de ces patients étaient pris en charge pour les interventions programmées. L’évaluation du risque anesthésique a montré que 91,9% des patients étaient de la classe ASA I et II. La chirurgie la plus pratiquée était viscérale (46,7%) suivie de la chirurgie gynéco-obstétricale (29,2%). Les différents types d'anesthésie étaient les suivants: anesthésie générale (87,6%), locorégionale (11,8%) et combinée (0,6%). Conclusion La pratique anesthésique dans la population d’étude était dominée par l'anesthésie générale. Les malades étaient au trois quart de sexe féminin et de la classe ASA I et II. Les résultats de cette étude indiquent la nécessité d’évaluer l'issue de cette pratique. La pratique anesthésique à Lubumbashi est tributaire du plateau technique, des compétences du personnel et de l'acceptabilité du type d'anesthésie par les patients. PMID:26523180

Etiologies et pronostic des occlusions intestinales aigues mécaniques à l’Hôpital National de Zinder: étude transversale sur 171 patients

PubMed Central

Adamou, Harissou; Magagi, Ibrahim Amadou; Habou, Oumarou; Magagi, Amadou; Maazou, Halidou; Adamou, Mansour; Harouna, Yacouba

2016-01-01

L’occlusion intestinale aigue (OIA) mécanique, représente l’une des pathologies les plus fréquentes en chirurgie digestive d’urgence. L’objectif de cette étude était de décrire les aspects étiologiques et pronostiques des occlusions intestinales aigues mécaniques à l’Hôpital National de Zinder (HNZ), Niger. Il s’agissait d’une étude transversale sur 24 mois (Janvier 2013 à Décembre 2014) ayant inclus tous les patients opérés pour OIA. Les occlusions intestinales mécaniques représentaient 24,50% (n=171) des urgences chirurgicales digestives (n=622). L’âge médian était à 25 ans (extrêmes: 1 jour et 95 ans). Le sexe ratio était à 3,5 en faveur des hommes. Les enfants représentaient 38,60% (n=66). Le siège de l’obstacle était sur le grêle dans 60,82% (n=104), colique dans 21,63%(n=37) et mixte dans 17,54% (n=30). Le mécanisme par strangulation constituait 88,89% (n=152) dont les hernies étranglées avec 49,70% (n=85) et les invaginations intestinales aigues avec 19,88% (n=34) des patients. Les malformations ano-rectales et les tumeurs constituaient les principales étiologies par obstruction avec respectivement 7,02% (n=12) et 3,51% (n=6). Une résection intestinale était faite dans 52 cas (30,41%). Les complications septiques prédominaient (n=39/53), dont la suppuration pariétale (n=23). Le séjour moyen était de 7,82 jours. La mortalité globale était 11,70% (n=20). Celle-ci était corrélée statistiquement à la nécrose intestinale (p=0,01) et au retard d’admission (p=0,04). Les étiologies des OIA sont multiples et dominées par les hernies étranglées. La morbi-mortalité élevée qu’elles entrainent pourrait être évitée par la prise en charge précoce avant l’installation d’une nécrose intestinale. PMID:27800103

[Perception of glaucoma and therapeutic adherence: A multicenter observational study].

PubMed

Chiche, A; Martin, G; Brasnu de Cenival, E; Rousseau, A; Giocanti, A; Fel, A; Kallel, S; Lombardi, M; Hamard, P; Baudouin, C; Labbe, A

2017-06-01

The purpose of this study was to evaluate medication adherence of glaucoma patients through the "Glaucoma treatment compliance assessment tool (GTCAT)" questionnaire and to correlate the results with clinical parameters. This multicenter prospective observational study was performed in the Département hospitalo-universitaire (DHU) Sight Restore, Paris, France. All patients had been followed for chronic open angle glaucoma (COAG) for at least 3 years. A French version of the GTCAT questionnaire was administered to patients. The results were correlated with clinical parameters of glaucoma, such as duration of disease, medications used, intraocular pressure (IOP) and mean deviation (MD) of the most recent visual field. Seventy-three patients were included in our study, with 60.9% declaring that they fully adhered to the treatment. There was a correlation between the amount of days missing treatment and difficulties using the eye drops. The main cause of missing the drops was forgetfulness (75%), followed by unavailability of the drop when it was time to take it (37.5%). The impact of glaucoma on quality of life was correlated to the amount of adverse effects of topical medications. The patient's perception of the importance of preserving vision was correlated to the level of confidence in the physician concerning the diagnosis of glaucoma. In glaucoma patients, the use of the GTCAT questionnaire confirmed the complex relationship between the patient, the disease and its treatment, and even his or her relationship with the ophthalmologist. These results emphasized the importance of therapeutic education but also the negative role of side effects of the eye drops on treatment adherence in glaucoma patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Length of stay after reaching clinical stability drives hospital costs associated with adult community-acquired pneumonia.

PubMed

Cortoos, Pieter-Jan; Gilissen, Christa; Laekeman, Gert; Peetermans, Willy E; Leenaers, Hilde; Vandorpe, Luc; Simoens, Steven

2013-03-01

Community-acquired pneumonia (CAP) has a considerable clinical and economic impact. The aim of this study was to identify drivers of hospital costs associated with CAP in 2 Belgian hospitals. Specifically, the influence of patient characteristics, quality indicators, and other treatment aspects on hospital costs was explored. The following were registered for patients admitted with a confirmed diagnosis of CAP in a large university hospital (Universitaire Ziekenhuizen Leuven, UZL) and a medium-sized secondary care hospital (Ziekenhuis Oost-Limburg, ZOL) in Belgium: the pneumonia severity index (PSI), time to clinical stability, length of stay, antibiotic therapy, outcomes, compliance with validated quality indicators, and the different costs (pharmacy, laboratory, and radiology, and total). Regression analysis was used to identify influential variables. Between October 2007 and June 2010, 803 patients were included, with a median total cost of €4794.57. The length of stay after clinical stability and time to clinical stability had the highest influence on the total cost (+6.3% and +4.9% per additional day, respectively; p < 0.0001). Other important drivers of higher costs were total therapy duration, PSI score, age, and admission to intensive care. Patients treated with moxifloxacin had significantly, but limited, lower costs. Quality indicator compliance, including guideline-compliant antibiotic treatment and therapy streamlining, had little influence. The most important driver of hospital costs associated with CAP was the time between clinical stability and actual hospital discharge. In order to substantially decrease the costs of CAP treatment, this period should be rigorously evaluated for possible intervention targets that would allow costs in CAP treatment to be decreased in a substantial manner.

Listériose humaine : Expériences cliniques avec cette zoonose chez 12 patients en Estrie, Québec sur une période de 19 ans (1976 à 1995)

PubMed Central

Maziade, Pierre-Jean; Marcoux, J André

1997-01-01

Une étude rétrospective a été faite dans le but de réviser l’épidémiologie, les facteurs de risque, les manifestations cliniques et l’évolution des cas d’infection à Listeria monocytogenes en Estrie, Québec de 1976–1995. Les patients ont été repérés à partir des cultures positives et du diagnostic donné par le Service des maladies infectieuses du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec. Un total de 12 patients ont fait partie de l’étude. La septicémie non reliée à la grossesse (4/12) et la méningite (6/12) ont été les deux présentations cliniques majeures. Il y avait 1 cas de listériose de grossesse et 1 cas de granulomatosis infanti septica. Dix patients avaient au moins une condition prédisposante. Un seul décès a été attribué à l’infection à L monocytogenes. Des séquelles neurologiques ont été observées chez la moitié des patients avec méningite tandis qu’aucune séquelle a été notée chez ceux avec septicémie. En conclusion, la listériose est une maladie de patients âgés et immunocompromis. La présentation clinique et l’évolution ne sont pas différentes de ce qui a déjà été rapporté dans d’autres régions industrialisées. PMID:22514474

Identifying gaps in the surgical training curriculum in Rwanda through evaluation of operative activity at a teaching hospital.

PubMed

Rickard, Jennifer L; Ntakiyiruta, Georges; Chu, Kathryn M

2015-01-01

To define the operations performed by surgical residents at a tertiary referral hospital in Rwanda to help guide development of the residency program. Cross-sectional study of all patients operated by surgical residents from October 2012 to September 2013. University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali [CHUK]), a public, tertiary referral hospital in Kigali, Rwanda. All patient data were entered into the operative database by surgical residents at CHUK. A total of 2833 cases were entered into the surgical database. Of them, 53 cases were excluded from further analysis because no surgical resident was listed as the primary or assistant surgeon, leaving 2780 cases for analysis. There were 2780 operations involving surgical residents. Of them, 51% of procedures were classified under general surgery, 38% orthopedics, 7% neurosurgery, and 4% urology. Emergency operations accounted for 64% of the procedures, with 56% of those being general surgery and 35% orthopedic. Further, 50% of all operations were trauma, with 71% of those orthopedic and 21% general surgery. Surgical faculty were involved in 45% of operations as either the primary or the assistant surgeons, while the remainder of operations did not involve surgical faculty. Residents were primary surgeons in 68% of procedures and assistant surgeons in 84% of procedures. The operative experience of surgery residents at CHUK primarily involves emergency and trauma procedures. Although this likely reflects the demographics of surgical care within Rwanda, more focus should be placed on elective procedures to ensure that surgical residents are broadly trained. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Landslides and vegetation cover in the 2005 North Pakistan earthquake: a GIS and statistical quantitative approach

NASA Astrophysics Data System (ADS)

Peduzzi, P.

2010-04-01

The growing concern for loss of services once provided by natural ecosystems is getting increasing attention. However, the accelerating rate of natural resources destruction calls for rapid and global action. With often very limited budgets, environmental agencies and NGOs need cost-efficient ways to quickly convince decision-makers that sound management of natural resources can help to protect human lives and their welfare. The methodology described in this paper, is based on geospatial and statistical analysis, involving simple Geographical Information System (GIS) and remote sensing algorithms. It is based on free or very low-cost data. It aims to scientifically assess the potential role of vegetation in mitigating landslides triggered by earthquakes by normalising for other factors such as slopes and distance from active fault. The methodology was applied to the 2005 North Pakistan/India earthquake which generated a large number of victims and hundreds of landslides. The study shows that if slopes and proximity from active fault are the main susceptibility factors for post landslides triggered by earthquakes in this area, the results clearly revealed that areas covered by denser vegetation suffered less and smaller landslides than areas with thinner (or devoid of) vegetation cover. Short distance from roads/trails and rivers also proved to be pertinent factors in increasing landslides susceptibility. This project is a component of a wider initiative involving the Global Resource Information Database Europe from the United Nations Environment Programme, the International Union for Conservation of Nature, the Institute of Geomatics and Risk Analysis from the University of Lausanne and the "institut universitaire d'études du développement" from the University of Geneva.

The teaching of medicine at the University Centre for Health Sciences Yaounde, Cameroon: its concordance with the Edinburgh Declaration on medical education.

PubMed

Monekosso, G L

1993-07-01

The University Centre for Health Sciences (UCHS) or as it is referred to in French 'Centre Universitaire des Sciences de la Santé' (CUSS), became functional in 1969 with the enrollment of the first group of students. The objective of this training programme was to produce a scientifically sound, multipurpose doctor who would be fully operational in a rural setting with minimal equipment and supplies (Monekosso 1970, 1972). The graduate had to be able to adapt readily to new situations and improvise whenever possible, calling for a high degree of competence and initiative. The training strategies adopted by UCHS in 1969 which met this requirement were later found to be in close concordance with the tenets of the World Conference on Medical Education held in Edinburgh in 1988, the Edinburgh Declaration. While some of the terminology may not have been worked out at the time, the programme developed embraced some new concepts hitherto untried or undeveloped: the problem-solving approach in the first to the sixth year; an integrated teaching approach during the first to sixth year of medical training; an integrated medicine internship in district hospitals in the sixth year; a community-based training approach throughout the training; team training of three different health professionals; competency-based training; health services linked research; health services linked training (Monekosso & Quenum 1978). The concordance of this programme to the Edinburgh Declaration is of great interest in realizing the World Federation for Medical Education programme and implementing the Edinburgh Declaration. The involvement of the three innovative medical schools in the planning stage of the curriculum explains this concordance.

Pharmacokinetics, phenotype and product choice in haemophilia B: how to strike a balance?

PubMed

Berntorp, E; Dolan, G; Hermans, C; Laffan, M; Santagostino, E; Tiede, A

2014-11-01

At the 7th Annual Congress of the European Association for Haemophilia and Allied Disorders (EAHAD) held in Brussels, Belgium, in February 2014, Pfizer sponsored a satellite symposium entitled: "Pharmacokinetics, phenotype and product choice in haemophilia B: How to strike a balance?" Co-chaired by Cedric Hermans (Cliniques Universitaires Saint Luc, Brussels, Belgium) and Mike Laffan (Imperial College, London, UK), the symposium provided an opportunity to debate whether pharmacokinetic (PK) parameters are good surrogates for clinical efficacy for haemophilia B in clinical practice, consider the perceptions and evidence of disease severity, and examine how these considerations can inform approaches to balancing the potential risks and benefits of the currently available treatment options for haemophilia B. PK parameters are routinely measured in clinical practice and are a requirement of regulatory bodies to demonstrate the clinical efficacy of products; however, the relationship between measured PK parameters and clinical efficacy is yet to be determined, an issue that was debated by Gerry Dolan (University Hospital, Queen's Medical Centre, Nottingham, UK) and Erik Berntorp (Lund University, Malmö Centre for Thrombosis and Haemostasis, Malmö, Sweden). Elena Santagostino (Universita degli Studi di Milano, Milano, Italy) reviewed how differing perceptions on the severity of haemophilia B compared with haemophilia A may have an impact on clinical decision-making. Finally, Andreas Tiede (Hannover Medical School, Hannover, Germany), examined the considerations for balancing the potential risks and benefits of the currently available treatment options for haemophilia B. Although the pathophysiology of haemophilia B has been widely studied and is largely understood, continued investigation and discussion around the optimal management course and appropriate therapeutic choice is warranted. © 2014 John Wiley & Sons Ltd.

Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: a research protocol

PubMed Central

Talbot, Lise R; Gaboury, Isabelle

2017-01-01

Background Intersectoral collaboration, known to promote more sustainable change within communities, will be examined in an oral health promotion program (OHPP). In Peru, an OHPP was implemented by the Ministry of Health, to reduce the incidence of caries in schoolchildren. In rural Andean communities, however, these initiatives achieved limited success. The objectives of this project are: (1) to understand the context and the underlying mechanisms associated with Peruvian OHPP's current effects among school children living in rural Andean communities and (2) to validate a theory explaining how and under which circumstances OHP intersectoral interventions on schoolchildren living in rural Andean communities produce their effects. Methods and analysis Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. This process will involve five different steps. In the first and second steps, a logic model and an initial theory are developed. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. In the fourth and fifth steps, iterative data analysis and a validation process will allow the identification of Context-Mechanism-Outcome configuration, and validate or refine the initial theory. Ethics and dissemination This research project has received approval from the Comité d’éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. The initial theory and research results will be published in relevant journals in public health and oral health. They will also be presented at realist evaluation and health promotion international conferences. PMID:28237962

Applications of 3D orbital computer-assisted surgery (CAS).

PubMed

Scolozzi, P

2017-09-01

The purpose of the present report is to describe the indications for use of 3D orbital computer-assisted surgery (CAS). We analyzed the clinical and radiological data of all patients with orbital deformities treated using intra-operative navigation and CAD/CAM techniques at the Hôpitaux Universitaires de Genève, Switzerland, between 2009 and 2016. We recorded age and gender, orbital deformity, technical and surgical procedure and postoperative complications. One hundred and three patients were included. Mean age was 39.5years (range, 5 to 84years) and 85 (87.5%) were men. Of the 103 patients, 96 had intra-operative navigation (34 for primary and 3 for secondary orbito-zygomatic fractures, 15 for Le Fort fractures, 16 for orbital floor fractures, 10 for combined orbital floor and medial wall fractures, 7 for orbital medial wall fractures, 3 for NOE (naso-orbito-ethmoidal) fractures, 2 for isolated comminuted zygomatic arch fractures, 1 for enophthalmos, 3 for TMJ ankylosis and 2 for fibrous dysplasia bone recontouring), 8 patients had CAD/CAM PEEK-PSI for correction of residual orbital bone contour following craniomaxillofacial trauma, and 1 patient had CAD/CAM surgical splints and cutting guides for correction of orbital hypertelorism. Two patient (1.9%) required revision surgery for readjustment of an orbital mesh. The 1-year follow-up examination showed stable cosmetic and dimensional results in all patients. This study demonstrated that the application of 3D orbital CAS with regards to intra-operative navigation and CAD/CAM techniques allowed for a successful outcome in the patients presented in this series. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Accuracy of straight leg raise and slump tests in detecting lumbar disc herniation: a pilot study.

PubMed

M'kumbuzi, V R P; Ntawukuriryayo, J T; Haminana, J D; Munyandamutsa, J; Nzakizwanimana, E

2012-01-01

To determine the accuracy of the Straight Leg Raise (SLR) and slump tests in detecting Lumbar Disc Herniation (LDH). Cross-sectional diagnostic accuracy study. Two referral hospitals in Kigali, Rwanda: King Faisal Hospital and Centre Hospitalier Universitaire de Kigali. All patients aged 18 to 70 who had an MRI and who were experiencing pain in the low back, leg or low back and leg. Closed Magnetic Resonance Imaging (MRI) investigations for each patient as witnessed by a radiologist who read the image were recorded by the first researcher and blinded to other researchers. The SLR and slump tests were performed three times on each patient by independent testers who were blinded to the result of the first test. The test order was randomized for each subject and the two tests were separated by one day wash-out period. Data were analyzed using a 2x2 table to ascertain diagnostic statistics including sensitivity and specificity with 95% confidence intervals. Thirty three from a possible 37 patients mean age 41.58 ± 10 years completed all of the tests. The sensitivity of SLR was greater (0.875; CI: 0.690-0.957) than that of the slump tests (0.800; CI: 0.6087-0.911) (p = 0.01) in detecting LDH. The specificity for SLR was 0.429 (CI: 0.158-0.750) and for slump was 0.714 (CI: 0.359-0.918). Substantial agreement (K = 0.774) was obtained between the SLR and MRI. The SLR was more accurate in detecting LDH. Further validation of this pilot finding is required by studying a larger sample.

A systematic diagnostic and therapeutic approach for the treatment of patients after cardio-pulmonary resuscitation: a prospective evaluation of 212 patients over 5 years.

PubMed

von Korn, Hubertus; Stefan, Victor; van Ewijk, Reyn; Chakraborty, Kamalesh; Sanwald, Burkhard; Hemker, Jan; Hink, Ulrich; Ohlow, Marc; Lauer, Bernward; Vagts, Dierk; Gruene, Stefan; Münzel, Thomas

2017-06-01

A literature on systematic treatment protocols for patients after resuscitation for cardiac arrest is lacking. We evaluated a systematic protocol, including ECG, echocardiogram, urgent cardiac catheterisation ("STEMI-like" workflow), CT scans, laboratory findings, IABP, hypothermia, and cMRI, prospectively over 5 years. The primary endpoint was the Cerebral Performance Category Scale (CPCS). During the period from January 2008 to December 2012, 212 patients were included. The mean age was 66.7 years, n = 151 (71.2 %) were male, mean time from the first medical contact to start of catheterisation was 76.6 min, and ventricular fibrillation (VF) was present in n = 99 (46.7 %). A significant coronary artery stenosis was seen in n = 130 (61.3 %), PCI was performed in n = 101 (47.6 %), an ACS was found in n = 100 (47.2 %), n = 91 patients (42.9 %) had another cardiac cause, an extra-cardiac cause was found in n = 12 (5.7 %, mostly a cerebral process), and in 9 patients (4.3 %), no cause was identifiable. A significant difference in mortality was found for patients with TIMI flow 2/3 vs. 0/1 (65.4 vs. 95.7 %, p < 0.01). The difference of intra-aortic balloon pumping vs. no pumping was not significant, performing hypothermia reduced mortality significantly (52.7 vs. 68.2 %, p = 0.04). The survival rate was n = 76 (35.9 %), a CPCS of 1/2 was reached in n = 68 pts (32.1 %), patients with ongoing resuscitation had a 100 % mortality (n = 41), and VF had a lower mortality (54.6 vs. 72.6 %, p < 0.01). A systematic algorithm may improve the outcome of patients after reanimation compared with classically reported outcomes. The data are hypothesis generating for further studies.

The history of therapeutic hypothermia and its use in neurosurgery.

PubMed

Bohl, Michael A; Martirosyan, Nikolay L; Killeen, Zachary W; Belykh, Evgenii; Zabramski, Joseph M; Spetzler, Robert F; Preul, Mark C

2018-05-25

Despite an overwhelming history demonstrating the potential of hypothermia to rescue and preserve the brain and spinal cord after injury or disease, clinical trials from the last 50 years have failed to show a convincing benefit. This comprehensive review provides the historical context needed to consider the current status of clinical hypothermia research and a view toward the future direction for this field. For millennia, accounts of hypothermic patients surviving typically fatal circumstances have piqued the interest of physicians and prompted many of the early investigations into hypothermic physiology. In 1650, for example, a 22-year-old woman in Oxford suffered a 30-minute execution by hanging on a notably cold and wet day but was found breathing hours later when her casket was opened in a medical school dissection laboratory. News of her complete recovery inspired pioneers such as John Hunter to perform the first complete and methodical experiments on life in a hypothermic state. Hunter's work helped spark a scientific revolution in Europe that saw the overthrow of the centuries-old dogma that volitional movement was created by hydraulic nerves filling muscle bladders with cerebrospinal fluid and replaced this theory with animal electricity. Central to this paradigm shift was Giovanni Aldini, whose public attempts to reanimate the hypothermic bodies of executed criminals not only inspired tremendous scientific debate but also inspired a young Mary Shelley to write her novel Frankenstein. Dr. Temple Fay introduced hypothermia to modern medicine with his human trials on systemic and focal cooling. His work was derailed after Nazi physicians in Dachau used his results to justify their infamous experiments on prisoners of war. The latter half of the 20th century saw the introduction of hypothermic cerebrovascular arrest in neurosurgical operating rooms. The ebb and flow of neurosurgical interest in hypothermia that has since persisted reflect our continuing

Distribution of yeast-like fungi at a university hospital in Turkey.

PubMed

Ece, Gulfem

2014-12-01

The increased life span has led to application of more invasive procedures for diagnosis and treatment of particularly immunosuppressed individuals. This situation drew more attention to fungal infections due to existence of yeast-like fungi. Candida infections have increased due to transplant in patients, prolonged intensive care unit (ICU) stays, and invasive procedures. Recently, identification of yeast-like fungi as well as antifungal susceptibility test has been gaining more importance. In our study, we aimed to evaluate the distribution of yeast-like fungi strains isolated from blood, urine, wound and respiratory specimens, which were sent from various departments of Izmir University School of Medicine University Hospital. The 262 yeast strains (of 13860 clinical specimens), isolated during 30.05.2012-20.05.2013, which were sent from various departments of Izmir University School of Medicine to Medical Microbiology Laboratory, were included in this study. Blood, wound, respiratory (sputum, tracheal secretion), and urine specimens were cultivated on blood agar and Sabouraud dextrose agar and incubated for 24-48 hours at 37°C. The isolates were cultivated on CHROMagar Candida and Cornmeal Tween 80 medium for identification. Besides, the automatized Vitek version 2.0 system was used for identification of the yeast strains as well as the antifungal susceptibility of blood culture strains. A total of 262 strains, isolated from the Anesthesiology and Reanimation Unit, as well as from the departments of Hematology, Urology, Infectious Diseases, Gynecology and Obstetrics, and Ear Nose and Throat, were included in this study. The most common isolated yeast-like species was Candida albicans. C. parapsilosis was the most common yeast-like fungus isolated from blood cultures. All the blood culture strains were susceptible to amphotericin B, flucytosine, fluconazole and voriconazole. Candida strains isolated from newborns, elderly patients, and intensive care patients

[Polyradiculomeningoencephalitis caused by Epstein-Barr virus infection--description of a case with fatal outcome].

PubMed

Ringelstein, E B; Sobczak, H; Pfeifer, B; Hacke, W

1984-03-01

A 21 years old high school student, who, since early childhood, suffered from complete spinal paraplegia of unknown cause at D 10, suddenly, after a three week period with influenca -like prodromal symptoms, presented with acute polyradiculomeningoencephalitis . Positive reactions following Paul-Bunnell- Davidsohn -test and tests for specific antivirus IgG as well as specific IgM revealed acute Epstein-Barr-Virus infection, although no glandular signs could be found. The clinical findings consisted of peripheral sensory-motor tetraparesis, ataxia, nystagmus and disturbances of the caudal cranial nerves. Initially, the diagnosis of Fisher's syndrome was made. The orbicularis oculi reflex, however, indicated a circumscribed brainstem lesion in the medial reticular formation. This finding lead to the additional clinical diagnosis of encephalitis. Shortly after admission, a heart-arrest occurred, and, after successful reanimation, the patient presented with a "locked-in syndrome". On the 12th day after admission, he succumbed during a sudden drop of blood-pressure. Necropsy revealed septic shock as the cause of death, due to perforation of a duodenal ulcer. In the lower thoracic spinal cord a neurocytoma was found, which once lead to the paraplegia. Additionally, moderate inflammatory infiltrations were found in the basal leptomeninges, in the walls of several subcortical vessels and in the hypoglossal nerve. The infiltrations, at some sites, contained a large number of atypical lymphoid cells in the inflammatory meningeal exsudate . Microglial proliferation with satellitosis was found in the inferior olives, thus confirming the clinical diagnosis of polyradiculomeningoencephalitis . This case report should emphasize special features of EBV-infection with neurological complications: (1) in inflammatory diseases of the peripheral and central nervous system, infectious mononucleosis should always be drawn into the diagnostic considerations, even if heterophil antibodies

[Accidents of fulguration].

PubMed

Virenque, C; Laguerre, J

1976-01-01

Fulguration, first electric accident in which the man was a victim, is to day better known. A clap of thunder is decomposed in two elements: lightning, and thunder. Lightning is caused by an electrical discharge, either within a cloud, or between two clouds, or, above all, between a cloud and the surface of the ground. Experimental equipments owned by the French Electricity Company and by the Atomic Energy Commission, have allowed to photograph lightnings and to measure certain physical characteristics (Intensity variable between 25 to 100 kA, voltage variable between 20 to 1 000 kV). The frequency of storms was learned: the isokeraunic level, in France, is about 20, meaning that thunder is heard twenty days during one year. Man may be stricken by thunder by direct hit, by sudden bursting, by earth current, or through various conductors. The electric charge which reached him may go to the earth directly by contact with the ground or may dissipate in the air through a bony promontory (elbow). The total number of victims, "wounded" or deceased, is not now known by statistics. Death comes by insulation breakdown of one of several anatomic cephalic formations: skull, meninx, brain. Many various lesions may happen in survivors: loss of consciousness, more or less long, sensorial or motion deficiencies. All these signs are momentary and generally reversible. Besides one may observe much more intense lesions on the skin: burns and, over all, characteristic aborescence (skin effect by high frequency current). The heart is protected, contrarily to what happens with industrial electrocution. The curative treatment is merely symptomatic : reanimation, surgery for burns or associated traumatic lesions. A prevention is researched to help the lonely man, in the country or in the mountains in the houses (lightning conductor, Faraday cage), in vehicles (aircraft, cars, ships). The mysterious and unforseeable character of lightning still stays, leaving a door opened for numerous

Eversion congénitale bilatérale des paupières: prise en charge d’un cas selon l’approche conservatrice au Centre Hospitalier Universitaire de Yaoundé, Cameroun

PubMed Central

Monebenimp, Francisca; Kagmeni, Gilles; Chelo, David; Bilong, Yannick; Moukouri, Ernest

2012-01-01

L’éversion congénitale des paupières est une affection rare. Son traitement en première intention est généralement conservateur, constitué de lubrifiant, d’antibiotiques, de manœuvres d’inversion de la paupière éversée et d’une éducation des parents. Nous présentons le cas d’un nouveau-né de huit heures de vie ayant une éversion congénitale bilatérale des paupières avec surinfection bactérienne. La ponction à l’aiguille de la conjonctive œdémateuse associée au traitement topique avec du sérum salé isotonique et des antibiotiques ont accéléré le processus de guérison. Une récidive n’a pas été observée lors des pleurs après trois semaines d’inversion des paupières. PMID:22514768

Is the outcome at surgery different when flat epithelial atypia and lobular neoplasia are found in association at biopsy?

PubMed

El Khoury, Mona; Sanchez, Lilia Maria; Lalonde, Lucie; Trop, Isabelle; David, Julie; Mesurolle, Benoît

2017-04-01

To assess the impact on the final outcome at surgery of flat epithelial atypia (FEA) when found concomitantly with lobular neoplasia (LN) in biopsy specimens compared with pure biopsy-proven FEA. The approval from the institutional review board of the CHUM (Centre Hospitalier Universitaire de Montréal) was obtained. A retrospective review of our database between 2009 and 2013 identified 81 females (mean age 54 years, range 38-90 years) with 81 FEA biopsy-proven lesions. These were pure or associated with LN only in 59/81 (73%) and 22/81 (27%) cases, respectively. Overall, 57/81 (70%) patients underwent surgery and 24/81 (30%) patients underwent mammographic surveillance with a mean follow-up of 36 months. FEA presented more often as microcalcifications in 68/81 (84%) patients and were mostly amorphous in 49/68 (72%). After excluding radio pathologically discordant cases, pure FEA proved to be malignant at surgery in 1/41 (2%; 95% confidence interval 0.06-12.9). There was no statistically significant difference in the upgrade to malignancy whether FEA lesions were pure or associated to LN at biopsy (p = 0.4245); however, when paired in biopsy specimens, these lesions were more frequently associated with atypical ductal hyperplasia (ADH) at surgery than with pure FEA (p = 0.012). Our results show a 2% upgrade rate to malignancy of pure FEA lesions. When FEA is found in association with LN at biopsy, surgical excision yields more frequently ADH than pure FEA thus warranting close surveillance or even surgical excision. Advances in knowledge: The association of LN with FEA at biopsy was more frequently associated with ADH at surgery than with pure FEA. If a biopsy-proven FEA lesion is deemed concordant with the imaging finding, when paired with LN at biopsy, careful surveillance or even surgical excision is suggested.

PREVIMER : Meteorological inputs and outputs

NASA Astrophysics Data System (ADS)

Ravenel, H.; Lecornu, F.; Kerléguer, L.

2009-09-01

PREVIMER is a pre-operational system aiming to provide a wide range of users, from private individuals to professionals, with short-term forecasts about the coastal environment along the French coastlines bordering the English Channel, the Atlantic Ocean, and the Mediterranean Sea. Observation data and digital modelling tools first provide 48-hour (probably 96-hour by summer 2009) forecasts of sea states, currents, sea water levels and temperatures. The follow-up of an increasing number of biological parameters will, in time, complete this overview of coastal environment. Working in partnership with the French Naval Hydrographic and Oceanographic Service (Service Hydrographique et Océanographique de la Marine, SHOM), the French National Weather Service (Météo-France), the French public science and technology research institute (Institut de Recherche pour le Développement, IRD), the European Institute of Marine Studies (Institut Universitaire Européen de la Mer, IUEM) and many others, IFREMER (the French public institute fo marine research) is supplying the technologies needed to ensure this pertinent information, available daily on Internet at http://www.previmer.org, and stored at the Operational Coastal Oceanographic Data Centre. Since 2006, PREVIMER publishes the results of demonstrators assigned to limited geographic areas and to specific applications. This system remains experimental. The following topics are covered : Hydrodynamic circulation, sea states, follow-up of passive tracers, conservative or non-conservative (specifically of microbiological origin), biogeochemical state, primary production. Lastly, PREVIMER provides researchers and R&D departments with modelling tools and access to the database, in which the observation data and the modelling results are stored, to undertake environmental studies on new sites. The communication will focus on meteorological inputs to and outputs from PREVIMER. It will draw the lessons from almost 3 years during

Improving flow in the OR.

PubMed

Blouin-Delisle, Charles Hubert; Drolet, Renee; Gagnon, Serge; Turcotte, Stephane; Boutet, Sylvie; Coulombe, Martin; Daneau, Eric

2018-03-12

Purpose The purpose of this paper is to increase efficiency in ORs without affecting quality of care by improving the workflow processes. Administrative processes independent of the surgical act can be challenging and may lead to clinical impacts such as increasing delays. The authors hypothesized that a Lean project could improve efficiency of surgical processes by reducing the length of stays in the recovery ward. Design/methodology/approach Two similar Lean projects were performed in the surgery departments of two hospitals of the Centre Hospitalier Universitaire de Québec: Hôtel Dieu de Quebec (HDQ) and Hôpital de l'Enfant Jesus (HEJ). The HDQ project designed around a Define, Measure, Analyse, Improve and Control process revision and a Kaizen workshop focused on patients who were hospitalized in a specific care unit after surgery and the HEJ project targeted patients in a post-operative ambulatory context. The recovery ward output delay was measured retrospectively before and after project. Findings For the HDQ Lean project, wasted time in the recovery ward was reduced by 62 minutes (68 percent reduction) between the two groups. The authors also observed an increase of about 25 percent of all admissions made in the daytime after the project compared to the time period before the project. For the HEJ Lean project, time passed in the recovery ward was reduced by 6 min (29 percent reduction). Originality/value These projects produced an improvement in the flow of the OR without targeting clinical practices in the OR itself. They demonstrated that change in administrative processes can have a great impact on the flow of clinical pathways and highlight the need for comprehensive and precise monitoring of every step of the elective surgery patient trajectory.

Impact of Surface Roughness and Soil Texture on Mineral Dust Emission Fluxes Modeling

NASA Technical Reports Server (NTRS)

Menut, Laurent; Perez, Carlos; Haustein, Karsten; Bessagnet, Bertrand; Prigent, Catherine; Alfaro, Stephane

2013-01-01

Dust production models (DPM) used to estimate vertical fluxes of mineral dust aerosols over arid regions need accurate data on soil and surface properties. The Laboratoire Inter-Universitaire des Systemes Atmospheriques (LISA) data set was developed for Northern Africa, the Middle East, and East Asia. This regional data set was built through dedicated field campaigns and include, among others, the aerodynamic roughness length, the smooth roughness length of the erodible fraction of the surface, and the dry (undisturbed) soil size distribution. Recently, satellite-derived roughness length and high-resolution soil texture data sets at the global scale have emerged and provide the opportunity for the use of advanced schemes in global models. This paper analyzes the behavior of the ERS satellite-derived global roughness length and the State Soil Geographic data base-Food and Agriculture Organization of the United Nations (STATSGO-FAO) soil texture data set (based on wet techniques) using an advanced DPM in comparison to the LISA data set over Northern Africa and the Middle East. We explore the sensitivity of the drag partition scheme (a critical component of the DPM) and of the dust vertical fluxes (intensity and spatial patterns) to the roughness length and soil texture data sets. We also compare the use of the drag partition scheme to a widely used preferential source approach in global models. Idealized experiments with prescribed wind speeds show that the ERS and STATSGO-FAO data sets provide realistic spatial patterns of dust emission and friction velocity thresholds in the region. Finally, we evaluate a dust transport model for the period of March to July 2011 with observed aerosol optical depths from Aerosol Robotic Network sites. Results show that ERS and STATSGO-FAO provide realistic simulations in the region.

Le syndrome d'embolie graisseuse post traumatique

PubMed Central

Berdai, Adnane Mohamed; Shimi, Abdelkarim; Khatouf, Mohammed

2014-01-01

Le syndrome d'embolie graisseuse est une complication grave des fractures des os longs, il est la conséquence de la dissémination des particules graisseuses dans la microcirculation. L'objectif de ce travail est de déterminer le profil épidémiologique, la présentation clinique et paraclinique de ce syndrome et sa prise en charge thérapeutique. Notre étude porte sur 11 cas de syndrome d'embolie graisseuse colligés au service de réanimation A1 au centre hospitalier universitaire Hassan II de Fès, de Janvier 2009 à Juin 2012. Le diagnostic positif est basé sur les critères de Gurd. Les cas collectés se caractérisent par la prédominance du sexe masculin, d'un âge inférieur à 40 ans, présentant une fracture fémorale. Ce syndrome survient souvent dans les 72 heures après le traumatisme. La présentation clinique est dominée par l'hypoxémie et les troubles de conscience. Sur le plan biologique: l'anémie et la thrombopénie sont les manifestations les plus fréquentes. La prise en charge est symptomatique, 63% des patients ont nécessité l'intubation et la ventilation. L’évolution n'est pas toujours bénigne. Nos résultats confirme le polymorphisme de la présentation clinique et paraclinique du syndrome d'embolie graisseuse. Le diagnostic de ce syndrome se base sur des critères cliniques, mais reste essentiellement un diagnostic d’élimination. La prise en charge est symptomatique. La prévention de ce syndrome est essentielle et se base sur une fixation précoce des fractures des os longs. PMID:25452829

Les fractures luxations du cotyle: prise en charge et pronostic à long terme; étude rétrospective portant sur 40 cas

PubMed Central

Chagou, Aniss; Hmouri, Ismail; Rhanim, Abdelkarim; Lahlou, Abdou; Berrada, Mohammed Saleh; Yaacoubi, Moradh

2014-01-01

Les fractures luxations du cotyle sont le plus souvent dues à des traumatismes de haute énergie. Elles constituent une urgence thérapeutique, l'association de la luxation à une fracture du cotyle fait apparaître la question du choix thérapeutique entre traitement orthopédique et traitement médical. L'objectif de l’étude est de mettre le point sur l'aspect thérapeutique dans ces lésions mais aussi leurs pronostics à long terme. Nous rapportons une étude rétrospective portant sur 40 cas colligés au service d'orthopédie du centre hospitalier universitaire de Rabat. Nous avons évalué les résultats de notre prise en charge mais aussi le pronostic à court et à long terme. Dans notre série, vingt cinq patients ont bénéficié d'un traitement orthopédique alors que les quinze restants ont été opérés, la voie d'abord la plus utilisée est la voie postérieure. Les résultats fonctionnels ont été évalués, après un recul de 3 à 8 ans, selon la cotation de Merle d'Aubigné. Nous avons obtenu 90% de résultats satisfaisants. La comparaison de nos résultats à ceux de la littérature montre que le résultat des traitements orthopédiques et chirurgicaux dépend essentiellement du type de fracture. Le pronostic à long terme reste imprévisible. La survenue des complications tardives telle que la nécrose céphalique et de l'arthrose reste toujours imprévisible, ce qui impose un suivi régulier et prolongé des patients. PMID:25722763

Health assessment of French university students and risk factors associated with mental health disorders.

PubMed

Tran, Antoine; Tran, Laurie; Geghre, Nicolas; Darmon, David; Rampal, Marion; Brandone, Diane; Gozzo, Jean-Michel; Haas, Hervé; Rebouillat-Savy, Karine; Caci, Hervé; Avillach, Paul

2017-01-01

The first year of university is a particularly stressful period and can impact academic performance and students' health. The aim of this study was to evaluate the health and lifestyle of undergraduates and assess risk factors associated with psychiatric symptoms. Between September 2012 and June 2013, we included all undergraduate students who underwent compulsory a medical visit at the university medical service in Nice (France) during which they were screened for potential diseases during a diagnostic interview. Data were collected prospectively in the CALCIUM database (Consultations Assistés par Logiciel pour les Centres Inter-Universitaire de Médecine) and included information about the students' lifestyle (living conditions, dietary behavior, physical activity, use of recreational drugs). The prevalence of psychiatric symptoms related to depression, anxiety and panic attacks was assessed and risk factors for these symptoms were analyzed using logistic regression. A total of 4,184 undergraduates were included. Prevalence for depression, anxiety and panic attacks were 12.6%, 7.6% and 1.0%, respectively. During the 30 days preceding the evaluation, 0.6% of the students regularly drank alcohol, 6.3% were frequent-to-heavy tobacco smokers, and 10.0% smoked marijuana. Dealing with financial difficulties and having learning disabilities were associated with psychiatric symptoms. Students who were dissatisfied with their living conditions and those with poor dietary behavior were at risk of depression. Being a woman and living alone were associated with anxiety. Students who screened positively for any psychiatric disorder assessed were at a higher risk of having another psychiatric disorder concomitantly. The prevalence of psychiatric disorders in undergraduate students is low but the rate of students at risk of developing chronic disease is far from being negligible. Understanding predictors for these symptoms may improve students' health by implementing targeted

Strengthening healthcare delivery in Haiti through nursing continuing education.

PubMed

Clark, M; Julmisse, M; Marcelin, N; Merry, L; Tuck, J; Gagnon, A J

2015-03-01

The aim of this paper was to (1) highlight nursing continuing education as a key initiative for strengthening healthcare delivery in low-resource settings, and (2) provide an example of a nursing continuing education programme in Haiti. Haiti and other low-resource settings face extreme challenges including severe shortages of healthcare workers, high rates of nurse out-migration and variations in nurse competency at entry-to-practice. Nursing continuing education has the potential to address these challenges and improve healthcare delivery through enhanced nurse performance and retention; however, it is underutilized in low-resource settings. A case study is presented from the Hôpital Universitaire de Mirebalais in Mirebalais, Haiti of a new nursing continuing education programme called the Beyond Expert Program. The case study highlights eight key dimensions of nursing continuing education in low-resource settings: (1) involving local stakeholders in planning process, (2) targeting programme to nurse participant level and area of care, (3) basing course content on local context, (4) including diverse range of nursing topics, (5) using participatory teaching methods, (6) addressing resource constraints in time and scheduling, (7) evaluating and monitoring outcomes, and (8) establishing partnerships. The case study provides guidance for others wishing to develop programmes in similar settings. Creating a nursing continuing education programme in a low-resource setting is possible when there is commitment and engagement for nursing continuing education at all levels of the organization. Our report suggests a need for policy-makers in resource-limited settings to make greater investments in nursing continuing education as a focus of human resources for health, as it is an important strategy for promoting nurse retention, building the knowledge and skill of the existing nursing workforce, and raising the image of nursing in low-resource settings. © 2015

Surgical site infections following transcatheter apical aortic valve implantation: incidence and management.

PubMed

Baillot, Richard; Fréchette, Éric; Cloutier, Daniel; Rodès-Cabau, Josep; Doyle, Daniel; Charbonneau, Éric; Mohammadi, Siamak; Dumont, Éric

2012-11-13

The present study was undertaken to examine the incidence and management of surgical site infection (SSI) in patients submitted to transapical transcatheter aortic valve implantation (TA-TAVI). From April 2007 to December 2011, 154 patients underwent TA-TAVI with an Edwards Sapien bioprosthesis (ES) at the Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ) as part of a multidisciplinary program to prospectively evaluate percutaneous aortic valve implantation. Patient demographics, perioperative variables, and postoperative complications were recorded in a prospective registry. Five (3.2%) patients in the cohort presented with an SSI during the study period. The infections were all hospital-acquired (HAI) and were considered as organ/space SSI's based on Center for Disease Control criteria (CDC). Within the first few weeks of the initial procedure, these patients presented with an abscess or chronic draining sinus in the left thoracotomy incision and were re-operated. The infection spread to the apex of the left ventricle in all cases where pledgeted mattress sutures could be seen during debridement. Patients received multiple antibiotic regimens without success until the wound was surgically debrided and covered with viable tissue. The greater omentum was used in three patients and the pectoralis major muscle in the other two. None of the patients died or had a recurrent infection. Three of the patients were infected with Staphylococcus epidermidis, one with Staphylococcus aureus, and one with Enterobacter cloacae. Patients with surgical site infections were significantly more obese with higher BMI (31.4±3.1 vs 26.2±4.4 p=0.0099) than the other patients in the cohort. While TA-TAVI is a minimally invasive technique, SSIs, which are associated with obesity, remain a concern. Debridement and rib resection followed by wound coverage with the greater omentum and/or the pectoralis major muscle were used successfully in these patients.

Physical activity assessment and counseling in Quebec family medicine groups.

PubMed

Baillot, Aurélie; Baillargeon, Jean-Patrice; Paré, Alex; Poder, Thomas G; Brown, Christine; Langlois, Marie-France

2018-05-01

To determine how often primary health care providers (PHCPs) in family medicine groups (FMGs) assess physical activity (PA) levels, provide PA counseling (PAC), and refer patients to exercise professionals; to describe patients' PA levels, physical fitness, and satisfaction regarding their PA management in FMGs; to describe available PA materials in FMGs and PHCPs' PAC self-efficacy and PA knowledge; and to identify characteristics of patients and PHCPs that determine the assessment of PA and PAC provided by PHCPs. Cross-sectional study using questionnaires and a medical chart audit. Ten FMGs within the Integrated University Health Network of the Centre hospitalier universitaire de Sherbrooke in Quebec. Forty FPs, 24 nurses, and 439 patients. Assessment of PA level and PAC provided by PHCPs. Overall, 51.9% of the patients had had their PA level assessed during the past 18 months, but only 21.6% received PAC from at least 1 of the PHCPs. Similar percentages were found among the inactive (n = 244) and more active (n = 195) patients. The median PAC self-efficacy score of PHCPs was 70.2% (interquartile range 52.0% to 84.7%) and the median PA knowledge score was 45.8% (interquartile range 41.7% to 54.2%), with no significant differences between nurses and FPs. In multivariate analysis, 34% of the variance in PAC provided was explained by assessment of PA level, overweight or obese status, type 2 diabetes or prediabetes, less FP experience, lower patient annual family income, more nurse encounters, and a higher patient physical component summary of quality of life. The rates of assessment of PA and provision of PAC in Quebec FMGs were low, even though most of the patients were inactive. Initiatives to support PHCPs and more resources to assess PA levels and provide PAC should be implemented. Copyright© the College of Family Physicians of Canada.

Dynamically Consistent Shallow-Atmosphere Equations with a Complete Coriolis force

NASA Astrophysics Data System (ADS)

Tort, Marine; Dubos, Thomas; Bouchut, François; Zeitlin, Vladimir

2014-05-01

Dynamically Consistent Shallow-Atmosphere Equations with a Complete Coriolis force Marine Tort1, Thomas Dubos1, François Bouchut2 & Vladimir Zeitlin1,3 1 Laboratoire of Dynamical Meteorology, Univ. P. and M. Curie, Ecole Normale Supérieure, and Ecole Polytechnique, FRANCE 2 Université Paris-Est, Laboratoire d'Analyse et de Mathématiques Appliquées, FRANCE 3 Institut Universitaire de France Atmospheric and oceanic motion are usually modeled within the shallow-fluid approximation, which simplifies the 3D spherical geometry. For dynamical consistency, i.e. to ensure conservation laws for potential vorticity, energy and angular momentum, the horizontal component of the Coriolis force is neglected. Here new equation sets combining consistently a simplified shallow-fluid geometry with a complete Coriolis force is presented. The derivation invokes Hamilton's principle of least action with an approximate Lagrangian capturing the small increase with height of the solid-body entrainment velocity due to planetary rotation. A three-dimensional compressible model and a one-layer shallow-water model are obtained. The latter extends previous work done on the f-plane and β-plane. Preliminary numerical results confirm the accuracy of the 3D model within the range of parameters for which the equations are relevant. These new models could be useful to incorporate a full Coriolis force into existing numerical models and to disentangle the effects of the shallow-atmosphere approximation from those of the traditional approximation. Related papers: Tort M., Dubos T., Bouchut F. and Zeitlin V. Consistent shallow-water equations on the rotating sphere with complete Coriolis force and topography. J. Fluid Mech. (under revisions) Tort M. and Dubos T. Dynamically consistent shallow-atmosphere equations with a complete Coriolis force. Q.J.R. Meteorol. Soc. (DOI: 10.1002/qj.2274)

Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: a research protocol.

PubMed

Bergeron, Dave A; Talbot, Lise R; Gaboury, Isabelle

2017-02-24

Intersectoral collaboration, known to promote more sustainable change within communities, will be examined in an oral health promotion program (OHPP). In Peru, an OHPP was implemented by the Ministry of Health, to reduce the incidence of caries in schoolchildren. In rural Andean communities, however, these initiatives achieved limited success. The objectives of this project are: (1) to understand the context and the underlying mechanisms associated with Peruvian OHPP's current effects among school children living in rural Andean communities and (2) to validate a theory explaining how and under which circumstances OHP intersectoral interventions on schoolchildren living in rural Andean communities produce their effects. Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. This process will involve five different steps. In the first and second steps, a logic model and an initial theory are developed. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. In the fourth and fifth steps, iterative data analysis and a validation process will allow the identification of Context-Mechanism-Outcome configuration, and validate or refine the initial theory. This research project has received approval from the Comité d'éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. The initial theory and research results will be published in relevant journals in public health and oral health. They will also be presented at realist evaluation and health promotion international conferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Métastase pleurale et pulmonaire d’une polyadénofibromatose dégénéréé: à propos d’un cas

PubMed Central

El Hachimi, Kawtar; Benjelloun, Hanane; Zaghba, Nahid; Yassine, Najiba

2017-01-01

La polyadénofibromatose ou l’adénofibromatose est définie par la présence d’au moins 3 adénofibromes, uni ou bilatéraux atteignant une taille importante responsable de troubles trophiques. Nous rapportons une observation colligée au service des maladies respiratoires du Centre Hospitalier Universitaire Ibn Rochd de Casablanca. Il s’agit d’une patiente âgée de 46ans, suivie depuis l’âge de 30 ans pour une adénofibromatose bilatérale opérée à 4 reprises. Suite à un bilan préopératoire d’une mastectomie bilatérale, une radio du thorax a été réalisée objectivant un hémithorax droit opaque avec refoulement des éléments du médiastin. L’examen clinique retrouvait un syndrome d’épanchement liquidien de l’hémithorax droit et une adénopathie cervicale sus claviculaire gauche. La ponction biopsie pleurale confirmait la localisation pleurale d’un carcinome peu différencié et invasif compatible avec une origine mammaire. La bronchoscopie après évacuation pleurale objectivait un aspect infiltré de tout l’arbre bronchique, dont les biopsies concluaient au même résultat anatomopathologique. Le traitement préconisé était une polychimiothérapie. L’évolution était marquée par l’apparition de métastases hépatiques. A travers cette observation, nous concluons que les adénofibromes nécessitent une surveillance régulière vu le risque de dégénérescence vers le cancer du sein qui est une cause fréquente de métastases pleuropulmonaires. PMID:29515733

Facteurs prédictifs de l’adhésion médicamenteuse chez les patients en insuffisance cardiaque chronique: expérience marocaine

PubMed Central

Ragbaoui, Yassine; Nouamou, Imad; Hammiri, Ayoub El; Habbal, Rachida

2017-01-01

L’adhésion médicamenteuse chez les patients ayant une insuffisance cardiaque chronique est reconnue comme l’un des problèmes majeurs dans la gestion de cette pathologie. L’état démographique et socioéconomique des pays africains peut avoir un impact sur l’adhésion au traitement de l’insuffisance cardiaque chronique. Nous avons réalisé une étude transversale de Septembre 2014 à Janvier 2015 portant sur les patients en insuffisance cardiaque chronique suivis au centre d’insuffisance cardiaque du département de cardiologie du centre hospitalier universitaire IBN ROCHD à Casablanca au Maroc. La mesure de l’adhésion médicamenteuse était basée sur un questionnaire: questionnaire CARDIA. Les informations relatifs aux facteurs prédictifs d’adhésion médicamenteuse était dérivés du model d’adhésion multidimensionnel. Nous avons inclus dans cette étude 147 patients insuffisants cardiaques chroniques. Le pourcentage de l’adhésion médicamenteuse était de 83.6% selon CARDIA-Questionary. Les facteurs prédictifs qui influencent significativement l’adhésion médicamenteuse était: La dépression (p=0.034), le niveau de support social (p=0.03) et la prise de médicaments par le patient lui-même (p=0.0001). Comme dans plusieurs régions au monde, l’adhésion médicamenteuse chez les patients ayant une insuffisance cardiaque chronique reste un problème de santé au Maroc. Les différentes stratégies qui agissent sur les facteurs prédictifs pourraient améliorer l’adhésion médicamenteuse. PMID:28533838

Les manifestations oculaires au cours de la pré-éclampsie sévère ou l’éclampsie au Centre Hospitalier Universitaire Sourô Sanou de Bobo Dioulasso

PubMed Central

Diallo, Jean Wenceslas; Méda, Nonfounikoun; Ahnoux-Zabsonré, Ahgbatouhabéba; Ouattara, Souleymane; Yanogo, Armande; Tougouma, Somnoma Jean Baptiste; Somé, Der; Sanou, Jérôme; Dolo, Mariam

2015-01-01

La pré-éclampsie sévère est un problème de santé publique. L'atteinte oculaire est une de ses nombreuses complications. Le but de notre travail était de décrire les atteintes oculaires chez les patientes présentant une pré-éclampsie et/ou éclampsie afin de contribuer à leur meilleure prise en charge. Il s'est agi d'une étude transversale descriptive à collecte prospective allant du 1er novembre 2013 au 31 juillet 2014, chez les patientes ayant souffert de pré-éclampsie sévère/éclampsie. Nous avons inclus 127 patientes dans notre étude. La moyenne d’âge des patientes de notre étude était de 26,37 ans (ET= 6,8 ans), avec des extrêmes de 15 et 40 ans. Les tranches d’âge les plus représentées étaient celles de 26 à 30 ans avec 29,1% des cas et celle des 15 à 20 ans avec 25,2%. Le diagnostic de pré-éclampsie sévère a été retenu dans 69,3% des cas. Les primigestes représentaient 40,9% de la population. Les troubles visuels à type de phosphènes ont été observés chez 33,1% des patientes. Nous avons noté un courant granulaire conjonctival dans 41,7%, des lésions du segment postérieur chez 32,3% des patientes. Ces résultats ont été discutés par rapport à la littérature, et nous notons plus de cas d'atteinte rétinienne. Nous n'avons pas trouvé de lien statistiquement significatif entre la tension artérielle à l'admission et le stade de la rétinopathie hypertensive. Les complications oculaires de la pré-éclampsie sévère sont très fréquentes et souvent ignorées. Les atteintes rétiniennes sont fréquentes mais de bon pronostic. PMID:26405485

Les contributions de la psychologie cognitive a l'enseignement strategique des langues secondes au niveau universitaire (The Contributions of Cognitive Psychology to Strategic Second Language Instruction at the University Level).

ERIC Educational Resources Information Center

Besnard, Christine

1995-01-01

Contributions of the field of cognitive psychology to second language instruction are reviewed. It is proposed that these concepts can contribute not only to classroom language instruction, but also to methodology of language teacher education. (MSE)

Les traumatismes de l’étage antérieur de la base du crane: à propos d'une série de 136 cas

PubMed Central

Bouchaouch, Abdelali; Hassani, Fahd Derkaoui; Abboud, Hilal; Mukengeshay, Jeff Ntalaja; El Fatemi, Nizare; Gana, Rachid; El Maaqili, Moulay Rchid; El Abbadi, Najia; Bellakhdar, Fouad

2015-01-01

Les traumatismes de l’étage antérieur de la base du crâne représentent 15 à 20% des traumatismes crâniens en général. Ils menacent les structures neuro-encéphaliques sus jacentes et sont très souvent responsables de brèches ostéo-méningées exposant au risque infectieux. Notre travail a concerné 136 dossiers exploitables de traumatisme de l’étage antérieur de la base du crâne colligés sur une période de 10 ans entre janvier 2003 et décembre 2012. Le diagnostic a été suspecté devant les signes cliniques évocateurs (ecchymose péri-orbitaire, rhinorrhée…) et a été confirmé dans la plupart des cas par la TDM. Le traitement idéal est la fermeture chirurgicale de la brèche en association aux moyens médicaux (vaccination, anti-épileptiques, mesures de réanimation…) Le moment idéal de la réparation est au-delà de la 72ème heure après la diminution de l'oedème cérébral en cas d'absence d'une lésion intracrânienne nécessitant une intervention en urgence. Notre équipe ne pratiquant pas la voie endoscopique, l'abord frontal est souvent indiqué. Le pronostic dépend des lésions cérébrales associées et surtout de la présence d'une brèche dont le diagnostic et la réparation doivent être les plus rapides et les plus précis possibles. Ainsi toute rhinorrhée post-traumatique nécessite une exploration systématique, le timing idéal: c'est la disparition de l'oedème cérébral pour faciliter l'exploration, ceci est en général possible à partir de la 72ème heure sauf dans les cas associés à une autre lésion intra crânienne nécessitant une exploration en urgence. PMID:26327992

Encéphalopathie pancréatique: à propos de deux cas

PubMed Central

Doghmi, Nawfal; Benakrout, Aziz; Meskine, Amine; Bensghir, Mustaphja; Baite, Abdelouah; Haimeur, Charki

2016-01-01

L'encéphalopathie pancréatique, est une complication rare de la pancréatite aiguë, notre étude porte sur 02 cas d'encéphalopathie pancréatique, hospitalisés et traités au sein du service de Réanimation chirurgicale de l'Hôpital Militaire d'Instruction Mohamed V de Rabat. L'âge des patients était compris entre 43 ans et 54 ans, nos 02 cas sont repartis en une femme et un homme. Le mécanisme physiopathologique de l'EP n'est pas encore bien élucidé, de nombreuses hypothèses ont été rapportées dans la littérature, certains auteurs suggèrent que la lipase et la Phospholipase A2 jouent un rôle dans le processus pathologique de l'EP. D'autres facteurs tels que les infections, les troubles hydroélectrolytiques, l'hypoxémie et la perturbation de la glycémie, peuvent être déclencheurs. Le diagnostic de l'encéphalopathie pancréatique est facile à établir, la symptomatologie clinique se résume le plus souvent à une confusion, avec stupeur, et agitation psychomotrice, Il s'y ajoute parfois des atteintes neurologiques comme des convulsions, une céphalée, des hémiparésies passagères, une dysarthrie, enfin des difficultés d'expression verbale et une amnésie. Les examens paracliniques, notamment L'IRM cérébrale et l'électroencéphalogramme, permettent de confirmer le diagnostic. Le traitement est d'abord symptomatique, il a comme objectif de lutter contre les facteurs qui favorisent l'apparition des signes neurologiques par les mesures de réanimation que réclame la gravité de la situation. L'évolution de l'EP est le plus souvent favorable, avec une disparition progressive des symptômes, cependant la persistance de quelques séquelles, est décrite dans la littérature. Le pronostic est fonction de la gravité de la pancréatite aigüe et des complications associées. Dans notre étude les données sont globalement comparables à celles publiées actuellement par la majorité des auteurs. PMID:28292109

Analyse sérologique de la toxoplasmose pergravidique: évaluation des risques et perspectives du dépistage prénatal au centre hospitalier universitaire de Bobo Dioulasso au Burkina Faso

PubMed Central

Bamba, Sanata; Some, Der Adolphe; Chemla, Cathy; Geers, Régine; Guiguemde, Tinga Robert; Villena, Isabelle

2012-01-01

Introduction La présente étude rapporte les données sérologiques de 306 sérums collectés chez des parturientes au CHU de Bobo Dioulasso et analysés rétrospectivement au CHU de Reims en 2011. Le but était de déterminer le statut sérologique de ces parturientes et d'en déduire la conduite à tenir. Méthodes La recherche des IgG et des IgM anti toxoplasmiques était systématique. Les techniques d'agglutination haute sensibilisée et celle d'Immunocapture M ont servi à la recherche respective des anticorps spécifiques IgG et des IgM. Résultats Sur 306 sérums analysés, 95 (31%) avaient des IgG positifs et aucun n'avait des IgM. Deux cent onze (211) sérums (69%) des sérums n'avaient ni IgG, ni IgM. Conclusion Nos résultats montrent que 31% des femmes en dehors d'une immunodépression sous jacente, possèdent une immunité résiduelle vis à vis de Toxoplasma gondii et n'ont pas la nécessité d'avoir une surveillance sérologique pendant la grossesse. Cependant, 69% (211) des parturientes sont à risque d'une séroconversion, et devraient bénéficier de conseils hygiéno diététiques, associés à une surveillance sérologique durant la grossesse. Ces résultats montrent l'intérêt de mettre en place des mesures de prévention contre la toxoplasmose congénitale, étant l'une des affections materno - foetales les plus fréquentes par la mise en place d'un diagnostic prénatal de la toxoplasmose en routine dans notre hôpital. PMID:22937183

Telemetry as a new concept in long term monitoring of SIDS-risk infant.

PubMed

Aly, A F; Afchine, D; Esser, P; Joos, M; Niewerth, H J; Wiater, A; Meier, M; Padeken, D; Pericas, A; Schwartmann, D; Weber, T; Wendrix, V; Wirtz, M

2000-01-26

Sudden Infant Death Syndrome (SIDS) is the most frequent cause of infant death within the period of 2 to 12 months in western countries. It has been found that a suit similar to that worn by the astronauts during the execution of experiments on the Spacelab Mission D-2 is a very simple and useful means to carry the sensors required to monitor vital signs of babies at risk. A small baby-suit has been developed with the same technology used for the Spacelab Mission. The baby s suit is equipped with similar sensors to record thoracic and abdominal respiratory movements as its big -space travel brother-. This is a typical example of a successful technology transfer from medical aerospace activities into fields of daily clinical routine. In addition to the above described sensors, ECG-electrodes were integrated, as well as sensors to record vascular oxygen saturation and the corresponding pulse curve, and the baby s movements. All these vital signs are registered by a medical monitor, and permanently stored and automatically analysed online. In case of a life-threatening situation the system alerts simultaneously the personal at hospital and the parents at home. The requisite software algorithms have been developed by DLR in Cooperation with the pediatricians of the Pediatric Hospital in Köln-Porz, Cologne. When the system registers an alteration of the parameters above described -as a signal of a change in the baby s health condition- all vital signs are transfered in real-time to the supervising hospital via radio data transmission devices, mobile phone or a fixed network phone. The parents are also alerted by the device, and they can carry out the necessary reanimation procedures in case of an emergency. Parents will be trained in such actions when newborns must to be monitored. But nevertheless, they are guided and tele-assisted by an expert via telephone during the action. A clinical field trial, that will start in December 1999 at the Pediatric Hospital in K�

The importance of choice in the rollout of ARV-based prevention to user groups in Kenya and South Africa: a qualitative study.

PubMed

Mack, Natasha; Evens, Emily M; Tolley, Elizabeth E; Brelsford, Kate; Mackenzie, Caroline; Milford, Cecilia; Smit, Jennifer A; Kimani, Joshua

2014-01-01

Stakeholders continue to discuss the appropriateness of antiretroviral-based pre-exposure prophylaxis (PrEP) for HIV prevention among sub-Saharan African and other women. In particular, women need formulations they can adhere to given that effectiveness has been found to correlate with adherence. Evidence from family planning shows that contraceptive use, continuation and adherence may be increased by expanding choices. To explore the potential role of choice in women's use of HIV prevention methods, we conducted a secondary analysis of research with female sex workers (FSWs) and men and women in serodiscordant couples (SDCs) in Kenya, and adolescent and young women in South Africa. Our objective here is to present their interest in and preferences for PrEP formulations - pills, gel and injectable. In this qualitative study, in Kenya we conducted three focus groups with FSWs, and three with SDCs. In South Africa, we conducted two focus groups with adolescent girls, and two with young women. All focus groups were audio-recorded, transcribed and translated into English as needed. We structurally and thematically coded transcripts using a codebook and QSR NVivo 9.0; generated code reports; and conducted inductive thematic analysis to identify major trends and themes. All groups expressed strong interest in PrEP products. In Kenya, FSWs said the products might help them earn more money, because they would feel safer accepting more clients or having sex without condoms for a higher price. SDCs said the products might replace condoms and reanimate couples' sex lives. Most sex workers and SDCs preferred an injectable because it would last longer, required little intervention and was private. In South Africa, adolescent girls believed it would be possible to obtain the products more privately than condoms. Young women were excited about PrEP but concerned about interactions with alcohol and drug use, which often precede sex. Adolescents did not prefer a particular

Surface electromyographic mapping of the orbicularis oculi muscle for real-time blink detection.

PubMed

Frigerio, Alice; Cavallari, Paolo; Frigeni, Marta; Pedrocchi, Alessandra; Sarasola, Andrea; Ferrante, Simona

2014-01-01

Facial paralysis is a life-altering condition that significantly impairs function, appearance, and communication. Facial rehabilitation via closed-loop pacing represents a potential but as yet theoretical approach to reanimation. A first critical step toward closed-loop facial pacing in cases of unilateral paralysis is the detection of healthy movements to use as a trigger to prosthetically elicit automatic artificial movements on the contralateral side of the face. To test and to maximize the performance of an electromyography (EMG)-based blink detection system for applications in closed-loop facial pacing. Blinking was detected across the periocular region by means of multichannel surface EMG at an academic neuroengineering and medical robotics laboratory among 15 healthy volunteers. Real-time blink detection was accomplished by mapping the surface of the orbicularis oculi muscle on one side of the face with a multichannel surface EMG. The biosignal from each channel was independently processed; custom software registered a blink when an amplitude-based or slope-based suprathreshold activity was detected. The experiments were performed when participants were relaxed and during the production of particular orofacial movements. An F1 score metric was used to analyze software performance in detecting blinks. The maximal software performance was achieved when a blink was recorded from the superomedial orbit quadrant. At this recording location, the median F1 scores were 0.89 during spontaneous blinking, 0.82 when chewing gum, 0.80 when raising the eyebrows, and 0.70 when smiling. The overall performance of blink detection was significantly better at the superomedial quadrant (F1 score, 0.75) than at the traditionally used inferolateral quadrant (F1 score, 0.40) (P < .05). Electromyographic recording represents an accurate tool to detect spontaneous blinks as part of closed-loop facial pacing systems. The early detection of blink activity may allow real

[Penetrating injury of the lungs and multiple injuries of lower extremities caused by aircraft bombs splinters].

PubMed

Golubović, Zoran; Stanić, Vojkan; Trenkić, Srbobran; Stojiljković, Predrag; Stevanović, Goran; Lesić, Aleksandar; Golubović, Ivan; Milić, Dragan; Visnjić, Aleksandar; Najman, Stevo

2010-08-01

Injuries caused by aircraft bombs cause severe damages to the human body. They are characterized by massive destruction of injured tissues and organs, primary contamination by polymorph bacterial flora and modified reactivity of the body. Upon being wounded by aircraft bombs projectiles a victim simultaneously sustains severe damages of many organs and organ systems due to the fact that a large number of projectiles at the same time injure the chest, stomach, head and extremities. We presented a patient, 41 years of age, injured by aircraft bomb with hemo-pneumothorax and destruction of the bone and soft tissue structures of the foot, as well as the treatment result of such heavy injuries. After receiving thoracocentesis and short reanimation, the patient underwent surgical procedure. The team performed thoracotomy, primary treatment of the wound and atypical resection of the left lung. Thoracic drains were placed. The wounds on the lower leg and feet were treated primarily. Due to massive destruction of bone tissue of the right foot by cluster bomb splinters, and impossibility of reconstruction of the foot, guillotine amputation of the right lower leg was performed. Twelve days after the wounding caused by cluster bomb splinters, soft tissue of the left lower leg was covered by Tirsch free transplant and the defect in the area of the left foot was covered by dorsalis pedis flap. The transplant and flap were accepted and the donor sites were epithelized. Twenty-six days following the wounding reamputation was performed and amputation stump of the right lower leg was closed. The patient was given a lower leg prosthesis with which he could move. Upon being wounded by aircraft bomb splinters, the injured person sustains severe wounds of multiple organs and organ systems due to simultaneous injuries caused by a large number of projectiles. It is necessary to take care of the vital organs first because they directly threaten the life of the wounded patient. Despite

Ipsilateral EEG mu rhythm reflects the excitability of uncrossed pathways projecting to shoulder muscles.

PubMed

Hasegawa, Keita; Kasuga, Shoko; Takasaki, Kenichi; Mizuno, Katsuhiro; Liu, Meigen; Ushiba, Junichi

2017-08-25

contralateral hemisphere during finger pinching. We found that trapezius MEPs increased during motor imagery of shoulder elevations and correlated with ipsilateral ERD amplitudes. Ipsilateral ERD during execution and imagery of shoulder girdle elevations appears to reflect the excitability of uncrossed pathways projecting to the shoulder muscles. As such, ipsilateral ERD could be used for neurofeedback training of shoulder movement, aiming at reanimation of the i-CST.

INFRARED- BASED BLINK DETECTING GLASSES FOR FACIAL PACING: TOWARDS A BIONIC BLINK

PubMed Central

Frigerio, Alice; Hadlock, Tessa A; Murray, Elizabeth H; Heaton, James T

2015-01-01

IMPORTANCE Facial paralysis remains one of the most challenging conditions to effectively manage, often causing life-altering deficits in both function and appearance. Facial rehabilitation via pacing and robotic technology has great yet unmet potential. A critical first step towards reanimating symmetrical facial movement in cases of unilateral paralysis is the detection of healthy movement to use as a trigger for stimulated movement. OBJECTIVE To test a blink detection system that can be attached to standard eyeglasses and used as part of a closed-loop facial pacing system. DESIGN Standard safety glasses were equipped with an infrared (IR) emitter/detector pair oriented horizontally across the palpebral fissure, creating a monitored IR beam that became interrupted when the eyelids closed. SETTING Tertiary care Facial Nerve Center. PARTICIPANTS 24 healthy volunteers. MAIN OUTCOME MEASURE Video-quantified blinking was compared with both IR sensor signal magnitude and rate of change in healthy participants with their gaze in repose, while they shifted gaze from central to far peripheral positions, and during the production of particular facial expressions. RESULTS Blink detection based on signal magnitude achieved 100% sensitivity in forward gaze, but generated false-detections on downward gaze. Calculations of peak rate of signal change (first derivative) typically distinguished blinks from gaze-related lid movements. During forward gaze, 87% of detected blink events were true positives, 11% were false positives, and 2% false negatives. Of the 11% false positives, 6% were associated with partial eyelid closures. During gaze changes, false blink detection occurred 6.3% of the time during lateral eye movements, 10.4% during upward movements, 46.5% during downward movements, and 5.6% for movements from an upward or downward gaze back to the primary gaze. Facial expressions disrupted sensor output if they caused substantial squinting or shifted the glasses. CONCLUSION

Macroscopic in vivo imaging of facial nerve regeneration in Thy1-GFP rats.

PubMed

Placheta, Eva; Wood, Matthew D; Lafontaine, Christine; Frey, Manfred; Gordon, Tessa; Borschel, Gregory H

2015-01-01

number of experimental animals, as they were subsequently imaged at multiple time points. The Thy1-GFP rat model will help improve clinical outcomes of facial reanimation surgery through improving the knowledge of facial nerve regeneration after surgical procedures. NA.

Distribution of Yeast-Like Fungi at a University Hospital in Turkey

PubMed Central

Ece, Gulfem

2014-01-01

Background: The increased life span has led to application of more invasive procedures for diagnosis and treatment of particularly immunosuppressed individuals. This situation drew more attention to fungal infections due to existence of yeast-like fungi. Candida infections have increased due to transplant in patients, prolonged intensive care unit (ICU) stays, and invasive procedures. Recently, identification of yeast-like fungi as well as antifungal susceptibility test has been gaining more importance. Objectives: In our study, we aimed to evaluate the distribution of yeast-like fungi strains isolated from blood, urine, wound and respiratory specimens, which were sent from various departments of Izmir University School of Medicine University Hospital. Materials and Methods: The 262 yeast strains (of 13860 clinical specimens), isolated during 30.05.2012-20.05.2013, which were sent from various departments of Izmir University School of Medicine to Medical Microbiology Laboratory, were included in this study. Blood, wound, respiratory (sputum, tracheal secretion), and urine specimens were cultivated on blood agar and Sabouraud dextrose agar and incubated for 24-48 hours at 37°C. The isolates were cultivated on CHROMagar Candida and Cornmeal Tween 80 medium for identification. Besides, the automatized Vitek version 2.0 system was used for identification of the yeast strains as well as the antifungal susceptibility of blood culture strains. Results: A total of 262 strains, isolated from the Anesthesiology and Reanimation Unit, as well as from the departments of Hematology, Urology, Infectious Diseases, Gynecology and Obstetrics, and Ear Nose and Throat, were included in this study. The most common isolated yeast-like species was Candida albicans. C. parapsilosis was the most common yeast-like fungus isolated from blood cultures. All the blood culture strains were susceptible to amphotericin B, flucytosine, fluconazole and voriconazole. Conclusions: Candida strains

Comparison of different techniques for in microgravity-a simple mathematic estimation of cardiopulmonary resuscitation quality for space environment.

PubMed

Braunecker, S; Douglas, B; Hinkelbein, J

2015-07-01

Since astronauts are selected carefully, are usually young, and are intensively observed before and during training, relevant medical problems are rare. Nevertheless, there is a certain risk for a cardiac arrest in space requiring cardiopulmonary resuscitation (CPR). Up to now, there are 5 known techniques to perform CPR in microgravity. The aim of the present study was to analyze different techniques for CPR during microgravity about quality of CPR. To identify relevant publications on CPR quality in microgravity, a systematic analysis with defined searching criteria was performed in the PubMed database (http://www.pubmed.com). For analysis, the keywords ("reanimation" or "CPR" or "resuscitation") and ("space" or "microgravity" or "weightlessness") and the specific names of the techniques ("Standard-technique" or "Straddling-manoeuvre" or "Reverse-bear-hug-technique" or "Evetts-Russomano-technique" or "Hand-stand-technique") were used. To compare quality and effectiveness of different techniques, we used the compression product (CP), a mathematical estimation for cardiac output. Using the predefined keywords for literature search, 4 different publications were identified (parabolic flight or under simulated conditions on earth) dealing with CPR efforts in microgravity and giving specific numbers. No study was performed under real-space conditions. Regarding compression depth, the handstand (HS) technique as well as the reverse bear hug (RBH) technique met parameters of the guidelines for CPR in 1G environments best (HS ratio, 0.91 ± 0.07; RBH ratio, 0.82 ± 0.13). Concerning compression rate, 4 of 5 techniques reached the required compression rate (ratio: HS, 1.08 ± 0.11; Evetts-Russomano [ER], 1.01 ± 0.06; standard side straddle, 1.00 ± 0.03; and straddling maneuver, 1.03 ± 0.12). The RBH method did not meet the required criteria (0.89 ± 0.09). The HS method showed the highest cardiac output (69.3% above the required CP), followed by the ER technique (33

[Effect of hypertonic-hyperoncotic solution infusion on tissue perfusion during surgical treatment of the abdominal aorta].

PubMed

Soskić, Ljiljana; Davidović, Lazar; Milicić, Biljana; Kocica, Mladen; Kovacević, Natasa; Simić, Tijana

2007-10-01

Decreasing of arterial flow below the critical level leads to capillary endothelium edema and to further worsening of tissue perfusion. Hypertonic solution infusion provides mild and short plasma osmolality increasing, while colloidal solutions intensify that effect. The aim of this study was to investigate the effect of hypertonic-hyperoncotic solution (HH) on the organs perfusion during reconstructive surgical procedure on the abdominal aorta (AA). The study included 40 patients submitted to AA reconstruction due to aneurysm or Leriche's syndrome. A clamp was put transversally to the aorta, under the outlets of the renal arterias. According to the solution received when a clamp was on the aorta, the patients were divided into two groups containing 20 patients each: the tested group (A) which received 4 ml/kg of the solution (7.2% NaCl/10% dextran), and the control group (B) which received 0.9% NaCl. The study excluded the patients with the preoperative creatinine level more than 139 micromol/l, and ejection heart fraction less than 40%. The mixed venous blood oxygen saturation increased from 73.3+/-7.33 to 74.95+/-6.19% in the group A, while it decreased from 65.35+/-10.39 to 62.65+/-10.42% in the group B (p = 0.001). The quantity of the provided oxygen in the group A increased significantly from 684.44+/-244.34 to 1362.45+/-2351.01 ml/min, while it decreased from 668.2+/-382.12 to 651.7+/-313.98 ml/min in the group B (p = 0.016). Alveolo-arterial difference in oxygen decreased from 23.12+/-14.74 to 21.1+/-10 mmHg in the group A, while it increased from 23.79+/-15.22 to 26.33+/-13.78 mmHg in the group B (p = 0.05). Satisfactory perfusion of organs during the AA surgery is obtained by using both HH and an isotonic solution. Due to maintaining the optimal values of the minute heart volume, saturation of vein blood blended with oxygen, and al-veolo-arterial difference in oxygen, it is recommended to use HH solution for reanimation of patients in declamping shock.

Is the outcome at surgery different when flat epithelial atypia and lobular neoplasia are found in association at biopsy?

PubMed Central

Sanchez, Lilia Maria; Lalonde, Lucie; Trop, Isabelle; David, Julie; Mesurolle, Benoît

2017-01-01

Objective: To assess the impact on the final outcome at surgery of flat epithelial atypia (FEA) when found concomitantly with lobular neoplasia (LN) in biopsy specimens compared with pure biopsy-proven FEA. Methods: The approval from the institutional review board of the CHUM (Centre Hospitalier Universitaire de Montréal) was obtained. A retrospective review of our database between 2009 and 2013 identified 81 females (mean age 54 years, range 38–90 years) with 81 FEA biopsy-proven lesions. These were pure or associated with LN only in 59/81 (73%) and 22/81 (27%) cases, respectively. Overall, 57/81 (70%) patients underwent surgery and 24/81 (30%) patients underwent mammographic surveillance with a mean follow-up of 36 months. Results: FEA presented more often as microcalcifications in 68/81 (84%) patients and were mostly amorphous in 49/68 (72%). After excluding radio pathologically discordant cases, pure FEA proved to be malignant at surgery in 1/41 (2%; 95% confidence interval 0.06–12.9). There was no statistically significant difference in the upgrade to malignancy whether FEA lesions were pure or associated to LN at biopsy (p = 0.4245); however, when paired in biopsy specimens, these lesions were more frequently associated with atypical ductal hyperplasia (ADH) at surgery than with pure FEA (p = 0.012). Conclusion: Our results show a 2% upgrade rate to malignancy of pure FEA lesions. When FEA is found in association with LN at biopsy, surgical excision yields more frequently ADH than pure FEA thus warranting close surveillance or even surgical excision. Advances in knowledge: The association of LN with FEA at biopsy was more frequently associated with ADH at surgery than with pure FEA. If a biopsy-proven FEA lesion is deemed concordant with the imaging finding, when paired with LN at biopsy, careful surveillance or even surgical excision is suggested. PMID:28118035

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol

PubMed Central

Pluye, Pierre; Légaré, France; Haggerty, Jeannie; Gore, Genevieve C; Sherif, Reem El; Poitras, Marie-Ève; Beaulieu, Marie-Claude; Beaulieu, Marie-Dominique; Bush, Paula L; Couturier, Yves; Débarges, Béatrice; Gagnon, Justin; Giguère, Anik; Grad, Roland; Granikov, Vera; Goulet, Serge; Hudon, Catherine; Kremer, Bernardo; Kröger, Edeltraut; Kudrina, Irina; Lebouché, Bertrand; Loignon, Christine; Lussier, Marie-Thérèse; Martello, Cristiano; Nguyen, Quynh; Pratt, Rebekah; Rihoux, Benoit; Rosenberg, Ellen; Samson, Isabelle; Senn, Nicolas; Li Tang, David; Tsujimoto, Masashi; Vedel, Isabelle; Ventelou, Bruno; Wensing, Michel; Bigras, Magali

2017-01-01

Introduction Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). Methods and analysis This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs’ qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). Ethics and dissemination This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing

Health assessment of French university students and risk factors associated with mental health disorders

PubMed Central

Geghre, Nicolas; Darmon, David; Rampal, Marion; Brandone, Diane; Gozzo, Jean-Michel; Haas, Hervé; Rebouillat-Savy, Karine; Caci, Hervé; Avillach, Paul

2017-01-01

Objective The first year of university is a particularly stressful period and can impact academic performance and students’ health. The aim of this study was to evaluate the health and lifestyle of undergraduates and assess risk factors associated with psychiatric symptoms. Materials and methods Between September 2012 and June 2013, we included all undergraduate students who underwent compulsory a medical visit at the university medical service in Nice (France) during which they were screened for potential diseases during a diagnostic interview. Data were collected prospectively in the CALCIUM database (Consultations Assistés par Logiciel pour les Centres Inter-Universitaire de Médecine) and included information about the students’ lifestyle (living conditions, dietary behavior, physical activity, use of recreational drugs). The prevalence of psychiatric symptoms related to depression, anxiety and panic attacks was assessed and risk factors for these symptoms were analyzed using logistic regression. Results A total of 4,184 undergraduates were included. Prevalence for depression, anxiety and panic attacks were 12.6%, 7.6% and 1.0%, respectively. During the 30 days preceding the evaluation, 0.6% of the students regularly drank alcohol, 6.3% were frequent-to-heavy tobacco smokers, and 10.0% smoked marijuana. Dealing with financial difficulties and having learning disabilities were associated with psychiatric symptoms. Students who were dissatisfied with their living conditions and those with poor dietary behavior were at risk of depression. Being a woman and living alone were associated with anxiety. Students who screened positively for any psychiatric disorder assessed were at a higher risk of having another psychiatric disorder concomitantly. Conclusion The prevalence of psychiatric disorders in undergraduate students is low but the rate of students at risk of developing chronic disease is far from being negligible. Understanding predictors for these symptoms

Enquete sur les aspects toxicologiques de la phytotherapie utilisee par un herboriste à Fes, Maroc

PubMed Central

Zeggwagh, Ali Amine; Lahlou, Younes; Bousliman, Yassir

2013-01-01

Introduction Dans le but d'étudier l'aspect toxicologique des plantes médicinales utilisées en médecine traditionnelle, une étude ethnobotanique a été réalisée à la ville de Fès au centre du Maroc. Méthodes Ont été inclus dans l'étude tous les patients ayant bénéficié d'une prescription par l'herboriste de plantes à visée thérapeutique. La discussion de nos résultats s'est faite sur la base d'une revue de la littérature avec identification des principales plantes toxiques utilisées en phytothérapie au Maroc. L'approche bibliographique a permis de compléter les informations. Résultats L'âge moyen des patients traités par des plantes (38 femmes, 32 hommes) était de 35 ± 18 ans. L'enquête ethnobotanique à révélé que la majorité des plantes médicinales étaient utilisées contre les affections urinaires (21%), suivi des maladies de l'appareil digestif (19.6%) et des maladies rhumatologiques (18.2%). Le nombre de plantes prescrits par l'herboriste a été de 53 dont 5 sont potentiellement toxiques. L'identification taxonomique des plantes prescrites a recensé 30 familles dont les plus représentées sont les Lamiaceae (23.33%), les Apiaceae (13,33%) et les Asteraceae (10%). La prescription des plantes considérées comme toxiques a concerné 7,1% des consultants traités par les plantes médicinales. Aucune complication inhérente aux plantes prescrites n'a été déplorée. Conclusion Malgré les résultats encourageants de notre enquête sur le compte de la phytothérapie, la pratique de la phytothérapie est laissée à la vulgarisation et à l'oubli scientifique, législatif et universitaire. PMID:23734270

Targeting bed nucleus of the stria terminalis for severe obsessive-compulsive disorder: more unexpected lead placement in obsessive-compulsive disorder than in surgery for movement disorders.

PubMed

Nuttin, Bart; Gielen, Frans; van Kuyck, Kris; Wu, Hemmings; Luyten, Laura; Welkenhuysen, Marleen; Brionne, Thomas C; Gabriëls, Loes

2013-01-01

In preparation for a multicenter study, a protocol was written on how to perform surgical targeting of the bed nucleus of the stria terminalis, based on the lead implantation experience in patients with treatment-refractory obsessive-compulsive disorder (OCD) at the Universitaire Ziekenhuizen Leuven (UZ Leuven). When analyzing the postoperative images, we were struck by the fact that the difference between the postoperative position of the leads and the planned position seemed larger than expected. The precision of targeting in four patients with severe OCD who received bilateral model 3391 leads (Medtronic) was compared with the precision of targeting in the last seven patients who underwent surgery at UZ Leuven for movement disorders (four with Parkinson disease and three with essential tremor; all received bilateral leads). Because the leads implanted in six of the seven patients with movement disorders were model 3387 leads (Medtronic), targeting precision was also analyzed in four patients with OCD in whom model 3387 leads were implanted in the same target as the other patients with OCD. In the patients with OCD, every implanted lead deviated at least 1.3 mm from its intended position in at least one of three directions (lateral, anteroposterior, and depth), whereas in the patients with movement disorders, the maximal deviation of any of all implanted leads was 1.3 mm. The deviations in lead placement were comparable in patients with OCD who received a model 3387 implant and patients who received a model 3391 implant. In the patients with OCD, all leads were implanted more posteriorly than planned. The cause of the posterior deviation could not be determined with certainty. The most likely cause was an increased mechanical resistance of the brain tissue along the trajectory when following the targeting protocol compared with the trajectories classically used for subthalamic nucleus or ventral intermediate nucleus of the thalamus stimulation. Copyright © 2013

Electroencephalography Predicts Poor and Good Outcomes After Cardiac Arrest: A Two-Center Study.

PubMed

Rossetti, Andrea O; Tovar Quiroga, Diego F; Juan, Elsa; Novy, Jan; White, Roger D; Ben-Hamouda, Nawfel; Britton, Jeffrey W; Oddo, Mauro; Rabinstein, Alejandro A

2017-07-01

The prognostic role of electroencephalography during and after targeted temperature management in postcardiac arrest patients, relatively to other predictors, is incompletely known. We assessed performances of electroencephalography during and after targeted temperature management toward good and poor outcomes, along with other recognized predictors. Cohort study (April 2009 to March 2016). Two academic hospitals (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Mayo Clinic, Rochester, MN). Consecutive comatose adults admitted after cardiac arrest, identified through prospective registries. All patients were managed with targeted temperature management, receiving prespecified standardized clinical, neurophysiologic (particularly, electroencephalography during and after targeted temperature management), and biochemical evaluations. We assessed electroencephalography variables (reactivity, continuity, epileptiform features, and prespecified "benign" or "highly malignant" patterns based on the American Clinical Neurophysiology Society nomenclature) and other clinical, neurophysiologic (somatosensory-evoked potential), and biochemical prognosticators. Good outcome (Cerebral Performance Categories 1 and 2) and mortality predictions at 3 months were calculated. Among 357 patients, early electroencephalography reactivity and continuity and flexor or better motor reaction had greater than 70% positive predictive value for good outcome; reactivity (80.4%; 95% CI, 75.9-84.4%) and motor response (80.1%; 95% CI, 75.6-84.1%) had highest accuracy. Early benign electroencephalography heralded good outcome in 86.2% (95% CI, 79.8-91.1%). False positive rates for mortality were less than 5% for epileptiform or nonreactive early electroencephalography, nonreactive late electroencephalography, absent somatosensory-evoked potential, absent pupillary or corneal reflexes, presence of myoclonus, and neuron-specific enolase greater than 75 µg/L; accuracy was highest for

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol.

PubMed

Bujold, Mathieu; Pluye, Pierre; Légaré, France; Haggerty, Jeannie; Gore, Genevieve C; Sherif, Reem El; Poitras, Marie-Eve; Beaulieu, Marie-Claude; Beaulieu, Marie-Dominique; Bush, Paula L; Couturier, Yves; Débarges, Beatrice; Gagnon, Justin; Giguère, Anik; Grad, Roland; Granikov, Vera; Goulet, Serge; Hudon, Catherine; Kremer, Bernardo; Kröger, Edeltraut; Kudrina, Irina; Lebouché, Bertrand; Loignon, Christine; Lussier, Marie-Therese; Martello, Cristiano; Nguyen, Quynh; Pratt, Rebekah; Rihoux, Benoit; Rosenberg, Ellen; Samson, Isabelle; Senn, Nicolas; Li Tang, David; Tsujimoto, Masashi; Vedel, Isabelle; Ventelou, Bruno; Wensing, Michel

2017-11-12

Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt

L’expression verbale de la douleur chez l’enfant : Comparaison intermodale entre sensation de douleur et manipulation tactile

PubMed Central

Bienvenu, Margaux; Jacquet, Denis; Michelutti, Marjolaine; Wood, Chantal

2011-01-01

HISTORIQUE: La présente étude se situe dans le contexte de l’expression verbale de la douleur chez l’enfant. Elle porte plus particulièrement sur la dimension qualitative de la sensation de douleur. OBJECTIF: Nous cherchons à repérer les particularités de l’expression verbale relativement à l’aspect qualitatif de la douleur. MÉTHODOLOGIE: La recherche a été menée auprès de 60 patients de quatre à 18 ans ressentant de la douleur, rencontrés dans un hôpital universitaire pédiatrique. Elle confirme en premier lieu l’origine des descripteurs sensoriels de la douleur, qui renvoient aux expériences perceptives passées de l’enfant, non nécessairement liées à la douleur. Ces expériences sont qualifiées de prototypiques, dans la mesure où, bien qu’elles soient liées à des contextes de vie variés, le type de rapport au monde qu’elles provoquent ne varie pas. RÉSULTATS: Dans ce cadre, le pincement, le tiraillement, le tapement, l’écrasement et l’appuiement, le picotement et le serrement constituent chacune des expériences sensorielles et motrices particulières dont la structure de base ne varie pas d’un contexte à l’autre. En second lieu, les résultats obtenus montrent que dès quatre ans, l’enfant est en mesure de comparer, puis de reconnaître une analogie entre une expérience exclusivement tactile et sa sensation de douleur. CONCLUSION: Ces résultats mettent en lumière le rôle primordial du raisonnement analogique dans l’expression verbale de la douleur, ce qui amène à affirmer que le niveau de développement cognitif de l’enfant n’est pas une variable a priori déterminante lorsqu’il s’agit de qualifier sa douleur. PMID:21766069

[Epidemiological and clinical characteristics of dissociative disorders and somatoform disorders in Burkina Faso].

PubMed

Karfo, K; Barro, Y; Ouédraogo, A

2012-02-01

The aim of this study was to determine the epidemiological and clinical features of dissociative and somatoform disorders in the psychiatry department of the Centre Hospitalier Universitaire Yalgado Ouédraogo, in Burkina Faso. We carried out a retrospective and descriptive study over five years, from January 2003 to December 2007, of patients admitted in the psychiatric department for dissociative and somatoform disorders. The data were extracted from the medical notes and registers of consultation. After identification of the patients, the medical notes were exploited with a structured collect form for data on sociodemographic characteristics, life events and ICD-10 diagnoses. All the data were recorded by the same person. Data analysis was performed with Epi info 2007. During a period of 5 years, 3967 patients were registered, 179 had the diagnosis of dissociative and somatoform disorders (3.65% of the admissions) and 145 were included in our study. The majority of the patients were followed as outpatients (71%). Women were more represented with a sex ratio of four women to one man. The majority of the patients were young with an average age of 30 and mostly single (57.9%). The majority of the patients had a low academic standard, in connection with young age of the population. A striking biographic event was found in the majority of the cases; essentially family difficulties and death. Neurological symptoms were the most frequent in 63% of the cases. According to ICD-1O, dissociative disorders were most frequent (65.6%). Depression was mainly associated in15 cases. Dissociative disorders and somatoform disorders are frequent in our hospital; we must overcome the difficulties due to the complexity of the diagnosis and the cultural resistances to modern health care to determine the real prevalence of these disorders among the population in Burkina Faso. Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Prise de suppléments multivitaminiques pour la prévention primaire des anomalies congénitalies

PubMed Central

Morin, Pascale; Demers, Karine; Giguère, Christine; Tribble, Denise St-Cyr; Lane, Julie

2007-01-01

RÉSUMÉ OBJECTIF Déterminer si les recommandations véhiculées par les professionnels de la santé sur l’importance de l’acide folique encouragent les femmes susceptibles de procréer de prendre les suppléments d’acide folique. CONCEPTION Enquête. CONTEXTE Centre de santé et de services sociaux, Institut universitaire de gériatrie de Sherbrooke, à Sherbrooke, Qué. PARTICIPANTS 323 femmes francophones âgées entre 18 et 45 ans. PRINCIPALES MESURES DES RÉSULTATS La consommation de suppléments de vitamines et de minéraux au cours de la dernière année. Des analyses statistiques descriptives et bivariées et une modélisation par régression logistique ont été effectuées pour déterminer si l’association observée entre la recommandation d’un professionnel de la santé et la consommation de vitamines et de minéraux persistait après avoir tenu compte de l’effet des variables de contrôle (consultation de documentation, connaissances, sources d’information, perception, âge, scolarité, revenu, état matrimonial, intention de devenir enceinte). RÉSULTATS Environ 41% des femmes rapportent que leur médecin leur avait recommandé de consommer un supplément de vitamines et de minéraux. Après avoir ajusté toutes les variables dans le modèle, il est apparu que le fait de se faire recommander par un professionnel de la santé de prendre un supplément de vitamines et de minéraux était significativement associé à la consommation de vitamines et de minéraux par les femmes susceptibles de devenir enceintes. CONCLUSION Les professionnels peuvent améliorer la santé de la population par une pratique clinique préventive. Nous soulignons l’importance de soutenir ces derniers dans leurs efforts d’intégrer puis d’appliquer des connaissances scientifiques dans leur pratique. PMID:18077754

Prévalence et caractéristiques de l'automédication chez les étudiants de 18 à 35 ans résidant au Campus de la Kasapa de l'Université de Lubumbashi

PubMed Central

Chiribagula, Valentin Bashige; Mboni, Henry Manya; Amuri, Salvius Bakari; kamulete, Grégoire Sangwa; Byanga, Joh Kahumba; Duez, Pierre; Simbi, Jean Baptiste Lumbu

2015-01-01

Introduction L'automédication est devenue un phénomène émergeant et menaçant de plus en plus la santé publique. La présente étude objective de déterminer la prévalence et les caractéristiques dans le campus Universitaire Kasapa de l'Université de Lubumbashi. Méthodes L'interview indirecte a servi à la collecte des données qui ont été traitées par le logiciel Graphpad version 5. Résultats De 515 étudiants consultés, l'automédication présente une prévalence de 99%, une partie des sujets l'ayant débutée à l'adolescence (35%). Des répondants, 78,8% reconnaissent que l'automédication peut conduire à un échec thérapeutique et que des erreurs de dose, un traitement inadapté, des effets secondaires et des erreurs diagnostiques sont plausibles. Cette pratique est acceptée pour autant qu'elle permette de prendre en charge des maladies ou symptômes présumés bénins et connus avec pour avantages, discrétion et économie de temps et d'argent. La malaria (82,4%), la fièvre (65,5%), les maux de tête (65,5%) en constituent les trois premières causes. L'amoxicilline (98,2%), le paracétamol (97,5%), l'acide ascorbique (91,6%) et la quinine (79,4%) sont les quatre premiers médicaments les plus consommés. L'association la plus utilisée est paracétamol’ vitamine(s) (88,8%) et la plus aberrante amoxycilline -Erytromycine (25,5%). Le comprimé (37%) constitue la forme la plus utilisée. La plupart des sujets (84,9%), recourent aux plantes médicinales. Conclusion Dans ce milieu, il existe une forte prévalence de l'automédication largement dans un but antipalustre avec quelques abus. PMID:26327945

[Not Available].

PubMed

Chafiki, N; Fassi Fihri, J; Boukind, E H

2007-03-31

Il s'agit d'une étude épidémiologique des séquelles de brûlures à propos de 100 cas colligés au service de chirurgie réparatrice et de brûlés du centre hospitalier universitaire Ibn Rochd (Casablanca). Les adultes représentent 55% de la population étudiée, l'âge moyen global est de 20 ans. Le sexe féminin est le plus touché avec 61% des cas. Les brûlures survenues à domicile sont les plus fréquentes avec 80%. L'agent causal le plus incriminé est la petite bouteille de butane avec 44,4%. Plus de la moitié de la population brûlée (55%) sont accueillis initialement au niveau d'hôpitaux régionaux. Le délai de cicatrisation moyen de 7 mois et 11 jours et par conséquent les séquelles mineures (dyschromie dans 90% des cas et prurit dans 49% des cas) et majeures (rétractions dans 86% et l'hypertrophie dans 51%) sont fréquentes. La répartition globale des séquelles montre une prédominance du segment cervicocéphalique avec 89% des cas et des membres supérieurs dans 82% des cas. Les différents aspects anatomocliniques essentiels ont été décrits au niveau de chaque segment corporel. Nos résultats ont été comparés aux données de la littérature, ce qui nous amène à considérer qu'une large campagne de prévention couplée à une meilleure prise en charge initiale, précoce, bien conduite et multidisciplinaire permet non seulement de réduire le nombre de séquelles mais aussi de diminuer leur sévérité.

Tumeurs sub-mandibulaires: profils épidémiologiques et histologiques

PubMed Central

Essobozou, Pegbessou Plaodezina; Malick, Ndiaye; Evelyne, Diom; Amadou, Thiam; Sanou, Diouf Mame; Djafarou, Boube; Cire, Ndiaye; Abdourhamane, Tall; Karim, Diallo Bay; Cheikh, Ndiaye Issa; Raymond, Diouf; Malick, Diop

2014-01-01

Introduction Il s'agit de déterminer les profils épidémiologiques et histologiques des tumeurs submandibulaires. Méthodes Il s'agissait d'une étude rétrospective et descriptive de 10 ans (1er janvier 2000 au 31 décembre 2009), réalisée dans le service universitaire d'ORL de l'hôpital de Fann. Etaient inclus dans cette étude tous patients porteurs d'une tumeur submandibulaire (opéré ou non), confirmée par un document histologique. Résultats Vingt-une tumeurs submandibulaires ont été colligées. L’âge moyen des patients était de 34,42 ans (± 14,10), avec des extrêmes de 2 et 55 ans. Quinze patients (71,4%) étaient de sexe féminin, soit un sex-ratio de 0,4. Les résultats histologiques étaient obtenus à partir de 4 biopsies et de 17 pièces opératoires. Dans 13 cas (61,9%) la tumeur était bénigne et dans 8 cas (38,1%) la tumeur était maligne. L'adénome pléomorphe dans 12 cas (57,1%), le carcinome épidermoïde dans 4 cas (19%) et l'adénocarcinome dans 2 cas (9,5%) étaient les types histologiques fréquents. Treize (13) patients étaient porteurs d'une tumeur bénigne, dont huit (8) patients étaient de sexe féminin. Huit (8) patients étaient porteurs d'une tumeur maligne. Sept patients étaient de sexe féminin. Conclusion Cette étude sur les tumeurs submandibulaires est marquée par une prédominance féminine et une fréquence élevée des adénomes pléomorphes et des carcinomes épidermoïdes. PMID:25400831

Apport de l'imagerie dans le diagnostic des sacroiliites infectieuses : à propos de 19 cas

PubMed Central

Abid, Hanen; Chaabouni, Salim; Frikha, Faten; Toumi, Nozha; Souissi, Basma; Lahiani, Dorra; Bahloul, Zouhir; Ben Mahfoudh, Khaireddine

2014-01-01

Les sacro-iliites infectieuses méritent d’être mieux connues. Leur diagnostic est souvent retardé en raison d'une symptomatologie trompeuse et des diffcultés d'exploration de l'articulation sacro-iliaque. Notre travail est basé sur une étude rétrospective portant sur les cas de SII, recueillis sur une période comprise entre 1997 et 2008 dans notre centre universitaire Sfax-Tunisie. Le diagnostic de sacro-iliite était retenu en présence d'arguments cliniques et radiologiques d'atteinte sacroiliaque. Nous rapportons dix neuf cas de sacroiliites infectieuses (10 hommes et 9 femmes), avec un âge moyen de 32 ans. L'atteinte était unilatérale dans tous les cas. Les radiographies standard faites dans tous les cas ont été suggestives dans 14 cas et normales dans les autres cas. La TDM faite dans 13 cas a montré, un abcès des parties molles dans 8 cas et un séquestre osseux dans 2 cas. L'IRM réalisée dans 8 cas, a objectivé une infiltration des parties molles dans tous les cas et un abcès dans 3 cas. Le germe a été identifié dans 9 cas (3 cas de tuberculose, 3 cas de brucellose, 2 sacro-iliites à pyogène et un cas de candidose). Cette identification était faite par biopsie dans 3 cas, hémocultures dans 2 cas, prélèvement au niveau de la porte d'entrée dans 1 cas et sérodiagnostic dans 3 cas. Pour les autres cas, l'origine pyogène a été retenue sur des arguments cliniques et biologiques. L'imagerie joue un rôle primordial dans le diagnostic précoce et l'orientation étiologique d'une sacroiliite infectieuse. PMID:25120884

Recherche universitaire et priorites nationales: l'effet du financement public sur la recherche energie solaire au Canada (University Research and National Priorities: The Effect of Public Financing on Solar Energy Research in Canada).

ERIC Educational Resources Information Center

Dalpe, Robert; Gingras, Yves

1990-01-01

The role of two main sources of university research financing in solar energy is examined to assess whether they oriented research in the direction of government programs. The strongest relationship appears to be in journal publication patterns. This scientific community has acquired the capacity to tap varying sources. (Author/MSE)

Cardiopathies congénitales: aspects épidémiologiques et échocardiographies à propos de 109 cas au centre hospitalier universitaire pédiatrique Charles de Gaulle (CHUP-CDG) de Ouagadougou, Burkina Faso

PubMed Central

Kinda, Georges; Millogo, Georges Rosario Christian; Koueta, Fla; Dao, Lassina; Talbousouma, Sollimy; Cissé, Hassane; Djiguimdé, Aristide; Yé, Diarra; Sorgho, Claudine Lougue

2015-01-01

Notre travail avait pour objectif d’étudier les aspects épidémiologiques et écho-cardiographiques des cardiopathies congénitales au CHUP-CDG afin d'y faire l’état des lieux. Pour se faire, nous avons mené sur une période de 27 mois d'aout 2009 à mai 2010 et d'octobre 2011 à décembre 2011, une étude rétrospective des comptes rendus d’échocardiographies Doppler des patients admis dans le service d'imagerie médicale. Nous avons utilisé une sonde cardiaque de 5MHz sur appareil Aloka Prosound 4000 Plus. Durant la période d’étude, 380 examens écho-cardiographiques ont été réalisés et ont permis de mettre en évidence 109 cas de cardiopathies congénitales avec 138 entités nosologiques différentes. Les cardiopathies congénitales représentaient 0,98% des 11169 entrées. Les souffles étaient au premier rang des motifs de demande de l’échographie Doppler cardiaque (121 cas sur 380) soit 39,53%. Les CIV étaient au premier plan des cardiopathies congénitales (28,26%), suivies des CIA (23,19%), des sténoses pulmonaires (19,57%), des Tétralogie de Fallot (9,42%). Dans leur forme isolée, les CIA étaient les plus fréquentes avec 21,95% des cas, suivies des CIV avec 20,73%. Sur 138 cas de cardiopathies congénitales (chez 109 enfants), 53 cas ont été observés chez des enfants de sexe féminin et 56 cas chez des enfants de sexe masculin soit un sexe ration de 1,1. La tranche d’âge présentant une fréquence élevée de cardiopathie congénitale est celle de 1mois- 30 mois avec 55% des cas. Les cardiopathies congénitales de l'enfant sont une réalité en Afrique, leurs fréquences dans toutes les séries rapportées sont certainement sous estimées en raison de l'inaccessibilité de l’échocardiographie doppler. PMID:26090039

History of the treatment of scapula fractures.

PubMed

Bartonícek, Jan; Cronier, Patrick

2010-01-01

The history of treatment of scapula fractures is closely connected with the history of the French surgery. Paré (Les œuvres d´Ambroise Paré, conseiller, et premier chirurgien du Roy, Gabriel Buon, Paris, p VCV, 1579), Petit (Traité des maladies des os. Tome second, Charles-Etienne Hochereau, Paris, pp 122–138, 1723), Du Verney (Traité des maladies des os. Tome I, de Burre, Paris, pp 220–231, 1751) and Desault (Œuvres chirurgicales, ou tableau de la doctrine et de la pratique dans le traitement des maladies externes par Xav. Bichat, Desault, Méquignon, Devilliers, Deroi, Paris, pp 98–106, 1798) were the first to point out the existence of these fractures. The first drawing of a scapula fracture was presented by Vogt (Dissertatio de ambarum scapularum dextroeque simul claviculae fractura rara, Dissertatione Universitae Vitembergensi, Wittenberg, 1799). This author was also the first to describe the scapula fracture associated with ipsilateral fracture of the clavicle. The first radiograph of scapula fracture (glenoid fossa fracture) was published by Struthers (Edinburgh Med J 4(3):147–149, 1910). The first internal fixation of scapula fracture using plate was done by Lambotte (1910) who was followed by Lane (The operative treatment of fractures, Medical Publishing Co, London, pp 99–101, 1914) and later by Lenormant (Sur l´ostéosynthèse dans certains fractures de l´omoplate Bulletins et mémoires de la Société de chirgie de Paris, pp 1501–1502, 1923), Dujarier (Fracture du col chirgical de l´omoplate. Ostéosynthèse par plaque en T. Bonne réduction. Bulletin et mémoires de la Société de chirurgie de Paris, pp 1492–1493, 1923) and Basset (Ostéosynthèse d´une fracture de l´omoplate. Bulletin et mémoires de la Société nationale de chirurgie. p 193, 1924). Dupont and Evrard (J Chir (Paris) 39:528–534, 1932) presented the first detailed description of the surgical approach along the lateral border of the scapula including two

Le conflit fémoro-acétabulaire et la coxarthrose

PubMed Central

Zhang, Charlie; Li, Linda; Forster, Bruce B.; Kopec, Jacek A.; Ratzlaff, Charles; Halai, Lalji; Cibere, Jolanda; Esdaile, John M.

2015-01-01

Objectif Expliquer la présentation clinique, les observations à l’examen physique, les critères diagnostiques et les options de prise en charge du conflit fémoroacétabulaire (CFA). Sources des données Une recherche documentaire a été effectuée dans PubMed pour trouver des articles pertinents sur la pathogenèse, le diagnostic, le traitement et le pronostic du CFA. Message principal Depuis les dernières années, on reconnaît de plus en plus que le CFA est un précurseur potentiel et une étiologie importante des douleurs à la hanche dans la population adulte et de la coxarthrose idiopathique plus tard dans la vie. Le conflit fémoro-acétabulaire désigne un ensemble d’anomalies morphologiques osseuses de l’articulation de la hanche qui se traduit par un contact anormal durant le mouvement. Le CFA par effet came concerne une proéminence osseuse non sphérique du col fémoral proximal ou de la jonction tête-col. Le CFM par effet tenaille désigne une couverture acétabulaire excessive par-dessus la tête du fémur, qui peut se produire en raison de diverses variantes morphologiques. Les patients qui ont un CFA présentent une douleur inguinale antérieure chronique, profonde ou lancinante, le plus souvent en position assise, durant ou après une activité. Les patients peuvent aussi ressentir des douleurs occasionnelles aiguës durant l’activité. Il faut procéder à une anamnèse approfondie portant notamment sur l’incidence de traumatismes ou la fréquence de l’exercice. Il faut aussi faire un examen physique complet des hanches, de la région lombaire et de l’abdomen pour évaluer d’autres causes de douleurs inguinales antérieures. Le diagnostic de CFA est confirmé par radiographie. Le conflit fémoro-acétabulaire peut être pris en charge selon une approche conservatrice comportant du repos, la modification des activités, des médicaments et de la physiothérapie ou encore être traité par intervention chirurgicale. Conclusion

Particularités de la cardiomyopathie du péripartum en Afrique: le cas du Togo sur une étude prospective de 41 cas au Centre Hospitalier et Universitaire Sylvanus Olympio de Lomé

PubMed Central

Pio, Machihude; Afassinou, Yaovi; Baragou, Soodougoua; Akue, Edem Goeh; Péssinaba, Souleymane; Atta, Borgatia; Ehlan, Koffi; Alate, Amouzou; Damorou, Findibe

2014-01-01

Introduction La cardiomyopathie du péripartum (CMPP) est une défaillance cardiaque dont l’étiologie demeure encore méconnue. Méthodes Il s'agit d'une étude prospective descriptive réalisée dans le service de cardiologie du CHU Sylvanus olympio de Lomé du 1er janvier 2010 au 30 avril 2012. Elle a concerné 41 patientes ayant présenté une insuffisance cardiaque entre le 8eme mois de la grossesse et les 5 premiers mois du post-partum. Résultats L’âge moyen des patientes était de 31,47 ans (extrêmes 21 et 44ans). L'incidence de la CMPP était de 1/362 grossesses. La parité moyenne était de 3,07 (extrêmes 1 et 6). Les symptômes étaient apparus dans le post-partum dans 90,24% des cas. Un retard important de diagnostic était observé. L'insuffisance cardiaque globale était le mode de décompensation dans 65,85%. Les signes électrocardiographiques étaient essentiellement la tachycardie sinusale (97,56%) et l'hypertrophie ventriculaire gauche (97,56%). L’échographie cardiaque a montré dans tous les cas une cardiomyopathie dilatée. Quatre cas de thrombus intraventriculaire gauche étaient notés. La FEVG était sévèrement altérée. L'HTAP était importante dans 56,09%. Conclusion La cardiomyopathie du péripartum est une complication cardiaque grave de la grossesse de cause inconnue, fréquente dans la population africaine. PMID:25309645

Think-Tank: The Present and Future of University Adult Education Programs in Quebec. Proceedings = Journee d'etude: le present et l'avenior des programmes universitaires en andragogie au Quebec. Rapport (Montreal, Quebec, April 26, 1988).

ERIC Educational Resources Information Center

Simon, Pierre; Heft, Riva

These proceedings, presented in English and French, summarize a seminar on the present and future of adult education programs in Quebec. Six Quebec universities were represented. The conference was opened by Dr. Pierre Simon, who introduced the theme and rationale of the day-long workshop. Dr. Charles Bertrand welcomed the participants,…

Paragangliome malin orbitaire, à propos d’un cas

PubMed Central

Andaloussi, Idriss Benatiya; Maaroufi, Mustapha; Benzagmout, Mohammed; Harmouch, Taoufiq; Abdellaoui, Meryem; Bhallil, Salima; Tizniti, Siham; Elfaiz, Mohammed Chaoui; Amarti, Afaf; Tahri, Hicham

2012-01-01

Les paragangliomes sont des tumeurs neuroendocrines développées aux dépens du système nerveux parasympathique. Ils peuvent se localiser n’ importe où dans l’organisme depuis la tète et cou jusqu’au pelvis. La localisation orbitaire de cette tumeur est très rare. Nous présentons le cas d’un patient âgé de 37 ans qui présente depuis 4 mois une exophtalmie unilatérale droite, d’installation progressive, sans douleur ni baisse de l’acuité visuelle associés. L’examen général montre une tuméfaction sous le cuire chevelu, sans adénopathies locorégionales ni hépato ou splénomégalie. La tomodensitométrie retrouve un processus tumoral occupant le cadran supéro-externe de l’orbite droite, mesurant 38 mm de grand axe, envahissant la paroi supérieure et externe de l’orbite avec une importante ostéolyse. Un body scan révèle alors une métastase pulmonaire. L’examen histopathologique complétés par l’immunohistochimie, réalisé après biopsie, révèle un marquage cytoplasmique par l’anticorps anti-chromogranin, l’anticorps anti-synaptophysine et un marquage des vaisseaux par l’anticorps anti-CD31 soulignant l’architecture en zellbalen des nids tumoraux. Cet aspect est en faveur d’un paragangliome malin. Une exérèse chirurgicale incomplète suivie d’une radiothérapie adjuvante, sont alors réalisés. L’origine exacte de cette tumeur au sein de l’orbite reste très controversée. L’exophtalmie reste le principal signe révélateur. La tomodensitométrie, l’imagerie par résonnance magnétique et la scintigraphie au Metaiodobenzylguanidine radioinonisée à l’iode (MIBG-I131) permettent d’orienter le diagnostic et faire un bilan d’extension de la tumeur. Le diagnostic de certitude repose sur l’histopathologie et l’immunohistochimie. L’excision totale de la lésion est le traitement de choix pour les lésions bien délimitées. Dans les formes plus étendues le traitement repose sur l�

L'ostéotomie de scarf dans le traitement de l'hallux valgus: à propos de 19 cas

PubMed Central

Boussakri, Hassan; Bachiri, Mohammed; Elidrissi, Mohammed; Shimi, Mohammed; Elibrahimi, Abdelhalim; Elmrini, Abdelmajid

2014-01-01

L'ostéotomie de Scarf constitue une technique chirurgicale bien décrite, grâce à ses résultats excellents, elle est considérée comme un traitement de choix de l'hallux valgus. Le but de ce travail est de décrire le profil épidémiologique et radio-clinique des hallux valgus, ainsi qu’évaluer les résultats radiologiques et fonctionnels des patients traités par la technique classique d'ostéotomie de Scarf. Nous avons mené une étude rétrospective, concernant 22 ostéotomies de Scarf chez 19 patients, opérés d'hallux valgus entre mai 2009 et janvier 2013. Le recul moyen était de 22,5 mois (3-42 mois). L'âge moyen des patients au moment de l'intervention était de 49 ans, avec des extrêmes de 19 et 75 ans. Tous les patients ont bénéficié d'une évaluation clinique et radiologique préopératoire et postopératoire ainsi qu'une analyse statistique. Au dernier recul, selon des critères subjectifs, nos résultats étaient très satisfaisants dans 42%, satisfaisants dans 52% et déçus dans 6%, et en fonction du score de l'AOFAS, les résultats étaient nettement améliorée avec un AOFAS préopératoire de 57% à 84% en postopératoire. Concernant les résultats radiologiques, la déformation métatarsophalangienne (angle M1P1) a été corrigée (43,63 °-12,8°) avec une p très significative (p <0,001). D'autre part une amélioration de l'Angle moyen M1M2, passer de 18,18° préopératoire à 12,95° au dernier recul, avec une correction significative (p <0,001). Le valgus épiphysaire de premier métatarsien (AADM) a été statistiquement amélioré (p <0,001), passer de 24,45° à 7,91°. Concernant les complications nous avons noté un cas de sepsis précoce superficiel géré par une antibiothérapie adaptée, deux cas de névrome et un cas d'ostéonécrose. Par contre on n'a pas noté aucune fracture per opératoire du premier métatarsien. Nous concluons que l'ostéotomie de Scarf est une technique reproductible fiable, en pleine �

Risk factors for pre-term birth in a Canadian cohort of HIV-positive women: role of ritonavir boosting?

PubMed Central

Kakkar, Fatima; Boucoiran, Isabelle; Lamarre, Valerie; Ducruet, Thierry; Amre, Devendra; Soudeyns, Hugo; Lapointe, Normand; Boucher, Marc

2015-01-01

Background The risk of pre-term birth (PTB) associated with the use of protease inhibitors (PIs) during pregnancy remains a subject of debate. Recent data suggest that ritonavir boosting of PIs may play a specific role in the initiation of PTB, through an effect on the maternal–fetal adrenal axis. The primary objective of this study is to compare the risk of PTB among women treated with boosted PI versus non-boosted PIs during pregnancy. Methods Between 1988 and 2011, 705 HIV-positive women were enrolled into the Centre Maternel et Infantile sur le SIDA mother–infant cohort at Centre Hospitalier Universitaire Sainte-Justine in Montreal, Canada. Inclusion criteria for the study were: 1) attendance at a minimum of two antenatal obstetric visits and 2) singleton live birth, at 24 weeks gestational or older. The association between PTB (defined as delivery at <37 weeks gestational age), antiretroviral drug exposure and maternal risk factors was assessed retrospectively using logistic regression. Results A total of 525 mother–infant pairs were included in the analysis. Among them, PI-based combination anti-retroviral therapy was used in 37.4%, boosted PI based in 24.4%, non-nucleoside reverse transcriptase inhibitor (NNRTI) or nucleoside reverse transcriptase inhibitor based in 28.1%, and no treatment was given in 10.0% of cases. Overall, 13.5% of women experienced PTB. Among women treated with antiretroviral therapy, the risk of PTB was significantly higher among women who received boosted versus non-boosted PI (OR 2.01, 95% CI 1.02–3.97). This remained significant after adjusting for maternal age, delivery CD4 count, hepatitis C co-infection, history of previous PTB, and parity (aOR 2.17, 95% CI 1.05–4.51). There was no increased risk of PTB with the use of unboosted PIs as compared to NNRTI- or NRTI-based regimens. Conclusion While previous studies on the association between PTB and PI use have generally considered all PIs the same, our results would

Aspects écho-cardiographiques au cours de la drépanocytose en Guadeloupe

PubMed Central

Ondze-Kafata, Louis Igor; Sanouiller, Alain; Hedreville, Mona; Hedreville, Segho; Larifla, Laurent

2014-01-01

Introduction L'atteinte cardiovasculaire représente le facteur pronostique majeur de la drépanocytose. Méthodes C’était une étude transversale et descriptive dans le service de cardiologie du centre hospitalier et universitaire de Pointe-à-Pitre. Résultats Nous avons inclus 82 patients, 23 hommes (28%) et 59 femmes (72%), âgés en moyenne de 40,0±12 ans. On avait 39 patients porteurs d'hémoglobinose SS (49,4%) et 40 porteurs d'hémoglobinose SC (50,6%). Le taux d'hémoglobine de base était en moyenne de 9,8±1,8 g/dl et celui de l'hémoglobine fœtale était en moyenne de 5,5±5,3 g/dl. La fraction de raccourcissement était de 36±4,9% en moyenne, la FeVG moyenne était de 65±5,9%. On avait 68 patients avec un profil mitral normal (82,9%) et 14 patients avec un profil pseudo normal (17,1%). On avait une dilatation ventriculaire gauche chez 26 patients (31,7%), ventriculaire droite chez 14 patients (17.1%), une dilatation auriculaire gauche chez 36 patients (43.9%), auriculaire droite chez 11 patients (13.4%). On avait une hypertrophie ventriculaire gauche chez 13 patients soit 15.9%. L'hypertension artérielle pulmonaire a été retrouvée chez 43 patients soit 52,4%. Après régression logistique, les facteurs suivants ont été associés à la présence d'une HTAP: âge (p=0,0024), le taux hémoglobine de base (p=0,032), le taux d'hémoglobine fœtale (p=0,011), le type SS (p=0,040), la dilatation de l'oreillette gauche (p=0,0012) et la dilatation de ventricule droit (p=0,047). Après comparaison, L'hémoglobinose SS s’était avérée plus sévère. Conclusion La drépanocytose est une pathologie sévère dont le pronostic est aggravé par l'atteinte cardiaque. PMID:25368734

Facteurs de risque de l'inobservance thérapeutique chez les patients schizophrènes: étude cas- témoins'

PubMed Central

Aarab, Chadya; Elghazouani, Fatima; Aalouane, Rachid; Rammouz, Ismail

2015-01-01

Les progrès réalisés dans le traitement de la schizophrénie n'ont jusqu'ici pas modifié de manière radicale l'importance de l'adhésion des patients à leur médication. L'objectif de ce travail est d'identifier les facteurs de risque de l'abandon du traitement sur un échantillon marocain de malades schizophrènes. C'est une étude transversale menée au centre psychiatrique universitaire de Fès sur une période de 4 mois. Les malades inclus présentaient une schizophrénie ou un trouble schizo-affectif, sélectionnés en deux groupes observant et non observant. L’évaluation de l'observance a été faite par un hétéro-questionnaire comprenant une liste de causes d'abandon du traitement avec des réponses par oui ou non et à l'aide de l’échelle MARS (Medication Adherence Rating Scale). Le traitement statistique des résultats a été réalisé par le logiciel Epi Info version 3.5.1. On a recruté 164 participants, 112 étaient des malades non observants à leur traitement (cas) et 52 patients bien observants (témoins). L’âge moyen est 31 ans, avec une prédominance masculine. Les facteurs de risque d'inobservance thérapeutique sont: l’âge jeune, le sexe masculin, le célibat, les troubles addictifs. Les principales raisons d'abandon du traitement sont le changement fréquent du médecin, le manque d'informations sur la maladie, un mauvais insight et les effets secondaires des antipsychotiques. Le groupe de schizophrènes non adhérents à leur traitement pharmacologique avait un score élevé à l’échelle MARS dans 80% cas. Ces résultats doivent être pris en considération par le personnel soignant pour optimiser l'observance thérapeutique chez les patients souffrant de schizophrénie. PMID:26161196

ShockOmics: multiscale approach to the identification of molecular biomarkers in acute heart failure induced by shock.

PubMed

Aletti, Federico; Conti, Costanza; Ferrario, Manuela; Ribas, Vicent; Bollen Pinto, Bernardo; Herpain, Antoine; Post, Emiel; Romay Medina, Eduardo; Barlassina, Cristina; de Oliveira, Eliandre; Pastorelli, Roberta; Tedeschi, Gabriella; Ristagno, Giuseppe; Taccone, Fabio S; Schmid-Schönbein, Geert W; Ferrer, Ricard; De Backer, Daniel; Bendjelid, Karim; Baselli, Giuseppe

2016-01-28

The ShockOmics study (ClinicalTrials.gov identifier NCT02141607) is a multicenter prospective observational trial aimed at identifying new biomarkers of acute heart failure in circulatory shock, by means of a multiscale analysis of blood samples and hemodynamic data from subjects with circulatory shock. Ninety septic shock and cardiogenic shock patients will be recruited in three intensive care units (ICU) (Hôpital Erasme, Université Libre de Bruxelles, Belgium; Hospital Universitari Mutua Terrassa, Spain; Hôpitaux Universitaires de Genève, Switzerland). Hemodynamic signals will be recorded every day for up to seven days from shock diagnosis (time T0). Clinical data and blood samples will be collected for analysis at: i) T1 < 16 h from T0; ii) T2 = 48 h after T0; iii) T3 = day 7 or before discharge or before discontinuation of therapy in case of fatal outcome; iv) T4 = day 100. The inclusion criteria are: shock, Sequential Organ Failure Assessment (SOFA) score > 5 and lactate levels ≥ 2 mmol/L. The exclusion criteria are: expected death within 24 h since ICU admission; > 4 units of red blood cells or >1 fresh frozen plasma transfused; active hematological malignancy; metastatic cancer; chronic immunodepression; pre-existing end stage renal disease requiring renal replacement therapy; recent cardiac surgery; Child-Pugh C cirrhosis; terminal illness. Enrollment will be preceded by the signature of the Informed Consent by the patient or his/her relatives and by the physician in charge. Three non-shock control groups will be included in the study: a) healthy blood donors (n = 5); b) septic patients (n = 10); c) acute myocardial infarction or patients with prolonged acute arrhythmia (n = 10). The hemodynamic data will be downloaded from the ICU monitors by means of dedicated software. The blood samples will be utilized for transcriptomics, proteomics and metabolomics ("-omics") analyses. ShockOmics will provide new insights into

Suivi prospectif sur 5 ans des tentatives de suicide en population clinique dans la région de Fès, Maroc

PubMed Central

Aarab, Chadya; Elghazouani, Fatima; Aalouane, Rachid; Rammouz, Ismail

2014-01-01

Au Maroc, les tentatives de suicide (TS) demeurent un sujet mal évalué à cause de considérations socioculturelles et l'absence d'approche longitudinale. L'objectif principal était d’évaluer le devenir des suicidants après 5ans au centre universitaire psychiatrique de Fès, les objectifs secondaires étaient l'estimation de la prévalence des TS, préciser les étiologies les plus fréquentes, et établir une corrélation entre les paramètres sociodémographiques, cliniques et évolutifs. Etude prospective à visée transversale et longitudinale, incluant les suicidants vus à l'hôpital psychiatrique de Fès, avec un suivi longitudinal sur 5ans. L’évaluation a été faite par un hétéro-questionnaire et le Mini International Neuropsychiatric Interview (MINI) cherchant le trouble psychiatrique sous jacent. On a recruté 105 patients suicidants, 62% des femmes, l’âge moyen est de 29,23ans. La prévalence des tentatives de suicide est de 3% sur l'ensemble des consultants à l’établissement. Les troubles de l'humeur, psychotiques et de personnalité ont occupé respectivement 37,6%, 27,7%, et 25,7% des cas. La récidive suicidaire a été notée chez 54% des patients, était significativement corrélée à la vie solitaire (P: 0,039) et à la présence d'antécédents familiaux de TS (P: 0,046). L'utilisation de moyens violents était significativement fréquente chez les patients psychotiques. Après 5ans, 32 patients ont répondu à notre appel. Le taux de récidive était de 15%. On a noté trois cas de décès dont deux suicides confirmés. Les résultats confirment les données de la littérature scientifique avec certaines particularités cliniques et évolutives. PMID:25478042

Prognostic Factors in Adult Soft Tissue Sarcoma Treated with Surgery Combined with Radiotherapy: A Retrospective Single-Center Study on 164 Patients

PubMed Central

Cai, Ling; Mirimanoff, René-Olivier; Mouhsine, Elyazid; Guillou, Louis; Leyvraz, Pierre-Francois; Leyvraz, Serge; Gay, Beatrice; Matzinger, Oscar; Ozsahin, Mahmut; Zouhair, Abderrahim

2013-01-01

The aim of the present study is to assess the disease profile, outcome and prognostic factors in patients treated with surgery combined with radiotherapy (RT), with or without chemotherapy (CXT), for soft-tissue sarcoma (STS) in a multidisciplinary setting. One hundred and sixty-four patients with STS treated between 1980 and 2010 at the Centre Hospitalier Universitaire Vaudois were enrolled in this retrospective study. Seventy-six percent of patients underwent postoperative RT with (24%), or without (52%) CXT, 15% preoperative RT with (5%), or without (10%) CXT, surgery alone (7%), or RT alone (2%) with or without CXT. The median follow-up was 60 months (range 6-292). Local failure was observed in 18%, and distant failure in 21% of the patients. Overall survival (OS), diseasefree survival (DFS), local control (LC) and distant metastases-free survival (DMFS) were 88%, 68%, 83%, and 79% at 5 years, and 80%, 56%, 76%, and 69% at 10 years, respectively. In univariate analyses, favorable prognostic factors for OS, DFS, and DMFS were tumor size 6 cm or less, World Health Organization (WHO)/Zubrod score 0, and stage 2 or less. Age and superficial tumors were favorable only for OS and DMFS respectively. STS involving the extremities had a better outcome regarding DFS and LC. Histological grade 2 or less was favorable for DFS, DMFS, and LC. Radical surgery was associated with better LC and DMFS. RT dose more than 60 Gy was favorable for OS, DFS, and LC. In multivariate analyses, independent factors were age for OS; tumor size for OS, DFS and DMFS; WHO/Zubrod score for OS, DFS and LC; hemoglobin level for DFS; site for DFS and LC; tumor depth for DMFS; histological grade for DFS and LC; surgical procedure for LC and DMFS; and RT dose for OS. This study confirms that in a multidisciplinary setting, STS have a fairly good prognosis. A number of prognostic and predictive factors, including the role of surgery combined with RT, were identified. Regarding RT, a dose of more than

Infections à méningocoque lors de purpura fébrile chez l’enfant dans un hôpital marocain: incidence et facteurs cliniques associés

PubMed Central

Gueddari, Widad; Sabri, Hayat; Chabah, Meryem

2017-01-01

Introduction Le purpura fébrile (PF) fait craindre une infection à méningocoque, et conduit presque toujours à la réalisation d’un bilan et au traitement par une antibiothérapie à large spectre. Notre objectif était de déterminer l’incidence des infections à méningocoque ainsi que les signes cliniques y associés chez les enfants hospitalisés aux urgences pour purpura fébrile. Méthodes Notre étude était descriptive, rétrospective, menée sur une période de 3 ans au service d’accueil des urgences Pédiatriques de l’Hôpital Universitaire d’Enfants de Casablanca. Les enfants inclus étaient ceux hospitalisés pour PF et qui avaient bénéficié d’une hémoculture, associée ou non à une ponction lombaire. Le logiciel SPSS v.16 a été utilisé pour l’analyse statistique. Résultats Nous avons inclus 96 enfants dont 49 garçons et 47 filles. La moyenne d’âge était de 53,3 ± 40,5 mois. La moyenne de la température corporelle était de 38,9°C. Une infection à méningocoque a été diagnostiquée chez 35/96 enfants. Une méningococcémie était retenue chez 22 enfants, associée à une méningite chez quatre. Les symptômes et signes physiques significativement associés à une infection à méningocoque étaient la léthargie (p = 0,04), les convulsions (p = 0,01) et la localisation du purpura en dehors du territoire cutané drainé par la veine cave supérieure (p = 0,01). Conclusion Un PF localisé en dehors du territoire cutané drainé par la veine cave supérieure ou associé à des convulsions est fortement associé à une infection à méningocoque dont l’incidence semble élevée chez l’enfant marocain. PMID:29515741

In Praise of Sociology.

PubMed

Connell, Raewyn

2017-08-01

This reflection on the relevance of sociology starts with the different forms of social knowledge, and some autobiographical reflection on my engagement with the discipline. A research-based social science is made urgent by the prevalence of distortion and pseudoscience in the public realm. However, the research-based knowledge formation is embedded in a global economy of knowledge that centers on a privileged group of institutions and produces major imbalances on a world scale. Sociological data collection has important uses in policy and public discussion. But data need to be embedded in a larger project of understanding the world; this is what gives excitement to the work. Sociology has a potential future of marginality or triviality in the neoliberal economy and its university system. There are better trajectories into the future-but they have to be fought for. Cette réflexion sur l'utilité de la sociologie commence avec les différentes formes de savoir social, ainsi que quelques réflexions biographiques sur mon engagement avec la discipline. Le besoin d'une science sociale orientée vers la recherche est devenue nécessaire suite à la prédominance de la distorsion et de la pseudoscience dans la sphère publique. Par contre, ce savoir centré sur la recherche est lié à une économie globale de la connaissance qui est proche d'un groupe privilégié d'institutions et produit des déséquilibres majeurs au niveau mondial. La collecte de données sociologiques a une grande utilité en politique et dans les discussions publiques. Mais ces données doivent être liées à un projet plus large de compréhension du monde ; c'est ce qui rend ce travail excitant. La sociologie risque la marginalisation ou la trivialité dans une économie néo-libérale et son système universitaire. Il existe de meilleures trajectoires pour l'avenir - mais elles doivent être défendues. © 2017 Canadian Sociological Association/La Société canadienne de sociologie.

Accuracy and generalizability of using automated methods for identifying adverse events from electronic health record data: a validation study protocol.

PubMed

Rochefort, Christian M; Buckeridge, David L; Tanguay, Andréanne; Biron, Alain; D'Aragon, Frédérick; Wang, Shengrui; Gallix, Benoit; Valiquette, Louis; Audet, Li-Anne; Lee, Todd C; Jayaraman, Dev; Petrucci, Bruno; Lefebvre, Patricia

2017-02-16

Adverse events (AEs) in acute care hospitals are frequent and associated with significant morbidity, mortality, and costs. Measuring AEs is necessary for quality improvement and benchmarking purposes, but current detection methods lack in accuracy, efficiency, and generalizability. The growing availability of electronic health records (EHR) and the development of natural language processing techniques for encoding narrative data offer an opportunity to develop potentially better methods. The purpose of this study is to determine the accuracy and generalizability of using automated methods for detecting three high-incidence and high-impact AEs from EHR data: a) hospital-acquired pneumonia, b) ventilator-associated event and, c) central line-associated bloodstream infection. This validation study will be conducted among medical, surgical and ICU patients admitted between 2013 and 2016 to the Centre hospitalier universitaire de Sherbrooke (CHUS) and the McGill University Health Centre (MUHC), which has both French and English sites. A random 60% sample of CHUS patients will be used for model development purposes (cohort 1, development set). Using a random sample of these patients, a reference standard assessment of their medical chart will be performed. Multivariate logistic regression and the area under the curve (AUC) will be employed to iteratively develop and optimize three automated AE detection models (i.e., one per AE of interest) using EHR data from the CHUS. These models will then be validated on a random sample of the remaining 40% of CHUS patients (cohort 1, internal validation set) using chart review to assess accuracy. The most accurate models developed and validated at the CHUS will then be applied to EHR data from a random sample of patients admitted to the MUHC French site (cohort 2) and English site (cohort 3)-a critical requirement given the use of narrative data -, and accuracy will be assessed using chart review. Generalizability will be determined

No personalization without participation: on the active contribution of psychiatric patients to the development of a mobile application for mental health.

PubMed

Pelletier, Jean-François; Rowe, Michael; François, Nathe; Bordeleau, Julie; Lupien, Sonia

2013-07-27

Despite the increasing pervasiveness of mobile computational technologies, knowledge about psychiatric patients' preferences regarding the design and utility of mobile applications is very poor. This paper reports on a pilot-study that involved 120 psychiatric patients in the development of a mobile application (app) that is being used for data entry into the Signature Project data bank at the Institut universitaire en santé mentale de Montréal (IUSMM), Canada. Participants were invited to comment on the 'look and feel' of the Signature App. Their input also extended the procedures for data collection. These suggestions may contribute to increased mental health literacy and empowerment of persons with mental illness receiving services at the IUSMM. Participants were recruited to fill out a questionnaire on a tablet computer while waiting at the Emergency Room (ER, n = 40), Psychotic Disorders outpatient clinic (n = 40) or Anxiety and Mood Disorders outpatient clinic (n = 40) of IUSMM. Nine patients from each of these sub-groups participated in a focus group to review the results and to discuss how the design and use of the Signature App could be improved to better meet the needs of patients. This study (n = 120) indicated that psychiatric patients are clearly capable of using a tablet computer to fill out questionnaires for quantitative data entry, and that they enjoyed this experience. Results from the focus groups (n = 27) highlight that the app could also be used by patients to communicate some personal and contextual qualitative information. This would support a holistic and person-centered approach, especially at the ER where people acutely need to describe their recent history and receive emotional support. This pilot-study has confirmed the necessity of involving patients not only in the testing of a new mobile application, but also as active contributors in the entire research and development process of a person-centered information and communication

Les séquelles de brûlures cervicocéphaliques chez l’enfant

PubMed Central

Sankale, A.A.; Ndiaye, A.; Ndoye, A.; Ndiaye, L.; Ndoye, M.

2011-01-01

Summary La peau, barrière protectrice de l’organisme, est très exposée aux agressions et donc aux brûlures. Le but de ce travail est d’apprécier les particularités des séquelles de brûlure cervicofaciales chez l’enfant en milieu sub-saharien et d’évaluer leur prise en charge. Il s’agit d’une étude rétrospective réalisée dans le service de Chirurgie Pédiatrique du Centre Hospitalo-universitaire Aristide Le Dantec de Dakar (Sénégal). Vingt-sept dossiers de patients ont été colligés entre mai 2001 et avril 2008. L’âge moyen lors de la consultation était de 6,7 ans et le sex ratio m:f de 1,7:1. La topographie des séquelles se répartit ainsi: la face (66,7%), le cou (29,6%) et le cuir chevelu (11,1%). Concernant le type de séquelles, les brides prédominaient (33,3%), suivies des cicatrices chéloïdiennes ou hypertrophiques (25,9%), des ectropions de paupières (18,5%), des alopécies du cuir chevelu (11,1%), des ulcérations chroniques (7,4%) et de dyschromie (3,7%). Le traitement a été chirurgical dans 55,7% des cas: plasties en Z suivies ou non d’une greffe de peau pour les brides et libération de bride suivie d’une greffe pour les ectropions de paupières. Pour ce qui concerne les patients opérés, la morbidité opératoire a été de 20% et la mortalité opératoire nulle. Les cicatrices chéloïdiennes ont fait l’objet d’un traitement médical par infiltrations de dermocorticoïdes. Au-delà de l’urgence, les brûlures cervicofaciales de l’enfant entraînent un préjudice esthétique et fonctionnel important. L’amélioration de leur pronostic passe par la qualité des premiers soins et par la sensibilisation des parents aux risques d’accidents domestiques. PMID:21991239

Cancer du sein bilatéral synchrone au Maroc: caractéristiques épidémiologiques et cliniques

PubMed Central

Boufettal, Houssine; Samouh, Naïma

2015-01-01

Préciser la fréquence, les facteurs de risque et le pronostic du cancer du sein bilatéral, à partir d'une étude rétrospective de 22 cas de cancer du sein bilatéral synchrone dans un pays du Maghreb. De 2002 à 2010, 625 patientes étaient prises en charge pour cancer du sein au service de Gynécologie-Obstétrique «C» du centre hospitalier universitaire de Casablanca. 22 cas de cancer bilatéral synchrone étaient diagnostiqués. Nos résultats sont comparés avec ceux de la littérature. La fréquence de la bilatéralité du cancer du sein synchrone était de 3,52% (22/625). L'intervalle de temps moyen entre les deux cancers est de 4 mois (0 à 6 mois). Les patientes âgées de moins de 40 ans lors du premier cancer avaient six fois plus de risque de développer un cancer au niveau du sein controlatéral que les femmes âgées de plus de 40 ans. Les patientes atteintes d'une tumeur T3 ou T4 avaient un risque neuf fois plus élevé que les autres. 90,9% (2/22) des cas des premiers cancers sont des adénocarcinomes infiltrants. Les types histologiques du premier et du douzième cancer étaient identiques dans 86,4% (19/22) des cas. Quant au pronostic, il dépend à la fois du stade du premier et du deuxième cancer et le traitement de ce dernier doit obéir aux mêmes règles du traitement du premier cancer. L'incidence du cancer bilatéral synchrone du sein est de 3,52% dans notre série. Le cancer du sein unilatéral constitue un facteur de risque de développement d'un cancer du sein controlatéral. Une surveillance à vie est nécessaire au cours d'un cancer du sein pour détecter un cancer controlatéral. PMID:26090066

A Feminist Intervention That Hurt Women: Biological Differences, Ergonomics, and Occupational Health: Une intervention féministe qui a nui aux femmes: différences biologiques, égalité, ergonomie et santé au travail.

PubMed

Messing, Karen

2017-11-01

The University of Québec in Montréal has agreements with trade unions providing access to university resources. Researchers involved in this program worked in partnership with union women's and health and safety committees for more than twenty years. Not all studies succeeded in improving women's working conditions. One joint project involved observational studies of tasks done by health-care workers, complemented by interviews and questionnaires. We found that task assignments, movements, postures, and work-related musculoskeletal disorders varied by gender/sex and made recommendations for change. However, issues of pay equity, spending on health care, and contracting-out of "ancillary work" were salient. Researchers learned that in the absence of changes in power relationships in the workplace, women may be disadvantaged by denial as well as by exaggeration of female-male differences. Men may also be at risk when their gender is invisible. We suggest some feminist approaches to workplace solutions and some pathways for research. Résumé L'Université du Québec à Montréal a signé avec des centrales syndicales des ententes leur donnant un accès à des ressources universitaires. Des chercheures ont travaillé en partenariat avec des comités syndicaux de condition des femmes et de santé-sécurité au travail pendant plus de 25 ans, mais ce ne sont pas toutes les études qui ont abouti à des améliorations. Un projet concernait des observations du travail d'employé.e.s du secteur de la santé, dont les tâches, mouvements, et postures variaient selon le genre/sexe. Nous avons recommandé des transformations, mais des enjeux d'équité salariale, de coûts et de sous-traitance y ont fait obstacle. Les chercheures ont appris qu'en l'absence de transformation des rapports de pouvoir au travail, le déni des différences hommes-femmes, autant que leur exagération, peut désavantager les travailleuses (et les travailleurs). Nous suggérons des approches f

In Situ Analysis of Mars Soil and Rocks Sample with the Sam Gcms Instrumentation Onboard Curiosity : Interpretation and Comparison of Measurements Done during the First Martian Year of Curiosity on Mars

NASA Astrophysics Data System (ADS)

Szopa, C.; Coll, P. J.; Cabane, M.; Buch, A.; Coscia, D.; Millan, M.; Francois, P.; Belmahadi, I.; Teinturier, S.; Navarro-Gonzalez, R.; Glavin, D. P.; Freissinet, C.; Steele, A.; Eigenbrode, J. L.; Mahaffy, P. R.

2014-12-01

), Science, [4] Ming D. et al. (2013), Science, 32, 64-67. Acknowledgements: SAM-GC team acknowledges support from the French Space Agency (CNES), French National Programme of Planetology (PNP), National French Council (CNRS), Pierre Simon Laplace Institute, Institut Universitaire de France (IUF) and ESEP Labex, and the great MSL team

In situ analysis of Mars soil sample with the sam gcms instrumentation onboard Curiosity : interpretation and comparison of measurements done at Rocknest and Yelloknife bay sites

NASA Astrophysics Data System (ADS)

Szopa, Cyril; Coll, Patrice; Cabane, Michel; Coscia, David; Buch, Arnaud; Francois, Pascaline; Millan, Maeva; Teinturier, Sammy; Navarro-Gonzales, Rafael; Glavin, Daniel; Freissinet, Caro; Steele, Andrew; Eigenbrode, Jen; Mahaffy, Paul

2014-05-01

-67. Acknowledgements: SAM-GC team acknowledges support from the French Space Agency (CNES), French National Programme of Planetology (PNP), National French Council (CNRS), Pierre Simon Laplace Institute, Institut Universitaire de France (IUF) and ESEP Labex.

Prévalence, facteurs associés et prédisposant au syndrome métabolique chez les personnes vivants avec le VIH sous traitement antirétroviral à Porto-Novo en 2014

PubMed Central

Adébayo, Alassani; Albert, Dovonou Comlan; Ericie, Sossou; Angelo, Attinsounon Cossi; Jules, Gninkoun; Armand, Wanvoegbe; Séraphin, Ahoui; Léopold, Codjo; Gabriel, Ade

2015-01-01

Introduction Le syndrome métabolique est associé aux maladies cardiovasculaires. L'infection au VIH est devenue aujourd'hui une maladie chronique. L'objectif de cette étude est de déterminer la prévalence, les facteurs associés et prédisposant au syndrome métabolique chez les patients infectés par le VIH sous traitement antirétroviral. Méthodes Il s'est agi d'une étude transversale, descriptive et analytique. La population d’étude est constituée des patients vivant avec le VIH sous antirétroviral suivis au Centre Hospitalier Universitaire de l'Ouémé-Plateau. Le syndrome métabolique a été défini selon les critères de la Fédération Internationale du Diabète. Résultats La population était constituée de 244 patients. La prévalence du syndrome métabolique était de 18,03% avec une prédominance féminine (74,6%). La moyenne d’âge était de 40,7 ± 9,71 ans. Les facteurs associés au syndrome métabolique étaient le sexe féminin, la sédentarité, l'antécédent d'HTA, le surpoids, l'apport énergétique élevé, l'apport lipidique élevé, la consommation d'alcool, la consommation de tabac et l'hypercholestérolémie. Les facteurs prédisposant au syndrome métabolique étaient la présence de l'HTA, le tour de taille élevé, l'hyperglycémie, l'hypocholestérolémie HDL et l'hypertriglycéridémie. Conclusion Le syndrome métabolique est fréquent chez les patients infectés par le VIH sous traitement antirétroviral. Une prévention prenant en compte les facteurs associés et prédisposant s'avère nécessaire. PMID:26966492

Syndromes drépanocytaires majeurs et infections associées chez l ’enfant au Burkina Faso

PubMed Central

Douamba, Sonia; Nagalo, Kisito; Tamini, Laure; Traoré, Ismaël; Kam, Madibèlè; Kouéta, Fla; Yé, Diarra

2017-01-01

Introduction Le but de cette étude était d’étudier les infections chez les enfants présentant un syndrome drépanocytaire majeur. Méthodes Étude hospitalière monocentrique, rétrospective descriptive sur dix années menée à Ouagadougou, Burkina Faso. Étaient inclus tous les enfants porteurs d'un syndrome drépanocytaire majeur (homozygote SS et double hétérozygote SC, SDPunjab, Sβ thalassémique, SOArab et SE) hospitalisés pour une infection bactérienne confirmée à la microbiologie. Résultats Cent trente trois patients répondaient à nos critères d’inclusion. Le phénotype SS représentait 63,2% des cas et le SC 36,8%. La fréquence des infections était de 21,8%. Celles-ci touchaient dans 45,9% des cas les enfants âgés de 0 à 5 ans. Les signes les plus fréquents étaient les douleurs ostéoarticulaires (42,1%), la toux (25,7%), les douleurs abdominales (23,3%), la pâleur (43,6%). Les broncho-pneumopathies (31,6%), le paludisme (16,5%), les ostéomyélites (12,8%) et les septicémies (10,5%) étaient les principaux diagnostics trouvés. Les agents pathogènes isolés étaient Streptococcus pneumoniae (35,5%) et Salmonella sp (33,3%). Les céphalosporines de 3e génération étaient les antibiotiques les plus fréquemment prescrits. Le taux brut de mortalité était de 7,5%. Conclusion Les infections bactériennes et le paludisme dominent le tableau des infections chez l'enfant drépanocytaire majeur au Centre Hospitalier Universitaire Pédiatrique Charles De Gaulle. Les auteurs recommandent la mise en place d’un programme national de prise en charge de la drépanocytose, ce qui permettrait de prévenir voire réduire la survenue des infections chez les enfants drépanocytaires. PMID:28450986

Tuberculose pulmonaire révélée par un purpura thrombopénique chez l'enfant-à propos d'un cas clinique observé au service de pédiatrie des Cliniques Universitaires de Lubumbashi

PubMed Central

Lubala, Toni Kasole; Mutombo, Augustin Mulangu; Munkana, Arthur Ndundula; Manika, Michel Muteya

2012-01-01

Nous rapportons le cas d'un enfant de 7 ans, de sexe masculin ayant présenté un purpura thrombopénique avec épistaxis, hématémèse, otorragies et pétéchies généralisées. Durant la même hospitalisation, nous avons mis en évidence une tuberculose pulmonaire documentée par la présence de bacilles acido-alcoolo résistants à l'examen des crachats. Nous avons observé une majoration du taux de plaquettes en une semaine de corticothérapie intraveineuse à haute dose, avant l'instauration d'une poly chimiothérapie antituberculeuse. Nous rappelons également la controverse que suscite la prise en charge de cette association rarement rapportée. PMID:23077696

Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients

PubMed Central

Nellis, Jason C.; Ishii, Masaru; Byrne, Patrick J.; Boahene, Kofi D. O.; Dey, Jacob K.; Ishii, Lisa E.

2017-01-01

IMPORTANCE Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL). OBJECTIVE To measure the association between depression, QOL, and facial paralysis in patients seeking treatment at a facial plastic surgery clinic. DESIGN, SETTING, PARTICIPANTS Data were prospectively collected for patients with all-cause facial paralysis and control patients initially presenting to a facial plastic surgery clinic from 2013 to 2015. The control group included a heterogeneous patient population presenting to facial plastic surgery clinic for evaluation. Patients who had prior facial reanimation surgery or missing demographic and psychometric data were excluded from analysis. MAIN OUTCOMES AND MEASURES Demographics, facial paralysis etiology, facial paralysis severity (graded on the House-Brackmann scale), Beck depression inventory, and QOL scores in both groups were examined. Potential confounders, including self-reported attractiveness and mood, were collected and analyzed. Self-reported scores were measured using a 0 to 100 visual analog scale. RESULTS There was a total of 263 patients (mean age, 48.8 years; 66.9% were female) were analyzed. There were 175 control patients and 88 patients with facial paralysis. Sex distributions were not significantly different between the facial paralysis and control groups. Patients with facial paralysis had significantly higher depression, lower self-reported attractiveness, lower mood, and lower QOL scores. Overall, 37 patients with facial paralysis (42.1%) screened positive for depression, with the greatest likelihood in patients with House-Brackmann grade 3 or greater (odds ratio, 10.8; 95% CI, 5.13–22.75) compared with 13 control patients (8.1%) (P < .001). In multivariate regression, facial paralysis and female sex were significantly associated with higher depression scores (constant, 2.08 [95% CI, 0.77–3.39]; facial paralysis effect, 5.98 [95% CI, 4.38–7

Simulated worlds, physical eschatology, the finite nature hypothesis and the final anthropic principle

NASA Astrophysics Data System (ADS)

Prince, N. H. E.

2005-10-01

Meaning and purpose can be given to life, consciousness, the laws of physics, etc. If one assumes that the Universe is endowed with some form of (strong) anthropic principle. In particular, the final anthropic principle (FAP) of Barrow and Tipler postulates that intelligent life will continue in the Universe until the far future when the computational power of descendent civilizations will be sufficient to run simulations of enormous scale and power. Tipler has claimed that it will be possible to create simulations with rendered environments and inhabitants, i.e. intelligent software constructs, which are effectively ‘people’. Proponents of this FAP claim that if both substrate independence and the pattern identity postulate hold, then these simulations would be able to contain reanimated individuals that once lived. These claims have been heavily criticized but the growing study of physical eschatology, initiated by Freeman Dyson in a seminal work, and the developments in computational theory have made some progress in showing that simulations containing intelligent information processing software constructs, which may be conscious, are not only feasible but may be a reality within the next few centuries. In this work, arguments and conservative calculations are given which concur with these latter more minimal claims. FAP-type simulations inevitably rely on cosmology type, but current observations would seem to rule appropriate models out. However, it is argued that dark energy, described in the recent forms of ‘quintessence’ cosmological models may show the current conclusions from observations to be too presumptive. In this paper some relevant physical and cosmological aspects are reviewed in the light of the recent propositions regarding the plausibility of certain simulations given by Bostrom, and the longer held postulate of finite nature due to Fredkin which has grown in credibility, following advances in quantum mechanics and the computational

A chimaeric-pattern flap design for implantable Doppler surrogate monitoring: a novel placement technique.

PubMed

Kim, Jeong Tae; Ho, Samuel Y M; Kim, Youn Hwan

2014-02-01

Postoperative flap monitoring is a vital aspect of free tissue transfer in order to detect early vascular compromise and to enable early flap salvage. The implantable Doppler monitoring system is one of many monitoring devices used to ensure accuracy and reduce unnecessary flap explorations. However, there are a number of concerns with its use, namely tension on the anastomosis, possible vessel constriction and false-negative detection. This study aimed to alleviate these concerns, by introducing a new method of placing the implantable Doppler probe on the adjacent vessel limb of a chimaeric flap. This is illustrated by a case series of chimaeric free tissue flaps that allow this surrogate placement of the Doppler probe. The flap is raised in a chimaeric fashion, with a main perforator pedicle to the skin or muscle paddle for the main reconstructive purpose and a side branch from the main pedicle going to a smaller adipofascial or muscle flap for monitoring. This branch vascular pedicle leading to the chimaeric tissue is kept sufficiently long to enable placement of the Doppler cuff and prevent turbulence. The probe of a Cook-Swartz implantable Doppler system is placed around the branch pedicle, approximately 5 mm from the branching point, and secured with a vessel clip. This is then secured away from the major vessels of the main free flap. Removal of the probe's crystal and wire is easily done with a single gentle traction on postoperative day 7. Five cases of chimaeric free flaps were performed with this manoeuvre: three thoracodorsal perforator chimaeric flaps for head-and-neck or extremity reconstruction, one latissimus dorsi neuromuscular chimaeric flap for facial reanimation and one digastric lymph node transfer for the treatment of lower limb lymphoedema. The Doppler system showed a low but sustained oscillating flow in all cases indicating vascular patency, with minimal flow interference from other large-calibre vessels. There was no discernible kinking on

Le dermatofibrosarcome de Darier et Ferrand, une tumeur cutanée particulière: à propos de 32 cas et revue de la littérature

PubMed Central

Elamrani, Driss; Droussi, Hatim; Boukind, Samira; Elatiqi, Keltoum; Dlimi, Meriem; Benchamkha, Yassine; Ettalbi, Saloua

2014-01-01

Le dermatofibrosarcome (DFS) est une tumeur fibreuse de la peau, de croissance lente, à très haut risque de récidive locale, mais à potentiel métastatique faible. A partir d'une étude rétrospective étalée sur une période de 5 ans (décembre 2008 - décembre 2013), nous avons analysé les caractéristiques épidémiologiques et cliniques, le délai de diagnostic, le type de thérapeutique et le devenir de 32 patients présentant des tumeurs de Darier et Ferrand histologiquement prouvées. Parmi les 32 patients, 10 se sont présentés initialement au service pour une récidive tumorale. Une discrète prédominance masculine a été notée. Les DFS touchent préférentiellement l'adulte jeune. Le délai diagnostique observé est en moyenne de 4 ans. Le tronc est la localisation préférentielle (60%), suivi par les extrémités proximales (30%). Les 32 patients ont été traités par exérèse chirurgicale avec une marge de 5cm en surface, emportant en profondeur une barrière anatomique saine. La couverture de la perte de substance (PDS) a été réalisée après confirmation anatomopathologique du caractère carcinologique de l'exérèse, et a fait appel à différents moyens allant de la greffe cutanée aux lambeaux musculo –cutanés libres. L’évolution a été marquée par la survenue d'une récidive tumorale chez 8 patients (3 cas parmi les tumeurs vues en première intention et 5 cas parmi les tumeurs vues en récidive) et les résultats ont été jugés satisfaisants sur le plan esthétique et fonctionnel. Le DFS de Darier et Ferrand est une tumeur dont le pronostic et le risque évolutif sont principalement liés au délai diagnostic et la qualité de la première exérèse. Le diagnostic tardif, rend difficile la chirurgie d'exérèse et de reconstruction Les possibilités de guérison en cas de chirurgie primaire bien conduite sont significativement supérieures à celles d'une chirurgie de rattrapage. L'amélioration du pronostic passe par

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age.

PubMed

Melo, José Roberto Tude; Di Rocco, Federico; Bourgeois, Marie; Puget, Stephanie; Blauwblomme, Thomas; Sainte-Rose, Christian; Meyer, Philippe G; Zerah, Michel

2014-04-01

Subdural hematoma (SDH) is the most common finding on cranial CT in pediatric victims of abusive head trauma (AHT). The hematomas are commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages. There is no consensus regarding the best surgical treatment in such cases nor are there standardized surgical protocols. The authors report their experience and discuss the routine surgical options in the management of traumatic SDH at a Level 1 Pediatric Trauma Center. In this paper, the authors describe a cross-sectional study with consecutive revision of data described in the medical records of Hôpital Universitaire Necker-Enfants Malades between January 2008 and January 2013. During this period, all children younger than 2 years of age who were admitted with a traumatic SDH identified on CT scans were included in this study. One hundred eighty-four children who had SDH and were younger than 2 years of age were included. Their median age was 5.8 months (range 5 days-23 months), and 70% of the children were male. On admission CT scans, the SDH was bilateral in 52% of cases and homogeneously hypodense in 77%. Neurosurgical treatment was undertaken in 111 children (60%) with an admission Glasgow Coma Scale score of 12 or less, bulging fontanels, or other signs suggestive of intracranial hypertension. The first surgical option was craniotomy in 1.8% (2) of these 111 cases, decompressive craniectomy in 1.8% (2), transcutaneous subdural puncture in 15% (17), external subdural drainage in 16% (18), subdural-subgaleal shunt placement in 17% (19), and subdural-peritoneal shunt placement in 48% (53). In 82% of the children initially treated with transcutaneous subdural puncture and in 50% of those treated with external subdural drainage, increase or persistence of the SDH, CSF or skin infection, or shunt system malfunction was observed and further surgical intervention was required. There was a 26% rate of complications in patients

Épidémiologie des accidents domestiques graves de l'enfant admis en réanimation pédiatrique polyvalente à l'hôpital d'enfants de Rabat-Maroc

PubMed Central

Rafai, Mostafa; Mekaoui, Nour; Chouaib, Naoufal; Bakkali, Hicham; Belyamani, Lahcen; El Koraichi, Alae; El Kettani, Salma Ech-Cherif

2015-01-01

Introduction Les accidents domestiques de l'enfant représentent un vrai problème de santé publique dans les pays industrialisés. Au Maroc, la priorité en santé publique est toujours donnée aux pathologies infectieuses, et bien qu'elle soit très peu décrite, la pathologie accidentelle de l'enfant devient de plus en plus fréquente dans notre pays avec une mortalité importante. L'objectif est de mettre le point sur la prévalence, la gravité, les aspects étiologiques, les facteurs de risque et les circonstances de survenue de ces accidents, ainsi que les moyens de prévention active et passive. Méthodes Enquête rétrospective descriptive sur une période de douze mois portant sur tous les enfants pris en charge pour accident domestique grave au service de réanimation pédiatrique polyvalente de l'hôpital universitaire d'enfants de Rabat. Résultats Parmi 698 admissions, 108 cas d'accidents domestiques graves ont étaient colligés (soit 15,5%), L’âge moyen des enfants était de 04ans tout accident confondu, avec un sex-ratio de 1,08 en faveur des garçons. L’évolution générale était marquée par le décès de 16 enfants (soit 14,8%) parmi 164 décès toute pathologie confondue au cours de la même période d’étude (soit 9,75% des décès) avec une durée moyenne d'hospitalisation de 04jours. les brûlures constituaient le premier accident dans notre série par 37cas, et elles étaient la première cause de mortalité par huit cas; par ailleurs, la population la plus à risque de brûlure était les nourrissons (67,6%). L'inhalation intrabronchique d’épingle à foulard (accident particulier dans notre contexte islamique) à été retrouvée chez six cas. Conclusion Les accidents domestiques de l'enfant constituent rarement une préoccupation de premier plan dans la population alors qu'ils sont parfois très graves et source d'une mortalité importante. Le meilleur traitement reste la prévention active et passive. PMID:26015848

Utilisation de lignes directrices dans le cadre de l’implantation de cabinets automatisés décentralisés en établissement de santé

PubMed Central

Brisseau, Lionel; Bussières, Jean-François; Lebel, Denis; Atkinson, Suzanne; Robinette, Louise; Fortin, Sylvie; Lemay, Michel

2011-01-01

RÉSUMÉ Contexte : Il existe peu de données sur les conséquences de l’utilisation des cabinets automatisés décentralisés (CAD) en établissements de santé. Méthode : Il s’agit d’une étude descriptive de la conformité des pratiques par rapport à des lignes directrices publiées dans le cadre de l’implantation de CAD. L’objectif principal de l’étude est d’évaluer la conformité globale et celle de chaque processus du circuit du médicament. L’étude se déroule au sein du Centre hospitalier universitaire (CHU) Sainte-Justine, un établissement mère–enfant de 500 lits. À partir des lignes directrices portant sur l’utilisation sécuritaire des CAD de l’Institute for Safe Medication Practice (aux États-Unis) (2008) et de son outil d’autoévaluation (2009), nous avons évalué la conformité de la pratique à 30 jours et à 120 jours après l’implantation. Résultats : Nous avons procédé de novembre 2009 à avril 2010 à l’implantation de sept stations de CAD au sein du CHU Sainte-Justine. Le profil de conformité est passé de 66 % à 74 % de janvier à avril 2010. Pour chaque processus relatif à l’utilisation sécuritaire des CAD, nous présentons une brève description des critères ainsi que les éléments de non-conformité liés à la technologie ou aux aspects organisationnels. Pour chaque élément de non-conformité, nous avons déterminé les actions requises auprès du fabricant afin de modifier l’équipement (c. à .d. aspects technologiques) et auprès de l’établissement afin de modifier les modalités d’utilisation (aspects organisationnels) en précisant le ou les processus impliqués. Conclusion : Cette étude décrit la conformité des pratiques au CHU Sainte-Justine par rapport à des lignes directrices publiées par l’Institute for Safe Medication Practices. L’utilisation de lignes directrices dans le cadre de l’implantation de cabinets automatisés décentralisés en établissement peut

L'observance thérapeutique dans les dermatoses chroniques: à propos de 200 cas

PubMed Central

Amraoui, Nissrine; Gallouj, Salim; Berraho, Mohamed Amine; Najjari, Chakib; Mernissi, Fatima zohra

2015-01-01

Introduction L'observance thérapeutique est la capacité à prendre correctement son traitement, tel qu'il est prescrit par le médecin. Elle est peu étudiée en dermatologie. Méthodes Le but de notre étude est d’évaluer l'observance chez les patients suivis au service de dermatologie du Centre Hospitalier Universitaire Hassan II de Fès pour une dermatose chronique et de rechercher les facteurs liés à une mauvaise observance à travers une étude incluant 200 patients suivis depuis au moins 6 mois. L’évaluation de l'observance s'est faite essentiellement à l'aide d'un entretien et les facteurs liés à l'observance ont été recherchés par un questionnaire. Résultats 68% de nos patients étaient observant, la mauvaise observance était associée à un niveau socio économique et d’étude bas, à une vie solitaire, à une durée de suivi longue, aux effets secondaires et au coût élevé des traitements, à l'absence d'efficacité, à une faible visibilité des lésions, à une ordonnance complexe, à une explication faible de la maladie, et à des difficultés d'accès à la consultation. Le taux d'observance retrouvé dans notre étude est un taux satisfaisant selon les données de la littérature, notre étude a confirmée certaines facteurs connues et a mis le point sur d'autres facteurs peu étudiés tel un traitement traditionnel associé, la part de chaque forme de traitement dans le respect de l'ordonnance, les dermatoses les plus touchées par les difficulté d'observance a savoir les dermatoses bulleuses et le psoriasis, et l'intérêt du pharmacien. Conclusion Cette analyse de la fréquence de ce phénomène et des facteurs essentiels qui l'influencent permet de cibler la prise en charge à travers une personnalisation de l'entretien médical, une adaptation du suivi au contexte de nos patients et à la nature de notre institution de santé. PMID:26848363

Le changement comme tradition dans la recherche et la formation a la recherche en biotechnologie et en peripherie Etude de cas en sciences de la sante, sciences naturelles et genie

NASA Astrophysics Data System (ADS)

Bourque, Claude Julie

luttes universitaires que scientifiques, concentrees sur la negociation du capital scientifique, symbolique et economique en jeu dans la formation doctorale, dans les carrieres auxquelles elle mene, et dans les qualites du titre de Ph.D. Au final, la confusion entre des logiques opposees peut etre reduite en reinterpretant le changement comme tradition du champ scientifique. Mots-cles Sociologie, education, enseignement superieur, science et technologie, biotechnologie, formation doctorale, champ scientifique, reseaux sociaux

The advantages of hypnosis intervention on breast cancer surgery and adjuvant therapy.

PubMed

Berlière, M; Roelants, F; Watremez, C; Docquier, M A; Piette, N; Lamerant, S; Megevand, V; Van Maanen, A; Piette, P; Gerday, A; Duhoux, F P

2018-02-01

In oncology, hypnosis has been used for pain relief in metastatic patients but rarely for induction of anesthesia. Between January 2010 and October 2015, 300 patients from our Breast Clinic (Cliniques universitaires Saint-Luc, Université catholique de Louvain) were included in an observational, non-randomized study approved by our local ethics committee (ClinicalTrials.gov - NCT03003611). The hypothesis of our study was that hypnosis intervention could decrease side effects of breast surgery. 150 consecutive patients underwent breast surgery while on general anesthesia (group I), and 150 consecutive patients underwent the same surgical procedures while on hypnosis sedation (group II). After surgery, in each group, 32 patients received chemotherapy, radiotherapy was administered to 123 patients, and 115 patients received endocrine therapy. Duration of hospitalization was statistically significantly reduced in group II versus group I: 3 versus 4.1 days (p = 0.0000057) for all surgical procedures. The number of post-mastectomy lymph punctures was reduced in group II (1-3, median value n = 1.5) versus group I (2-5, median value n = 3.1) (p = 0.01), as was the quantity of lymph removed (103 ml versus 462.7 ml) (p = 0.0297) in the group of mastectomies. Anxiety scale was also statistically reduced in the postoperative period among the group of patients undergoing surgery while on hypnosis sedation (p = 0.0000000000000002). The incidence of asthenia during chemotherapy was statistically decreased (p = 0.01) in group II. In this group, there was a statistically non-significant trend towards a decrease in the incidence of nausea/vomiting (p = 0.1), and the frequency of radiodermitis (p = 0.002) and post-radiotherapy asthenia (p = 0.000000881) was also reduced. Finally, the incidence of hot flashes (p = 0.0000000000021), joint and muscle pain (p = 0.0000000000021) and asthenia while on endocrine therapy (p = 0.000000022) were statistically

Is prostate-specific antigen a valid surrogate end point for survival in hormonally treated patients with metastatic prostate cancer? Joint research of the European Organisation for Research and Treatment of Cancer, the Limburgs Universitair Centrum, and AstraZeneca Pharmaceuticals.

PubMed

Collette, Laurence; Burzykowski, Tomasz; Carroll, Kevin J; Newling, Don; Morris, Tom; Schröder, Fritz H

2005-09-01

The long duration of phase III clinical trials of overall survival (OS) slows down the treatment-development process. It could be shortened by using surrogate end points. Prostate-specific antigen (PSA) is the most studied biomarker in prostate cancer (PCa). This study attempts to validate PSA end points as surrogates for OS in advanced PCa. Individual data from 2,161 advanced PCa patients treated in studies comparing bicalutamide to castration were used in a meta-analytic approach to surrogate end-point validation. PSA response, PSA normalization, time to PSA progression, and longitudinal PSA measurements were considered. The known association between PSA and OS at the individual patient level was confirmed. The association between the effect of intervention on any PSA end point and on OS was generally low (determination coefficient, < 0.69). It is a common misconception that high correlation between biomarkers and true end point justify the use of the former as surrogates. To statistically validate surrogate end points, a high correlation between the treatment effects on the surrogate and true end point needs to be established across groups of patients treated with two alternative interventions. The levels of association observed in this study indicate that the effect of hormonal treatment on OS cannot be predicted with a high degree of precision from observed treatment effects on PSA end points, and thus statistical validity is unproven. In practice, non-null treatment effects on OS can be predicted only from precisely estimated large effects on time to PSA progression (TTPP; hazard ratio, < 0.50).

[History of anaesthesia in Belgium].

PubMed

De Rood, M

2012-01-01

anesthesia and surgery in Belgium. After the Liberation, Belgian doctors specifically trained in anesthesia by the British army, or elsewhere in non-occupied countries, will form the core of a new specialty, "anesthesiology-reanimation", who will fight to be recognized as a specialty in itself in Belgium. It will beneficiate from--and largely contribute to--the technical and scientific advances in the medical field. Initially based on clinical symptoms, monitoring and care of operated patients, during and after operation, will beneficiate from modern monitoring and other technical apparatus, which will allow the most audacious surgical technical performances in all domains. Postoperative and intensive care units will appear in the years 1960's. Nowadays, anesthesiologists work in all hospital settings, and also organize One-day clinics and Pain clinics. In Belgium, the quality of the clinical and scientific training of anesthesiologists is widely acknowledged, as well as clinical and experimental research.

Meeting the Challenge of Providing Flexible Learning Opportunities: Considerations for Technology Adoption amongst Academic Staff (Relever le défi de fournir des occasions d'apprentissage flexibles: considérations pour l'adoption de la technologie par le personnel universitaire)

ERIC Educational Resources Information Center

Mirriahi, Negin; Vaid, Bhuvinder S.; Burns, David P.

2015-01-01

This paper reports on a subset of findings from a larger study investigating resistance from academic staff to the integration of technology with on-campus foreign language teaching at one North American higher education institution. The study revealed that the factors influencing technology adoption paralleled Davis' Technology Acceptance Model's…

Prescription d’examens de santé préventifs par des résidents en médecine familiale

PubMed Central

Fung, Daisy; Schabort, Inge; MacLean, Catherine A.; Asrar, Farhan M.; Khory, Ayesha; Vandermeer, Ben; Michael Allan, G.

2015-01-01

Résumé Objectif Déterminer quels sont les examens de dépistage prescrits par les résidents en médecine familiale dans le cadre des soins de santé préventifs. Conception Une enquête transversale. Contexte Alberta et Ontario. Participants Résidents en médecine familiale de première et de deuxième année à l’Université de l’Alberta à Edmonton, à l’Université de Calgary en Alberta et à l’Université McMaster à Hamilton en Ontario, durant l’année universitaire 2011–2012. Principaux paramètres d’évaluation Données démographiques, scores à l’échelle de Likert évaluant les habitudes de prescription et sélections parmi une liste de 38 examens pouvant être prescrits en soins préventifs à un échantillon de patients de sexe féminin et masculin de 38 et de 55 ans. Les statistiques descriptives et comparatives ont été calculées. Résultats Au total, 318 résidents sur 482 (66 %) ont répondu au sondage. Les examens recommandés ou appropriés ont été prescrits par 82 % (pour la cytologie cervicale) à 95 % (pour la glycémie à jeun) des résidents. Parmi les différents patients de l’échantillon, les résidents ont prescrit en moyenne 3,3 à 5,7 examens inappropriés par patient, et 58 à 92 % ont prescrit au moins 1 examen inapproprié par patient. Les coûts excédentaires moyens ont été estimés à 38,39 $ pour un homme de 38 ans et à 106,46 $ pour une femme de 55 ans. Le recours plus fréquent à une grille de référence des examens médicaux périodiques n’a pas amélioré la situation (p = 0,88). Conclusion En général, les résidents ont raisonnablement bien prescrit les examens médicaux préventifs appropriés, mais ils ont aussi prescrit en moyenne 3,3 à 5,7 examens inappropriés à chaque patient. Les programmes de formation doivent mieux préparer les étudiants à reconnaître le dépistage approprié et doivent s’efforcer d’inculquer des comportements de prescription exemplaires avant que les r

The Missing Memory of Canadian Sociology: Reflexive Government and "the Social Science".

PubMed

Curtis, Bruce

2016-05-01

The modest literature on the history of Canadian Sociology takes the appearance of a named academic discipline as its object. Canadian Sociology is held to have had some precursors in the 1880s, but really to appear only in the 1920s. It is described as a foreign import and as an activity first of intellectual speculation and moral reform. Observational and analytic practice are absent before 1880. The activities of state agents and government departments in the social field are not discussed. This article offers a richer account through an examination of the larger field from which Sociology was extracted, "the social science," which was practiced actively in colonial Canada from the early nineteenth century. The social science shaped and was itself shaped by colonial conditions. The article outlines three interrelated moments in social science to carry its claims: inventory-making, the emergence of "population-thinking," and "reflexive government." Attending to the social science underlines the complex and convoluted relations of sociology with state power. Les rares oeuvrages académiques portant sur l'histoire de la sociologie canadienne prend pour objet l'apparition du terme dans le contexte universitaire. Dans cet optique, ils signalent certains précurseurs de la sociologie canadienne dès les années 1880, mais en fait ils affirment que cette discipline n'apparaît que dans les années 1920. Cette discipline est présentée comme une importation académique et, d'abord et avant tout, comme de la spéculation intellectuelle et comme un projet de réforme morale. D'après cette vision, les pratiques d'observation et d'analyse sociales ne semblent pas exister avant 1880, et les acteurs politiques et administratifs sont absents du terrain. Notre article propose un examen plus riche du vaste champ duquel la sociologie académique fut arrachée: activement pratiquée au Canada à l'époque coloniale dès le début du XIXe si

P06.19 TERT promoter mutation is an independent prognostic factor in 1p/19q co-deleted oligodendrogliomas: a POLA network study

PubMed Central

Alentorn, A.; Carpentier, C.; Labreche, K.; Ducray, F.; Dehais, C.; Mokhtari, K.; Uro-Coste, E.; Figarella-Branger, D.; Delattre, J.; Idbaih, A.

2016-01-01

independent favorable prognostic factor in the POLA cohort (p=0.037, HR=3.7 (1.1–13)) and in the TCGA dataset (p=0.01, HR=9.8 (1.6–60)). Conclusion: This study identifies TERTp mutation as a novel independent prognostic biomarker in oligodendrogliomas toward a better stratification of this tumor type. Acknowledgements: The results shown here are in whole or part based upon data generated by the TCGA Research Network: http://cancergenome.nih.gov/. La Ligue Nationale Contre La Cancer. The Institut Universitaire de Cancérologie (IUC). The program Investissements d’avenir” ANR-10-IAIHU-06. POLA network is supported by Institut National du Cancer.

A time-driven activity-based costing model to improve health-care resource use in Mirebalais, Haiti.

PubMed

Mandigo, Morgan; O'Neill, Kathleen; Mistry, Bipin; Mundy, Bryan; Millien, Christophe; Nazaire, Yolande; Damuse, Ruth; Pierre, Claire; Mugunga, Jean Claude; Gillies, Rowan; Lucien, Franciscka; Bertrand, Karla; Luo, Eva; Costas, Ainhoa; Greenberg, Sarah L M; Meara, John G; Kaplan, Robert

2015-04-27

In resource-limited settings, efficiency is crucial to maximise resources available for patient care. Time driven activity-based costing (TDABC) estimates costs directly from clinical and administrative processes used in patient care, thereby providing valuable information for process improvements. TDABC is more accurate and simpler than traditional activity-based costing because it assigns resource costs to patients based on the amount of time clinical and staff resources are used in patient encounters. Other costing approaches use somewhat arbitrary allocations that provide little transparency into the actual clinical processes used to treat medical conditions. TDABC has been successfully applied in European and US health-care settings to facilitate process improvements and new reimbursement approaches, but it has not been used in resource-limited settings. We aimed to optimise TDABC for use in a resource-limited setting to provide accurate procedure and service costs, reliably predict financing needs, inform quality improvement initiatives, and maximise efficiency. A multidisciplinary team used TDABC to map clinical processes for obstetric care (vaginal and caesarean deliveries, from triage to post-partum discharge) and breast cancer care (diagnosis, chemotherapy, surgery, and support services, such as pharmacy, radiology, laboratory, and counselling) at Hôpital Universitaire de Mirebalais (HUM) in Haiti. The team estimated the direct costs of personnel, equipment, and facilities used in patient care based on the amount of time each of these resources was used. We calculated inpatient personnel costs by allocating provider costs per staffed bed, and assigned indirect costs (administration, facility maintenance and operations, education, procurement and warehouse, bloodbank, and morgue) to various subgroups of the patient population. This study was approved by the Partners in Health/Zanmi Lasante Research Committee. The direct cost of an uncomplicated vaginal

[Reflections and recommendations from Quebec mental health university institutes on the working paper of the provincial forum for the 2014-2020 Mental Health Action Plan].

PubMed

Fortin, Denise; McVey, Lynne; Racine, Simon; Luyet, André J; Israël, Mimi; Villeneuve, Evens; Trudel, Jean-François; Fortier, Linda

2014-01-01

Quebec's three mental health university institutes (DMHUI, IUSMM and the IUSMQ) and the Centre hospitalier universitaire de Sherbrooke submitted a statement to the provincial consultation forum on the 2014-2020 Mental Health Action Plan (MHAP), which was held in January 2014 and organized by the Ministère de la Santé et des Services sociaux (MSSS). This article presents these institutes' main recommendations. Mental health university institutes deliver a wide and diverse range of services. They know about the challenges of organizing mental health services and are aware of national and international trends in the delivery of the best organizational and clinical practices in mental health. It is therefore as key stakeholders in the mental health care network that they commented on each component in the working paper. The proposed orientations are consistent with the 2005-2010 MHAP. The presented themes clearly reflect current issues, although the guidelines must be more explicit regarding the vision of how services will be organized in coming years. These institutes therefore suggest that the following principles be included: the full exercise of citizenship rights, the organization of services within integrated networks, performance, continuous improvement and innovation, as well as a global and integrated vision of health. The complexity of today's problems requires flexibility, complementarity and continuity of services, particularly for youth, aboriginals, and people with concomitant disorders. These institutions therefore stress the importance of prevention, early intervention programs, and increased support for first-line general practitioners and health care professionals. They also emphasized that specialized inpatient and outpatient services should not be neglected. Community services must also be structured around various levels of support, such as ICM and ACT, as well as around specialized programs available in hospital outpatient clinics. The

Démarche pour la mise à niveau d’un secteur de soins pharmaceutiques : le cas de l’hémato-oncologie pédiatrique

PubMed Central

Bussières, Jean-François; Robelet, Antoine; Therrien, Roxane; Touzin, Karine

2010-01-01

Contexte : Bien que le concept de pharmacie clinique ait été développé dans les années soixante, il existe une grande variété de programmes et une grande disparité entre les programmes en clinique externe et en hospitalisation, bénéficiant de la présence d’un pharmacien dans un secteur de soins. Objectif: Éprouver une méthode de mise à niveau des secteurs de soins pharmaceutiques en établissement de santé. Méthode : Il s’agit d’une étude descriptive se déroulant au Centre hospitalier universitaire Sainte-Justine, un établissement mère-enfant de 500 lits. Le secteur de soins pharmaceutiques ciblé pour illustrer la méthode de mise à niveau est l’hématologie-oncologie pédiatrique. La méthode comporte trois étapes, soit une revue de la documentation scientifique, un profil du secteur et une mise à jour du niveau de pratique selon un profil des activités pharmaceutiques dans le secteur avant et après la mise à niveau. Résultats : Au total, 108 articles ont été recensés et 22 ont été retenus à partir d’une recherche dans PubMed. Après une recherche manuelle complémentaire, 36 articles ont finalement été évalués. Parmi les articles retenus, on compte trois lignes directrices, 11 études de développement, une revue de la littérature scientifique, six études pré- et post-interventions et 15 études quasi expérimentales. Bien que les patients de ce secteur ne comptent que pour 5 % des admissions de l’hôpital, la complexité des cas est élevée tant sur le plan de la codification de l’épisode de soins que du potentiel d’intervention pharmaceutique par admission. Conclusion : Il existe peu de données illustrant une démarche de mise à niveau de la pratique dans un secteur de soins pharmaceutiques. Cette étude a éprouvé une méthode de mise à niveau dans un service d’hématologie-oncologie pédiatrique et comporte une revue de la documentation scientifique, un profil du secteur et une description des t

Cirque du Monde as a health intervention: perceptions of medical students and social circus experts.

PubMed

Fournier, Cynthia; Drouin, Mélodie-Anne; Marcoux, Jérémie; Garel, Patricia; Bochud, Emmanuel; Théberge, Julie; Aubertin, Patrice; Favreau, Gil; Fleet, Richard

2014-11-01

To present Cirque du Soleil's social circus program, Cirque du Monde, to explore its potential as a primary health care tool for family physicians. A review of the literature in PubMed, the Cochrane Library, PsycINFO, LaPresse, Eureka, Google Scholar, and Érudit using the key words circus, social circus, Cirque du Monde, and Cirque du Soleil; a Montreal-based initiative, Espace Transition, modeled on Cirque du Monde; and personal communication with Cirque du Soleil's Social Circus Training Advisor. The first 50 articles or websites identified for each key word in each of the databases were examined on the basis of their titles and abstracts in the case of articles, and on the basis of their titles and page content in the case of websites. Articles and websites that explored an aspect of social circuses or that described an intervention that involved circuses were then retained for analysis. Because all literature on social circuses was searched, no criterion for year of publication was used. No articles on the social circus as a health intervention were found. One study on the use of the circus as an intervention in schools was identified. It demonstrated an increase in self-esteem in the children who took part. One study on the use of the circus in a First Nations community was found; it contained nonspecific, qualitative findings. The other articles identified were merely descriptions of social circuses. One website was identified on the use of the social circus to help youth who had been treated in a hospital setting for major psychiatric disorders to re-enter the community. The team in the pediatric psychiatry department at Centre Hospitalier Universitaire Sainte-Justine, the children's hospital in Montreal, Que, was contacted; they were leading this project, called Espace Transition. The unpublished preliminary findings of its pilot project demonstrate substantial improvements in overall patient functioning. According to Cirque du Soleil, there are several

Cirque du Monde as a health intervention

PubMed Central

Fournier, Cynthia; Drouin, Mélodie-Anne; Marcoux, Jérémie; Garel, Patricia; Bochud, Emmanuel; Théberge, Julie; Aubertin, Patrice; Favreau, Gil; Fleet, Richard

2014-01-01

Abstract Objective To present Cirque du Soleil’s social circus program, Cirque du Monde, to explore its potential as a primary health care tool for family physicians. Data sources A review of the literature in PubMed, the Cochrane Library, PsycINFO, LaPresse, Eureka, Google Scholar, and Érudit using the key words circus, social circus, Cirque du Monde, and Cirque du Soleil; a Montreal-based initiative, Espace Transition, modeled on Cirque du Monde; and personal communication with Cirque du Soleil’s Social Circus Training Advisor. Study selection The first 50 articles or websites identified for each key word in each of the databases were examined on the basis of their titles and abstracts in the case of articles, and on the basis of their titles and page content in the case of websites. Articles and websites that explored an aspect of social circuses or that described an intervention that involved circuses were then retained for analysis. Because all literature on social circuses was searched, no criterion for year of publication was used. Synthesis No articles on the social circus as a health intervention were found. One study on the use of the circus as an intervention in schools was identified. It demonstrated an increase in self-esteem in the children who took part. One study on the use of the circus in a First Nations community was found; it contained nonspecific, qualitative findings. The other articles identified were merely descriptions of social circuses. One website was identified on the use of the social circus to help youth who had been treated in a hospital setting for major psychiatric disorders to re-enter the community. The team in the pediatric psychiatry department at Centre Hospitalier Universitaire Sainte-Justine, the children’s hospital in Montreal, Que, was contacted; they were leading this project, called Espace Transition. The unpublished preliminary findings of its pilot project demonstrate substantial improvements in overall patient

[Chondrodermatitis nodularis chronica helicis: a descriptive study of 99 patients].

PubMed

Wettlé, C; Keller, F; Will, F; Lefebvre, F; Cribier, B

2013-11-01

Painful nodule of the ear was described at the start of the 20th century as a form of chronic chondrodermatitis nodularis helicis (CNH). It comprises a painful erythematous papule or nodule appearing on the ear and adhering to cartilage, and which may or may not have a central scab. The aim of this study was to describe the clinical characteristics of CNH as well as the population currently affected by such lesions, and to identify predisposing factors. The secondary aim was to describe treatments commonly used in private dermatological practice and to examine their efficacy. Questionnaires were sent out to private dermatologists belonging to the Association d'information post-universitaire en dermato-vénérologie de Strasbourg [Association for post-university information in dermatology-venerology] in Strasbourg. Patients were included in the study if they consulted for CNH, clinically diagnosed as such by the dermatologist. The questionnaire was used to analyze the age, gender and phototype of patients, as well as pain assessed on a numeric scale, duration, site, supposed trigger factors, treatment and outcome after treatment. A total of 99 patients was included by 27 dermatologists between March 2010 and October 2011, mainly men (sex-ratio: 1.6). The mean age was 65 years. Patients had no significant previous history. Pain was moderate in 23 patients, severe in 59 and unbearable in 14; in most patients it was brought on by provocation (78 patients). The right ear was affected in 48 patients and the left ear in 39. CNH had been present for a mean 14 months. The most common site was the upper/horizontal section and the angle of the helix of the ear (62 patients). Exposure to sunlight or to cold were the predisposing factors most frequently mentioned (56 patients). Medical treatment was given for 52 patients, and resulted in cure of almost half of this population. Surgery was performed in 34 patients, with only one case of relapse. Our study shows that the current

How does the association of iron oxides and perchlorate salts influence organic matter evolution when using Sample Analysis at Mars pyrolysis onboard Curiosity?

NASA Astrophysics Data System (ADS)

François, Pascaline; Coll, Patrice; Szopa, Cyril; Buch, Arnaud; Cabane, Michel; McAdam, Amy; Freissinet, Caroline; Eigenbrode, Jennifer L.; Glavin, Daniel P.; Navarro-Gonzalez, Rafael; Mahaffy, Paul R.

2014-05-01

al. (2013), JGR. [3] Ming, D. et al. (2013), Science, DOI: 10.1126/science.1245267 [4] Navarro-Gonzalez, R. et al. (2010), JGR. [5] Vaniman, D. T. et al (2013), Science, DOI: 10.1126/science.1243480. 71, 9-17. [6] Iniguez, E. et al. (2009), Geophysical Research Letters, 36. Acknowledgments: SAM-GC team acknowledges support from the French Space Agency (CNES), French National Programme of Planetology (PNP), National French Council (CNRS), Pierre Simon Laplace Institute, Institut Universitaire de France (IUF) and ESEP Labex. J. Eigenbrode and D. Glavin were supported by the NASA MSL participating scientist program.

Deep Structures of The Angola Margin

NASA Astrophysics Data System (ADS)

Moulin, M.; Contrucci, I.; Olivet, J.-L.; Aslanian, D.; Géli, L.; Sibuet, J.-C.

1 Ifremer Centre de Brest, DRO/Géosciences Marines, B.P. 70, 29280 Plouzané cedex (France) mmoulin@ifremer.fr/Fax : 33 2 98 22 45 49 2 Université de Bretagne Occidentale, Institut Universitaire Europeen de la Mer, Place Nicolas Copernic, 29280 Plouzane (France) 3 Total Fina Elf, DGEP/GSR/PN -GEOLOGIE, 2,place de la Coupole-La Defense 6, 92078 Paris la Defense Cedex Deep reflection and refraction seismic data were collected in April 2000 on the West African margin, offshore Angola, within the framework of the Zaiango Joint Project, conducted by Ifremer and Total Fina Elf Production. Vertical multichannel reflection seismic data generated by a « single-bubble » air gun array array (Avedik et al., 1993) were recorded on a 4.5 km long, digital streamer, while refraction and wide angle reflection seismic data were acquired on OBSs (Ocean Bottom Seismometers). Despite the complexity of the margin (5 s TWT of sediment, salt tectonics), the combination of seismic reflection and refraction methods results in an image and a velocity model of the ground structures below the Aptian salt layer. Three large seismic units appear in the reflection seismic section from the deep part on the margin under the base of salt. The upper seismic unit is layered with reflectors parallel to the base of the salt ; it represents unstructured sediments, filling a basin. The middle unit is seismically transparent. The lower unit is characterized by highly energetic reflectors. According to the OBS refraction data, these two units correspond to the continental crust and the base of the high energetic unit corresponds to the Moho. The margin appears to be divided in 3 domains, from east to west : i) a domain with an unthinned, 30 km thick, continental crust ; ii) a domain located between the hinge line and the foot of the continental slope, where the crust thins sharply, from 30 km to less than 7 km, this domain is underlain by an anormal layer with velocities comprising between 7,2 and 7

Toward a new cold and warm nondepolarizing, normokalemic arrest paradigm for orthotopic heart transplantation.

PubMed

Rudd, Donna M; Dobson, Geoffrey P

2009-01-01

Currently, the safe human heart preservation time is limited to around 4 to 5 hours of cold ischemic storage. Longer arrest times can lead to donor heart damage, early graft dysfunction, and chronic rejection. The aim of this study was to examine a new nondepolarizing, normokalemic preservation solution with adenosine and lidocaine for as long as 6 hours of arrest at cold and warmer storage temperatures. Isolated perfused rat hearts (n = 87) were switched from working to Langendorff (nonworking) mode and arrested at 37 degrees C with 200-micromol/L adenosine and 500-micromol/L lidocaine in Krebs-Henseleit buffer (10-mmol/L glucose, pH 7.7, 37 degrees C) or with Celsior (Sangstat Medical Corp, Fremont, CA). Hearts were removed and placed in static storage at 4 degrees C for 2 and 6 hours or remained on the apparatus and were intermittently flushed at 37 degrees C every 20 minutes for 2 minutes at 68 mm Hg (average arrest temperature 28 degrees -30 degrees C) for 2 and 6 hours. We further investigated the effect of the warmer adenosine-lidocaine solution supplemented with 1- or 5-mmol/L pyruvate. Adenosine-lidocaine solution arrested hearts in 16 +/- 2 seconds (n = 32), whereas Celsior did so in 39 +/- 4 seconds (n = 23). After 2 hours of cold static storage, there were no functional differences between the adenosine-lidocaine and Celsior groups, with approximately 70% return of cardiac output. In contrast, after 6 hours of 4 degrees C storage, adenosine-lidocaine hearts had significantly higher functional recoveries (68% +/- 5% cardiac output) than Celsior hearts (47% +/- 14% cardiac output) during 60 minutes of reperfusion. In addition, Celsior hearts took 5 minutes longer to reanimate and showed early reperfusion arrhythmias. At warmer temperatures after 2 hours of arrest, adenosine-lidocaine and Celsior hearts were not significantly different, despite a 43% higher cardiac output in adenosine-lidocaine hearts (80% +/- 3% vs 56% +/- 12%). After 6 hours, adenosine

Dormant state in bacteria: Conceptions and implications for terrestrial biogeoscience and astrobiology

NASA Astrophysics Data System (ADS)

Mulyukin, A.

2003-04-01

cells and to that the conditions that are most appropriate to wake resting cells to growth are unknown to microbiologists. Furthermore, resting bacterial cells of just the same species differ in their ability to recover the growth and multiplication and profundity of the dormant state, so special 'reanimation' procedures are required. To overcome obstacles due to an expectable underestimation of total cell number in the environmental samples, it is important to find out the criteria, which allow one to distinguish between microbial cells of different physiological state, including the resting cells, by direct methods. Some of such approaches to revealing the specific features of potentially viable resting cells (in laboratory cultures) were developed in our works and used for a primary detection of microbial cells in situ and for appraisal of their physiological state. So, it is worth to discuss what we can propose for a better understanding of the phenomenon of long-term preservation of microorganisms in cold terrestrial ecosystems and whether resting cells of non-spore-forming-bacteria can be regarded as a target in exobiological explorations.

Epidémiologie et facteurs de risque des complications respiratoires majeures après chirurgie de l'aorte abdominale au CHU Ibn Sina, Maroc

PubMed Central

Awab, Almahdi; Elahmadi, Brahim; Lamkinsi, Tarik; El Moussaoui, Rachid; El Hijri, Ahmed; Azzouzi, Abderrahim; Alilou, Mustapha

2013-01-01

Introduction L'incidence des complications respiratoires postopératoires (CRPO) reste très diversement appréciées selon les critères diagnostiques retenues dans les différentes études, ce qui la fait varier de 5 à plus de 50%. Les CRPO majeurs après chirurgie de l'aorte abdominale sont responsables d'une grande morbi-mortalité pouvant aller jusqu’à 36%, d'une durée d'hospitalisation et d'un coût plus importants. Ainsi dans l'optique d'améliorer notre prise en charge périopératoire de la chirurgie de l'aorte, nous avons décidé de mener une étude pour dresser le profil épidémiologique et déterminer les facteurs de risque des complications respiratoires dans notre contexte Méthodes Il s'agit d'une étude de cohorte rétrospective du mois de Janvier 2007 au mois de décembre 2011 portant sur l'ensemble des patients opérés pour pathologie aortique au bloc opératoire central de l'hôpital Ibn Sina de Rabat, Maroc. Résultats Cent vingt cinq patients ont été inclus dans notre étude, 24 patients ont été opérés pour anévrysme de l'aorte abdominale et 101 patients pour lésion occlusive aortoiliaque. Dans notre série 22 malades soit 17,6% ont présenté une complication respiratoire majeure avec, une reventilation dans 4,8% des cas, une difficulté de sevrage de la ventilation artificielle dans 3,2% des cas, une pneumopathie dans 4% des cas, un syndrome de détresse respiratoire aigue (SDRA) dans 4% des cas et une nécessité de fibroaspiration bronchique dans 1,6% des cas. En analyse univariée: l’âge, la présence d'une BPCO avec dyspnée stade 3 ou 4, la présence d'une anomalie à l'EFR préopératoire, la présence d'un stade avancé (III ou IV) de LOAI et la reprise chirurgicale étaient statistiquement associés à la survenue d'une complication respiratoire postopératoire. En analyse multivariée, seule une anomalie à l'EFR en préopératoire constituait un facteur de risque indépendant de survenue d'une complication

Cross-sectional, observational study of anterior segment parameters using anterior segment optical coherence tomography in North Indian Population.

PubMed

Dalal, Latika Khatri; Dhasmana, Renu; Maitreya, Amit

2017-01-01

érents groupes d'âge. Résultats: l'âge moyen des participants était de 48,3 ± 13,9 ans et 50,6% des hommes. L'ACA a diminué avec l'âge alors que ICSA, IT et IC ont augmenté avec l'âge. L'ACA (P = 0,0001 par voie nasale et temporelle), ICSA (P = 0,011 nasale, P = 0,027 temporellement), IT750 (P = 0,001 par voie nasale, P = 0,011 temporellement), IT1500 (P = 0,002 par voie nasale, P = 0,002 temporellement) Et IC (P = 0,059 nasal, P = 0,128 temporellement) ont subi des changements statistiquement significatifs avec l'âge. Aucune différence significative n'a été observée dans les paramètres du sexe différent. Dans ce sous-ensemble de la population indienne, la variation des paramètres CA avec l'âge influence les dimensions AC prédisposant l'oeil aux conditions glaucomateuses. Ces données sont applicables cliniquement pour l'évaluation et la gestion chirurgicale des patients nécessitant une chirurgie AS.

Aspects épidémiologique, clinique, thérapeutique et évolutif de la maladie de Basedow en Médecine Interne au CHU Ledantec Dakar (Sénégal)

PubMed Central

Diagne, Nafissatou; Faye, Atoumane; Ndao, Awa Cheikh; Djiba, Boundia; Kane, Baidy Sy; Ndongo, Souhaibou; Pouye, Abdoulaye

2016-01-01

La maladie de Basedow est une affection auto immune associant une thyrotoxicose à des manifestations de fréquence variable comme le goitre, l'ophtalmopathie et le myxœdème prétibial. Son diagnostic est souvent facile, tandis que sa prise en charge demeure encore difficile. L'instauration d'un traitement médical simple expose à un risque de récidive. Au Sénégal et en Afrique Sub-saharienne peu d'études ont porté sur la maladie de Basedow. L'objectif de l'étude était de décrire les aspects épidémiologique, clinique, thérapeutique et évolutif de la maladie de Basedow en milieu hospitalier à Dakar. Il s'agissait d'une étude rétrospective menée du 1er janvier 2010 au 31 décembre 2013 dans le service de Médecine Interne du centre hospitalier universitaire Aristide Le Dantec. Durant la période, 108 patients suivis en consultation externe pour maladie de Basedow, ont été inclus sur un total de 834 patients suivis en consultation externe. le diagnostic a été retenu devant les signes cliniques, biologiques et immunologiques. Cent huit patients, atteints de maladie de Basedow ont été inclus sur un total de 834 consultations. Le sex ratio était de 7,3 et la moyenne d'âge de 34,6 ans. Les principaux motifs de consultation étaient : les palpitations et l'amaigrissement dans respectivement 46,3% et 39,8% des cas. Le syndrome de thyrotoxicose était présent chez 93,5% des patients, un goitre était noté chez 87% des patients et une exophtalmie chez 78,7% des patients. La principale complication était à type de cardiothyréose retrouvée chez 11,1% des patients. Tous les patients ont eu un traitement par antithyroïdiens de synthèse. L'évolution a été favorable dans 19,4% des cas. Une récidive à été notée dans 57% des cas et dans 23,1% des cas les patients ont été perdus de vue. La maladie de Basedow est la cause de la plus fréquente d'hyperthyroïdie. Le tableau est dominé par les manifestations cliniques liées à l'hyper m

["Les Impatients": expression through art].

PubMed

Lamontagne, Céline; Palardy, Lorraine

2015-01-01

The organization called "Les Impatients" was founded in 1992. Using a unique model, Les Impatients welcomes those with mental health issues who would like to express themselves through art. Les Impatients offers free creative workshops and encourages exchanges with the community through the sharing of its participants' creations. The name Les Impatients reinforces the idea that the organization does not consider those attending its workshops as patients, but rather creators who are eager to heal, develop their craft and find their place in society. The participants contribute to the collective objective of breaking down the stigma that surrounds mental illness.Les Impatients collaborates with various mental health organizations in Quebec, such as the Institut universitaire en santé mentale de Montréal (IUSMM) affiliated to the Université de Montréal, Douglas Mental Health University Institute (DMHUI), the Centre de santé et services sociaux Drummond (CSSS Drummond) and the Centre de santé et services sociaux Pierre-Boucher (CSSS Pierre-Boucher). Les Impatients offers more than 48 workshops in eight different locations to around 450 participants each week.Dissemination activities, remarkable events, original projects: Les Impatients stands out through its realizations. Examples are exhibitions, collections of love letters, comic books, CD, concerts, and reading nights. The organization's originality resides in the exploration of the links between the work of the participants and that of professional artists. An illustration of this interest is the annual Parle-moi d'amour auction-exhibition, which has been one of Les Impatients' major events since 1999.As part of its mission, Les Impatients conserves the works of art created by the participants during the workshops. Its collection includes more than 15,000 works of art from Les Impatients as well as pieces donated by collectors of unconventional art, commonly known as "art brut" or "outsider art". The

Analyse de la prise en charge du nouveau-né dans le cadre de la stratégie nationale de subvention des accouchements et des soins obstétricaux et néonatals d'urgence au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou (Burkina Faso)

PubMed Central

Ouédraogo, Solange Odile Yugbaré; Yougbaré, Nestor; Kouéta, Fla; Dao; Ouédraogo, Moussa; Lougué, Claudine; Ludovic, Kam; Traoré, Ramata Ouédraogo; Yé, Diarra

2015-01-01

Introduction Il s'agit d'analyser la prise en charge du nouveau-né dans le cadre de la stratégie na-tionale de subvention des accouchements et des soins obstétricaux et néonatals d'urgence mis en place par le gouvernement du Burkina Faso en 2006. Méthodes Nous avons menée une étude à visée descriptive et analytique comportant un volet ré-trospectif du 01 janvier 2006 au 31 décembre 2010 portant sur les paramètres épidémiologiques, cliniques des nouveau-nés hospitalisés et un volet prospectif du 3 octobre 2011 au 29 février 2012 par une entrevue des accompagnateurs des nouveau-nés et des prestataires des services de santé. Résultats Les hospitalisations ont augmenté de 43,65% entre 2006 à 2010 Le taux de mortalité néo-natale hospitalière qui était de 11,04% a connu une réduction moyenne annuelle de 3,95%. L'entrevue a porté sur 110 accompagnateurs et 76 prestataires. La majorité des prestataires (97,44%) et des ac-compagnateurs (88,18%) étaient informés de la stratégie mais n'avait pas une connaissance exacte de sa définition. Les prestataires (94,74%) ont signalé des ruptures de médicaments, consommables médicaux et des pannes d’ appareils de laboratoire et d'imagerie. Parmi les accompagnateurs (89%) disaient être satisfaits des services offerts et (72,89%) trouvaient les coûts abordables mais évoquaient les difficultés du transport. Conclusion: La subvention a amélioré la prise en charge du nou-veau-né mais son optimisation nécessiterait une meilleur information et implication de tous les acteurs. Conclusion La subvention a amélioré la prise en charge du nouveau-né mais son optimisation nécessiterait une meilleur information et implication de tous les acteurs. PMID:26161166

[Life conditions of Togolese doctors].

PubMed

Koffi-Tessio, Annick Viwalé; Oniankitan, Owonayo; Mijiyawa, Moustafa

2010-09-01

A study has been carried out by Togolese medical doctors in order to determine the perceived and the real life of their profession. The study, which was transversal, has taken in account a sample of 52 medical doctors made on the basis of a cautious choice. Most of these medical doctors (15 general practitioners, 23 specialists and 14 hospitalo-universitaires) work in the medical cares centres of Lomé. A sheet of survey has permitted the collection of demographic data and data relating to the medical studies and career. The 52 medical doctors included in the study (7 women, 45 men) were between 25 and 59 years old; their age of getting their A-level was between 16 and 23 years old, and that of getting the doctorate diploma between 24 and 37. The length of professional experience stands between 8 months and 27 years. The marital status was specified by 47 of the 52 medical doctors: 13 single, one divorced, and 33 married; 5 of the 7 women who took part in the survey were single and without any child. The love of the profession (65%), the social status it confers (37%) and the honour tied to the profession (27%) were the main motives of choosing the profession. The decision of doing medical studies was taken during secondary studies by 45 of the 52 persons. The faculty of medicine of Lomé has been the study frame to general medicine studies of 35 persons (67%). The low payment (83%), the poverty of the patients (83%), the narrowness of the technical platform (79%), the insufficiency of cares structures in paramedical personnel (67%), the insufficiency of continuing education (60%), and the lack or insufficiency of drugs (58%) were the main problems encountered during their professional experience by the people questioned. 22 medical doctors (43%) have estimated that their profession has given them a particular social status. Only 8 medical doctors have found that the real things they have gone trough in the profession matches with the idea they had, while 32 (62

Resumes de texte en langue maternelle et en langue seconde: Differences dans l'application des macroregles entre experts et etudiants de differents niveaux universitaires (Test Summaries in the Mother Tongue and in a Second Language: Differences in the Application of Macrorules between Experts and University Students of Various Levels).

ERIC Educational Resources Information Center

Corbeil, Giselle

2001-01-01

Analyzes differences between experts and university students of various academic levels in the application of the macrorules of deletion, generalization, and construction of text summaries. Learners of French as a second language wrote summaries of a French text in French as well as in English, their mother tongue, while professors of French and…

[POSTRESUSCITATION CICATRICIAL TRACHEAL STENOSIS. CURRENT STATE OF THE PROBLEM - THE SUCCESSES, THE HOPES AND DISAPPOINTMENTS.

PubMed

Parshin, V D; Vyzhigina, M A; Rusakov, M A; Parshin, V V; Titov, V A; Starostin, A V

2016-09-01

, the principle of "every patient his own version of operation" allows to minimize the risk oftreatment and to get a good lasting result. Proof of such provision may be the fact that the frequency of complications and postoperative mortality at our patients have had a tendency to decrease and currently stands at 12.9 and 0.7 %, respectively for many years. It is 2.3 and 9.6 times less, respectively, than in the periodfrom 1963 to 2000. It appears that further reduction of these indicators will be at a slower pace, afurther solution of the CTS problem will be based on the prevention of disease. Prevention of cicatricial tracheal stenosis in the departments of reanimation and intensive care is currently inadequate. It requires fundamentally new approaches, but reform still has not brought the desired results. Diagnosis of the CTS at an early stage allows early treatment and to avoid complex and risky operations. Increasingly important, apart tracheoscopy for diagnosis of tracheomalacia purchase dynamic computed tomography and magnetic resonance - tomography. Treatment ofpatients with CTS requires a multidisciplinary approach, individual selection operations for a particular patient. The general trend of the further development of tracheal surgery is associated with an increase in the number of simultaneous resections, including at the long, two-level stenosis, as well as at relapse. The patients who had refused treatment or have elected him palliative options made possible surgery. The frequency of postoperative comnlications and mortality decreased significantiv, including after extensive and traumatic operations on the trachea.

EDITORIAL: Special issue containing contributions from the 39th Neural Interfaces Conference Special issue containing contributions from the 39th Neural Interfaces Conference

NASA Astrophysics Data System (ADS)

Weiland, James D.

2011-07-01

Implantable neural interfaces provide substantial benefits to individuals with neurological disorders. That was the unequivocal message delivered by speaker after speaker from the podium of the 39th Neural Interfaces Conference (NIC2010) held in Long Beach, California, in June 2010. Giving benefit to patients is the most important measure for any biomedical technology, and myriad presentations at NIC2010 made clear that implantable neurostimulation technology has achieved this goal. Cochlear implants allow deaf people to communicate through speech. Deep brain stimulators give back mobility and dexterity necessary for so many daily tasks that are often taken for granted. Chronic pain can be alleviated through spinal cord stimulation. Motor prosthesis systems have been demonstrated in humans, through both reanimation of paralyzed limbs and neural control of robotic arms. Earlier this year, a retinal prosthesis was approved for sale in Europe, providing some hope for the blind. In sum, current clinical implants have been tremendously beneficial for today's patients and experimental systems that will be translated to the clinic promise to expand the number of people helped through bioelectronic therapies. Yet there are significant opportunities for improvement. For sensory prostheses, patients report an artificial sensation, clearly different from the natural sensation they remember. Neuromodulation systems, such as deep brain stimulation and pain stimulators, often have side effects that are tolerated as long as the side effects are less impactful than the disease. The papers published in the special issue from NIC2010 reflect the maturing and expanding field of neural interfaces. Our field has moved past proof-of-principle demonstrations and is now focusing on proving the longevity required for clinical implementation of new devices, extending existing approaches to new diseases and improving current devices for better outcomes. Closed-loop neuromodulation is a

Expression of adhesion and extracellular matrix genes in human blastocysts upon attachment in a 2D co-culture system.

PubMed

Aberkane, A; Essahib, W; Spits, C; De Paepe, C; Sermon, K; Adriaenssens, T; Mackens, S; Tournaye, H; Brosens, J J; Van de, Velde H

2018-05-26

level in firmly attached 7dpf embryos. Thrombospondin 1 (THBS1) resided in the cytoplasm of embryonic cells whereas laminin subunit alpha 3 (LAMA3) and tenascin C (TNC) were expressed on the cell surface of trophectoderm cells. Incubation with a neutralizing TNC antibody did not affect the rate of embryo attachment or hCG secretion. None. This in-vitro study made use of an endometrial adenocarcinoma cell line to mimic receptive luminal epithelium. Also, the number of embryos was limited. Contamination of recovered embryos with Ishikawa cells was unlikely based on their differential gene expression profiles. Taken together, we provide a 'proof of concept' that initiation of the implantation process coincides with the induction of specific embryonic genes. Genome-wide expression profiling of a larger sample set may provide insights into the molecular embryonic pathways underlying successful or failed implantation. A.A. was supported by a grant from the "Instituut voor Innovatie door Wetenschap en Technologie" (IWT, 121716, Flanders, Belgium). This work was supported by the "Wetenschappelijk Fonds Willy Gepts" (WFWG G142 and G170, Universitair Ziekenhuis Brussel). The authors declare no conflict of interest.

Evénements indésirables peropératoire: lecture critique du registre du bloc opératoire de l’hôpital militaire Moulay Ismail Meknès

PubMed Central

Kechna, Hicham; Ouzzad, Omar; Chkoura, Khalid; Loutid, Jaouad; Hachimi, Moulay Ahmed; Hanafi, Sidi Mohamed

2016-01-01

Introduction Malgré les importants progrès qui ont été faits dans le domaine de la sécurité en anesthésie, la morbidité (grave ou non, liée complètement ou partiellement à l’anesthésie) reste cependant fréquente, et aucun praticien n’est aujourd’hui à l’abri d’un accident. Dans le contexte actuel où la priorité est donnée à la formation, à l’amélioration de la qualité et de la sécurité des soins, la survenue d’un accident d’anesthésie au bloc opératoire est un événement extrêmement traumatisant. La crainte de poursuite, le contexte émotionnel rendent cette gestion parfois très difficile. Pour cette raison, elle doit faire l’objet d’une codification, à la manière des protocoles de bloc, avec trois grands axes de gestion: le patient victime, le personnel médical et paramédical impliqué et l’analyse de l’incident pour éviter une récidive. Méthodes Dans un but d’améliorer les soins prodigués au bloc opératoire nous avons établi un registre où sont consignés continuellement les différents incidents et accidents survenu soit en salle opératoire ou en salle de surveillance post interventionnelle. Une première lecture a été faite à l’occasion des Journées d'Enseignement Post Universitaire (JEPU) de Fès (Maroc) organisées en partenariat avec les JEPU de la Pitié salpêtrière de Paris à la faculté de Médecine et de Pharmacie de Fès sous le thème: «Les Situations Critiques Au Bloc Opératoire» les 17 et 18 Avril 2015. Résultats 1761 patients ont été admis aux différentes salles du bloc opératoire dont 96 en salle d’endoscopie et 17 sédations en radiologie. 29 patients (1.64%) ont présentés un incident et/ou un accident en péri opératoire. La plupart des effets indésirables sont survenus en per opératoire (58,6%). Dans 28,6% des cas en postopératoire immédiat ou en salle de surveillance post interventionnelle (SSPI). La plupart des complications survenues sont d�

[Validation of a sport injury locus of control scale].

PubMed

Paquet, Y

2008-04-01

In the area of health psychology, locus of control (LOC) [Psychol Monogr 80 (1966) 1-28] has consistently been considered as a dimension of personality which may entail many potential benefits for the individual. Originally, the LOC by Rotter [Psychol Monogr 80 (1966) 1-28] is a unidimensional concept. He defines: on one hand individuals with an internal LOC who establish a link between their behavior and the reinforcement obtained, and on the other hand, individuals with an external LOC who do not establish any link between their behavior and the reinforcement obtained. However, since Rotter, other authors like Levenson [Distinctions within the concept of internal-external control: development of a new scale. In: Proceedings of the 80th annual convention of the American psychological association. 1972. p. 261-2] have claimed a multidimensional concept with three factors: the internal (I), powerful other (P), and chance (C). The MHLCS was constructed with three factors, according to Levenson's model. Numerous scales have been designed in order to assess health-related LOC. The most widely used is the MHLCS [Health Educ Monogr 6 (1978) 160-170]. According to Lecocq [La réhabilitation après la blessure. In: Manuel de psychologie du sport : l'intervention auprès du sportif. Paris: Revue EPS; 2003. p. 377-402], such a multidimensional view would allow in-depth examinations of sport injuries. Indeed, from a theoretical perspective, sport participants with high LOC ratings are assumed to suffer less frequent injuries than those scoring low on this dimension. The purpose of the present paper is to present an adapted version of the MHLCS in French language. For Bruchon-Schweitzer [Bruchon-Schweitzer M, Dantzer R. Introduction à la psychologie de la santé. Paris: Presses universitaires de France; 1994], the three factors (I, P, and C) are independent or a little intercorrelated. Therefore, two models of sport injury LOC scale have been studied: the first with three

Legitimizing Security in the Ivory Tower: Canadian University Corporate Security Services' Public Quest for Legitimacy.

PubMed

Wilkinson, Blair

2016-05-01

This article examines how university corporate security (UCS) services engage in legitimation work in their attempts to make their university communities (i.e., faculty, staff, students) and political masters (i.e., university administrators, boards of governors, senators) believe that they are honest, trustworthy, and caring and have authority that should be deferred to. This is accomplished through the analysis of interview and observational data collected as part of a research project exploring UCS services at five Canadian universities and an examination of how UCS services at 14 Canadian universities communicate using the social media service Twitter. These UCS services were found to primarily use Twitter for the purposes of soliciting or requesting information and for networking. In communicating through Twitter, UCS services engage in public legitimation work in which they make claims about and attempt to demonstrate their expertise, authority, and accountability. This article argues that both UCS services' particular legitimacy problem (i.e., their possession of both private and public attributes) and the interactive nature of public legitimation work create tensions that may serve to disrupt UCS services' ability to attain legitimacy. Cet article examine la manière dont les services de sécurité d'entreprise à l'université (SEU) s'engagent à légitimer leurs tentatives de persuader leurs communautés universitaires (c'est-à-dire le corps professoral, le personnel et les étudiants) ainsi que la haute administration (c'est-à-dire les administrateurs de l'université, le conseil des gouverneurs et les sénateurs) qu'ils sont honnêtes, attentifs, dignes de confiance, et qu'ils possèdent un niveau d'autorité auquel quiconque devrait se référer. Ceci sera accompli en analysant un corpus d'entrevues et d'observations dans le cadre d'un projet de recherche examinant les services de type SEU dans cinq universités canadiennes, ainsi qu'une étude sur

Neural correlates of consciousness in patients who have emerged from a minimally conscious state: a cross-sectional multimodal imaging study.

PubMed

Di Perri, Carol; Bahri, Mohamed Ali; Amico, Enrico; Thibaut, Aurore; Heine, Lizette; Antonopoulos, Georgios; Charland-Verville, Vanessa; Wannez, Sarah; Gomez, Francisco; Hustinx, Roland; Tshibanda, Luaba; Demertzi, Athena; Soddu, Andrea; Laureys, Steven

2016-07-01

Between pathologically impaired consciousness and normal consciousness exists a scarcely researched transition zone, referred to as emergence from minimally conscious state, in which patients regain the capacity for functional communication, object use, or both. We investigated neural correlates of consciousness in these patients compared with patients with disorders of consciousness and healthy controls, by multimodal imaging. In this cross-sectional, multimodal imaging study, patients with unresponsive wakefulness syndrome, patients in a minimally conscious state, and patients who had emerged from a minimally conscious state, diagnosed with the Coma Recovery Scale-Revised, were recruited from the neurology department of the Centre Hospitalier Universitaire de Liège, Belgium. Key exclusion criteria were neuroimaging examination in an acute state, sedation or anaesthesia during scanning, large focal brain damage, motion parameters of more than 3 mm in translation and 3° in rotation, and suboptimal segmentation and normalisation. We acquired resting state functional and structural MRI data and (18)F-fluorodeoxyglucose (FDG) PET data; we used seed-based functional MRI (fMRI) analysis to investigate positive default mode network connectivity (within-network correlations) and negative default mode network connectivity (between-network anticorrelations). We correlated FDG-PET brain metabolism with fMRI connectivity. We used voxel-based morphometry to test the effect of anatomical deformations on functional connectivity. We recruited a convenience sample of 58 patients (21 [36%] with unresponsive wakefulness syndrome, 24 [41%] in a minimally conscious state, and 13 [22%] who had emerged from a minimally conscious state) and 35 healthy controls between Oct 1, 2009, and Oct 31, 2014. We detected consciousness-level-dependent increases (from unresponsive wakefulness syndrome, minimally conscious state, emergence from minimally conscious state, to healthy controls) for

[Issues, dilemmas and managerial strategies of potential ethical risks associated with the implementation of patient partnership practices in psychiatry: a case study].

PubMed

Lierville, Anne-Lise; Grou, Christine; Pelletier, Jean-François

2015-01-01

In terms of health and social services, the territory of the province of Quebec is covered by four large 'integrated university health networks,' which are involved in the coordination of care delivery and medical training. The francophone components of the public mental health system for Montreal are thus primarily linked to the Integrated University Health Network of University of Montreal. In 2010, the Faculty of Medicine of the University of Montreal has included in its development strategy a firm commitment to the development and implementation of the 'patient partner expertise' in research, training and care in order to make this expertise no less than the brand of the Faculty. This commitment applies to all medical specialties that are taught at University of Montreal, including in psychiatry. More recently, the Institut universitaire en santé mentale de Montréal (IUSMM) has endorsed a new clinical vision that promotes full citizenship, which implies that service users and carers are considered as full partners with a specific expertise to be fully deployed. The objective of this paper is to examine, from an ethical point of view, the challenges that may be associated with involving such lay persons in various levels of mental health care planning and delivery, and in research. This study is mainly based on a review of the institutional processes that are in place at the IUSMM to promote service users' participation in care planning and delivery, and in research. The focus is on the practicalities and conditions for the exercise of such an active participation, as some questions and concerns emerged through a series of interviews with different stakeholders. These issues are addressed and discussed through the lenses of the ethical values that were formalized at IUSMM. Despite a firm institutional commitment at IUSMM to implement its new citizenship-oriented clinical vision through greater service users' involvement, little is known about the possible

Detection and estimation trends linked to air quality and mortality on French Riviera over the 1990-2005 period to develop a prediction model of an aggregate risk index

NASA Astrophysics Data System (ADS)

Sicard, P.; Mangin, A.; Hebel, P.; Lesne, O.; Malléa, P.

2009-04-01

There is a profound relation between human health and well being from the one side and air pollution levels from the other. Air quality in South of France and more specifically in Nice, is known to be bad, especially in summer. The main objectives are to establish correlations between air pollution, exposure of people and reactivity of these people to this aggression, to validate a risk index built from air quality and pollen data in the area of Nice and to construct a prediction model of this sanitary index. The spatial extent of the experiment will be mainly the territory of "Alpes Maritimes". All the tasks are performed in collaboration with the "Heath-Environment Network" of the "Centre Hospitalier Universitaire" of Nice. The development of an adequate tool for observation (health index and/or indices per pathology) to understand impacts of pollution levels in an area is of utmost importance. These indexes should take into account the possible adverse effects associated with the coexistence of all the pollutants and environmental parameters. This tool must be able to inform the citizens about the levels of pollution in an adequate and understandable way but also to be used by relevant authorities to take a series of predetermined measures to protect the health of the population. This paper describes the first step to construct a prediction model of this sanitary index with a confidence interval 99% (and 95%): detection and estimation trends observed in concentrations of pollutants, emissions and mortality over the 1990-2005 period in the "Alpes Maritimes" area. The non-parametric Mann-Kendall test has been developed for detecting and estimating monotonic trends in the time series and applied in our study at annual values of pollutants air concentrations. An important objective of many environmental monitoring programs is to detect changes or trends in pollution levels over time. Over the period 1990-2005, concerning the emissions of the main pollutants, we

[History of the department of Psychiatry at the University of Montreal].

PubMed

Stip, Emmanuel

2015-01-01

In its current form, the Département de psychiatrie at the Université de Montréal (UdeM) was created in 1964. The first person to have headed was Dr. Gerard Beaudoin… Between 1948 and 1964, several others psychiatrists were heading the Département without necessary bearing a particular title.The directors of the Département from 1951 to now were: Drs. Fernand Côté, Camille Laurin, Gerard Beaudoin, Yvon Gauthier, Arthur Amyot, Francis Borgeat, Hugues Cormier, Sylvain Palardy, Jean Hébert, and Emmanuel Stip.When the Département opened, it was the second institution in Montréal that was training psychiatrists. During the first year, there were 3 psychiatric residents, but within 20 years this number had increased to 63. From the early years, teaching psychiatry to residents, and subsequently to all UdeM medical students, has been a priority in the Département, and over the years many psychiatrists trained at UdeM have attained leadership positions elsewhere. The Département attained an early reputation for excellence in both clinical and basic research.The strengths the Département developed in its early years in clinical psychopharmacology, in basic research in neurotransmitters, sleep, cognition, forensic, and in community psychiatry have been augmented more recently with active programs in psychotherapy research, substance abuse research, psychoneuroendocrinology, developmental aspects of behavior, genetics, epigenetics as well as the study of the brain through a variety of brain scanning techniques.The history of the Département de psychiatrie de l'Université de Montréal is largely dependent on that of each of the institutions affiliated to the Université: the Pavillon Albert-Prévost de l'Hôpital du Sacré-Coeur de Montréal (HSCM), the Institut universitaire en santé mentale de Montréal (IUSMM) and the CHU Sainte-Justine. We must also remember that the discovery of the potentiating of lithium by antidepressants was made by Dr. Demontigny

Les complications tardives de prothèse totale de la hanche: à propos de 42 cas

PubMed Central

Azarkane, Mohamed; Boussakri, Hassan; Shimi, Mohamed; Elibrahimi, Abdlehalim; Elmrini, Abdlemeji

2013-01-01

luxation tardive de PTH. Comme facteur de risque dans notre série nous avons trouvé le sexe féminin et le surpoids. Sur le plan technique la malposition de cotyle a été constituée l'étiologie principale avec 4 cas. Nous avons traité les cas de luxation par réduction simple avec traction dans 3 cas et une reprise chirurgicale pour corriger la malposition de cotyle dans 4 cas. Nos résultats sont comparables avec ceux de la littérature. Selon les résultats de la littérature le descellement aseptique constitue la complication la plus fréquente. Pour traiter cette complication les 2 modalités la plus fréquemment utilisées dans a littérature sont la reprise avec des greffes et anneaux de reconstruction ou fixer la nouvelle cupule sur os sain de néocotyle créé par descellement. Le résultat de la littérature objective aussi la responsabilité de staphylococcus comme agent causal la plus fréquent. Il montre également l'efficacité de traitement chirurgical par réimplantation de la prothèse en un seul ou en 2 temps. L'étude de la littérature objective aussi que La prise en charge des fractures sur PTH est difficile en raison de l'âge souvent avancé et de la fragilité des patients, de l'ostéoporose, et de la menace que ces fractures font peser sur la fixation de la prothèse parfois déjà défaillante. Les complications tardives de PTH sont fréquentes et sont causes de reprises de chirurgie prothétique et rendent leur prise en charge très difficile. Elles peuvent transformer les légitimes espoirs fonctionnels en catastrophe invalidante. PMID:23503704

Improvement of the knowledge in the historical coastal hazards in Brittany by combining archives and geoindicators

NASA Astrophysics Data System (ADS)

Hénaff, A.; Van Vliet-Lanoë, B.; Le Cornec, E.

2012-04-01

'inventaire des événements les plus récents pour lesquels on dispose d'observations directes et de mesures. Afin d'améliorer la connaissance historique des aléas littoraux sur les rivages de la Bretagne, deux types de données sont collectés. Il s'agit d'indicateurs indirects susceptibles de rendre compte des évolutions spatiales et temporelles des conditions météo-marines sur la période historique. Le premier type consiste en un inventaire des dommages générés par les tempêtes sur les littoraux bretons depuis le début du XXe siècle. Cet inventaire construit à partir du dépouillement des journaux locaux, des documents universitaires et des données d'archives ; il a permis de constituer une base de données géoréférencées. Il permet de suivre les évolutions de la distribution spatiale et temporelle des impacts des tempêtes. Le second type consiste en l'enregistrement par des géo-indicateurs naturels que constituent les accumulations littorales en queues de comète dont l'orientation est déterminée par les directions moyennes des houles parvenant sur les rivages. L'évolution de leurs orientations dans le temps et de, manière indirecte, celle de l'orientations des houles est suivi à l'aide des photographies aériennes ainsi que des cartes actuelles et anciennes. L'utilisation conjointe de ces deux types de données permet d'améliorer les connaissances des aléas et des forçages naturels affectant les littoraux à l'échelle régionale.

Depression, pregnancy-related anxiety and parental-antenatal attachment in couples using preimplantation genetic diagnosis.

PubMed

Winter, C; Van Acker, F; Bonduelle, M; Van Berkel, K; Belva, F; Liebaers, I; Nekkebroeck, J

2016-06-01

Do preimplantation genetic diagnosis (PGD) couples experience higher levels of stress during pregnancy and the perinatal period compared with couples who conceive spontaneously (SC) or with ICSI? PGD couples did not experience more psychological stress during pregnancy and beyond than ICSI or SC couples. Previous studies have shown that assisted reproduction technology (ART) couples are more prone to pregnancy-related anxieties than SC couples, but display depressed feelings to an equal or lesser extent. However, only one study has focused on a female PGD sample, which may be a more vulnerable group than other ART groups, due to the potentially complex hereditary background, adverse childhood experiences and losses. In that study, PGD women experienced a reduction in state anxiety, and maternal-antenatal attachment did not differ from normative data. Unfortunately, no data exist on pregnancy-related anxiety, depression and parental-antenatal attachment. Valuable information from both parents (e.g.: couples) is also lacking. For this longitudinal prospective study questionnaire, data from 185 women and 157 men (157 couples) were collected between February 2012 until April 2014. Data were analysed using multilevel analysis. The couples conceiving after PGD, ICSI or SC were followed from the first trimester of the pregnancy until the third month post-partum. A total of 60 PGD, 58 ICSI and 69 SC couples were initially recruited by various departments of Universitair Ziekenhuis Brussel (UZ Brussel). At each trimester (T1: 12-14 weeks, T2: 20-22 weeks, T3: 30-32 weeks) of pregnancy, depression (EPDS), pregnancy-related anxieties (PRAQ) and parental-antenatal attachment (M/PAAS) were recorded. At T4 (3 months post-partum), depression (EPDS) was assessed again. In the first trimester (T1) broad socio-demographic data and at T4 perinatal health data of both mother and child were recorded. Differences between conception groups over time were analysed using multilevel

Fertility preservation in the male pediatric population: factors influencing the decision of parents and children.

PubMed

Wyns, C; Collienne, C; Shenfield, F; Robert, A; Laurent, P; Roegiers, L; Brichard, B

2015-09-01

ethics board before being sent. Of the 348 eligible patients, 44 died and 14 were lost to follow-up. Thus, 290 patients (77 aged 12-18 years and 213 aged <12 years) were sent a questionnaire. In total, 120 questionnaires were recovered, 45.5% (n = 35/77) from adolescents and 39.9% (n = 85/213) from children. FP acceptance rates were, respectively, 74 and 78.6% for boys aged <12 and 12-18 years. The content of information provided to patients and parents appeared to positively impact on the decision to preserve fertility (P = 0.04). While the majority of boys aged >12 years considered the information to be clear (72%), complete (80%) and understandable (90.9%), only 33.3% of boys aged <12 years were able to comprehend the information. Pressure from doctors to reduce the delay between diagnosis and cancer treatment increased the number of refusals (P<0.01), while hope for future parenthood favored acceptance (P < 0.01). Family support was considered important for 75% of adolescents and 58% of children, and medical support for 50% of adolescents and 42% of children. This single-center survey does not allow extrapolation of the information to other settings. Recall bias and lack of full external validation of the questionnaires are further limitations. Modification of the current MCCP should be further evaluated according to our results. Acknowledging the issues faced and familiarizing oneself with the care of patients undergoing fertility-threatening therapies supply primary care providers with the appropriate quality management tools in the field of FP in centers for reproductive medicine. Expectations reported in the survey allow appropriate support to be included within the MCCP design. Funding by hospital/clinic(s); Cliniques Universitaires Saint Luc, Brussels, Belgium. The authors have no conflict of interest to declare. NCT02411214. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All

Knowledge, attitude, and experience of cervical cancer and screening among Sub-saharan African female students in a UK University.

PubMed

Ogbonna, Faith Sopuruchukwu

2017-01-01

�té négligé dans les pays en développement en raison du manque de connaissances, d'idées fausses et de croyances culturelles. Matériel et Méthodes: Une étude transversale impliquant seulement des étudiantes d'Afrique subsaharienne (SSA) dans un université britannique. Résultats: Cent quatre-vingt-six (42%) étudiantes africaines ont été recrutées parmi les 442 étudiants SSA fréquentant l'une des plus grandes universités du Royaume-Uni. Soixante et onze (38,2%) des étudiants étaient au courant du dépistage du cancer du col, mais seulement 20 (10,8%) ont déclaré avoir une connaissance du cancer du col de l'utérus. Un faible pourcentage d'environ 26,9% (50 étudiants)Font déjà partie de ce programme de dépistage; 81 (43,5%) se sont montrés disposés à participer à de futurs programmes de dépistage. De plus, il était évident que la perception des étudiants dépendait de leur expérience de la maladie (P = 000), tout comme leur participation au programme de dépistage dépendait de leur niveau de sensibilisation (P ≤ 0,01). Les étudiantes africaines de la région de l'Afrique subsaharienne connaissent mal la maladie et ont influencé leur attitude envers le dépistage. Davantage de mesures doivent être prises pour accroître la sensibilisation et l'adoption du dépistage dans l'environnement scolaire, car le cadre universitaire constitue une plate-forme viable pour promouvoir un comportement sain.

Cirque du Monde en tant qu’intervention en santé

PubMed Central

Fournier, Cynthia; Drouin, Mélodie-Anne; Marcoux, Jérémie; Garel, Patricia; Bochud, Emmanuel; Théberge, Julie; Aubertin, Patrice; Favreau, Gil; Fleet, Richard

2014-01-01

faciliter la réintégration sociale de jeunes traités en milieu hospitalier pour un trouble psychiatrique majeur a été répertorié. L’équipe du département de pédopsychiatrie du Centre hospitalier universitaire Sainte-Justine responsable de ce projet nommé Espace Transition a été contactée. Des résultats préliminaires non publiés du projet pilote montrent des améliorations significatives du fonctionnement général des patients. Selon le Cirque du Soleil, plusieurs projets de recherche portant sur l’impact thérapeutique du cirque social sont en cours à travers le monde. Conclusion Cirque du Monde rejoint une clientèle marginalisée difficilement accessible par le système de santé. Ce programme revêt un potentiel thérapeutique de par sa clientèle cible, sa promotion de saines habitudes de vie et le soutien qu’il offre par l’intermédiaire du groupe et des intervenants. Compte tenu des investissements financiers importants du Cirque du Soleil dans ce projet, le manque de littérature donnant accès à des données probantes constitue un enjeu important.

Psychosocial development of full term singletons, born after preimplantation genetic diagnosis (PGD) at preschool age and family functioning: a prospective case-controlled study and multi-informant approach.

PubMed

Winter, C; Van Acker, F; Bonduelle, M; Desmyttere, S; Nekkebroeck, J

2015-05-01

Do full term singletons born after preimplantation genetic diagnosis (PGD) differ in their psychosocial functioning from children born after intracytoplasmic sperm injection (ICSI) and spontaneous conceived controls (SC)? The psychosocial maturation process of 5-6-year-old PGD children is comparable between the three conception groups (PGD, ICSI and SC). In general, a lot of research has been published regarding follow-up of children born after artificial reproductive technologies (ART), which mainly is reassuring. But the ART population itself is marked by broad diversity [IVF, ICSI, gamete donation, preimplantation genetic screening (PGS) or PGD] which complicates comparisons. Some literature concerning the socio-emotional development of PGD/PGS children is available and it suggests a normal maturation process. However, the complex reality of PGD families (e.g. safety of the technique and psychological burden of genetic histories) asks for an exclusive PGD sample with matched control groups and a multi-informant approach. Between April 2011 and May 2013, the psychosocial wellbeing of preschoolers and their families born after PGD was assessed in a prospective case-controlled, matched follow-up study, with a multi-informant approach. A group of 47 PGD, 50 ICSI and 55 SC 5-6-year-old children participated in a follow-up study performed at the Centre for Medical Genetics of the Universitair Ziekenhuis Brussel (UZ Brussel). Assessments took place in the hospital and in kindergartens. Children performed the Bene-Anthony family relations test (FRT), yielding their perceptions upon family relationships. Parents and teachers completed the child behaviour checklist (CBCL) and Caregiver Teacher Report Form (C-/TRF), respectively. Parental and family functioning were measured by the NEO-FFi, the parenting stress index (PSI), the Greenberger Work-Parenting Investment Questionnaire and the Marlowe-Crowne Social Desirability Scale (MCSDS). Statistical analysis was performed by

Cognitive and neuroimaging features and brain β-amyloidosis in individuals at risk of Alzheimer's disease (INSIGHT-preAD): a longitudinal observational study.

PubMed

Dubois, Bruno; Epelbaum, Stephane; Nyasse, Francis; Bakardjian, Hovagim; Gagliardi, Geoffroy; Uspenskaya, Olga; Houot, Marion; Lista, Simone; Cacciamani, Federica; Potier, Marie-Claude; Bertrand, Anne; Lamari, Foudil; Benali, Habib; Mangin, Jean-François; Colliot, Olivier; Genthon, Remy; Habert, Marie-Odile; Hampel, Harald

2018-04-01

� deposition and the remainder did not. The amyloid β subgroups did not differ for any psychobehavioural, cognitive, actigraphy, and structural and functional neuroimaging results after adjustment for age, sex, and level of education More participants positive for amyloid β deposition had the APOE ε4 allele (33 [38%] vs 29 [13%], p<0·0001). Amyloid β 1-42 concentration in CSF significantly correlated with mean 18 F-florbetapir uptake at baseline (r=-0·62, p<0·0001) and the ratio of amyloid β 1-42 to amyloid β 1-40 (r=-0·61, p<0·0001), and identified amyloid β deposition status with high accuracy (mean area under the curve values 0·89, 95% CI 0·80-0·98 and 0·84, 0·72-0·96, respectively). No difference was seen in MMSE (28·3 [SD 2·0] vs 28·9 [1·2], p=0·16) and Clinical Dementia Rating scores (0·06 [0·2] vs 0·05 [0·3]; p=0·79) at 30 months (n=274) between participants positive or negative for amyloid β. Four participants (all positive for amyloid β deposition at baseline) progressed to prodromal Alzheimer's disease. They were older than other participants positive for amyloid β deposition at baseline (mean 80·2 years [SD 4·1] vs 76·8 years [SD 3·4]) and had greater 18 F-florbetapir uptake at baseline (mean standard uptake value ratio 1·46 [SD 0·16] vs 1·02 [SD 0·20]), and more were carriers of the APOE ε4 allele (three [75%] of four vs 33 [39%] of 83). They also had mild executive dysfunction at baseline (mean FCSRT free recall score 21·25 [SD 2·75] vs 29·08 [5·44] and Frontal Assessment Battery total score 13·25 [1·50] vs 16·05 [1·68]). Brain β-amyloidosis alone did not predict progression to prodromal Alzheimer's disease within 30 months. Longer follow-up is needed to establish whether this finding remains consistent. Institut Hospitalo-Universitaire and Institut du Cerveau et de la Moelle Epinière (IHU-A-ICM), Ministry of Research, Fondation Plan Alzheimer, Pfizer, and Avid. Copyright © 2018 Elsevier Ltd. All rights reserved.

Reproductive hormones of ICSI-conceived young adult men: the first results.

PubMed

Belva, Florence; Roelants, Mathieu; De Schepper, Jean; Van Steirteghem, André; Tournaye, Herman; Bonduelle, Maryse

2017-02-01

, Serono Symposia and Merck. The Universitair Ziekenhuis Brussel (UZ Brussel) and the Centre for Medical Genetics have received several educational grants from IBSA, Ferring, Organon, Shering-Plough, Merck for establishing the database for follow-up research and organizing the data collection. The institution of HT receives research grants from the 'Research Fund of Flanders' (FWO), an unconditional grant from Ferring for research on testicular stem cells and research grants from Ferring, Merck, MSD, Roche, Besins, Goodlife and Cook for several research projects in female infertility. H.T. has received consultancy fees from Finox, Abbott and ObsEva for research projects in female infertility. N/A. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Semen quality of young adult ICSI offspring: the first results.

PubMed

Belva, F; Bonduelle, M; Roelants, M; Michielsen, D; Van Steirteghem, A; Verheyen, G; Tournaye, H

2016-12-01

, Serono Symposia and Merck. The Universitair Ziekenhuis Brussel (UZ Brussel) and the Centre for Medical Genetics have received several educational grants from IBSA, Ferring, Organon, Shering-Plough and Merck for establishing the database for follow-up research and organizing the data collection. The institution of H.T. has received research grants from the Research Fund of Flanders (FWO), an unconditional grant from Ferring for research on testicular stem cells and research grants from Ferring, Merck, MSD, Roche, Besins, Goodlife and Cook for several research projects in female infertility. H.T. has received consultancy fees from Finox, Abbott and ObsEva for research projects in female infertility. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Foreword

NASA Astrophysics Data System (ADS)

Aime, C.; Soummer, R.

This book reports the proceedings of the second Journées d'Imagerie grave{a} Très Haute Dynamique et Détection d'Exoplanètes (Days on High Contrast Imaging and Exoplanets Detection) that were held in Nice in October, 6-10, 2003 with the joint efforts of the Collège de France, the Observatoire de la Côte d'Azur, the CNRS (Centre National de la Recherche Scientifique) and the Laboratoire Universitaire d'Astrophysique de Nice which organized the meeting. The first Journées led to the publication of Volume 8, 2003 EAS Publications Series: Astronomy with High Contrast Imaging: From Planetary Systems to Active Galactic Nuclei that collected 33 papers presented during the session of May, 13-16, 2002. It covered a very large domain of research in high contrast imaging for exoplanet detection: astrophysical science (from protoplanetary disks to AGNs), instruments and techniques (from coronagraphy to nulling), data processing. These Journées took place because of the need of a working session giving enough time to the participants to explain their work and understand that of their colleagues. The second Journées took the form of an École thématique du CNRS. The courses were held in French, but the reports are in English. The present edition reports 29 courses and short presentations given at this occasion. The texts correspond to original presentations, and a few communications, too similar to those of 2002, were not reported here to avoid duplication. This makes the two books complementary. The general theme of the school was similar to that of the former meeting, with a marked teaching objective. The courses and presentations were also more centered in optics and instrumental techniques. The main idea was to study what we could call “exoplanetographs”, instruments using apodisation, coronagraphy, nulling or other techniques to directly record the light of an exoplanet. Fundamental aspects of signal processing were deferred to a third edition of the school. A

Groundwater contamination in the basement-complex area of Ile-Ife, southwestern Nigeria: A case study using the electrical-resistivity geophysical method

NASA Astrophysics Data System (ADS)

Adepelumi, A. A.; Ako, B. D.; Ajayi, T. R.

2001-11-01

Hydrogeoenvironmental studies were carried out at the sewage-disposal site of Obafemi Awolowo University campus, Ile-Ife, Nigeria. The objective of the survey was to determine the reliability of the electrical-resistivity method in mapping pollution plumes in a bedrock environment. Fifty stations were occupied with the ABEM SAS 300C Terrameter using the Wenner array. The electrical-resistivity data were interpreted by a computer-iteration technique. Water samples were collected at a depth of 5.0 m in 20 test pits and analyzed for quality. The concentrations of Cr, Cd, Pb, Zn, and Cu are moderately above the World Health Organization recommended guidelines. Plumes of contaminated water issuing from the sewage ponds were delineated. The geoelectric sections reveal four subsurface layers, with increasing depth, lateritic clay, clayey sand/sand, and weathered/fractured bedrock, and fresh bedrock. The deepest layers, 3 and 4, constitute the main aquifer, which has a thickness of 3.1-67.1 m. The distribution of the elements in the sewage effluent confirms a hydrological communication between the disposal ponds and groundwater. The groundwater is contaminated, as shown by sampling and the geophysical results. Thus, the results demonstrate the reliability of the direct-current electrical-resistivity geophysical method in sensing and mapping pollution plumes in a crystalline bedrock environment. Résumé. Des études géo-environnementales ont été réalisées sur le site d'épandages du campus universitaire d'Obafemi Awolowo, à Ile-Ife (Nigeria). L'objectif de ce travail était de déterminer la fiabilité de la méthode des résistivités électriques pour cartographier les panaches de pollution dans un environnement de socle. Cinquante stations ont été soumises à mesures au moyen d'un ABEM SAS 300C Terrameter en utilisant le dispositif de Wenner. Les données de résistivité électrique ont été interprétées au moyen d'une technique de calcul itérative. Des �

Chronic respiratory disease in adults treated for tuberculosis in Khartoum, Sudan.

PubMed

Osman, R K; Mortimer, K; Bjune, G; El Sony, A I

2016-09-01

Background: Chronic respiratory disease (CRD) causes substantial morbidity and mortality. Although the global CRD epidemic collides with the tuberculosis (TB) epidemic in many low- and middle-income country settings, the risk of TB-associated CRD is not well described in countries with a high burden of TB. Methods: We recruited 136 patients with a history of sputum smear-positive pulmonary TB (PTB) from the TB clinic at Omdurman Teaching Hospital in Khartoum, Sudan, and 136 age- and sex-matched community controls, between 28 July 2013 and 30 December 2013. Data were collected using standardised questionnaires and spirometry was performed before and after bronchodilator. Results: The mean age of the subjects with previous PTB and controls was respectively 44.0 years (SD 8.5) and 44.5 years (SD 8.6), with 27.2% females in both groups. Chronic respiratory symptoms such as chronic cough (OR 6.67, 95%CI 2.98-14.90, P < 0.001) and the presence of chronic airflow obstruction (OR 12.4, 95%CI 1.56-98.40, P = 0.02) were both strongly associated with a past history of PTB after adjusting for potential confounders. Conclusion: The clinical features of CRDs are strongly associated with past history of PTB. An integrated approach to improve the management of these common conditions should be considered. Contexte : Les maladies respiratoires chroniques (MRC) sont à l'origine d'une morbidité et d'une mortalité considérables dans le monde. Bien que l'épidémie mondiale des MRC entre en conflit avec l'épidémie de tuberculose (TB) dans de nombreux pays à revenu faible ou moyen, le risque de MRC associée à la TB n'est pas bien décrit dans les pays durement frappés par la TB. Méthodes : Nous avons recruté 136 patients ayant des antécédents de tuberculose pulmonaire (TBP) à frottis positif dans le service de pneumologie du Centre Hospitalier Universitaire Omdurman à Khartoum, Soudan, et 136 témoins de la communauté, appariés sur l'âge et le sexe, entre le 28

Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea

PubMed Central

Delamou, Alexandre; Diallo, Moustapha; Beavogui, Abdoul Habib; Delvaux, Thérèse; Millimono, Sita; Kourouma, Mamady; Beattie, Karen; Barone, Mark; Barry, Thierno Hamidou; Khogali, Mohamed; Edginton, Mary; Hinderaker, Sven Gudmund; Ruminjo, Joseph; Zhang, Wei-Hong; De Brouwere, Vincent

2015-01-01

ée. L'objectif de cet article est de présenter et de discuter les résultats cliniques de sept années de travail impliquant 2116 femmes traitées dans trois hôpitaux à travers le pays. Méthodes Il s'agit d'une étude de cohorte rétrospective utilisant des données extraites des dossiers médicaux de réparations de fistules menées de 2007 à 2013. Les données de l’étude ont été analysées au cours de la période allant d'avril à août 2014. Résultats La majorité des 2116 femmes qui ont subi une réparation chirurgicale avaient une fistule vésico vaginale (n = 2 045, 97%) et 3% avaient une fistule recto vaginale ou une combinaison des deux. Au total, 1748 (83%) femmes ont eu leur fistule refermée et sont devenues continentes d'urine immédiatement après la chirurgie. À la sortie, 1795 femmes (85%) avaient une fistule fermée et 1680 (79%) étaient sèches, c'est à dire qu'elles n'avaient plus de fuite d'urine et/ou de matières fécales. 115 (5%) femmes avaient toujours une incontinence résiduelle malgré la fermeture de la fistule. Le suivi à trois mois a été complété par 1663 (79%) femmes dont 1405 (84,5%) ont eu leur fistule fermée et 80% étaient continentes. 21% ont été perdues au suivi. Conclusion La réparation programmatique de routine de la fistule obstétricale dans les régions à faibles ressources peut donner de bons résultats. Toutefois, davantage d'efforts sont nécessaires pour remédier à la perte au suivi, maintenir les résultats et prévenir l'apparition et/ou la réapparition de fistules. Objetivos La fístula genital femenina continúa siendo una preocupación de salud pública en países en vías de desarrollo. Entre Enero 2007 y Septiembre 2013, el proyecto Fistula Care, manejado por EngenderHealth junto con el Ministerio de Salud de Guinea, y financiado por USAID, integró los servicios de reparación de fistula en las maternidades de hospitales generales en Guinea. El objetivo de este artículo es presentar y

Chronic respiratory disease in adults treated for tuberculosis in Khartoum, Sudan

PubMed Central

Mortimer, K.; Bjune, G.; El Sony, A. I.

2016-01-01

Background: Chronic respiratory disease (CRD) causes substantial morbidity and mortality. Although the global CRD epidemic collides with the tuberculosis (TB) epidemic in many low- and middle-income country settings, the risk of TB-associated CRD is not well described in countries with a high burden of TB. Methods: We recruited 136 patients with a history of sputum smear-positive pulmonary TB (PTB) from the TB clinic at Omdurman Teaching Hospital in Khartoum, Sudan, and 136 age- and sex-matched community controls, between 28 July 2013 and 30 December 2013. Data were collected using standardised questionnaires and spirometry was performed before and after bronchodilator. Results: The mean age of the subjects with previous PTB and controls was respectively 44.0 years (SD 8.5) and 44.5 years (SD 8.6), with 27.2% females in both groups. Chronic respiratory symptoms such as chronic cough (OR 6.67, 95%CI 2.98–14.90, P < 0.001) and the presence of chronic airflow obstruction (OR 12.4, 95%CI 1.56–98.40, P = 0.02) were both strongly associated with a past history of PTB after adjusting for potential confounders. Conclusion: The clinical features of CRDs are strongly associated with past history of PTB. An integrated approach to improve the management of these common conditions should be considered. Contexte : Les maladies respiratoires chroniques (MRC) sont à l'origine d'une morbidité et d'une mortalité considérables dans le monde. Bien que l'épidémie mondiale des MRC entre en conflit avec l'épidémie de tuberculose (TB) dans de nombreux pays à revenu faible ou moyen, le risque de MRC associée à la TB n'est pas bien décrit dans les pays durement frappés par la TB. Méthodes : Nous avons recruté 136 patients ayant des antécédents de tuberculose pulmonaire (TBP) à frottis positif dans le service de pneumologie du Centre Hospitalier Universitaire Omdurman à Khartoum, Soudan, et 136 témoins de la communauté, appariés sur l'âge et le sexe, entre le 28

Speaking, writing, and memory span in children: output modality affects cognitive performance.

PubMed

Grabowski, Joachim

2010-02-01

écrit chez les enfants sont cognitivement plus coûteux que ceux impliqués dans le langage parlé. Ceci a été démontré par des auteurs français qui ont comparé la performance de l'étendue de la mémoire orale et écrite. L'observation de difficultés dans les processus de bas niveau dans l'écriture chez les enfants, et non chez les adultes, pourrait être due aux inadéquations graphomotoriques et orthographiques. Nous rapportons cinq expérimentations dont le but était de répliquer et d'élargir les résultats originaux. Premièrement, les résultats français ont été répliqués avec succès pour les élèves allemands de troisième année et pour les étudiants universitaires. Ensuite, les changements développmentaux des coûts cognitifs de l'écriture ont été examinés à l'école primaire en comparant la performance des élèves de deuxième et de quatrième années. Par la suite, nous avons montré que les modes d'écriture non pratiqués qui étaient expérimentalement induits indiquent une diminution de la performance de la mémoire, chez les adults aussi, ce qui supporte la supposition qu'un manque d'automatisme graphomotorique est responsable des effets observés chez les enfants. Cependant, une écriture à la main sans entraînement mène à des résultats plus claires que la dactylographie sans entraînement. Enfin, nous avons tenté de séparer les influences des difficultés graphomotoriques versus difficultés orthographiques à travers la composition des mots en les indiquant sur un tableau d'ortographe. Cependant, cette tentative n'a pas réussi, probablement à cause du fait d'indiquer les lettres présente d'autres coûts dont le niveau est bas. En résumé, à travers les quatre années de l'école primaire, les enfants allemands montrent une pire performance de l'étendue de mémoire dans l'écriture, en comparaison au rappel oral, avec une augmentation globale dans les deux modalités. Ainsi, toujours à la fin de l

Are Japanese groups more competitive than Japanese individuals? A cross-cultural validation of the interindividual-intergroup discontinuity effect.

PubMed

Takemura, Kosuke; Yuki, Masaki

2007-02-01

Study of Cultural and Ecological Foundations of the Mind, a 21(st) Century Center of Excellence Program at Hokkaido University. The authors would like to thank Dr. Laura Hernández-Guzmán, three anonymous reviewers, and Robin Cooper, Mark H. B. Radford, and Paul A. Wehr for their helpful comments on earlier versions of this article. They would also like to thank Dr. Chester A. Insko for his kind and valuable advice during the planning of this experiment as well as the interpretation of its results, Kaori Akaishi for her help with data collection, and, finally, colleagues at Hokkaido University who helped to recruit potential participants from their classes. L'effet de discontinuité entre les individus et entre les groupes est la tendance des relations entre les groupes à être plus compétitives que les relations entre les individus. Cet effet fut fermement démontré dans des études menées aux États-Unis, une société caractérisée d' «individualiste». Dans la présente étude, nous avons exploré dans quelle mesure l'effet était applicable à une société «collectiviste» comme le Japon. À partir du point de vue traditionnel de la psychologie interculturelle, laquelle met l'emphase sur la nature collectiviste des peuples de l'Asie de l'Est, il était attendu que l'effet de discontinuité allait être plus grand au Japon qu'aux États-Unis. D'un autre côté, se basant sur les données empiriques récentes qui suggèrent que les Nord-américains ne sont pas moins orientés vers le groupe que les Asiatiques de l'Est, il était attendu que l'effet de discontinuité ne serait pas plus important au Japon qu'aux États-Unis. Cent soixante étudiants universitaires japonais ont pris part à un jeu de dilemme de prisonnier de 10 essais répétés: 26 sessions entre individus et 18 sessions entre groupes. Suivant exactement la procédure des expériences menées précédemment aux États-Unis, les individus et les groupes avaient la permission de communiquer face

The Sky Through Three Giant Eyes

NASA Astrophysics Data System (ADS)

2007-02-01

precise and careful study of the wind and the shockwave coming from the nova. The stream of results from the VLTI and AMBER is no doubt going to increase in the coming years with the availability of new functionalities. "In addition to the 8.2-m Unit Telescopes, the VLTI can also combine the light from up to 4 movable 1.8-m Auxiliary Telescopes. AMBER fed by three of these AT's will be offered to the user community as of April this year, and from October we will also make FINITO available," said Melnick. "This 'fringe-tracking' device allows us to stabilise changes in the atmospheric conditions and thus to substantially improve the efficiency of the observations. By effectively 'freezing' the interferometric fringes, FINITO allows astronomers to significantly increase the exposure times." The Astronomy & Astrophysics special feature (volume 464 - March II 2007) on AMBER first results includes 11 articles. They are freely available on the A&A web site. More Information The AMBER consortium, led by Romain Petrov (Nice, France), includes researchers from the Laboratoire d'Astrophysique de Grenoble (France), Laboratoire d'Astrophysique Universitaire de Nice (France), Max-Planck Institut für Radioastronomie (Bonn, Germany), INAF-Osservatorio Astrofisico di Arcetri (Italy), and the Observatoire de la Côte d'Azur (Nice, France). In March 2004, the first on-line tests of AMBER (Astronomical Multiple BEam Recombiner) were completed, when astronomers combined the two beams of light from the southern star Theta Centauri from two test 40-cm aperture telescopes (ESO 07/04). It was later used to combine light from two, then three Unit Telescopes of ESO's VLT and light from the Auxiliary Telescopes. AMBER is part of the VLT Interferometer (VLTI) and completes the planned set of first-generation instruments for this facility. It continues the success story of the interferometric mode of the VLT, following the unique initial scientific results obtained by the VINCI and MIDI instruments