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Safia O, Asma J, Hana H, Sarra J, Aymen Z, Mouna J, Amal M, Rym BK. [Infective endocarditis : In-hospital mortality predictive factors]. Ann Cardiol Angeiol (Paris) 2024; 73:101740. [PMID: 38417204 DOI: 10.1016/j.ancard.2024.101740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Infective endocarditis (IE) remains a serious disease with significant morbidity and mortality despite therapeutic advancements. The aim of our study was to determine the predictive factors of in-hospital mortality. PATIENTS AND METHODS A prospective comparative study over a period of 54 months was conducted, including all patients admitted for definite infective endocarditis, diagnosed according to the modified Duke criteria published in 2015 by the European Society of Cardiology. RESULTS Thirty-four patients were included. Drug addiction was the main risk factor for infective endocarditis (56%). Tricuspid valve involvement was predominant (50%). Staphylococcus aureus was the most commonly isolated pathogen (65%). In-hospital mortality rate was 47%. In multivariate analysis, predictive factors for mortality were acute heart failure (OR=7.4; p=0.026; 95% CI [1.2-44]) and cerebral embolic localization (OR=11.1; p=0.024; 95% CI [13-90]). CONCLUSIONS Cardiac and cerebral complications influence the prognosis of IE. Thus, close collaboration among multidisciplinary teams is necessary for improved diagnostic and therapeutic management.
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Affiliation(s)
- Othmani Safia
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Jendoubi Asma
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie.
| | - Hedhli Hana
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Jouini Sarra
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Zoubli Aymen
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Jemai Mouna
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
| | - Maaref Amal
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie
| | - Ben Kaddour Rym
- Service des urgences, hôpital Charles Nicolle, boulevard 9 Avril 1938 bab saadoun ; 1006 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunisie
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Poret J, Fauviaux E, Jany B, Bourges JL, Tran THC. [Creation and evaluation of a triage survey for ophthalmology emergencies]. J Fr Ophtalmol 2024; 47:104017. [PMID: 37945430 DOI: 10.1016/j.jfo.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The demand for eye care is growing continuously. We created a triage survey system, based on categories of severity, to optimize first line patient care in an ophthalmology emergency department. METHODS This cross-sectional study was carried out from July 7th, 2021 to October 10th, 2021. During this period, a survey was taken by patients upon arrival to the emergency department. Patients completed the survey by ticking boxes that best fitted their situation. The survey classified patients into three categories of severity: GREEN, ORANGE and RED. A chart review was performed to record the final diagnoses. The severity of each diagnosis was rated according to the Base Score. This score was then compared to the level of severity as determined by our survey to calculate the agreement between the two methods. RESULTS We collected 767 survey forms, with an 80% response rate. We noted 78 different diagnoses. We scored 564 patients as GREEN, 107 as ORANGE and 96 as RED. The sensitivity rates for the green, orange and red categories were 90%, 70% and 96% respectively. The specificity rates were 90% for the green category, 95% for orange and 94% for red, with good agreement (kappa coefficient=0.70). CONCLUSION Our results suggest that a self-administered survey could be useful as a triage tool for common ocular emergencies. This survey could be performed better if complete by the patients with the assistance of emergency staff. Potentially helpful for high flow structures such as university-based hospitals, this triage survey might also help in comprehensive clinics or emergency departments.
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Affiliation(s)
- J Poret
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France.
| | - E Fauviaux
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France
| | - B Jany
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France
| | - J L Bourges
- Ophtalmopôle de Paris, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Cité, Paris, France
| | - T H C Tran
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France
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Rosely M, Meurice L, Larrieu S, Vilain P, Chatignoux E, Forgeot C, Filleul L. Impact of the COVID-19 pandemic and lockdowns on emergency data related to mental health disorders in Nouvelle-Aquitaine, France. Encephale 2024:S0013-7006(24)00009-5. [PMID: 38311490 DOI: 10.1016/j.encep.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
This study estimates the association between emergency department (ED) visits for mental health disorders (MHDs) and the health context of the COVID-19 pandemic in the French region of Nouvelle-Aquitaine. This retrospective study took place between 2018 and 2021 using ED data. We defined the main exposure according to five periods: "Pre-pandemic (reference)", "First lockdown", "Second lockdown", "Third lockdown", and "Pandemic out-of-lockdown." We constructed the daily indicators for each MHD-related ED visit based on medical diagnoses. We described and then modeled the daily time series using generalized additive models with a quasi-Poisson regression. The analysis included 5,693,341 ED visits of which MHDs accounted for 4%. We observed a decline in ED use for most indicators, particularly during the first lockdown. Models revealed a statistically significant relative increase in ED visits for almost all MHDs during the first lockdown; for anxiety and child psychiatric disorders during the second lockdown; and only for child psychiatric disorders during the pandemic out-of-lockdown period. The public health crisis and lockdowns associated with the COVID-19 pandemic have been important sources of stress that could partially explain the deterioration of MHD indicators, thus leading to new public health concerns (notably among the youngest age group). Mental health is a major determinant of overall health and should therefore be considered in the management of crises that may require similar responses in the future.
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Affiliation(s)
- Maëva Rosely
- Santé publique France Nouvelle-Aquitaine, C/o ARS Nouvelle-Aquitaine, 103, bis, rue Belleville, 33063 Bordeaux cedex, France.
| | - Laure Meurice
- Santé publique France Nouvelle-Aquitaine, C/o ARS Nouvelle-Aquitaine, 103, bis, rue Belleville, 33063 Bordeaux cedex, France
| | - Sophie Larrieu
- HORIANA, 80, bis rue Paul-Camelle, 33100 Bordeaux, France
| | - Pascal Vilain
- Santé publique France Nouvelle-Aquitaine, C/o ARS Nouvelle-Aquitaine, 103, bis, rue Belleville, 33063 Bordeaux cedex, France
| | - Edouard Chatignoux
- Santé publique France Nouvelle-Aquitaine, C/o ARS Nouvelle-Aquitaine, 103, bis, rue Belleville, 33063 Bordeaux cedex, France
| | - Cécile Forgeot
- Santé publique France Nouvelle-Aquitaine, C/o ARS Nouvelle-Aquitaine, 103, bis, rue Belleville, 33063 Bordeaux cedex, France
| | - Laurent Filleul
- Santé publique France Nouvelle-Aquitaine, C/o ARS Nouvelle-Aquitaine, 103, bis, rue Belleville, 33063 Bordeaux cedex, France
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Lapostolle F, Loyeau A, Bataille S, Moiteaux B, Lambert Y. [e-MUST Registry - Evaluation of prehospital medical management of STEMI in Île-de-France]. Ann Cardiol Angeiol (Paris) 2023; 72:101687. [PMID: 37948923 DOI: 10.1016/j.ancard.2023.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
The e-MUST registry has continuously and comprehensively documented ST-segment elevation myocardial infarctions (STEMIs) managed in the prehospital setting by the 39 Mobile Emergency and Resuscitation Services (SMUR) of the 8 Emergency Medical Assistance System (SAMU) and subsequently managed in the 36 interventional cardiology services in Île-de-France since 2000. This encompasses a population of over 12 million residents. To date, nearly 44,000 patients have been enrolled. The analysis of these findings reflects the real-world management of these patients and the evolution of their care. The results are shared annually with the investigators' teams and have led to around twenty publications. The latest acquired results have demonstrated, in a series of over 630 patients aged over 90, that nonagenarians particularly benefit from prehospital coronary reperfusion decisions, resulting in a nearly 60% reduction in mortality.
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Affiliation(s)
- Frédéric Lapostolle
- SAMU 93, UF Recherche-Enseignement-Qualité, Hôpital Avicenne, Bobigny, Université Paris 13, France.
| | - Aurélie Loyeau
- SAMU 93, UF Recherche-Enseignement-Qualité, Hôpital Avicenne, Bobigny, Université Paris 13, France
| | - Sophie Bataille
- Département de l'offre de soins, Agence Régionale de Santé d'Île-de-France, Paris, France
| | - Brice Moiteaux
- Département Traitement de l'information, GIP SESAN, Paris , France
| | - Yves Lambert
- SAMU 78, Centre Hospitalier de Versailles, Le Chesnay, France
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Renom M, Feuvrier D, Obert L, Sergent AP, Loisel F, Pluvy I. [Emergency free flap in reconstruction of the lower limb: About 23 cases over 11 years]. ANN CHIR PLAST ESTH 2023; 68:326-332. [PMID: 36463023 DOI: 10.1016/j.anplas.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES To study the coverage period influence and various parameters concerning the microsurgical act on the patient clinical outcomes. METHODS We report 23 cases of reconstruction of lower limb loss of substance by free flap operated from 2010 to 2021. Among them, 9 patients were operated on as an emergency versus 14 in the secondary or late phase of the trauma. RESULTS The average age of injured patients operated on emergency was 42 years (17-68 years) and 34 years for the patients who undergo deferred surgery (17-57 years). The sex ratio (female/male) was 22% in patients operated on urgently and 7% in patients operated on later. Regarding the type of free flap, it was Serratus anterior muscle flap in 10 cases, Latissismus dorsi flap in 9 cases, ALT flap in 3 cases and Gracilis muscle flap in 1 case. There were 2 failures of vascularized free transfer (8.7%) with complete necrosis of the flap and 3 revision surgeries on venous thrombosis which finally made it possible to obtain 3 flap successes. We analyze the results (complications/osteitis) according to the time to coverage. CONCLUSIONS In our study, we did not find any significant difference between the groups operated in emergency and at a distance concerning the rate of infection and failure of the flaps.
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Affiliation(s)
- M Renom
- Service de chirurgie orthopédique, traumatologique, chirurgie plastique et assistance main, CHU Besançon, 25000 Besançon, France.
| | - D Feuvrier
- Service de chirurgie orthopédique, traumatologique, chirurgie plastique et assistance main, CHU Besançon, 25000 Besançon, France
| | - L Obert
- Service de chirurgie orthopédique, traumatologique, chirurgie plastique et assistance main, CHU Besançon, 25000 Besançon, France
| | - A-P Sergent
- Service de chirurgie orthopédique, traumatologique, chirurgie plastique et assistance main, CHU Besançon, 25000 Besançon, France
| | - F Loisel
- Service de chirurgie orthopédique, traumatologique, chirurgie plastique et assistance main, CHU Besançon, 25000 Besançon, France
| | - I Pluvy
- Service de chirurgie orthopédique, traumatologique, chirurgie plastique et assistance main, CHU Besançon, 25000 Besançon, France
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Fouasson-Chailloux A, Jager T, Pomares G. Emergency reconstruction of extensor terminal slip defect by tendon plasty. Hand Surg Rehabil 2023:S2468-1229(23)00082-8. [PMID: 37207802 DOI: 10.1016/j.hansur.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION We report our experience with a tendon plasty technique to reconstruct extensor terminal slip defect, with results in 11 patients. MATERIAL AND METHODS The technique was proposed to 11 patients with mean tendon defects of 6 mm. Mean follow-up was 10.6 months. Clinical assessment comprised active distal interphalangeal (DIP) range of motion, active DIP extension and spontaneous DIP extension deficit. RESULTS Mean range of motion was 50 °. Active extension was restored in all cases. There was a mean 11 ° spontaneous DIP extension deficit. DISCUSSION The present results confirmed those in the literature for this type of tendon plasty. As well as these encouraging outcomes, the technique has the advantage of being simple, with low morbidity thanks to remote harvesting.
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Affiliation(s)
- A Fouasson-Chailloux
- Institut Européen de la Main, 9 rue Edward Steichen, L2540 Luxembourg, Luxembourg; Medical Training Center, 9 rue Edward Steichen, L2540 Luxembourg, Luxembourg; Médecine Physique et de Réadaptation, Médecine du sport, CHU de Nantes, 85 Rue Saint Jacques, F44093 Nantes, France
| | - T Jager
- Institut Européen de la Main, 9 rue Edward Steichen, L2540 Luxembourg, Luxembourg; Medical Training Center, 9 rue Edward Steichen, L2540 Luxembourg, Luxembourg
| | - G Pomares
- Institut Européen de la Main, 9 rue Edward Steichen, L2540 Luxembourg, Luxembourg; Medical Training Center, 9 rue Edward Steichen, L2540 Luxembourg, Luxembourg.
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Oumerzouk J, El Filali O, Zbitou A, Slioui B, Belasri S, Kissani N. Neurological complications of giant cell arteritis: A study of 15 cases and a review of the literature. J Fr Ophtalmol 2023; 46:211-215. [PMID: 36642599 DOI: 10.1016/j.jfo.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Giant cell arteritis (GCA) is considered a neuro-ophthalmologic emergency. New-onset headache in patients aged 50 years and above with elevated erythrocyte sedimentation rate should prompt evaluation for GCA. MATERIAL AND METHODS Retrospective study of 15 patients presenting with GCA from 1991 to 2008 at the Mohamed V Military hospital at Rabat and Avicenne Military hospital of Marrakech. RESULTS Fifteen cases were recorded, with female predominance (male to female ratio 2:3) and a mean age of 63 years (range: 55-83 years). All patients (100%) presented with headache. The headache was isolated in 20% of cases and neuro-ophthalmic complications were found in 73% of cases. Biopsy was conclusive for GCA in 67% of cases and all of our patients were placed on steroids with spectacular improvement. CONCLUSION New-onset headache in patients aged 50 years and above should prompt evaluation for GCA. Steroids, especially during the acute phase, must be started urgently to avoid irreversible neurological impairment.
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Affiliation(s)
- J Oumerzouk
- Neurology department, Military hospital Avicenne, Marrakech, Morocco; Neuroscience research laboratory, Marrakech Medical school, Cadi Ayyad university, Marrakech, Morocco.
| | - O El Filali
- Vascular surgery department, Military hospital Avicenne, Marrakech, Morocco
| | - A Zbitou
- Cardiovascular department, Military hospital Avicenne, Marrakech, Morocco
| | - B Slioui
- Radiology department, Military hospital Avicenne, Marrakech, Morocco
| | - S Belasri
- Radiology department, Military hospital Avicenne, Marrakech, Morocco
| | - N Kissani
- Neurology department, Mohamed VI hospital, Marrakesh, Morocco; Neuroscience research laboratory, Marrakech Medical school, Cadi Ayyad university, Marrakech, Morocco
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Lapostolle F, Petrovic T. [Prehospital ultrasound and cardiological emergencies]. Ann Cardiol Angeiol (Paris) 2022; 71:345-349. [PMID: 36273951 DOI: 10.1016/j.ancard.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Technological advances over the past two decades have paved the way for the prehospital use of ultrasound. This practice was first developed in traumatology and then in a multitude of other indications, including cardiology. The development of pulmonary ultrasound is certainly the most visible illustration of this. Firstly, because it is an extra-cardiac examination that provides the answer to a cardiac question. Secondly because from a theoretical point of view this ultrasound indication was a bad indication for the use of ultrasound due to the air contained in the thorax. Thirdly, because this indication has become a 'standard of care' when caring for a patient with dyspnea - a practice that has become widespread during the COVID epidemic. In patients with heart failure, ultrasound has a high diagnostic power (including for alternative diagnoses) which is all the more precise since the technique is non-invasive, the response is obtained quickly, the examination can be repeated at desire to follow the evolution of the patient. The main other indications for prehospital ultrasound are cardiac arrest to search for a curable cause, identification of residual mechanical cardiac activity, monitoring of cerebral perfusion; chest pain, for both positive and negative diagnoses; shock for the search for an etiology and therapeutic follow-up or even pulmonary embolism or ultrasound for the search for dilation of the right ventricle which is now at the forefront of the recommendation algorithm.
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Affiliation(s)
- Frédéric Lapostolle
- SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Tomislav Petrovic
- SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France
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Labarthe A, Mennecart T, Imfeld C, Lély P, Ausset S. Pre-hospital transfusion of post-traumatic hemorrhage: Medical and regulatory aspects. Transfus Clin Biol 2021; 28:391-396. [PMID: 34464713 DOI: 10.1016/j.tracli.2021.08.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
Data of good methodological quality have recently become available to support prehospital use of transfusion in the severe trauma setting. Consistent with recent guidelines for the implementation of damage control resuscitation in the hospital in this setting and in the wake of numerous cohort study data from wartime medicine, they are now guided by recent guidelines for the use of freeze-dried plasma. The main difficulties to overcome in order to implement a practice are of a regulatory and logistic nature.
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Affiliation(s)
- A Labarthe
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France
| | - T Mennecart
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France
| | - C Imfeld
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France
| | - P Lély
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France
| | - S Ausset
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France.
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Seizilles de Mazancourt E, Vallée M, Sotto A, Le Goux C, Dihn A, Therby A, Boissier R, Savoie PH, Long JA, Bruyere F. [Infectious emergencies in urology]. Prog Urol 2021; 31:978-986. [PMID: 34420878 DOI: 10.1016/j.purol.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the nature, diagnosis and therapeutic strategy of infectious emergencies in urology. MATERIAL AND METHODS Bibliographic research from Pubmed, Embase, and Google scholar in July 2021. A synthesis of the guidelines of national infectious diseases societies. RESULTS Urosepsis and complicated urinary tract infection have a standardized definition. Diagnosis and therapeutic strategy are presented for upper tract urinary infection, male urinary infection, healthcare associated urinary infection, symptomatic canduria and urinary infections of the elderly. Appropriate antibiotherapy should be tailored to the degree of severity, bacterial ecosystem, patient characteristics et localization of the infection. CONCLUSION Urinary infections can be critical and require immediate care. Knowledge of the guidelines and of appropriate diagnosis and therapeutics strategy improve care which should be rapidly applied, and collegial.
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Affiliation(s)
- E Seizilles de Mazancourt
- Service d'urologie et de la transplantation, Hôpital Édouard-Herriot, hospices civils de Lyon, 69008 Lyon, France
| | - M Vallée
- Service d'urologie, CHRU Poitiers, 86000 Poitiers, France
| | - A Sotto
- Service de maladies infectieuses, CHU Nîmes, 30000 Nîmes, France
| | - C Le Goux
- Centre Alfred-Kastler, Hôpital privé Nord parisien, 95200 Sarcelles, France
| | - A Dihn
- Service de maladies infectieuses, CHU Garches, 92380 France
| | - A Therby
- Service de maladies infectieuses, CH Versailles, 78150 France
| | - R Boissier
- Hopital de la conception, Assistance publique Hôpitaux de Marseille, 13005, France
| | - P H Savoie
- Hôpital d'Instruction des Armées Saint-Anne, BP 600, 83190 Toulon cedex 09
| | - J A Long
- Service d'urologie, Centre hospitalier universitaire de Grenoble, 38000 France; TIMC-IMAG, CNRS 5525, France
| | - F Bruyere
- Service d'urologie, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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Durand M, Bentellis I, Barthe F, Tibi B, Shaikh A, Mellouki A, Berthet JP, Legueult K, Pradier C, Piche T, Ahallal Y, Chevallier D. [Outcomes following the triage of patients for urological cancer and non-cancer surgery during Covid-19 pandemic peak]. Prog Urol 2021; 31:716-724. [PMID: 34256992 PMCID: PMC7914008 DOI: 10.1016/j.purol.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
Introduction Lors de la première vague épidémique Covid-19, des mesures de triage, sans PCR systématique, étaient mises en place pour sélectionner les patients à opérer. Notre étude a comparé leurs résultats chirurgicaux après triage à ceux d’un groupe contrôle. Matériel L’analyse portait sur l’ensemble des patients initialement programmés dans un centre Covid de référence et inclus consécutivement, du 15 mars au 1er mai 2020 (NCT04352699). Leurs données étaient recueillies prospectivement et ultérieurement comparées à celles des patients opérés 1 an auparavant sur la même période dans ce centre. Le critère d’évaluation principal était l’admission post-opératoire en unité de soins intensifs (USI). La morbidité, la mortalité postopératoire, le report d’interventions, les tests PCR étaient évalués. Des analyses de sous-groupes étaient réalisés pour les patients opérés de cancer. Résultats Après triage, 96 des 142 interventions programmées ont dû être reportées. Sur les opérés, 48 (68 %) l’étaient pour cancer. Au total, aucun cas de pneumonie Covid-19 post-opératoire n’a été identifié. Trois patients (4 %) ont été admis en USI, dont un finalement décédé pour sepsis urinaire. Chez ces patients, les RT-PCR étaient négatives. Globalement, comparativement au groupe contrôle, aucune différence d’admission en USI, ni de taux de mortalité post-opératoire n’ont été rapportées. Conclusions Le triage de la première vague n’a pas surexposé les patients sélectionnés à un risque de complication ou de décès post-opératoire, particulièrement pas pour ceux opérés pour cancer. En revanche, 67 % des patients ont été reportés, avec un risque associé à des retard de soins pouvant conduire au décès. Niveau de preuve 3.
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Affiliation(s)
- M Durand
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France; Inserm U1081 - CNRS UMR 7284, université de Nice Côte d'Azur, France.
| | - I Bentellis
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - F Barthe
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - B Tibi
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - A Shaikh
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - A Mellouki
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - J-P Berthet
- Service de Chirurgie Thoracique, Hôpital Pasteur, CHU de Nice, Nice, France
| | - K Legueult
- Service de santé publique, hôpital de L'Archet, université de Nice, Nice, France
| | - C Pradier
- Service de santé publique, hôpital de L'Archet, université de Nice, Nice, France
| | - T Piche
- Université Nice Côte d'Azur, CHU Nice, Inserm, U1065, C3M, France
| | - Y Ahallal
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - D Chevallier
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
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12
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Besch V, Debbané M, Greiner C, Magnin C, De Néris M, Ambrosetti J, Perroud N, Poulet E, Prada P. Emergency psychiatric management of borderline personality disorder: Towards an articulation of modalities for personalised integrative care. Encephale 2020; 46:463-70. [PMID: 32571544 DOI: 10.1016/j.encep.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 11/20/2022]
Abstract
Building on existing literature, the authors draw the landscape of psychiatric emergencies, and focus on borderline personality disorder, frequently encountered, and strongly linked to death by suicide. A review of knowledge in terms of diagnosis, prognosis, etiology, and treatment, as well as their own experiences, lead them to propose areas of progress that would secure the patient's care pathway. The evolution of society has led psychiatric emergency departments to play the role of a safety net and an entry point to the mental health system. Borderline personality disorder is one of the most common pathologies encountered in psychiatric emergencies. It represents a major concern, long characterized by an often dramatic evolution, and by the human and economic stress it generates. However, since the 1990s, knowledge of this disorder has been refined, and today there are various means of evaluation, good clinical practices and psychotherapeutic treatments, thanks to which significant and lasting improvement is possible. Recent studies highlight the crucial role of hospital caregivers, and the benefit of consolidating their skills by providing them with the knowledge and tools specific to this disorder. They also converge on the interest of setting up specific emergency treatment modalities, particularly highly structured, safe and empowering for the patient, in order to improve their effectiveness. The authors suggest that a case formulation model for persons with borderline personality disorder in emergency would make it possible to activate these two levers of progress, while improving collaboration between hospital and outpatient care. This would also address their main concern of optimizing the patient's therapeutic pathway and reinforcing adherence to treatment that could bring remission, and should be supported by data from empirical research.
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Thiam I, Doh K, Seck M, Kammoun C, Woto Gaye G. [Appendicitis schistosomiasis]. Ann Pathol 2020; 40:411-3. [PMID: 32446732 DOI: 10.1016/j.annpat.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/14/2018] [Accepted: 04/13/2020] [Indexed: 11/22/2022]
Abstract
Appendiceal schistosomiasis is a rare disease of only histopathological diagnosis. Appendectomy should be followed by treatment with praziquantel to avoid complications. We report two cases of appendiceal schistosomiasis and discuss the role of this infection of this infection in the pathogenesis of appendicitis. Finally, we recommend a routine pathological examination of all appendicectomy specimen in endemic areas for better care for patients.
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14
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Sentilhes L, Galley-Raulin F, Boithias C, Sfez M, Goffinet F, Le Roux S, Benhamou D, Garnier JM, Paysant S, Bounan S, Michel C, Coudray J, Elleboode B, Rozé JC, Ducloy-Bouthors AS. [Human Resources for Unplanned Activities in Obstetrics and Gynecology. Consensus statements by the CNGOF, CARO, CNSF, FFRSP, SFAR, SFMP and SFN]. ACTA ACUST UNITED AC 2019; 47:63-78. [PMID: 30579968 DOI: 10.1016/j.gofs.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine a minimum threshold of human resources (midwives, obstetricians and gynecologists, anesthesiology and intensive care units, pediatricians) to ensure the safety and quality of unplanned activities in Obstetrics and Gynecology. MATERIALS AND METHODS Consultation of the MedLine database, the Cochrane Library and the recommendations of authorities. Meetings of representative members in different modes of practice (university, hospital, liberal) under the aegis of and belonging to the French College of Obstetricians and Gynecologists (CNGOF), the French Society of Anesthesia and Resuscitation (SFAR), the French Society of Neonatalogy (SFN), the French Society of Perinatal Medicine (SFMP), the French College of Midwives (CNSF), the French Federation of Perinatal Care Networks (FFRSP) with elaboration of a re-read text by external experts, in particular by the members of the Boards of Directors of these authorities and of Club of Anesthesiology-Intensive Care Medicine in Obstetrics (CARO). RESULTS Different minimum thresholds for each category of caregivers were proposed based on the number of births/year. These proposed minimum thresholds can be modulated upwards according to the types (level I, IIA, IIB or III) or the activity (existence of an emergency reception service, maternal-fetal and/or surgical activity of resort or referral). Due to peak activity and the possibility of unpredictable concomitance of urgent medical procedures, it is necessary that organizations plan to use resource persons. The occupancy rate of the target beds of a maternity ward must be 85%. CONCLUSION These proposed minimum thresholds are intended to help caregivers providing non-scheduled perinatal as well as Obstetrics and Gynecology care to make the most of the human resources allocated to institutional bodies to ensure their safety and quality.
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Jebali C, Radaoui N, Hassine NI, Kahloul M, Jaouadi MA, Naija M, Naija W, Chebili N. [Effect of frontal electrodes location on the electrocardiogram quality of obese subjects: Roots versus limb of extremities]. Ann Cardiol Angeiol (Paris) 2018; 68:139-143. [PMID: 30290918 DOI: 10.1016/j.ancard.2018.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In obese patients, standard recording of electrocardiogram seems to have specific electrical modifications related to obesity. These modifications could be minimized by the use of alternative recording techniques. The aim of this study is to evaluate the effect of the recording technique (standard versus Lund) on the electrocardiogram quality in healthy obese patients. METHOD This is an observational and descriptive study carried out in emergency medical services during a two years period. Healthy subjects with an age over 18 years and a body mass index (BMI)≥30kg/m2 were included. Each participant had an electrocardiogram according to Lund's technique immediately followed by a standard recording. Deflections amplitude and their respective axes were compared between the two techniques. The primary endpoint was the frequency of microvoltage. The secondary endpoints were the flat T wave at the inferior and the left axial deviations. RESULTS Fifty obese patients were included. The average BMI was 36.8±6.6kg/m2. The average age was 45±13 years with a sex ratio of 0.52. The standard technique was associated with a higher incidence of microvoltage (40% versus 20%, P=0.029) and flattening of the T wave (40% versus 18%, P=0.015). Analysis of the variance of the P, QRS and T wave axes did not find any difference between the two techniques. CONCLUSION The Lund technique reduces the incidence of electrical abnormalities in the electrocardiogram of healthy obese patients.
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Affiliation(s)
- C Jebali
- Service d'aide médicale urgente 03 Sahloul, Sousse, Tunisie; Faculté de médecine « Ibn Al Jazzar », Sousse, Tunisie
| | - N Radaoui
- Service des urgences Al Aghaliba Kairouan, Tunisie; Faculté de médecine « Ibn Al Jazzar », Sousse, Tunisie
| | - N Ibn Hassine
- Service des urgences Ibn Jazzar Kairaoun, Tunisie; Faculté de médecine « Ibn Al Jazzar », Sousse, Tunisie
| | - M Kahloul
- Département d'anesthésie réanimation, CHU Sahloul, route de la Ceinture, cité Sahloul, 4054 Sousse, Tunisie; Faculté de médecine « Ibn Al Jazzar », Sousse, Tunisie.
| | - M A Jaouadi
- Service d'aide médicale urgente 03 Sahloul, Sousse, Tunisie; Faculté de médecine « Ibn Al Jazzar », Sousse, Tunisie
| | - M Naija
- Service d'aide médicale urgente 03 Sahloul, Sousse, Tunisie
| | - W Naija
- Département d'anesthésie réanimation, CHU Sahloul, route de la Ceinture, cité Sahloul, 4054 Sousse, Tunisie; Faculté de médecine « Ibn Al Jazzar », Sousse, Tunisie
| | - N Chebili
- Service d'aide médicale urgente 03 Sahloul, Sousse, Tunisie; Faculté de médecine « Ibn Al Jazzar », Sousse, Tunisie
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Prunières G, Igeta Y, Hidalgo Díaz JJ, Gouzou S, Facca S, Xavier F, Liverneaux P. Ultrasound for the diagnosis of pyogenic flexor tenosynovitis. Hand Surg Rehabil 2018; 37:S2468-1229(18)30061-6. [PMID: 29759904 DOI: 10.1016/j.hansur.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/25/2018] [Accepted: 03/15/2018] [Indexed: 11/27/2022]
Abstract
The usefulness of ultrasound for making the diagnosis of pyogenic flexor tenosynovitis (PFTS) has been demonstrated. The primary goal of this study was to show that the diameter of the flexor sheath near the A2 pulley was larger when PFTS was present compared to the healthy contralateral finger. The secondary goal was to determine the reproducibility of these ultrasound measurements. Our series included 20 patients (12 men and 8 women) operated due to PFTS. The average age was 41.7 years old. The average diameter of the digital sheath measured near the A2 pulley on transverse and longitudinal ultrasound sections was 5.01mm (transverse 5mm, longitudinal 5.03mm) on infected fingers, and 4.17mm on healthy contralateral fingers. Reproducibility, as measured by the intraclass coefficient between transverse and longitudinal values, was 0.910 for infected fingers and 0.928 for contralateral fingers, thus was excellent. Our hypothesis was confirmed. A unilateral increase of more than 20% in diameter of the flexor sheath measured in transverse or longitudinal ultrasound sections near the pulley A2 contributes to the surgical indication when a patient presents with PFTS.
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Affiliation(s)
- G Prunières
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - Y Igeta
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France; Department of Orthopedic Surgery, Juntendo University, 3-1-3 Hongo Bunkyo-ku, 113-8431 Tokyo, Japan
| | - J J Hidalgo Díaz
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - S Gouzou
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - S Facca
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - F Xavier
- Department of Spine Surgery, Dalhousie University, QEII Health Sciences Centre, Hali 1796, Summer street, Halifax, NS, B3H 3A7, Canada
| | - P Liverneaux
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France.
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Ben Saad S, Abdenadher M, Attia M, Daghfous H, Tritar F. [White hemithorax in a young women carrying coffee and milk spots]. Rev Pneumol Clin 2018; 74:100-103. [PMID: 29580726 DOI: 10.1016/j.pneumo.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/10/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Neurofibromatosis type 1 (NF1) or Von Recklinghausen disease is an autosomal dominant genetic disorder with multivisceral manifestations. We report the case of a spontaneous haemothorax in a young lady wearing this genetic pathology. CASE REPORT A 31-year-old woman with kyphoscoliosis developed acute chest pain and dyspnea. The physical examination revealed a right pleuritic syndrome, coffee and milk spots and neurofibromas of the trunk. Biological assessment showed anemia at 6.4g/dl. Chest x-ray revealed a right side opacification. The pleural puncture showed an incoagulable hemorrhagic fluid. The chest CT scan showed no vascular abnormalities. The diagnosis of spontaneous haemothorax, revealing NF1, was retained. Transfusion and thoracic drainage were performed followed by haemostasis surgery. Pleural exploration showed pleural hematoma with regard to the 5th intercostal space. Electrocoagulation and declogging were performed. The evolution of the patient was favorable. CONCLUSION Haemothorax is a rare and serious complication which may reveal NF1. It must be suspected when sudden and spontaneous white haemithorax occurs in NF1.
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Affiliation(s)
- S Ben Saad
- Université El-Manar, Tunisie; Service de pneumologie (C), hôpital Abderahmen-Mami, 1, rue de l'hôpital, Pavillon C, 2080 Ariana, Tunisie.
| | - M Abdenadher
- Université El-Manar, Tunisie; Service de chirurgie thoracique, hôpital Abderahmen-Mami, Ariana, Tunisie
| | - M Attia
- Université El-Manar, Tunisie; Service de radiologie, hôpital Abderahmen-Mami, Ariana, Tunisie
| | - H Daghfous
- Université El-Manar, Tunisie; Service de pneumologie (C), hôpital Abderahmen-Mami, 1, rue de l'hôpital, Pavillon C, 2080 Ariana, Tunisie
| | - F Tritar
- Université El-Manar, Tunisie; Service de pneumologie (C), hôpital Abderahmen-Mami, 1, rue de l'hôpital, Pavillon C, 2080 Ariana, Tunisie
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Deloumeaux J, Samut G, Rochemont D, Merault H, Dufresne R, Galantine V, Tirolien Y, Léonardi C, Adenis A, Peruvien J, Nacher M, Gabriel JM. [Initiation of first dialysis and three months quality of life of patients with end stage renal disease in the French territories of Guadeloupe and Guyane]. Nephrol Ther 2018; 14:467-473. [PMID: 29477278 DOI: 10.1016/j.nephro.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022]
Abstract
End stage renal disease is a major public health problem in the French Departments of Guadeloupe and Guiana because of the high prevalence of both type 2 diabetes and hypertension. We investigated factors associated with an emergency start of dialysis, 3 months' quality of life for patients starting a first replacement therapy in Guadeloupe and French Guiana using the data of the Réseau épidémiologie et information en néphrologie network, completed with data from the quality of life questionnaires SF-36 and KDQoL. A total of 242 patients (184 in Guadeloupe and 58 in Guiana) were included. An emergency start was found for 112 (46.5%) patients (Guiana: 74.1%; Guadeloupe: 37.7%). In the multivariate model, an emergency start was associated with the number of nephrology consultations in the year before dialysis and the creation of an arteriovenous fistula prior to the first dialysis. The quality of life scores did not differ between the groups emergency start or not but were higher than those measured in mainland French studies on dialyzed population. Lack of nephrology consultations and dialysis preparation are the main factors associated with an emergency start of the first dialysis, highlighting the need to adapt the provision of care for chronic kidney disease in these departments.
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Affiliation(s)
- Jacqueline Deloumeaux
- Registre REIN, centre hospitalier universitaire de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe.
| | - Gaël Samut
- Registre REIN, centre hospitalier universitaire de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - Devi Rochemont
- Registre REIN, centre hospitalier de Cayenne, avenue des Flamboyants, BP 6006, 97306 Cayenne cedex, Guyane française
| | - Henri Merault
- Service de néphrologie, centre hospitalier universitaire de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe; Centre de dialyse Audra, centre hospitalier universitaire de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | | | - Valérie Galantine
- Service de néphrologie, centre hospitalier universitaire de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - Yannick Tirolien
- Service de néphrologie, centre hospitalier universitaire de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe; Centre de dialyse Dialybt, Basse-Terre, Guadeloupe
| | - Catherine Léonardi
- Service de néphrologie, centre hospitalier universitaire de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - Antoine Adenis
- Registre REIN, centre hospitalier de Cayenne, avenue des Flamboyants, BP 6006, 97306 Cayenne cedex, Guyane française; Inserm CIC 1424, centre hospitalier de Cayenne, avenue des Flamboyants, BP 6006, 97306 Cayenne cedex, Guyane française
| | - Jessica Peruvien
- Registre REIN, centre hospitalier universitaire de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - Mathieu Nacher
- Registre REIN, centre hospitalier de Cayenne, avenue des Flamboyants, BP 6006, 97306 Cayenne cedex, Guyane française; Inserm CIC 1424, centre hospitalier de Cayenne, avenue des Flamboyants, BP 6006, 97306 Cayenne cedex, Guyane française
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Jardin E, Delord M, Aubry S, Loisel F, Obert L. Usefulness of ultrasound for the diagnosis of pyogenic flexor tenosynovitis: A prospective single-center study of 57 cases. Hand Surg Rehabil 2018; 37:95-98. [PMID: 29396150 DOI: 10.1016/j.hansur.2017.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 12/16/2017] [Accepted: 12/29/2017] [Indexed: 11/18/2022]
Abstract
Pyogenic flexor tenosynovitis (PFT) is a functional emergency in hand surgery; however, its diagnosis can be difficult to make. It should always be considered when a patient presents with an inflamed finger. The goal of this study was to investigate the usefulness of ultrasound in the diagnosis of early PFT. Seventy-three patients with suspected pyogenic flexor tenosynovitis were candidates for the study. Since the diagnosis of PFT was obvious in 16 patients, they were excluded from the study and immediately underwent surgery. The remaining 57 patients underwent a clinical examination by a senior surgeon, a blood test for C-reactive protein levels and an ultrasound (US). The US results were compared to the intraoperative findings if the patients were operated or to the clinical outcome in non-operated patients. Seventeen patients had the US diagnosis of PFT confirmed intraoperatively. In 10 patients, the US diagnosis of PFT was not confirmed intraoperatively. In 29 other patients, the diagnosis of PFT was ruled out by US; they all had good outcomes after being treated with antibiotics. In one patient for whom the diagnosis of PFT had been ruled out by US, PFT was actually present. Ultrasound had 94% sensitivity, 65% specificity, 63% positive predictive value, and 95% negative predictive value. Ultrasound is useful as a diagnostic tool for managing early PFT thanks to its excellent negative predictive value and specificity. This objective examination complements the surgeon's subjective clinical examination.
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Affiliation(s)
- E Jardin
- Clinique de Diaconat-Roosevelt-Service SOS Mains, 14, boulevard du Président Roosevelt, 68200 Mulhouse, France.
| | - M Delord
- Service de chirurgie orthopédique traumatologique plastique assistance main, CHU Jean-Minjoz, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - S Aubry
- Service de radiologie, CHU Jean-Minjoz, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - F Loisel
- Service de chirurgie orthopédique traumatologique plastique assistance main, CHU Jean-Minjoz, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - L Obert
- Service de chirurgie orthopédique traumatologique plastique assistance main, CHU Jean-Minjoz, boulevard Alexandre-Fleming, 25000 Besançon, France.
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Gas J, Liaigre-Ramos A, Beauval JB, Roumiguié M, Tostivint V, Patard PM, Huyghe E, Soulié M, Charpentier S, Gamé X. [Epidemiology of emergency consultations for acute urine retention]. Prog Urol 2018; 28:107-113. [PMID: 29337127 DOI: 10.1016/j.purol.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 11/16/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Acute urinary retention (AUR) is a common reason for emergency consultation. It may be spontaneous or precipitated and affects both men and women. The purpose of this study was to determine the profile of men visiting emergency departments for an AUR. MATERIEL AND METHODS A retrospective monocentric study including all men who consulted the emergency department between January 2014 and December 2016 for AUR was conducted. RESULTS In 3 years, 731 patients were admitted for AUR (611 men and 120 women). The mean age was 71.6±14 years with a mean retention volume of 948±668mL drained for 96% of patients (n=584) through a bladder catheter and 4% (n=27) with a suprapubic catheter. Most patients had an urological (66%, n=104) or neurologic (40%, n=242) history and 23% (n=136) already had an episode of AUR. In 28% of cases (n=173), the globe was not painful. A majority of AUR were spontaneous, 53% (n=326) versus 46% (n=279) who were precipitated, secondary to a recent surgical procedure (<1 month) (15%, n=89), hematuria (9%, n=54), or male urinary tract infections (7%, n=42). Patients were treated externally in 71% (n=436), 25% (n=153) were hospitalized with significantly more comorbidities. CONCLUSION Men consulting emergency for AUR are 72 years old, with a globe volume of 942mL. Thirty-three percent have a history of BPH, with a prostate treatment like alpha-blockers type. Almost all patients were treated with a bladder catheter and the majority was treated externally. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- J Gas
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France.
| | - A Liaigre-Ramos
- Service d'accueil des urgences, CHU de Toulouse, 31059 Toulouse, France
| | - J B Beauval
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - M Roumiguié
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - V Tostivint
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - P-M Patard
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - E Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - M Soulié
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - S Charpentier
- Service d'accueil des urgences, CHU de Toulouse, 31059 Toulouse, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
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Moris V, Loisel F, Cheval D, See LA, Tchurukdichian A, Pluvy I, Gindraux F, Pauchot J, Zwetyenga N, Obert L. Functional and radiographic evaluation of the treatment of traumatic bone loss of the hand using the Masquelet technique. Hand Surg Rehabil 2016; 35:114-21. [PMID: 27117125 DOI: 10.1016/j.hansur.2015.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/16/2022]
Abstract
This study was a retrospective evaluation of 18 patients with traumatic bone loss affecting the fingers, hand and wrist who were treated using the induced-membrane technique. Sixteen men and two women, mean age 54years (27-74) presented a hand injury including bone loss. Sixteen patients were treated on an emergency basis and two following nonunion of their fractures. There were 13 cases of open fracture of the phalanx and 5 cases of metacarpal fractures. These patients were treated with debridement and the injuries were covered when necessary. To address the bone loss, the first step of the induced-membrane technique involved placing a cement spacer (polymethylmethacrylate [PMMA]) without antibiotics in the defect. During the second step, the cement spacer was removed and replaced by autologous cancellous bone graft. The graft was placed within the biological tube left empty after removal of the cement. For each patient, bone union was assessed with radiographs and/or CT scan. Failure was defined as nonunion at 1year. In 16 patients, the fractures had healed after 4months (1.5-12months) on average. Two failures were noted (one nonunion treated using a PIP prosthesis and one case of delayed union). Mobility of the fingers, evaluated using the Total Active Motion (TAM) was 145° (75°-270°). The Kapandji score reached 8 for the thumb. Grip strength reached 21kg/F and pinch strength was 5kg/F; these values were 50% of those in the healthy hand. The induced-membrane technique is simple and can be used to treat traumatic bone loss in an emergency, thus avoiding amputation and limb shortening, while preserving limb function. It provides immediate stability and allows early mobilization.
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Affiliation(s)
- V Moris
- Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - F Loisel
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
| | - D Cheval
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France
| | - L A See
- Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - A Tchurukdichian
- Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - I Pluvy
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
| | - F Gindraux
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France
| | - J Pauchot
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
| | - N Zwetyenga
- Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - L Obert
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
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Linck C, Choserot M, Cristinelli S, Callec R, Morel O. [Emergency caesarean sections in primary care maternity: Impact of a color code]. ACTA ACUST UNITED AC 2016; 45:701-7. [PMID: 26775201 DOI: 10.1016/j.jgyn.2015.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/09/2015] [Accepted: 11/24/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate the impact of the introduction of color code on the decision to birth-delay (DDB) used to prioritize the emergency caesarean sections in a primary care maternity. MATERIALS AND METHODS All patients who had an emergency caesarean section, for a single fetus, were included. The obstetrician, the anesthesiologist and the nurse of operating theatre were not on call in the maternity in nighttime. The study was divided into phase I corresponding to the period before the introduction of the color code and phase II, the period after introduction of the color code. The DDB was studied for each phase and for each color code in phase II, and depending on the day or night period. RESULTS Two hundred and seventy-six patients were included. In phase I, the average DDB was 54minutes against 44minutes in phase II (P=0.0003). The average time between the decision and caesarean birth for the green code was 62minutes, 42minutes for orange code, 22minutes for red code (P<0.001). There was no action on the time of caesarean decision on the choice of color code. There was no time difference between daytime and nighttime either in phases I or II. CONCLUSION The introduction of color code for emergency caesarean sections was a benefit in reducing the DDB. There was no observed difference between day or night periods regarding DDB or color codes.
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Affiliation(s)
- C Linck
- Maternité, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France.
| | - M Choserot
- Maternité, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France
| | - S Cristinelli
- Clinique de l'Arc-en-Ciel, 11, avenue Rose-Poirier, 88000 Épinal, France
| | - R Callec
- Maternité, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France
| | - O Morel
- Maternité, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France
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Tolou C, Mahieu-Durringer L, Cassagne M, Hamid S, Billette de Villemeur R, Gualino V, Susini A, Pagot Mathis V, Gallini A, Soler V. [Treatment delay in patients with first episode of retinal detachment in the studied eye in Midi-Pyrénées]. J Fr Ophtalmol 2015; 39:90-7. [PMID: 26707754 DOI: 10.1016/j.jfo.2015.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/29/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it. MATERIAL AND METHODS Observational, cross-sectional, multicentric study, carried out over a 6-month period. PRIMARY OUTCOME time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend. RESULTS One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P<0.001), or of a weekend with public holiday (P=0.023), and by macular detachment (P=0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P=0.023), and by macular detachment (P=0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery. CONCLUSION The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center.
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Affiliation(s)
- C Tolou
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France.
| | - L Mahieu-Durringer
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - M Cassagne
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - S Hamid
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - R Billette de Villemeur
- Unité de soutien méthodologique à la recherche, service d'épidémiologie, CHU de Toulouse, 31000 Toulouse, France
| | - V Gualino
- Clinique Caves, 82000 Montauban, France
| | - A Susini
- Clinique de l'Union, 31240 Saint-Jean, France
| | - V Pagot Mathis
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - A Gallini
- Unité de soutien méthodologique à la recherche, service d'épidémiologie, CHU de Toulouse, 31000 Toulouse, France
| | - V Soler
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France; Laboratoire GR2DE, EA4555, centre de physiopathologie Toulouse-Purpan, 31000 Toulouse, France
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Lapostolle F, Deltour S, Petrovic T. [Ultrasound in emergency medicine]. Ann Cardiol Angeiol (Paris) 2015; 64:446-8. [PMID: 26574136 DOI: 10.1016/j.ancard.2015.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ultrasound has revolutionized the practice of emergency medicine, particularly in prehospital setting. About a patient with dyspnea, we present the role of ultrasound in the diagnosis and emergency treatment. Echocardiography, but also hemodynamic ultrasound (vena cava) and lung exam are valuable tools. Achieving lung ultrasound and diagnostic value of B lines B are detailed.
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Affiliation(s)
- F Lapostolle
- Inserm U942, Samu 93, UF recherche-enseignement-qualité, université Paris 13, Sorbonne Paris cité, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - S Deltour
- Urgences cérébro-vasculaires, hôpital de la Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - T Petrovic
- Inserm U942, Samu 93, UF recherche-enseignement-qualité, université Paris 13, Sorbonne Paris cité, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France
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25
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Andre A, Rongieres M, Laffosse JM, Pailhe R, Lauwers F, Grolleau JL. [Cross-hand replantation in bilateral upper limb amputation: An anatomical emergency]. ANN CHIR PLAST ESTH 2014; 60:340-5. [PMID: 25498535 DOI: 10.1016/j.anplas.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/08/2014] [Indexed: 11/28/2022]
Abstract
Bilateral amputations of upper limbs are excessively rare clinical situations. We report an exceptional clinical case of bilateral amputation of upper limbs at different levels: destruction of the right hand and left transhumeral amputation in a patient after an attempted suicide on train lines. This special situation led us to perform a cross-hand replantation of the left hand to the right forearm. Only 4 other similar cases have been published in the literature. Once the surgical indication had been formulated collectively, and taking into account all the ethical issues surrounding such a decision, we had to solve the issue of inverting anatomical structures in emergency. We have provided a detailed description of our surgical technique. The aim was to save at least one organ used for grasping. The result obtained is presented and reviewed.
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Affiliation(s)
- A Andre
- Institut de l'appareil locomoteur, unité de chirurgie de la main et chirurgie réparatrice des membres, hôpital Pierre-Paul-Riquet, centre hospitalier universitaire de Toulouse, place Baylac, 31059 Toulouse cedex, France; Laboratoire d'anatomie, faculté de médecine, 133, route de Narbonne, 31400 Toulouse, France.
| | - M Rongieres
- Institut de l'appareil locomoteur, unité de chirurgie de la main et chirurgie réparatrice des membres, hôpital Pierre-Paul-Riquet, centre hospitalier universitaire de Toulouse, place Baylac, 31059 Toulouse cedex, France; Laboratoire d'anatomie, faculté de médecine, 133, route de Narbonne, 31400 Toulouse, France
| | - J-M Laffosse
- Institut de l'appareil locomoteur, unité de chirurgie de la main et chirurgie réparatrice des membres, hôpital Pierre-Paul-Riquet, centre hospitalier universitaire de Toulouse, place Baylac, 31059 Toulouse cedex, France
| | - R Pailhe
- Institut de l'appareil locomoteur, unité de chirurgie de la main et chirurgie réparatrice des membres, hôpital Pierre-Paul-Riquet, centre hospitalier universitaire de Toulouse, place Baylac, 31059 Toulouse cedex, France
| | - F Lauwers
- Laboratoire d'anatomie, faculté de médecine, 133, route de Narbonne, 31400 Toulouse, France
| | - J-L Grolleau
- Institut de l'appareil locomoteur, unité de chirurgie de la main et chirurgie réparatrice des membres, hôpital Pierre-Paul-Riquet, centre hospitalier universitaire de Toulouse, place Baylac, 31059 Toulouse cedex, France
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26
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Hounkpatin B, Hamani Saibou I, Oloudé N, Tixier V, Ferrier N, Marcaggi X. [Interest of emergency coronary computed tomography for exclusion of coronary artery disease in patients with acute chest pain and low to intermediate risk]. Ann Cardiol Angeiol (Paris) 2014; 63:279-283. [PMID: 25281997 DOI: 10.1016/j.ancard.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/24/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To demonstrate the usefulness of the multislice computer tomography coronary angiography (CCTA) in patients with suspected acute chest pain without electrical changes or enzyme rise, and with low cardiovascular risk. PATIENTS AND METHODS Fifty-three patients at low or intermediate risk for coronary artery disease, who were admitted in the emergency department for an acute chest pain, and who underwent a CCTA, were included in the study. Results of the CCTA were classified as normal, non-obstructive stenosis (≤ 50% stenosis in diameter), obstructive stenosis (> 50% stenosis in diameter). The mortality was assessed during a 4-years follow-up period. RESULTS Mean age was 61 years (36-86), 43% of patients were women. The CCTA was normal in 35 patients (66%), seven patients (13%) had non-obstructive stenosis and 11 (21%) had obstructive stenosis. In the group of normal CCTA, 8.5% of patients were admitted in cardiac intensive care unit, 57.1% in the non-obstructive stenosis and 90.9% in the group of obstructive stenosis. No deaths occurred during the 4-year follow up in the group of patients with normal CCTA. CONCLUSION This study confirms the negative predictive value of CCTA for the diagnosis of coronary artery disease and for further clinical events in patients at low or intermediate risk referred to emergency department for an acute chest pain.
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Affiliation(s)
- B Hounkpatin
- Unité de réanimation polyvalente et soins intensifs cardiaques, médecine interne et cardiologie, exploration cardiaque, centre hospitalier Jacques-Lacarin, boulevard Denière, 03207 Vichy, France.
| | - I Hamani Saibou
- Service de cardiologie, centre hospitalier Henri-Mondor, 50, avenue de la République, 15000 Aurillac, France
| | - N Oloudé
- Unité de réanimation polyvalente et soins intensifs cardiaques, médecine interne et cardiologie, exploration cardiaque, centre hospitalier Jacques-Lacarin, boulevard Denière, 03207 Vichy, France
| | - V Tixier
- Unité de réanimation polyvalente et soins intensifs cardiaques, médecine interne et cardiologie, exploration cardiaque, centre hospitalier Jacques-Lacarin, boulevard Denière, 03207 Vichy, France
| | - N Ferrier
- Unité de réanimation polyvalente et soins intensifs cardiaques, médecine interne et cardiologie, exploration cardiaque, centre hospitalier Jacques-Lacarin, boulevard Denière, 03207 Vichy, France
| | - X Marcaggi
- Unité de réanimation polyvalente et soins intensifs cardiaques, médecine interne et cardiologie, exploration cardiaque, centre hospitalier Jacques-Lacarin, boulevard Denière, 03207 Vichy, France
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27
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Lefort H, Cesareo E, Domanski L, Tourtier JP, Tazarourte K. [Penetrating neck injuries: importance of one systematic clinical examination associated with a MDCT angiography]. ACTA ACUST UNITED AC 2014; 33:188-90. [PMID: 24456615 DOI: 10.1016/j.annfar.2013.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Lefort
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France.
| | - E Cesareo
- Samu/Smur 77, rue Freteau de Peny, 77000 Melun, France
| | - L Domanski
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
| | - J P Tourtier
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
| | - K Tazarourte
- Samu/Smur 77, rue Freteau de Peny, 77000 Melun, France
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28
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Samaké BM, Kanté L, Kéita M, Diallo Y, Togola M, Kéita B, Goita D, Togo A, Diallo A. [Tracheal intubation in the Emergency Unit: accidents and incidents in the teaching hospital of Gabriel Touré of Bamako]. Mali Med 2014; 29:1-4. [PMID: 30049121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Intubation in urgency is characterized by a greater difficulty compared with intubation in situation regulated with the operating theatre suite. In urgency, the determination of the predictive anatomical factors of difficult intubation is secondary. The incidence of the complications of endotracheal intubations in urgency in the French system was 11,6% with a rate of failure to 0,5. OBJECTIVE To study the incidents and accidents during endotracheal intubations in the service of reception of the urgencies with the Gabriel TOURE teaching hospital of Bamako. PATIENTS AND METHOD A prospective cross-sectional study was conducted from October 2010 at September 2011 with the service of reception of the urgencies of the Gabriel Touré teaching hospital. All the intubated patients were included. All the patients received a clinical evaluation and paraclinic examinations. Clinical monitoring was carried out in the 24 hours following the accident. The statistical test which was used for the comparison of our results was Khi 2 with a threshold of significance fixed at P<0,05. RESULTS For the period of study 120 cases of accidents and incidents were collected for 320 intubated patients - a frequency of 37,5%. The age bracket 15 - 29 was prevalent representing 30,8 % of patients. The sex ratio was 2,3 in favour of men. In 44.3% of cases patients died in the 24 hours following intervention. Only patients admitted for cranial traumatism presented undesirable side effects in 50% of the cases versus 50% for the other joined reasons for admission. CONCLUSION The accidents during endotracheal intubation in urgent interventions are considerable, hence the acquisition of more suitable material and good training would decrease incidence.
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Affiliation(s)
- B M Samaké
- Service anesthésie réanimation C.H.U. Gabriel Touré
| | - L Kanté
- Service de chirurgie générale C.H.U. Gabriel Touré
| | - M Kéita
- Service anesthésie réanimation C.H.U. du Point G
| | - Y Diallo
- Service anesthésie réanimation C.H.U. Gabriel Touré
| | - M Togola
- Service anesthésie réanimation C.H.U. Gabriel Touré
| | - B Kéita
- Service anesthésie réanimation C.H.U. Gabriel Touré
| | - D Goita
- Service anesthésie réanimation C.H.U. du Point G
| | - A Togo
- Service de chirurgie générale C.H.U. Gabriel Touré
| | - A Diallo
- Service anesthésie réanimation C.H.U. Gabriel Touré
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Moustafa F, Garrouste C, Bertrand PM, Kauffmann S, Schmidt J. [Lactic acidosis after inhaled beta-2 agonists: about 2 cases]. ACTA ACUST UNITED AC 2013; 33:49-51. [PMID: 24378041 DOI: 10.1016/j.annfar.2013.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Affiliation(s)
- F Moustafa
- Pôle Samu-Smur-urgences, service d'urgences adultes, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
| | - C Garrouste
- Pôle REUNIR, service de néphrologie, CHU Clermont-Ferrand, 8, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
| | - P-M Bertrand
- Pôle REUNIR, service de réanimation médicale, CHU Clermont-Ferrand, 8, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
| | - S Kauffmann
- Département d'anesthésie-réanimation, service de neuro-réanimation, CHU Clermont-Ferrand, 8, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
| | - J Schmidt
- Pôle Samu-Smur-urgences, service d'urgences adultes, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
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30
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Secco M, Tillou X, Desmonts A, Orczyk C, Le Gal S, Bensadoun H, Doerfler A. [Emergency nephrectomies: retrospective monocentric study, about eight cases]. Prog Urol 2013; 23:1400-6. [PMID: 24274944 DOI: 10.1016/j.purol.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/09/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Emergency nephrectomies are rare because of the improvement of the management of urinary tract infections and the development of radio-embolization. Few series of patients have been reported. The objective of our study is to assess the indication, the morbi-mortality and the outcome of the emergency nephrectomy performed in our hospital. PATIENTS Between January 2011 and November 2012, eight patients underwent an emergency nephrectomy at the University Hospital Center of Caen. The present review reports the characteristics of this emergency nephrectomy and their morbi-mortality. RESULTS Six women and two men were analyzed retrospectively between January 2011 and November 2012. All patients except one needed intensive care for a multiple-organ failure. All these eight emergency nephrectomies concerned a native kidney with a surgical approach as a lombotomy or subcostal laparotomy. Both patients survived. One patient need a renal dialysis support. CONCLUSION Emergency nephrectomy are rare. Uncontrolled urinary sepsis represents the main indication. Identifying the population at risk of evolution to the toxic shock is indispensable for a better and faster care and to reduce the mortality bound to the sepsis.
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Affiliation(s)
- M Secco
- Service d'urologie, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
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31
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Mertes PM, Sirieix D. [New oral anticoagulants and emergency procedures]. ACTA ACUST UNITED AC 2013; 32:648-9. [PMID: 23958180 DOI: 10.1016/j.annfar.2013.07.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P M Mertes
- Service d'anesthésie-réanimation chirurgicale, Nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France; Groupe des anesthésistes-réanimateurs de l'hôpital privé d'Antony (GARHPA), 1, rue Velpeau, 92160 Antony, France.
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Schlanger S, Daurat G. [Blood products delivery by hospital blood banks in emergency situations in France]. Transfus Clin Biol 2013; 20:482-9. [PMID: 23876372 DOI: 10.1016/j.tracli.2013.03.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
In France, 13.5% of labile blood products (LBP) are delivered by 644 hospital blood banks, 472 being devoted to emergency only. A nation-wide survey aimed to describe their activity in emergency situations was carried out from September 12th to 26th, 2011. All of 26 French regions but two participated, 548 (85%) of their hospital blood banks answered a questionnaire, of which 56% had actually issued blood in emergency situations. A total of 5241 LBP were delivered, 24% for utmost vital emergencies (UVE), 25% for vital emergencies (VE) and 51% for relative emergencies (RE). In UVE and VE, 47% of the packed red blood cells (PRBC) delivered were O RH1. Females were half of the 2102 patients, mean age was 67 years. In UVE, banks devoted to emergency only, issued LBP for 228 patients (57%) and other banks for 169, acute digestive tract and surgical hemorrhage being the most frequent indications. The average number of PRBC transfused in 24 hours per patient varied with the criticality of the emergency: 2.3 for RE, 3.9 for VE and 6.1 for UVE. The mortality rate at 24 hours of first delivery was 1.2% in RE, 2.8% in VE and 10.1% in UVE. Time between prescription and start of transfusion of PRBC in UVE was within 15 minutes in 50% of cases and within 25 minutes in 75% of cases for emergency devoted banks but respectively 25% and less than 50% for others. The proportion of surviving patients having received more than three LBP in 24 hours was 58% in UVE, 33% in VE and 10% in RE. The proportion of over the limit waiting time for PRBC transfusion in UVE is critical, mainly for banks not only devoted to emergencies. The high proportion of UVE and VE patients receiving three PRBC or less in 24 hours may also be an indicator that some physicians do not comply with emergency prescription rules. An effort should be made to improve the activity, in emergencies, of a part of hospital blood banks and the way physicians use them.
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Affiliation(s)
- S Schlanger
- Agence régionale de santé Alsace, 14, rue du Maréchal-Juin, 67084 Strasbourg cedex, France.
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Martin L, Pillot P, Bardonnaud N, Lillaz J, Chabannes E, Bernardini S, Guichard G, Bittard H, Kleinclauss F. [Evaluation of the activity of a urological emergency unit in university hospital]. Prog Urol 2013; 24:62-6. [PMID: 24365631 DOI: 10.1016/j.purol.2013.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
AIM OF THE STUDY To determine the epidemiology of urological emergencies in a university hospital and the interest of a dedicated urological emergency unit. PATIENTS AND METHODS In 2008, a dedicated urological emergency unit was individualized in our department of urology. We conducted a retrospective study including all patients consulting in this unit in 2009 with epidemiological, clinical and therapeutic data. RESULTS During 2009, 1257 patients consulted in this unit. Main diagnoses were acute urinary retention (303, 24.11%), renal colic (219, 17.42%), urinary infections (278, 22.11%), postoperative complications (141, 11.22%), symptomatic benign prostate hyperplasia (65, 5.17%), genitourinary cancers (61, 4.85%), trauma of urinary apparel (41, 3.26%), and spermatic cords torsion (10, 0.8%). In 99 cases (7.88%) diagnosis did not involved the urinary system. The treatment was surgical in 213 (17.7%) cases, technical procedure under local anesthesia in 368 (29.3%) and a medical treatment in 675 (53.7%) cases. Six hundred and sixty (52.5%) patients were managed ambulatory whereas 596 (47.5%) needed hospitalization. CONCLUSION The opening of a dedicated urological emergency unit lead to 1257 emergency consultations. Frequent etiologies were acute urinary retention, renal colic and urinary infection. The creation of this unit allowed to register and to valorize this emergency activity through the ATU emergency amount.
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Affiliation(s)
- L Martin
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; UFR SMP, université de Franche-Comté, 25000 Besançon, France
| | - P Pillot
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France
| | - N Bardonnaud
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; UFR SMP, université de Franche-Comté, 25000 Besançon, France
| | - J Lillaz
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; UFR SMP, université de Franche-Comté, 25000 Besançon, France
| | - E Chabannes
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France
| | - S Bernardini
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France
| | - G Guichard
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France
| | - H Bittard
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; UFR SMP, université de Franche-Comté, 25000 Besançon, France
| | - F Kleinclauss
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; UFR SMP, université de Franche-Comté, 25000 Besançon, France; UMR 1098, 25000 Besançon, France.
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Bouet PE, Chabernaud JL, Duc F, Khouri T, Leboucher B, Riethmuller D, Descamps P, Sentilhes L. [Accidental out-of-hospital deliveries]. ACTA ACUST UNITED AC 2013; 43:218-28. [PMID: 23773899 DOI: 10.1016/j.jgyn.2013.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 04/13/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
Abstract
Unexpected out-of-hospital delivery accounts for 0.5% of the total number of delivery in France. The parturient is placed under constant multiparametric monitoring. Fetus heart rate is monitored thanks to fetal doppler. A high concentration mask containing a 50-to-50 percent mix of O(2) and NO performs analgesia. Assistance of mobile pediatric service can be required under certain circumstances such as premature birth, gemellary pregnancy, maternal illness or fetal heart rate impairment. Maternal efforts should start only when head reaches the pelvic floor, only if the rupture of the membranes is done and the dilation is completed. The expulsion should not exceed 30 min. Episiotomy should not be systematically performed. A systematic active management of third stage of labour is recommended. Routine care such as warming and soft drying can be performed when the following conditions are fulfilled: clear amniotic liquid, normal breathing, crying and a good tonus. Every 30 seconds assessment of heart rate, breathing quality and muscular tonus then guide the care. The redaction of birth certificate is a legal obligation and rests with the attending doctor.
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Affiliation(s)
- P-E Bouet
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
| | - J-L Chabernaud
- Service de pédiatrie et réanimation néonatales, Smur pédiatrique (Samu 92), hôpital Antoine-Béclère (AP-HP), 157, rue de la Porte-de-Trivaux, 92141 Clamart cedex, France.
| | - F Duc
- Service d'anesthésie et réanimation médicale, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
| | - T Khouri
- Service d'anesthésie et réanimation médicale, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
| | - B Leboucher
- Service de réanimation néonatale, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
| | - D Riethmuller
- Service de gynécologie-obstétrique, centre hospitalier universitaire, CHU de Besançon, avenue du 8-Mai-1945, 25030 Besançon cedex, France.
| | - P Descamps
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
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