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Hulot J, Roseau JB, Gomez-Merino D, Chennaoui M, Saguin E. Clinical description of sleep and trauma-related nightmares in a population of French active-duty members and veterans with Post-Traumatic Stress Disorder. Encephale 2024; 50:11-19. [PMID: 36424208 DOI: 10.1016/j.encep.2022.10.002] [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] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a major public health problem. The most frequent complaints in this pathology are sleep disorders and trauma-related nightmares in particular. Trauma-related nightmares are characteristic of PTSD and impact its severity insofar as they are associated with more severe, longer-lasting symptoms and resistance to first-line treatments. There are specific characteristics associated with military personnel, including overrepresentation of replicative trauma-related nightmares. The aim of this study was to provide an accurate description of sleep patterns and the characteristics of trauma-related nightmares in a population of active-duty members or veterans diagnosed with PTSD. METHODS We recruited active-duty service members and veterans receiving treatment for PTSD in the psychiatric departments of five Military Teaching Hospitals (Hôpitaux d'Instruction des Armées, HIA) and described their sleep characteristics using a questionnaire, the Trauma-Related Nightmare Survey French version (TRNS-FR). RESULTS Out of 77 patients, 72 (93.5%) who experienced traumatic nightmares were included. This population had very severe clinical manifestations of PTSD, with a mean PCL-S score of 62.6 and an estimated total sleep time of 5.3h (317min). Among these patients, 31% had replicative nightmares and 57.7% had partially replicative nightmares. Nightmares were frequent (4.7 nightmares on average over the previous week), highly realistic, and highly immersive with exacerbated symptoms during the nightmare and also upon awakening. DISCUSSION Sleep quality was seriously altered among active-duty service members and veterans treated in Military Hospitals for PTSD with trauma-related nightmares. Certain criteria were identified to help characterize trauma-related nightmares: their level of replication, recurrence and the impact of these symptoms on patients' lives. CONCLUSION Long-term traumatic nightmares are a prominent feature in the symptomatology of active service members and veterans suffering from PTSD. This symptom is of particular interest as it may be a sign of changes in the patient's condition and a potential therapeutic target.
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Affiliation(s)
- J Hulot
- HIA Percy, 92140 Clamart, France.
| | - J-B Roseau
- Service de pneumologie et de médecine du sommeil, HIA Clermont-Tonnerre, 29240 Brest, France
| | - D Gomez-Merino
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France; Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France
| | - M Chennaoui
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France; Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France
| | - E Saguin
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France; Service de Psychiatrie, HIA Bégin, 94160 Saint-Mandé, France
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Choughri H, Bertheuil N, Chaput B, Pélissier P, Dahmam A, Alabdulkareem M, Chasseuil H, Leclère FM. Indications, functional results and patient satisfaction after isolated second ray resection following traumatic injury: A retrospective review of 25 patients. Hand Surg Rehabil 2019; 39:125-130. [PMID: 31866499 DOI: 10.1016/j.hansur.2019.11.007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 11/16/2019] [Accepted: 11/20/2019] [Indexed: 11/25/2022]
Abstract
Amputation of the second ray is a surgical treatment option when reconstruction and/or reimplantation fail. The aim of our study was to review the outcomes after transmetacarpal resection of the second ray following a post-traumatic injury and to assess indications, functional outcomes, and patient satisfaction. Between January 2003 and December 2013, 25 patients (6 women and 19 men with a mean age of 51 years) underwent transmetacarpal resection of their second ray after a post-traumatic injury. Sixteen patients were right-handed and 9 were left-handed. Injuries involved the dominant hand in 14 cases (60%). In order to differentiate patients with preserved index finger length preoperatively from those with a shorter, amputated index finger stump, patients were divided into 2 groups. Group 1 included those with an "intact finger" and Group 2 included patients with an "amputated stump". Data collection, including patient satisfaction and functional outcomes, was performed at 83 months postoperative on average. Average length of follow-up was 7.0±1.0 years (range 5-12 years). Group 1 (intact finger) and 2 (amputated stump) included 15 and 10 patients, respectively. Six patients (24%) had primary ray amputation and 19 (76%) had secondary ray amputation. No surgical revision was necessary. In Group 1, the indications were purely functional in all but two cases, whereas aesthetic indications played a role in all patients in Group 2. The average total time off work was 3 months. There was no difference between Group 1 and 2 (P>0.05). However, patients with primary ray resection averaged 10 weeks of lost work compared to 17 weeks for secondary amputation. There was no functional difference between Groups 1 and 2. Scores for cosmetic appearance and patient satisfaction were higher in Group 2. In certain specific situations after complex hand trauma, transmetacarpal amputation of the second ray is indicated as soon as possible, in order to reduce the time off work. Patient satisfaction following this surgical procedure is high, especially in groups with amputated stumps. A 30% decrease in pinch and grip strength is the rule. No secondary surgery is normally required.
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Affiliation(s)
- H Choughri
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - N Bertheuil
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud, Rennes, France
| | - B Chaput
- Department of Plastic Reconstructive Surgery and Burns, Toulouse Rangueil University Hospital, Toulouse, France
| | - P Pélissier
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Dahmam
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - M Alabdulkareem
- Service de chirurgie plastique, brûlologie, chirurgie de la main, et chirurgie de la réassignation génitale, université de Poitiers, CHU de Poitiers-La Milétrie, 2, rue de la Milétrie, 86000 Poitiers, France
| | - H Chasseuil
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - F-M Leclère
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Service de chirurgie plastique, brûlologie, chirurgie de la main, et chirurgie de la réassignation génitale, université de Poitiers, CHU de Poitiers-La Milétrie, 2, rue de la Milétrie, 86000 Poitiers, France
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Abissegue Y, Lyazidi Y, Bakkali T, Chtata HT, Taberkant M. [Coil embolization therapy in post-traumatic pseudoaneurysms and arteriovenous fistula of knee and leg arteries]. ACTA ACUST UNITED AC 2016; 41:74-9. [PMID: 26803565 DOI: 10.1016/j.jmv.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/28/2015] [Indexed: 11/24/2022]
Abstract
Pseudoaneurysms remain a rare complication of knee and leg trauma. They may go unnoticed and manifest late after the initial trauma; they are often associated with arteriovenous fistula. No standard treatment is recognized. We report a case of post-traumatic pseudoaneurysm of the inferior articular artery of the knee, treated by coil embolization and a case of post-traumatic pseudoaneurysm of the anterior tibial artery associated with an arteriovenous fistula, treated with coil embolization and decompression surgery. Follow-up in both patients was satisfactory.
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